York U-led study finds those who detransition avoid medical help

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A new study out of York University draws attention to insufficient clinical care and support for those who discontinue or seek to reverse prior gender-affirming interventions.

Medical education, research and clinical guidelines are all available to support the initiation of gender-affirming care for transgender people, but a York University-led qualitative study has found these resources are sparse when patients discontinue or reverse gender-affirming medical or surgical interventions – referred to as detransition.

The study is published in the journal JAMA Network Open indicates that individuals detransition for various reasons including physical and mental health concerns or an evolving gender identity, such as shifting from trans men or trans women, to non-binary or re-identifying with their birth sex.

Kinnon Ross MacKinnon

“A majority of respondents reported little decisional regrets regarding prior gender-affirming interventions; however, participants frequently discussed stopping gender-affirming hormones ‘cold turkey’ without medical supervision, facing provider stigma and experiencing clinicians who lacked detransition-related clinical knowledge,” says Professor Kinnon Ross MacKinnon, lead author of the study.

One study participant stated they stopped talking to clinicians after deciding to quit testosterone therapy for fear of being judged for detransitioning. Although during her initial medical transition she had positive relationships with her health care providers and therapist, she felt guilt and shame about detransitioning, and was worried that her clinicians would misinterpret her initial transition as a mistake and subsequent detransition as regret.

“Rather than relying on clinicians who were often a source of distrust, many turned instead to online detransition networks and social media. Often, they did not have a clear understanding of what health implications to expect when stopping gender-affirming hormones,” points out MacKinnon.

Medical detransition was often experienced as physically and psychologically challenging. Some individuals initiated the process after gonadectomies or lower surgeries, which meant switching from masculinizing to feminizing hormones or vice-versa. 

Another study participant who now identifies as female reported a lack of understanding from medical pracitioners. In her initial transition process as a transgender young person, her gender dysphoria had been treated with testosterone and both oophorectomy and hysterectomy. However, when she was seeking medical support to detransition and switch from testosterone to estrogen, she felt her medical providers were unprepared to meet her needs.

Aside from physical and mental health concerns, factors motivating detransition included surgical complications and post-operative pain, unsupportive parents or romantic partners, and employment discrimination. In the last two years, the COVID-19 pandemic and related lockdowns was an additional impediment, causing difficulty accessing clinical appointments or gender-affirming surgeries.

For the study, 28 adults between the ages of 2 and 53 – the majority of whom were assigned female at birth – were interviewed about their experiences of detransition, including their health care encounters when discontinuing or reversing gender-affirming medical or surgical care.

MacKinnon and other researchers from Simon Fraser University, University of British Columbia, University of Michigan, and University of Toronto who worked on this study, conclude that further research and clinical guidance is required to address the unmet needs of those who discontinue or seek to reverse prior gender-affirming interventions.