Does anyone regret having undergone gender-affirming treatment? The question runs through political and media debates in much of the world, yet it is almost never answered with general-population data. A team from the Karolinska Institutet (Sweden) and Yale University (United States) now publishes in JAMA Network Open a survey carried out within a national Swedish cohort: among the 72 transgender people who had received affirming hormones or surgery, 100% said they were satisfied with their decision and not one reported dissatisfaction.
A national cohort, a small sample
The data come from the BLISS study (Biopsychosocial Mechanisms Linking Health and Social Stress), which began in October 2022 with a random sample of the Swedish population aged 16 and over: 199,993 people invited. In the second wave, a specific survey on transgender experiences was offered to the 95 people who identified as transgender — or had done so previously —; 83 agreed to take part and 72 completed the questionnaire, a response rate of 86.7%. Data were collected between February and April 2025.
What they had received and what they still lacked
- 42.3% (30 of 72) were receiving gender-affirming hormone treatment when they answered; 2.8% had used it before and 54.9% (39 of 72) had never used it.
- Almost a third of the sample (32.4%) had undergone some form of gender-affirming surgery.
- Among people assigned female at birth (n = 46), the most frequent procedures were masculinising chest surgery (43.5%) and genital surgery (10.9%).
- Among those assigned male at birth (n = 25), hair removal stood out (32%), followed by voice therapy or surgery (28%), genital surgery (12%) and chest surgery (4%).
The uncomfortable finding: demand that goes unmet
The authors highlight not only satisfaction but unmet desire. Among those who had not received a specific treatment, masculinising chest surgery was the most wanted (65.4% of those still waiting for it) and hysterectomy was mentioned by 28.6%. In the group assigned male at birth, the most desired treatments were hair removal (47.1%), orchiectomy (45.4%) and voice therapy (44.4%). In other words, a large part of the sample was living with affirming needs that the health system had not yet resolved.
Ages, waiting and a figure that dismantles a headline
The mean age at first hormone treatment was 25, and about ten years had passed on average between that first affirming treatment and the survey. Participants placed the moment they felt “different” at around age 12, but did not disclose it to anyone until age 21 on average. And only one of the 72 had started hormones at 17: the rest were 18 or older, just as with surgery, where nobody was a minor. Nearly half (47.9%) had a gender dysphoria diagnosis recorded in Swedish health registries.
The caveats that must be put on the table
The sample is small — 72 people — and loss to follow-up was high: those who did not respond were older (mean 43.5 versus 33.7 years) and more often born outside Sweden (28.1% versus 8.3%), so the picture is skewed towards younger, native-born people. The study includes adults only and its results cannot be transferred to children or adolescents. On top of that, the Swedish context — universal healthcare, high institutional trust and long waiting lists — cannot simply be extrapolated to other countries.
Why it matters
The authors read the total absence of dissatisfaction as the joint result of demanding clinical standards, the strong motivation of those seeking these treatments and a system that filters people through waiting. The practical consequence cuts two ways: if nobody regrets it, the problem lies not in the conviction of those who are treated but in access; and if most of those who have not received treatment want it, the relevant clinical question is not whether they want treatment but why they have been unable to get it. The article itself asks clinicians to ask proactively about affirming experiences — both those received and those still pending — in order to tailor each person’s goals.
Source: Gender-Affirming Medical Treatment Prevalence, Decision Satisfaction, and Future Need Among Transgender Adults. Pachankis JE, Smart BD, Bränström R. JAMA Network Open 2026;9(10):e2637857. DOI: 10.1001/jamanetworkopen.2026.37857.
Article published on dosier.es. Image generated with artificial intelligence (marta ai → marta.syf.es).
