Detransition, Desistance and Regret

DetransitionDataDetransition Desistance & Regret
Written By Bel H

Why Are rates of detransition and regret under-reported?

PSYCHOLOGICAL FACTORS

Detransitioners can often feel stigmatised or shunned by their former trans communities. One Australian woman who realised that her mastectomy was a “terrible mistake” told researchers that the subject was 'taboo':

“I'm really sad that there's going to be so many women, many of whom are children today, who are not going to be able to have children of their own because they're being sterilised. And I'm very frustrated, that it's taboo to talk about that… I am speaking because I want to spare future mothers and babies what we went through if I can.”

Detransitioners may also feel distrustful of former health providers and decide not to report their desire to detransition.. Some, like Ritchie Herron, have described being gaslight and ignored by their doctors when they tried to express their feelings of regret.

Research suggests that regret can take anywhere between 4-10 years on average to form, but most studies only examine the first few years or months of a person’s transition. It may also be difficult for some patients to acknowledge regret (even to themselves) especially when they have been left with irreversible side-effects like infertility. Read more about the risks of gender affirming care on the pages below.

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POOR DATA COLLECTION AND STUDY DESIGN

There are no formal reporting obligations for gender affirming providers to report detrantion/desistance or regret. Additionally, when patients stop gender affirming treatments or stop returning to clinics, they are often not followed up on. This is called ‘loss to follow-up.

In the paper, “The Rate of Detransition is Unknown,” Cohn examines the reasons behind the conflicting estimates of detrantion/regret and identifies four quality standard indicators that many studies do not meet:

  • Wait Long Enough to Observe Regrets - Evaluating the outcomes of patients who medically transition requires continual patient follow-up over subsequent years and decades. The egret can take years to form, but many studies only focus on outcomes within months of treatment.
  • Have a Small Loss to Follow-up - For example Cohn writes, "If those who leave the study sample (who are treated but not followed up) are different from those who did not, this will bias the sample and results. For example, people who stop medical interventions may be dropped from record searches, and stopping medical intervention is potentially related to regret, detransition, and/or discontinuation."
  • Use an Appropriate Measurement Instrument - Studies should use clear definitions that can be measured using "validated or standardized assessment instruments".
  • Study a Relevant Sample - Cohn writes, "If regret is measured for a sample which is too different from the group of interest, the regret rate found will not be relevant. For sample comparison, the screening protocol for starting treatment is important, as are other characteristics of the group in the study, such as age at presentation for care, age of onset, and comorbidities..

The Reuters report, Why detransitioners are crucial to the science of gender care, contains an analysis of several notable regret studies and details their limitations.

WANDERING DEFINITIONS

Detransition, desistance and transition regret have all been defined inconsistently by research and academia, making it difficult to track the rate of patient dissatisfaction over time.

One critical review found at least eight different terms were used to refer to detranition, and that "in many cases no operational definitions of the terms are provided, or qualitatively different terms are used equivalently or interchangeably."

Sometimes, regret or cessation is re-framed as ‘just another part of a patient’s gender journey’:

“…there have been attempts to reframe detransition as a neutral or even positive outcome—part of a larger “gender journey,” “identity exploration,” or “dynamic desires for gender-affirming medical interventions” (Coleman et al., Citation2022; Turban, Brady, & Olson-Kennedy, Citation2022). Rather than acknowledging the severity of the problem or that the medical community bears responsibility for the harm done to these young people, the message is that there have been no mistakes - the situation is dynamic.”- Jorgensen, 2023

Kozlowska et al., have provided a useful guide to terminology (however, usage remains variable).

"Desistance  refers to children who received a formal diagnosis of gender dysphoria (or equivalent) but who did not continue to have it when they were older (2003).  The word was first used in 2003, in a presentation entitled “Persistence and   Desistance of Gender Identity Disorder in children.” Desistance may or may  not overlap with detransition and regret (Zucker,   2003).
Detransition “refers to the stopping or reversal of transitioning which could be social  (gender presentation, pronouns), medical (hormone therapy), surgical, or  legal” (p. e4261)(Irwig,   2022). The term can be used across the life span. Detransition may or may not overlap with desistance or regret.
Regret  is typically used to refer to sorrow regarding the irreversible outcomes of hormone use or surgery (Irwig,   2022; Lindemalm   et al., 1987). Regret may or may not overlap with desistance or detransition."

Are detransitioners taking legal action?

Stories of patient’s harmed by gender affirming care have risen steadily in the past 5-10 years. Among them are a growing number of Australian detransitioners including Jay Langadinos Courney Coulson, Ollie Davies, and former patients featured on Channel 7’s De-transitioning.

Are there resources for detransitioners?

People harmed by gender affirming care continue to be ignored and undercounted.

As is often the case overseas, Australian clinics have no obligation to collect data on detransition or regret, so exact numbers can’t be known.

The lack of recognition extends all the way to the The World Health Organization. According to the organisation Detrans Help:

“We have reached out to World Professional Association for Transgender Health, WPATH, and the World Health Organization, WHO, expressing our concerns. Our request for dialogue was met with silence. While trans individuals are on the boards of these organizations, there is not one detransitioner to represent our needs. 
In addition to this, the WHO manages the ICD-10 codes that are used for billing. There is no medical code for detransition. Because detransitioners do fit the definition of gender variance, billing detransitioners under gender affirming care puts providers at risk for medical fraud and erases detransitioners from being medically documented. The goal should always be to provide better health care, but detransitioner needs have been ignored and silenced.” - Camille Kiefel, President, Detrans Help

In Australia, The Royal Australian and New Zealand College of Psychiatrists is one of very few medical bodies to acknowledge that detransitioners may have difficulty accessing health care services, despite having poor health outcomes.

In response to the lack of recognition from the healthcare sector, hundreds of grass-roots, de trans-support-networks have emerged to assist the growing community of people harmed and ignored by gender affirming doctors. Many of these communities can be found at Genspect’s Detransitioner Resources page.

Why do people detransition?

There many reasons behind detransition belies the simplicity of the gender affirmation model, which posits that the only reason for a person’s gender distress is because of a trans identity, and that careful psychological evaluation is unnecessary.

A 2021 study of study 237 detransitioners found that the most frequently reported reason for detransitioning was: ‘Realized that my gender dysphoria was related to other issues’ (70%):

Another study of 100 detransitioners found that the most common reason was to do with becoming more comfortable identifying with their natal sex.

Detransitioners often call attention to the ways in which their mental health comorbidities were overlooked during their diagnosis and treatment. After receiving a mastectomy at 20, one patient later became distraught over her inability to breastfeed her new baby. She told researchers that her desire to transition may have been an unconscious attempt to avoid other psychological issues:

“Although her surgeon did not discuss breastfeeding, Elizabeth believed that if he had she would not have welcomed the conversation, “I don't think I would have been receptive, I would have felt insulted and I would have said it was triggering my gender dysphoria.” However, Elizabeth explains that this response would have been an avoidance tactic, “That wouldn't really have been true. It would have been because…maybe I did want children… but it's like this trump card, gender dysphoria, meaning you can't have any conversation.” That is, mention of gender dysphoria stops health professionals from further exploration.”  - Detransitioner identified as Elizabeth

Other detransitioners report that their decision to transition was influenced by their peers and social media, but that these influences were only short-term. 

“I was going through a period where I was just really isolated at school, so I turned to the Internet.”
“My dysphoria was definitely triggered by this online community. I never thought about my gender or had a problem with being a girl before going on Tumblr.”
“There was a lot of negativity around being a cis, heterosexual, white girl, and I took those messages really, really personally.”  - Helena Kerschner, USA

For others, like Chloe Cole, their transition and detransition were shaped by their relationship with their body image:

“Because my body didn’t match beauty ideals, I started to wonder if there was something wrong with me. I thought I wasn’t pretty enough to be a girl, so I’d be better off as a boy. Deep inside, I wanted to be pretty all along, but that’s something I kept suppressed.” - Chloe Cole, USA
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Bel H
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