Introduction to Detransition
Detransitioners and desisters are a growing population that are in need of competent psychotherapeutic treatment. For the purposes of this website, the word “detransitioner” describes anyone who identified as transgender and took any medical steps toward transition, including taking puberty blockers, cross sex hormones, or having surgery, and then decided to go back to reidentifying with his or her natal sex. Reidentification may involve stopping taking cross sex hormones, changing gender presentation, or other steps. The word “desister” refers to anyone who identified as trans who later desisted from that identification and went on to reidentify with his or her natal sex. Desisters who identified as trans may have undergone a social transition in which they changed names, pronouns, and presentations. Reidentification may involve changing back to using a birth name, for example.
Since approximately 2010, the numbers of children and young people identifying as transgender began a precipitous rise throughout the Western world. No one is sure exactly why such a rise occurred. Some posit that greater acceptability of gender variant people encouraged those who might have remained closeted to come out. Others point to factors that indicate that social contagion may be implicated in the rising numbers. In any case, many more children and young people have been seeking and receiving gender transition medical treatment. More recently, there have been a growing number of detransitioners and desisters writing and speaking about their experiences and seeking mental health treatment to deal with the aftermath of their gender transition.
Destransitioners and desisters have some unique needs and therapists working with this population should be aware of these. On the other hand, they are also an incredibly diverse group, and each person will likely present with his or her own individual story. This introduction to the topic is meant as a broad overview only, and necessarily can’t convey the full complexity of these clinical cases. Nevertheless, there are some common themes that are seen with this population.
Many Detransitioners and Desisters Are Young
Most of the detransitioners and desisters seeking therapy are between the ages of 15 and 34. Many of them became trans identified during their teen years or in their early twenties. An informal survey conducted in 2016 found that the average detransitioner came out as trans at age 17, and detransitioned at 21. The survey further found that the average length of time that respondents were trans was four years. This means that many of these young people were negotiating a gender transition and detransition during a time in which they were negotiating other significant developmental milestones related to identity and belonging.
Many Detransitioners and Desisters are Female
As the numbers of young people seeking gender treatment soared, another trend was noticed. While most gender dysphoric children in the past were natal males, starting around 2010, there was a reversal in the sex ratio, with many more natal females identifying as trans. This trend was observed throughout the Western world. No one understand exactly why this happened. Correspondingly, many of the detransitioners and desisters coming forward are natal females. It is estimated that natal males account for around 30% of detransitioners and desisters.
Many Detransitioners and Desisters Had Complicated Mental Health Needs Before They Transitioned
There is considerable literature documenting the fact that many transgender young people have comorbid conditions. It therefore is no surprise that the detransitioners and desisters seeking therapy often note that they were struggling with mental health issues at the time they became trans identified. This is significant for working with this population as most of the time, these mental health issues remain a concern after detransition. Issues of clinical concern that may have predated a trans identification may include any of the following: social isolation, high functioning autism, giftedness, learning disabilities, depression, anxiety, obsessive-compulsive disorder, anorexia, bulimia, and self-harm. There appears to be a very high incidence of detransitioners who also have eating disorders. Serious mental health issues such as borderline personality disorder, bipolar disorder, or psychosis are also sometimes seen in this population. These issues often remained unaddressed during the gender transition and may reassert themselves with renewed vehemence after detransition.
The Majority of Detransitioners and Desisters are Same-sex Attracted
Most of the young people presenting for therapy after reversing a gender transition now understand themselves to be gay or lesbian. Many now understand their transition to have been motivated by internalized homophobia.
Some Detransitioners Feel Traumatized by Transition
This is certainly not the case for everyone. Some detransitioners and desisters feel grateful for their gender exploration. They may appreciate the physical changes that resulted from taking cross sex hormones, or even surgeries. However, quite a few detransitioners do describe their transition as traumatizing. They may feel betrayed by the mental health and medical communities that sanctioned what has been described as “medically assisted self-harm.” They may feel deep regret and sadness about the loss of their natural speaking voice, their breasts, or other organs. In general, the more medical intervention a detransitioner has had, the more likely he or she is to feel traumatized. The experience of someone who socially transitioned but never had any medical intervention is very different from someone who took testosterone and may have to deal with a permanently altered voice, a receding hairline, or unwanted facial hair. Her experience will differ again from someone who took testosterone and also had a bilateral mastectomy, who may be dealing with grief about the loss of her breasts, as well as scarring and nerve damage. And this latter person will have a very different experience from the detransitioner who may have taken testosterone, had a mastectomy, as well as a hysterectomy and oophorectomy. Those who have had the latter two procedures will be dependent on synthetic hormones for the rest of their lives. There are also additional possible health complications that comes along with having had a hysterectomy. It is important for therapists to understand that these interventions can be the source of regret and trauma for some people.
Detransitioners and Desisters Are Often Isolated
Many detransitioners and desisters had a supportive community when they went through transition. They likely lost these supports when they began to detransition. Although detransitioners and desisters are finding each other online and developing new communities and networks, they may not know other detransitioners in person. In addition, many report that talking about their detransition publicly exposes them to angry criticisms and misunderstandings as they are often accused of being “transphobic.”
Some detransitioners and desisters feel alienated from their family of origin. There may have been conflict over their initial gender transition. The young person may feel somewhat ashamed of “admitting they were wrong” and therefore be reluctant to share their detransition with parents. In some cases, the conflict with parents may have been so extreme that it damaged the relationship. On the other hand, some detransitioners whose parents were quick to affirm their trans identity and support their medical transition feel betrayed that no one tried to slow them down.
Detransitioners and Desisters May Have Educational or Vocational Issues
Many detransitioners report that they had to take time off of school during their transition or detransition process. They may have difficulty re-engaging in school or finding employment. They may not have much in the way of financial resources, and their lives may be chaotic.
Detransitioners and Desisters May Be Contending with Unlearning Ideology
Many detransitioners and desisters report that their trans identification was influenced by gender identity ideology – the belief that we all have an innate gender identity, and this can differ from and take precedence over our biology. Many detransitioners and desisters now reject this belief and find it difficult to interact with therapists who don’t understand how important it is to have reclaimed their birth sex and have rejected the notion of innate gender identity.