Onderzoekers roepen op tot een einde aan politisering – mensen die detransitioneren hebben onvervulde gezondheidsbehoeften

Detransitie heeft meer begrip nodig, geen controverse

Commentaar & analyse Detransitie & spijt Zorg & ondersteuning voor detransitioners

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

Dit is een analyseartikel, geen volledige review van het onderzoek: het vat enkele vroege studies samen en doet aanbevelingen, zonder nieuwe gegevens.
De aangehaalde studies (bijvoorbeeld een online enquête onder 237 detransitioners, 92% vrouw, en een Canadese interviewstudie onder 28) suggereren dat veel detransitioners als vrouw geboren waren en vóór hun 25e transitioneerden.
Redenen voor detransitie zijn een verandering in identiteit, genderklachten die transitie niet oploste, zorgen over lichamelijke of geestelijke gezondheid, discriminatie, en nood veroorzaakt door de behandeling zelf ('omgekeerde dysforie').
Na detransitie beschrijven veel mensen aanhoudende genderklachten, spijt, verdriet of gemengde gevoelens, verlies van steun van lhbtq+-vrienden, en het vermijden van artsen uit angst om veroordeeld te worden.
De auteurs zeggen dat 1 tot 2 jaar volgen te kort is, omdat detransitie meestal enkele jaren na de behandeling plaatsvindt. Ze bevelen minstens 5 tot 10 jaar aan.
Ze waarschuwen dat in sommige genderzorgstudies meer dan 30% van de patiënten afhaakt, en dat onderzoekers er niet van uit moeten gaan dat deze mensen zich nog als trans identificeren of geen verdere behoeften hebben.
Ze bevelen aan studiegroepen te kiezen op basis van de behandeling die mensen kregen in plaats van hun huidige identiteit, de woorden 'detrans' en 'detransitie' te gebruiken, en niet-oordelende detransitiezorg in te bouwen in genderdiensten.

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.

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Summary

Key findings

Abstract

Conclusion