Prevalence of Gender-Affirming Medical Care, Satisfaction With Treatment Decisions, and Unmet Need Among Transgender Adults

By
John E. Pachankis
Benjamin D. Smart
Richard Bränström
October 7, 2026

Jama Network Open

Overview

In a Swedish cohort survey, 72 adults who currently or formerly identified as transgender reported varied use of gender-affirming medical care, and many participants who had not received specific treatments said they wanted them. All participants who had received hormone treatment, surgery, and/or a procedure reported satisfaction with their treatment decisions. Findings are descriptive and based on a small follow-up sample.

Background

Earlier estimates of gender-affirming treatment experiences were based on clinical records of people who pursued treatment or surveys of people currently identifying as transgender. This study used a national population-based cohort in Sweden to include people who currently or formerly identified as transgender. It assessed treatment prevalence, satisfaction with treatment decisions, and desired treatments not yet received. The study authors noted that population calibration weights could not be constructed because relevant sociodemographic benchmarks for transgender individuals in Sweden were unavailable.

Data Highlights

Measure	Finding
Completed follow-up survey	72 participants; 86.7% response rate among those who consented
Any gender-affirming surgery	23 participants (32.4%)
Ongoing gender-affirming hormone treatment	30 participants (42.3%); 2 (2.8%) had used hormones previously, and 39 (54.9%) had never used them
Satisfaction with treatment decisions	100% among participants who had received any gender-affirming hormone treatment, surgery, and/or procedure
Most desired treatment among participants assigned female at birth who had not received masculinizing treatments	Chest surgery (65.4%); hysterectomy (28.6%)
Frequently desired treatments among participants assigned male at birth without prior feminizing treatments	Hair removal: 8 (47.1%); orchiectomy: 10 (45.4%); voice therapy: 8 (44.4%)

Key Findings

The 72 respondents included 6 people who had previously identified as transgender; none of those 6 had received gender-affirming treatment.
Any gender-affirming surgery was reported by 23 participants (32.4%). Among participants assigned female at birth, 20 (43.5%) reported masculinizing chest surgery and 5 (10.9%) masculinizing genital surgery.
Among participants assigned male at birth, 3 (12.0%) reported feminizing genital surgery; 1 (4.0%) reported chest surgery and 1 (4.0%) facial and/or throat surgery. Hair removal was reported by 8 (32.0%) of participants assigned male at birth; all identified as female or transfeminine.
Ongoing hormone treatment was reported by 30 participants (42.3%); 2 (2.8%) had used hormones previously but were not currently using them, and 39 (54.9%) had never used hormones.
Every participant who had received any gender-affirming hormone treatment, surgery, and/or procedure reported satisfaction with their treatment decision. The mean interval from first gender-affirming medical treatment to study completion was approximately 10 years.
Many participants who had not undergone particular treatments indicated that they wanted them. The related article on transgender youth reports high satisfaction and low regret among youth who received puberty blockers and gender-affirming hormones, but the supplied context provides no numerical outcome estimates.

Clinical Implications

The survey documents both treatment experiences and expressed desire for treatments not yet received among transgender adults in this Swedish cohort. Its small sample, follow-up participation, and lack of available population calibration benchmarks limit how broadly the descriptive estimates can be applied.

Conclusion

In this cohort, treatment prevalence varied by intervention, many participants reported unmet treatment desires, and all recipients of gender-affirming medical treatment reported satisfaction with their decisions. The findings describe the surveyed participants and do not establish population-wide estimates.