Key Findings

• The paper proposes a new typology distinguishing 'core' detransition (driven by reidentification with birth sex) from 'non-core' detransition (stopping transition while still identifying as transgender due to external pressures or health concerns).
• Healthcare providers should not rely solely on patient self-identification for clinical decisions, as identities can be fluid; comprehensive psychological assessments and differential diagnosis remain essential.
• Clinicians need to provide honest, transparent communication about the benefits, risks, and limitations of gender-affirming treatments to ensure meaningful informed consent.
• Core and non-core detransitioners have different healthcare needs, requiring tailored clinical guidelines—core detransitioners need help coping with dysphoria without medical transition, while non-core detransitioners may need support for discrimination or medical complications.
• Detransition should not be viewed as automatic 'failure' or 'regret'; clinicians must adopt non-judgmental, compassionate approaches with regular long-term follow-ups for all patients.
• Some individuals initially detransition to non-binary identities before fully reidentifying with their birth sex, suggesting non-binary identification can function as a stepping-stone rather than endpoint.
• The paper notes elevated rates of autism spectrum traits among core detransitioners, possibly linked to intense or obsessional interests around gender. This co-occurrence warrants careful clinical screening rather than automatic affirmation.

Abstract

Gender detransition, i.e., the process of reidentifying with one's birth sex after having undergone a gender transition, has captured the attention of the scientific community, the media, and the public in the last few years. Despite not being a genuinely novel phenomenon from a historical perspective—psychiatrist Harry Benjamin described one such case in his 1966 book The Transsexual Phenomenon—, research on detransition has been absent from the academic literature until recently. As a consequence, our understanding of this issue is still limited and primarily based on anecdotal evidence, which comes from a variety of sources such as personal testimonies shared on the internet, parent reports, informal surveys carried out by detransitioners, media outlets, support groups, documentaries, case studies, and the experiences of clinicians who work with this cohort. Gender detransition is as scientifically fascinating as socially controversial, for it poses significant professional and bioethical challenges for those clinicians working in the field of gender dysphoria. However, the scarcity of information, along with the lack of formal recognition of detransitioners and their experiences, has contributed to a state of things in which we fall short of a shared and scientifically consolidated language to approach detransition. This gap has favored the proliferation of inconsistent usages of the concept, thus adding to the confusion and unclarity. The term 'detransition' has been used to describe two types of situations. In the first, a person stops identifying as transgender after having socially, legally, or medically transitioned. In the second, a person stops transitioning due to health concerns, lack of societal/familial support, or dissatisfaction with the results—but does not cease to identify as transgender. This article proposes a typology of gender detransition based on the cessation or continuation of a transgender identity, distinguishing between core (primary) and non-core (secondary) detransitions, and discusses its implications for healthcare providers working with gender dysphoric patients.

Summary

This paper proposes a typology of gender detransition that distinguishes between 'core' detransition (cessation of transgender identity and reidentification with birth sex) and 'non-core' detransition (stopping or reversing transition while maintaining transgender identity due to external factors like discrimination, health concerns, or dissatisfaction with results). The author argues this framework can help resolve inconsistent uses of the term 'detransition' and provides tailored clinical recommendations for healthcare providers working with gender dysphoric patients, emphasizing comprehensive psychological assessments, informed consent, and the need for specific guidelines to support the distinct needs of both detransitioner populations.

Conclusion

Gender detransition is an emerging yet poorly understood phenomenon in our society, which poses significant professional and bioethical challenges for clinicians working in the field of GD. The absence of systematic research around detransition has given rise to inconsistencies in its conceptual use and application, adding to the unclarity and confusion. A typology of gender detransition based on the cessation or the continuation of a transgender identity could address these issues, while offering clinicians a framework to reflect on their therapeutic endeavor when treating patients with GD. Furthermore, recognizing the disparities between core and non-core detransitioners could also help develop clinical guidelines, thus assisting healthcare providers to accommodate their different needs and demands. The conducting of comprehensive exploratory assessments can prove to be a useful tool to ensure thoughtful decision-making and prevent any potential harm associated with the experience of detransition. In conclusion, detransitioners are an underserved population whose experiences we need to listen to and understand if we truly aim to improve healthcare for people with GD. This will require extensive research to learn more about their unique experiences, motivations, needs, and demands.