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Christina M Roberts et al. J Clin Endocrinol Metab . 2022 .
. 2022 Aug 18;107(9):e3937-e3943. doi: 10.1210/clinem/dgac251.Item in Clipboard
Introduction: Concerns about future regret and treatment discontinuation have led to restricted access to gender-affirming medical treatment for transgender and gender-diverse (TGD) minors in some jurisdictions. However, these concerns are merely speculative because few studies have examined gender-affirming hormone continuation rates among TGD individuals.
Methods: We performed a secondary analysis of 2009 to 2018 medical and pharmacy records from the US Military Healthcare System. We identified TGD patients who were children and spouses of active-duty, retired, or deceased military members using International Classification of Diseases-9/10 codes. We assessed initiation and continuation of gender-affirming hormones using pharmacy records. Kaplan-Meier and Cox proportional hazard analyses estimated continuation rates.
Results: The study sample included 627 transmasculine and 325 transfeminine individuals with an average age of 19.2 ± 5.3 years. The 4-year gender-affirming hormone continuation rate was 70.2% (95% CI, 63.9-76.5). Transfeminine individuals had a higher continuation rate than transmasculine individuals 81.0% (72.0%-90.0%) vs 64.4% (56.0%-72.8%). People who started hormones as minors had higher continuation rate than people who started as adults 74.4% (66.0%-82.8%) vs 64.4% (56.0%-72.8%). Continuation was not associated with household income or family member type. In Cox regression, both transmasculine gender identity (hazard ratio, 2.40; 95% CI, 1.50-3.86) and starting hormones as an adult (hazard ratio, 1.69; 95% CI, 1.14-2.52) were independently associated with increased discontinuation rates.
Discussion: Our results suggest that >70% of TGD individuals who start gender-affirming hormones will continue use beyond 4 years, with higher continuation rates in transfeminine individuals. Patients who start hormones, with their parents' assistance, before age 18 years have higher continuation rates than adults.
Keywords: adolescent; adult; sex-hormones; transgender gender dysphoria; treatment.
Published by Oxford University Press on behalf of the Endocrine Society 2022.
van der Loos MATC, Hannema SE, Klink DT, den Heijer M, Wiepjes CM. van der Loos MATC, et al. Lancet Child Adolesc Health. 2022 Dec;6(12):869-875. doi: 10.1016/S2352-4642(22)00254-1. Epub 2022 Oct 21. Lancet Child Adolesc Health. 2022. PMID: 36273487
Hisle-Gorman E, Schvey NA, Adirim TA, Rayne AK, Susi A, Roberts TA, Klein DA. Hisle-Gorman E, et al. J Sex Med. 2021 Aug;18(8):1444-1454. doi: 10.1016/j.jsxm.2021.05.014. Epub 2021 Jul 8. J Sex Med. 2021. PMID: 34247956
Van Donge N, Schvey NA, Roberts TA, Klein DA. Van Donge N, et al. Mil Med. 2019 May 1;184(5-6):e447-e454. doi: 10.1093/milmed/usy264. Mil Med. 2019. PMID: 30325452
Iwamoto SJ, Grimstad F, Irwig MS, Rothman MS. Iwamoto SJ, et al. J Gen Intern Med. 2021 May;36(5):1380-1389. doi: 10.1007/s11606-021-06634-7. Epub 2021 Feb 5. J Gen Intern Med. 2021. PMID: 33547576 Free PMC article. Review.
Ellis SA, Dalke L. Ellis SA, et al. J Midwifery Womens Health. 2019 May;64(3):298-311. doi: 10.1111/jmwh.12957. Epub 2019 Apr 8. J Midwifery Womens Health. 2019. PMID: 30957961 Review.
Sun CF, Xie H, Metsutnan V, Draeger JH, Lin Y, Hankey MS, Kablinger AS. Sun CF, et al. Gen Psychiatr. 2023 Jun 2;36(3):e100972. doi: 10.1136/gpsych-2022-100972. eCollection 2023. Gen Psychiatr. 2023. PMID: 37396783 Free PMC article. No abstract available.
MacKinnon KR, Expósito-Campos P, Gould WA. MacKinnon KR, et al. BMJ. 2023 Jun 14;381:e073584. doi: 10.1136/bmj-2022-073584. BMJ. 2023. PMID: 37315956 Free PMC article.
Cohn J. Cohn J. Arch Sex Behav. 2023 Jul;52(5):1937-1952. doi: 10.1007/s10508-023-02623-5. Epub 2023 Jun 12. Arch Sex Behav. 2023. PMID: 37308601 Free PMC article. No abstract available.
Jorgensen SCJ. Jorgensen SCJ. Arch Sex Behav. 2023 Jul;52(5):2173-2184. doi: 10.1007/s10508-023-02626-2. Epub 2023 Jun 2. Arch Sex Behav. 2023. PMID: 37266795 Free PMC article.
Hranilovich JA, Millington K. Hranilovich JA, et al. Headache. 2023 Apr;63(4):517-522. doi: 10.1111/head.14493. Epub 2023 Mar 29. Headache. 2023. PMID: 36988085