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

• Ze 147 klinicystów, którzy zaczęli ankietę, 61 odpowiedziało na tyle, by ich uwzględnić; 77% praktykowało opiekę afirmującą płeć, 6,6% holenderskie „czujne wyczekiwanie”, a 16,4% inne podejście.
• 56% powiedziało, że śledziło młodą osobę, która przerwała tranzycję, a 8% sądziło, że być może; 36% nigdy takiej nie widziało.
• Spośród 39 osób, które widziały lub być może widziały taką młodzież, 82% widziało od 1 do 5 w całej karierze, a 8% widziało 21 lub więcej.
• W swoim ostatnim przypadku 40% powiedziało, że młoda osoba znów identyfikowała się ze swoją płcią urodzeniową, a 31% że częściowo tak było.
• 59% powiedziało, że młoda osoba miała problemy ze zdrowiem psychicznym przed rozpoczęciem tranzycji, a tylko 18% że ich nie miała.
• 21% powiedziało, że młoda osoba żałowała rozpoczęcia tranzycji, a kolejne 21% widziało „trochę” żalu; 38% powiedziało, że młoda osoba nie wydawała się zadowolona, że zaczęła i przerwała.
• Większość opisywała młodą osobę jako wspieraną przez przyjaciół (71%) i mającą dostęp do potrzebnej opieki medycznej (68%), co sugeruje, że w tych przypadkach zewnętrzna presja nie była głównym powodem.

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.