Health, Psychology, recent

The Ranks of Gender Detransitioners Are Growing. We Need to Understand Why

A recent NBC News report warned that media coverage of detransitioners—formerly transgender individuals seeking to return to the gender associated with their biological sex—is misleading and potentially harmful. “No one disputes that transition regret does exist,” author Liam Knox writes. “However, trans advocates say some of the recent coverage around the topic portrays detransitioning as much more common than it actually is.” The article suggests that journalists are creating a “panic” about detransition, and fuelling the “misconception” that trans individuals are “just temporarily confused or suffering from a misdiagnosed psychological disorder.”

Knox quotes Dr. Jack Turban, a psychiatric resident at Massachusetts General Hospital who researches the mental health of trans youth, to the effect that “affirming” a child’s gender transition in general (and providing puberty-blocking drugs, in particular) is usually the most prudent course of action—though the article does not offer evidence to support this assertion, nor specify how the associated risks and benefits might be compared.

Readers of such articles might not realize that data regarding the medical transition of children and adolescents is limited. As Dr. James Cantor wrote in a peer-reviewed journal article published last month, there are few studies examining adult outcomes for children who present as transgender; and those few studies indicate that the majority of pre-pubescent children who present as transgender eventually drop their trans identity and desist to their natal sex.

NBC reports that “in a 2015 survey of nearly 28,000 people conducted by the U.S.-based National Center for Transgender Equality (NCTE), only 8 percent of respondents reported detransitioning, and 62 percent of those people said they only detransitioned temporarily.” Even if this 8 percent figure were accurate, that would certainly merit attention and concern, given the rising numbers of minors who now present as transgender. But the actual figure is likely much higher than 8 percent, because the referenced study is based exclusively on survey respondents who identify as transgender. Many of the detransitioners I have spoken with, by contrast, have cut ties completely with the transgender community, and certainly don’t identify as trans.

A second study cited in the NBC report, titled An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960-2010: Prevalence, Incidence, and Regrets, applied more robust methodology. These researchers found that only about 2 percent of the studied patients expressed regret. But the study was confined only to the small subset of trans Swedes who applied for both legal and surgical sex reassignment. This strict selection criteria would not capture the much broader class of trans-identified individuals who transition socially but have not undergone surgical transition or applied for a change in legal status. By my observation, moreover, some detransitioners are living with significant mental and physical health issues as a result of their transition, and so taking steps to publicly revert to their original gender markers is not a high personal priority.

Most of the individuals covered in the Swedish study transitioned before the recent dramatic rise in young people self-identifying as transgender. (Over the 50-year span covered by the study, the 767 Swedes who applied for legal and surgical sex reassignment amounted to about 15 per year, just a little more than one per month.) The population transitioning in recent years is also qualitatively different from predecessor cohorts. For one thing, many of those now transitioning are much younger. In the UK, there was an increase of more than 1,000 percent in the annual rate of natal male children and adolescents seeking specialist gender services from 2009 to 2019, with a 4,400 percent increase among natal female children and adolescents—from 40 in 2009-10 to more than 1,800 a decade later. Similar increases have been noticed in other Western countries.

Until recently, those seeking transition generally were subject to extensive assessment by mental health practitioners. These stringent guidelines were relaxed in recent years because they were perceived as impinging on patient autonomy, and were considered burdensome and intrusive. According to this new trend, so called “gatekeeping” practices should give way to a model based on “affirmation” of a patient’s announced perception of his or her gender identity. And so many people have been able to access transition interventions after only minimal evaluation. This rush to “affirm” patients has outpaced the clinical data that would support such an approach. Therefore, it seems reasonable to expect that protocols aimed at fast-tracking treatment for trans individuals would increase the rate of false positives.

Then there is the problem of bias reinforcement. For adolescents struggling to understand themselves and their place in the world, a self-diagnosis as transgender can offer seemingly easy answers. But clinicians shouldn’t be “affirming” that sort of self-diagnosis on a no-questions-asked basis. By contrast, an approach that emphasizes supportive, neutral counseling over time (the so-called “watchful waiting” approach), which includes a realistic discussion of biology and explores the risks as well as benefits of transition, could facilitate better decision making. This approach would be best for young people, but it has fallen out of fashion among members of the medical community who prioritize ideology over best practices.

Dr. Turban encourages journalists and politicians to talk to “transgender people and the physicians and researchers who actually study this topic,” rather than “cisgender [i.e., non-trans] political pundits and people who don’t care for trans youth.” In keeping with Dr. Turban’s suggestion, I offer my own perspective. I’m a Philadelphia-based clinician who treats detransitioned individuals. Though my sample size is small, I have seen a number of common themes emerge among clients.

The detransitioners I see in my practice are all female, and they are all in their early twenties. At the time they became trans-identified, many were suffering from complex social and mental health issues. Transition often not only failed to address these issues, but at times exacerbated them or added new issues. These young women often became derailed from educational or vocational goals during their period of trans identification.

Since detransitioning, they have lost the support of the trans community, often both online and in person. Some report that they are vilified if they speak about their experience as a detransitioner. And so, in addition to suffering from their pre-existing conditions, they also now suffer social isolation and a lack of peer support.

The young women with whom I have worked became trans identified during adolescence. They frequently did so in the context of significant family dysfunction or complex psycho-social issues. Sexual assault and sexual harassment were common precursors. A majority had an eating disorder at the time they became trans identified. Since detransitioning, most now understand themselves to be butch lesbians. In our work together, they traced complex histories of coming to terms with their homosexuality. Some faced vicious homophobic bullying before they announced their trans identification.

All of these young women report that their experience of gender dysphoria had been sincerely felt. According to their recollections, they were as “truly trans” as anyone. In some cases, they received a formal diagnosis of gender dysphoria from mental-health clinicians. Others attended informed-consent clinics, through which they were able to access testosterone after only a brief discussion with a health provider.

For most of these young women, identifying as trans worsened their mental health. Although some report that starting on hormones initially brought an increase in confidence and well-being, these drugs eventually seemed to make some of them more emotionally labile, and intensified depression and suicidality. Some of the women who underwent surgeries such as mastectomies or hysterectomies found that these procedures brought no relief from their suffering and instead resulted in nerve damage, regret and, in some cases, life-long dependence on synthetic hormones.

NBC News cited the NCTE claim that most instances of detransition are temporary. But as noted above, the group surveyed in the NCTE’s study consisted of those who identify as trans, and so does not include detransitioned individuals who now have no connection to the trans community.

The NBC article claims “the most common reason for detransitioning, according to the survey, was pressure from a parent, while only 0.4 percent of respondents said they detransitioned after realizing transitioning wasn’t right for them.” But again, this claim originates in a study of people who still self-identified as trans at the time they were surveyed. The women with whom I have worked, on the other hand, all detransitioned because they did not feel that transition had addressed their problems; and, in some cases, because they felt that transition had made their problems worse. They are now certain that transition was a mistake. In many cases, they feel angry at the medical and mental health providers who “affirmed” them. In hindsight, some of these women say that they wished that therapists and doctors had not encouraged them to believe that their body was defective, nor to believe that extreme physical modification was a healthy option for dealing with distress about their bodies.

For the reasons discussed, none of the women with whom I have worked would likely be counted in the studies cited by trans activists. Indeed, most of them are still likely counted by their transition doctors as examples of “successful” transition stories, since they have simply stopped reporting for treatment.

To repeat: The clinical observations I have shared here are based on a small sample size, with a selection bias corresponding to the nature of my clinical practice. They don’t come close to capturing the full complexity of either those who transition and are happy, or those who detransition. However, such impressions help paint a picture, and indicate areas where more data is needed. Though the NBC article asserts that detransition is not common, we actually have no idea how widespread the phenomenon is—and we need more research to find out.

Dismissing detransition as a “panic” stirred up by biased media outlets does a grave disservice to the real men and women who are struggling through the difficult experience of detransition. It isn’t good science—or good journalism—to ignore a category of people simply because their pain is politically inconvenient.

 

 

Lisa Marchiano is a Jungian analyst in private practice. She has been writing on issues related to gender dysphoria since 2016. She podcasts at ThisJungianLife.com. Follow her on Twitter at @LisaMarchiano.

Featured image: Adapted from The Trouble with Transing Children, with Lisa Marchiano