Detransition/Desistance
OVERVIEW
Terminology
Detransition is the process of stopping or reversing a transgender identification or gender transition. It is not a single event and the methods by which the process takes place can vary greatly among individuals. These methods include changes to one’s gender expression, social identity, legal identity documents, and/or anatomy. Reasons for detransitioning vary, as well. Not all detranstitioners regret their transition. Furthermore, all who regret their transition do not detransition or desist. Neither do all who detransition assume the gender identity they had prior to transition.
Desistance generally refers to the cessation of an identification or the experience of gender dysphoria. This term is often applied to children who “desist” prior to medical transition or to young people who in the early stages of medical transition stop the process.
Rates of Detransition
There are few studies of detransition. Estimates of the rates for detransition and desistance vary greatly, and lack consistent terminology and methodology in their assessments. In addition, until very recently efforts to maintain follow-up records has been very poor and many who do later desist or detransition do not recontact the clinicians who provided the original care. Based on the available evidence, detransition/desistance rates for individuals who first presented with a transgender identity or gender dysphoria as a minor vary depending on age, the extent of medical transition and the time at which the minor first presented.
Children Desistance Rates
Most studies of destransition/desistance were performed prior to the changes in the DSM-V in 2013 and review rates for children with early onset dysphoria prior to puberty. The rate of desistance for this population has not been clearly established. Studies show the rate to be between 60-90%. However, it is not known how and whether changes to the DSM-V, early social transition and the advent of puberty blockers has impacted persistence rates. For a comprehensive discussion of earlier studies and the the rates please see a summary by Dr. James Cantor “Do trans- kids stay trans- when they grow up?”.
Adolescent Rates
There are even fewer studies that have tracked resistance rates with respect to young people who initially present with a gender identity or gender dysphoria after the onset of puberty. A 2019 clinical assessment found that 9.4% of patients either stoped their pursuit of medical interventions or no longer held a gender identity incongruent with their biological sex.
With the introduction of the Informed Consent Model which requires no mental health assessment prior to prescribing cross sex hormones for all adolescents 18 years old and in States with Mature Minor Consent regulations at 16 years old, the rates of detransition/desistance will probably be much higher than in the past.
Reasons/Motives
The reasons commonly cited by detransitioners for their destranstion/desistance are: trauma, isolation, dissociation, inadequate mental healthcare, and social pressure. Many who detransition say that the progressive medical steps to “pass” as their self-perceived gender increased their gender dysphoria. Additional causes include financial barriers to transition, social rejection and depression due to transition, discomfort with sexual characteristics developed during transition, as well as, concern for lack of data on long-term effects of hormone therapy, concern for loss of fertility, and complications from surgery.
Standards of Care/Guidelines for Detransitioners
There are currently no professional guidelines or resources for providers who encounter patients who experience regret and/or seek detransition and limited discussion of the care needed by this population.
Please refer to ReIME’s Principles of Hormone Discontinuation.