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

• Av 147 kliniker som började enkäten svarade 61 tillräckligt för att inkluderas. 77 % bedrev könsbekräftande vård, 6,6 % det nederländska förhållningssättet ‘avvaktande observation’ och 16,4 % ett annat förhållningssätt.
• 56 % sa att de hade följt en ung person som slutade transitionera och 8 % trodde att de kanske hade det. 36 % hade aldrig sett någon.
• Av de 39 som hade eller kanske hade sett sådana unga hade 82 % sett 1 till 5 under hela sin karriär, medan 8 % hade sett 21 eller fler.
• I sitt senaste fall sa 40 % att den unga hade gått tillbaka till att identifiera sig med sitt biologiska kön och 31 % sa att detta delvis stämde.
• 59 % sa att den unga hade psykiska problem innan transitionen påbörjades, och bara 18 % sa att den inte hade det.
• 21 % sa att den unga ångrade att ha påbörjat transitionen och ytterligare 21 % såg ‘lite’ ånger. 38 % sa att den unga inte verkade glad över att ha börjat och slutat.
• De flesta beskrev den unga som stödd av vänner (71 %) och som att den kunde få den medicinska vård den behövde (68 %), vilket antyder att yttre påtryckningar inte var det främsta skälet i dessa fall.

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.