Debate: The pressing need for research and services for gender desisters/detransitioners

Abstract

The number of people presenting at gender clinics is increasing worldwide. Many people undergo a gender transition with subsequent improved psychological well‐being (Paediatrics, 2014, 134, 696). However, some people choose to stop this journey, ‘desisters’, or to reverse their transition, ‘detransitioners’. It has been suggested that some professionals and activists are reluctant to acknowledge the existence of desisters and detransitioners, possibly fearing that they may delegitimize persisters’ experiences (International Journal of Transgenderism, 2018, 19, 231). Certainly, despite their presence in all follow‐up studies of young people who have experienced gender dysphoria (GD), little thought has been given to how we might support this cohort. Levine (Archives of Sexual Behaviour, 2017, 47, 1295) reports that the 8th edition of the WPATH Standards of Care will include a section on detransitioning – confirming that this is an increasingly witnessed phenomenon worldwide. It also highlights that compared to the extensive protocols for working with children, adolescents and adults who wish to transition, nothing exists for those working with desisters or detransitioners. With very little research and no clear guidance on how to work with this population, and with numbers of referrals to gender services increasing, this is a timely juncture to consider factors that should be taken into account within clinical settings and areas for future research.

A Typology of Gender Detransition and Its Implications for Healthcare Providers

“…This category potentially includes anyone who identified as transgender, socially or medically transitioned, and later returned to identifying with his/her birth sex. The reasons behind core or primary detransitions are multifarious, and may comprise: realizing that transitioning does not alleviate GD (Dodsworth, 2020;Herzog, 2017;Lev, 2019;Marchiano, 2020), finding alternative ways to cope with GD (Herzog, 2017;Stella, 2016), mental health concerns (Post-Trans, n.d.;Stella, 2016), solving previous psychological/emotional problems that contributed to GD (Butler & Hutchinson, 2020;Stella, 2016), the remission of GD itself over time (Stella, 2016), understanding how past trauma, internalized sexism, and other psychological difficulties influenced the experience of GD (Dodsworth, 2020;Gonz alez, 2019;Herzog, 2017;McFadden, 2017;Post-Trans, n.d.;Stella, 2016;Yoo, 2018); the reconciliation with one's sexuality (Marchiano, 2020;GNC Centric, 2019;Pazos-Guerra et al, 2020;Post-Trans, n.d.); and a change in individual, political, social, or religious views that leads the person to question his/her transgender status (Dodsworth, 2020;Exp osito-Campos, 2020;Herzog, 2017;Kermode, 2019;Stella, 2016;Turban & Keuroghlian, 2018).…”

“…Gender detransition is as scientifically fascinating as socially controversial, for it poses significant professional and bioethical challenges for those clinicians working in the field of gender dysphoria (henceforth "GD"). However, the scarcity of information, along with the lack of formal recognition of detransitioners and their experiences-although this trend seems to be changing (e.g., Butler & Hutchinson, 2020;Entwistle, 2020)-, has contributed to a state of things in which we fall short of a shared and scientifically consolidated language to approach detransition. This gap has favored the proliferation of inconsistent usages of the concept, thus adding to the confusion and unclarity.…”

One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria

“…The importance of continued access to non-affirmation -nonconversion, agenda-free evaluation, and treatment is further underscored by the increasing numbers of detransitioning patients speaking out in social media forums following gender transitions they have come to regret (Entwistle, 2020). The rate of regret, detransition, and desistance from transgender identification is largely unknown (Butler & Hutchinson, 2020). The majority of patients with classical, childhoodonset gender dysphoria (61%-98%) desist from transgender identification some time in adolescence or young adulthood (Korte et al, 2008;Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013;Zucker, 2018).…”

Debate: Reality check – Detransitioner's testimonies require us to rethink gender dysphoria

“…The five articles in the debate section of the February 2020 issue of Child and Adolescent Mental Health push the envelope on gender dysphoria (GD), transgender and detransition. Butler and Hutchinson's consideration (Butler & Hutchinson, 2020) of young people who desist and detransition represents an overdue formal acknowledgement of this population and should mark the beginning of a necessary shift in clinical practice and theory. Crucially, detransitioners having their cognitive, emotional and physical needs properly attended to and their experiences and testimonies being integrated into evolving theories of gender dysphoria and improvements in clinical practice.…”