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 oseb, starih od 20 do 53 let, je bilo intervjuvanih med oktobrom 2021 in januarjem 2022; 71 % jih je bilo v dvajsetih letih, 64 % pa rojenih kot ženske.
• 27 jih je jemalo hormone nasprotnega spola in 11 jih je imelo operacijo, vključno z dvojno mastektomijo (8), odstranitvijo jajčnikov ali mod (6) in operacijo spolovil (3); ena oseba je uporabljala zaviralce pubertete (zdravila, ki zaustavijo pubertetu).
• 57 % jih je reklo, da so sčasoma imeli tri ali več spolnih identitet, 60 % pa jih je prešlo iz moške ali ženske trans identitete na začetku v nebinarno pozneje.
• Približno ena od treh oseb je izrazila obžalovanje ali mešana čustva glede tranzicije, oba, ki sta začela medicinsko tranzicijo pri 15 letih, pa sta jo obžalovala.
• Obžalovanje so pogosto opisovali skupaj z občutkom, da pred zdravljenjem niso bili dovolj obveščeni o tveganjih, koristih in drugih možnostih.
• Nekateri so čutili, da so nelagodje zaradi privlačnosti do istega spola, travma, avtizem ali duševna bolezen hranili njihovo stisko in da jih kliniki nikoli niso raziskali.
• Večina je še vedno podpirala, da ljudje sami sprejemajo odločitve, in priporočala prilagojeno, „nevtralno“ oskrbo ob podpori za duševno zdravje.

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.