What is Detransition?
We consider detransition to be the process of stopping medical or social transition and reverting back to identifying with one’s biological sex. It’s difficult to correlate detransition with regret because many people who stop medical transition may not regret their transition (at least at a young age). We’ve also heard from some Canadians that it is difficult to detransition as they would like to because they now feel “stuck” in a different gender. People in this vulnerable situation can be suicidal. Canadian detransitioners often choose to detransition when they start a new school or otherwise undergo a major life change. Detransition is not an accepted process for young people in Canadian society and we strongly advocate for schools and other institutions to become informed and accepting of the truly “fluid” nature of gender.
The reasons that people detransition are a new area of study because of the growing numbers of detransitioners speaking out about being harmed by medical clinicians that did not question why they wanted to transition in the first place. We’ve compiled an overview and the best research to date about detransition and regret.
Detransition & Regret
Regret is a very difficult factor to measure. Studies often discount the number of Detransitioners as rare, or not “true trans”, or find very low (1%) regret rates with poor study design. Loss to follow-up is typically extremely high (over 30%) and regret is usually defined in very narrow terms Horvath (2018) and D’Angelo (2018 – attached pdf). The current studies on regret are poor quality due to “lost to follow up” and other methodological limitations. This recent Letter to the Editor of a medical journal is an excellent example of the methodological flaws: https://journals.lww.com/prsgo/Fulltext/2021/11000/Letter_to_the_Editor__Regret_after.29.aspx
Studies conducted in the last two years show that the rate of discontinuation of medical transition is already 10-30% just a few years following transition (Boyd et al.,2021; Hall et al., 2021; Roberts et al., 2022). Some reasons detransitioners do not continue with their healthcare can be found here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794543
A good summary of the state of research on detransitioning and regret can be found here: Transgender medicalization and the attempt to evade psychological distress (see Detransition section). It is also a fascinating read in its entirety as it explores some of the factors that are impacting society’s ability to engage in a constructive and objective conversation about the topic of gender transitioning.
The following are very good studies that explore the recent phenomenon of detransition:
Assisting Detransitioners in Accessing Care
Due to significant need, Genspect recently launched the Beyond Transition program to assist Detransitioners in accessing care. This largely unadvertised pilot program is gaining an average of one detransitioner per day since its inception in the fall of 2022. This may seem a small number, but in a virtually unknown program, the interest is concerning: hundreds of medicalized Detransitioners have reached out to the program and the rate is not slowing down.
The demographics of this group represent a range of North American young people who medicalized at puberty, in their teens, early to mid-twenties and older. Their needs include assistance for general medical care with regard to hormone management, reconstructive surgery, legal action, group therapy and 60% seeking individual therapy.
Long-Term Needs of Transitioners/Detransitioners
Medical and psychological support for detransitioners in Canada is non-existent, and expertise in correcting complications in many surgeries is also lacking, a failure point in providing end-to-end care with life-changing irreversible treatments. The Women’s College Hospital in Toronto recently announced the need to set up a specialized clinic to assist transgender individuals who are experiencing ongoing issues with their surgeries. It is not known whether the clinic provides services to detransitioners.
It is difficult to find reconstructive surgery and post-transition care. Even when gender clinicians say “You can get your breasts back if you want them” (Joanna Olsen Kennedy) – in practice it’s not that easy, nor does that restore the function of this part of one’s reproductive system. For example, a young woman in Saskatchewan was able to have her breasts removed in-province when she was 19 and thought she was transgender. This young woman has a history of mental health issues and suffers from extreme anxiety. The only option she has been given to undergo reconstructive breast surgery is to travel to the specialized transgender surgery clinic in Montreal. This is not an option for her due to her anxiety and the need for long-term post-operative care that includes stretching to accommodate the breast implants.
Neutral and supportive psychological services for transitioners and detransitioners are also very difficult to find and not available under public health funding. Support for autistic young adults, for example, is almost non-existent, to begin with. Add to this the complex needs of someone who has transitioned and detransitioned and the available psychological supports are virtually nil.
Legal recourse and Informed Consent
Detransitioners have begun to seek legal recourse worldwide. Regardless of the various outcomes from Bell v Tavistock decision , ultimately the UK Tavistock pediatric gender clinic is being closed due to unacceptable risk of patient harm highlighted by this legal action. This was brought forward by a single detransitioner. Further litiation is already in process with Richie Herron (age 35) against the NHS Foundation Trust placing more groundwork for lawsuits worldwide.
The first legal action by a Canadian detransitioner was initiated by Michelle Z. She is suing 8 Ontario based healthcare professionals for medical malpractice because they never questioned her desire to transition, even while she had ongoing mental health issues.
Canadian healthcare providers are largely relying on patient “capacity to consent” in order to extricate themselves from recourse for medical harms. The question of whether young people can reasonably provide consent to these life-changing gender treatments is best addressed in Levine, Abbruzzese & Mason (2022) Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults
How is it even possible that young people can understand the long-term risks of loss of sexual function and future medical issues under a “consent” model if 62% of young people are being prescribed puberty blockers or cross-sex hormones at their first visit. We’ve written about the problems of informed consent in a Canadian context in a briefing to the Ontario government here.
One feature of informed consent is that the patient must be made aware of alternative options. As of this year, alternative, evidence-based options for care that do not involve easy access to invasive medical interventions will be developed in Sweden and the UK, along with a growing list of other regions.
Considerations for Detransitioners
Gender transitioners and detransitioners have a wide range of care needs beyond access to surgery or hormonal interventions. Wholistic care is an excellent feature of the UK’s new model. We expect the UK NHS under the guidance of the Cass Review will continue to evolve their service specification based on high-quality evidence over the coming years and that this will form an important comparison point for patients of the Canadian provincial healthcare systems. It is clear that there is pressure being applied in Canada to make it easy for minors to access surgery. It is critical to consider the potential consequences of doing so given that there is no defencible evidence of improved health outcomes.