Las personas destransicionadas suelen dejar las hormonas «en seco» sin apoyo médico, según un estudio canadiense

Experiencias de atención sanitaria de pacientes que interrumpen o revierten tratamientos previos de afirmación de género

Entrevistas e investigación cualitativa Atención y apoyo a destransicionadores

Authors: Kinnon R. MacKinnon, Hannah Kia, Travis Salway, Florence Ashley, Ashley Lacombe-Duncan, Alex Abramovich, Gabriel Enxuga, Lori E. Ross
Journal: JAMA Network Open
Year: 2022
Source: https://doi.org/10.1001/jamanetworkopen.2022.24717

Summary

Researchers interviewed 28 Canadians who had stopped or reversed a gender transition about their health care. Many stopped hormones suddenly and without medical advice, often because they feared being judged by clinicians or found care hard to get. They described changes in mood and energy, gender distress coming back, and doctors who did not know how to help. Many relied on online detransition communities instead. Some younger people had been pushed by parents to stop and later restarted. Most of those who had medically transitioned did not regret it, while about a fifth did. The study makes a believable case that people who stop treatment lack medical guidance and support. It cannot say how common these experiences or views are, because the group was small, self-selected and loosely defined, and the interviewers had all used gender-affirming treatment.

Key findings

Se entrevistó a 28 adultos de Canadá (18 nacidos mujer y 10 nacidos varón; el 71 % de 20 a 29 años). 27 habían hecho la transición médica, y el 56 % de ellos empezó entre los 18 y los 24 años.
Los motivos de la detransición incluían preocupaciones de salud, complicaciones de la cirugía, un sentido cambiante de la identidad de género, padres o parejas que no apoyaban, discriminación y dificultad para acceder a la atención.
Muchos dejaron las hormonas de golpe ('en seco') sin apoyo de salud mental ni supervisión médica, y las clínicas rara vez les hacían seguimiento después de que dejaran de acudir.
Las personas describieron a los clínicos como poco preparados o críticos con la detransición, y muchas buscaron información en grupos de detransición en línea.
De 27 que hicieron la transición médica, 18 (67 %) no expresaron arrepentimiento o valoraban positivamente el tratamiento pasado, 6 (22 %) se arrepintieron y 3 (11 %) tenían sentimientos encontrados.
Quienes cambiaban de hormonas tras la extirpación de testículos u ovarios solían tener supervisión médica, pero a menudo describían la atención como mala.
Los autores piden una guía médica sobre la detransición y que los clínicos no avergüencen a los pacientes que paran o revierten el tratamiento.

Abstract

Importance: Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition.

Objective: To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice.

Design, setting, and participants: Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed.

Main outcomes and measures: In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions.

Results: Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs.

Conclusions and relevance: This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.

Conclusion

This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions. The authors report accounts of people ceasing or reversing gender-affirming treatments with sub-optimal care, and call for research on clinicians' knowledge of detransition and the sources of detransition-related stigma.

Methodological limitations

Small, self-selected group: 28 people were found through social media, clinicians, detransition groups and personal contacts, including word of mouth. The findings, including the share with no regret, cannot be applied to detransitioners in general.
Very broad definition of detransition: Anyone who had stopped, changed or reversed any social, legal or medical transition could take part, including people who still identify as trans or nonbinary. This mixes very different experiences, from stopping hormones while staying trans to fully identifying again with one's birth sex.
Regret not properly measured: Regret, satisfaction and mixed feelings were judged from what people said in interviews, not with a tested questionnaire. So the 67%, 22% and 11% split is the researchers' sorting of interviews, not a true rate.
Memory may be wrong: Most people described events stretching over more than ten years, as the authors admit.
Accounts not checked: Clinicians and medical records were not consulted, so descriptions of the quality of care were not confirmed, as the authors admit.
Interviewers' and team's own stake: All interviews were done by trans or nonbinary interviewers who had used gender-affirming treatment, and the team includes supporters of such care. This may have helped people open up, but could also shape what they said and how the findings were read.
Claims go beyond the data: The discussion says hormones and surgery work well across the population. That claim comes from other research, which independent evidence reviews rate as low certainty, not from this study.
Canadian setting: The findings reflect Canadian health policies and access to care during COVID-19 lockdowns, and may not apply to other health systems.

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Abstract

Conclusion