Discontinuation of Gender-Affirming Medical Treatments: Prevalence and Associated Features in a Nonprobabilistic Sample of Transgender and Gender-Diverse Adolescents and Young Adults in Canada and the United States.

ABSTRACT

PURPOSE: This study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America. METHODS: This exploratory study used data from an online survey of sexual and gender minority adolescents and young adults aged 15-29 years living in Canada or the United States of America (March-August 2022). The analytic sample was constituted by participants who responded to questions regarding starting and stopping GAMT, as well as reasons for stopping. Correlates of discontinuing GAMT were assessed using univariate logistic regression. RESULTS: The mean age of the analytic sample (N = 3,937) was 21.1 years. Participants were predominantly nonbinary (54.2%) and assigned female at birth (80.8%). 75.5% lived in Canada and 24.5% in the United States of America. Among those who had started GAMT, 121 of 720 (16.8%) reported having ever discontinued treatment. Forty five of 121 (37.2%) who ceased GAMT reported "Yes, but I wish I hadn't." The most frequently endorsed reasons for discontinuing GAMT were health reasons (37.3%), a change in gender identity (32.0%), and cost (16.0%). Greater age; nonbinary identity, 'other' gender identity; diagnosis of or self-identifying as living with schizophrenia; residing in the United States of America (relative to Canada); and endorsing a current Christian identity were associated with discontinuation. Ninety seven of 121 (80.2%) who discontinued GAMT reported a current transgender or gender-diverse identity. DISCUSSION: Given the dearth of information about the subpopulation who discontinue GAMT, this study advances candidate factors to inform future longitudinal research to better understand the multiple reasons and contexts for stopping GAMT.