What is the regret rate for medical transition, particularly for gender affirmation surgeries and hormone replacement therapy (HRT) with estrogen or testosterone?

Regret Rate of Medical Transition

The regret rate following gender-affirming medical interventions is extremely low at approximately 1%, with the highest quality systematic review of 27 studies pooling 7,928 transgender patients demonstrating this minimal prevalence across both surgical and hormonal treatments. 1, 2

Specific Regret Rates by Intervention Type

Gender-Affirming Surgery (GAS)

• Overall surgical regret rate: 1% (95% CI <1%-2%) across all gender-affirming surgical procedures 1, 2
• Transmasculine surgeries: <1% regret rate (95% CI <1%-<1%) 2
• Transfeminine surgeries: 1% regret rate (95% CI <1%-2%) 2
• Trans women specifically show 2% regret for gender-affirming treatment overall 1
• Trans men specifically show 1% regret for gender-affirming treatment overall 1

Gender-Affirming Hormone Therapy (GAHT)

• Little to no evidence of significant regret following hormone therapy with estrogen or testosterone 1
• No evidence that GAHT produces adverse mental health outcomes that would lead to regret 1, 3
• Hormone therapy demonstrates 20% decrease in depression after 1 year of treatment in both trans men and women 1, 3

Classification of Regret When It Occurs

When the rare cases of regret do occur, they fall into distinct categories that are critical for clinical understanding:

True Gender-Related Regret (42% of regret cases)

• Actual change in gender identity or realization that transition was not aligned with authentic identity 4
• This represents the minority of regret cases despite common assumptions 4

Social Regret (37% of regret cases)

• Loss of family, social, and occupational support are the leading causes 1
• Mistreatment at work and poor family support drive this category 1
• These patients regret the social consequences, not the medical intervention itself 1, 4

Medical/Surgical Regret (8% of regret cases)

• Dissatisfaction with surgical results, including suboptimal cosmetic outcomes 1
• Poor sexual function following surgery 1
• Complications or functional issues from the procedure 4

Real-World Clinical Data

A single-center study from a major transgender health program reported that among 1,989 individuals who underwent GAS between 2016-2021, only 6 patients (0.3%) either requested reversal surgery or transitioned back to their sex assigned at birth 5. This represents one of the most rigorous prospective assessments available and confirms the systematic review findings.

A survey of 46 surgeons (30% response rate) who collectively treated between 18,125-27,325 transgender individuals found that 57% of surgeons encountered at least one patient expressing regret, totaling only 62 patients (0.2-0.3% prevalence) 4.

Quality of Life Outcomes Supporting Low Regret

The low regret rates align with substantial quality of life improvements:

• Trans men: 5.5-point increase on a 10-point QOL scale after 1 year of GAHT 1
• Trans women: 16% improvement in QOL scores after 1 year of hormone treatment 1, 3
• Gender-affirming surgery improves QOL, decreases gender dysphoria, and increases satisfaction with sexual experiences 1
• Body satisfaction and positivity significantly improve following surgical intervention 1

Critical Clinical Caveats

The extremely low regret rate should not be misinterpreted as justification for inadequate assessment or support structures. The evidence demonstrates that proper patient selection, comprehensive informed consent, and robust postoperative support systems are already embedded in current practice patterns, which is precisely why regret rates remain so low 1, 5, 2.

Discontinuing hormone therapy due to concerns about potential regret significantly worsens gender dysphoria and mental health outcomes, making this approach counterproductive 3, 6. The mental health benefits of GAHT include decreased depression and anxiety, with no evidence of adverse mental health effects 1, 3.

Postoperative psychological and spiritual support during recovery is valued by patients, with 61% of patients grateful for chaplain visits and 58% requesting follow-up support calls 1. This suggests that normal postoperative distress should not be conflated with true regret 5.

Limitations of Current Evidence

The assessment of regret demonstrates high subjectivity and lacks standardized questionnaires, which represents a significant limitation in the literature 2. The AFFIRM (Affirming Surgery Form and Function Individual Reporting Measure) questionnaire has been validated with good reliability (Cronbach's α = 0.79) to better measure patient-reported outcomes 1.

Research remains in its infancy regarding detransition experiences, with inconsistent terminology and little guidance on best practices for clinicians managing these rare cases 7, 8. However, this knowledge gap does not change the fundamental finding that regret occurs in only 1% of cases 1, 2.