Forskare uppmanar till att stoppa politiseringen – personer som avbryter könsbyte har otillfredsställda vårdbehov

Detransition behöver mer förståelse, inte kontrovers

Kommentarer & analyser Av-transition & ånger Vård & stöd för av-transitionerade

Authors: Kinnon Ross MacKinnon, Pablo Expósito-Campos, W Ariel Gould
Journal: BMJ
Year: 2023
Source: www.bmj.com/content/381/bmj-2022-073584

Summary

Writing in the BMJ, Kinnon MacKinnon, Pablo Expósito-Campos and W Ariel Gould argue that people who stop or reverse a gender transition have been ignored by research and care, partly because the topic has become political. Drawing on a few small studies of volunteers, they describe detransitioners as varied, but often female and young when they transitioned. Their reasons range from a change in identity and gender distress that didn't go away, to health worries and discrimination. Many have medical and mental health needs that aren't being met. The authors recommend following patients for at least 5 to 10 years and not assuming that people who drop out of studies (over 30% in some) are doing well. It is a sensible research plan, not new evidence. There was no formal search, and some claims rest on news reports or the authors' own studies.

Key findings

Detta är en analysartikel, inte en fullständig översikt av forskningen: den sammanfattar några tidiga studier och ger rekommendationer, utan nya data.
De citerade studierna (till exempel en nätenkät bland 237 detransitionerare, 92 % kvinnor, och en kanadensisk intervjustudie av 28) antyder att många detransitionerare var födda som kvinnor och transitionerade före 25 års ålder.
Orsaker till detransition är en förändrad identitet, könsrelaterat lidande som transitionen inte löste, oro för fysisk eller psykisk hälsa, diskriminering och lidande som orsakats av själva behandlingen (‘omvänd dysfori’).
Efter detransition beskriver många pågående könsrelaterat lidande, ånger, sorg eller blandade känslor, förlorat stöd från HBTQ+-vänner och att man undviker läkare av rädsla för att bli dömd.
Författarna säger att uppföljning i 1 till 2 år är för kort, eftersom detransition vanligtvis sker flera år efter behandlingen. De rekommenderar minst 5 till 10 år.
De varnar för att över 30 % av patienterna hoppar av i vissa studier om könsvård, och att forskare inte bör anta att dessa personer fortfarande identifierar sig som trans eller saknar ytterligare behov.
De rekommenderar att studiegrupper väljs utifrån den behandling människor fått snarare än deras nuvarande identitet, att orden ‘detrans’ och ‘detransition’ används och att icke-dömande detransitionsvård byggs in i könsvården.

Abstract

Kinnon MacKinnon and colleagues call for robust, sensitive research to inform comprehensive gender care services for people who detransition

Conclusion

Rigorous and nuanced detransition research is indispensable. Investigating the experiences of people who detransition will provide a better understanding of the development of gender identity, as well as all health and psychosocial outcomes following gender care. This aligns with priorities identified by trans health experts. Unfortunately, ongoing debates and politicisation of gender care have resulted in the depiction of trans and detrans people as completely distinct groups with divergent needs and experiences, and who are doomed to conflict. However, we believe that trans and detrans people are more similar than different, and that detransition research holds value for advancing the healthcare of all those who transition, and for responsibly moving gender care research and practice forward.

Methodological limitations

Not a full review: The article says it weaves together existing research, with no search method, rules for which studies to include, or quality checks. Which studies are cited, and how much weight they get, is the authors' choice.
Few, unrepresentative studies: Its picture of detransitioners rests on a few groups of volunteers found online or through networks (Vandenbussche, 237 people; Littman, 100; MacKinnon et al., 28; Pullen Sansfaçon et al., 20). The authors admit these recruitment methods can skew the results.
Lots of self-citation: Three of the 25 references are the lead author's own studies, and the Canadian interview findings used again and again come from the same research group.
Key claim backed by news reports: The statement that identity change and detransition 'are unlikely to represent the majority' is backed only by a Guardian news article. The US figures on how many people transition come from a Reuters analysis, not peer-reviewed research.
Strong label without evidence: The belief that trans identity can be temporary is called 'stigmatised, transantagonistic, and erroneous' with no supporting source, in an article that elsewhere describes identity changing after transition.
No idea how common detransition is: The authors say this can't be estimated yet, so the article can't say how big the unmet need is, or how detransitioners fare compared with people who continue.
Belief, not finding: The closing claim that 'trans and detrans people are more similar than different' is the authors' belief and is not tested against data.
Little detail on detransitioner input: Four people who had detransitioned were consulted, but the article doesn't say how they were chosen or how their input shaped it.
Narrow focus: The piece looks at care needs after detransition. It does not ask whether weak assessment, or weak evidence for the original treatments, helps cause detransition, even though its call for longer follow-up bears directly on that question.
Authors' perspective: All three authors are gender care researchers, and two have had gender-affirming medical care themselves (disclosed). No competing interests were declared, but the article clearly presents detransition research as part of gender-affirming care.

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Summary

Key findings

Abstract

Conclusion