Nearly a third of patients on 'gender affirming' hormones stop taking them, military study finds

Republican-led legislatures and governors seeking to put the brakes on puberty blockers, cross-sex hormones and surgical removal of healthy breasts and genitals for gender-confused minors have a new weapon from the U.S. military.

Nearly a third of "transgender and gender-diverse" patients who received so-called gender-affirming hormones had stopped taking them within four years, according to a study of children and spouses of soldiers who received treatment through the U.S. Military Healthcare System.

Those most likely to stop were females and adults, which could be seen as supporting theories that the explosion in gender-confused teen girls is driven by "social contagion" and that medicalizing gender confusion at a young age cements an identity that would otherwise fade.

The findings accord with a smaller study of just youths at Children's National Hospital, in Washington, D.C., which found 29% of them "reported a shift in request" for their gender-affirming therapies. A plurality of those (45%) made a medical request, withdrew it, then "re-requested" the change.

The research is likely to boost and possibly expand the scope of state legislation cracking down on drugs and surgery with potentially irreversible effects for gender-confused children.

Florida Gov. Ron DeSantis (R) on Wednesday signed SB 254, which not only prohibits "sex-reassignment prescriptions and procedures" for minors but also grants state courts "temporary emergency jurisdiction" over children subjected to or "threatened with" such prescriptions or procedures. It does not give Florida power to "kidnap" out-of-state children at Disney World, according to a Politifact analysis.

Previous studies have found a much higher rate of desistance for children who don't undergo social or medical transitions, roughly 80%. Some predate the rise of rapid-onset gender dysphoria in the past decade, when females became the majority of transition-ers and gender confusion morphed into an adolescent experience, counter to its origins in very young boys. 

Mainstream medical organizations that went all-in on medical transitions for minors are currently torn on how much credence to give social factors in transition.

The American Academy of Pediatrics faced criticism from its own allies for publishing purportedly weak research dismissing the "social contagion" explanation, while the World Professional Association for Transgender Health belatedly recognized "social influence" as a transition factor in its latest standards of care.

Clinicians who performed treatments may be legally liable for resulting harms. North American de-transitioners including Chloe Cole, Michelle Zacchigna and Camille Kiefel have sued their providers, following the path by U.K. trailblazer Keira Bell, whose litigation played a role in the shutdown of the National Health Service's gender identity clinic for youth.

The U.S. Military Healthcare System study, whose full text remains behind a paywall at the Journal of Clinical Endocrinology and Metabolism despite its public-domain label, apparently flew under the radar for several months before the abstract drew attention this week. Corresponding author Christina Roberts, of Children's Mercy Kansas City, shared the full paper with Just the News.

The researchers conducted a "secondary analysis of 2009 to 2018 medical and pharmacy records" for nearly 1,000 patients with an average age of 19. Two-thirds were female, three-in-five were adults and 90% were children of service members.

Patients were identified as discontinuing hormones if they didn't refill their prescription more than 90 days after completing the most recent prescription. Those who discontinued kept getting military medical care for another 11 months on average. 

Most patients (58%) started transgender-related care after it was added as a military TRICARE benefit in 2016. Because TRICARE copays are so much lower than private insurance for such treatment, it's "less likely" patients would switch insurers for hormones while otherwise staying on TRICARE, the authors say.

While the four-year "continuation rate" was 70.2%, the minority "trans-feminine" patients – males identifying as women – had a notably higher rate (81%) than the majority trans-masculine patients (64.4%) identifying as men. 

In a head-to-head comparison, the latter were more than twice as likely to drop hormones.

"This has not been observed in previous studies" and the researchers cannot explain it, they wrote.

Those who started hormones as minors had a higher continuation rate (74.4%) than those as adults (64.4%), the latter about one-and-a-half times more likely to drop hormones.

While this discrepancy is also a new finding, the researchers theorize that since parental consent was required for the treatment, this reflects parental support and thus reinforces the new identity.

Family income, family member type and starting hormones before or after TRICARE coverage had "no influence on continuation rates."

Going off hormones in the military system "does not equal regret or de-transitioning," corresponding author Roberts emphasized to Just the News.

"In prior surveys people stopped for [a] variety of reasons, usually money or social pressure," she wrote in an email. Younger patients may have obtained new insurance through work or college, "transmen … may have gotten the deeper voice and facial hair (permanent effects)" they wanted and "some may have transitioned to a new gender identity which fits them better."

The full paper doesn't include an age breakdown within minors to discern any differences among children before, during and after puberty, or older and younger adolescents. Roberts said they could not find an "obvious place to split" them: minors were mostly 15-17 "with a smattering of 14 year olds" and adults mostly 18 to "late 20s."

The Children's National study, whose full text in the Journal of Adolescent Health is also behind a paywall but includes "section snippets," is based on a study of 68 out of 130 patients in its youth gender clinic from 2010-2021 who met inclusion criteria. The average age was 15.

"This sample was de facto enriched for autistic gender diverse youth, due to the presence of an autism and gender diversity specialized clinic," states the paper, referring to the observed association between autism and gender dysphoria. Nearly half were autistic.

Twenty patients changed their requested treatment, though only three did so after starting hormones, according to the paper. Nonbinary patients who identify as neither men nor women, 22% of the sample, were most likely to shift their requests.

"No significant differences were found by age, autism status, or designated sex at birth," the researchers wrote.