1% Of Transgender People Regret Transitioning, We Think...

How many transgenders regret transitioning? Well, we do not actually know.

Recently, there have been claims that only 1% of transgenders regret transitioning. In this short article, I will argue that the data is too poor to make any definitive claims since the current studies on the issue are not rigorous enough.

According to Lance from the online commentary channel The Serfs, “The meta studies on GAC show a less than 1-5% regret rate” (Twitter 2023). Tanner (2023) echoes the same number, saying 1% regret their transitioning. Indeed, this has been a claim among many social and academic circles (e.g. Boyd, Hacket, and Bewley 2022; Ashley 2022; Catalan and Emilova 2023; Shen and Shen 2023). A look at the original data often cited to support this claim, however, displays clear issues with drawing conclusions and the failure of academics to remain skeptical in the pursuit of truth.

In Bustos et al. (2022), their meta-analysis and systemic review find a pooled prevalence regret rate of 1%. This means that, according to their data, the vast majority of transgender people do not regret transitioning, contra to claims made by critics of sex reassignment surgery/ hormone therapy.

However, there are a few issues with Bustos et al.’s meta-analysis. As Exposito-Campus and D’Angel (2021) point out, of the 27 studies analyzed: 9 were of poor quality, 13 were deemed fair, and 5 were good. 14 of them had a medium risk of bias, 9 had a high risk of bias, and 4 had a low risk of bias. Risk of bias matters when analyzing studies because it can affect the validity of the study's findings. A study with a high risk of bias is more likely to produce misleading results. This can lead to wasted resources, lost opportunities for effective interventions, or harm to consumers.

Second, the authors in some of these studies did not directly ask people who had undergone sex reassignment surgery if they themselves regretted it, instead, they searched medical records for signs of regret or surgical reversal (Bederblom 2022). By doing this, it could underestimate the actual regret rate since it’s possible not all transgender people might decide to reverse the surgery or show signs of regret that warrant a medical record (i.e, they might keep it to themselves rather than going to a medical professional showing signs of regret). Third, some of the studies had large losses during follow-ups. For example, in one of the cited studies “Many of the included studies had participants with follow-up periods of only 1 or 2 years postsurgical transition. None appear to have a long enough follow-up period to reliably identify regret” (Exposito-Campus and D’Angelo). One of the studies that had a large sample size in their meta-analysis had a 36% loss during follow-up. The good quality studies had a loss of follow-ups ranging from 28% to 40%. None of the studies were undertaken long enough to reliability measure regret.

Finally, as both Bederblom and Exposito-Campus and D’Angelo note, there were issues of entry errors in their analysis. One sample of 2,627 was inflated to 4,836. Bederblom notes that,

I spent some time going over the whole table in detail, finding dozens of errors. If we include inconsistencies and erroneous footnotes, the number approaches 50 — for a single table! There are errors in every single column, and for 19 of the 27 papers. The most frequent error is that Bustos et al. claims that data was “not specified” in a paper where it actually was. For example in Landén et al. (who they here call Laden) the sex ratio is clearly provided but is listed as not specified in the review, one of dozens of this type of error. There appears to have been no effective proof reading stage of any kind.

Another study comes from Narayan et al. (2021), found that among a survey of 154 surgeons who registered for the 2016 WPATH (World Professional Association for Transgender Health) and 2017 USPATH conference, the estimated regret rate was 0.2% to 0.3%.

Similar to Bustos et al., Cohn (2023) remarks that these values were calculated by dividing the number of people who expressed regret by the total number of surgeries done by the surgeons. This method lacks follow-up time, loss to follow-up, and the measurement used to define regret (unknown if there was consistency in the measurement). The final point is an important issue as many studies differ in how they define “regret”, as Cohn notes. For example, in Table 2 from Cohn, you can see that not all studies measured “regret” the same — casting doubt on how accurate these studies are due to differences in measurement.

So, how many transgenders regret transitioning? Well, we don’t know. The data continues to suffer from significant issues noted in other works related to studies on transgender people and SRS/ hormone therapy (e.g. Horvath 2020; Blake 2019;  Arif 1997, 2004; Jensen et al. 2016). We should remain agnostic on this specific issue of transgender regret and not make claims relying on poor data.