Summary

Finnish clinicians reviewed the records of, and reassessed, the nine adults who came back to their gender clinic in 2018 to 2019 wanting to detransition. Most had had hormones and chest or breast surgery years earlier. Nearly all had serious mental health histories, including depression, anxiety, borderline personality disorder, eating problems, self-harm and childhood trauma or sexual abuse. Looking back, most said their wish to transition came from difficulties growing up, especially as girls, and from unresolved distress, rather than from their gender identity. The clinic then made it easier for detransitioners to return and paid more attention to trauma. The study gives rare clinical detail on detransitioners. But it is tiny, has no comparison group, relies on records and memories gathered after regret, and compares its mental health figures with a different group of patients.

Key findings

• 研究涵蓋 2018 至 2019 年間轉介到赫爾辛基成人性別門診來去過渡的全部九名成人：七人出生時為女性，都有重大後悔；兩人出生時為男性，有輕微後悔。
• 他們平均在 25 歲時首次被診斷，去過渡評估時為 33 歲。後悔平均要七年才出現（2010 年後接受評估者為五年）。
• 八人曾接受乳房切除或隆乳手術，四人的子宮與卵巢被切除。除一人外，其餘都需要醫療處置才能去過渡。
• 心理健康問題非常常見：89% 有情緒障礙，78% 有焦慮症，56% 有邊緣型人格障礙，78% 有飲食障礙或症狀。六人曾遭到性虐待或強暴。
• 在去過渡評估時，五人認同出生性別，三人認同為非二元性別，一人仍認同為跨性別。
• 被問到為何過渡時，六人表示身為女性長大很辛苦。其他原因包括無法融入、創傷，還有一個案例是將同志誤認為跨性別。
• 門診改變了運作方式：回診不需要轉介、與患者的精神科醫師更緊密合作、提供免費短期治療，以及對工作人員進行保持中立的培訓。
• 作者表示，這些結果既不支持關閉過渡服務，也不支持在沒有適當評估的情況下過渡。

Abstract

The aim of this study was to analyze the pathways of detransitioning, which is a rare, but serious complication of gender-affirming treatments (GATs). The patient group consisted of all patients who were referred to the Helsinki University Hospital's Gender Identity Clinic (GIC) wanting medical treatment for detransition from 2018 to 2019. A new assessment was made systematically and retrospective data were collected. The sample consisted of nine patients originally diagnosed with gender identity disorder (F64.0). Seven of them were assigned female at birth and two were assigned male at birth. All seven females at birth had "major" regret and both males at birth had "minor" regret. All patients except one male assigned at birth wanted their previous GAT to be reversed. The mean regret time (i.e., time from the first diagnosis of F64.0 to the beginning of the new evaluation period) was seven years. The detransitioners had a high number of psychiatric diagnoses. Childhood trauma, sexual abuse or rape, eating disorder symptoms, borderline personality, and psychotic symptoms were common among detransitioners. Retrospectively, the patients reported that the need for transitioning in the first place was not the transgender identity or gender dysphoria, but reasons related to the maturation process and unresolved psychological stressors. An assessment made by the psychologist at the GIC revealed childhood trauma and severe challenges in parenting and attachment. It is important to acknowledge, support, and evaluate those regretting treatments and/or detransition, and to learn from them.

Conclusion

Even though most adults seeking gender-affirming treatment benefit from it and are satisfied with the treatment, it is important to acknowledge, support and evaluate those regretting treatments and/or who wish to detransition, and to learn from them. Those who detransition have a high amount of childhood and sexual trauma, eating disorder symptoms, borderline personality disorders and psychotic symptoms. Evaluating and treating serious psychiatric illnesses first, to determine if the patients' dysphoria resolves without gender-affirming treatment, might reduce the cases of detransitioning. Sufficient psychotherapy might help prior to irreversible gender-affirming treatment. The need for more research is urgent, and a wider, unprejudiced voice in public discussion about detransitioning and regret is needed. It is important to encourage detransitioners to notify the gender identity clinic that they detransitioned, as it would provide valuable information to clinicians about patient outcomes. The results of this study should be used to inform the evaluation process, counseling, informed consent, and medical decision-making for patients with gender dysphoria. The results do not support eliminating transition services nor do they support proceeding to transition without adequate evaluation.