Summary

This study asked clinicians who work with trans and nonbinary young people what they had seen of youth who stop a gender transition. Of 61 who completed the survey, mostly in North America and Europe and mostly practising gender-affirming care, about two-thirds had followed at least one such young person, usually only 1 to 5 in their career. Asked about their latest case, providers often said the youth had mental health problems before transitioning, and many said the youth had gone back to identifying with their birth sex; about 4 in 10 noted some regret. The authors concluded that stopping is varied, probably uncommon, and happens under every treatment approach. Because the group was small, self-selected and reporting second-hand, the study cannot say how often youth stop or compare approaches.

Key findings

• Sur 147 cliniciens qui ont commencé l'enquête, 61 ont répondu suffisamment pour être inclus ; 77 % pratiquaient des soins d'affirmation de genre, 6,6 % l'approche néerlandaise d'« attente vigilante » et 16,4 % une autre approche.
• 56 % ont dit avoir suivi un jeune qui avait arrêté sa transition et 8 % pensaient peut-être l'avoir fait ; 36 % n'en avaient jamais vu.
• Sur les 39 qui avaient vu, ou peut-être vu, de tels jeunes, 82 % en avaient vu 1 à 5 dans toute leur carrière, tandis que 8 % en avaient vu 21 ou plus.
• Dans leur cas le plus récent, 40 % ont dit que le jeune s'était remis à s'identifier à son sexe de naissance et 31 % que cela s'appliquait en partie.
• 59 % ont dit que le jeune avait des problèmes de santé mentale avant de commencer la transition, et seulement 18 % ont dit que non.
• 21 % ont dit que le jeune regrettait d'avoir commencé la transition et 21 % de plus voyaient « un peu » de regret ; 38 % ont dit que le jeune ne semblait pas heureux d'avoir commencé puis arrêté.
• La plupart ont décrit le jeune comme soutenu par ses amis (71 %) et capable d'obtenir les soins médicaux dont il avait besoin (68 %), ce qui suggère que la pression extérieure n'était pas la raison principale dans ces cas.

Abstract

The idea of "detransition" is stimulating debates among researchers and providers working with trans and nonbinary youth (TNBY), but research on this phenomenon is still in its early stages. This study presents the characteristics and experiences of providers who work directly with TNBY, including some who have discontinued a transition. Sixty-one providers in trans health care were recruited internationally and responded to an online survey. They come from various regions of the world and disciplines and 77% worked according to the trans-affirming approach. Sixty-four percent of them had followed a youth who discontinued their transition. Among those, 82% reported a range of 1–5 youth in their entire career. Professionals reported their observations of discontinuation with regard to the youth's individual characteristics, and parental and social support. The results suggest that professionals had experience with youth who had discontinued regardless of their approach to intervention (e.g., trans-affirming, watchful waiting, or exploratory) and have observed a diversity of characteristics when describing the youth they followed.

Conclusion

From the providers' observations, youth who discontinue a transition form a diverse group. Many providers had encountered such youth, but most had worked with only a few, which the authors take to indicate the phenomenon may not be frequent. Because providers using a range of approaches (gender-affirming, watchful waiting or other) had all encountered discontinuation, the authors question the idea that one intervention approach explains it, and argue that providers should not try to avoid discontinuation "at any cost" but should support youth in exploring their needs, hopes, doubts and capacity to consent, whether or not they later discontinue. They also argue that media coverage of discontinuation has begun to limit access to gender-affirming care.