Prelogar and Strangio argued that regret among medical transitioners is rare. The reality is more complicated.
Making the case against a Tennessee law banning transgender procedures for minors before the Supreme Court on Wednesday, the U.S. solicitor general and an ACLU lawyer cited dubious statistics to support their argument that the benefits associated with hormone therapies and surgeries easily outweigh the attendant risks.
During oral arguments in United States v. Skrmetti, Justice Kavanaugh asked U.S. solicitor general Elizabeth Barchas Prelogar whether detransitioners — a growing group of individuals who eventually come to regret their medical transitions — should be considered in weighing the harms associated with such procedures.
“Yes, yes,” Prelogar responded. “We’re certainly not denying that some people might regret this care, but all of the available evidence shows that it’s a very small number.”
In their brief to the court, the ACLU claimed that less than 1 percent of minors who undergo gender transition later come to regret the decision, a far smaller proportion than the 85 percent put forward by the Tennessee attorney general’s office.
Justice Sotomayor asked transgender-identifying ACLU attorney Chase Strangio to explain the discrepancy.
Strangio argued that the 85 percent figure is “misleading” because it pertains to older studies of prepubertal children who underwent gender medicalization.
“The evidence shows that once an adolescent reaches the onset of puberty, their likelihood to ultimately identify with their birth sex is very low,” Strangio said. “And then as to the question of the 1 percent…the rate of regret when people receive this medication, is as low as 1 percent. What’s important here, and the solicitor general mentioned this, that is exponentially lower than the rates of treatment permitted by SB-1.”
Puberty for girls usually starts between the ages of eight and 13, whereas puberty for boys usually starts sometime between the ages of nine and 14, according to the Cleveland Clinic.
Sotomayor appeared to conflate rate of desistance with rate of regret in her question. The 85 percent figure likely refers to the rate of desistance, or the rate at which gender-confused children desist from their trans identification by adulthood. This is different from the percentage of children who experience regret after receiving gender-reconstructive surgery or hormone therapy. A 2021 study conducted by Canadian scientists reported follow-up data on what was at the time the largest sample of boys who had been referred to clinics for gender dysphoria. At follow-up, once the boys had reached adulthood, 87.8 percent were classified as desisters and 12.2 percent were classified as persisters, or those who maintained their trans identity into adulthood. While they would not be included in Strangio’s 1 percent of individuals who regret receiving hormone treatments, the boys’ decision to reject their trans identity suggests they likely do regret receiving medical interventions to support a gender identity which they jettisoned by adulthood.
An August Manhattan Institute analysis of an all-payer, all-claims national insurance database similarly suggested that a significant percentage of children with gender dysphoria would eventually grow out of it once they matured. In the 12.5–17.5 age category, 43.7–46.2 percent of those who had a gender-dysphoria diagnosis in 2017 retained a gender-related diagnosis by 2023, the study found. In the combined 7.5–17.5 age-group category, the diagnostic persistence rate was slightly lower, at 42.2–44.5 percent. The takeaways are that, despite what the trans lobby insists, most adolescents diagnosed with gender dysphoria will not have this diagnosis within as few as seven years, during the period of rapid-identity development. Therefore, a diagnosis of gender dysphoria is a wobbly justification for invasive, permanent, and life-altering medical intervention for minors.
The meta-study Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence is often cited as the source for the statistic that trans regret is “only 1-3%.” However, one objection to the validity of this statistic is the loss of follow-up bias, or respondents refusing to participate in a follow-up study. An analysis on X by detransitioner Michelle Alleva found that the average loss of follow-up is 30.9 percent, suggesting that the real percentage of youth patients who may regret their transition is much higher than the 1 percent cited by the plaintiff attorneys before the Supreme Court.
Individuals who transition, especially those who take testosterone to masculinize their appearance, often experience euphoria after beginning the radically transformative procedures, which are advertised as the cure to patients’ underlying gender confusion. Once the psychological high wears off, many patients come to regret their decision because it doesn’t ameliorate suffering from whatever underlying psychiatric condition went untreated. A groundbreaking Finnish study from March showed that psychiatric distress can be an antecedent to gender dysphoria, rather than a byproduct. The study solidified that comorbid psychiatric conditions, a well-known risk factor for suicide, are prevalent in gender-dysphoric youth.
Chloe Cole, a prominent detransitioner who experienced intense regret after getting her healthy breasts removed and testosterone infusions as a child, protested with a crowd outside the Supreme Court to sound the alarm on the permanent bodily damage of gender medicalization.
“No child deserves to cry in anticipation of whether they’ve been sterilized or not by cross-sex hormones and yet this is how I live every single day,” Cole said.
Kavanaugh raised the point that multiple European countries, such as the U.K. and Sweden, have rolled back their youth gender transition programs in recognition of the lack of longterm studies to support their efficacy. In April, an independent review of gender-related medical services for minors and young adults commissioned by NHS England was released. Hilary Cass, the former president of the Royal College of Paediatrics and Child Health who led the review, concluded that there is insufficient evidence on the long-term consequences of these gender interventions.
“It strikes me as a pretty heavy yellow light if not red light for this court to come in, the nine of us, and constitutionalize the whole area when the rest of the world, or at least the countries that have been at the forefront of this are pumping the brakes on this kind of treatment because of concerns about the risks,” Kavanaugh said Wednesday.
At several points during oral arguments, Strangio and Perlogar appealed to the support their side of the argument has received from leading American and international medical associations, despite the mounting evidence that those organizations have been captured by a commitment to gender ideology and a resistance to evidence of its harms.
In March, leaked internal documents revealed that members of WPATH, the leading global medical organization devoted to transgender health care, admitted privately that youth gender interventions are largely experimental and that minors struggle to give informed consent before undergoing the procedures. WPATH members acknowledged behind closed doors that young people often lack the health literacy and discernment to comprehend the gravity of the procedures and their possible ramifications, such as sterility, derailed sexual development, and general regret.
In January 2022, WPATH president Marci Bowers said during a board meeting that the effects of puberty blockers on fertility and “the onset of orgasmic response” are not fully known. Boys who have their puberty blocked early can have “problematic surgical outcomes,” she said, and extreme difficulty climaxing. On WPATH’s internal messaging forum, members at various dates discussed serious complications among youth who received these hormones and surgeries. One member mentioned the story of a female “young patient” who after three years of testosterone developed pelvic inflammatory disease and vaginal atrophy, a typically post-menopausal phenomenon that makes intercourse painful and can also lead to distressing urinary symptoms. A registered nurse reported male patients who described their erections as “feeling like broken glass.”
Other WPATH members recognized that the industry’s so-called treatment protocol of gender-affirming cate may be correlated with advanced disease, like cancer. In December 2021, a doctor in the WPATH forum said that a 16-year-old patient had developed large liver tumors after being prescribed norethindrone acetate, which can serve as a puberty-blocker substitute, to suppress menstruation for several years and testosterone for one year. Another doctor responded that a female colleague had a similar experience, developing hepatocarcinomas after eight to ten years of taking testosterone.
“To the best of my knowledge, it was linked to his hormone treatment,” the doctor said.
During the opening arguments, Kavanaugh also asked the plaintiff lawyers to explain what it would mean for women’s and girls’ sports if they prevail in the case.
Kavanaugh asked: “Would transgender athletes have a constitutional right, as you see it, to play in women’s and girls’ sports, basketball, swimming, volleyball, track, etc. notwithstanding the competitive fairness and safety issues that have been vocally raised by some female athletes seeing in the amicus brief seen in the many women athletes in this case?”
Prelogar suggested that the situations of male intrusion into women’s sports and youth having access to gender transition medicalization are distinct in terms of satisfying intermediate scrutiny. The former potentially disenfranchises female athletes in competition whereas the latter doesn’t adversely impact anyone besides the child patient, she said.
“We think it applies in both contexts but there are a different status- a different set of state interests at play,” Prelogar said.