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

• 20~53세 28명이 2021년 10월부터 2022년 1월 사이 인터뷰했습니다. 71%가 20대였고 64%가 출생 시 여성이었습니다.
• 27명이 반대 성 호르몬을 썼고 11명이 수술을 받았으며, 양쪽 유방절제술(8명), 난소 또는 고환 제거(6명), 생식기 수술(3명)이 포함됩니다. 1명은 사춘기 차단제(사춘기를 멈추는 약)를 썼습니다.
• 57%는 시간이 지나며 세 가지 이상의 성 정체성을 가졌다고 말했고, 60%는 처음의 남성 또는 여성 트랜스 정체성에서 이후 논바이너리 정체성으로 옮겨 갔습니다.
• 약 3명 중 1명이 전환에 대한 후회나 복합적인 감정을 표현했고, 15세에 의학적 전환을 시작한 두 사람은 모두 후회했습니다.
• 후회는 치료 전에 위험, 이점, 다른 선택지에 대해 충분히 안내받지 못했다는 느낌과 함께 설명되는 경우가 많았습니다.
• 일부는 같은 성에 끌리는 것에 대한 불편함, 트라우마, 자폐, 정신질환이 자신의 고통을 키웠는데 임상의가 이를 한 번도 탐색하지 않았다고 느꼈습니다.
• 대부분은 여전히 사람들이 스스로 결정하는 것을 지지했고, 정신 건강 지원과 함께 맞춤형 ‘중립적’ 진료를 권고했습니다.

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.