Overview

Some decisions change the person who makes them. Becoming a parent, converting to a religion, emigrating, or taking hormones that reshape the body and mind are not just choices between outcomes. They change what the chooser knows, what they value and who they are. The philosopher L. A. Paul calls these transformative experiences, and her book Transformative Experience (Paul 2014) argues that the ordinary picture of rational choice breaks down when we face them.

This page sets out Paul's argument and the main replies to it. It then adds findings from the psychology of prediction and regret, and applies both to gender transition and detransition. The framework cuts both ways. It explains how a person can be completely certain about transition and later regret it without having been foolish. It also explains why detransition is a leap into the unknown in its own right, and why some trans-identified people say their future self is exactly who they hoped to become. What it cannot do is let anyone, whether a teenager, a parent or a clinician, know ahead of time which of those futures is coming.

Many detransitioners describe the gap between what they expected and what they lived:

It's also denying that "knowing the risks" of a decision is completely different than actually experiencing it. Most people who transition think they are 100% sure it's what they want —wetfart41968, detrans female

L. A. Paul and the vampire problem

Paul opens her book with a thought experiment. Suppose you could become a vampire. Every friend who has done it says it is wonderful. But you cannot know what it would be like to be a vampire until you are one, and once you are one your tastes, priorities and sense of self will be a vampire's, not yours. How could you rationally decide? The example is fanciful on purpose. Paul's real target is ordinary life, and her central case is deciding to have a first child (Paul 2015a).

Epistemic transformation

An experience is epistemically transformative when you cannot know what it is like until you have it. Knowing every fact about it is not enough. Paul draws on an older debate in the philosophy of mind, Frank Jackson's thought experiment about Mary, a colour scientist raised in a black-and-white room who learns something new the first time she sees red. Some knowledge, on this view, comes only from experience (Chan 2023). Tasting a new fruit is epistemically transformative, but trivially so.

Personal transformation

An experience is personally transformative when it changes your core preferences, your life goals or your sense of who you are. A new parent may come to value things they never cared about, such as sleep, safety or a particular small person, and stop caring about things that once defined them. Paul's important cases are those that are both epistemically and personally transformative. They are high-stakes because you cannot know what the experience is like, and the person who will live with the result will judge it by values you do not yet hold (Paul 2014).

Why expected-value reasoning breaks down

Standard decision theory tells you to list the possible outcomes, estimate how likely each one is, give each a value, and choose the option with the highest expected value (each outcome's value weighted by its probability). Paul argues that transformative choices undermine this in three ways (Chan 2023):

• "What it's like" uncertainty: if you cannot know what the experience will be like, you cannot assign it a value from your own point of view.
• Future preference uncertainty: even if you could, the values you would use belong to your present self, and the experience may replace them with different ones.
• Self uncertainty: if the change is deep enough, the person who comes out the other side may not feel like the same person, so it is unclear whose interests the decision is meant to serve.

In her summary of the book, Paul puts the trap simply: in these choices "we only learn what we really need to know after we have already committed ourselves" (Paul 2015b). She adds that refusing the experience is also a choice. Doing nothing is not a neutral option.

Paul's answer: choosing for revelation

Paul does not conclude that big decisions are hopeless. She suggests reframing them. Instead of asking "will I like the outcome?", you can ask "do I want to discover what this life is like and who I will become?" On this view you choose transformation partly for the sake of the revelation itself, and the choice is both rational and authentic, because it rests on your own wish to find out (Chan 2023).

Critics point out two weaknesses. Revelation is a poor reason when other people's welfare is at stake, as with a child. It also does not help you choose between two different transformations, because both would be revealing. Both weaknesses matter for gender transition, as later sections show.

Responses and alternatives

Ullmann-Margalit: big decisions

Before Paul, the Israeli philosopher Edna Ullmann-Margalit described "big decisions" as "core-affecting": choices that transform one's future self, so that one comes out a different person (Ullmann-Margalit 2006). She distinguished three ways people arrive at such changes:

• Opting: deliberately choosing one path over another.
• Converting: a sudden, sweeping shift of outlook, like a religious conversion.
• Drifting: sliding into a new life through small steps, without a single moment of decision.

Ullmann-Margalit doubted that big decisions could be fully rational in the decision-theory sense. She argued they could still be made reasonably. Her practical suggestion was to reduce two features that make big decisions dangerous: the sharpness of the break with one's previous life, and the point of no return. Moving in together before marrying is her example, because it softens the break and keeps a way out (Chan 2023).

All three routes appear in detransitioners' accounts. Some describe a deliberate, researched choice. Some describe something closer to conversion:

This is EXACTLY why I transitioned in the first place. It felt like a religious conversion where life suddenly had a deeper purpose and meaning. The hardest part of detransitioning was losing that. Now I feel like I’m on the outside looking in. —Ok-Parsnip4951, detrans male

Others describe drift: a new name, then a binder, then a prescription, with each step following from the one before. Drift is philosophically the most troubling of the three, because the big decision is never actually faced as one.

Pettigrew: choosing for changing selves

The philosopher Richard Pettigrew, in Choosing for Changing Selves (Pettigrew 2019), accepts that our values change over a lifetime. He argues that decision theory can be extended to handle this. In outline, you estimate how likely different future value-sets are, often using evidence about how people's preferences shift after similar experiences. You then weigh the interests of your past, present and future selves together, rather like a fair vote among them.

Paul has replied that this treats future selves like strangers whose preferences are pooled, which is exactly the relationship transformation disrupts. She also doubts that the satisfaction of very different selves can be meaningfully compared (Paul 2022). For this topic, Pettigrew's approach raises a practical question: what evidence is there about how people's values change after transition, and who collected it? The section on informed consent below returns to this.

Callard: aspiration

Agnes Callard's Aspiration: The Agency of Becoming (Callard 2018) argues that people can rationally work towards values they do not yet fully hold, as someone learning to love classical music or wine does. She calls the provisional reasons that guide such efforts proleptic reasons (reasons that anticipate a good one only partly understands). On her view, many transformations are not single leaps but long, effortful journeys. That gives some structure to the trans-identified person's claim that they are becoming who they aspire to be. It also fits detransitioners' accounts of slowly learning to inhabit their sexed body.

Can we know in advance after all?

Some philosophers deny that transformative experiences are as unknowable as Paul suggests. Elizabeth Harman argues that testimony from others and related experiences, such as caring for a younger sibling, give real evidence about what parenthood is like (Harman 2015). Others argue that the problem is a weak imagination rather than knowledge that is impossible in principle (Chan 2023). If they are right, then whose testimony a person hears before transitioning matters a great deal. Hearing only from people who are glad they transitioned is a biased sample of the futures available.

What decision science adds

Psychology does not settle the philosophical question, but it shows that people mispredict their future selves in systematic, measurable ways, even for choices that are not dramatically transformative.

Affective forecasting

Affective forecasting is predicting how we will feel about future events. Research by Timothy Wilson and Daniel Gilbert shows that people tend to overestimate how intensely and how long future events will affect them (Wilson & Gilbert 2005). One source of error is immune neglect: we underestimate how well we will adapt to bad events, so we fear them more than we need to (Gilbert et al. 1998). Another is focalism: when imagining a change, we picture the one thing that changes and forget the rest of life, which carries on much as before.

Both errors are relevant. A distressed teenager may predict that remaining in their sexed body will be unbearable for ever, and that transition will lift the whole weight. Detransitioners often describe the second prediction failing:

I was convinced that by taking hrt and going through the surgery my body would just magically fix itself and go through this metamorphosis and I'd be reborn into a new figure. This was not the case for me. —EveningAccident8319, socially trans, regrets medical transition

The end-of-history illusion

In a study of more than 19,000 people aged 18 to 68, Jordi Quoidbach, Daniel Gilbert and Timothy Wilson found that people at every age recalled changing a great deal in their personality, values and preferences over the previous decade, yet predicted they would change very little over the next one (Quoidbach et al. 2013). The authors called this the end-of-history illusion: each of us tends to think the person we are now is more or less finished.

The finding has critics. Commentators have pointed out that it compares people's memories of the past with their predictions of the future, rather than measuring actual change, and that "I will stay the same" can be the sensible guess when you know you will change but cannot say in which direction (BPS Research Digest 2013). Even so, the basic lesson holds. Present certainty about one's future values is weak evidence about what those values will be.

Detransitioners often describe their earlier self from exactly this distance:

Yes, I cannot believe I was in that mindset for years when I am so completely different now. How could I have thought those things and believed those things? Yes, it feels like a complete different person. —apricotblues, detrans female

Projection bias and preference change

Economists George Loewenstein, Ted O'Donoghue and Matthew Rabin describe projection bias: people exaggerate how much their future tastes will resemble their current ones (Loewenstein et al. 2003). Their examples are everyday ones, such as shopping while hungry, but the same bias applies to decisions about fertility, sexuality and the body. Wanting children is the clearest case in detransitioners' accounts:

So, to start with, you are very young. I'm 5 years older, and I can tell you, in the 5 years between me being 18 and 23, there's so much in my life that changed and in my life plans that have completely flipped on their axis. I used to want to get a hysterectomy as soon as possible, get rid of my breasts. … I never thought I'd ever want children, but I very much do. —Yraeve, desisted female

Some describe the change in preference happening only after coming off cross-sex hormones. The medication itself may be part of what shapes the values a person uses to judge it:

I realised I wanted a child only when I stopped the testosterone. For the first time my natural hormones were allowed to develop my body and mind as they should, and in a way that made me more sure of my decision to detransition, if that makes sense? —ExperienceNo2543, detrans female

Regret and regret aversion

Regret theory, developed by economists Graham Loomes and Robert Sugden, models people as weighing not only outcomes but the regret they expect to feel if another option would have turned out better (Loomes & Sugden 1982). Later research found that this anticipated regret shapes real choices, especially when people expect to learn how the road not taken would have gone (Zeelenberg 1999).

Thomas Gilovich and Victoria Medvec reviewed evidence that regrets have a time pattern: in the short term people regret things they did, but over a lifetime they more often regret things they didn't do (Gilovich & Medvec 1995). This finding is used on both sides of the transition debate. Trans-identified people often cite fear of never trying. Detransitioners point out that the research mostly concerns ordinary missed chances, not irreversible changes to the body, and that a regretted mastectomy cannot fade the way a regretted job choice can.

Transition as a transformative choice

Medical transition fits Paul's definition unusually well. No one can know beforehand what years of cross-sex hormones will feel like from the inside, how their sexuality and mood will respond, or how they will see their body at forty. The treatment may also change the very preferences by which they will later judge it. One philosopher writing from a trans-affirming perspective has described gender transition as a central example of transformative experience (McKinnon 2015). The detrans perspective agrees with the description and draws different conclusions from it.

Knowing the risks versus living them

Consent forms list effects. They cannot convey what those effects are like to live with. Detransitioners repeatedly describe this gap:

I do, even after my distress with my chest was so extreme it felt like torture. I could have never known it'd flip back around and hurt. It makes sense now but it was something I felt 100% sure of at the time. —Available-Snail, detrans female

She couldn't have predicted how she would feel before experiencing it. This is entirely understandable to many of us who went through the same sort of experience regardless of what we thought we knew going in. —UniquelyDefined, detrans male

The second comment comes close to Paul's own formulation. Certainty is not knowledge. The feeling of being "100% sure" was present both in people who stayed content and in people who later regretted, so it cannot tell them apart in advance.

Informed consent when the decision changes the decider

Informed consent means agreeing to treatment with an adequate understanding of its nature, risks, benefits and alternatives. The transformative-experience framework raises a deeper problem than missing information, which the critique of informed consent in gender medicine covers. Even complete information cannot give the patient experiential knowledge of the outcome or tell them what their future values will be.

In a survey of 100 detransitioners, 55% felt they had not been adequately evaluated before transition (Littman 2021). In a later sample of 78 young adults who had stopped identifying as transgender, most felt inadequately informed about risks and alternatives (Littman et al. 2024). These are self-selected samples, but they suggest that many patients did not get even the information that could have been given.

Paul and the sociologist Kieran Healy identify a related problem for research. When a treatment is transformative, studies comparing treated and untreated groups can mislead, because the treatment changes the people being measured (Paul & Healy 2018). Satisfaction surveys after transition are answered by the transformed self, using values the treatment may have helped shape. The same caution applies to detransitioners' retrospective verdicts, which also come from a changed person.

Time adds a further distortion. In the Amsterdam gender clinic cohort, the average time from starting hormones to expressing regret about gonadectomy (surgical removal of the testes or ovaries) was 130 months, nearly 11 years. The authors noted it might be too early to judge regret among people treated in the previous decade (Wiepjes et al. 2018). In a Swedish register study, the mean time from legal sex change to a regret application was 7.5 to 8.5 years (Dhejne et al. 2014, as summarised by Kettula et al. 2025). Follow-up that is shorter than the time it takes the future self to arrive will tend to miss it. See transition regret for more on how regret is measured.

Adolescents choosing for future adults

The philosophical literature discusses parents choosing transformative paths for children, for example whether a deaf infant should receive cochlear implants (Chan 2023). Youth gender medicine combines two such problems. A young person makes a transformative choice for an adult who does not yet exist, while parents and clinicians make a second choice about whether to allow it. The adolescent has the least life experience to imagine from, and, as the growing older page discusses, is at the age when identity and values are changing fastest.

In the detrans.ai cohort of about 3,094 r/detrans accounts, the median age at transition was 17 (n = 1,089), at starting hormones 18 (n = 876) and at detransition 21 (n = 877) (detrans.ai stats). These figures are self-selected and AI-extracted, not population rates. They still show a common pattern in these accounts: a decision made in the teenage years and reversed in the early twenties.

I knew the effects intimately, but because I was 15, it was in the same way as a child knowing about sex with an adult—the consent isn't meaningful. —Gwen543, detrans gay male

even 18 is far too young. i took my first T shot a week after my 18th birthday. it felt like making my first "adult decision" and that made me feel like i couldn't back out of it even when i had doubts. 18 year olds aren't thinking about their decisions longterm. —kickbugs, detrans female

Fertility is the sharpest example, because parenthood is Paul's own paradigm of an experience nobody can value in advance. A young teenager who says they will never want biological children is making a forecast about a preference that, for many people, has not yet formed. England's independent Cass Review recommended that all young people considered for a medical pathway be offered fertility counselling and preservation first, and that hormones from age 16 be prescribed with extreme caution (Cass 2024). Counselling can explain what infertility means. It cannot tell a 14-year-old how a 30-year-old version of themselves will feel about it. See wanting children.

Reasonable at the time, regretted later

The framework offers detransitioners a way to think about their past choices without self-contempt and without denial. A choice can be reasonable given what the person knew and felt at the time, and still turn out to be wrong for the person they became. Both things can be true:

Regret is such a loaded term. I don't regret my transition, but if I could do it again I certainly wouldn't. … That doesn't mean transitioning was the right thing for me to do, but at the time I made the best choice I could make with the knowledge I had. —verytiredcatto, detrans male

You did all that out of a place of love. You were trying to love your future self, and it turns out you changed your mind. —Creative-Act-952, detrans female

One commenter points out that the advice the person later wishes they had taken would have been heard by their earlier self, not their present one:

… Hindsight is 20/20, but even if you had stayed with that therapist it would have been as the person you were then, not the person you are now. You were likely never going to listen to her. —Nazianzun

This does not dissolve responsibility. It moves much of it. An individual cannot be blamed for being unable to know what Paul argues cannot be known in advance. Institutions are in a different position. Clinicians and guideline writers do have access to the aggregate evidence: regret that appears years later, people lost to follow-up, and the unreliability of certainty. Many detransitioners argue that the people with that knowledge carried the duty to slow down and explore other explanations for distress (see reframing dysphoria), and that the duty should not fall on a distressed teenager's confidence.

Detransition is also transformative

Detransition is not a return to a saved file. The person who stops hormones is not the person who started them. Their body, social world and self-understanding have all changed, and they cannot know in advance what living as their sex will be like as an adult. In Paul's terms, detransition is also epistemically and personally transformative, and it is chosen under the same uncertainty:

… Not knowing what our life can look like if we make a change can be terrifying, but you are going to face doubt either way. —OnceBitten8240, detrans female

Some detransitioners grieve an untransformed self they will never meet:

… I started transitioning medically at 14 years old. Looking back at old pictures of myself, it's hard to know what I would have looked like. That is my greatest difficulty having detransitioned. I don't know who I could have been, what I would have looked like. —pineconepygmy, detrans female

Seeing detransition this way has three consequences. First, detransition, like transition, can be reached by opting, converting or drifting. Some "click" moments described on the realisation moments page resemble conversion. Second, Paul's point that refusing a change is also a choice applies here too: staying on a medical pathway out of fear of the unknown is itself a decision. Third, the detransitioned self's judgement of the past is, like the transitioned self's, made from a transformed point of view. The existentialism page explores this further: we choose our selves without a fixed vantage point from which to judge the choice.

Most, if not all, detrans people couldn't fathom the thought of detransitioning or regretting their transition. That's the whole point. —fir3dyk3, desisted female

"My future self is who I wanted to become"

Many trans-identified people describe their decision in terms close to Paul's idea of choosing for revelation, and to the research on regret over things not done:

The thought of reaching the end of my life and wondering, "What if I had? Could I have finally been happy?" was more terrifying to me than the slim possibility I might be wrong.

I had to know. —Confirm_restart, mtf

I realized that I wouldn't regret doing something that I felt was the right choice for me at the time, but I WOULD regret NOT doing it, because I would never know what might have happened. … —skiestostars, ftm

Others describe their present self as the person they set out to become:

… my way of looking at it is I spent that time figuring out who I'm not so now I can fully commit to being me without any regrets or what-ifs. —ottersinabox, MTF

Such accounts deserve to be taken at face value. People who are content with their transition are not shown to be wrong by this framework. The trans-affirming philosophical argument is also serious. If a person's present life involves severe, persistent distress, then even without knowing what transition will be like they may judge that the status quo is bad enough to justify the leap (McKinnon 2015, as summarised by Chan 2023).

From a detrans perspective, the framework adds three cautions:

• Satisfaction is not foresight. Content trans people and later detransitioners often describe the same certainty beforehand. A satisfied future self shows that the leap worked for that person, not that it was predictable, so it cannot reassure the next person that it will work for them.
• Revelation has a price. Paul's revelation reason works best when the experience can be had and then left behind. "I had to know" weighs very differently for a social experiment than for a mastectomy or lost fertility, where the knowledge arrives after the point of no return.
• The status quo is not the only alternative. McKinnon's argument compares transition with untreated distress. Detransitioners often say that a third path, treating trauma, depression, internalised homophobia or misogyny, or simply waiting, was never presented to them as an option. See distress persisted.

What the framework suggests

None of this is medical advice. Philosophically, though, the transformative-choice literature points in a consistent direction for anyone facing an identity-changing decision, and for the adults around them:

• Prefer revocable steps. Following Ullmann-Margalit, reduce the break with your previous life and the point of no return. Change how you dress, explore, and take time before taking any step that cannot be undone. Gender non-conformity needs no medical step at all.
• Widen your evidence. If others' experiences can partly substitute for your own, as Harman argues, listen to people who regret transition as well as people who are glad they did. The stories and videos archives collect detransitioners' accounts.
• Distrust certainty, including your own. The end-of-history illusion and affective-forecasting research suggest that the feeling of a settled future self is a feature of the present moment.
• Expect to change anyway. Whatever you choose, you will become someone you cannot fully picture now. That fact is not in itself a reason to make the most irreversible choice available.

Related pages

• Philosophical frameworks
• Existentialism
• Transition regret
• Growing older
• Critique of informed consent
• Healing and recovery
• Support directory

References

• Callard, A. (2018). Aspiration: The Agency of Becoming. Oxford University Press. publisher.
• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page, source.
• Chan, R. (2023). Transformative Experience. Stanford Encyclopedia of Philosophy. source.
• Dhejne, C., et al. (2014). An analysis of all applications for sex reassignment surgery in Sweden, 1960–2010: Prevalence, incidence, and regrets. Archives of Sexual Behavior, 43(8). doi.
• Gilbert, D. T., Pinel, E. C., Wilson, T. D., Blumberg, S. J., & Wheatley, T. P. (1998). Immune neglect: A source of durability bias in affective forecasting. Journal of Personality and Social Psychology, 75(3), 617–638. doi.
• Gilovich, T., & Medvec, V. H. (1995). The experience of regret: What, when, and why. Psychological Review, 102(2), 379–395. doi.
• Harman, E. (2015). Transformative experiences and reliance on moral testimony. Res Philosophica, 92(2), 323–339. doi.
• Kettula, K., et al. (2025). Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland. study page, source.
• Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. study page, source.
• Littman, L., O'Malley, S., Kerschner, H., & Bailey, J. M. (2024). Detransition and Desistance Among Previously Trans-Identified Young Adults. study page, source.
• Loewenstein, G., O'Donoghue, T., & Rabin, M. (2003). Projection bias in predicting future utility. Quarterly Journal of Economics, 118(4), 1209–1248. doi.
• Loomes, G., & Sugden, R. (1982). Regret theory: An alternative theory of rational choice under uncertainty. Economic Journal, 92(368), 805–824. doi.
• McKinnon, R. (2015). Trans*formative experiences. Res Philosophica, 92(2), 419–440. doi.
• Paul, L. A. (2014). Transformative Experience. Oxford University Press. doi.
• Paul, L. A. (2015a). What you can't expect when you're expecting. Res Philosophica, 92(2), 149–170. doi.
• Paul, L. A. (2015b). Précis of Transformative Experience. Philosophy and Phenomenological Research, 91(3). source.
• Paul, L. A. (2022). Review of Choosing for Changing Selves, by Richard Pettigrew. Philosophical Review, 131(2), 230–235. doi.
• Paul, L. A., & Healy, K. (2018). Transformative treatments. Noûs, 52(2), 320–335. doi.
• Pettigrew, R. (2019). Choosing for Changing Selves. Oxford University Press. doi.
• Quoidbach, J., Gilbert, D. T., & Wilson, T. D. (2013). The end of history illusion. Science, 339(6115), 96–98. doi.
• BPS Research Digest (2013). "The end of history illusion" illusion. British Psychological Society. source.
• Ullmann-Margalit, E. (2006). Big decisions: Opting, converting, drifting. Royal Institute of Philosophy Supplement, 58, 157–172. doi.
• Wiepjes, C. M., et al. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in prevalence, treatment, and regrets. Journal of Sexual Medicine, 15(4), 582–590. doi.
• Wilson, T. D., & Gilbert, D. T. (2005). Affective forecasting: Knowing what to want. Current Directions in Psychological Science, 14(3), 131–134. doi.
• Zeelenberg, M. (1999). Anticipated regret, expected feedback and behavioral decision making. Journal of Behavioral Decision Making, 12, 93–106. source.