Summary
This paper calls for research and clinical guidance for people who stop or reverse a gender transition. The authors note these people turn up in every follow-up study of young people with gender distress, yet professionals and activists have largely ignored them. They review figures on how common desistance is, theories about why it happens, and big gaps in the research, especially that today's patients are very different from those in older studies. They suggest early advice: support without judgement, accept that gender and sexuality can change, and keep medical teams on hand to help reverse treatment. They argue that with referrals rising, building evidence and clear guidance is urgent. It is a reasonable call to action, but it is opinion based on selected older studies, not new research, and its advice is not yet tested.
Key findings
- کسانی که دست می‌کشند یا دترنزیشن می‌کنند در هر مطالعهٔ پیگیری جوانان دارای ناراحتی جنسیتی دیده می‌شوند. با این حال نویسندگان اشاره می‌کنند راهنمایی برای حمایت از آن‌ها وجود نداشت، در حالی که راهنمایی برای گذار دقیق است.
- برآوردهای مورد استناد می‌گویند 73% تا 98% کودکان دارای ناراحتی جنسیتی از آن عبور کردند (ریستوری و استینزما، 2016). مطالعات قدیمی‌تر ممکن است کودکانی را شامل شده باشند که با هنجارهای جنسیتی جور نبودند اما ناراحتی جنسیتی نداشتند.
- مطالعات پیگیری بزرگسالان اغلب افراد زیادی را از دست می‌دهند و حدود یک سال طول می‌کشند. در یک مطالعهٔ سوئدی پشیمانی به‌طور میانگین 8 سال طول کشید تا ظاهر شود، پس ارقام کنونی پشیمانی هنوز ممکن است بیماران امروز را منعکس نکند.
- آن‌ها پنج تغییر در بیماران را فهرست می‌کنند: ارجاع‌های جوان بسیار بیشتر، زن‌متولدهای بیشتر، غیرباینری‌های بیشتر، افراد بیشتری که پیشاپیش گذار اجتماعی کرده‌اند، و افراد بیشتری که ناراحتی‌شان در بلوغ آغاز شد.
- بسیاری از بیماران کنونی شرایط سلامت روان دیگر یا اوتیسم هم دارند، که پژوهش‌های پیشین به‌ندرت به آن پرداخت.
- توصیهٔ آن‌ها: حمایت بدون قضاوت، در نظر گرفتن هویت جنسیتی و جنسی به‌عنوان چیزهایی که می‌توانند تغییر کنند، توجه به خانواده و زندگی اجتماعی، پیوند دادن افراد با گروه‌های همسالان متنوع، و در دسترس نگه داشتن تیم‌های پزشکی برای کمک به برگرداندن درمان.
Abstract
The number of people presenting at gender clinics is increasing worldwide. Many people undergo a gender transition with subsequent improved psychological wellbeing (de Vries et al., 2014). However, some people choose to stop this journey, ‘desisters’, or to reverse their transition, ‘detransitioners’. It has been suggested that some professionals and activists are reluctant to acknowledge the existence of desisters and detransitioners, possibly fearing that they may delegitimise persisters’ experiences (Zucker, 2018). Certainly, despite their presence in all follow-up studies of young people who have experienced Gender Dysphoria (GD), little thought has been given to how we might support this cohort. Levine (2017) reports that the 8th edition of the WPATH Standards of Care will include a section on detransitioning - confirming that this is an increasingly witnessed phenomenon worldwide. It also highlights that compared to the extensive protocols for working with children, adolescents and adults who wish to transition, nothing exists for those working with desisters or detransitioners. With very little research and no clear guidance on how to work with this population, and with numbers of referrals to gender services increasing, this is a timely juncture to consider factors that should be taken into account within clinical settings and areas for future research.
Conclusion
Research with populations who desist and detransition is in its infancy and little is known about how best to work with this growing population. While there is increasing recognition of the need for support for those who require it, there are still no clear guidelines on how to do this work. We are at an important juncture where our evidence-base is based on previous cohorts that may not be applicable to the current population of desisters and detransitioners; it is prudent to consider their needs alongside those who go on to identify as trans for life.