The clinical evidence on gender-affirming care outcomes is now extensive and consistent. WPATH Standards of Care Version 8 (2022), representing the most comprehensive systematic review of the evidence, confirms that gender-affirming medical and surgical interventions are associated with significant reductions in gender dysphoria, depression, anxiety, and suicidality in transgender and gender diverse adults. Bustos et al.’s 2021 systematic review and meta-analysis of 27 studies pooling 7,928 patients who underwent gender-affirming surgery found a pooled regret prevalence of 1% (95% CI <1%–2%), consistent with the 1–4% contemporary range as patient selection and surgical techniques have improved. Regret rates for hormonal treatment alone are lower than for surgery. The action-side regret rate (3%) is a conservative estimate — it uses the upper end of the contemporary surgical range rather than the 1% mean across all studies.
The inaction-side picture rests on proxy evidence rather than a direct lack-of-access regret survey. The 2022 U.S. Transgender Survey — the largest survey of transgender people in US history, with 92,329 respondents — reports that nearly all care recipients said it made them more satisfied with their lives: 98% of those receiving gender-affirming hormone therapy and 97% of those receiving transition-related surgery. Turban et al.’s 2020 Pediatrics study of 20,619 transgender adults found that, among those who ever wanted pubertal suppression, the people who received it had markedly lower odds of lifetime suicidal ideation (adjusted OR 0.3) than those who wanted but could not access it. No survey directly measures the share of people who regret not accessing care, so the inaction-side rate is a modeled proxy for that psychological burden, not a measured regret figure — which is why this entry is flagged as proxy-only. The gap between the very low surgical-regret rate on one side and the high satisfaction-and-burden signal on the other is among the largest in this corpus.
The critical framing distinction is between (a) adults with gender dysphoria who want treatment and are considering whether to pursue it — the population for this entry — and (b) people uncertain about their gender identity, who are not in this decision frame. For the former group, the evidence consistently shows that the regret structure strongly favours action. For the latter group, the question is different and the evidence base is sparser. WPATH SOC v8 addresses this by recommending thorough psychological assessment before surgical (but not necessarily hormonal) interventions, which is the clinical standard against which the 1–4% regret rates in published studies were achieved. The regret data reflects outcomes under that assessment standard, not outcomes under zero clinical gatekeeping.