Detransition

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Detransition is the cessation or reversal of a transgender identification or gender transition, whether by social, legal, or medical means. Some individuals detransition on a temporary basis.

Contents

Desistance is a related term used to describe the cessation of transgender identity or gender dysphoria and has a higher occurrence.

Direct, formal research of detransition is lacking. Professional interest in the phenomenon has been met with contention. Detransitioners (persons who detransition) have similarly experienced controversy and struggle.

Background and terminology

Transition is the process of a transgender person changing their gender presentation and/or sex characteristics to accord with their internal sense of gender identity. [1] Transition commonly involves social changes (such as clothing, personal name, and pronouns), legal changes (such as legal name and legal gender), and medical/physical changes (such as hormone replacement therapy and sex reassignment surgery).

Detransition (sometimes called retransition) is the process of halting or reverting a transgender identification or gender transition. [2] Like transition, detransition is not a single event. Methods of detransitioning can vary greatly among individuals, and can involve changes to one's gender expression, social identity, legal identity documents, and/or anatomy. [3] Desistance is a general term for any cessation, [4] and it is commonly applied specifically to the cessation of transgender identity or gender dysphoria. [5] Those who undertake detransition are known as detransitioners. [6] Detransition is commonly associated with transition regret, but regret and detransition do not always coincide. [7]

Occurrence

Formal studies of detransition have been few in number, [8] of disputed quality, [9] and politically controversial. [10] Frequency estimates for detransition and desistance vary greatly, with notable differences in terminology and methodology. [11] [12] Detransition is more common in the earlier stages of transition, particularly before surgeries.[ citation needed ] It is estimated that the number of detransitioners ranged from less than one per cent to as many as five per cent. [13] [ unreliable source? ] A 2018 survey of WPATH (World Professional Association for Transgender Health) surgeons found that approximately 0.3% of patients who underwent transition-related surgery later requested detransition-related surgical care. [14] The 2015 U.S. Transgender Survey collected responses from individuals who identified as transgender at the time of the survey. 8% of those who had transitioned reported having ever detransitioned; 62% of that group were living as a gender other than the one assigned to them at birth at the time of the survey. [15]

Desistance rates among young children may be higher. Of children referred to gender clinics for either gender dysphoria or gender non-conformity, a 2008 study found 61% desisted from their gender incongruence or nonconformity before reaching the age of 29, [16] and a 2013 study found 63% desisted before age 20. [17] A 2019 clinical assessment found that 9.4% of patients with adolescent-emerging gender dysphoria either ceased wishing to pursue medical interventions or no longer felt that their gender identity was incongruent with their assigned sex at birth within an eighteen-month period. [18] Research prior to 2000 might report inflated numbers of desistance, as gender-nonconforming children without gender dysphoria might have been included in studies. [19]

A 2003 German study found evidence for an increase in the number of demands for detransition, blaming poor practice on the part of "well-meaning but certainly not unproblematic" clinicians who—contrary to international best practices—assumed that transitioning as quickly as possible should be the only correct course of action. [20] Surgeon Miroslav Djordjevic and psychotherapist James Caspian have reported that demand for surgical reversal of the physical effects of medical transition has been on the rise. [21]

Detransitioners have commonly cited trauma, isolation, dissociation, inadequate mental healthcare, and social pressure as motivations for pursuing transition. [22] Informed consent and affirmation of self-diagnosis (both newer but increasingly employed models for transgender healthcare) have been criticized for failing to meet the needs of those who eventually detransition. [23] Among eventual detransitioners, the progression of transition has been found to magnify, rather than remedy, gender dysphoria. Sufferers may fixate on passing (being perceived as their preferred gender), leading them to pursue ever further steps in medical transition. [24]

Motives for detransitioning commonly include financial barriers to transition, social rejection in transition, depression or suicidality due to transition, and discomfort with sexual characteristics developed during transition. Additional motives include concern for lack of data on long-term effects of hormone replacement therapy, concern for loss of fertility, complications from surgery, and changes in gender identity. [25] 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. [26] Transgender elders may also detransition out of concern for whether they can receive adequate or respectful care in later life. [27] A qualitative study comparing child desisters to persisters (those with persisting gender dysphoria) found that while persisters related their dysphoria primarily to a mismatch between their bodies and their identity, desisters' dysphoria was more likely to be, at least retroactively, related to a desire to fulfill the other gender role. [28]

Most childhood desisters go on to identify as cisgender and gay or lesbian. [19]

Individual accounts

Mike Penner, a sportswriter for the Los Angeles Times, publicly identified as transsexual in April 2007 under the name Christine Daniels and wrote of his experience with transition until October 2008, when he resumed his male identity. He died by suicide in November 2009. [29]

Since 2011, Walt Heyer has written several books on his experience of regret and detransition. [30]

Carey Callahan began speaking openly about her detransition in 2016. Callahan identified as trans for four years. Her employment at a gender clinic led her to seek alternatives to transition. She advocates for detransitioners and gender-nonconforming people while working as a licensed therapist. She was profiled by The Atlantic in 2018. [31]

Longtime New York performance artist Brian Belovitch (formerly known as Tish Gervais) transitioned in 1972, following social pressure to conform his feminine personality to binary gender norms. He lived as a trans woman for fifteen years before "retransitioning", as he terms it, in 1987. Belovitch cites his changed views on his own gender identity (referring to himself now as "genderqueer or gender nonconforming") for prompting his reversal. He was profiled by Paper magazine in 2018; he published his memoir later that year. [32]

In March 2019, James Shupe, the first American to win legal recognition of having a nonbinary gender, criticized his transition and publicly re-identified as a man. Shupe had lived as a trans woman for two years and as a nonbinary person for three. [33]

In 2020, 23-year-old Keira Bell joined a lawsuit against the NHS Gender Identity Development Service. [34] Bell was prescribed puberty blockers at age 16 and testosterone a year later, and had her breasts removed before stopping hormone treatments and reidentifying as a woman. She states that she should have been "challenged more" by the gender clinic, criticising the lack of therapy or questioning she received before being prescribed the puberty blockers. The lawsuit will argue that minors cannot give informed consent to transitioning treatments. [34]

Transitioning after detransitioning

Marissa Dainton surgically transitioned to a woman in 1993. Four years after that, she had joined an evangelical church, and decided to resume a male identity, because she viewed her first transition as sinful. When she married a woman from the congregation, she had her surgically-constructed vagina removed, leaving her without genitalia. However, she continued to crossdress in secret, and in 2003 decided to transition again. She obtained breast implants, but decided against constructing a new vagina due to possible complications from the type of procedure it would require the second time. [35]

Sam Kane surgically transitioned to a woman in 1997, but seven years later had found life as a woman "shallow" and stated that men did not take her seriously in business as a woman. She transitioned back to a male gender role and had a new penis surgically constructed in 2004. She did not consider herself to have successfully returned to being a man, and stated, "Having become Samantha, I should have stayed Samantha." She again transitioned into a female gender role, this time non-surgically, in 2017. [36]

Cultural and political impact

There is a lack of legal, medical, and psychological guidelines on the topic of detransition [37] and a perceived atmosphere of censorship around researching the phenomenon. [38] Detransitioners say they have been harassed by activists who view detransition as a political threat to trans rights.[ clarification needed ] [39] Controversy surrounding detransition within trans activism primarily arises from how the subject is framed in mainstream media and right-wing politics. [40]

In August 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. [41] 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." [42]

In September 2017, Bath Spa University revoked permission for James Caspian, a Jungian psychotherapist [43] who works with transgender people and is a trustee of The Beaumont Trust, to research regret of gender-reassignment procedures and pursuit of detransition. Caspian alleged the reason for the university's refusal was that it was "a potentially politically incorrect piece of research, [which] carries a risk to the university. Attacks on social media may not be confined to the researcher, but may involve the university. The posting of unpleasant material on blogs or social media may be detrimental to the reputation of the university." [44] The university stated that Caspian's proposal "was not refused because of the subject matter, but rather because of his proposed methodological approach. The university was not satisfied this approach would guarantee the anonymity of his participants or the confidentiality of the data." [45] He took the matter to the High Court, who concluded his application for a judicial review was "totally without merit". [45] The outcome was also considered by the Office of the Independent Adjudicator for Higher Education, who determined the university's conclusion was reasonable. [45]

WPATH's Standards of Care have offered no mention of detransition, [46] though a majority of WPATH surgeons have expressed a desire for detransition guidelines to be included, [47] and former WPATH president and longtime chair of WPATH's SOC revision team, Eli Coleman, has listed detransition among the topics that he would like to see included in the eighth edition. [48]

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. [49] On the left, radical feminists see detransitioners' experiences as further proof of patriarchal enforcement of gender roles and medicalized erasure of gays and lesbians. [50] This attention has elicited in detransitioners mixed feelings of both exploitation and support. [51]

See also

Related Research Articles

Gender dysphoria (GD) is the distress a person feels due to a mismatch between their gender identity and their sex assigned at birth. People with gender dysphoria are typically transgender. The diagnostic label gender identity disorder (GID) was used until 2013 with the release of the DSM-5. The condition was renamed to remove the stigma associated with the term disorder.

Sex reassignment surgery (SRS), also known as gender reassignment surgery (GRS) and several other names, is a surgical procedure by which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble those socially associated with their identified gender. It is part of a treatment for gender dysphoria in transgender people.

The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People are international clinical protocols outlining the recommended assessment and treatment for gender non-conforming individuals across the lifespan or transgender or transsexual people who wish to undergo social, hormonal or surgical transition to the other sex. Clinicians' decisions regarding patients' treatment are often influenced by this standard of care (SOC). They are most widespread SOC used by professionals working with transsexual, transgender, or gender variant people. However, other sets of SOCs, protocols and guidelines do exist, especially outside the United States.

Sex reassignment therapy is the medical aspect of gender transitioning, that is, modifying one's characteristics to better suit one's gender identity. It can consist of hormone therapy to modify secondary sex characteristics, sex reassignment surgery to alter primary sex characteristics, and other procedures altering appearance, including permanent hair removal for trans women.

Transitioning is the process of changing one's gender presentation and/or sex characteristics to accord with one's internal sense of gender identity – the idea of what it means to be a man or a woman, or to be non-binary or genderqueer. For transgender and transsexual people, this process commonly involves reassignment therapy, with their gender identity being opposite that of their birth-assigned sex and gender. Transitioning might involve medical treatment, but it does not always involve it. Cross-dressers, drag queens, and drag kings tend not to transition, since their variant gender presentations are (usually) only adopted temporarily.

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for children who experience significant discontent due to a mismatch between their assigned sex and gender identity. The diagnostic label gender identity disorder in children (GIDC) was used by the Diagnostic and Statistical Manual of Mental Disorders (DSM) until it was renamed gender dysphoria in children in 2013 with the release of the DSM-5. The diagnosis was renamed to remove the stigma associated with the term disorder.

Blanchard's transsexualism typology is a psychological typology of gender dysphoria, transsexualism, and fetishistic transvestism, created by Ray Blanchard through the 1980s and 1990s, building on the work of prior researchers, including his colleague Kurt Freund. Blanchard categorized trans women into two groups: homosexual transsexuals who are attracted exclusively to men, and who seek sex reassignment surgery because they are feminine in both behavior and appearance; and autogynephilic transsexuals who are sexually aroused at the idea of having a female body. Blanchard's typology broke from earlier ones in that neither group was considered falsely transsexual; both autogynephilic and homosexual transsexuals were shown to benefit from transition. Before Blanchard, the idea that some types were not transsexual at all was a recurring theme in scholarly literature.

Transgender Gender identity that does not match sex assigned at birth

Transgender people have a gender identity or gender expression that differs from their sex assigned at birth. Some transgender people who desire medical assistance to transition from one sex to another identify as transsexual. Transgender, often shortened as trans, is also an umbrella term. In addition to including people whose gender identity is the opposite of their assigned sex, it may include people who are not exclusively masculine or feminine. Other definitions of transgender also include people who belong to a third gender, or else conceptualize transgender people as a third gender. The term transgender may be defined very broadly to include cross-dressers.

Transsexual People experiencing a gender identity inconsistent with their assigned sex

Transsexual people experience a gender identity that is inconsistent with their assigned sex and desire 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.

A trans woman is a woman who was assigned male at birth. Trans women may experience gender dysphoria and may transition; this process commonly includes hormone replacement therapy and sometimes sex reassignment surgery, which can bring relief and resolve feelings of gender dysphoria. Trans women may be heterosexual, bisexual, homosexual, asexual, or identify with other terms.

Puberty blockers, also called puberty inhibitors, are drugs used to postpone puberty in children. These drugs are called gonadotropin-releasing hormone (GnRH) agonists, and they inhibit the action of testosterone. Delaying or temporarily suspending puberty is a medical treatment for children whose puberty started abnormally early. They are also commonly used for children with idiopathic short stature and for whom these drugs can be used to promote development of long bones and increase adult height. Additionally, they are used for transgender children, to stop the development of features that they considered their wrong sex, with the intent to provide transgender youth more time to explore their identity.

Transgender hormone therapy, also sometimes called cross-sex 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 feminization or masculinization:

The real-life experience (RLE), sometimes called the real-life test (RLT), is a period of time in which transgender individuals live full-time in their identified (discovered) gender role. The purpose of the RLE is to confirm that a given transgender person can 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 is a requirement of some physicians before prescribing hormone replacement therapy (HRT), and a requirement of most surgeons before performing genital reassignment surgery (GRS).

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References

  1. Fenway Health 2010; HRC n.d.
  2. Clark-Flory 2015; Herzog 2017a; Graham 2017; Tobia 2018
  3. Merriam-Webster n.d.; Collins n.d.
  4. Marchiano 2017; Steensma et al. 2013; Wallien and Cohen-Kettenis 2008
  5. Herzog 2017a; Graham 2017; Singal 2018
    • "Not everyone who detransitions regrets transitioning in the first place, and, like transitioning, the process of deciding to detransition is a very individual and personal choice." Yarbrough 2018 , p. 130. See also Graham 2017; Herzog 2017a.
    • "There is a paucity of literature." Danker et al. 2018
    • "We urgently need systematic data on this point in order to inform best practice clinical care." Zucker 2019
    • "The research on outcomes post-transition is mixed at best." Marchiano 2017
    • "[R]esearch in this field is extremely controversial." Danker et al. 2018
    • "[A] potentially politically incorrect piece of research carries a risk to the university. Attacks on social media may not be confined to the researcher, but may involve the university. The posting of unpleasant material on blogs or social media may be detrimental to the reputation of the university." Weale 2017. See also BBC 2017
  6. Detransition estimates:
    • "Eight percent of respondents to the 2015 [U.S. Transgender] Survey reported detransitioning at some point, that is, returning to living as the gender they were assigned at birth; however, most detransitioned only temporarily, and 62 percent of those who had once detransitioned reported living in their felt gender identity." Boslaugh 2018 , p. 43
    • "Detransitioning after surgical interventions ... is exceedingly rare. Research has often put the percentage of regret between 1 and 2% ... Detransitioning is actually far more common in the stages before surgery, when people are still exploring their options. 'There are people who take hormones and then decide to go off hormones,' says Randi Ettner, a therapist who has served on the board of the World Professional Association for Transgender Health. 'That is not uncommon.'" Clark-Flory 2015
    • "A 50-year study out of Sweden found that only 2.2 percent of people who medically transitioned later experienced 'transition regret'" Herzog 2017a
      • "There were 15 (5 [female-to-male] and 10 [male-to-female]) regret applications corresponding to a 2.2% regret rate for both sexes. There was a significant decline of regrets over the time period." (Dhejne et al. define "regret" as "application for reversal of the legal gender status among those who were sex reassigned" which "gives the person the right to treatment to reverse the body as much as possible.") Dhejne et al. 2014
  7. Desistance estimates:
    • "There is a wealth of replicated research that tells us that 80–95% of children who experience a cross-sex identification in childhood will eventually desist and come to identify with their natal sex as adults." Marchiano 2017
    • There have, however, been almost a dozen studies looking at the rate of desistance among trans-identified kids [which] James Cantor summarized [as] '[V]ery few trans kids ... transition by the time they are adults'. The exact rate of desistance varied by study, but overall they concluded that about 80% ... identified as their sex at birth.... [T]he most recent study ... found that two-thirds ultimately identified as the gender they were assigned at birth." Herzog 2017a
    • "For decades, follow-up studies of transgender kids have shown that a substantial majority—anywhere from 65 to 94%—eventually ceased to identify as transgender." Brooks 2018
    • "Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood." Cantor 2016
  8. Goldberg, Michelle (2014-07-28). "What Is a Woman?". ISSN   0028-792X . Retrieved 2019-11-06.
  9. Danker et al. 2018
  10. Boslaugh 2018 , p. 43; James et al. 2016 , pp. 111, 292–294
  11. Stein 2009; Wallien and Cohen-Kettenis 2008
  12. Brooks 2018; Herzog 2017a; Steensma et al. 2013
  13. Churcher Clarke & Spiliadis 2019
  14. 1 2 Butler, Catherine; Hutchinson, Anna (2020). "Debate: The pressing need for research and services for gender desisters/Detransitioners". Child and Adolescent Mental Health. 25 (1): 45–47. doi:10.1111/camh.12361. PMID   32285632.
  15. "In jüngster Zeit gibt es jedoch einige Hinweise für die Zunahme von Rückumwandulungsbegehren und es stellen sich zunehmend Patienten vor, bei denen schondie erste diagnostische Exploration Hinweise auf übergreifende Identitätsstörungen, u. U. auch auf transvestitisch-fetischistische Neigungen, auf unrealistische Erwartungen hin-sichtlich eines „völlig neuen Lebens“, jedoch nicht auf eine gelebte und innerlich fixierteGeschlechtsrollentransposition gibt. In Anbetracht derartiger Verläufe besorgt die zwarwohlmeinende, aber keinesfalls unproblematische Einstellung einiger Behandler, die annehmen, dass das möglichst schnelle Bedienen der vehement vorgetragenen Patienten-wünsche die einzig richtige Vorgehensweise wäre,„da man da sowieso nichts anderes machen kann.“ Dies widerspricht eklatant den Erfahrungen internationaler Gender-Zentren" Bosinski 2003
    • Borreli 2017
    • Shute 2017
    • "... his preliminary findings that suggested growing numbers of young people, particularly women, were regretting gender reassignment ... [H]e was first alerted to the issue of gender reassignment reversal in 2014, when a Belgrade doctor told him he had been asked to carry out an unprecedented seven reversals that year." Weale 2017
    • "[H]e wanted to study people who had swapped gender and then changed their minds after coming across evidence of a growing number of people who regretted having the surgery and finding no research had been done into the subject ... 'I found it very difficult to get people willing to talk openly about the experience of reversing surgery. They said they felt too traumatised to talk about it ...'" BBC 2017
  16. Marchiano 2017
  17. Graham 2017; Marchiano 2017; Singal 2018; Yoo 2018
  18. Marchiano 2017
  19. Americo 2018; Kanner 2018
  20. Witten 2015
  21. Steensma, Thomas D.; Biemond, Roeline; De Boer, Fijgje; Cohen-Kettenis, Peggy T. (2011). "Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study". Clinical Child Psychology and Psychiatry. 16 (4): 499–516. doi:10.1177/1359104510378303. PMID   21216800.
  22. Pieper 2015; Friess 2009; Herman 2011
  23. Heyer n.d.; Dumas 2015
  24. Pollock 2018; Singal 2018; Graham et al. 2017; Murphy 2018; Graham et al. 2017
  25. Tobia 2018; Belovitch 2018
  26. Showalter 2019; Christian Today 2019; Shupe 2019
  27. 1 2 Holt, Alison (March 1, 2020). "NHS gender clinic 'should have challenged me more' over transition". BBC . Retrieved March 3, 2020.
  28. Batty, David (30 July 2004). "Mistaken identity". The Guardian. Retrieved 21 March 2020.
  29. "Top London lawyer changed gender three times". NZ Herald. The New Zealand Herald. 1 April 2017. Retrieved 21 March 2020.
  30. Graham 2017
  31. Shute 2017; BBC 2017; Borreli 2017; Stein 2009; Veissière 2018
    • "'The complexity of our viewpoint is pretty inconvenient to people on all sides of the political spectrum,' Carey says in the film. For her, detransitioning has resulted in the most harassment she has ever faced in her life." Pollock 2018
    • "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
    • "[Other messages received] were from clinicians and detransitioners, thanking me for presenting a perspective they felt so many were scared to voice." Veissière 2018
    • ""[T]he trans community does our best to pretend that retransitioning never happens ... trans people who have retransitioned are often treated as outcasts, as aberrations or as an embarrassment to our community's goals. They are assumed to be failures, traitors to the cause of trans liberation." Tobia 2018
  32. Slothouber, Van (2020). "(De)trans visibility: Moral panic in mainstream media reports on de/Retransition". European Journal of English Studies. 24: 89–99. doi:10.1080/13825577.2020.1730052.
  33. Rodriguez 2017; Herzog 2017b
  34. Mazzoni 2017
  35. Caspian
  36. BBC 2017; Weale 2017; Hurst 2017
  37. 1 2 3 Petherick, Sam (February 20, 2019). "Ex-Bath Spa student James Caspian fails in court fight against university". Somerset Live . Retrieved May 1, 2020.
  38. "There are currently no professional guidelines or resources for providers who encounter patients who experience regret and/or seek detransition." Danker et al. 2018
  39. "88% of respondents feel that WPATH SOC 8 should include a chapter on detransition" Danker et al. 2018
  40. "Miscellaneous suggestions ... detransition." Coleman 2017
  41. Ford 2018; Herzog 2017a; Bowen 2007; Tobia 2018
  42. Herzog 2017a; Bowen 2007
  43. Herzog 2017a; Bowen 2007

Sources

Books

Journal articles

News

Online sources

Further reading