On May 23rd CBS’ 60 Minutes ran a segment reporting on the healthcare challenges facing the trans community in the US. Although the report responds to the legal reforms happening in places like Arkansas that make it illegal to treat transgender youth, and provides clear medical evidence of how harmful this legislation is to American young people, it also devotes a considerable amount of airtime to interviewing ‘detransitioners’ – people who have partially or fully medically transitioned but since come to regret their decisions.
The segment has since been heavily criticised by LGBT+ activists including Laverne Cox who, in a lengthy post on instagram pointed out, among other things, that most medical professionals agree that gender affirming care for trans people is “very successful”.
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Although the segment does quietly acknowledge that “the vast majority of transgender youth and adults are satisfied with their transitions,” it does not give any information on the rarity or circumstances of detransition. This is an issue because it presents the medical benefits of transition and the risk of detransition as if they are two equally weighted sides of the matter, which is emphatically untrue. Less than 1% of people who medically transition express transition-related regret, and even fewer actually detransition. And while no medical process is without risk, this is statistically insignificant compared to the substantial reductions in suicidality and improvements in mental health and quality of life that result from providing transgender young people with access to transition options. To present these outcomes as equivalents not only distorts the truth, it runs the risk of inviting transphobic groups to weaponise the report against transgender people, or to use it as support for further anti-trans legislation.
The 60 Minutes report portrays detransition as the result of inadequate rigor when assessing patients for gender dysphoria or referring them for treatments. Earlier this year we sat down with Dr Jack Turban, Fellow in Child and Adult Psychiatry at Stanford University School of Medicine, to talk seriously about detransition. Dr Turban told us how his research has found that, among Americans who detransition, close to 90% do so because of external pressures from family, work, school, or society in general. Others detransition but without regret, for instance, going from a binary gender identity to a non-binary one and no longer wanting to pursue full medical transition. There is even evidence that young LGBTQ+ people who explore transition but change their minds are exploited by so-called ‘gender-critical’ groups. In fact, in the majority of these cases detransition isn’t a consequence of clinical misjudgement or bad medical practice, but of the social pressures and poor education surrounding transgender people and gender identity. Creating stigma or spreading misinformation about the risk and causes of detransition only serves to make the problem worse.
GenderGP is fully in favour of robust guidelines for the assessment and treatment of trans people – but not arbitrary rules that force patients to ‘prove’ that they are trans by conforming to medically and socially outdated stereotypes. We follow the standards of care set out by organisations like the World Professional Association for Transgender Health (WPATH) that provide affirming pathways to treatment for trans people while also recognising there are “various expressions of gender that may not necessitate psychological, hormonal, or surgical treatments”. Even during the detransition segment it was emphasised that WPATH guidelines should have been followed, making the problem not one endemic to trans healthcare but to a lack of support and understanding around trans healthcare.
Putting additional arbitrary barriers to trans healthcare in place won’t help those who choose to detransition but it will make life substantially worse for trans people. Look at the UK, where access to trans healthcare is gatekept by lengthy psychiatric reviews (despite gender dysphoria having been removed from the DSM in 2011) and subject to spiralling waiting times. If the NHS subscribed to internationally recognised guidelines then the situation would be improved for everyone. We should focus on that unity. This isn’t about trans people vs. detransitioners. It’s about better education around gender identity and better healthcare for trans people being the best option for everybody.
So what can we do to ensure that everybody gets the support they need? The most important thing is that these stories are told in the right context. Nobody’s voice should be erased, and it’s really important to talk about the need for guidelines and standards in transgender healthcare, but detransition shouldn’t be used as an argument against the overwhelming benefits of gender-affirming care.
Likewise, we shouldn’t lose sight of the narratives that these kinds of stories can feed if they get into the wrong hands. The 60 Minutes segment isn’t entirely unreasonable – it presents stories of successful transition, and emphasises the evidence supporting gender-affirming care. But in misunderstanding the factors underlying detransition, and misrepresenting the risks associated with transition, it runs the risk of harming everyone, trans or not.