Summary

This paper suggests splitting detransition into two types. In 'core' detransition, a person stops identifying as transgender and identifies with their birth sex again. In 'non-core' detransition, a person stops or reverses transition but still identifies as trans, because of things like discrimination, health worries or being unhappy with results. The author argues this would clear up confusion, since 'detransition' is used to mean both. He gives advice for clinicians: thorough mental health assessment, honest consent about benefits, risks and unknowns, offering talking therapy alongside medical options, long-term follow-up, and guidelines for both groups. It is a useful way to think about the topic, but it is based on stories and opinion rather than data, and nobody has yet tested whether the types work in practice.

Key findings

• Papperet föreslår två typer: ‘kärn’- eller primär detransition (att inte längre identifiera sig som transperson och åter identifiera sig med sitt biologiska kön) och ‘icke-kärn’- eller sekundär detransition (att sluta eller vända transitionen samtidigt som man fortfarande identifierar sig som trans).
• Orsaker till kärn-detransition är bland annat att man finner att transitionen inte lindrade det könsrelaterade lidandet, och att man kommer att se det lidandet som kopplat till trauma, inre skam över att vara homosexuell, sexism eller andra psykiska svårigheter.
• Orsaker till icke-kärn-detransition är bland annat medicinska problem, missnöje med resultaten, diskriminering, brist på pengar eller stöd, påtryckningar från familjen och önskan att få barn eller skydda fertiliteten.
• Typerna är inte fasta: en icke-kärn-detransition kan senare bli en kärn-detransition, och vissa identifierar sig som icke-binära en tid innan de åter identifierar sig med sitt biologiska kön.
• Författaren noterar informella rapporter om att autism är vanligare bland detransitionerare än i den allmänna befolkningen, men säger att detta behöver undersökas.
• Han rekommenderar noggrann psykiatrisk bedömning, ärligt samtycke som omfattar fördelar, risker och okända faktorer, att erbjuda utforskande samtalsterapi vid sidan av medicinska alternativ samt långsiktig uppföljning.
• Detransition är inte alltid ånger: han ber kliniker att bemöta dem utan att döma och att skriva kliniska riktlinjer för båda grupperna.

Abstract

Gender detransition, i.e., the process of reidentifying with one's birth sex after having undergone a gender transition, has captured the attention of the scientific community, the media, and the public in the last few years. Despite not being a genuinely novel phenomenon from a historical perspective—psychiatrist Harry Benjamin described one such case in his 1966 book The Transsexual Phenomenon—, research on detransition has been absent from the academic literature until recently. As a consequence, our understanding of this issue is still limited and primarily based on anecdotal evidence, which comes from a variety of sources such as personal testimonies shared on the internet, parent reports, informal surveys carried out by detransitioners, media outlets, support groups, documentaries, case studies, and the experiences of clinicians who work with this cohort. Gender detransition is as scientifically fascinating as socially controversial, for it poses significant professional and bioethical challenges for those clinicians working in the field of gender dysphoria. However, the scarcity of information, along with the lack of formal recognition of detransitioners and their experiences, has contributed to a state of things in which we fall short of a shared and scientifically consolidated language to approach detransition. This gap has favored the proliferation of inconsistent usages of the concept, thus adding to the confusion and unclarity. The term 'detransition' has been used to describe two types of situations. In the first, a person stops identifying as transgender after having socially, legally, or medically transitioned. In the second, a person stops transitioning due to health concerns, lack of societal/familial support, or dissatisfaction with the results—but does not cease to identify as transgender. This article proposes a typology of gender detransition based on the cessation or continuation of a transgender identity, distinguishing between core (primary) and non-core (secondary) detransitions, and discusses its implications for healthcare providers working with gender dysphoric patients.

Conclusion

Gender detransition is an emerging yet poorly understood phenomenon in our society, which poses significant professional and bioethical challenges for clinicians working in the field of GD. The absence of systematic research around detransition has given rise to inconsistencies in its conceptual use and application, adding to the unclarity and confusion. A typology of gender detransition based on the cessation or the continuation of a transgender identity could address these issues, while offering clinicians a framework to reflect on their therapeutic endeavor when treating patients with GD. Furthermore, recognizing the disparities between core and non-core detransitioners could also help develop clinical guidelines, thus assisting healthcare providers to accommodate their different needs and demands. The conducting of comprehensive exploratory assessments can prove to be a useful tool to ensure thoughtful decision-making and prevent any potential harm associated with the experience of detransition. In conclusion, detransitioners are an underserved population whose experiences we need to listen to and understand if we truly aim to improve healthcare for people with GD. This will require extensive research to learn more about their unique experiences, motivations, needs, and demands.