Detransitioners: 55% say clinicians didn’t give adequate evaluation before gender transition

The research on gender dysphoria and transition in Western nations reveals a couple of clear trends. For one, the rates of sex reassignment surgeries and adolescents being referred to gender clinics have risen sharply over the past decade, amounting to what one researcher recently described as an “international phenomenon.” 

As these populations have grown, their demographics have been changing, too. In the mid-2000s, the majority of adolescents who sought treatment for gender dysphoria were natal males. But over the past decade or so, that sex-ratio has decidedly flipped, with far more natal females seeking treatment and many deciding to transition. The exact reasons for these changes remain unclear.

What is also missing in the research literature on gender dysphoria and transition is comprehensive data on a particular subpopulation: detransitioners — people who had gender dysphoria, pursued transition through medication or surgery, and then either stopped taking medication or had surgery to reverse a prior transition, or both. 

Detransitioning is a controversial subject. Some transgender rights advocates argue that media reports often exaggerate the prevalence of detransitioners, and that such overestimates risk fueling transphobia, delegitimizing the transgender experience, and discouraging young people with gender dysphoria from pursuing transitioning, which is beneficial for many people. 

But the reality is there’s hardly any empirical data on detransitioners or the size of their population. This lack of research is concerning to some medical professionals who feel that, amid the fast-rising rates of transitions and referrals to gender clinics, some young people might not be receiving sufficient, comprehensive medical evaluations and guidance.

A recent study aimed to shed light on the issue by surveying people who had detransitioned. The results, published in the Archives of Sexual Behavior, showed that the majority of respondents felt that their doctor or mental health professional failed to provide them with an adequate medical evaluation prior to transitioning. What’s more, most respondents did not inform their clinicians after they had detransitioned, suggesting that the total number of detransitioners could be underestimated. 

The study has limitations concerning sample size and anonymity, and the results don’t provide a comprehensive overview of the detransitioner population. But the study does raise questions about how medical professionals are approaching gender dysphoria, and it highlights the fact that transitioning is a complex process that is likely to help some people more than others. 

Surveying detransitioners

The study — conducted by Dr. Lisa Littman, a physician and scientist who researches gender dysphoria — centered on a 115-item survey completed by 100 people who reported that they had detransitioned. According to the definition in the study, detransitioning meant that the respondent had either stopped taking hormone medications or had surgery to reverse a prior transition, or both. About two-thirds of respondents were natal females and one-third were natal males. 

At the time of the survey, the respondents’ mean age was 29.2 years and 80% identified as transgender, 15% as nonbinary, and 3% as both. About 96% of the respondents had taken cross-sex hormone drugs; a minority had undergone genital or breast surgery.

The survey results included:

• Encouraging factors: Social media and online communities were reported as the top influencing factors in leading respondents to believe that transitioning would help them.
  
• Pressure to transition: 37% of respondents, most of whom were natal females, reported feeling pressured to transition. In open-ended answers, the respondents wrote statements like:
  • “My gender therapist acted like it [transition] was a panacea for everything.”
  • “[My] [d]octor pushed drugs and surgery at every visit.”
  • “I was dating a trans woman and she framed our relationship in a way that was contingent on my being trans.”
  • “A couple of later trans friends kept insisting that I needed to stop delaying things.”
    
• Reasons for transitioning: The most common reasons for transitioning included statements like:
  • “I wanted others to perceive me as the target gender.”
  • “I thought transitioning was my only option to feel better.”
  • “My body felt wrong to me the way it was.”
    
• Reasons for detransitioning: The most common reason for detransitioning was that the respondent’s “personal definition of male and female changed and they became comfortable identifying with their natal sex (60.0%).” Meanwhile, 23% of respondents reported discrimination as a reason for detransitioning.

Medical evaluations 

Most respondents (55%) felt that their pre-transition medical evaluation was inadequate. Additionally, 65.3% said their clinicians did not explore whether their desire to transition might be related to trauma or a mental health condition. That could be cause for concern, considering that 38% of respondents reported that one of the reasons they detransitioned was “discovering that something specific like trauma or a mental health condition caused their gender dysphoria,” as the study noted.

Research on children with gender dysphoria shows that the condition tends to resolve itself over time for about 85% of people. It is not exactly clear why. But the process, called “desistance,” might be a byproduct of getting older, or it could be due to the fact that many people who present with gender dysphoria, especially young people, ultimately turn out to be gay, lesbian, or bisexual, and many eventually come to peace with that identity.

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In the recent study, for example, 23% of respondents reported that “internalized homophobia and difficulty accepting oneself as lesbian, gay, or bisexual” was a reason for transitioning. Some of their responses included statements like:

• “At the time I was trying to figure out my identity and felt very male and thought I was transgender. I later discovered that I was a lesbian…”
• “Well, after deep discovery, I realized I was a gay man and realized that a sexual trauma after puberty might [have] confused my thought. I wanted to live as a gay man again.” 
• “What would have helped me is being able to access women’s community, specifically lesbian community. I needed access to diverse female role-models and mentors, especially other butch women.”

Of course, for many people with gender dysphoria, transitioning is the best option. But Littman noted that gender dysphoria is complex, and it is important to value the experiences and well-being of all people who experience it.

“This means caring about people who have been helped by transition and people who have been harmed by transition; people who had underlying conditions causing their gender dysphoria and people who did not; people whose gender dysphoria persisted and people whose gender dysphoria resolved,” Littman told Big Think. 

Although transitioning helps many people, Littman said that some cases of gender dysphoria require clinicians to take a more nuanced and comprehensive approach. “Failing to explore co-morbidities and the context in which the gender dysphoria emerged puts patients at risk of harm from misdiagnosis, delayed diagnosis, and receiving the wrong treatment for their distress.”