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

• Studien omfattet alle ni voksne som ble henvist til kjønnsklinikken for voksne i Helsinki for å detransisjonere i 2018 til 2019: sju født som kvinner, alle med stor anger, og to født som menn med lite anger.
• I gjennomsnitt var de 25 da de først ble diagnostisert og 33 ved vurderingen av detransisjon. Det tok i gjennomsnitt sju år før angeren kom til syne (fem år for dem som ble vurdert etter 2010).
• Åtte hadde fått utført brystfjerning eller brystforstørrelse, og fire hadde fått fjernet livmor og eggstokker. Alle unntatt én trengte medisinsk behandling for å detransisjonere.
• Psykiske problemer var svært vanlige: stemningslidelser hos 89 %, angstlidelser hos 78 %, emosjonelt ustabil personlighetsforstyrrelse hos 56 %, og spiseforstyrrelser eller symptomer hos 78 %. Seks hadde vært utsatt for seksuelle overgrep eller voldtekt.
• Ved vurderingen av detransisjon identifiserte fem seg med fødselskjønnet sitt, tre som ikke-binære og én fortsatt som transkjønnet.
• På spørsmål om hvorfor de gikk gjennom overgang sa seks at det var vanskelig å vokse opp som kvinne. Andre grunner inkluderte å ikke passe inn, traumer, og i ett tilfelle å forveksle det å være homofil med det å være transkjønnet.
• Klinikken endret arbeidsmåten: ingen henvisning nødvendig for å komme tilbake, tettere samarbeid med pasientenes psykiatere, gratis korttidsterapi og opplæring av ansatte i å holde seg nøytrale.
• Forfatterne sier at resultatene verken støtter å legge ned tilbud om overgang eller å gjennomføre overgang uten ordentlig vurdering.

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.