Endocrine Abstracts

JOINT309

Background: The dramatic increase in individuals seeking Gender-Affirming Therapy (GAT) has sparked debates about gender dysphoria, including concerns about detransition rates, irreversible effects, and the contentious issue of access to treatment, particularly for minors. While reported detransition rates vary widely (0.5-30%), prior studies have lacked systematic efforts to track and interview individuals who discontinued attendance at specialized gender clinics.

Aim and Methods: This study evaluated detransition rates among individuals initiating GAT at Tel Aviv Sourasky Transgender Health Center between May 2014 and December 2022. Subjects who discontinued follow-up after ≥2 visits were contacted, and those who detransitioned participated in structured interviews to understand the motives and circumstances leading to their decision.

Results: Of 709 adults initiating GAT, 239 (33.8%) discontinued follow-up. All but 15 were successfully contacted, providing 694 subjects for analysis. Among the 224 subjects who discontinued clinic attendance, 13 had detransitioned, representing a detransition rate of 1.87% (CI 0.86-2.88). All other subjects, including the 470 who maintained clinic attendance, continued their gender-affirming process. Focusing on the group of 224 individuals who had discontinued clinic attendance, we found no differences between the 13 detransitioners and those continuing treatment (usually under family physician care) in demographic (gender, age, ethnicity) or socioeconomic (education, profession, employment) parameters. Detransitioners had received GAT for a shorter duration (median 12 vs 79 months, P < 0.001) and had lower rates of surgical procedures (23.1% vs 58.8%, P < 0.001), with only one subject having undergone genital surgery. Additionally, detransitioners demonstrated markedly higher rates of complete lack of family support (38.5% vs 8.5%, P = 0.003), were less likely to reside in the Tel Aviv-Central area (38.5% vs 61.1%, P < 0.001), and more frequently had pre-existing psychiatric diagnoses (84.6% vs 41.7%, P = 0.01).

Conclusions: In this first systematic follow-up study of transgender individuals who discontinued clinic attendance, we found a notably low detransition rate of 1.87%. While detransitions occurred across various treatment durations, they rarely followed irreversible surgical interventions. Distance from specialized care centers, lack of family support, and pre-existing psychiatric conditions may influence detransition risk, emphasizing the importance of accessible care and comprehensive support systems.