Summary

Researchers interviewed 28 Canadians who had stopped or reversed a gender transition about their health care. Many stopped hormones suddenly and without medical advice, often because they feared being judged by clinicians or found care hard to get. They described changes in mood and energy, gender distress coming back, and doctors who did not know how to help. Many relied on online detransition communities instead. Some younger people had been pushed by parents to stop and later restarted. Most of those who had medically transitioned did not regret it, while about a fifth did. The study makes a believable case that people who stop treatment lack medical guidance and support. It cannot say how common these experiences or views are, because the group was small, self-selected and loosely defined, and the interviewers had all used gender-affirming treatment.

Key findings

• 캐나다 성인 28명(출생 시 여성 18명, 남성 10명, 71%가 20~29세)을 인터뷰했습니다. 27명이 의학적으로 전환했고 그중 56%가 18~24세에 시작했습니다.
• 디트랜지션의 이유에는 건강 걱정, 수술 합병증, 변화하는 성 정체성 감각, 지지하지 않는 부모나 파트너, 차별, 진료를 받기 어려움이 포함되었습니다.
• 많은 이들이 정신 건강 지원이나 의학적 감독 없이 호르몬을 갑자기(‘한 번에 끊기’) 중단했고, 클리닉은 이들이 오지 않게 된 뒤 거의 추적하지 않았습니다.
• 사람들은 임상의가 디트랜지션에 대해 준비되어 있지 않거나 판단적이라고 설명했고, 많은 이들이 대신 온라인 디트랜지션 모임에서 정보를 찾았습니다.
• 의학적으로 전환한 27명 중 18명(67%)은 후회가 없거나 과거 치료에 긍정적이었고, 6명(22%)은 후회했으며, 3명(11%)은 복합적인 감정이었습니다.
• 고환이나 난소 제거 후 호르몬을 바꾼 사람들은 보통 의학적 감독을 받았지만, 진료가 부실했다고 설명하는 경우가 많았습니다.
• 저자들은 디트랜지션에 대한 의학적 지침을 요구하며, 임상의가 치료를 중단하거나 되돌리는 환자에게 수치심을 주지 말아야 한다고 말합니다.

Abstract

Importance: Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition.

Objective: To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice.

Design, setting, and participants: Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed.

Main outcomes and measures: In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions.

Results: Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs.

Conclusions and relevance: This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.

Conclusion

This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions. The authors report accounts of people ceasing or reversing gender-affirming treatments with sub-optimal care, and call for research on clinicians' knowledge of detransition and the sources of detransition-related stigma.