Satisfaction, Regret, and Harm After Hormone Therapy in Youth From a Multidisciplinary Gender Clinic

Importance Concerns about regret and harm have led to restrictions on transgender and gender-diverse youths’ access to testosterone or estrogen therapy (ie, hormone therapy [HT]), while empirical data on decisional regret among those initiating HT as youth remain limited. Objectives To examine satisfaction, regret, and perceived harm among individuals who initiated HT as youth and to identify demographic and clinical characteristics associated with regret or harm and current HT status (receiving vs not). Design, Setting, and Participants This cohort study evaluates self-report surveys collected from October 2023 to October 2025 among former patients who initiated HT as youth at a single multidisciplinary gender clinic in the US. Data analysis was conducted from December 2025 to August 2026. Exposure Initiation of estrogen or testosterone. Main Outcomes and Measures Decision Regret Scale (DRS) total score (range, 0-100; higher scores indicate greater regret); item-level satisfaction, regret, and perceived harm; and current HT status. Associations with demographic and clinical characteristics were examined using nonparametric, Welch t , Fisher exact, or Pearson χ 2 tests as appropriate, with parametric sensitivity analyses for the DRS total score. Results Of the 376 participants who initiated HT as youth (112 [29.8%] initiating estrogen and 264 [70.2%] initiating testosterone; current age, 14-28 years; mean [SD] age, 20.9 [2.9] years; time since HT initiation: range, 1.2 months to 10.7 years; mean [SD], 4.9 [2.5] years), 4 were missing DRS scores, all of whom were currently receiving HT. Among the 372 respondents with DRS scores, overall decisional regret was very low (mean [SD] DRS score, 4.3 [14.7]; median [IQR], 0 [0-0]); 360 participants (96.8%) endorsed that receiving HT was the right decision, 10 (2.7%) reported regret, and 7 (1.9%) reported perceived harm. DRS scores were higher among participants not currently receiving HT vs currently receiving HT and among those identifying on the nonbinary vs binary spectrum; parametric sensitivity analyses estimated mean differences of 15.95 points (95% CI, 8.50-23.39) and 6.07 points (95% CI, 2.15-9.99), respectively. Participants not currently receiving HT (65 participants [17.3%]) were more likely than those currently receiving HT (311 [82.7%]) to have received testosterone (odds ratio, 3.58; 95% CI, 1.65-7.78; P = .001) and identify on the nonbinary spectrum (odds ratio, 8.88; 95% CI, 4.76-16.58; P < .001), were older (mean difference, 1.04 years; 95% CI, 0.45-1.64 years; P = .001), and had longer time since initiating HT (mean difference, 1.00 year; 95% CI, 0.48-1.53 years; P < .001). Neither regret or harm nor current HT status was associated with age at HT initiation or prepubertal gender diversity. Conclusions and Relevance The findings of this cohort study complement the literature documenting mental health benefits of HT, providing further support for existing standards of care for transgender and gender-diverse youth.