https://www.aarp.org/health/conditions-treatments/info-2018/...

Not great numbers, but sample sizes and study integrity, as with the data on gender affirming care, is the killer.

- trans people who only take hormones,

- who do that and have top surgery,

- who are castrated and,

- who have top and bottom surgery

Personally, I think bottom surgery is not quite there and is definitely a medical frontier and free-for-all. Hormones and top surgery are fairly reversible via application of more money, exercise and time.

Based on that, I am forced to fall back to first principles, and feel that given that the risk of lasting damage is low on some procedures, that those procedures which give perfectly acceptable and also potentially reversible results are reasonable to offer in this way.

Between 1% and 8%, depending on how detransition is defined. This article found 6.9% (12/175, 6 clearly detransitioning and 6 ambiguous) at one clinic, including anyone who sought and received care over a certain interval.

When an elderly person rejects knee replacement prior to surgery e.g., because they’ve learned the risks, they’re also not counted in the regret rate for knee replacement.

EDIT: Those that disengaged did not complete treatment, therefore they cannot regret completing treatment. Perhaps they regret starting treatment and perhaps they don’t; either way, that’s not the same thing as detransition. I can’t read their minds to figure out why they disengaged, and neither can anyone else.

The article talks about youth transitioning. Can't hormone treatment during the early years have lasting, permanent effects?

It can, although the GP's assertion that this is more reversible than knee surgery is probably still true.

At which point if they still did take puberty blockers at this more appropriate (critical?) age, wouldn't there be permanent effects?

And no. Puberty blockers are well understood (been using for over 50 years), and their use restricted to timeframes where it won't impact the child's development.

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4...

Prior estimates were 90% would desist..

https://www.frontiersin.org/articles/10.3389/fpsyt.2021.6327...

https://cass.independent-review.uk/wp-content/uploads/2022/0...

The Cass review supports transition.

But nothing really life altering. Will the child end up looking different if they de-transition after taking hormones, yes. More breast tissue if they took E, and more muscle definition if they took T. However, these are also body developments that can also happen without human intervention.

Anyway, aside from effects on bone density, I did find this:

> One of the disadvantages in adolescent girls who have been treated with GnRH analogues at an early age is the possibility of insufficient skin for penile inversion vaginoplasty. > How Young Is Too Young: Ethical Concerns in Genital Surgery of the Transgender MTF Adolescent

I could be misunderstanding this, but it sounds like there could be lasting effects on penis growth. Wouldn't that make sense, since your body would be getting estrogen during a time where it'd normally be developing in a way where it'd otherwise would be receiving testosterone?

This - being licensed in children, and being used mostly in line with the license - is better than many paediatric meds.

We have a lot of research about use in precocious puberty - they meds are mostly harmless. We don't have a huge amount of research in trans children, but that's for exactly the same reason we don't have research in a bunch of different meds for children.