Estimates of the rate at which detransitioning occurs vary. Reasons for detransitioning also vary, and may include health-related concerns, finding that transition did not alleviate gender dysphoria, an unaffirming social environment, financial concerns, the realization that the individual's gender dysphoria was a manifestation of another condition, or political, religious, or philosophical disagreements with the transgender movement.
Academic research into detransition is underdeveloped. Professional interest in the phenomenon has been met with contention, and some scholars have argued there is censorship around the topic. In politics and popular culture, detransitioning is a contentious topic. Some who detransition report feeling a loss of support by their LGBT friends and family. Various sides in the debate over detransitioning have reported harassment from other individuals.
Detransition (sometimes called retransition) is the process of halting or reverting a transgender identification or gender transition. 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.Desistance is a general term for any cessation, and it is commonly applied specifically to the cessation of transgender identity or gender dysphoria. Those who undertake detransition are known as detransitioners. Detransition is commonly associated with transition regret, but regret and detransition do not always coincide.
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". The term has also been conflated with transition regret, and thereby become associated with a politically motivated push to restrict the access of transgender people to transition-related healthcare.
Formal studies of detransition have been few in number, of disputed quality, and politically controversial. Frequency estimates for detransition and desistance vary greatly, with notable differences in terminology and methodology. Detransition is more common in the earlier stages of transition, particularly before surgeries. The number of detransitioners is unknown, with estimates ranging from less than 1% to as many as 8%.
Studies have reported higher rates of desistance among prepubertal children. A 2016 review of 10 prospective follow-up studies from childhood to adolescence found desistance rates ranging from 61% to 98%, with evidence suggesting that they might be less than 85% more generally. These studies have been criticized on the grounds that they count as 'desistance' cases where the child met the criteria for gender identity disorder as defined in the DSM-III or DSM-IV, but would likely not have met the updated criteria for gender dysphoria in the DSM-5, established in 2013. Prior to the DSM-III in 1980, there was no diagnostic criteria for gender dysphoria, so research on desistance rates published prior to 2000 might report inflated numbers of desistance, as gender-nonconforming children without gender dysphoria were included in studies. Additionally, the evidence offered has been criticized for citing studies which have been labelled conversion therapy for discouraging social transition and trying to prevent a transgender outcome. The diagnostic criteria for gender dysphoria used in the studies only required gender-nonconformity, and did not require a child to state a transgender identity or a desire for medical or social transition. Most childhood desisters go on to identify as cisgender and gay or lesbian.
A 2019 poster presentation examined the records of 3398 patients who attended a UK gender identity clinic between August 2016 and August 2017. Davies and colleagues searched for assessment reports with keywords related to regret or detransition. They identified 16 individuals (0.47%) who expressed regret or had detransitioned. Of those 16, 3 (0.09%) had detransitioned permanently. 10 (0.29%) had detransitioned temporarily, to later retransition. 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. A 2021 study examining the case notes of 175 adults discharged from a UK gender identity clinic between September 2017 and August 2018 found that 12 (6.9%) met the researchers' criteria for detransitioning—that is, they returned to living as their assigned gender. Six individuals were found to have experiences that "overlap" with detransitioners, but were not counted as such for this study due to displaying "gender identity confusion" during treatment.
Those who undergo sex reassignment surgery have very low rates of detransition or regret. A 2005 Dutch study included 162 adults who received sex reassignment surgery, 126 of whom participated in follow-up assessments one to four years after surgery. Two individuals expressed regret at follow-up, only one of whom said that they would not transition again if given the opportunity. 98.4% expressed no regrets about transitioning. A 2021 meta-analysis of 27 studies concluded that "there is an extremely low prevalence of regret in transgender patients after [gender-affirmation surgery]".
Studies of regret or detransition in different populations have found different (average or median) elapsed times before these occurred: a 2018 study found 10 years and 10 months on average to regret (but not necessarily detransition) from start of hormonal therapy, and a 2014 study of those who had surgery found a median lag of 8 years before requesting a reversal of legal gender status. A 2021 UK study found evidence that supports detransitioning occurring on average 4–8 years after transitioning.
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.
Criticisms have been made regarding the "persistence-desistance" dichotomy as ignoring reasons why a person's gender identity may desist outside of simply being cisgender in the first place. For example, an assertion of a cisgender identity may be treated with validity and as an invalidation of a previously stated transgender identity; however, an assertion of a transgender identity may only be treated with the same validity if it is held throughout one's life. An individual may repress or realize their identity at any point in their life for a variety of reasons; some individuals' gender identities are fluid and/or may change throughout their lifetime, and some individuals whose identities are non-binary are effectively excluded due to a study's assumption of a gender binary.
The 2015 U.S. Transgender Survey collected responses from individuals who identified as transgender at the time of the survey. 8% of respondents 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. About 36% reported having detransitioned due to pressure from parent, 33% because it was too difficult, 31% due to discrimination, 29% due to difficulty getting a job, 26% pressure from family members, 18% pressure from a spouse, and 17% due to pressure from an employer.
In a 2021 study of 237 detransitioners, recruited via online detransitioner communities and who no longer identify as transgender, the most prevalent reasons to detransition were the realization that gender dysphoria was related to other issues (70%), health concerns (for 62%), and that transitioning didn’t help their gender dysphoria (50%). In a 2021 study of 2,242 individuals recruited via community outreach organizations who detransitioned and who continue to identify as transgender or gender diverse, 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." 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. 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. Transgender elders may also detransition out of concern for whether they can receive adequate or respectful care in later life. 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.
Cultural and political impactEdit
There are no legal, medical, and psychological guidelines on the topic of detransition. The Standards of Care by the World Professional Association for Transgender Health (WPATH) do not mention detransition, though 37 WPATH surgeons have expressed a desire for detransition guidelines to be included, 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.
Some researchers perceive there to be an atmosphere of censorship around studying the phenomenon. Various sides involved in the dispute over detransitioning say they have been harassed and have described each other as threats to transgender rights. A study in 2021 involving detransitioners found that many of them felt they lost support from the LGBT+ community and friends.
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. 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."
In September 2017, Bath Spa University revoked permission for James Caspian, a Jungian psychotherapist 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." 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." In May 2017, he took the matter to the High Court, which concluded his application for a judicial review was "totally without merit". The outcome was also considered by the Office of the Independent Adjudicator for Higher Education, who determined the university's conclusion was reasonable. Caspian appealed to the High Court for judicial review again in 2019; the judge ruled against him, saying, "I entirely accept that there are important issues of freedom of expression. I just do not accept that, on the facts of this particular case, there is an arguable case made out," and adding that the application was too late. Caspian claimed that he was "refused permission for a Judicial Review on points of procedure" and that the judge "was clearly sympathetic to the case but felt that his hands were tied by legal procedure;" in February 2021, he appealed to the European Court of Human Rights.
Ky Schevers, whose detransition was prominently profiled by Katie Herzog and The Outline, spoke about her experiences in a community of radical feminist detransitioned women, drawing parallels to the ex-gay movement and conversion therapy. 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.
Many ex-gay and Christian Right affiliated organizations also offer services to transgender people, either through themselves or partner organizations. A key characteristic of these organizations are the construction of "transgenderism" as a sin against God or the natural order. In the 1970's, 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.
^ abVandenbussche, Elie (2021-04-30). "Detransition-Related Needs and Support: A Cross-Sectional Online Survey". Journal of Homosexuality: 1–19. doi:10.1080/00918369.2021.1919479. ISSN 0091-8369. PMID33929297. S2CID 233459164.
^ abc"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
"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.
^Turban, Jack L.; Loo, Stephanie S.; Almazan, Anthony N.; Keuroghlian, Alex S. (2021-06-01). "Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis". LGBT Health. 8 (4): 273–280. doi:10.1089/lgbt.2020.0437. ISSN 2325-8292. PMC8213007. PMID33794108.
"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
"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."), "the median time lag until applying for a reversal was 8 years." Dhejne et al. 2014
"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
"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
^"Detransitioning after surgical interventions ... is exceedingly rare....Detransitioning is actually far more common in the stages before surgery, when people are still exploring their options." Clark-Flory 2015
^Hall, R.; Mitchell, L.; Sachdeva, J. (1 October 2021). "Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review". BJPsych Open. 7 (6). doi:10.1192/bjo.2021.1022. ISSN 2056-4724 – via Cambridge University Press. Rates of detransitioning are unknown, with estimates ranging from less than 1% to 8%.
^Kaltiala-Heino, Riittakerttu; Bergman, Hannah; Työläjärvi, Marja; Frisén, Louise (2018-03-02). "Gender dysphoria in adolescence: current perspectives". Adolescent Health, Medicine and Therapeutics. 9: 31–41. doi:10.2147/AHMT.S135432. ISSN 1179-318X. PMC5841333. PMID29535563. Evidence from the 10 available prospective follow-up studies from childhood to adolescence (reviewed in the study by Ristori and Steensma 28) indicates that for ~80% of children who meet the criteria for GDC, the GD recedes with puberty. Instead, many of these adolescents will identify as non-heterosexual.
^Ristori, Jiska; Steensma, Thomas D. (2016). "Gender dysphoria in childhood". International Review of Psychiatry (Abingdon, England). 28 (1): 13–20. doi:10.3109/09540261.2015.1115754. ISSN 1369-1627. PMID26754056. S2CID 5461482. As is shown in Table 1 there is much variation in the reported persistence rates between the studies, ranging from 2% to 39%. ", " Based on this information, it seems reasonable to conclude that the persistence of GD may well be higher than 15%. However, desistence of GD still seems to be the case in the majority of children with GD.
^ abTemple Newhook, Julia; Pyne, Jake; Winters, Kelley; Feder, Stephen; Holmes, Cindy; Tosh, Jemma; Sinnott, Mari-Lynne; Jamieson, Ally; Pickett, Sarah (2018-04-03). "A critical commentary on follow-up studies and "desistance" theories about transgender and gender-nonconforming children". International Journal of Transgenderism. 19 (2): 212–224. doi:10.1080/15532739.2018.1456390. ISSN 1553-2739. S2CID 150338824. Due to such shifting diagnostic categories and inclusion criteria over time, these studies included children who, by current DSM-5 standards, would not likely have been categorized as transgender (i.e., they would not meet the criteria for gender dysphoria) and therefore, it is not surprising that they would not iden- tify as transgender at follow-up. Current criteria require identification with a gender other than what was assigned at birth, which was not a necessity in prior versions of the diagnosis.
^ abButler, 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. PMID32285632. S2CID 210484832.
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^Newhook, Julia Temple; Pyne, Jake; Winters, Kelley; Feder, Stephen; Holmes, Cindy; Tosh, Jemma; Sinnott, Mari-Lynne; Jamieson, Ally; Pickett, Sarah (2018-04-03). "A critical commentary on follow-up studies and "desistance" theories about transgender and gender-nonconforming children". International Journal of Transgenderism. 19 (2): 212–224. doi:10.1080/15532739.2018.1456390. ISSN 1553-2739. S2CID 150338824.
^ abSteensma, Thomas (2018). "A critical commentary on "A critical commentary on follow-up studies and "desistence" theories about transgender and gender non-conforming children"". International Journal of Transgenderism. 19 (2): 225–230. doi:10.1080/15532739.2018.1468292. S2CID 150062632 – via Taylor & Francis Online.
^ abDavies, Skye; McIntyre, Stephen; Rypma, Craig (April 2019). Detransition rates in a national UK Gender Identity Clinic(PDF). 3rd Biennial EPATH Conference: Inside Matters, On Law, Ethics and Religion. p. 118.
^ abHall 2021 harvnb error: no target: CITEREFHall2021 (help)
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^Wiepjes, Chantal M.; Nota, Nienke M.; de Blok, Christel J. M.; Klaver, Maartje; de Vries, Annelou L. C.; Wensing-Kruger, S. Annelijn; de Jongh, Renate T.; Bouman, Mark-Bram; Steensma, Thomas D.; Cohen-Kettenis, Peggy; Gooren, Louis J. G. (April 2018). "The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets". The Journal of Sexual Medicine. 15 (4): 582–590. doi:10.1016/j.jsxm.2018.01.016. ISSN 1743-6109. PMID29463477. In addition, in our population the average time to regret was 130 months, so it might be too early to examine regret rates in people who started with HT in the past 10 years.
^Boslaugh, Sarah (2018-08-03). Transgender Health Issues. ABC-CLIO. pp. 43–44. ISBN 978-1-4408-5888-8.
^Vandenbussche, Elie (2021-04-30). "Detransition-Related Needs and Support: A Cross-Sectional Online Survey". Journal of Homosexuality: 1–19. doi:10.1080/00918369.2021.1919479. ISSN 1540-3602. PMID33929297. S2CID 233459164. “The most common reported reason for detransitioning was realized that my gender dysphoria was related to other issues (70%). The second one was health concerns (62%), followed by transition did not help my dysphoria (50%), found alternatives to deal with my dysphoria (45%), unhappy with the social changes (44%), and change in political views (43%). At the very bottom of the list are: lack of support from social surroundings (13%), financial concerns (12%) and discrimination (10%) (see Figure 1).”
^Turban, Jack L.; Loo, Stephanie S.; Almazan, Anthony N.; Keuroghlian, Alex S. (May 2021). "Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis". LGBT Health. 8 (4): 273–280. doi:10.1089/lgbt.2020.0437. ISSN 2325-8306. PMC8213007. PMID33794108. "Because the USTS only surveyed currently TGD-identified people, our study does not offer insights into reasons for detransition in previously TGD-identified people who currently identify as cisgender." "The vast majority of participants reported detransition due at least in part to external factors, such as pressure from family, nonaffirming school environments, and sexual assault." "iIt was just too hard for me" is shown in table 2.
^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. PMID21216800. S2CID 1789558.
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