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Transgender care is the pivotal topic of America’s current culture wars, and many people are caught in the middle as a healthcare topic becomes political. Two extremely vocal sides dominate this debate. Conservatives claim they oppose the availability of transgender care and rights on moral or religious grounds. Supporters of transgender rights assert that gender-affirming care is the appropriate treatment for gender dysphoria. However, there is a third perspective that is often lost. That is the experience of people who detransition.
What is detransitioning?
Detransitioning describes when someone with gender dysphoria stops using medical interventions for their gender transition. Gender transitions involve taking medical, social, or legal means to affirm a gender identity different from the one they received at birth. Reversing this process can involve all or just some of these steps. This can mean that someone reverts to living as their assigned sex at birth or begins to align with a gender identity different from the one they transitioned to, such as identifying as “non-binary”.
Why is talking about detransitioning controversial?
Most arguments over the topic tend to boil down to two extreme positions. People questioning gender transitions are hate-filled trans-phobes, and people supporting transitions are perverts and pedophiles. These polarizing view points leave little room for discussion.
People who oppose transitioning and trans rights frequently point to the rare stories of people who detransition as evidence against the practice. They claim people are detransitioning because they regret their past decisions and are unsatisfied with the results. They think it is proof that gender dysphoria is made up or just a temporary phase.
On the other hand, supporters of trans rights fear the topic of detransitioning precisely because of how it is exploited by their opponents. They are rightly worried about any crack in the armor of their arguments for the right of people to transition. They also note the glaring lack of positive media coverage of people living well after transitioning, which is the vast majority of cases.
How often does this happen?
Exploring one’s gender identity is a complex process. Viewing it as “transitioning vs. detransitioning” really simplifies it too much. Trans rights advocates argue that this views gender as binary. It assumes people are either the gender they were born or the other gender they transitioned to. In fact, there are plenty of people who identify neither as male or as female. They are “non-binary”. These people and others may start and discontinue (and maybe start again) different treatments for gender dysphoria over time. This does not necessarily mean that they are unhappy with or regret their treatment.
With that in mind, let’s hear some numbers. The largest studies on the topic surveyed over 17,000 trans and non binary people who received treatment for gender dysphoria. This includes people who got hormonal or surgical treatment, as well as those who only transitioned socially (such as changing pronouns, names, and how they present themselves). It found that 13% of them stopped treatment at some point in time. Another long term study of roughly 1,000 trans people receiving hormone therapy found that just over 70% of them were still using that treatment 4 years later.
Why do people detransition?
Transitioning is a complex and personal process, and the emotions behind it can vary widely among individuals. However, detransitioning is very often less about what the individual is feeling on the inside and much more about external forces pressuring them. That same study of 17,000 trans people found that, of people who detransitioned, over 82% cited external factors forcing them to do so. External factors include pressure from family, hostile work, school, or social environments, harassment, or trouble keeping or getting a job. In turn, only 16% of people cited internal reasons, such as changes or uncertainty in gender identity.
Do people ever regret transitioning?
Regret is rare, very rare. An analysis of 27 studies on the topic, covering the experiences of almost 8,000 trans people aged 13 and older found the rate of regret of trans surgeries to be under 1%. This regret rate is much lower than regret rates for many other common surgeries.
To put it in perspective, roughly 1 in 5 people who get knee replacements regret the procedure. Additionally, over 15% of people who get cosmetic nose surgery regret that procedure. In brief, a regret rate of 1% for any procedure is very low.
For people who do not get gender surgery and just use hormone treatments, slightly higher numbers do ultimately discontinue that treatment. A large study of almost 1,100 adolescents receiving hormonal treatment found that just over 5% stopped before age 18. Smaller studies found similar rates. Even in these cases, though, stopping treatment is not the same as regret.
Politics kills nuance
Political conflict over trans issues has come to dominate any discussions on the topic. In this constant sparring, trans and gender-questioning kids, trans adults, as well as people who have detransitioned are all reduced to political tokens. States that are hostile to trans rights have new laws that prohibit healthcare professionals from providing gender-related medical treatments. These states also restrict trans youth from participating in sports teams or using bathroom facilities that align with their gender identity. The number of gender and sexuality based hate crimes in schools are rising much faster in these states than in others. These conservative policies are truly putting lives at risk.
The push and pull has also resulted in changes to how people with gender dysphoria are evaluated in medical settings. In the past, feelings of gender dysphoria demanded thorough evaluation. This was intended to determine whether gender-related distress stemmed from genuine gender dysphoria, other mental health issues, or social reasons.
However, many trans people and activists felt these evaluations were just one more barrier in a society determined not to accept them. This has led to a shift towards more affirmation, an approach believing that people with gender dysphoria know what treatments are best for themselves. This means fewer and less involved psychiatric evaluations before people are referred for hormonal and surgical treatment.
This is the true nuance of this polarizing situation: How much autonomy should kids have over their transitions? This is a debate for healthcare professionals and parents to have, not politicians seeking votes. However, the idea of “detransitioning” – that trans people will doubt or regret their decisions – needs more thought and less hyperbole. For many people, exploring their own gender is a journey, rather than an either-or decision that you can be wrong or right about.