Work

20-year outcomes in Gender-Affirming Care from Johns Hopkins Hospital

Year: 2026

Type: article

Abstract: PURPOSE: The Johns Hopkins Sex and Gender Clinic (SGC), established in 1971, is the longest continuously running clinic in the United States providing gender-affirming care (GAC). With over five decades of clinical service, the SGC provides the unique opportunity to assess long-term treatment outcomes for transgender and nonbinary (TGNB) individuals. Here we characterize outcomes of individuals presenting for gender incongruence to capture durability of gender identity, treatment pathways, and regret. METHODS: We conducted a retrospective review of demographic and clinical data of 224 patients who presented to the SGC between 2005-2020 with a chief complaint related to gender presentation or incongruence. Exclusion criteria included intersex conditions, follow-up 6 months, or lack of patient expressed gender incongruence. Primary outcomes included incidence of gender dysphoria (GD) diagnosis at initial evaluation, rates of gender-affirming hormone therapy (GAHT) and surgery (GAS), persistence of TGNB presentation, reasons for maintaining sex assigned at birth (SAAB), and regret. RESULTS: The median age at presentation was 21 years (IQR: 17-30; range: 4-85). In total, 74.1% (n=166/224) individuals met inclusion criteria, and had mean follow-up of 7.7 years (range: 7.3 mo - 19.1 yrs). At most recent follow-up, 92.8% (n=154/166) lived openly as TGNB, while 7.2% (12/166) presented as their SAAB (Figure 1). Specifically, among the 12 patients who continued to present as their SAAB, 3 themes were identified as deterrents for transitioning: 6 cited family rejection or stigma, 4 cited medical contraindications to hormones or surgery, and 2 indicated evolving gender identities (Figure 1). 6 of the 12 patients had started and discontinued hormones, among which 1 patient had reversal of chest masculinization surgery (Figure 1). Notably, no patients expressed regret. 88.6% (n=147/166) of patients met diagnostic criteria for GD after the first clinical assessment by the SGC, of which 89.8% (n=132/147) initiated GAHT and/or GAS (Table 1). The remaining 12.4% were initially diagnosed with alternate diagnoses such as mood disorders 47.4% (n=9/19), adjustment disorder 21.1% (n=4/19), or autism spectrum disorder 21.1% (n=4/19). Notably, 73.7% (n=14/19) patients who did not receive an initial GD diagnosis subsequently pursued GAHT or GAS (Table 1). Patients who did not pursue medical transition most often attributed their decision to family opposition or ongoing exploration of their gender expression. CONCLUSION: This study represents the largest U.S. cohort of patients receiving GAC with multi-decade follow-up. In this review, detransition—defined as discontinuing GAHT or reversing GAS to align with one's SAAB—occurred in 6 of 166 patients (3.6%), primarily due to lack of social acceptance or medical contraindications to care. No patient expressed regret and patients' self-identified gender incongruence remained durable over time. Table 1: GAHT/GAS Initiation by Initial Diagnosis Initiated GAHT/GAS Did not initiate GAHT/GAS Total Diagnosed with GD at initial encounter 132 15 147 Not diagnosed with GD at initial encounter 14 5 19 Total 146 20 166

Source: Plastic & Reconstructive Surgery Global Open

DOI: 10.1097/01.gox.0001279508.24096.70