Transition Regret and Detransition: Meanings and Uncertainties

Abstract

Gender transition is undertaken to improve the well-being of people suffering from gender dysphoria. However, some have argued that the evidence supporting medical interventions for gender transition (e.g., hormonal therapies and surgery) is weak and inconclusive, and an increasing number of people have come forward recently to share their experiences of transition regret and detransition. In this essay, I discuss emerging clinical and research issues related to transition regret and detransition with the aim of arming clinicians with the latest information so they can support patients navigating the challenges of regret and detransition. I begin by describing recent changes in the epidemiology of gender dysphoria, conceptualization of transgender identification, and models of care. I then discuss the potential impact of these changes on regret and detransition; the prevalence of desistance, regret, and detransition; reasons for detransition; and medical and mental healthcare needs of detransitioners. Although recent data have shed light on a complex range of experiences that lead people to detransition, research remains very much in its infancy. Little is known about the medical and mental healthcare needs of these patients, and there is currently no guidance on best practices for clinicians involved in their care. Moreover, the term detransition can hold a wide array of possible meanings for transgender-identifying people, detransitioners, and researchers, leading to inconsistences in its usage. Moving forward, minimizing harm will require conducting robust research, challenging fundamental assumptions, scrutinizing of practice patterns, and embracing debate.

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

“…The growing awareness of detransitioners who deeply regret their transition and feel they were harmed by those who facilitated it attests to our inability to reliably distinguish between those who will derive net benefit from medical transition and those who will be harmed (Butler & Hutchinson, 2020 ; Entwistle, 2021 ; Exposito-Campos, 2021 ; Gribble et al, 2023 ; Jorgensen, 2023a , 2023b ; Littman, 2021 ; Vandenbussche, 2022 ). The overall rates of detransition and regret in people who began medical transition as children are largely unknown; there are no large-scale studies with long-term follow-up on this cohort (Cohn, 2023 ; MacKinnon et al, 2023 ).…”

“…Moreover, it can take 8–10 years for regret to manifest in those who transitioned as adults (Dhejne et al, 2014 ; Wiepjes et al, 2018 ), after an initial “honeymoon period” lasting from several months to several years (Nobili et al, 2018 ), suggesting it may be many years before the full extent of regret is known for people who transitioned as children under the gender affirming care model. Last, regret, which implies personal agency, may not be an appropriate endpoint to evaluate iatrogenic harm for those who lacked decisional competence to consent to puberty suppression due to immaturity or co-existing psychiatric or neurodevelopmental conditions (Jorgensen, 2023b ).…”

A qualitative metasummary of detransition experiences with recommendations for psychological support

“…The prevalence of detransition fluctuates between less than 1 % and over 13 %, although estimates vary considerably according to case definitions and are affected by conceptual and methodological shortcomings ( Expósito-Campos et al, 2023 ). The last decade has seen an increase in the number of young people transitioning and detransitioning, leading to controversy about possible driving factors, particularly changing models of care, unrecognized psychological problems, and peer influence ( Jorgensen, 2023 ).…”

“…Cross-sectional online surveys of clinicians working in TGD healthcare ( Narayan et al, 2021 ; Pullen Sansfaçon, Planchat, et al, 2023 ) and retrospective case note reviews from gender identity services ( Butler et al, 2022 ; Hall et al, 2021 ; Pazos Guerra et al, 2020 ) provide emerging evidence of detransition-related clinical encounters. Despite this, there is currently no guidance to support providers working with individuals who detransition ( Jorgensen, 2023 ; MacKinnon et al, 2022b ) and informal resources are scarce. In practice, this means that individuals who detransition may have unmet health needs ( MacKinnon et al, 2023 ), while providers may be unaware of or unprepared to respond to the diversity of detransition experiences and trajectories ( Jorgensen, 2023 ).…”

“…Despite this, there is currently no guidance to support providers working with individuals who detransition ( Jorgensen, 2023 ; MacKinnon et al, 2022b ) and informal resources are scarce. In practice, this means that individuals who detransition may have unmet health needs ( MacKinnon et al, 2023 ), while providers may be unaware of or unprepared to respond to the diversity of detransition experiences and trajectories ( Jorgensen, 2023 ). This has prompted numerous calls for rigorous research and the development of detransition-centered care services ( Butler & Hutchinson, 2020 ; Entwistle, 2021 ; Irwig, 2022 ; MacKinnon et al, 2023 ).…”