Detransitioner canadesi poco informati prima del trattamento: vogliono cure individualizzate con supporto mentale

Esplorare le esperienze e le prospettive sull'assistenza di genere di persone che hanno interrotto la transizione o fatto detransition in Canada

Interviste e ricerca qualitativa Cura e supporto per detransizionanti Etica medica e consenso

Authors: Kinnon R. MacKinnon, W. Ariel Gould, Gabriel Enxuga, Hannah Kia, Alex Abramovich, June S. H. Lam, Lori E. Ross
Journal: PLOS ONE
Year: 2023
Source: https://doi.org/10.1371/journal.pone.0293868

Summary

Researchers interviewed 28 Canadians who had stopped or reversed a gender transition about how they got care and how it could be better. Most went through clinics that assessed them before treatment. Many felt the process pushed a fixed, step-by-step path toward becoming fully male or female, and that talks about consent were rushed or shallow. Those who regretted treatment often felt they had not been told enough about risks. Some believed their same-sex attraction, trauma, autism or mental illness had not been looked at. One person agreed to testosterone while on a day pass from a psychiatric hold. Most still valued making their own choices and wanted care tailored to them, with mental health support. The stories are useful, but they come from a small, self-selected group, most of whom still identify as trans.

Key findings

28 persone tra 20 e 53 anni sono state intervistate tra ottobre 2021 e gennaio 2022; il 71% aveva vent'anni e il 64% era nato femmina.
27 avevano assunto ormoni cross-sex e 11 avevano subito un intervento chirurgico, tra cui doppia mastectomia (8), asportazione di ovaie o testicoli (6) e chirurgia genitale (3); una aveva usato bloccanti della pubertà (farmaci che mettono in pausa la pubertà).
Il 57% ha detto di aver avuto tre o più identità di genere nel tempo, e il 60% è passato da un'identità trans maschile o femminile all'inizio a un'identità non binaria in seguito.
Circa una persona su tre ha espresso rimpianto o sentimenti contrastanti sulla transizione, ed entrambe le persone che avevano iniziato la transizione medica a 15 anni se ne sono pentite.
Il rimpianto veniva spesso descritto insieme alla sensazione di essere stati poco informati su rischi, benefici e altre opzioni prima del trattamento.
Alcuni sentivano che il disagio nell'essere attratti dallo stesso sesso, i traumi, l'autismo o la malattia mentale avessero alimentato il loro disagio e non fossero mai stati esplorati dai clinici.
La maggior parte sosteneva ancora il diritto delle persone a prendere le proprie decisioni e raccomandava un'assistenza «neutrale» e su misura insieme al sostegno per la salute mentale.

Abstract

Background: Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice.

Aims: To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition).

Methods: Between October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants' social networks. Interviews ranged between 50-90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants' experiences of, and recommendations for, gender care.

Results: Participants were between the ages of 20-53 (71% were between 20-29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers' "informed consent" procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports.

Conclusions: To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.

Conclusion

To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.

Methodological limitations

Small, self-selected group: The 28 people were found through social media, detransition support groups, clinicians and word of mouth. The authors themselves say the results are exploratory and cannot be applied to everyone.
Most still identify as trans: 75% still identified as trans or gender diverse, so people who now fully identify with their birth sex are under-represented. Other surveys suggest that group often reports more regret.
Same interviews used twice: This paper re-analyses the same 28 interviews published in JAMA Network Open in 2022. The two papers should not be counted as separate evidence.
Memories of past events: People described assessments and consent talks from years earlier, and how they feel now may shape those memories, as the authors acknowledge.
Regret not properly measured: 'Regret', 'mixed feelings' and 'satisfaction' were judged from what people said in interviews, not from a tested questionnaire. So the 'one in three' figure is not a measured rate.
Conclusions go beyond the evidence: The authors say their results do not support exploratory therapy, yet no one in the study had received that kind of therapy, and several wanted more in-depth 'neutral' therapy. Their backing of the WPATH (a trans health professional body) Standards of Care, version 8, is their own view, not something the study tested.
No cross-checking: What people said about assessments and consent was not checked against clinicians' accounts or medical records.
Canadian setting: Most people went through Canadian provincial clinics following older (version 7) WPATH guidelines, so the findings may not reflect clinics that give hormones on request without assessment, or US care.
Authors' own stake: The team includes trans and detransitioned researchers and a clinician at a Canadian adult gender clinic (CAMH). This brings insider knowledge but also a stake in how gender care is judged.

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Summary

Key findings

Abstract

Conclusion