Continuation of Gender-Affirming Hormone Therapy in Transgender and Gender-Diverse Individuals: A Systematic Review

Objective: Gender-affirming hormone therapy (GAHT) is often used by transgender and gender-diverse individuals to align their physical appearance with their gender identity. Discontinuation rates and factors leading to discontinuation of GAHT are not fully understood. We aimed to assess the continuation and discontinuation rates of GAHT and the factors leading to discontinuation of GAHT in a systematic review of the literature.

Methods: We searched PubMed from 2009 until April 01, 2024, for all published studies that described initiation, discontinuation, and reasons for discontinuation of GAHT. Studies were screened by 2 authors independently. We included 6 studies that met the inclusion and exclusion criteria published between 2021 and 2024.

Results: Five studies reported GAHT discontinuation rates under 10%, whereas 1 study reported a discontinuation/lost to follow-up rate of 30.8%. Only 1 study was prospective, whereas all other studies were retrospective. Reasons for discontinuation of GAHT were described in only 2 studies. One study reported GAHT discontinuation primarily from external factors, whereas the other study suggested that GAHT discontinuation occurred due to change in gender identity.

Conclusion: Current data on discontinuation of GAHT show that the rates of GAHT discontinuation appear to be low and the reasons include both external pressures and internal change of gender identity. A better understanding of the internal and external pressures that impact the decision to continue GAHT is needed in future studies.