Summary

Researchers surveyed 957 people in the US and Canada who said they had stopped, changed or reversed a gender transition, or wanted to. Most were born female and most described themselves as lesbian, bisexual or queer; 42% had at some point stopped and later restarted transition. Many reported poor care after detransitioning: about 43% said providers never seemed to know anything about detransition, and more than half sometimes or always avoided health care. People most often asked for clinicians who understand detransition, contact with other detransitioners, accurate advice on stopping hormones, help with reconstructive surgery, and therapy that takes trauma into account. Some stopped only because of cost, family rejection or losing access to care. The results show real unmet needs, but come from a self-selected online group and cannot show how common these experiences are.

Key findings

• 957 personnes ont été incluses (sur 1 377 enquêtes complétées, après retrait des robots et des fausses réponses) ; 79 % étaient nées femmes et 74 % vivaient aux États-Unis.
• La plupart étaient lesbiennes, gays, bisexuelles ou queer (45 % bisexuelles, 29 % queer, 27 % lesbiennes), et 42 % avaient arrêté puis repris une transition.
• Après la détransition, 43 % disaient que leur soignant ne semblait jamais connaître la détransition, et seulement 7 % disaient que leurs soignants la connaissaient toujours.
• L'évitement des soins était courant : 13 % évitaient toujours et 45 % parfois les soignants quand elles avaient besoin de soins, et 46 % avaient parfois ou toujours besoin de soins sans les obtenir.
• Dans 563 réponses écrites, les besoins non satisfaits les plus courants étaient le soutien communautaire et par les pairs (29 %), des soignants qui comprennent la détransition (29 %), un soutien personnel (22 %) et des soins de santé mentale (16 %).
• 46 réponses demandaient des conseils pour arrêter les hormones en sécurité, et certaines décrivaient un refus de chirurgie reconstructrice, par exemple l'avoir été par quatre chirurgiens.
• Certaines décrivaient avoir été forcées d'arrêter par le coût, la perte d'accès aux soins ou le rejet familial, et voulaient de l'aide pour reprendre une transition.

Abstract

BACKGROUND: Detransition refers to stopping, shifting, or reversal of an initial gender transition. Some people detransition temporarily, and later re-start a transition process, or retransition. Despite calls for research and care surrounding detransition/retransition, these experiences remain poorly understood by care providers and LGBTQ2S+ community-serving organizations.

METHODS: Between December 2023-April 2024, a cross-sectional survey was administered to 957 individuals (aged 16 and older) living in the US or Canada who self-identified with experiences of detransition. Participants were recruited via advertisements across eight major social media platforms, direct emails sent to ∼1200 former research participants, and to >615 LGBTQ2S+ organizations and gender-affirming care providers. Mixed qualitative and quantitative data were collected and analyzed regarding participants' experiences and care needs during detransition and, if relevant, retransition. Data about care experiences and needs were analyzed descriptively using frequencies and percentages. Interpretive description was utilized to analyze qualitative responses.

RESULTS: Participants reported a wide range of current gender identities/expressions such as: woman (n = 386; 40.3%); gender nonconforming woman (n = 241; 25.2%); nonbinary (n = 238; 24.9%); and/or detrans woman; (n = 152; 22.5%). A majority of the sample were sexual minorities. A majority reported being bisexual (n = 429; 44.8%), queer (n = 277; 28.9%), and/or lesbian (n = 254; 26.5%). Qualitative analysis identified three key themes: (1) accessing detransition-related care needs within the gender-affirming care system; (2) detransition-related social/legal needs to navigate a second transition; and (3) detransition preventative and retransition needs. Each of these themes encompassed four subthemes, including access to detrans-knowledgeable care providers (n = 162; 28.8%); medical information (n = 62; 11.0%); mental healthcare and supports (n = 92; 16.3%); interpersonal supports (n = 124; 22.0%); and community supports (n = 163; 29.0%).

CONCLUSION: Greater understanding and community-led care relating to detransition/retransition from an LGBTQ2S+-affirming lens can help to mitigate minority stressors and distress associated with these experiences.

Conclusion

The current study contributes to the limited body of work regarding the experiences and care needs of detrans people and other SGM people who report identity fluidity and detransition/retransition. Findings indicate that, like other SGM people, detransition may be inadequately understood by some LGBTQ2S+ serving and gender-affirming care practitioners. Future research and community-led research on detransition/retransition can ameliorate this knowledge gap. Importantly, given the potential for country-specific differences in detransition/retransition experiences, future research should be more sensitive to geopolitical and healthcare delivery dynamics. (Abstract conclusion: greater understanding and community-led care relating to detransition/retransition from an LGBTQ2S+-affirming lens can help to mitigate minority stressors and distress associated with these experiences.)