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

• Исследование охватило всех девятерых взрослых, направленных в хельсинкскую взрослую гендерную клинику для детранзиции в 2018–2019 годах: семь рождены женщинами, все с сильным сожалением, и двое рождены мужчинами с небольшим сожалением.
• В среднем им было 25 лет при первичном диагнозе и 33 при оценке для детранзиции. Сожаление в среднем проявилось через семь лет (через пять лет у оценённых после 2010 года).
• Восемь перенесли удаление или увеличение груди, а четверым удалили матку и яичники. Все, кроме одного, нуждались в медицинском лечении для детранзиции.
• Проблемы с психическим здоровьем были очень частыми: расстройства настроения у 89%, тревожные расстройства у 78%, пограничное расстройство личности у 56% и расстройства пищевого поведения или их симптомы у 78%. Шестеро подвергались сексуальному насилию или изнасилованию.
• При оценке для детранзиции пятеро отождествляли себя с рождённым полом, трое — как небинарные и один по-прежнему как трансгендерный.
• На вопрос, почему они прошли транзицию, шестеро сказали, что расти женщиной было трудно. Другие причины включали ощущение неприкаянности, травму и, в одном случае, принятие гомосексуальности за трансгендерность.
• Клиника изменила работу: для возвращения не нужно направление, более тесная работа с психиатрами пациентов, бесплатная краткосрочная терапия и обучение персонала сохранению нейтральности.
• Авторы говорят, что результаты не поддерживают ни закрытие служб транзиции, ни транзицию без надлежащей оценки.

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.