Aucun protocole n'existe pour les détransitionneurs : Les leaders cliniques appellent à des recherches et services urgents

Débat : le besoin pressant de recherche et de services pour les personnes qui renoncent à la transition ou détransitionnent

Commentaire & analyse Détransition & regret Soins & soutien aux détransitionneurs

Authors: Catherine Butler, Anna Hutchinson
Journal: Child and Adolescent Mental Health
Year: 2020
Source: acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.12361

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

Des personnes qui cessent ou détransitionnent apparaissent dans toutes les études de suivi de jeunes en détresse de genre. Pourtant, notent les auteurs, il n'existait aucune recommandation pour les accompagner, alors que celles pour la transition sont détaillées.
Les estimations citées indiquent que 73 à 98 % des enfants en détresse de genre l'ont dépassée (Ristori et Steensma, 2016). Les études plus anciennes ont pu inclure des enfants qui ne se conformaient pas aux normes de genre mais n'avaient pas de détresse de genre.
Les études de suivi d'adultes perdent souvent beaucoup de personnes et durent environ un an. Dans une étude suédoise, le regret mettait 8 ans en moyenne à apparaître ; les chiffres actuels de regret ne reflètent donc peut-être pas encore les patients d'aujourd'hui.
Ils énumèrent cinq changements chez les patients : beaucoup plus d'orientations de jeunes, plus de personnes nées filles, plus de personnes non binaires, plus de personnes ayant déjà fait une transition sociale, et plus de personnes dont la détresse a commencé à la puberté.
Beaucoup de patients actuels ont aussi d'autres troubles de santé mentale ou de l'autisme, ce que les recherches antérieures examinaient rarement.
Leurs conseils : soutenir sans jugement, considérer l'identité de genre et sexuelle comme pouvant changer, prêter attention à la famille et à la vie sociale, mettre les personnes en lien avec des groupes de pairs variés, et garder les équipes médicales disponibles pour aider à inverser le traitement.

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.

Methodological limitations

Short opinion piece: This is a three-page debate article with no search method, rules for choosing studies or quality checks. The evidence it cites is hand-picked and may be incomplete.
No new data: It has no new data, interviews or analysis. Its advice for clinicians is expert opinion.
Disputed figures on children growing out of it: The 73 to 98% figures come from older Dutch and North American studies whose methods are disputed, for example including children without a diagnosis, or counting people who dropped out as having desisted. The authors mention the diagnosis issue but not the wider debate (Temple Newhook et al., 2018), apart from citing Zucker's reply.
Benefit claim rests on one study: The claims that many people improve after transition, and that no teenager on hormones desisted after a year, both come from one Dutch study (de Vries et al., 2014). Whether it applies to today's patients has since been questioned (for example by Abbruzzese, Levine and Mason, 2023).
Old evidence for a new group: The authors argue that today's patients are very different from earlier ones, but they have to rely on research about those earlier patients. So their advice rests only partly on evidence about today's patients.
Little evidence about detransitioners themselves: Almost all the evidence cited is about children growing out of gender distress or adults regretting surgery. There were basically no studies of detransitioners' needs at the time, so the advice for them is guesswork from other groups.
Sexual orientation claim not examined: The claim that all the young people whose gender distress persisted in Steensma et al. (2011) were attracted to the same sex, and took this to confirm they were the other sex, comes from one small interview study, and its small size isn't discussed.
Author perspective: Hutchinson co-wrote a 2020 letter supporting research into 'rapid-onset gender dysphoria' (the idea that gender distress can appear suddenly under social influence) with Midgen and Spiliadis. No competing interests were declared.

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