Detransitioners report significant unmet medical and psychological needs, and a lack of compassion and help from medical and mental health practitioners, show new survey results that aim to fill an important research gap.
They also report distress associated with "outright rejection from the LGBT+ (lesbian gay bisexual transgender +) community."
"Most detransitioners could benefit from some form of counseling and, in particular, psychological support on matters such as gender dysphoria, comorbid conditions, feelings of regret, social and physical changes, and internalized homophobia," said sole author of the study Elie Vandenbussche, BA, Faculty of Society and Economics, Rhine-Waal University of Applied Sciences, Kleve, Germany.
Better medical support was also found to be needed by many to address concerns related to stopping or changing hormone therapy, issues related to surgery, and any treatment complications in general, as well as access to reversal interventions.
The study was published online in the Journal of Homosexuality.
Politics Is Pitting Those With the Same Issues Against Each Other
Vandenbussche cofounded the organization Post Trans, which collects stories from people who have detransitioned. She personally detransitioned from trans male back to cisgender female in 2019 after 4 years of medical therapy involving testosterone treatment and a mastectomy.
"My decision to detransition was tied to health complications related to hormone therapy at first, and later to the realization that internalized sexist and homophobic prejudices played an important role in the onset of my gender dysphoria."
Speaking to Medscape Medical News, she explained what motivated the survey: "The scale of detransitioning, as a well as the needs and support for detransitioners, is largely unknown, and such a knowledge vacuum needs to be addressed urgently."
A significant part of the problem is the unreliable record of the number of detransitioners.
"The results of my survey show that a lot of detransitioners don't go back to the same doctor that treated them during their transition, so then they're just lost and off the record. But just because the numbers are low — but currently growing — that's not a reason not to look at their needs properly," emphasized Vandenbussche.
Julie Graham, a marriage and family therapist, and gender health specialist, is cofounder of Gender Health SF. She was previously director of transgender health services for the San Francisco Department of Public Health, California, and has spent 20 years trying to get better care for people who detransition.
She agrees that the number of detransitioners is rising. "Because more people are transitioning, more will be detransitioning. Because there is more information available, we will see more people exploring gender identity — that wasn't possible in the past."
"But this topic is complex, is polarizing, and it exists in a context, one that right now is highly politicized, and filled with stigma, reactivity, and struggle," she notes. "People who transition and people who detransition are generally the same group — people who have gender issues. Politics has pitted people with the same general issue against each other."
She also pointed out that, if someone does have gender issues, it's likely they will have gender issues throughout life, to some degree. "For some people, gender identity is a life-long developmental issue. We'd prefer to identify a problem, fix it, and have it go away, but gender isn't like that for many people. We evolve and grow as people, and it's okay to question decisions we've made. It's good."
Survey Was Mostly Female Detransitioners
The survey aimed to examine detransitioners' needs and support, and broadly explored psychological, medical, legal, and social needs, although Vandenbussche explains this is a simplification of a complex situation.
"I wanted to offer an overview of the current needs of detransitioners from online detransitioner communities to serve as a useful basis for further work around the issues involved."
A total of 237 detransitioners (92% born female; 8% born male) were recruited via social media comprising Post Trans, Facebook, Instagram, and Twitter, and a Reddit forum for detransitioners (r/detrans). Detransitioners could be any age or nationality. All participants had transitioned medically and/or socially and then stopped.
The average transition age of female participants was 17.4 years, and for detransition was 22.2 years (30 years for males). Most detransitioners stopped transitioning before their mid-20s, after an average of 4 years of transition. Most of the sample underwent hormone therapy (62% for females, 80% for males), and 45% of those who medically transitioned also underwent gender-affirming surgeries.
Graham welcomes the survey, but strikes a note of caution. She draws attention to the fact that the survey is based on a convenience sample and highlights that Vandenbussche's conclusions are about a specific group of detransitioners who need attention and help.
The survey also largely recruited via www.post-trans.com, a platform for female detransitioners.
"There are genuine limitations to the use of surveys. It's great that people are finding each other through the internet, but this research is very narrow as a result. It doesn't mean it's unimportant, but it's narrow," Graham observed.
Medical, Psychological, Legal, and Social Needs Reported
Findings related to medical needs showed that 84% of respondents reported having experienced both social dysphoria (a strong desire to be seen and treated as being of a different gender) and body dysphoria (a strong desire to have sex characteristics of the opposite sex/rejection of own sex).
Some of the most common reasons reported for detransitioning included realization that their gender dysphoria was related to other issues (70%), health concerns (62%), transition did not help the individual's dysphoria (50%), found alternatives to manage their dysphoria (45%), unhappiness with the social changes (44%), and change in political views (43%).
Least reported reasons for detransitioning were lack of support from social surroundings (13%), financial concerns (12%), and discrimination (10%).
"Comorbid issues seem to be really overlooked," said Vandenbussche. "The questions raised by detransitioners, such as, how does gender dysphoria interact with coexisting mental health conditions? What are the long-term health effects of hormone therapy? Or questions around alternatives to medical transition, are all highly important and answering them would improve the healthcare provided to all gender dysphoric people."
Psychological needs appeared to be the most prevalent; the survey found only 4% of participants reported not having any.
Other answers included working on comorbid mental issues related to gender dysphoria (70% had diagnosed depression, and 63% diagnosed anxiety) and learning to cope with gender dysphoria (65%); finding alternatives to medical transition (65%); learning to cope with feelings of regret (60%); learning to cope with the new physical and/or social changes related to detransitioning (53%); and learning to cope with internalized homophobia (52%).
Better Conversations Needed Around Expectations for Transitioning
Graham explained the pressing need to have better conversations about expectations around transitioning.
"If people don't have realistic expectations, they will be disappointed. If they expect that having surgery to create a vulva and vagina will make their trauma history disappear, that is a mismatch," she said, stressing that "conversations are hard to have because we have harmed transgender people so much that people don't trust us to tell us what their reality is."
Graham added that individuals with adverse childhood experiences make up a large proportion of gender diverse individuals. As the survey shows, they are more likely to have both mental health and physical health issues.
"We are going to see more mental health issues in the transgender population due to discrimination, abuse, and minority stress, so people coming in might have lives that have many complicated, interlocking, concerns," she said.
Vandenbussche agreed that good communication is the way forward but highlighted her particular concern around the rejection detransitioners felt from the LGBT+ community.
"It's really a fear of certain narratives being pushed against transition that might strip away access to transition, and this makes open dialogue around detransitioning so taboo and impossible to talk about within LGBT+ spaces. And that's really a problem, because I think that these conversations need to happen and to benefit everyone," Vandenbussche said.
The main legal need expressed by respondents was changing back legal gender/sex marker and/or name (40%), and the main social needs were to hear about other detransition stories (87%) and make contact with other detransitioners (76%).
Free-text survey questions revealed a need for different types of therapy and counseling for dealing with issues of dissociation, childhood sexual trauma, anorexia, relationship issues, and body issues caused by irreversible gender-affirming surgeries.
One participant also mentioned the importance of suicide prevention for those in need. Difficulty finding a detrans-friendly therapist and lack of offered alternatives to transitioning were also cited.
"LGBT+ organizations don't want to talk about detransition," wrote one. "I did not feel welcome at LGBT+ events after I detransitioned," wrote another. "LGBT+ friends I had...they deemed me transphobic/TERF [trans-exclusionary radical feminist], only non-LGBT+ friends supported me."
Detransitioners Feel Let Down by Much of the Medical Community
Respondents made it clear that medical needs for detransitioners are going unmet. Nearly half the sample (49%) reported a need for receiving accurate information about stopping or changing hormone therapy, and almost a quarter (24%) reported the need for help with complications related to surgeries or hormone therapy.
Vandenbussche also drew attention to the 45% of the whole sample who reported not feeling properly informed about the health implications of treatments and interventions before undergoing them.
"This is particularly concerning given the negative medical experiences recounted by participants. For example, their doctors either did not believe them, did not listen to them, refused them services, or simply did not have the required knowledge to help them during their detransition process," she said.
"From my experience, I know the desire to detransition is hard to bring to your doctor because you don't know how it's going to be received," recounted Vandenbussche. "I think that a lot of medical professionals are reluctant to give treatments to detransition, and there's really a lack of trust in general, and with medical communities."
Regarding medical and mental health needs, respondents wrote: "The team that transitioned you is not willing to help you detransition. You need new doctors."
And, "I struggled to find a therapist who supported questioning my trans identity and considering alternatives to transitioning; most only knew how to encourage transitioning and reinforced the harmful ideas that led to my wrongly identifying as FtM [female to male] in the first place."
Graham points out that problems related to transitioning and detransitioning highlight flaws in the medical system. "The system is siloed — mental health, primary care, various surgeons, etc. Good gender care needs to be interdisciplinary that actively includes the patient."
Also, reflecting the court ruling last December in the case won by detransitioner Keira Bell against the Tavistock Centre, London, UK, Graham highlighted the need for better ways to provide the information necessary for informed consent.
"Usually it's about time — the one thing overburdened providers don't really have enough of. It requires individualized care rather than a 'one-size-fits-all' approach. We want to provide the necessary information so a person can make their best decision."
"Gender is complex and the experience of dysphoria is very individual. For many people, it changes over time. But when it's around gender identity, we want it to be static and get resolved and handled. The common medical frame, here is a problem — X intervention fixes the problem. Take this pill, get a stent, a new hip, etc. Gender isn't like that."
The US channel CBS recently aired an episode of 60 minutes discussing the issues faced by people who had detransitioned. Along with Medscape Medical News, it is one of the first US media outlets to openly publicize the issues faced by this group of mainly young people.
Host Lesley Stahl interviewed a young woman who recounted her story of transition and detransition that happened within the space of just 1 year. Medics were also interviewed, some of whom were concerned about the speed at which hormones are given to young people but noted there is a fear of being labeled transphobic if they speak openly about rethinking care for gender dysphoria.
J Homosex. Published online April 30, 2021. Abstract
Vandenbussche and Graham have reported no relevant financial relationships.
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Cite this: Medical and Mental Health Needs of 'Detransitioners' Largely Unmet - Medscape - Jun 02, 2021.