Detransition

Transition is the process of a transgender person changing their gender presentation and/or sex characteristics to accord with their internal sense of gender identity.[1] Transition commonly involves social changes (such as clothing, personal name, and pronouns), legal changes (such as legal name and legal gender), and medical/physical changes (such as hormone replacement therapy and sex reassignment surgery).

Detransition (sometimes called retransition) is the process of halting or reverting a transgender identification or gender transition.[2] Like transition, detransition is not a single event. Methods of detransitioning can vary greatly among individuals, and can involve changes to one's gender expression, social identity, legal identity documents, and/or anatomy.[3] Desistance is a general term for any cessation,[4] and it is commonly applied specifically to the cessation of transgender identity or gender dysphoria.[5] Those who undertake detransition are known as detransitioners.[6] Detransition is commonly associated with transition regret, but regret and detransition do not always coincide.[7]

Formal studies of detransition have been few in number,[8] of disputed quality,[9] and politically controversial.[10] Frequency estimates for detransition and desistance vary greatly, with notable differences in terminology and methodology.[11][12] Detransition is more common in the earlier stages of transition, particularly before surgeries. It is estimated that the number of detransitioners ranged from less than one per cent to as many as five per cent.[13] A 2018 survey of WPATH (World Professional Association for Transgender Health) surgeons found that approximately 0.3% of patients who underwent transition-related surgery later requested detransition-related surgical care.[14] The 2015 U.S. Transgender Survey collected responses from individuals who identified as transgender at the time of the survey. 8% of those who had transitioned reported having ever detransitioned; 62% of that group were living as a gender other than the one assigned to them at birth at the time of the survey.[15]

Desistance rates among young children may be higher. Of children referred to gender clinics for either gender dysphoria or gender non-conformity, a 2008 study found 61% desisted from their gender incongruence or nonconformity before reaching the age of 29,[16] and a 2013 study found 63% desisted before age 20.[17] A 2019 clinical assessment found that 9.4% of patients with adolescent-emerging gender dysphoria either ceased wishing to pursue medical interventions or no longer felt that their gender identity was incongruent with their assigned sex at birth within an eighteen-month period.[18] Research prior to 2000 might report inflated numbers of desistance, as gender-nonconforming children without gender dysphoria might have been included in studies.[19]

A 2003 German study found evidence for an increase in the number of demands for detransition, blaming poor practice on the part of "well-meaning but certainly not unproblematic" clinicians who—contrary to international best practices—assumed that transitioning as quickly as possible should be the only correct course of action.[20] Surgeon Miroslav Djordjevic and psychotherapist James Caspian have reported that demand for surgical reversal of the physical effects of medical transition has been on the rise.[21]

Detransitioners have commonly cited trauma, isolation, dissociation, inadequate mental healthcare, and social pressure as motivations for pursuing transition.[22] Informed consent and affirmation of self-diagnosis (both newer but increasingly employed models for transgender healthcare) have been criticized for failing to meet the needs of those who eventually detransition.[23] Among eventual detransitioners, the progression of transition has been found to magnify, rather than remedy, gender dysphoria. Sufferers may fixate on passing (being perceived as their preferred gender), leading them to pursue ever further steps in medical transition.[24]

Motives for detransitioning commonly include financial barriers to transition, social rejection in transition, depression or suicidality due to transition, and discomfort with sexual characteristics developed during transition. Additional motives include concern for lack of data on long-term effects of hormone replacement therapy, concern for loss of fertility, complications from surgery, and changes in gender identity.[25] Some people detransition on a temporary basis, in order to accomplish a particular aim, such as having biologically related children, or until barriers to transition have been resolved or removed.[26] Transgender elders may also detransition out of concern for whether they can receive adequate or respectful care in later life.[27] A qualitative study comparing child desisters to persisters (those with persisting gender dysphoria) found that while persisters related their dysphoria primarily to a mismatch between their bodies and their identity, desisters' dysphoria was more likely to be, at least retroactively, related to a desire to fulfill the other gender role.[28]

Most childhood desisters go on to identify as cisgender and gay or lesbian.[19]

Mike Penner, a sportswriter for the Los Angeles Times, publicly identified as transsexual in April 2007 under the name Christine Daniels and wrote of his experience with transition until October 2008, when he resumed his male identity. He died by suicide in November 2009.[29]

Since 2011, Walt Heyer has written several books on his experience of regret and detransition.[30]

Carey Callahan began speaking openly about her detransition in 2016. Callahan identified as trans for four years. Her employment at a gender clinic led her to seek alternatives to transition. She advocates for detransitioners and gender-nonconforming people while working as a licensed therapist. She was profiled by The Atlantic in 2018.[31]

Longtime New York performance artist Brian Belovitch (formerly known as Tish Gervais) transitioned in 1972, following social pressure to conform his feminine personality to binary gender norms. He lived as a trans woman for fifteen years before "retransitioning", as he terms it, in 1987. Belovitch cites his changed views on his own gender identity (referring to himself now as "genderqueer or gender nonconforming") for prompting his reversal. He was profiled by Paper magazine in 2018; he published his memoir later that year.[32]

In March 2019, James Shupe, the first American to win legal recognition of having a nonbinary gender, criticized his transition and publicly re-identified as a man. Shupe had lived as a trans woman for two years and as a nonbinary person for three.[33]

In 2020, 23-year-old Keira Bell joined a lawsuit against the NHS Gender Identity Development Service.[34] Bell was prescribed puberty blockers at age 16 and testosterone a year later, and had her breasts removed before stopping hormone treatments and reidentifying as a woman. She states that she should have been "challenged more" by the gender clinic, criticising the lack of therapy or questioning she received before being prescribed the puberty blockers. The lawsuit will argue that minors cannot give informed consent to transitioning treatments.[34]

There is a lack of legal, medical, and psychological guidelines on the topic of detransition[37] and a perceived atmosphere of censorship around researching the phenomenon.[38] Detransitioners say they have been harassed by activists who view detransition as a political threat to trans rights.[39] Controversy surrounding detransition within trans activism primarily arises from how the subject is framed in mainstream media and right-wing politics.[40]

In August 2017, the Mazzoni Center's Philadelphia Trans Health Conference, which is an annual meeting of transgender people, advocates, and healthcare providers, canceled two panel discussions on detransition and alternate methods of working with gender dysphoria.[41] The conference organizers said, "When a topic becomes controversial, such as this one has turned on social media, there is a duty to make sure that the debate does not get out of control at the conference itself. After several days of considerations and reviewing feedback, the planning committee voted that the workshops, while valid, cannot be presented at the conference as planned."[42]

In September 2017, Bath Spa University revoked permission for James Caspian, a Jungian psychotherapist[43] who works with transgender people and is a trustee of The Beaumont Trust, to research regret of gender-reassignment procedures and pursuit of detransition. Caspian alleged the reason for the university's refusal was that it was "a potentially politically incorrect piece of research, [which] carries a risk to the university. Attacks on social media may not be confined to the researcher, but may involve the university. The posting of unpleasant material on blogs or social media may be detrimental to the reputation of the university."[44] The university stated that Caspian's proposal "was not refused because of the subject matter, but rather because of his proposed methodological approach. The university was not satisfied this approach would guarantee the anonymity of his participants or the confidentiality of the data."[45] He took the matter to the High Court, who concluded his application for a judicial review was "totally without merit".[45] The outcome was also considered by the Office of the Independent Adjudicator for Higher Education, who determined the university's conclusion was reasonable.[45]

WPATH's Standards of Care have offered no mention of detransition,[46] though a majority of WPATH surgeons have expressed a desire for detransition guidelines to be included,[47] and former WPATH president and longtime chair of WPATH's SOC revision team, Eli Coleman, has listed detransition among the topics that he would like to see included in the eighth edition.[48]

Detransition has attracted interest from both social conservatives on the political right and radical feminists on the political left. Activists on the right have been accused of using detransitioners' stories to further their work against trans rights.[49] On the left, radical feminists see detransitioners' experiences as further proof of patriarchal enforcement of gender roles and medicalized erasure of gays and lesbians.[50] This attention has elicited in detransitioners mixed feelings of both exploitation and support.[51]

• Category:People who detransitioned
• Healthcare and the LGBT community
• LGBT rights by country or territory
• LGBT social movements