Summary

This paper calls for research and clinical guidance for people who stop or reverse a gender transition. The authors note these people turn up in every follow-up study of young people with gender distress, yet professionals and activists have largely ignored them. They review figures on how common desistance is, theories about why it happens, and big gaps in the research, especially that today's patients are very different from those in older studies. They suggest early advice: support without judgement, accept that gender and sexuality can change, and keep medical teams on hand to help reverse treatment. They argue that with referrals rising, building evidence and clear guidance is urgent. It is a reasonable call to action, but it is opinion based on selected older studies, not new research, and its advice is not yet tested.

Key findings

• يظهر من يتوقفون أو يتراجعون عن التحول في كل دراسة متابعة للشباب ذوي الكرب الجندري. ومع ذلك تلاحظ المؤلفتان أنه لم تكن هناك إرشادات لدعمهم، بينما إرشادات التحول مفصلة.
• تقول التقديرات المستشهد بها إن 73% إلى 98% من الأطفال ذوي الكرب الجندري تجاوزوه (ريستوري وستينسما، 2016). وقد تكون الدراسات الأقدم شملت أطفالاً لا يتوافقون مع الأعراف الجندرية لكن ليس لديهم كرب جندري.
• كثيراً ما تفقد دراسات متابعة البالغين كثيراً من الناس وتدوم نحو سنة. وفي دراسة سويدية استغرق ظهور الندم 8 سنوات في المتوسط، لذا قد لا تعكس أرقام الندم الحالية مرضى اليوم بعد.
• تسردان خمسة تغيرات في المرضى: إحالات أكثر بكثير من الصغار، وأكثر ممن وُلدوا إناثاً، وأكثر من اللا ثنائيين، وأكثر ممن تحولوا اجتماعياً بالفعل، وأكثر ممن بدأ كربهم عند البلوغ.
• كما أن لدى كثير من المرضى الحاليين حالات نفسية أخرى أو توحداً، وهو ما نادراً ما نظرت فيه الأبحاث السابقة.
• نصيحتهما: الدعم دون حكم، والتعامل مع الهوية الجندرية والجنسية على أنها قابلة للتغير، والاهتمام بالأسرة والحياة الاجتماعية، وربط الناس بمجموعات أقران متنوعة، وإبقاء الفرق الطبية متاحة للمساعدة في عكس العلاج.

Abstract

The number of people presenting at gender clinics is increasing worldwide. Many people undergo a gender transition with subsequent improved psychological wellbeing (de Vries et al., 2014). However, some people choose to stop this journey, ‘desisters’, or to reverse their transition, ‘detransitioners’. It has been suggested that some professionals and activists are reluctant to acknowledge the existence of desisters and detransitioners, possibly fearing that they may delegitimise persisters’ experiences (Zucker, 2018). Certainly, despite their presence in all follow-up studies of young people who have experienced Gender Dysphoria (GD), little thought has been given to how we might support this cohort. Levine (2017) reports that the 8th edition of the WPATH Standards of Care will include a section on detransitioning - confirming that this is an increasingly witnessed phenomenon worldwide. It also highlights that compared to the extensive protocols for working with children, adolescents and adults who wish to transition, nothing exists for those working with desisters or detransitioners. With very little research and no clear guidance on how to work with this population, and with numbers of referrals to gender services increasing, this is a timely juncture to consider factors that should be taken into account within clinical settings and areas for future research.

Conclusion

Research with populations who desist and detransition is in its infancy and little is known about how best to work with this growing population. While there is increasing recognition of the need for support for those who require it, there are still no clear guidelines on how to do this work. We are at an important juncture where our evidence-base is based on previous cohorts that may not be applicable to the current population of desisters and detransitioners; it is prudent to consider their needs alongside those who go on to identify as trans for life.