Uptake, reidentification and regret in pediatric gender care
- 1Murdoch Children's Research Institute
Abstract
BackgroundGender-affirming medical care (GAMC) for children and adolescents in Australia has become increasingly politicized, despite care being provided in accordance with latest evidence-based international guidelines. Critics of GAMC claim that current assessment and deliberation processes are insufficient, and that too many young people are accessing medical interventions, no longer identifying as trans, and expressing treatment regret. These claims have led to widespread bans on the provision of pediatric GAMC, despite growing evidence regarding harms caused by such bans.
AimThis study sought to describe the care journeys of the young people attending Australias largest pediatric gender service, with a focus on reporting the rates at which young people commenced medical interventions, re-identified with their birth-assigned sex, and expressed regret about their treatment.
MethodsThe Royal Childrens Hospital Gender Service (RCHGS) is a statewide service that provides individualised multidisciplinary care to trans and gender diverse young people in Victoria, Australia. An initial extended triage appointment explores the needs and goals of the young person and their family. Some proceed to receive individualised multidisciplinary care (MDC) at RCHGS which can include psychosocial assessment and management, family support, and medical interventions including pubertal suppression (PS) and gender-affirming hormonal therapy (GAHT). We undertook a retrospective file audit of all patients who had attended at least one RCHGS appointment and been discharged between 1/1/2017- 31/12/2024. For each person, key data were extracted from their electronic medical record and recorded in REDCap.
Results1,391 patients were discharged over the 8-year study period and many different care trajectories were observed. 814 (58.5%) did not access ongoing MDC. Of the remaining 577, 353 (25.4% of total cohort) started a medical intervention ((PS: n=64/1391 (4.6%); estradiol: n=97/1391 (7.0%); testosterone: n=244/1391 (17.5%)). For those who started these medical interventions, the median duration and number of sessions from first appointment until commencement of medications was 530 (IQR: 371-693) days and 9 (IQR: 7-13) sessions. 346 of these patients (98.0%) had data on gender identity at discharge and subsequent care pathways. 7 (2.0%) re-identified with their birth-registered sex and stopped treatment: 4 did so after commencing PS (4/61=6.6% of those starting PS), 2 did so after commencing testosterone, and 1 did so after commencing estradiol (3/341=0.9% of those starting GAHT). Just one of these patients, who had been on estradiol for 1 month, expressed treatment regret given concerns about initial breast budding and future fertility.
ConclusionThis study highlights varied trajectories of those referred to pediatric gender services, directly challenges claims used to justify restrictions on pediatric GAMC and underscores the importance of a person-centred approach to care.
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BibTeX
@misc{tollit2026uptake,
title = {{Uptake, reidentification and regret in pediatric gender care}},
author = {M. A. Tollit and W. Conabere and K. Gray and C. Sibley and I. Ayub and C. C. Pace and A. Traill and T. Russo-Batterham and B. S. Cavve and T. Ravipati and C. Rayner and K. C. Pang},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.17.26363359},
url = {https://www.medrxiv.org/content/10.64898/2026.09.17.26363359v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Uptake, reidentification and regret in pediatric gender care
AU - M. A. Tollit
AU - W. Conabere
AU - K. Gray
AU - C. Sibley
AU - I. Ayub
AU - C. C. Pace
AU - A. Traill
AU - T. Russo-Batterham
AU - B. S. Cavve
AU - T. Ravipati
AU - C. Rayner
AU - K. C. Pang
PY - 2026
DA - 2026/09/17
PB - medRxiv
DO - 10.64898/2026.09.17.26363359
UR - https://www.medrxiv.org/content/10.64898/2026.09.17.26363359v1
AB - BackgroundGender-affirming medical care (GAMC) for children and adolescents in Australia has become increasingly politicized, despite care being provided in accordance with latest evidence-based international guidelines. Critics of GAMC claim that current assessment and deliberation processes are insufficient, and that too many young people are accessing medical interventions, no longer identifying as trans, and expressing treatment regret. These claims have led to widespread bans on the provision of pediatric GAMC, despite growing evidence regarding harms caused by such bans. AimThis study sought to describe the care journeys of the young people attending Australias largest pediatric gender service, with a focus on reporting the rates at which young people commenced medical interventions, re-identified with their birth-assigned sex, and expressed regret about their treatment. MethodsThe Royal Childrens Hospital Gender Service (RCHGS) is a statewide service that provides individualised multidisciplinary care to trans and gender diverse young people in Victoria, Australia. An initial extended triage appointment explores the needs and goals of the young person and their family. Some proceed to receive individualised multidisciplinary care (MDC) at RCHGS which can include psychosocial assessment and management, family support, and medical interventions including pubertal suppression (PS) and gender-affirming hormonal therapy (GAHT). We undertook a retrospective file audit of all patients who had attended at least one RCHGS appointment and been discharged between 1/1/2017- 31/12/2024. For each person, key data were extracted from their electronic medical record and recorded in REDCap. Results1,391 patients were discharged over the 8-year study period and many different care trajectories were observed. 814 (58.5%) did not access ongoing MDC. Of the remaining 577, 353 (25.4% of total cohort) started a medical intervention ((PS: n=64/1391 (4.6%); estradiol: n=97/1391 (7.0%); testosterone: n=244/1391 (17.5%)). For those who started these medical interventions, the median duration and number of sessions from first appointment until commencement of medications was 530 (IQR: 371-693) days and 9 (IQR: 7-13) sessions. 346 of these patients (98.0%) had data on gender identity at discharge and subsequent care pathways. 7 (2.0%) re-identified with their birth-registered sex and stopped treatment: 4 did so after commencing PS (4/61=6.6% of those starting PS), 2 did so after commencing testosterone, and 1 did so after commencing estradiol (3/341=0.9% of those starting GAHT). Just one of these patients, who had been on estradiol for 1 month, expressed treatment regret given concerns about initial breast budding and future fertility. ConclusionThis study highlights varied trajectories of those referred to pediatric gender services, directly challenges claims used to justify restrictions on pediatric GAMC and underscores the importance of a person-centred approach to care.
ER -