What Does the Research Say About Youth Transition? A Sourced Guide for Families

TransHealthHub

6 days ago

4 min read

Key Takeaways

Youth transition is mostly social, and many transgender young people never take medication.
In a U.S. study following 317 socially transitioned children for about five years, 94 percent identified as binary transgender.
A four-clinic U.S. study of 315 teens starting hormones reported lower depression and anxiety over two years, without a comparison group.
Among 220 youth who received medical care, 97 percent were continuing it years later.
Evidence reviews rate this research as low certainty, while major U.S. medical societies regard the care as evidence-based and medically necessary.

The short answer

What the research says about youth transition is that most of it is social rather than medical, that most young people in long-term studies still identify as transgender years later, and that medical care, when it happens, is associated with better mental health and high satisfaction. Most studies are observational, so they show associations rather than proof of cause. At TransHealthHub, we summarize the main studies and their gaps.

What does "transition" mean for a young person?

For most young people, transition means a new name, pronouns, or hairstyle, often alongside counseling and family support. Our social transition guide explains these steps.

In The Trevor Project's 2025 national survey of more than 16,000 LGBTQ+ young people ages 13 to 24, 10 percent of transgender and nonbinary respondents ages 13 to 17 reported taking hormones, and 3 percent of all transgender and nonbinary respondents reported taking puberty-pausing medication.

Among 5,155,282 commercially insured U.S. adolescents ages 8 to 17 from 2018 to 2022, a 2025 JAMA Pediatrics study found prescribing rates of roughly 15 to 21 per 100,000 for puberty-pausing medication and 25 to 50 per 100,000 for hormones, and no adolescent younger than 12 received a hormone prescription. A 2022 legal analysis in Cell Reports Medicine noted that under existing guidelines, genital surgery "is not considered for minors."

What happens after a social transition?

Most children studied kept the identity they transitioned to. The Trans Youth Project followed 317 youth, average age 8 at the start, across the United States and Canada. In Pediatrics in 2022, researchers reported that about five years after social transition, 94 percent identified as binary transgender, 3.5 percent as nonbinary, and 2.5 percent as cisgender. The authors said the results "suggest that retransitions are infrequent." The cohort drew on supportive, self-selected families without a comparison group, so the figures describe this group and may not apply to all youth.

What does research show about mental health after medical care?

The strongest prospective U.S. data show average improvement, with wide individual variation. A 2023 New England Journal of Medicine study followed 315 transgender and nonbinary youth ages 12 to 20 at four U.S. gender clinics for two years after starting hormones. Depression and anxiety symptoms decreased, and life satisfaction increased. The study had no comparison group, and gains were significant among youth designated female at birth but not the smaller group designated male at birth, which the authors speculate may call for longer follow-up.

The American Medical Association, American Academy of Pediatrics, American Psychological Association, and Endocrine Society regard this care as evidence-based and medically necessary. Our mental health outcomes summary covers more studies.

How satisfied are young people with their care?

Satisfaction was high in a long-running U.S. cohort. A 2024 JAMA Pediatrics study of 220 Trans Youth Project participants, surveyed in 2023, an average of 4.86 years after starting puberty-pausing medication, found 97 percent continuing care. Nine of the 220 expressed regret about at least one treatment; four of them were still continuing care, which the authors said suggests "regret is not synonymous with stopping care." The sample was mostly White and from higher-income families.

Stopping treatment also differs from detransition. In a military health system study of 952 adolescents and adults with an average age of 19.2, the four-year hormone continuation rate was 70.2 percent. Pharmacy-record gaps and moves can register as stopping, so that figure is not a detransition rate.

Research question	What U.S. studies found	Main limit
How common is medical care?	Rare among insured teens; no hormones under age 12	Excludes Medicaid and uninsured youth
Do identities hold after social transition?	94 percent of 317 youth binary transgender after about five years	Supportive, self-selected families
Mental health after hormones	Lower depression and anxiety over two years in 315 teens	No comparison group
Satisfaction with care	97 percent of 220 youth continuing; 9 reported regret	Mostly White, higher-income sample

How certain is this evidence?

Evidence reviews rate this research as low certainty. England's Cass Review and a 2025 U.S. Department of Health and Human Services report both reached that conclusion, a judgment about confidence in the results, not evidence of harm. The medical societies named above maintain their support for this care. Our Cass Review explainer covers that debate.

Frequently asked questions

What does the research say about youth transition overall? Most transition is social, most youth studied keep their identity, and medical care is associated with better mental health, though certainty is rated low.

Do most transgender teens take medication? No. Surveys and insurance data show only a minority do.

Does stopping treatment mean someone detransitioned? Not necessarily. Researchers note that people may stop after reaching a desired effect or when they can no longer pay for care.