Summary

This study asked clinicians who work with trans and nonbinary young people what they had seen of youth who stop a gender transition. Of 61 who completed the survey, mostly in North America and Europe and mostly practising gender-affirming care, about two-thirds had followed at least one such young person, usually only 1 to 5 in their career. Asked about their latest case, providers often said the youth had mental health problems before transitioning, and many said the youth had gone back to identifying with their birth sex; about 4 in 10 noted some regret. The authors concluded that stopping is varied, probably uncommon, and happens under every treatment approach. Because the group was small, self-selected and reporting second-hand, the study cannot say how often youth stop or compare approaches.

Key findings

• Van 147 behandelaars die de enquête begonnen, antwoordden er 61 genoeg om mee te tellen; 77% praktiseerde genderbevestigende zorg, 6,6% de Nederlandse aanpak van 'waakzaam afwachten' en 16,4% een andere aanpak.
• 56% zei een jongere te hebben gevolgd die met transitioneren stopte en 8% dacht van misschien; 36% had er nooit een gezien.
• Van de 39 die zulke jongeren hadden of misschien hadden gezien, had 82% er in hun hele loopbaan 1 tot 5 gezien, terwijl 8% er 21 of meer had gezien.
• In hun laatste geval zei 40% dat de jongere zich weer met het geboortegeslacht was gaan identificeren en zei 31% dat dit gedeeltelijk van toepassing was.
• 59% zei dat de jongere vóór het begin van de transitie psychische problemen had, en slechts 18% zei van niet.
• 21% zei dat de jongere spijt had van het starten met transitie en nog eens 21% zag 'een beetje' spijt; 38% zei dat de jongere niet gelukkig leek dat hij of zij was begonnen en gestopt.
• De meesten beschreven de jongere als gesteund door vrienden (71%) en in staat de benodigde medische zorg te krijgen (68%), wat suggereert dat druk van buitenaf in deze gevallen niet de hoofdreden was.

Abstract

The idea of "detransition" is stimulating debates among researchers and providers working with trans and nonbinary youth (TNBY), but research on this phenomenon is still in its early stages. This study presents the characteristics and experiences of providers who work directly with TNBY, including some who have discontinued a transition. Sixty-one providers in trans health care were recruited internationally and responded to an online survey. They come from various regions of the world and disciplines and 77% worked according to the trans-affirming approach. Sixty-four percent of them had followed a youth who discontinued their transition. Among those, 82% reported a range of 1–5 youth in their entire career. Professionals reported their observations of discontinuation with regard to the youth's individual characteristics, and parental and social support. The results suggest that professionals had experience with youth who had discontinued regardless of their approach to intervention (e.g., trans-affirming, watchful waiting, or exploratory) and have observed a diversity of characteristics when describing the youth they followed.

Conclusion

From the providers' observations, youth who discontinue a transition form a diverse group. Many providers had encountered such youth, but most had worked with only a few, which the authors take to indicate the phenomenon may not be frequent. Because providers using a range of approaches (gender-affirming, watchful waiting or other) had all encountered discontinuation, the authors question the idea that one intervention approach explains it, and argue that providers should not try to avoid discontinuation "at any cost" but should support youth in exploring their needs, hopes, doubts and capacity to consent, whether or not they later discontinue. They also argue that media coverage of discontinuation has begun to limit access to gender-affirming care.