Summary

Researchers interviewed 28 Canadians who had stopped or reversed a gender transition about their health care. Many stopped hormones suddenly and without medical advice, often because they feared being judged by clinicians or found care hard to get. They described changes in mood and energy, gender distress coming back, and doctors who did not know how to help. Many relied on online detransition communities instead. Some younger people had been pushed by parents to stop and later restarted. Most of those who had medically transitioned did not regret it, while about a fifth did. The study makes a believable case that people who stop treatment lack medical guidance and support. It cannot say how common these experiences or views are, because the group was small, self-selected and loosely defined, and the interviewers had all used gender-affirming treatment.

Key findings

• 28 adultes au Canada (18 nées femmes et 10 nés hommes ; 71 % de 20 à 29 ans) ont été interrogés. 27 avaient fait une transition médicale, et 56 % d'entre eux avaient commencé entre 18 et 24 ans.
• Les raisons de la détransition comprenaient des inquiétudes pour la santé, des complications chirurgicales, un sentiment d'identité de genre changeant, des parents ou partenaires peu soutenants, la discrimination et la difficulté d'accéder aux soins.
• Beaucoup ont arrêté brutalement les hormones (« cold turkey ») sans soutien en santé mentale ni suivi médical, et les cliniques assuraient rarement un suivi après qu'ils avaient cessé de venir.
• Les personnes ont décrit des cliniciens non préparés ou jugeants face à la détransition, et beaucoup ont cherché de l'information dans des groupes de détransition en ligne à la place.
• Sur 27 personnes ayant fait une transition médicale, 18 (67 %) n'ont exprimé aucun regret ou jugeaient positivement leur traitement passé, 6 (22 %) l'ont regretté et 3 (11 %) avaient des sentiments mitigés.
• Les personnes qui changeaient d'hormones après l'ablation des testicules ou des ovaires avaient généralement un suivi médical, mais décrivaient souvent les soins comme médiocres.
• Les auteurs appellent à des recommandations médicales sur la détransition et à ce que les cliniciens ne fassent pas honte aux patients qui arrêtent ou inversent un traitement.

Abstract

Importance: Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition.

Objective: To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice.

Design, setting, and participants: Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed.

Main outcomes and measures: In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions.

Results: Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs.

Conclusions and relevance: This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.

Conclusion

This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions. The authors report accounts of people ceasing or reversing gender-affirming treatments with sub-optimal care, and call for research on clinicians' knowledge of detransition and the sources of detransition-related stigma.