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Researchers Call for End to Politicization—Detransitioners Have Unmet Healthcare Needs

Detransition needs further understanding, not controversy

mental healthdetransitionmedical ethicsgender dysphoriaqualitative researchgender-affirming care
Authors
Kinnon Ross MacKinnon, Pablo Expósito-Campos, W Ariel Gould
Year
2023
Journal
BMJ

Methodological Limitations

  • The paper itself acknowledges that existing research on detransition suffers from significant methodological limitations, including 'non-probability sampling,' 'analysis of short term gender care outcomes,' and studies using 'purposive and snowball sampling, thus introducing selection bias'—yet the authors cite these same limited studies extensively to support their arguments without adequately accounting for these weaknesses in their own synthesis.
  • The authors state that 'it is a challenge to estimate the prevalence of detransition and describe this population' due to methodological limitations, yet they simultaneously make confident assertions about demographic patterns (e.g., 'high proportion were assigned female at birth, transitioned before the age of 25, and experienced identity fluidity') based on the very 'exploratory, non-representative studies' they acknowledge as methodologically weak.
  • The authors cite a Reuters analysis finding that 'over 14,000 young people aged 17 and younger starting to take gender affirming hormones' between 2017-2021, but this figure is from a journalistic investigation commissioned by a news organization, not peer-reviewed research, and its methodology for data collection is not described or critically evaluated.
  • The paper references the claim that 'Around 64% of gender dysphoria diagnoses are made in patients assigned female at birth' (citing Thompson et al., 2022), but this statistic is presented without critical examination of whether diagnostic patterns may reflect sociocultural factors, referral biases, or changes in clinical presentation rather than true epidemiological shifts.
  • The authors acknowledge that 'some authors even caution against applying the concept of detransition' but dismiss this position as merely 'an understandable response to sociopolitical environments,' potentially mischaracterizing legitimate methodological or conceptual concerns as purely politically motivated rather than engaging with them substantively.
  • The paper's recommendation for 'follow-up of at least 5-10 years after interventions' conflicts with its own reliance on and citation of studies with much shorter follow-up periods (e.g., the Amsterdam Cohort study with regrets data, or contemporary studies with 1-2 year follow-ups) without clearly flagging this temporal mismatch when citing them.
  • The authors state that 'those who disconnect from care or who refuse to participate in gender care follow-up studies, over 30% in some studies, are poorly understood,' yet they do not adequately address how this substantial attrition rate undermines the validity of prevalence estimates and outcome data they cite from those same studies.
  • The patient and public involvement section notes that 'Four people who have detransitioned since receiving gender affirming care were also consulted,' but provides no information about how these individuals were selected, whether they represent diverse perspectives, or how their input was systematically incorporated—raising questions about selection bias and the representativeness of these consultations.
  • The authors claim that 'trans and detrans people are more similar than different' as a belief statement near the conclusion, but this assertion is not empirically demonstrated in the paper and appears to be a normative position rather than a research finding, potentially conflating advocacy goals with objective research characterization.
  • The paper critiques researchers who 'fear the concept of detransition because of the political environment' and those who use 'euphemisms,' yet the authors themselves may be subject to similar ideological influences—two authors having had 'gender affirming medical care' and the paper's framing consistently emphasizing continuity between trans and detrans experiences rather than genuinely exploring potential tensions or differences in healthcare needs.

Key Findings

  • Detransition is poorly understood due to limited research and stigma, leaving people with unmet healthcare needs and no clinical guidelines for care.
  • People who detransition are diverse: many are female, transitioned young, and may re-identify with their birth sex, sexual orientation, or continue identifying as trans.
  • Common reasons for detransition include persistent or returning gender dysphoria, health concerns, social discrimination, identity exploration, or unresolved dysphoria despite treatment.
  • Research on detransition needs major improvements: longer follow-up periods (5-10 years), using patients' preferred language, and including those lost to follow-up to avoid biased conclusions.
  • Trans and detrans people share more similarities than differences; studying detransition benefits all gender-diverse individuals and strengthens comprehensive gender care for everyone.

Abstract

**Objective** To synthesize existing evidence on gender detransition and provide guidance for future research design and comprehensive clinical care for people who discontinue or reverse gender-affirming medical or surgical interventions. **Background** Detransition has been thrust into public and legal discourse, often weaponized to restrict access to gender-affirming care. Despite growing visibility, the phenomenon remains poorly understood, with research and clinical guidance overwhelmingly focused on initiating rather than discontinuing treatment. Stigma, politicization, and methodological limitations have contributed to the erasure of detrans people and their care needs. **Key arguments** People who detransition are demographically heterogeneous, though many were assigned female at birth and transitioned before age 25. Reasons for detransition are multifaceted, encompassing gender identity fluidity, unresolved or iatrogenic gender dysphoria, physical and mental health concerns, and social discrimination. Following detransition, individuals often report ongoing gender-related distress, complex emotions including regret, grief, and ambivalence, and significant unmet physical and mental healthcare needs. Many also experience healthcare avoidance due to anticipated judgment and loss of peer support networks. **Recommendations** Future research should adopt the self-identified language of “detrans” and “detransition,” employ long-term follow-up periods of at least 5–10 years, and avoid assuming that participants lost to follow-up remain trans or have no further care needs. Clinicians and service providers must offer non-judgmental, tailored support that acknowledges the full range of detrans experiences, including those who view their transition as a meaningful process of self-discovery as well as those who experience profound regret. **Conclusion** Rigorous, sensitive detransition research is indispensable for advancing gender care. Trans and detrans people share more similarities than differences; understanding detransition benefits all who transition and is essential to responsible, evidence-based gender care research and practice.

Summary

This paper argues that detransition—the discontinuation or reversal of gender-affirming medical or surgical interventions—requires rigorous, sensitive research rather than political controversy. The authors highlight significant gaps in current knowledge due to methodological limitations, short follow-up periods, and stigma that has led to erasure of detransitioners in academic literature. They call for improved research design, use of preferred language, and longer-term studies to better understand the diverse experiences and unmet healthcare needs of people who detransition, ultimately advocating for comprehensive gender care services that serve both trans and detrans populations.

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.