“Only one to two percent detransition. Why should we gate-keep health services to the ninety-eight percent of happy trans people to help such a small minority?”
We can refer to this as the Greater Good argument, which is frequently used to dismiss complaints expressed by detransitioners about the state of “gender affirming care.” It’s a problematic and narrow mindset, as it ignores the needs of a vulnerable population and discourages inquiry into alternative treatment methods for managing gender dysphoria.
In an article published in 2019, NBC asserts that“[Trans advocates] say that the current narrative makes ‘transition regret’ seem more common than it is and contributes to misconceptions about transgender people in general”(1). The feature then proceeds to condemn the spread of “misinformation” about the transition process whilst platforming agenda-driven activists, including Jack Turban, a researcher specializing in gender medicine who receives stipends from the same pharmaceutical companies that manufacture puberty blockers (2,3). Ironically, the piece is packed with misinformation about detransition (among other dangerous myths, like the Suicide Myth and the myth of puberty blockers being reversible).
The article cites the 2015 US Transgender Survey conducted by the National Center for Transgender Equality, noting that it found that eight percent claimed to have detransitioned at some point, but that an overwhelming majority did so due to external factors such as social pressure and discrimination (4). According to the authors, only 0.4 percent of the participants detransitioned after realizing transitioning wasn’t for them. Researchers like Turban, news outlets like NBC, and trans-positive organizations like gendergp.com and Stonewall cite this figure as confirmation that detransition is generally rare, and that most who detransition do so because of external factors (5-7).
On a surface level, this conclusion may seem logical. However, the authors of the 2015 US Transgender Survey describe their methodology as inclusive of all individuals who identified as “transgender, trans, genderqueer, and non-binary.” Notably, “detransitioner” was not one of the options listed.
Of the detransitioners who have shared publicly on social media as well as conventional media, the vast majority no longer claim a trans, genderqueer, or non-binary identity, so the 2015 survey’s design would have omitted all of them. It also doesn’t account for the numbers of individuals who, tragically, may have taken their own lives after transition didn’t turn out to be the cure-all that trans activists and clinicians promised.
Observation and speculation alone aren’t the most reliable sources, but in addition to what we see in the media, recent research also indicates that most people who detransition no longer identify as transgender. A 2021 online survey of 237 detransitioners revealed that seventy percent of those surveyed reported detransitioning because they realized their gender dysphoria was related to other issues (8). A second survey of 100 detransitioners, also published in 2021, found that the most common reason for detransitioning was that participants became more comfortable identifying as their natal sex (9). Ideally, there would be more studies on this population with larger sample sizes, but it’s remarkable that detransitioners’ own accounts of their experiences prove to be wildly different than how trans advocates characterize them.
Conducting detransition research on a population that still identifies as “gender-diverse” is only one method of omitting detransitioners, however. Some of the largest studies to date on detransition only examined cases of reported regret, in which a patient informs their doctor or gender clinic of their detransition. One of these is a 2019 study by Davies, McIntyre and Rypma, which boasts a detransition rate of only 0.47% (10). Its methodology consisted of scanning electronic medical records for words related to detransition or regret. This study, along with the 2015 Transgender Survey, is cited on gendergp.com, a hub of scientific and medical misinformation and one of the first search results to appear upon Googling “detransition.”
It seems unlikely that a patient who was traumatized by medical treatment would go back to the same provider who harmed them, and indeed, the majority of detransitioners who responded to the 2021 survey by Littman admitted to never having gone back to their previous providers (9).
Some detransition studies, like a Swedish study published in 2018 (which is cited in the 2019 NBC article and on gendergp.com) examined the rates of transition regret in individuals who legally and/or surgically transitioned between the years of 1960 and 2010 (11). Until 2013, Swedish people considering transition were required to be unmarried and already sterile, as well as having experienced gender dysphoria since early childhood and presented as the opposite sex for a considerable amount of time. It is outrageous to calculate a detransition rate based on this population and presume it to be applicable to today’s cohort of patients, as the Swedish requirements are no longer in place, and the demographic of people seeking transition today is drastically different than it was decades ago. In many places in the US, hormone prescriptions and letters of approval for surgeries can be accessed after a single appointment as per the “informed consent” model, and in some cases via telehealth or online services (12-15). Trans activists have pushed so hard for the removal of safeguards that any barriers to irreversible body modification now are decried as dated at best, and transphobic at worst.
Yet another method of excluding detransitioners from research on trans “healthcare” is through shockingly high loss-to-follow-up rates, i.e. percentages of participants who do not complete the studies they are involved in. In scientific research, a loss-to-follow-up rate of 20 percent or higher is considered to seriously impact the validity of a study’s conclusion (16). Within the body of research examining outcomes of medical transition, a 20 percent (and often much higher) loss-to-follow-up rate is common. Roberto D’Angelo notes in a 2018 Australaisan Psychiatry article that five well-cited studies in the field allege positive outcomes of medical transition, despite reporting loss-to-follow-up rates ranging between 20 and 63 percent (17). D’Angelo explains, “...most studies have very high drop-out rates, which results in a selection bias, as individuals who regard their sex-reassignment surgery (SRS) as a failure are more likely to be lost to follow-up.” He also comments in the conclusion that, “It is not known whether… [these patients] have not been helped or indeed harmed, and most concerningly, it is generally not known whether they are alive or dead.”
Similarly, studies with short durations conveniently and perhaps deliberately filter out detransitioners and others with negative transition outcomes. According to Vandenbussche’s survey, the average time elapsed between the participants’ transition and detransition was 4.7 years (8). Other sources found this time period to be even longer, up to 8.5 years (18). A 2021 meta-analysis on regret after “gender-affirmation” surgery which found a regret rate of one percent included no studies with a long enough follow-up period to reliably identify regret (18, 19).
Between 2019 and 2022, many right-wing media outlets reported on the phenomenon of detransition (20-23). But mainstream and left-wing news outlets were mostly silent, and when they did broach the subject, it was usually to parrot the talking points of trans influencers while overstating the reliability of their sources.
However, two very recent articles from more mainstream media outlets – Reuters and The Atlantic – finally acknowledge the increase in detransitioners and the lack of sound science on the matter. The authors of the Reuters article note, “Studies that are available yield a wide range of results for various definitions of detransition, regret, or continuation of care. Due to their limitations, the studies lack definitive answers.” It then goes on to list the enormous range of calculated detransition rates from different studies – from less than one percent up to twenty-five percent depending on the study (24). Most of these papers examined trans adults and not minors, meaning that the detransition rate for minors is even more uncertain. However, eleven studies suggest that most children who are met with a watchful waiting approach to treating gender dysphoria desist (recover) from their condition naturally, without medical intervention (25).
The Atlantic article posits, “Even if the 2 percent figure holds, the absolute number of detransitioners is likely to increase dramatically as more trans and nonbinary people elect medical and surgical treatments” (26). This touches on a critical point: even if detransitioners are a small minority of those who transition, they are still real people who have been harmed, and any treatment model that results in irreversible, devastating, and avoidable effects should be heavily scrutinized.
Although we do not currently have enough information to determine whether detransition is relatively rare or not, it is clear that increasing numbers of detransitioners are coming forward with disturbing stories of medical malpractice and suffering at the hands of their providers. Our Transition Justice project is designed to connect these vulnerable people with legal assistance, so that they can seek reparations for the harms done to them. Thank you for your contributions, as they help us to continue providing support for those hurt by gender medicine and their families.
References
Knox, Liam. “Media’s ‘detransition’ narrative is fueling misconceptions, trans advocates say.” NBC News. 19 Dec 2019.
“Incomplete Financial Disclosure in a Viewpoint.” JAMA. 2021;326(1):90. 4 Jun 2021.
Turban, et. al. “Pubertal suppression for transgender youth and risk of suicidal ideation”: Erratum. Pediatrics. 147(4), Article e2020049767. 1 April 2021.
James, et. al. “The Report of the 2015 U.S. Transgender Survey.” National Center for Transgender Equality. 2016.
Turban, et. al.. “Factors Leading to ‘Detransition’ Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis.” LGBT Health. 1 Jun 2021.
“Detransition Facts and Statistics 2022: Exploding the Myths Around Detransitioning.” GenderGP. 21 Jun 2021.
“Dispelling myths around detransition.” Stonewall. 07 Oct 2019.
Vandenbussche, Elie. “Detransition-Related Needs and Support: A Cross-Sectional Online Survey.” Journal of Homosexuality. Vol. 69, Issue 9. 20 Apr 2021.
Littman, L. “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):3353-3369 19 Oct 2021.
Davies, S., McIntyre, S., Rypma, Ca. “Detransition rates in a national UK Gender Identity Clinic.” 3rd biennial EPATH Conference Inside Matters. 11 Apr 2019.
Dhejne, et. al. “An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960-2010: Prevalence, Incidence, and Regrets.” Archives of Sexual Behavior. 43(8). May 2014.
Riedel, Samantha. “This Map of Informed Consent Clinics is Helping Trans People Find HRT.” Them.us. 17 Feb 2022.
“What to Expect on Your First Visit and Beyond.” Planned Parenthood Mar Monte.
Gender-affirming care from home Plume. getplume.co.
HRT made easy. Folx Health. folxhealth.com.
Dettori, Joseph. “Loss to follow-up.” Evidence-Based Spinal Care. 2(1):7-10. Feb 2011.
D’Angelo, Roberto. “Psychiatry’s ethical involvement in gender-affirming care.” 26(5) 21 May 2018.
Exposito-Campos, P., D’Angelo, Roberto. “Letter to the Editor: Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence.” Plastic and Reconstructive Surgery - Global Open. 9(11):p e3951. Nov 2021.
Bustos, et.al. “Regret after gender-affirmation surgery: a systematic review and meta-analysis of prevalence.” Plastic and Reconstructive Surgery- Global Open. 2021;9:e3477.
Schlott, Rikki. “Gender-affirming care for transgender kids is going to backfire: experts.” New York Post. 3 Sep 2022.
Lockwood, Sally. “‘Hundreds’ of young trans people seeking help to return to original sex.” Sky News. 5 Oct 2019.
Kearns, Madeleine. “Wanting to Be Women Again.” National Review. 14 July 2020.
“Portrait of a detransitioner as a young woman.” The Economist. 6 Nov 2021.
Respaut, R., Terhune, C., Conlin, M. “Why detransitioners are crucial to the science of gender care.” Reuters. 22 Dec 2022.
Levine, S., Abbruzzese, E., Mason, J. “Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults.” Journal of Sex & Marital Therapy. 48:7, 706-727. 17 Mar 2022.
Valdes, Leo & MacKinnon, Kinnon. “Take Detransitioners Seriously.” The Atlantic. 18 Jan 2022.
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