Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments

Abstract

IMPORTANCEMedical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition. OBJECTIVE To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice.DESIGN, SETTING, AND PARTICIPANTS Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. MAIN OUTCOMES AND MEASURESIn-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. RESULTS Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs.CONCLUSIONS AND RELEVANCE This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.

Sampling sexual and gender minority youth in Canada and the US: Lessons in cost-effectiveness from the UnACoRN internet-based survey (Preprint)

“…Some subgroups or communities (eg, people who have detransitioned, that is, discontinued or reversed gender-affirming health care [ 16 ]) required specific recruitment methods to reach an adequate sample size. Therefore, we mapped approximately two dozen subreddits—community-specific forums on the Reddit social media website—and contacted their moderators to ask for permission to post the survey.…”

“…Because conversion therapy is poorly defined and closely related to a set of similar anti–two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) experiences known as sexual orientation and gender identity and expression change efforts (SOGIECE), measures of conversion therapy should be coupled with experiences of SOGIECE, heterosexism, cissexism, and related threats to health equity in SGM populations [ 15 ]. Moreover, because conversion therapy constitutes just one of a possible series of threats to 2S/LGBTQ identity expression, studies should also investigate the range of these threats (and opportunities, in the case of 2S/LGBTQ-affirming actions), including access to gender-affirming medical care and detransition experiences [ 16 ] and felt inclusion or exclusion in a wide range of social spheres (eg, team sports, religion, and school).…”

Understanding and Supporting Patients With Dynamic Desires for Gender-Affirming Medical Interventions

“…4,5 Despite the fact that discontinuation of gender-affirming medical or surgical interventions is rare, clinical protocols should be in place to support patients who have dynamic needs surrounding these interventions. In this issue of JAMA Network Open, MacKinnon et al 6 provide findings from qualitative interviews to better understand the diverse perspectives of patients who wished to discontinue or reverse prior gender-affirming treatments, their clinical needs, and what research should be conducted to better support these individuals.…”

“…A common theme among participants in the MacKinnon et al 6 study was the concern that their decision to discontinue interventions would be stigmatized by their clinicians. MacKinnon et al 6 emphasize the importance of clinicians regularly reminding patients that they will be supported regardless of how their gender identity and needs related to gender-affirming medical care evolve.…”

“…9 Exploring such factors can help clinicians understand how to best support patients experiencing evolution of gender-affirmation needs.Although the field of gender medicine has historically focused on binary and static conceptualizations of gender identity and gender-affirmation needs, the time has come for clinicians to recognize that these conceptual frameworks do not align with the lived experiences and embodiment goals of every individual seeking care. Gender-affirming care should encompass the entirety of an individual's embodiment goals, even when those goals may have pivoted over time.MacKinnon et al6 provide a key jumping off point to move the field forward, as we continue to study factors that drive evolving embodiment goals and the physiologic and psychological impacts of dynamic provision of gender-affirming care. What is most vital throughout this process is that patients know their clinicians will respect and support them regardless of how their trajectory evolves, and that they will continue to strive toward research and models of care that support all patients.ARTICLE INFORMATION Published: July 25, 2022. doi:10.1001/jamanetworkopen.2022.24722 Open Access: This is an open access article distributed under the terms of the CC-BY License.…”