Summary

Detransition is often called rare. In this short opinion piece, Sarah Jorgensen argues that the rising number of young people who regret transition should be seen as harm caused by medical care, like past cases where drugs later proved harmful. She says the gender-affirming approach skips proper assessment, plays down risks, blames mental health problems mostly on stigma, and rests on weak evidence, as official reviews in Sweden, Finland and England found. She notes the main guidelines give little advice on detransition. She calls for open debate, more research, and recognition and support for detransitioners. It is a clear statement of concerns, but it is opinion, not new research. Its 10 to 30% figures come from a few studies that counted people stopping treatment, which is not the same as regret.

Key findings

• Jorgensen opisuje naraščajočo detranzicijo med mladimi kot škodo, ki jo povzroča medicinska oskrba. Primerja jo s preteklimi medicinskimi škodami, kot so poškodbe srčnih zaklopk zaradi tablet za hujšanje, srčna tveganja nekaterih protibolečinskih zdravil in opioidna kriza.
• Navaja študije, ki nakazujejo, da 10 do 30 % ljudi, ki začnejo medicinsko tranzicijo, preneha v 16 mesecih do štirih letih. V eni anketi je le 24 % detranzicionarjev povedalo svoji kliniki za spol.
• Trdi, da nizke številke obžalovanja večinoma izhajajo iz odraslih, zdravljenih po strožjih pravilih, iz študij, kjer je veliko ljudi izpadlo, in iz ozkih opredelitev obžalovanja, na primer prošnje za razveljavitev pravnega spola ali operacije.
• Pravi, da se ocena duševnega zdravja pogosto zavrača kot „vratarjenje“ in da se stigma uporablja za razlago duševne bolezni in avtizma, ki sta pogosto nastopila pred spolno stisko.
• Opozarja, da glavne mednarodne smernice za oskrbo transspolnih (8. izdaja WPATH) nimajo poglavja o detranziciji, ključne smernice za hormone ne svetujejo, kako varno prenehati jemati hormone, izjava ameriških pediatrov iz leta 2018 pa obžalovanja ne omenja.
• Opozarja na Švedsko, Finsko in Anglijo, katerih uradni pregledi so ugotovili šibke dokaze in so se preusmerile tako, da imajo za mladoletnike na prvem mestu pogovorno terapijo in zdravljenje drugih težav z duševnim zdravjem.
• Poziva k odprti razpravi, raziskavam in sodelovanju med kliniki, da obžalovanje resnično postane redko, ter k temu, da se detranzicionarje prizna kot osebe, ki jim je oskrba škodovala, in jim zagotovi prilagojena podpora.

Abstract

Although transition regret and detransition are often dismissed as rare, the increasing number of young detransitioners who have come forward in recent years to publicly share their experiences suggests that there are cracks in the gender-affirmation model of care that can no longer be ignored. In this commentary, I argue that the medical community must find ways to have more open discussions and commit to research and clinical collaboration so that regret and detransition really are vanishingly rare outcomes. Moving forward, we must recognize detransitioners as survivors of iatrogenic harm and provide them with the personalized medicine and supports they require.

Conclusion

The medical community must find ways to have more open discussions and commit to research and clinical collaboration so that regret and detransition really are vanishingly rare outcomes. Last, we must recognize detransitioners as survivors of iatrogenic harm and provide them with the personalized medicine and supportive care that they need.