Summary

Detransition is often called rare. In this short opinion piece, Sarah Jorgensen argues that the rising number of young people who regret transition should be seen as harm caused by medical care, like past cases where drugs later proved harmful. She says the gender-affirming approach skips proper assessment, plays down risks, blames mental health problems mostly on stigma, and rests on weak evidence, as official reviews in Sweden, Finland and England found. She notes the main guidelines give little advice on detransition. She calls for open debate, more research, and recognition and support for detransitioners. It is a clear statement of concerns, but it is opinion, not new research. Its 10 to 30% figures come from a few studies that counted people stopping treatment, which is not the same as regret.

Key findings

• Jorgensen beskriver stigende detransition blandt unge som skade forårsaget af medicinsk behandling. Hun sammenligner det med tidligere medicinske skader såsom hjerteklapskader fra slankepiller, hjerterisici fra visse smertestillende midler og opioidkrisen.
• Hun citerer studier, der tyder på, at 10 til 30 % af dem, der begynder på medicinsk transition, stopper inden for 16 måneder til fire år. I én undersøgelse havde kun 24 % af detransitionisterne fortalt det til deres kønsklinik.
• Hun argumenterer for, at lave fortrydelsestal for det meste stammer fra voksne behandlet under strengere regler, fra studier hvor mange faldt fra, og fra snævre definitioner af fortrydelse, såsom at bede om at omgøre juridisk køn eller kirurgi.
• Hun siger, at psykisk vurdering ofte afvises som ‘gatekeeping’, og at stigma bruges til at forklare psykisk sygdom og autisme, der ofte begyndte før kønslidelsen.
• Hun bemærker, at den vigtigste internationale retningslinje for transkønnet behandling (WPATH's 8. udgave) ikke har noget kapitel om detransition, en vigtig hormonretningslinje giver ingen råd om sikkert at stoppe hormoner, og en amerikansk pædiatrisk erklæring fra 2018 ikke nævner fortrydelse.
• Hun peger på Sverige, Finland og England, hvis officielle gennemgange fandt evidensen svag, som at have gået over til at sætte samtaleterapi og behandling af andre psykiske problemer først for mindreårige.
• Hun opfordrer til åben debat, forskning og samarbejde mellem behandlere, så fortrydelse bliver virkelig sjælden, og til at detransitionister anerkendes som mennesker, der er skadet af behandling, og får skræddersyet støtte.

Abstract

Although transition regret and detransition are often dismissed as rare, the increasing number of young detransitioners who have come forward in recent years to publicly share their experiences suggests that there are cracks in the gender-affirmation model of care that can no longer be ignored. In this commentary, I argue that the medical community must find ways to have more open discussions and commit to research and clinical collaboration so that regret and detransition really are vanishingly rare outcomes. Moving forward, we must recognize detransitioners as survivors of iatrogenic harm and provide them with the personalized medicine and supports they require.

Conclusion

The medical community must find ways to have more open discussions and commit to research and clinical collaboration so that regret and detransition really are vanishingly rare outcomes. Last, we must recognize detransitioners as survivors of iatrogenic harm and provide them with the personalized medicine and supportive care that they need.