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50-year Retrospective Review Of Gender-affirming Care Outcomes From Johns Hopkins Hospital
Calvin R. Schuster, BA, Yu Jui Kung, BS, Bashar Hassan, MD, Gabriela Drew, MD, Gillian Hilscher, BA, Molly Baxter, BA, Margaret R. Wang, BS, Camille Blackman, BA, Danielle Mayorga-Young, MD, Olubunmi Solano, BS, Sarah Bejo, BS, Danielle Sim, MD, Kate Thomas, PhD, Fabian Saleh, MD, Richard J. Redett, MD, Fan Liang, MD.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
PURPOSE: The Hopkins Sex and Gender Clinic (SGC), established in 1971, is the longest continuously operating U.S. clinic providing gender-affirming care (GAC). Here we characterize long-term outcomes.
METHODS: Retrospective review of 854 patients who presented between 1972-2020 with a concern related to gender identity. Data were extracted from clinician notes. Follow-up was defined as ≥6 months.
RESULTS: In total, 24.0% (n=205/854) had follow-up for a median of 7.7 years (IQR: 5.3-13.8 years; range: 0.6-49.9 years). Median age at presentation was 23 (IQR: 18-31; range: 9-85). At follow-up, 85.4% (n=175/205) lived openly as TGNB, while 14.6% (n=30/205) presented as their sex assigned at birth (SAAB). Three themes were identified as reasons for not transitioning: family rejection/stigma (n=14/30), medical contraindications (n=4/30), and evolving understanding of identity (n=4/30). Nine started then discontinued gender-affirming hormone therapy (GAHT), including one who reversed chest masculinization surgery. None expressed regret. A majority (83.9%, n=172/205) met diagnostic criteria for gender dysphoria (GD) at initial evaluation; 57.6% (n=19/33) without an initial GD diagnosis subsequently pursued GAHT/GAS.
CONCLUSION: This 50-year review demonstrates durability of TGNB identity despite substantial social barriers in the late 20th century. Discontinuation of GAHT or reversal of surgery was rare, and no patients expressed regret.
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