![[Adobe Stock]](https://sp-ao.shortpixel.ai/client/to_webp,q_glossy,ret_img,w_750,h_375/https://www.psypost.org/wp-content/uploads/2026/11/transgender-750x375.jpg)
Most people who began hormone therapy as teenagers at a U.S. gender clinic and answered a follow-up survey said starting treatment had been the right decision, according to a cohort study published in JAMA Pediatrics. Even among former patients who eventually stopped taking hormones, more than four out of five still reported that starting treatment had been the right choice for them. Very few respondents reported regretting the decision or feeling harmed by it, providing longer-term clinical data amid ongoing policy debates over adolescent medical care.
Gender-affirming hormone therapy involves taking prescribed estrogen or testosterone to develop physical traits that align with a person’s gender identity rather than the sex they were assigned at birth. Estrogen promotes changes such as breast growth and softer skin, whereas testosterone deepens the voice and stimulates facial and body hair growth, with some of these effects becoming permanent over time. Transgender and gender-diverse youth, whose gender identities differ from their birth-assigned sex and may be binary (male or female) or nonbinary, make up an estimated 3.3% of teenagers in the United States, though fewer than 0.1% of U.S. adolescents receive hormone therapy.
Short-term studies have consistently reported mental health improvements among teenagers receiving these medications, the new study’s authors note. For instance, a 2020 study by two of those authors followed youth at the same clinic for one year after they started hormone therapy or puberty blockers and found reductions in depression, anxiety, and distress over their physical appearance. Still, concerns about potential regret and harm have fueled restrictions on care across many U.S. states.
Prior research with adults indicates that pausing or stopping medical transition does not necessarily mean a person regrets the treatment. In a 2021 survey analysis of U.S. transgender adults, which included only people who still identified as transgender or gender-diverse, more than four-fifths of respondents who had ever halted or reversed their transition cited outside pressures, such as family rejection or social stigma, as contributing reasons.
Don’t miss the next big psychology finding
Every morning, PsyPost sends a short briefing on the most interesting new peer-reviewed research in psychology and neuroscience.
More recently, a 2024 survey of transgender youth found high satisfaction and rare regret after adolescent medical care, though that sample consisted specifically of young people who had socially transitioned early in childhood.
Questions have persisted about whether contemporary clinic patients, many of whom first recognize or express their gender identity around or after puberty, face a higher likelihood of later regret. The research, led by Laura Kuper of the University of Texas Southwestern Medical Center, sought to measure satisfaction, decisional regret, and perceived harm among youth who initiated hormone therapy through a multidisciplinary clinic, including former patients who were no longer taking hormones. The team also tested whether clinical factors, such as starting age or childhood signs of gender diversity, were linked to either regret or stopping treatment.
The researchers analyzed survey responses and medical records from former patients of a multidisciplinary pediatric gender program in the United States. Most patients started hormone therapy after completing a structured evaluation with a mental health professional alongside their parents or guardians (a minority began hormones before or after being seen by the program), and minors at the clinic needed consent from all parents or guardians holding legal medical decision-making rights in addition to their own assent.
Between October 2023 and October 2025, the team invited 698 former patients who had previously agreed to longitudinal research to complete annual online surveys, explicitly encouraging participation from people who had stopped taking hormones or left the clinic.
A total of 376 participants who had started estrogen or testosterone as youth completed the survey, representing just over half of all former patients invited (another 25 respondents had never started hormones). Roughly 70% of the hormone-treated sample had been assigned female at birth and initiated testosterone, while about 30% had been assigned male at birth and initiated estrogen. Nearly 92% had begun taking hormones at age 17 or younger, starting at an average age of 16, and participants ranged from 14 to 28 years old (averaging nearly 21) when surveyed.
An average of 4.9 years had passed since participants started hormone therapy, with follow-up periods spanning from just over a month to nearly 11 years. Respondents completed the Decision Regret Scale, a five-item questionnaire scored from 0 to 100 that asks patients whether starting hormone therapy was the right decision, whether they regret the choice, and whether the choice did them harm, with higher scores reflecting greater regret. Using clinic intake notes and survey answers, the authors also tracked current hormone use, binary versus nonbinary gender identity, the age patients first identified with their gender, and whether clinicians had recorded gender nonconformity or physical gender distress before puberty.
Before examining regret, the researchers checked whether survey respondents differed in their initial clinic records from former patients who did not participate. Patients who originally agreed to join the research pool did not differ in age, birth-assigned sex, or ethnicity from those who declined or could not be reached, though among enrolled patients, individuals assigned male at birth and those with documented physical gender distress before puberty were less likely to complete the follow-up survey.
Among the 372 participants who completed the regret scale, overall regret was minimal, with an average score of 4.3 out of 100 and a median score of zero, meaning most respondents reported zero regret. As a point of comparison, the authors note that this 4.3 average sits well below the 16.5 average reported across studies of other medical decisions using the same scale.
On their most recent survey, 96.8% of respondents (360 individuals) agreed or strongly agreed that starting hormone therapy had been the right decision. In contrast, 2.7% (10 participants) agreed or strongly agreed that they regretted the choice, and 1.9% (7 participants, all of whom also reported regret) agreed or strongly agreed that the choice had done them a lot of harm.
Three additional participants had reported regret or harm on an earlier annual survey wave but did not endorse those feelings on their latest questionnaire, bringing the total number of people who ever indicated regret or harm to 13. Seven of the 13 now identified exclusively with the sex they were assigned at birth. Twelve of those 13 individuals had stopped taking hormones, while the remaining person agreed with both positively and negatively worded items and may have misread the response scale, according to the authors.
Nine respondents wrote open-ended explanations of their regret or perceived harm, most commonly reporting that they had not felt adequately prepared to make an informed decision because of their age or maturity, mental health difficulties, or insufficient support from parents or therapists (7 of the 9). Six described physical hormone effects they no longer wanted, such as body hair, voice deepening, or breast growth, and four cited adverse effects including mood shifts attributed to hormones, vaginal atrophy (a thinning and drying of vaginal tissue), or concerns about possible fertility impairment.
Most participants (82.7%, or 311 individuals) were still taking hormones when surveyed, whereas 17.3% (65 individuals) were not. Regret scores were higher on average by roughly 16 points among those who had stopped taking hormones compared to ongoing users, and higher by roughly 6 points among nonbinary participants compared to those with binary male or female identities.
Among the 65 who had stopped, 9 (about 14%) agreed or strongly agreed that they regretted the decision and 6 (about 9%) that it had done them a lot of harm, while 54 (83%) still agreed or strongly agreed that starting treatment had been the right decision. The authors describe regret as low in absolute terms in both subgroups.
Former patients who had stopped taking hormones tended to be about a year older on average, had started treatment roughly a year earlier, and were much more likely than ongoing users to have taken testosterone and to identify on the nonbinary spectrum. Nearly 59% of non-cisgender participants who had discontinued hormones identified on the nonbinary spectrum, compared to roughly 14% of those still receiving hormone therapy. Differences in regret scores between testosterone and estrogen users were not statistically significant.
Neither regret nor current hormone continuation showed a statistically significant association with how old participants were when they started hormones, the age they first identified as transgender or gender-diverse, or whether they had shown signs of gender diversity prior to puberty. The authors write that their findings do not support concerns that teenagers without childhood-onset gender distress are at greater risk of regret, at least over the period studied, while acknowledging that the small number of people reporting regret likely limited their ability to detect such links.
At the same time, the researchers suggest that the accounts from the small subset reporting regret illustrate how decision-making breakdowns can still occur within structured clinical programs, pointing to a need for clinicians to emphasize that hormones can be paused or stopped at any time and to maintain ongoing support.
“Among the respondents, about five years after starting hormone therapy on average, satisfaction with the decision was very high and regret was rare (2.7%),” Aleksandra M. Rogowska, a professor and director of the Institute of Psychology at the University of Opole in Poland who was not involved in the study, told PsyPost. “This is the largest study to date focused specifically on decisional regret in this population, and it adds longer-term self-report data to a literature dominated by short follow-ups.” She added that the findings “largely confirm earlier clinic-based studies reporting regret rates of 0–4%.”
In prior work cited by the study’s authors, long-term clinic records from the Netherlands found that roughly 2% of adolescents who began puberty blockers and hormones later stopped treatment, whereas an analysis of U.S. military family insurance claims indicated that about a quarter discontinued hormones within four years.
“One finding deserves more attention than it receives: 17.3% of participants were no longer on hormone therapy,” Rogowska said. “That is considerably higher than the roughly 2% discontinuation reported in the Dutch cohort, and closer to US insurance-based estimates. Among those who stopped, about one in seven reported regret. The overall average conceals this subgroup.”
There are a few things to keep in mind when reading these results. Nearly 300 of the 698 former patients invited to take the survey did not respond, leaving their current hormone status and views on treatment unknown. Although respondents and non-respondents looked largely similar in their initial clinic records, the authors point out that the political climate surrounding transgender healthcare may have deterred some former patients from participating or motivated people with especially strong views in favor of or against youth access to respond.
The authors note that their response rate of roughly 57% (counting the 25 respondents who never started hormones) is in line with, or above, the averages reported for long-term follow-ups in a 2020 review of patient-outcome registries, and higher than is typical for online patient surveys. That same review cautions, however, that more satisfied patients may be overrepresented among those who respond to such surveys.
“I would describe my confidence as moderate for the descriptive findings and low for any broader generalization,” Rogowska said. “‘2.7% regret’ is not a population rate. It describes those who chose to respond.”
The study was also conducted by clinicians from the clinic where participants had received care, which the authors note may have increased trust for some former patients while deterring others from responding.
Rogowska pointed to how that arrangement could affect the results: “People who stopped treatment or regret it may be less likely to respond to the clinic that treated them, which would push the regret estimate downward.”
Because statistical power depends on having enough cases of an outcome to reliably detect differences between groups, Rogowska also cautioned against reading too much into the null findings on starting age and childhood-onset gender dysphoria, or distress over a mismatch between one’s gender identity and assigned sex. “The absence of associations with age at initiation or with childhood-onset gender dysphoria should not be read as evidence that these factors do not matter,” she said. “With only 13 participants reporting regret, the study had very little power to detect such effects.”
In addition, the survey assessed regret over the initial decision to begin hormone therapy rather than satisfaction with specific physical effects, and it did not ask the broader group of people who stopped taking hormones why they discontinued. The authors note that stopping treatment is not the same as regret and can reflect outside barriers, which they expect have grown as access has been restricted.
All participants also received care through a single multidisciplinary clinic with parental consent and more than 93% were White, meaning experiences could differ in more racially diverse populations or care settings with less family and mental health support.
Regarding the study’s timeframe, Rogowska noted, “Some regret in the broader literature has appeared years after treatment. A mean follow-up of 4.9 years, with some participants followed for only a few months, may be too short to capture it.”
Drawing on the high satisfaction and rare regret reported in the survey, the study’s authors conclude that their results provide further support for existing standards of care and do not support efforts to categorically restrict or ban adolescents’ access to hormone therapy. They also caution against making assumptions about treatment satisfaction, regret, or harm based on demographic traits or clinical history.
Rogowska cautioned against drawing broad policy conclusions from the survey. “Low decisional regret is not the same as evidence of long-term benefit or safety,” she said. “The study measures how people evaluate a past decision, not physical or mental health outcomes.” Regarding the regulatory debate, she added, “The authors’ policy conclusions go further than a single-site observational study can support, in either direction.”
To help address these open questions in future studies that track patients forward from the start of care, Rogowska said she would like to see “multi-site prospective cohorts with active follow-up of non-responders and of people who discontinue treatment, ideally run by researchers independent of the treating clinics.” She also called for “systematic assessment of the reasons for discontinuation, separating external barriers from changes in identity or adverse effects,” along with “follow-up extending to 10 years or more, and a closer look at the nonbinary subgroup.” As she noted, “In this sample, nonbinary identity was associated with almost nine times higher odds of not currently receiving therapy.”
The study, “Satisfaction, Regret, and Harm After Hormone Therapy in Youth From a Multidisciplinary Gender Clinic,” was authored by Laura Kuper, Megan Ungerman, Bree Horrocks, Diane Chen, and Ximena Lopez.
