Summary

Researchers surveyed 957 people in the US and Canada who said they had stopped, changed or reversed a gender transition, or wanted to. Most were born female and most described themselves as lesbian, bisexual or queer; 42% had at some point stopped and later restarted transition. Many reported poor care after detransitioning: about 43% said providers never seemed to know anything about detransition, and more than half sometimes or always avoided health care. People most often asked for clinicians who understand detransition, contact with other detransitioners, accurate advice on stopping hormones, help with reconstructive surgery, and therapy that takes trauma into account. Some stopped only because of cost, family rejection or losing access to care. The results show real unmet needs, but come from a self-selected online group and cannot show how common these experiences are.

Key findings

• 957 Personen wurden einbezogen (von 1.377 ausgefüllten Befragungen, nach Entfernung von Bots und gefälschten Antworten); 79 % waren weiblich geboren und 74 % lebten in den USA.
• Die meisten waren lesbisch, schwul, bisexuell oder queer (45 % bisexuell, 29 % queer, 27 % lesbisch), und 42 % hatten eine Transition beendet und später wieder aufgenommen.
• Nach der Detransition sagten 43 %, ihre Gesundheitsfachkraft habe nie von Detransition zu wissen geschienen, und nur 7 % sagten, die Behandelnden hätten immer davon gewusst.
• Das Meiden von Versorgung war häufig: 13 % mieden Gesundheitsfachkräfte immer und 45 % manchmal, wenn sie Versorgung brauchten, und 46 % brauchten manchmal oder immer Versorgung, bekamen sie aber nicht.
• In 563 schriftlichen Antworten waren die häufigsten unerfüllten Bedürfnisse Gemeinschaft und Unterstützung durch Gleichgesinnte (29 %), Behandelnde, die Detransition verstehen (29 %), persönliche Unterstützung (22 %) und psychische Versorgung (16 %).
• 46 Antworten baten um Rat zum sicheren Absetzen von Hormonen, und manche beschrieben, dass ihnen eine rekonstruktive Operation verweigert wurde, etwa durch vier Chirurgen abgelehnt zu werden.
• Manche beschrieben, durch Kosten, Verlust des Zugangs zur Versorgung oder Ablehnung durch die Familie zum Aufhören gezwungen worden zu sein, und wünschten sich Hilfe, die Transition wieder aufzunehmen.

Abstract

BACKGROUND: Detransition refers to stopping, shifting, or reversal of an initial gender transition. Some people detransition temporarily, and later re-start a transition process, or retransition. Despite calls for research and care surrounding detransition/retransition, these experiences remain poorly understood by care providers and LGBTQ2S+ community-serving organizations.

METHODS: Between December 2023-April 2024, a cross-sectional survey was administered to 957 individuals (aged 16 and older) living in the US or Canada who self-identified with experiences of detransition. Participants were recruited via advertisements across eight major social media platforms, direct emails sent to ∼1200 former research participants, and to >615 LGBTQ2S+ organizations and gender-affirming care providers. Mixed qualitative and quantitative data were collected and analyzed regarding participants' experiences and care needs during detransition and, if relevant, retransition. Data about care experiences and needs were analyzed descriptively using frequencies and percentages. Interpretive description was utilized to analyze qualitative responses.

RESULTS: Participants reported a wide range of current gender identities/expressions such as: woman (n = 386; 40.3%); gender nonconforming woman (n = 241; 25.2%); nonbinary (n = 238; 24.9%); and/or detrans woman; (n = 152; 22.5%). A majority of the sample were sexual minorities. A majority reported being bisexual (n = 429; 44.8%), queer (n = 277; 28.9%), and/or lesbian (n = 254; 26.5%). Qualitative analysis identified three key themes: (1) accessing detransition-related care needs within the gender-affirming care system; (2) detransition-related social/legal needs to navigate a second transition; and (3) detransition preventative and retransition needs. Each of these themes encompassed four subthemes, including access to detrans-knowledgeable care providers (n = 162; 28.8%); medical information (n = 62; 11.0%); mental healthcare and supports (n = 92; 16.3%); interpersonal supports (n = 124; 22.0%); and community supports (n = 163; 29.0%).

CONCLUSION: Greater understanding and community-led care relating to detransition/retransition from an LGBTQ2S+-affirming lens can help to mitigate minority stressors and distress associated with these experiences.

Conclusion

The current study contributes to the limited body of work regarding the experiences and care needs of detrans people and other SGM people who report identity fluidity and detransition/retransition. Findings indicate that, like other SGM people, detransition may be inadequately understood by some LGBTQ2S+ serving and gender-affirming care practitioners. Future research and community-led research on detransition/retransition can ameliorate this knowledge gap. Importantly, given the potential for country-specific differences in detransition/retransition experiences, future research should be more sensitive to geopolitical and healthcare delivery dynamics. (Abstract conclusion: greater understanding and community-led care relating to detransition/retransition from an LGBTQ2S+-affirming lens can help to mitigate minority stressors and distress associated with these experiences.)