연구자들은 정치화의 종식을 촉구하며—디트랜지션을 하는 사람들은 충족되지 않은 의료 요구를 가지고 있다

디트랜지션은 논란이 아닌 더 깊은 이해가 필요하다

Authors: Kinnon Ross MacKinnon, Pablo Expósito-Campos, W Ariel Gould
Journal: BMJ
Year: 2023
Source: www.bmj.com/content/381/bmj-2022-073584

Summary

Writing in the BMJ, Kinnon MacKinnon, Pablo Expósito-Campos and W Ariel Gould argue that people who stop or reverse a gender transition have been ignored by research and care, partly because the topic has become political. Drawing on a few small studies of volunteers, they describe detransitioners as varied, but often female and young when they transitioned. Their reasons range from a change in identity and gender distress that didn't go away, to health worries and discrimination. Many have medical and mental health needs that aren't being met. The authors recommend following patients for at least 5 to 10 years and not assuming that people who drop out of studies (over 30% in some) are doing well. It is a sensible research plan, not new evidence. There was no formal search, and some claims rest on news reports or the authors' own studies.

Key findings

이 글은 연구의 전체 검토가 아니라 분석 글입니다. 몇몇 초기 연구를 요약하고 권고를 하며, 새로운 자료는 없습니다.
인용된 연구들(예: 디트랜지셔너 237명의 온라인 설문, 92%가 여성, 그리고 28명의 캐나다 인터뷰 연구)은 많은 디트랜지셔너가 출생 시 여성이었고 25세 이전에 전환했음을 시사합니다.
디트랜지션 이유에는 정체성의 변화, 전환이 해결해 주지 못한 성별 고통, 신체적 또는 정신적 건강 걱정, 차별, 치료 자체가 일으킨 고통(‘역불쾌감’)이 포함됩니다.
디트랜지션 후 많은 사람이 계속되는 성별 고통, 후회, 슬픔 또는 복합적인 감정, LGBTQ+ 친구들의 지지 상실, 판단당할까 두려워 의사를 피하는 것을 이야기합니다.
저자들은 디트랜지션이 보통 치료 몇 년 후에 일어나므로 1~2년 추적은 너무 짧다고 말합니다. 최소 5~10년을 권고합니다.
일부 성별 진료 연구에서는 환자의 30% 넘게가 이탈하며, 연구자들은 이들이 여전히 트랜스로 정체화하거나 더 이상 필요가 없다고 가정해서는 안 된다고 경고합니다.
현재의 정체성이 아니라 사람들이 받은 치료를 기준으로 연구 집단을 고르고, ‘디트랜스’와 ‘디트랜지션’이라는 용어를 쓰며, 판단하지 않는 디트랜지션 진료를 성별 서비스에 포함할 것을 권고합니다.

Abstract

Kinnon MacKinnon and colleagues call for robust, sensitive research to inform comprehensive gender care services for people who detransition

Conclusion

Rigorous and nuanced detransition research is indispensable. Investigating the experiences of people who detransition will provide a better understanding of the development of gender identity, as well as all health and psychosocial outcomes following gender care. This aligns with priorities identified by trans health experts. Unfortunately, ongoing debates and politicisation of gender care have resulted in the depiction of trans and detrans people as completely distinct groups with divergent needs and experiences, and who are doomed to conflict. However, we believe that trans and detrans people are more similar than different, and that detransition research holds value for advancing the healthcare of all those who transition, and for responsibly moving gender care research and practice forward.

Methodological limitations

Not a full review: The article says it weaves together existing research, with no search method, rules for which studies to include, or quality checks. Which studies are cited, and how much weight they get, is the authors' choice.
Few, unrepresentative studies: Its picture of detransitioners rests on a few groups of volunteers found online or through networks (Vandenbussche, 237 people; Littman, 100; MacKinnon et al., 28; Pullen Sansfaçon et al., 20). The authors admit these recruitment methods can skew the results.
Lots of self-citation: Three of the 25 references are the lead author's own studies, and the Canadian interview findings used again and again come from the same research group.
Key claim backed by news reports: The statement that identity change and detransition 'are unlikely to represent the majority' is backed only by a Guardian news article. The US figures on how many people transition come from a Reuters analysis, not peer-reviewed research.
Strong label without evidence: The belief that trans identity can be temporary is called 'stigmatised, transantagonistic, and erroneous' with no supporting source, in an article that elsewhere describes identity changing after transition.
No idea how common detransition is: The authors say this can't be estimated yet, so the article can't say how big the unmet need is, or how detransitioners fare compared with people who continue.
Belief, not finding: The closing claim that 'trans and detrans people are more similar than different' is the authors' belief and is not tested against data.
Little detail on detransitioner input: Four people who had detransitioned were consulted, but the article doesn't say how they were chosen or how their input shaped it.
Narrow focus: The piece looks at care needs after detransition. It does not ask whether weak assessment, or weak evidence for the original treatments, helps cause detransition, even though its call for longer follow-up bears directly on that question.
Authors' perspective: All three authors are gender care researchers, and two have had gender-affirming medical care themselves (disclosed). No competing interests were declared, but the article clearly presents detransition research as part of gender-affirming care.

detrans.ai

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Key findings

Abstract

Conclusion