What do the terms ‘detransition’ and ‘desistance’ mean?

A detransitioner is someone who previously identified as transgender and received medical and/or surgical interventions as a result, but stopped taking these interventions and no longer identifies as transgender in the same way.

Detransition and desistance both describe processes where people cease to pursue medical transition and/or stop identifying as transgender. These two concepts are not consistently defined, even in the academic literature, so clinicians should be sensitive to their patients’ circumstances and how they self-describe (Jongeling and Vandenbussche, no date). It is unknown how many people who initially identify as transgender later detransition or desist: there is a general lack of data on what happens to patients long-term after they receive medical interventions for gender dysphoria. This particular outcome is understudied. Although detransition is said to be uncommon, individuals often do not return to their treating clinicians and may disconnect from LGBTQ+ communities, meaning it is difficult to estimate how frequently this occurs (Littman, 2021). There is little support for individuals who wish to detransition or desist (Butler and Hutchinson, 2020).

Who are detransitioners? 

A detransitioner is someone who previously identified as transgender and received medical and/or surgical interventions as a result, but stopped taking these interventions and no longer identifies as transgender in the same way. The person would self-describe as a detransitioner (Vandenbussche, 2021). Medical interventions may have included puberty blockers and cross sex hormones. Surgical interventions may have included double mastectomy, oophorectomy, hysterectomy and neophalloplasty for females or an orchiectomy, neovaginoplasty and breast implants for males. After having undergone one or many these medico-surgical interventions, detransitioners stop pursuing their transgender identity and most often re-identify with their biological sex. Medically, this process of re-identification may involve discontinuation of cross sex hormones, supplementary hormones of the natal sex (particularly if the individual has undergone gondadectomy), and further surgical procedures to attempt to reverse prior operations. However, it is typically not possible to fully erase the impact of any medical interventions the detransitioner initially received. Infertility and loss of sexual function is a risk in females and males, particularly if puberty has been disrupted. Effects of testosterone in females are difficult if not impossible to mitigate, and may include: male pattern baldness and thinning hair, an increase in facial and body hair, a permanently deepened voice and vaginal atrophy. Organs that have been surgically excised are irretrievable.

The psychological burden for detransitioners is significant and complex and is often complicated by considerable pre-existing psychological and psychiatric comorbidity (IATDD, 2020). 

Who are desisters?

A desister is someone who previously identified as transgender but who re-identified with their biological sex prior to any medical intervention. Prior to re-identifying with their biological sex, many desisters underwent some degree of social transition including a change of name, pronouns, clothes, hairstyle and/or other modifications to their appearance so they could express their gender identity. Lasting physical sequelae of this period of identification are uncommon but may involve damage to breast tissue caused by binders in females. Whilst the physical effects are less noticeable than for detransitioners, desisters may have many of the social and psychological issues reported by detransitioners following their re-identification with their biological sex. These include isolation, ostracism from parts of transgender communities, criticism and attacks on social media and guilt (Vandenbussche, 2021).

Regret?

In the literature on medical interventions for transgender identities, the reports of detransitioners may be wrongly framed as ‘post treatment regret’. An editorial in a medical journal claimed ‘no one can know whether post-treatment regret will occur’ (The Lancet Child & Adolescent Health, 2021). Subsequent correspondence also argued that young trans people ‘have the right to be wrong’ (Pang et al., 2021).

While young people do have the right to be wrong, adolescents also have the right, including legal rights, to be protected from many of the decisions they make during this stage of their lives when their brains are still developing (see FAQ How does adolescence affect decision-making?). The conceptualisation of a patient’s dissatisfaction with any outcome as ‘regret’ wrongly places the full responsibility for these medical interventions with the patients and abrogates any responsibility the treating clinicians have for the outcome. People who were unable to provide informed consent and/or who were offered an inappropriate medical or surgical intervention for a misdiagnosed or misunderstood condition cannot be expected to shoulder accountability for an adverse set of circumstances directly influenced by the actions of healthcare practitioners.

References:

Butler, C. and Hutchinson, A. (2020) ‘Debate: The pressing need for research and services for gender desisters/detransitioners’, Child and Adolescent Mental Health, 25(1), pp. 45–47. doi: 10.1111/camh.12361.

IATDD (2020) Introduction to Detransition for Therapists, International Association of Therapists for Desisters and Detransitioners. Available at: https://iatdd.com/introduction-to-detransition-for-therapists/.

Jongeling, N. P. and Vandenbussche, E. (no date) Gender Detransition: a path towards self-acceptance, Post Trans. Available at: https://post-trans.com/Detransition-Booklet.

Littman, L. (2021) ‘Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners’, Archives of Sexual Behavior, 50(8), pp. 3353–3369. doi: 10.1007/s10508-021-02163-w.

Pang, K. C. et al. (2021) ‘Regret, informed decision making, and respect for autonomy of trans young people’, The Lancet Child & Adolescent Health, 5(9), pp. e34–e35. doi: 10.1016/S2352-4642(21)00236-4.

The Lancet Child & Adolescent Health (2021) ‘A flawed agenda for trans youth’, The Lancet Child & Adolescent Health, 5(6), p. 385. doi: 10.1016/S2352-4642(21)00139-5.

Vandenbussche, E. (2021) ‘Detransition-Related Needs and Support: A Cross-Sectional Online Survey’, Journal of Homosexuality, pp. 1–19. doi: 10.1080/00918369.2021.1919479.