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20-year outcomes in Gender-Affirming Care from Johns Hopkins Hospital
Yu Jui Kung
*2, Bashar Hassan
2, Calvin R. Schuster
2, Camille F. Blackman
2, Danielle Mayorga-Young
2, Olubunmi Solano
2, Sarah Bejo
2, Danielle Sim
2, Kate Thomas
2, Fabian Saleh
1, Fan Liang
21Johns Hopkins School of Medicine, Baltimore, MD; 2Department of Plastic and Reconstructive Surgery, Center for Transgender and Gender Expansive Health, Johns Hopkins University School of Medicine, Baltimore, MD
Background: The Johns Hopkins Sex and Gender Clinic (SGC), established in 1971, is the longest continuously running clinic in the U.S. providing gender-affirming care (GAC). We characterize outcomes of individuals presenting for gender incongruence to capture durability of gender identity, treatment pathways, and regret.
Methods: We conducted a retrospective review of 220 patients who presented to the SGC between 2005-2020 with a chief complaint related to gender presentation or incongruence. Exclusion criteria included intersex conditions, follow-up <6 months, or lack of patient expressed gender incongruence. Primary outcomes included incidence of gender dysphoria (GD) diagnosis at initial evaluation, rates of gender-affirming hormone therapy (GAHT) and surgery (GAS), persistence of TGNB presentation, reasons for maintaining sex assigned at birth (SAAB), and regret.
Results: Median age at presentation was 23 years (IQR: 17-31; range: 9-85). 80.0% (176/220) met inclusion criteria and had mean follow-up of 7.4 years (range: 6.1 months-19.7 years). At most recent follow-up, 93.2% (164/176) lived openly as TGNB, while 6.8% (12/176) presented as their SAAB, most often due to family rejection or stigma, medical contraindications to GAHT or GAS, or evolving understanding of gender identity. 6 of the 12 patients had started and discontinued hormones, including 1 surgical reversal. Notably, no patients expressed regret. 88.6% (156/176) of patients met diagnostic criteria for GD at initial evaluation, of which 89.1% (139/156) initiated GAHT and/or GAS. 75.0% (15/20) patients who did not receive an initial GD diagnosis subsequently pursued GAHT or GAS.
Conclusion: This study represents the largest U.S. cohort of patients receiving GAC with multi-decade follow-up. Detransition, defined here as discontinuing GAHT or reversing GAS to align with one's SAAB, occurred in 6 of 176 patients (3.4%), primarily due to lack of social acceptance or medical contraindications to care. No patient expressed regret and patients' self-identified gender incongruence remained durable over time.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
