Detransition

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Detransition is the cessation or reversal of a transgender identification or of gender transition, temporarily or permanently, through social, legal, and/or medical means. [1] The term is distinct from the concept of 'regret', and the decision may be based on a number of reasons, including a shift in gender identity, health concerns, social or economic pressure, discrimination, stigma, [2] political beliefs, [3] or religious beliefs. [4]

Contents

Some studies use the term retransition rather than detransition. [5] Retransition is also commonly used to describe the resumption of transition or transgender identity following a detransition. [6]

The estimated prevalence of detransition varies depending on definitions and methodology, with estimates ranging from 1% to 8%. [7] There is uncertainty around estimates due to methodological limitations. [6] Formal studies of detransition have been few in number, [8] politically controversial, [9] and inconsistent in the way they characterize the phenomenon. [10] Professional interest in the phenomenon has been met with contention, and some scholars have argued there is censorship around the topic. [11]

Some former detransitioners regret detransitioning and choose to retransition later. [5] [ not in body ] Some organizations with ties to conversion therapy have used detransition narratives to push transphobic rhetoric and legislation. [12]

Background and terminology

Gender transition, often shortened to just transition, is the process of a transgender person changing their gender expression and/or sex characteristics to accord with their internal sense of gender identity. [13] Methods of transition vary from person to person, but the process commonly involves social changes (such as clothing, personal name, and pronouns), legal changes (such as changes in legal name and legal gender), and medical/physical changes (such as hormone replacement therapy and gender-affirming surgery).

Detransition is the process of halting or reversing social, medical, or legal aspects of a gender transition, partially or completely. It can be temporary or permanent. Detransition and regret over transition are often erroneously conflated, though there are cases of detransition without regret and regret without detransition. [14] The terms "primary detransition" and "detransition with identity desistance" have been used to describe those who cease to identify as transgender, while "secondary detransition" and "detransition without identity desistance" are used for those who continue to identify as transgender. [14] Retransition is sometimes used as a synonym for detransition but more commonly refers to restarting or resuming a stopped or reversed gender transition. [14] Those who undergo detransition are commonly called detransitioners or detrans. [14]

Desistance has been commonly used in research literature but poorly defined. It is commonly being used to refer to children whose gender dysphoria subsides or who cease to identify as transgender during puberty. These definitions are often conflated. The definitions are primarily used to claim that transgender children who desist will identify as cisgender after puberty, based on biased research from the 1960s to 1980s and poor-quality research in the 2000s. It is sometimes used to refer to adults who ceased identifying as transgender prior to medically transitioning. [15] [14]

The term detransition is controversial within the transgender community. According to Turban et al., this is because, as with the word transition, it carries an "incorrect implication that gender identity is contingent upon gender affirmation processes". [16] The term has become associated with movements that aim to restrict the access of transgender people to transition-related healthcare by over-emphasizing the risk of regret and detransition. [16] [17]

Occurrence

Detransition has been heterogenously defined in the literature, but available estimates indicate detransition is rare. [18] [14] [19] Politicization of the concept has created an atmosphere of censorship for detransitioners, transgender people, and medical professionals. [14] Some have argued that research should focus on supporting detransitioners rather than preventing detransition. [14]

A review in 2023 found estimates ranged from 0-13.1% for detransition or regret, 1.9%-29.8% for discontinuation of medical care, 0-2.4% for detransition or regret after surgery, and 0-9.8% for detransition or regret after hormonal treatment. [14] A review in 2024 analyzed detransition among those who received puberty blockers or cross-sex hormones. It found the studies used heterogenous methodologies and definitions of the term, with small time frames, low participation, and lack of consideration for patient-level data and confounding factors. The majority of studies were small cohorts from specialized gender clinics or were limited to pediatric/adolescent ages. Most were from the Netherlands, the USA, the United Kingdom and Denmark. It gave point-prevalence proportions of 1.6–9.8% for discontinuation of cross-sex hormone and 1–7.6% for discontinuation of puberty blockers among the transgender population. The review noted that the "current literature shows that the decision to detransition appears to be rare" and stated that estimates of those who detransition due to a change in identity are likely overinflated due to conflation between a change in identity and other reasons for discontinuation reported such as "financial barriers, side effects, poor compliance, social issues or goals of treatment met". [18]

A 2021 meta-analysis of 27 studies concluded that "there is an extremely low prevalence of regret in transgender patients after [gender-affirmation surgery]", with a pooled prevalence of 1%, with under 1% for transmasculine surgeries and under 2% for transfeminine ones. [19] A review in 2024 found a pooled prevalence of regret for gender-affirming surgeries was 1.94%, with 4.0% for transfeminine individuals and 0.8% for transmasculine ones. [20]

Reasons

Reasons for detransition vary and may include internal factors such as a changed understanding of their gender identity, regret, physical health concerns or side-effects, or remission of gender dysphoria, or having met the goals of treatment. External factors include financial or legal issues, social and familial stigma and discrimination, difficulty accessing medical treatment, or cultural and ideological pressures. [14] [18] Some people detransition on a temporary basis, in order to accomplish a particular aim, such as having biologically related children, or until barriers to transition have been resolved or removed. [21] Transgender elders may also detransition out of concern for whether they can receive adequate or respectful care in later life. [22]

The National Center for Transgender Equality conducted a survey of individuals who identified as transgender. [23] The results published in the 2015 U.S. Transgender Survey found that 8% of respondents reported having ever detransitioned; 62% of that group reported having subsequently retransitioned. [24] 33% reported detransitioning because it was too difficult, 31% due to discrimination, and 29% due to difficulty getting a job. Others reported the reason as being pressure from parents (about 36%), family members (26%), spouses (18%), and employers (17%). [2]

A mixed-methods analysis of the survey's data published in 2021 found that the vast majority said detransition was in part due to external factors, such as pressure from family, sexual assault, and nonaffirming school environments; another highly cited factor was "it was just too hard for me." [25]

Forced medical detransition

Some state legislatures in the United States have enacted or sought to enact laws which would force transgender people who were unable to flee to medically detransition by criminalizing or restricting their access to care. [26] [27] [28] [29] [30] [31] Arkansas was the first US state to ban transgender healthcare for minors, which had increased to 26 by August 2024. States have also sought to ban such care for those under 26, restrict access for all ages, or limit public and private insurance coverage of it. In 2024, over 112 bills in 40 states proposed bans on trans healthcare for minors. A study by the Williams Institute found that approximately 114,000 transgender minors lived in states which banned transgender healthcare, and approximately 240,000 transgender minors lived in states that banned it or proposed banning it in 2024. [26]

In May 2024, leaked documents from the NHS suggested said that transgender youth who received gender-affirming care from unregulated or overseas advisors could be forced to choose between medical detransition or being subject to safeguarding referrals and investigations. The documents called for the approximately 6,000 youth on the waiting list for NHS gender-affirming care to be interviewed and advised per the recommendations of the Cass Review not to receive gender-affirming care obtained via routes without "appropriate care", and if they were found to disregard the advice in a way the provider considers to put them "at increased risk", then to make safeguarding referalls. [32] [33]

Transgender prisoners are often forcibly detransitioned in many state and federal prisons within the US. [34] [35] [36] Transgender prisoners have been subject to the same in the UK. [37]

On March 12, 2023, a Saudi trans woman named Eden Knight died by suicide after being forcefully detransitioned. Knight wrote in a suicide note that her parents had hired an American private intelligence firm and a Saudi lawyer to relocate and forcibly socially and medically detransition her. After becoming dependent on the lawyer for food and shelter and fearing he would report her to U.S. immigration authorities, Knight wrote that she returned to her parents in Saudi Arabia. She secretly continued feminizing hormone replacement therapy, but after being found out twice she died by suicide. [38] [39] [40] [41]

Clinical pathway

As of 2023, there were no clinical guidelines for detransition. [14] The World Professional Association for Transgender Health's 8th edition of its Standards of Care recommended that "health care professionals assessing adults who wish to detransition and seek gender-related hormone intervention, surgical intervention, or both, utilize a comprehensive multidisciplinary assessment that will include additional viewpoints from experienced health care professional in transgender health and that considers, together with the individual, the role of social transition as part of the assessment process". [42]

In August 2024, following recommendations in the Cass Review, NHS England announced plans for the first NHS service to support patients wishing to detransition. They said: "There is no defined clinical pathway in the NHS for individuals who are considering detransition. NHS England will establish a programme of work to explore the issues around a detransition pathway by October 2024." [43]

Cultural and political impact

Controversy surrounding detransition within trans activism primarily arises from how the subject is framed as a subject of moral panic in mainstream media and right-wing politics. [44] Detransition has attracted interest from both social conservatives on the political right and radical feminists on the political left. Activists on the right have been accused of using detransitioners' stories to further their work against trans rights. [45] On the left, some radical feminists see detransitioners' experiences as further proof of patriarchal enforcement of gender roles and medicalized erasure of gays and lesbians. [46] Other feminists have expressed disagreement with this opinion, referring to those who hold these beliefs as trans-exclusionary radical feminists (TERF). [47] This attention has elicited in detransitioners mixed feelings of both exploitation and support. [46] [48]

In 2017, the Mazzoni Center's Philadelphia Trans Health Conference, which is an annual meeting of transgender people, advocates, and healthcare providers, canceled two panel discussions on detransition and alternate methods of working with gender dysphoria. [49] The conference organizers said, "When a topic becomes controversial, such as this one has turned on social media, there is a duty to make sure that the debate does not get out of control at the conference itself. After several days of considerations and reviewing feedback, the planning committee voted that the workshops, while valid, cannot be presented at the conference as planned." [50]

Many ex-gay and Christian Right affiliated organizations also promote programs aiming to discourage transition, promote reversal or desistence of transition, and to change individuals' gender identities. A key characteristic of these organizations are the construction of "transgenderism" as a sin against God or the natural order. In the 1970s, Exodus International platformed Perry Desmond, an "ex-transsexual" who evangelized throughout the US and supported Anita Bryant's Save Our Children campaign. Another prominent characteristic is ex-transgender testimonials, which depict "the transgender lifestyle" as destructive as opposed to contemplation of God and encourage other transgender people to join them. These organizations portray "gender ideology" and "transgender ideology" as a social contagion threatening to the natural order. [51]

Ky Schevers, an "ex-detransitioner" whose detransition was prominently profiled by Katie Herzog [52] and The Outline, [53] spoke about her experiences in a community of radical feminist detransitioned women, drawing parallels to the ex-gay movement and conversion therapy. [48] Parallels drawn include suppressing rather than addressing or removing the underlying dysphoria, stating that not only their gender dysphoria but everyone's dysphoria was a result of internalized sexism and trauma, and language from the twelve-step program being used to describe the desire to transition. [48]

Schevers noted that during the Bell v Tavistock ruling, her lawyer had connections to the right-wing and anti-LGBT-rights organization the Alliance Defending Freedom, which she described as pushing most of the anti-trans bills in the United States. Schevers later created Health Liberation Now! alongside Lee Leveille, who'd also previously been involved in detransition communities that were transphobic, to "give voice to folks who have complicated experiences with transition or detransition, retransition and shifting senses of self that goes beyond a lot of the TERFy areas that people are inevitably getting funnelled into". The group has reported on conversion therapy practices and maintains resources to help identify relationships between clinical conversion therapists and astroturfed campaigns led by anti-trans groups. [12]

See also

Related Research Articles

Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder. The International Classification of Diseases uses the term gender incongruence instead of gender dysphoria, defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment.

Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender. The phrase is most often associated with transgender health care and intersex medical interventions, though many such treatments are also pursued by cisgender and non-intersex persons. It is also known as sex reassignment surgery (SRS), gender confirmation surgery (GCS), and several other names.

The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and gender dysphoria, and creating standardized treatment for transgender and gender variant people. WPATH was founded in 1979 and named HBIGDA in honor of Harry Benjamin during a period where there was no clinical consensus on how and when to provide gender-affirming care.

The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.

Gender transition is the process of affirming and expressing one's internal sense of gender, rather than the gender assigned to them at birth. It is the recommended course of treatment for individuals struggling with gender dysphoria, providing improved mental health outcomes in the majority of people.

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.

<span class="mw-page-title-main">Transgender</span> Gender identity other than sex assigned at birth

A transgender person is someone whose gender identity differs from that typically associated with the sex they were assigned at birth.

<span class="mw-page-title-main">Transsexual</span> People experiencing a gender identity inconsistent with their assigned sex

A transsexual person is someone who experiences a gender identity that is inconsistent with their assigned sex, and desires to permanently transition to the sex or gender with which they identify, usually seeking medical assistance to help them align their body with their identified sex or gender.

<span class="mw-page-title-main">Transgender youth</span> Children and adolescents who are transgender

Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, they face different challenges compared to adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.

Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

The real-life experience (RLE), sometimes called the real-life test (RLT), is a period of time or process in which transgender individuals live full-time in their identified gender role in order to be eligible to receive gender-affirming treatment. The purpose of the RLE has been to confirm that a given transgender person could function successfully as a member of said gender in society, as well as to confirm that they are sure they want to live as said gender for the rest of their life. A documented RLE was previously a requirement of many physicians before prescribing gender-affirming hormone therapy, and a requirement of most surgeons before performing gender-affirming surgery.

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world. Gender affirming health care can include psychological, medical, physical, and social behavioral care. The purpose of gender affirming care is to help a transgender individual conform to their desired gender identity.

Rapid-onset gender dysphoria (ROGD) is a controversial, scientifically unsupported hypothesis which claims that some adolescents identify as transgender and experience gender dysphoria due to peer influence and social contagion, particularly those assigned female at birth. ROGD is not recognized as a valid mental health diagnosis by any major professional association. The APA, WPATH and 60 other medical professional organizations have called for its elimination from clinical settings due to a lack of reputable scientific evidence for the concept, major methodological issues in existing research, and its stigmatization of gender-affirming care for transgender youth.

<span class="mw-page-title-main">Jesse Singal</span> American journalist

Jesse Singal is an American journalist. He has written for publications including New York magazine, The New York Times and The Atlantic. Singal also publishes a newsletter on Substack and hosts the podcast Blocked and Reported with journalist Katie Herzog.

<span class="mw-page-title-main">Stella O'Malley</span> Irish psychotherapist and author

Stella O'Malley is an Irish psychotherapist and author, with three books on parenting and mental health. She is a regular contributor to Irish national newspapers, podcasts, and TV. She made a documentary about gender dysphoria in children for Channel 4, and is the founder of Genspect, a self-described gender critical organisation opposed to gender affirming care.

<span class="mw-page-title-main">Genspect</span> Organization opposing transgender rights

Genspect is an international group founded in June 2021 by psychotherapist Stella O'Malley that has been described as gender-critical. Genspect opposes gender-affirming care, as well as social and medical transition for transgender people. Genspect opposes allowing transgender people under 25 years old to transition, and opposes laws that would ban conversion therapy on the basis of gender identity. Genspect also endorses the unproven concept of rapid-onset gender dysphoria (ROGD), which proposes a subclass of gender dysphoria caused by peer influence and social contagion. ROGD has been rejected by major medical organisations due to its lack of evidence and likelihood to cause harm by stigmatizing gender-affirming care.

<span class="mw-page-title-main">Chloe Cole</span> American activist (born 2004)

Chloe Cole is an American activist who opposes gender-affirming care for minors and supports bans on such care following her own detransition. She has appeared with conservative politicians and in the media, supporting and advocating for such bans. Cole says that she began transitioning at 12, having undergone treatment which included puberty blockers, testosterone, and a double mastectomy at age 15. She began detransitioning at 17 after experiencing hallucinations during an LSD trip, and converted to Christianity.

<span class="mw-page-title-main">Ky Schevers</span> American transgender rights activist

Ky Schevers is an American transgender rights activist. She was assigned female at birth, but gradually transitioned to male, including medical transition at the age of 20. Five years after, she detransitioned to female. She became prominent among the detransitioned community and for writing and making online videos about the gender transition and detransition process under the pen names Crash or CrashChaosCats. Another nine years after detransitioning, Schevers broke with the detransitioned community over its attacks on gender transition in general, and began to retransition. She now identifies as transmasculine and genderqueer, but using feminine pronouns, and she co-leads "Health Liberation Now!", an organization defending transgender rights.

Kinnon Ross MacKinnon is a Canadian social scientist who researches detransition, gender-affirming healthcare, and gender and sexual minorities. MacKinnon is an Assistant Professor of social work at York University in Toronto.

False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used to legislatively restrict transgender people's healthcare. The claims have primarily relied on manufactured uncertainty generated by various conservative religious organizations, pseudoscientific or discredited researchers, and anti-trans activists.

References

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  46. 1 2 Herzog 2017a; Bowen 2007
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  50. ↑ Mazzoni Center 2017
  51. ↑ Robinson, Christine M.; Spivey, Sue E. (June 19, 2019). "Ungodly Genders: Deconstructing Ex-Gay Movement Discourses of "Transgenderism" in the US". Social Sciences. 8 (6): 191. doi: 10.3390/socsci8060191 . ISSN   2076-0760.
  52. ↑ "This has ignited a contentious debate both in and outside the trans community, with various sides accusing each other of bigotry, harassment, censorship, and damaging the fight for trans rights. It's such a fraught issue that many people I interviewed requested anonymity. (All the names of detransitioners have been changed.) Others refused to speak on the record, afraid of the potential fallout." Herzog 2017a
  53. ↑ Monroe, Rachel (December 4, 2016). "Detransitioning: a story about discovery". The Outline . Archived from the original on July 29, 2020. Retrieved March 18, 2019.

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