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

• 28 personer i alderen 20 til 53 år ble intervjuet mellom oktober 2021 og januar 2022. 71 % var i tjueårene og 64 % var født som kvinner.
• 27 hadde brukt kryssjønnede hormoner og 11 hadde hatt kirurgi, inkludert dobbel mastektomi (8), fjerning av eggstokker eller testikler (6) og genital kirurgi (3). Én hadde brukt pubertetsblokkere (medisiner som setter puberteten på pause).
• 57 % sa at de hadde hatt tre eller flere kjønnsidentiteter over tid, og 60 % gikk fra en mannlig eller kvinnelig transidentitet i begynnelsen til en ikke-binær identitet senere.
• Omtrent én av tre uttrykte anger eller blandede følelser over å ha gått gjennom overgang, og begge som begynte på medisinsk overgang ved 15 år angret.
• Anger ble ofte beskrevet sammen med en følelse av å ha fått for lite informasjon om risikoer, fordeler og andre alternativer før behandling.
• Noen følte at ubehag ved å være tiltrukket av eget kjønn, traumer, autisme eller psykisk sykdom hadde næret plagene deres og aldri ble utforsket av klinikere.
• De fleste støttet fortsatt at folk tar sine egne beslutninger og anbefalte skreddersydd, «nøytral» omsorg sammen med støtte for psykisk helse.

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.