Rates of discontinuation and regret in trans and gender diverse adolescents receiving puberty blockers and hormone therapy: a systematic review

Background: Concerns about treatment discontinuation and regret are frequently cited to justify bans or restrictions on gender-affirming care for adolescents. However, there has not been a systematic review of the rates of and reasons for treatment discontinuation and regret for adolescents receiving puberty blockers and gender-affirming hormones (GAH). Methods: MEDLINE, EMBASE, PsycINFO, and PubMed were searched for studies published before November 21, 2024 that described treatment discontinuation and/or regret in individuals who received gender-affirming medical care with puberty blockers and/or GAH aged 18 years or younger. Findings: 27 studies met inclusion criteria. For puberty blockers, the median discontinuation rate was 4.5% (interquartile range (IQR): 1.6%–7.6% = 6.0%). For GAH, the median discontinuation rate was 1.9% (IQR: 0%–3.3% = 3.3%). Discontinuing these treatments occurred for a range of reasons, few of which indicate harm had occurred, and was only infrequently associated with a change in gender identity. For puberty blockers and GAH, the overall regret rate was 1.2% (11 cases of 916) and 0.6% (6 cases of 1033) respectively. No reasons were reported for the cases of regret identified. Interpretation: The vast majority of adolescents who begin puberty blockers or GAH as part of pediatric gender care continue treatment. When treatment is discontinued, this decision can be for a range of reasons and is not typically associated with a change in gender identity. Current evidence does not support claims that regret is prevalent for trans adolescents that access puberty blockers or GAH.