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Regret figures and methodological problems

"Only 1% regrets transition" is a frequently repeated claim reassuringly presented to patients before irreversible procedures. The source is Bustos 2021 — a meta-analysis with massive dropout, short follow-up, and a definition of "regret" that excludes most genuine regretters. The figure is an artifact of poor methodology, not a scientific fact.

The Bustos study

Bustos et al. (2021) conducted a meta-analysis of 27 studies (total ~7,928 patients). Conclusion: 1% regret. The figure was politically inflated and pops up everywhere — from WPATH guidelines to Dutch counseling leaflets. The methodological problems are fatal.

Problem 1 — extremely high dropout rate (survivorship bias)

In many of the analyzed studies, 36% to 60% of patients dropped out of follow-up. Detransitioners avoid the clinic where they were previously treated—out of shame, anger, or because their trauma resides there. Vandenbussche (2021) recorded that 70% of detransitioners never informed the practitioner : a British online survey among former patients of Tavistock found that 25-30% no longer identified themselves as trans at some point—without this becoming visible in clinic statistics. Someone who no longer makes contact is counted as "no regret" in these studies. Whereas regret is actually a good reason to stay away. Classic survivorship bias: you only measure the satisfied because the dissatisfied no longer show up.

Problem 2 — Follow-up is way too short

Regret often appears only eight to eleven years after transition (Dhejne 2014). Vandenbussche found a median time between the start of transition and detransition of four to five years — beyond the reach of virtually all clinical follow-up. Studies with two to three years of follow-up are unsuitable for measuring regret — the group with regret is then still in the "honeymoon" phase of the transition. Bustos included a large proportion of short-term studies. Fertility regret often manifests itself only around the age of 25-35, when the desire for children becomes relevant; mastectomy regret can wait years for the moment of awareness. The result: a snapshot that says nothing about lifelong outcomes.

Problem 3 — remove a definition that defines regret

In the studies, "regret" is strictly defined as an "official request for reverse surgery" or a formal legal revocation of gender registration. Most people with regret do not request a reverse operation: due to cost, shame, or because their body has changed irreversibly—breasts gone, fertility gone, voice low. Someone who stops testosterone independently and never sees the clinic again—by far the most common pattern—does not count. Someone who still uses testosterone but identifies as a woman again: does not count. Someone who has silent regret but cannot reverse the mastectomy: does not count. Their regret exists, but it is not reflected in the numbers. That is not a detail; that is statistical fraud in slow motion.

Problem 4 — wrong population

The cited studies predominantly include patients who transitioned in the 1980s and 1990s: different selection criteria, a different threshold of due care, and a different population. The old cohorts (on which the 1% claim rests) consisted of classic early childhood dysphoria patients, primarily boys. That group hardly exists in the current consulting room. Referrals are dominated by teenage girls who only present during puberty, often with autism spectrum disorder, eating disorders, depression, or trauma. For this ROGD population , detransition and regret rates are likely much higher, because their dysphoria was constructed within a cultural context, and the same social dynamics that gave rise to it cause it to fade later. See also detransition research .

Showing realistic figures

Studies with longer follow-up and better dropout management report regret rates that are fundamentally different:

• Hall et al. (2021, BJPsych Open): detransition frequencies between 7% and 30% depending on definition and follow-up.
• Boyd et al. (2022, Int J Transgender Health): 12.2% detransition or medical stop in a UK NHS practice in the last decade.
• Roberts et al. (2022, US Military Health System): 29.8% discontinued within four years after hormone start.
• University of York (Cass evidence reviews): 5-15% detransition within ten years among medicalized minors, with a strong underestimation due to follow-up loss.
• Voorzij study: up to one-third trans regret among adult female detrans respondents.
• Littman (2021): 60% not adequately informed about alternatives; 38% not advised about fertility loss; 22% not assessed for psychiatric comorbidity.
• Levine et al. (2023): "The myth of low regret" — points to data suggesting that 20-30% of the current adolescent girl cohort detransition within ten years.

A more detailed discussion with methodological analysis can be found at transgenderidentiteit.nl — how often does it really occur — and at transitieschade.nl/detrans/cijfers . As long as clinics do not conduct follow-up measurements, the 1% narrative will continue to circulate.

The difference between 1% and 30% determines whether the treatment model is defensible.

A detransition rate of 1% justifies substantial medicalization of minors — risks for the few, benefits for the majority. A rate of 15-30% makes that same calculation impossible. At those percentages, no other medical intervention — no treatment for depression, no orthopedic surgery, no psychiatric medication — would be prescribed as standard practice. Certainly not for minors, and certainly not with irreversible consequences. The difference between 1% and 30% is therefore not an academic curiosity; it determines whether the entire treatment model is medically and ethically defensible. For Cass, NICE, SBU, and COHERE, the answer has already been provided: given the current state of evidence, caution is a moral duty.

What detransitioners themselves say

The pattern described by detransitioners in the Littman survey (2021, 100 respondents) and the Vandenbussche survey (2021, 237 respondents from 22 countries) is strikingly consistent: rapid diagnosis, a trajectory that unfolds naturally, an environment that reinforces affirmation and disqualifies doubt. Underlying problems (trauma, autogynephilia in men, autism, eating disorders, homosexual struggle) ignored. Families torn apart. Regret structural, not exceptional. Collected portraits of Keira Bell, Chloe Cole, Helena Kerschner, Prisha Mosley, Sinead Watson, and Walt Heyer can be found at transitieschade.nl/detrans .

Regret that cannot be undone

Mastectomy and gonadectomy are the two most regretted procedures in every detrans study (Vandenbussche, Boyd). Regret regarding these procedures is permanent mourning:

• Breast tissue: all glandular tissue removed; no mammary glands or breastfeeding possible; loss of nipple sensation in 30-50%; chronic pain in 10-25%. In the US, the number of mastectomies in young women rose from a few hundred per year in 2010 to more than 8,000 in 2021 (see irreversible loss of breast tissue ).
• Fertility: puberty blockers + cross-sex hormones from a young age → almost always permanently infertile; gonadectomy definitively rules out reproduction. The Cass Review notes that fertility preservation in minors was insufficiently discussed or unrealistic — a serious informed consent deficit (see infertility after hormones and surgery ).
• Voice, beard growth, male pattern baldness: testosterone has a lasting effect. Women who detransition retain a low voice and facial hair for life.
• Genital surgery: permanent loss of function; pelvic problems; chronic pain.

Cass: WPATH response without substantive refutation

In April 2024, Hilary Cass published the Final Report concluding that the evidence base for puberty blockers and cross-sex hormones is "remarkably weak." Within weeks, WPATH published a response that Cass calls "biased," "ideological," and "in conflict with international consensus." The response does not address the substance of the systematic reviews Cass commissioned from the University of York, nor does it formulate alternative evidence that contradicts Cass's conclusions. A scientific response to a systematic review refutes methodology, cites counter-evidence, or acknowledges partial validity — the WPATH response does none of these three. This supports the proposition that SOC8 is not primarily a scientific but an ideological publication. See the analysis at wpath.nl/wpath-files/respons-cass .

The political custom

"99% have no regrets" is used to reduce informed consent to a formality. Patients are presented with it as if it were hard scientific evidence. It is a creed presented as a fact. The Cass Review has explicitly declared the figure unreliable; WPATH ignores that . The pattern of publication bias is thus complete: positive studies overpublished, negative ones suppressed, methodologically weak outcomes sold as a fact of faith. Transition does not heal — and everyone should hear that before a scalpel is touched.