Dismissing harmful stereotypes, Freya Petterson delves into the common misconceptions surrounding ‘detransitioning’ - a surgical process available for transgender individuals wishing to reverse their transition.
‘Detransition’ refers to “the stopping or reversal of transitioning which could be social (gender presentation, pronouns), medical (hormone therapy), surgical, or legal” [1].
Globally, there has been a steady increase in the sharing of transphobic rhetoric – particularly online. So many people get their social-political information from Twitter or Facebook and believe statistics relayed to them second-hand by high-profile celebrities, who cannot be relied upon to be factually accurate.
In the current political climate – which saw a bill presented in Florida, USA, that aims to restrict access to gender-affirming care and classify it as child abuse [2] – the danger posed simply by misinformation becomes critical. This concern presupposes that parents who support their children in gender affirmative action cannot be trusted to do so with their child’s best safety in mind. A common-sense counterargument would follow that children who are questioning their gender are first offered avenues to transition socially (haircuts, wardrobe changes, pronoun changes and such) and recommended to wait until after adolescence before considering anything surgical.
There have also been articles lately talking about the dangers of gender-affirmative medical treatments, such as hormone therapy and gender-affirmative surgery being potentially too accessible to people – especially young people. This concern presupposes that medical professionals are not capable of navigating these same concerns at an individual level. No doctors are leaping at the chance to offer gender-affirmative surgery to teens. It’s just effective propaganda.
Dr Michael Irwig of the Division of Endocrinology, Diabetes & Metabolism at Harvard Medical Centre gave his commentary on the heightening political awareness within public discourse on discontinuation rates following hormones or feelings of regret that were not relevant outside of the medical community until around 2016 [3].
The political implications of detransition rates being quoted as higher or lower than what is factually accurate means that finding readily accessible and unbiased information about the phenomenon online is much more difficult. Instances of regret and dissatisfaction following affirmative treatment are now being used to rally for stricter laws around who can and should be allowed to choose to transition and at what age.
So, what does it actually mean to detransition? Is a 1% regret rate unusual? If the rate of regret is higher than previously thought, then is it a concern? All of this is made clear through context and information. After compiling a vast array of scientific studies and meta-analyses, I’ve dug through the heavy reading so that you don’t have to.
Many early studies focused on the prevalence of feelings of regret following gender-affirmative surgical procedures without necessarily differentiating between what the source of regret was. This article speaks specifically to the rate of detransition following surgical treatment and the feelings most often associated.
There is an oft-cited statistic brought up in defence of gender affirmation treatment: "Only 1% of people who transition medically choose to later detransition” [4]. This statistic was originally stated in The Lancet Child & Adolescent Health’s Editorial. There has been further research since then that suggests the true rate might be higher, somewhere between 1 and 4 per cent.
One of the largest studies to look at detransition rates was a 2015 cross-sectional nonprobability study of 27,715 transgender and gender-diverse adults. The survey found that about 8% had detransitioned at some point following treatment, but the majority of these only did so temporarily. “Rates of detransition were higher in transgender women (11%) than transgender men (4%). The most common reasons cited were pressure from a parent (36%), transitioning was too hard (33%), too much harassment or discrimination (31%), and trouble getting a job (29%). [5]”
In a later 2020 meta-analysis of 7,928 transgender and gender-diverse individuals who had gender confirmation surgery, 1% expressed regret after surgery [6]. This was, in most cases, due to feelings of regret because of changes in psychological circumstances, particularly from a lack of support or negative reception from family, friends, and employers. This same meta-analysis noted one reason for regret was “poor surgical outcomes”, a concern that is less relevant as medical and surgical standards have improved.
Taking all of these statistics and extrapolating numbers of those who detransitioned for reasons other than true regret, the number of detransitioners is, in fact, 1% or less. People who detransition to return to their previous gender often had mental health factors at play or trauma originating from internalised misogyny. Some patients misinterpreted their sexual identity for gender dysphoria - “they assumed they were transgender because they did not yet understand themselves to be lesbian, gay or bisexual” [7]. The surgery itself is highly traumatic, and people who experience regret following gender affirmation surgery that prompts them to detransition deserve compassion. They don’t deserve to have their trauma monopolised by transphobes looking for a new narrative.
The fact is that surgical procedures like knee surgery or even elective surgical procedures like nose jobs or breast augmentation are not ever put to the same intense scrutiny gender affirmation surgeries are. This is not due to a lack of insight on the part of the medical professional, only a perceived moral difference.
No matter how high the regret rate is, what is most important is the autonomy of the patient and their right to make informed decisions regarding their own health. Any risk regarding later regret has to be balanced against the risk of not providing treatment. There is documented evidence that not providing affirmative treatment to transgender and gender-diverse individuals when it is requested leads to higher rates of self-harm and suicidality [8].
Sometimes a bad-faith argument is exactly that. A misappropriation of statistics and biased commentary meant to offer the bare bones of a factual statement while still fitting the political narrative most fitting to the arguer.
Some people detransition because they realise afterwards that they made a mistake and want to return to the way they were. This group deserves to be represented and supported, and they deserve more than being misrepresented and used to further the political goals of transphobes. It isn’t fair to them or to the vast majority of transgender and gender-diverse people who go on to live much happier lives after taking steps to medically and/or surgically transition.
[1] Michael S. Irwig MD. “Detransition Among Transgender and Gender-Diverse People – An Increasing and Increasingly Complex Phenomenon.” OXFORD ENDOCRINE SOCIETY: The Journal of Clinical Endocrinology & Metabolism. 2022, 107, e4261-e4262, https://doi.org/10.1210/clinem/dgac356
[2] Katherine Tangalakis-Lippert and Katie Balevic. “A rash of proposed Florida laws use 'genocidal rhetoric' to attack trans people, legal experts say.” Insider. Mar 14, 2023, https://www.businessinsider.com/legal-experts-proposed-florida-laws-genocide-against-trans-people-2023-3?op=1
[3] Michael S. Irwig MD. “Detransition Among Transgender and Gender-Diverse People – An Increasing and Increasingly Complex Phenomenon.” OXFORD ENDOCRINE SOCIETY: The Journal of Clinical Endocrinology & Metabolism. 2022, 107, e4261-e4262, https://doi.org/10.1210/clinem/dgac356
[4] Ken C. Pang et al. “Regret, Informed Decision Making, and Respect for Autonomy of Trans Young People.” THE LANCET: Child and Adolescent Health. Vol. 5, Issue 9. September 2021, https://doi.org/10.1016/S2352-4642(21)00236-4
[5] Michael S. Irwig MD. “Detransition Among Transgender and Gender-Diverse People – An Increasing and Increasingly Complex Phenomenon.” OXFORD ENDOCRINE SOCIETY: The Journal of Clinical Endocrinology & Metabolism. 2022, 107, e4261-e4262, https://doi.org/10.1210/clinem/dgac356
[6] Bustos, Valeria P et al. “Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence.” Plastic and reconstructive surgery. Global open vol. 9,3 e3477. 19 Mar. 2021, doi:10.1097/GOX.0000000000003477
[7] Littman L. “Individuals treated for gender dysphoria with medical and/or surgical transition who subsequently detransitioned: a survey of 100 detransitioners”. Arch Sex Behav. 2021;50(8):3353-3369.
[8] Bustos, Valeria P et al. “Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence.” Plastic and reconstructive surgery. Global open vol. 9,3 e3477. 19 Mar. 2021, doi:10.1097/GOX.0000000000003477