Transition describes the social, psychological, and/or medical processes by which a transgender person realigns themselves towards the gender with which they identify.
Detransition is when a person who has already transitioned returns, for any reason, to live as the gender corresponding to their birth assigned sex. Detransition is a loaded term, and importantly it doesn’t mean an unsatisfactory or regrettable result. Rather, it simply refers to the small group of people who transition and then go back.
One study, which is often cited, has claimed an 80% desistance rate in trans children. However, when the study was scrutinised, it was discovered that the methodology was deeply flawed. The study in question did not differentiate between young people with gender dysphoria, young people who socially but not medically transitioned, and young people who were simply exploring gender-diversity. In fact, nearly half of the children involved in the study could not be located at its conclusion, and were recorded as ‘desisters’ by default. The only justifiable conclusion that could be drawn from the study on a subsequent review of its data, was that strong gender dysphoria was a good predictor of future medical transition.
When the possibility of detransition is prioritised, it can lead to gender affirming-care for children and adults being withheld. Some healthcare professionals may wonder how they can support a trans person in their medical transition if there is a possibility they may change their mind – especially young people, and especially in light of the fact that some of the physical changes brought about by gender-affirming medication are irreversible.
Misinformation around how and why people stop medical transition has led to widespread misconceptions about transgender people and healthcare. Because of this, it’s really important to know the facts. It’s sometimes suggested that lots of trans people later regret their transition. In fact, almost none of them do.
The number of people who do not continue with transition varies depending on where in the world they live, and is subject to a number of factors, including societal acceptance of transgender people and access to healthcare.
For instance, in the UK a survey of 3398 attendees of a gender identity clinic found that just sixteen – about 0.47% – experienced transition-related regret. Of these, even fewer went on to actually detransition.
In the US, a survey of nearly 28,000 people found that only eight percent of respondents reported some kind of detransition. Of these, sixty-two percent only did so temporarily.
In Sweden, a fifty-year longitudinal study on a cohort of 767 transgender people found that around two percent of participants expressed regret following gender affirming surgery, although it is unclear how many of these participants detransitioned as a consequence.
In the Netherlands, a study of transgender young people found that only 1.9% of young people on puberty blockers did not want to continue with medical transition.
On average, this means that around ninety-seven percent of people who transition experience no regret.
The main reason cited for detransition is social pressure. Recent research by Dr Jack Turban has found that around 90 percent of people who return to their birth gender in the US don’t do so because of regret or dissatisfaction, but because of pressure from family, school, work, or society in general.
The National Center for Transgender Equality found that the most common reasons for detransitioning were lack of support at home, problems in the workplace, and harassment and discrimination.
Other reasons include exploring a different gender identity, unrelated health issues, and financial complications. Only five percent of people who detransitioned (0.4% of all trans people) did so because they felt transition was not right for them.
The situation is also aggravated by gatekeeping and combative attitudes in healthcare. In many countries, like the UK, trans people have to spend years proving they are who they say they are in order to access treatment. The financial, social, and mental burdens this causes actually increase the chance of detransition.
A similar phenomenon can happen with non-binary people. The emphasis on proving you are either male or female in order to access trans healthcare can lead to people who are neither of these genders being offered only full transmasculine or transfeminine transition pathways. If they later do not go through with full medical transition because it does not correspond with their gender identity, they are seen to have ‘detransitioned’, when in fact they have reoriented themselves with their true gender identity.
Some studies have shown that cases where children were exploring their gender diversity, but had no intention of transitioning, have also been misinterpreted as detransitioners. Allowing children to freely explore their gender identities is important to their healthy development, and supporting them with non-medical interventions like social transition (allowing them to dress and behave in a way that comes naturally) will help them decide if medical transition is right for them, or not.
Although the rate of detransition is already low, it can be further reduced by supporting and accepting transgender people. Around ninety-five percent of the reasons listed for ‘detransition’ in fact have nothing to do with transition, and are due to issues beyond the control of the person transitioning. All interventions have both risks and benefits, but it is widely accepted that the benefits of gender-affirming care greatly outweigh the risks.
It is important to differentiate between detransitioning and regret. While regret and detransition stories regularly make the news cycle, we rarely hear about people who re-transition. This refers to the cohort of trans people who detransition due to external pressures such as work, finances or their family situation and later re-transition when their circumstances change.
All evidence suggests that medical transition is the right decision for the overwhelming majority of trans people, it’s important to make sure that both our clinical practices and our social attitudes support transition for all who need it.