Commentary Argues Rising Youth Detransition Signals Iatrogenic Harm in Gender-Affirming Care

Iatrogenic Harm in Gender Medicine

Commentary & analysis Detransition & regret Medical ethics & consent

Authors: Sarah C. J. Jorgensen
Journal: Journal of Sex & Marital Therapy
Year: 2023
Source: www.tandfonline.com/doi/full/10.1080/0092623X.2023.2224320

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 describes rising detransition among young people as harm caused by medical care. She compares it to past medical harms such as heart valve damage from diet pills, heart risks from some painkillers, and the opioid crisis.
She cites studies suggesting 10 to 30% of people who start medical transition stop within 16 months to four years. In one survey, only 24% of detransitioners told their gender clinic.
She argues that low regret figures mostly come from adults treated under stricter rules, from studies where many people dropped out, and from narrow definitions of regret, such as asking to reverse legal sex or surgery.
She says mental health assessment is often dismissed as 'gatekeeping', and that stigma is used to explain mental illness and autism that often started before the gender distress.
She notes that the main international transgender care guideline (WPATH's 8th edition) has no chapter on detransition, a key hormone guideline gives no advice on safely stopping hormones, and a 2018 US paediatric statement does not mention regret.
She points to Sweden, Finland and England, whose official reviews found the evidence weak, as having moved to put talking therapy and treatment of other mental health problems first for minors.
She calls for open debate, research and teamwork between clinicians so that regret becomes truly rare, and for detransitioners to be recognised as people harmed by care and given tailored support.

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.

Methodological limitations

Opinion, not new research: This is a six-page opinion piece. It has no new data and no systematic review of the evidence, so its main claim, that detransition shows harm from care, is argued rather than shown.
Stopping treatment isn't the same as regret: The 10 to 30% figure comes from a UK adult clinic records review (Hall et al. 2021, where 12 of 175 people, or 6.9%, fit a detransition definition) and US military pharmacy data (Roberts et al. 2022, average age 19, 70% still on hormones at 4 years). Neither focuses on people who started as teens, and neither measures regret or harm.
No overall balance of harm and benefit: Without figures for benefit, regret and harm in the same group of patients, the piece cannot show how often this care does more harm than good overall, as opposed to harming some people.
The comparison assumes the answer: Comparing youth transition with diet pills, a withdrawn painkiller or opioids presents harm as proven. The evidence the author describes is mainly uncertain, not proof of overall harm.
Leans on self-selected detransitioner surveys: Claims about why people detransition rely heavily on online surveys of volunteers (Littman 2021; Vandenbussche 2022) and one case report (Gribble et al. 2023). These may over-represent people with bad experiences.
One-sided on stigma: The piece notes that mental illness and autism often come before gender distress, but does not discuss evidence that stigma and discrimination also harm transgender people's mental health.
Not every detransitioner was harmed: Some people detransition because of outside pressures, or do not regret their earlier treatment (for example Turban et al. 2021). Calling all of them 'survivors of iatrogenic harm' (harm caused by medical care) may not fit everyone.
Guideline criticism partly overstated: WPATH's 8th edition has no dedicated chapter on detransition, but it does discuss it in several places. Saying there is little guidance is fairer than suggesting the topic is ignored.
Policy changes simplified: Sweden, Finland and England restricted medical transition for minors rather than banning it, keeping it for selected cases or research. The piece compresses this.
Clear position, no conflicts declared: The author declares no conflicts of interest. She writes as an advocate for caution and does not engage with the strongest counter-arguments or evidence that some patients benefit.

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