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

• 이 연구는 2018~2019년 헬싱키 성인 성별 클리닉에 디트랜지션을 위해 의뢰된 성인 9명 전원을 대상으로 했습니다. 출생 시 여성 7명은 모두 큰 후회를, 출생 시 남성 2명은 작은 후회를 느꼈습니다.
• 평균적으로 처음 진단받았을 때 25세였고 디트랜지션 평가 때 33세였습니다. 후회가 나타나는 데 평균 7년이 걸렸습니다(2010년 이후 평가받은 사람은 5년).
• 8명이 유방 제거 또는 유방 확대 수술을 받았고 4명이 자궁과 난소를 제거했습니다. 1명을 제외하고 모두 디트랜지션을 위해 의학적 치료가 필요했습니다.
• 정신 건강 문제가 매우 흔했습니다. 기분장애 89%, 불안장애 78%, 경계성 성격장애 56%, 섭식장애 또는 증상 78%였습니다. 6명은 성적 학대나 강간을 당했습니다.
• 디트랜지션 평가 시 5명은 출생 성별로, 3명은 논바이너리로, 1명은 여전히 트랜스젠더로 정체화했습니다.
• 왜 전환했는지 묻자 6명은 여성으로 자라는 것이 힘들었다고 답했습니다. 다른 이유로는 어울리지 못한 것, 트라우마, 한 경우에는 동성애를 트랜스젠더로 오해한 것이 있었습니다.
• 클리닉은 운영 방식을 바꿨습니다. 돌아올 때 의뢰서가 필요 없고, 환자의 정신과 의사와 더 긴밀히 일하고, 무료 단기 치료를 제공하며, 중립을 지키는 직원 교육을 합니다.
• 저자들은 이 결과가 전환 서비스를 닫는 것도, 제대로 된 평가 없이 전환하는 것도 지지하지 않는다고 말합니다.

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.