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

• 2021年10月至2022年1月间访谈了28名20至53岁的人；71%在二十多岁，64%出生时为女性。
• 27人使用过跨性别激素，11人做过手术，包括双侧乳房切除（8人）、切除卵巢或睾丸（6人）和生殖器手术（3人）；一人使用过青春期阻断剂（暂停青春期的药物）。
• 57%说他们随时间持有过三种或更多种性别认同，60%从一开始的男性或女性跨性别认同转变为后来的非二元性别认同。
• 约三分之一的人对过渡表示后悔或感受复杂，两位在15岁开始医学过渡的人都后悔了。
• 后悔常常与治疗前觉得对风险、益处和其他选择了解不足一起被描述。
• 有些人觉得，对同性吸引感到不自在、创伤、自闭症或精神疾病加剧了他们的痛苦，而临床医生从未探讨过这些。
• 大多数人仍然支持人们自己作决定，并推荐在提供心理健康支持的同时，提供量身定制的“中立”护理。

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.