Barndomstraumer, ikke ægte kønsdysfori: Finske detransitionærer afslører de virkelige årsager til transition

Kønsdysfori og detransition hos voksne: En analyse af ni patienter fra en kønsidentitetsklinik i Finland

Kasusrapporter Detransition & fortrydelse Autisme, trauma & samtidige tilstande

Authors: Kaisa Kettula, Niina Puustinen, Lotta Tynkkynen, Liisa Lempinen, Katinka Tuisku
Journal: Archives of Sexual Behavior
Year: 2025
Source: pubmed.ncbi.nlm.nih.gov/40394447/

Summary

Finnish clinicians reviewed the records of, and reassessed, the nine adults who came back to their gender clinic in 2018 to 2019 wanting to detransition. Most had had hormones and chest or breast surgery years earlier. Nearly all had serious mental health histories, including depression, anxiety, borderline personality disorder, eating problems, self-harm and childhood trauma or sexual abuse. Looking back, most said their wish to transition came from difficulties growing up, especially as girls, and from unresolved distress, rather than from their gender identity. The clinic then made it easier for detransitioners to return and paid more attention to trauma. The study gives rare clinical detail on detransitioners. But it is tiny, has no comparison group, relies on records and memories gathered after regret, and compares its mental health figures with a different group of patients.

Key findings

Studiet dækkede alle ni voksne, der blev henvist til Helsinkis kønsklinik for voksne for at detransitionere i 2018 til 2019: syv født som kvinder, alle med stor fortrydelse, og to født som mænd med mindre fortrydelse.
I gennemsnit var de 25 ved første diagnose og 33 ved vurderingen af detransition. Fortrydelsen tog i gennemsnit syv år at vise sig (fem år for dem vurderet efter 2010).
Otte havde fået fjernet eller forstørret brysterne kirurgisk, og fire havde fået fjernet livmoder og æggestokke. På nær én havde alle brug for medicinsk behandling for at detransitionere.
Psykiske problemer var meget almindelige: humørforstyrrelser hos 89 %, angstlidelser hos 78 %, borderline personlighedsforstyrrelse hos 56 % og spiseforstyrrelser eller symptomer hos 78 %. Seks var blevet seksuelt misbrugt eller voldtaget.
Ved vurderingen af detransition identificerede fem sig med deres fødselskøn, tre som ikke-binære og én stadig som transkønnet.
Spurgt om, hvorfor de transitionerede, sagde seks, at det var hårdt at vokse op som kvinde. Andre årsager omfattede ikke at passe ind, traumer og i ét tilfælde at forveksle det at være homoseksuel med at være transkønnet.
Klinikken ændrede sin måde at arbejde på: ingen henvisning nødvendig for at komme tilbage, tættere samarbejde med patienternes psykiatere, gratis korttidsterapi og uddannelse af personale i at forblive neutrale.
Forfatterne siger, at resultaterne hverken støtter at lukke transitionstilbud eller at transitionere uden ordentlig vurdering.

Abstract

The aim of this study was to analyze the pathways of detransitioning, which is a rare, but serious complication of gender-affirming treatments (GATs). The patient group consisted of all patients who were referred to the Helsinki University Hospital's Gender Identity Clinic (GIC) wanting medical treatment for detransition from 2018 to 2019. A new assessment was made systematically and retrospective data were collected. The sample consisted of nine patients originally diagnosed with gender identity disorder (F64.0). Seven of them were assigned female at birth and two were assigned male at birth. All seven females at birth had "major" regret and both males at birth had "minor" regret. All patients except one male assigned at birth wanted their previous GAT to be reversed. The mean regret time (i.e., time from the first diagnosis of F64.0 to the beginning of the new evaluation period) was seven years. The detransitioners had a high number of psychiatric diagnoses. Childhood trauma, sexual abuse or rape, eating disorder symptoms, borderline personality, and psychotic symptoms were common among detransitioners. Retrospectively, the patients reported that the need for transitioning in the first place was not the transgender identity or gender dysphoria, but reasons related to the maturation process and unresolved psychological stressors. An assessment made by the psychologist at the GIC revealed childhood trauma and severe challenges in parenting and attachment. It is important to acknowledge, support, and evaluate those regretting treatments and/or detransition, and to learn from them.

Conclusion

Even though most adults seeking gender-affirming treatment benefit from it and are satisfied with the treatment, it is important to acknowledge, support and evaluate those regretting treatments and/or who wish to detransition, and to learn from them. Those who detransition have a high amount of childhood and sexual trauma, eating disorder symptoms, borderline personality disorders and psychotic symptoms. Evaluating and treating serious psychiatric illnesses first, to determine if the patients' dysphoria resolves without gender-affirming treatment, might reduce the cases of detransitioning. Sufficient psychotherapy might help prior to irreversible gender-affirming treatment. The need for more research is urgent, and a wider, unprejudiced voice in public discussion about detransitioning and regret is needed. It is important to encourage detransitioners to notify the gender identity clinic that they detransitioned, as it would provide valuable information to clinicians about patient outcomes. The results of this study should be used to inform the evaluation process, counseling, informed consent, and medical decision-making for patients with gender dysphoria. The results do not support eliminating transition services nor do they support proceeding to transition without adequate evaluation.

Methodological limitations

Only nine people: The authors admit it is hard to generalise, yet they still make clinical recommendations. Figures such as 89% are based on counts of fewer than ten people.
No comparison group: Without similar patients who didn't detransition, the study can't show that trauma or mental illness predicts detransition, rather than being common among all clinic patients.
Not a typical group: Only detransitioners who came back to this clinic for treatment or a legal gender change were included. The authors cite surveys suggesting only 24 to 29% of detransitioners tell their clinic.
People left out after the fact: Of 13 people found, three first assessed at another clinic (Tampere) were left out, as was one who developed psychosis (losing touch with reality) after starting treatment. Leaving that person out removes a relevant kind of harm.
Looking back after regret: Reasons for transitioning were taken from interview records made after patients had come to regret it, and may be coloured by how they see things now.
Sorted by clinic staff: Patients' reflections were taken from notes and sorted by one psychiatrist (one of the authors), with no independent second person checking.
Measures changed over time: Gender identity questionnaires and a gender and life satisfaction scale were only added in 2018, so there is no like-for-like comparison with the first assessment.
Regret not measured with a tested tool: 'Major' and 'minor' regret used Pfäfflin's 1993 categories, made for regret after surgery, and were judged by the clinicians.
Gaps in relationship data: A questionnaire on how people form close relationships was filled in by only six of nine patients, and the psychologist assessed eight. The gaps aren't explained.
Numbers don't match: The discussion says substance use disorders rose from 16% to 56%, and that eating disorders were 'rare (2%)' at first assessment. These don't match the counts in the paper's own table.
Unfair comparison: The mental health rates are compared with a 2014 group of transgender people (Heylens et al.) at a different time and place, so how much higher they are can't be measured reliably.
Claims go beyond what the study can show: The conclusion that treating mental illness first 'might reduce' detransition is untested, since all patients had been through the clinic's mental health assessment (though three started hormones on their own and two had private chest surgery before it was finished).
Old cases: First assessments took place between 1996 and 2014 at an adult clinic, so the findings may not reflect today's younger patients whose distress began in their teens.
Clinic judging itself: The work was funded by Helsinki University Hospital research money, and the authors are assessing their own clinic's process, though they declare no conflicts.

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Summary

Key findings

Abstract

Conclusion