Summary

Finnish clinicians reviewed the records of, and reassessed, the nine adults who came back to their gender clinic in 2018 to 2019 wanting to detransition. Most had had hormones and chest or breast surgery years earlier. Nearly all had serious mental health histories, including depression, anxiety, borderline personality disorder, eating problems, self-harm and childhood trauma or sexual abuse. Looking back, most said their wish to transition came from difficulties growing up, especially as girls, and from unresolved distress, rather than from their gender identity. The clinic then made it easier for detransitioners to return and paid more attention to trauma. The study gives rare clinical detail on detransitioners. But it is tiny, has no comparison group, relies on records and memories gathered after regret, and compares its mental health figures with a different group of patients.

Key findings

• この研究は、2018年から2019年にデトランジションのためにヘルシンキの成人ジェンダークリニックに紹介された成人9人全員を対象としました。女性として生まれた7人は全員が大きな後悔を、男性として生まれた2人は小さな後悔を抱えていました。
• 平均して、最初に診断されたのは25歳、デトランジションの評価時は33歳でした。後悔が表れるまで平均7年かかりました（2010年以降に評価された人では5年）。
• 8人は乳房切除または豊胸手術を受けており、4人は子宮と卵巣を摘出していました。1人を除く全員が、デトランジションのために医学的治療を必要としました。
• メンタルヘルスの問題は非常に多く、気分障害が89%、不安障害が78%、境界性パーソナリティ障害が56%、摂食障害またはその症状が78%でした。6人が性的虐待またはレイプを受けていました。
• デトランジションの評価時点で、5人は生まれつきの性別を自認し、3人はノンバイナリー、1人は引き続きトランスジェンダーと自認していました。
• なぜトランジションしたのかを尋ねると、6人が女性として育つのがつらかったと答えました。他の理由には、なじめなかったこと、トラウマ、そして1人はゲイであることをトランスジェンダーと取り違えたことが含まれました。
• クリニックは運営を変更しました。戻るための紹介状は不要にし、患者の精神科医とのより緊密な連携、無料の短期セラピー、中立を保つためのスタッフ研修です。
• 著者らは、この結果はトランジションサービスの閉鎖も、適切な評価なしのトランジションも支持しないと述べています。

Abstract

The aim of this study was to analyze the pathways of detransitioning, which is a rare, but serious complication of gender-affirming treatments (GATs). The patient group consisted of all patients who were referred to the Helsinki University Hospital's Gender Identity Clinic (GIC) wanting medical treatment for detransition from 2018 to 2019. A new assessment was made systematically and retrospective data were collected. The sample consisted of nine patients originally diagnosed with gender identity disorder (F64.0). Seven of them were assigned female at birth and two were assigned male at birth. All seven females at birth had "major" regret and both males at birth had "minor" regret. All patients except one male assigned at birth wanted their previous GAT to be reversed. The mean regret time (i.e., time from the first diagnosis of F64.0 to the beginning of the new evaluation period) was seven years. The detransitioners had a high number of psychiatric diagnoses. Childhood trauma, sexual abuse or rape, eating disorder symptoms, borderline personality, and psychotic symptoms were common among detransitioners. Retrospectively, the patients reported that the need for transitioning in the first place was not the transgender identity or gender dysphoria, but reasons related to the maturation process and unresolved psychological stressors. An assessment made by the psychologist at the GIC revealed childhood trauma and severe challenges in parenting and attachment. It is important to acknowledge, support, and evaluate those regretting treatments and/or detransition, and to learn from them.

Conclusion

Even though most adults seeking gender-affirming treatment benefit from it and are satisfied with the treatment, it is important to acknowledge, support and evaluate those regretting treatments and/or who wish to detransition, and to learn from them. Those who detransition have a high amount of childhood and sexual trauma, eating disorder symptoms, borderline personality disorders and psychotic symptoms. Evaluating and treating serious psychiatric illnesses first, to determine if the patients' dysphoria resolves without gender-affirming treatment, might reduce the cases of detransitioning. Sufficient psychotherapy might help prior to irreversible gender-affirming treatment. The need for more research is urgent, and a wider, unprejudiced voice in public discussion about detransitioning and regret is needed. It is important to encourage detransitioners to notify the gender identity clinic that they detransitioned, as it would provide valuable information to clinicians about patient outcomes. The results of this study should be used to inform the evaluation process, counseling, informed consent, and medical decision-making for patients with gender dysphoria. The results do not support eliminating transition services nor do they support proceeding to transition without adequate evaluation.