A groundbreaking study from Perth, Australia, published in JAMA Pediatrics has found that only 1% of transgender youth receiving gender-affirming care at a clinic reidentified with their sex assigned at birth. This is in addition to the 4% who reidentified during the mental health assessment period or earlier and did not proceed with receiving gender-affirming care. The study, based on 552 young patients from 2014 to 2020, is poised to significantly influence the debate on gender-affirming care due to its unique methodology, which does not suffer from loss to follow-up—the detransition status of 548 patients was successfully determined. It will likely be cited as the most compelling study on low detransition rates in the coming months.

The study was made possible by the unique circumstances of the Perth Gender Diversity Service (GDS) clinic. As the only youth gender clinic in the state of Western Australia, the system was relatively isolated from other gender clinics. The clinicians treating patients took detailed notes on case closures and the reasons for those closures and followed up with appointments extensively. This allowed researchers to examine not only medical databases to find the status of each individual patient but also to research each patient’s clinical circumstances. As a result, reidentification status was able to be determined at the point of measurement for nearly every patient.

The study examined every patient who attended the clinic from 2014 to 2020. Out of 995 referred patients, 552 had their records closed by 2020. For these closed records, researchers determined the reasons by examining medical databases to ascertain if patients continued to adult care. If not, they deeply reviewed clinical notes to identify the closure reason—only in four cases were they unable to find a reason, completely bypassing “loss to follow-up,” a term referring to the portion of a research dataset that could not be collected when following up with patients who do not respond when contacted in studies that use a follow-up methodology. The vast majority of records were closed due to transfer to adult services. Only 29 patients reidentified with their sex assigned at birth, and of those, only two did so after the mental health assessment and commencement of gender-affirming medical care.