Detransition in Europe: studies and registries

What do European registries and studies show about detransition and regret?

“Detransition” is not a single measurable outcome. It can mean stopping puberty blockers or cross-sex hormones, reversing a legal sex marker, changing one’s name or presentation, seeking reconstructive or reversal treatment, or simply coming to regret an earlier medical decision. These are related but different events. A patient may cease hormones because of adverse effects, cost, fertility plans, health concerns, dissatisfaction, a changed identity, inadequate follow-up, or a temporary interruption; discontinuation is therefore not automatically proof of regret. Equally, recorded regret is no

Detransition in Europe: studies and registries

Key facts

1972 In the Amsterdam cohort, 0.6% of natal males and 0.3% of natal females who underwent gonadectomy were recorded as regretting it between 1972 and 2015.

2024 In Finland, 107 of 1,359 people, or 7.9%, discontinued established cross-sex hormones during a mean follow-up of 8.5 years (Kaltiala et al., 2024).

2013 Finnish patients entering specialist services in 2013–2019 had a 2.7-fold higher adjusted risk of hormonal discontinuation than the 1996–2005 cohort.

2023 The Swedish SBU concluded in 2023 that the literature on regret and detransition is heterogeneous, sparse and generally of low certainty.

2023 Norway’s UKOM reported in March 2023 that no national system then tracked withdrawals, completion, outcomes or detransition across services.

2022 Sweden’s National Board of Health and Welfare concluded in February 2022 that, for under-18s as a group, the risks of hormonal treatment then outweighed its possible benefits.

Background

This distinction matters because the most frequently quoted European figures come from older, highly selected clinical cohorts. They should not be presented as a forecast for the newer adolescent population, which in several countries has grown rapidly and has a different sex ratio, age profile and pattern of co-occurring mental-health and neurodevelopmental difficulties. The Dutch, Swedish and Finnish records are valuable precisely because they reveal both the limited evidence and the limits of the data.

What the documents say

The Netherlands: low recorded surgical regret in the historic Dutch protocol cohort

Wiepjes and colleagues reviewed records from Amsterdam’s gender identity clinic for 6,793 patients seen between 1972 and 2015. The clinic treated more than 95% of the Dutch transgender population during much of that period. Among people who had undergone gonadectomy, the study identified regret in 0.6% of natal males and 0.3% of natal females (Wiepjes et al., 2018). This is evidence of low recorded regret after a particular irreversible operation in a historically screened clinic population; it is not a population-wide detransition rate, nor does it measure dissatisfaction with hormones, social transition, chest surgery or treatment begun in the recent adolescent surge.

The same Dutch cohort included 812 adolescents aged 12–18. Of these, 41% started puberty suppression and 1.9% of starters discontinued it. The follow-up duration for that particular measure was not reported. Earlier Dutch follow-up studies were very small: for example, de Vries et al. followed 55 carefully selected young people through suppression, hormones and surgery and reported no regret. Sweden’s SBU later collated these studies but stressed their small samples, variable definitions and short or incompletely reported follow-up (SBU, 2023).

Finland: a national register finds more hormonal discontinuation

Finland provides the strongest European registry evidence on established hormonal discontinuation. Kaltiala, Helminen, Holttinen and Tuisku linked national specialist-care, surgery and reimbursed-prescription records for everyone who began hormonal gender reassignment in Finland between 1996 and 2019. Of 1,359 people, 7.9% discontinued established masculinising or feminising hormones over a mean 8.5 years of follow-up (Kaltiala et al., 2024).

The authors found a higher risk in the latest referral cohort: those first attending gender identity services in 2013–2019 had an adjusted hazard ratio of 2.7 compared with those attending in 1996–2005. Discontinuation also occurred sooner in later cohorts. The paper does not claim that every discontinuation is regret or a return to living in one’s birth sex. Its measure is administrative and clinical: stopping an established reimbursed hormonal treatment or switching hormonal direction. Nonetheless, it demonstrates that the older claim that detransition is vanishingly rare cannot safely be inferred from historical surgical-regret series.

Finland’s Council for Choices in Health Care, COHERE, issued its recommendation on treatment for minors in June 2020. It placed psychosocial support first and stated that puberty suppression could be considered case by case after careful assessment; surgery was not recommended for minors. The subsequent registry programme is important because policy caution without long-term outcome recording cannot answer the central question.

Sweden and Norway: evidence reviews identify an outcome-data gap

Sweden’s SBU published its review, Regret and detransition in gender dysphoria, in 2023. Its conclusion was not that regret never occurs, nor that a reliable national prevalence is known. Rather, the underlying research was sparse and heterogeneous, with low certainty where conclusions could be drawn (SBU, 2023). Sweden’s National Board of Health and Welfare had already revised its youth guidance in February 2022, judging that the risks of puberty blockers and cross-sex hormones outweighed possible benefits for under-18s as a group, while allowing exceptional individually assessed cases and research participation. Karolinska University Hospital’s earlier restriction of routine youth hormonal treatment formed part of the Swedish reassessment, but neither Karolinska nor SBU supplied a national detransition percentage.

Norway’s UKOM patient-safety investigation reached a similar institutional conclusion in March 2023: there was no nationwide overview of patient histories, refusals, self-withdrawals, completed treatment or outcomes after treatment. UKOM recommended a national medical quality register. This is a crucial finding. A health system cannot reassure patients that regret is rare if it does not systematically count, contact and support those who discontinue or regret treatment (UKOM, 2023).

Germany, France, Denmark and Spain

Germany’s AWMF guideline on gender incongruence and dysphoria in children and adolescents was published in March 2025. It explicitly distinguishes detransition from regret and acknowledges that detransition remains little researched. It discusses the low surgical-regret estimates from older literature while accepting substantial uncertainty. This is a guideline synthesis, not a German national registry result.

France’s Haute Autorité de Santé published adult transition-care guidelines on 18 July 2025. The guidance explicitly includes detransition and re-transition as possible pathways, but it does not offer a national rate. France’s under-18 guidance remained at scoping stage in May 2026. Denmark has unusually powerful linked national health registers, including hospital and prescription data, but the existence of data infrastructure is not the same as a published national estimate of detransition or regret. Spain’s Law 4/2023 concerns equality and legal recognition; it does not establish a national clinical outcomes register capable of measuring medical detransition.

European courts protect legal recognition and free movement, not clinical claims about regret. In A.P., Garçon and Nicot v France (European Court of Human Rights, 6 April 2017), the Court held that requiring an irreversible change in appearance for legal recognition violated Article 8. In Mirin (C-4/23, 4 October 2024), the Court of Justice of the European Union required cross-border recognition of lawfully acquired changes of name and gender identity. These judgments do not determine whether medical transition benefits particular patients, nor do they create a registry of reversals.

The positions

Supporters of medical transition point to the low recorded regret after surgery in older European cohorts, to the distress experienced by many people with gender dysphoria, and to the fact that some people who stop treatment do not regret having started it. They argue that conflating discontinuation with regret can overstate dissatisfaction and may stigmatise patients who need care.

Gender-critical and safeguarding advocates reply that surgical-regret studies are the wrong denominator for today’s question. They concern adults or tightly selected patients, often treated years ago, and do not capture those who discontinue before surgery, are lost to follow-up, or seek help outside the original service. They also argue that the rise in Finnish discontinuation, alongside official Swedish, Norwegian and Finnish concern about weak long-term evidence, makes comprehensive follow-up a matter of informed consent and patient safety.

Interpretation

Beyond Gender’s reading is that Europe does not possess a credible single figure for detransition or regret. The claim that regret is “below 1%” is defensible only when carefully limited to recorded regret after particular surgeries in older and selected cohorts. It is not an evidence-based description of all medical transition, especially among contemporary adolescents.

The Finnish register is therefore more informative than the oft-repeated Dutch surgical figure, although it too is incomplete: stopping hormones is not identical to regret, and records cannot fully reveal motive or social outcome. Its 7.9% figure should neither be inflated into a universal regret rate nor dismissed because it is not a perfect measure. It establishes that clinically meaningful discontinuation exists, rises in later cohorts, and deserves systematic investigation.

The policy consequence is straightforward: every European service prescribing puberty blockers, cross-sex hormones or surgery should maintain prospective, sex-disaggregated registers; record comorbidities, treatment exposure, discontinuation, re-transition, adverse events, fertility outcomes and patient-reported regret; and offer independent care to people who detransition. Rights to legal recognition must not be used as a substitute for evidence about medical risk, benefit and long-term outcomes.

Open questions

Europe still needs long follow-up of recent adolescent cohorts, not merely historic adult series. Registries should distinguish stopping a prescription from changed identity, regret, loss to follow-up and re-transition. They should also record which physical changes were reversible, partly reversible or irreversible, and whether patients can obtain appropriate endocrine, surgical, reproductive and psychological support after discontinuation.

Above all, national services should publish denominators. How many were referred, assessed, prescribed blockers or hormones, underwent each operation, discontinued, switched treatment, sought reversal, were lost to follow-up, or later reported regret? Until those questions are answered transparently, both assurances that detransition is negligible and claims that it is widespread exceed the European record.