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

 

 

 

 

Comments

  1. Excellent article. It is very clear that the bars to research in the trans area are extremely high.

    1. There are bars to admitting that you are detransitioning
    2. In most cases, once you admit to considering being trans, you are bullied into full committment. And those who caution patience are called transphobes
    3. There seems to be a plethora of counseling venues which are pro-trans. Those who are either skeptical, anti-trans, or dispassionate are eliminated. In Canada, Dr. Zucker ran a clinic with a “watchful-waiting” approach. He was removed from the clinic
    4. There is no research on the long-term outcome of transgender therapies
  2. I am astonished to read this. Absolutely astonished. Subjectivity led to any number of medical atrocities.

    What we have is experimentation on children. There is no theory here. The “most modern treatment” in 1950 was lobotomy. This “cured” mental illness by putting a mixmaster into their frontal lobes, and turning on the power.

    Now, we are cutting off people’s DICKS, under the deranged notion that this is helping them. We are removing their BREASTS. This is not medicine. This is butchery, mutilation. There is no science here. You do not cut off the DICK of a man because he has a tummy ache. Mutilation is not medical treatment.

    I have worked with, planned, managed, clinical trials involving psychology/ psychiatry. There is subjectivity and great variability in psychiatry. There is, however, NOTHING involving the mutilation of children. Clinical trials in psychiatry require considerable care in definition, in clear specification of the protocol, in defining the outcome, in defining the process of rating evaluation of symptoms.

    When someone is suffering, cutting off his DICK is not a solution. This is madness.

  3. Oh, I think that this is a completely accurate statement. Here is how it works:

    1. A child is having the normal adolescent changes in body, emotions, odors, sexual tensions
    2. They feel an emotion from the “other sex”. Girls feel tough, boys like babies.
    3. Friends suggest trans
    4. This is a special thing - the special snowflake is truly special
    5. Here is the bullying - once the trans idea is floated, you get locked in. Others force you to continue. You are not allowed to detransition, or you get shunned and defriended.
  4. That link is to a publication about injecting yourself with hormones. So, a male will be injecting himself with female hormones, a female with male hormones.

    What is the long-term effect of this?

    Here is a quote from Planned Parenthood: " How Do I Make an Appointment?

    Please contact us at 212-965-7000 to schedule an appointment for an Initial Hormone Therapy visit. At this appointment, we will review your medical history, review the Informed Consent form, and draw lab tests. Depending on your medical history, we will either prescribe the hormones to you at your first visit or wait to prescribe the hormones until we get your lab results back."

    Hormones of the wrong sex on the first visit. First visit. It took 3 visits to my doctor to get a steroid shot to address my hip socket inflammation. In what insane world can a woman get testosterone on the first visit to a clinic?

    A quick google of “cross sex hormone therapy” yields several papers. But I find NO example of a large scale cohort study of 3-5 years specifying all possible outcomes. In males, testosterone is linked to tendon integrity. Does lowering testosterone lead to tendon rupture? Heart conditions? It leads to weight gain, for sure.

    In most hospitals, to administer drugs which have not been shown in evidence-based trials takes all kinds of IRB exceptions. Everywhere but trans “medicine”.

  5. @WRMF @Kiashu

    Didn’t see your posts on the recent Mars article.

    Quillette, like every other publication, is responsive to what viewers engage with. Complaints about the article, even shallow ones about the choice of topic, are less conducive to your goals than engaging with the material you want to see more of instead.

  6. You are kidding right.? The diversity on quillette is quite comprehensive. If you don’t like the topic don’t read it.

  7. In most cases where parent(s) are encouraging children to transition, I believe we are witnessing Munchausen by Proxy.

    Children as attention getting props. How many celebrities have gone out of their way to announce that their children are being raised gender neutral?

  8. The Trans Debacle deserves attention. It’s a serious issue with huge ramifications. At one time it was a small population, not anymore. It has evolved into a cult.

    The more articles there are, perhaps the more urgently people will discuss the issue. It must be discussed with intellectual honesty. It’s going to be the social error of our time.

  9. It’s true there are a lot of tranny articles on Quillette but I suspect there aren’t many venues available for anyone even slightly questioning the transagenda. I think the real question should be: why don’t we see these perfectly reasonable articles anywhere else?

    Thank you to Q for offering a space for these writers.

  10. When the detransitioners start suing, then things might change for the better. As it is, the money train is firmly on the trans track. A lifetime of hormone treatment? Unnecessary operations? What’s not to like (for big pharm and surgeons). But a major lawsuit because now a young woman has been rendered infertile by greedy docs…? Bring it on, in fact make it a class action.

  11. What of all the trans suicides that we hear so much of? I would think that they count as de-transitioning.

  12. Yes, it matters. First I want to say thank you for your calm and reasoned post. I disagree with it but appreciate your writing it.

    But it matters if we are wrong because the risk of harm is so high. It’s risk/benefit. To give an analogy: I come to you and tell you I’m suffering because my left hand and my left leg don’t belong to my body. (This is a real condition by the way.) I’ve felt this way all my life. I just want them removed; they hurt me every time I look at them. And what do you do? You…amputate my left arm and left leg because you’re “simply trying to help a group that is suffering”?

    The risks of “transitioning” need to be divided into two main categories:

    1. Minors who cannot possibly give informed consent.
    2. Adults.

    The risks are: permanent sterilization, permanent deformation, operating risks, powerful artificial hormones whose long term effects are utterly unknown but for which there may well be a risk of cancer, death, and other permanent risks.

    The benefit is a temporary and unknown alleviation of gender dysphoria. How long does that last? We don’t know. And what if, ten years later, they decide it hasn’t helped? They are left with a mutilated body and sterilization at the least.

    To me, the minors are no-brainers. They should never, ever, be treated. They can identity as the opposite gender if they wish, but that’s as far as it should go. Let’s look through another prism: Several studies have shown that up to 80% of boys who claim they are trans, end up becoming simply gay when they reach sexual maturity as an adult.

    So the child treatment is strikingly and appallingly sexist and homophobic (imagine saying: let’s take gay boys and sterilize them and even castrate them and tell them they’re really girls. But we are saying that).

    Trans treats a concept of gender as this abstract idea in the nether, or else in the soul—but if it’s so clear as to be abstract-able, that must mean there are principles that define what they are. But there aren’t. What does it mean to be a man? A woman? They end up, particularly with children, to come up with appalling sexist definitions, eg “You’re really a girl because you play with dolls and like dresses” - as though to be a woman means that. Without the clear biological definition we are left with inanities and nebulous subjective assertions of the soul that would literally be treated as evidence of insanity for any other self-delusion, or evidence of a high imagination if a child (eg they believe they are really a wolf, which my son believed by the way from ages 4 to 6).

    I have two friends who transitioned, both female to male. They are both happy now, although both transitioned within the last 10 years. They both transitioned as adults, and gradually, over a period of yeas. Will they be happy at 50? Who knows. But in their cases, they made a decision as an adult and were informed and they simply are living their lives. Unfortunately, they could not be told the long term risks of transitioning and taking powerful chemicals for life as there is no research - and what research there is is repressed; they are being used as human guinea pigs.

    It’s a global scandal. Ten years from now the lawsuits will begin…Good intentions are not equivalent to good outcomes.

    It’s very true, as you say @jerjapan, that much of medicine is subjective. I totally agree. But that doesn’t mean one should embrace subjectivity regardless of risk.

  13. The key issue is that the confusion, ambiguity, and general lack of information about risks AND benefits is due to a lack of research. The lack of research is also a deliberate thing - the trans community is setting up the situation so that it, the trans community, is the only source of information.

    Why do they have such a strong view of trans situations, forbidding discussion of detransitioning, forbidding research? I believe that it is a simple thing - they have made a choice which is extremely dubious, and the only way that this choice can be justified is if others also make it. The pain, confusion, suicidal thoughts, and other things associated with trans are only justified if others also make the same decision. The decision thus gains an artifactual certitude - if you think you are trans, you MUST BE TRANS and there MUST BE no uncertainty or second thoughts. Because if someone else has second thoughts, MY second thoughts may be appropriate, and that may mean that I have destroyed my life for no reason.

  14. I would not call it bullied. However, there are certain tactics that work well on teens in this situation, especially considering the stress and negative emotions that they are experiencing.

    What is being called bullying here I would call Love bombing. This is something that you see online a lot, as well as from administration. School administrators often are sensitive to lawsuits and other bad press, and so often go a bit overboard, especially in middle school. The child receives such a lot of support that it is clear that this behavior is extremely rewarded. For a child suffering from adverse life events or pubertal stress, this can be very attractive. In fact, this was the subject of a paper from a professor at Brown University who has written on Quillette about her experience publishing that paper.

    Whatever adults in school may say, and we are hired to be responsible adults, online it is a whole different zoo. You can get into a forum and get love bombed there, while dealing with very subtle or less subtle disapproval if you don’t fit their mold. This is not so much bullying as cult tactics, you get approval if you fit their mold, and lose it if you don’t.

    To a child struggling with something, the instant and overwhelming approval is extremely intoxicating. However, things they may be struggling with when they want to transition have been shown to include:

    1. Being gay (60-90% of kids who think they might be trans and join a lot of these groups are actually gay. It turns out that the sex you are and the sex you want to sleep with are easily confusable until you get old enough and mature enough to figure out the difference. Unfortunately the therapists who pushed for psychotherapy alone and in group to deal from this have been having problems with activists going after their clinics. )
    2. According to the research out of Brown University, some proportion of girls wanting to transition may be on the spectrum and just seeking love and support from their peers. This is a good way to get it. This is the ROGD that gets talked about. Rapid Onset Gender Dysphoria.
    3. Be trans, though this percentage is less than 40% and may be less than 10%.

    With those percentages, you see why maybe pushing people into transition before they know which category they are in might be a problem?

    And this also doesn’t take into account the effects of the puberty blockers, which may cause infertility and have been reported to cause a decrease in IQ as parts of the brain don’t develop at the right time. Given that brain development has a lot of critical periods involved, this has the possibility to be permanent.

  15. Benitacanova nails it. Quillette is likely the only platform for anyone to challenge the standard MSM conventional wisdom on transgender issues, especially relating to children/adolescents. Don’t hold your breath waiting for Anderson Cooper, Chuck Todd or NYT/WashPo to allow these conversations.

Continue the discussion in Quillette Circle

78 more replies

Participants

Comments have moved to our forum