Summary

Researchers interviewed 28 Canadians who had stopped or reversed a gender transition about their health care. Many stopped hormones suddenly and without medical advice, often because they feared being judged by clinicians or found care hard to get. They described changes in mood and energy, gender distress coming back, and doctors who did not know how to help. Many relied on online detransition communities instead. Some younger people had been pushed by parents to stop and later restarted. Most of those who had medically transitioned did not regret it, while about a fifth did. The study makes a believable case that people who stop treatment lack medical guidance and support. It cannot say how common these experiences or views are, because the group was small, self-selected and loosely defined, and the interviewers had all used gender-affirming treatment.

Key findings

• 访谈了加拿大的28名成年人（18名出生时为女性，10名出生时为男性；71%年龄在20至29岁之间）。27人进行过医学过渡，其中56%在18至24岁之间开始。
• 去过渡的原因包括健康担忧、手术并发症、性别认同感的变化、不支持的父母或伴侣、歧视以及难以获得护理。
• 许多人在没有心理健康支持或医疗监督的情况下突然（“戒断式”）停用激素，诊所在他们不再来之后很少跟进。
• 人们描述临床医生对去过渡毫无准备或带有评判，许多人转而在网上的去过渡团体中寻找信息。
• 在27名进行过医学过渡的人中，18人（67%）表示没有后悔或对过去的治疗感觉积极，6人（22%）后悔，3人（11%）感受复杂。
• 在切除睾丸或卵巢后改用其他激素的人通常有医疗监督，但常常描述护理很差。
• 作者呼吁提供关于去过渡的医学指导，并呼吁临床医生不要羞辱停止或逆转治疗的患者。

Abstract

Importance: Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition.

Objective: To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice.

Design, setting, and participants: Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed.

Main outcomes and measures: In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions.

Results: Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs.

Conclusions and relevance: This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.

Conclusion

This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions. The authors report accounts of people ceasing or reversing gender-affirming treatments with sub-optimal care, and call for research on clinicians' knowledge of detransition and the sources of detransition-related stigma.