Summary

This paper suggests splitting detransition into two types. In 'core' detransition, a person stops identifying as transgender and identifies with their birth sex again. In 'non-core' detransition, a person stops or reverses transition but still identifies as trans, because of things like discrimination, health worries or being unhappy with results. The author argues this would clear up confusion, since 'detransition' is used to mean both. He gives advice for clinicians: thorough mental health assessment, honest consent about benefits, risks and unknowns, offering talking therapy alongside medical options, long-term follow-up, and guidelines for both groups. It is a useful way to think about the topic, but it is based on stories and opinion rather than data, and nobody has yet tested whether the types work in practice.

Key findings

• Paperi ehdottaa kahta tyyppiä: ”ydin”- eli ensisijainen detransitio (ei enää identifioidu transsukupuoliseksi ja identifioituu jälleen syntymäsukupuoleensa) ja ”ei-ydin”- eli toissijainen detransitio (korjauksen lopettaminen tai peruuttaminen vaikka identifioituu edelleen transiksi).
• Syitä ydindetransitioon ovat havainto, ettei korjaus lievittänyt sukupuoliahdistusta, sekä sen ymmärtäminen, että ahdistus liittyi traumaan, sisäiseen häpeään homoudesta, seksismiin tai muihin mielenterveysongelmiin.
• Syitä ei-ydindetransitioon ovat lääketieteelliset ongelmat, tyytymättömyys tuloksiin, syrjintä, rahan tai tuen puute, perheen paine sekä halu saada lapsia tai suojata hedelmällisyyttä.
• Tyypit eivät ole kiinteitä: ei-ydindetransitio voi myöhemmin muuttua ydindetransitioksi, ja jotkut identifioituvat jonkin aikaa ei-binääriksi ennen kuin identifioituvat jälleen syntymäsukupuoleensa.
• Kirjoittaja huomauttaa epävirallisista raporteista, joiden mukaan autismi on yleisempää detransitioituneilla kuin väestössä, mutta sanoo tämän vaativan tutkimusta.
• Hän suosittelee perusteellista mielenterveysarviota, rehellistä suostumusta, joka kattaa hyödyt, riskit ja tuntemattomat tekijät, tutkivan puheterapian tarjoamista lääketieteellisten vaihtoehtojen rinnalla sekä pitkäaikaista seurantaa.
• Detransitio ei aina ole katumusta: hän pyytää kliinikoita vastaamaan tuomitsematta ja kirjoittamaan kliiniset ohjeet molemmille ryhmille.

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.

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.