May 18, 2023 - 7:15am

Yesterday, the New York Times ran a hit piece on a handful of young detransitioners who have been criss-crossing the United States to speak out about their experiences on the wrong end of “gender-affirming care”.

If taken seriously, detransition threatens the very foundation of “gender-affirming care” — because if patients can be mistaken, then clinicians can harm. The experiences of detransitioners like Chloe Cole clearly show the need for careful evaluation — gatekeeping, in other words — and the risk that affirming a patient’s fluctuating sense of identity with irreversible interventions like hormones and surgeries can pose. That’s why clinicians, researchers and, yes, reporters who are committed to affirmation spend more time and energy waging war on detransitioners, rather than reforming their approach to working with gender-questioning patients to prevent medical harm and regret.

High-quality research on detransitioning is hard to come by. Most studies that follow patients long enough to capture regret focus on an entirely different patient population (adult males who transitioned after undergoing intensive clinical screening) and tell us next to nothing about how today’s crop of trans-identifying patients — dominated by adolescent girls — will fare. The research that exists suffers from high loss-to-follow-up and researchers go out of their way to bury or muddle inconvenient findings.

Dutch researchers decided to lump all changes of patient self-identification together — from “nonbinary” to “elf” to “human” to “detransitioner” — under the heading of patients experiencing “multiple attenuations” of gender identity. This means that there is no detransition head count, and enables researchers to focus on the creativity and diversity of gender identifications their research subjects adopted, while minimising evidence of regret. Some researchers point to studies of people who currently identify as transgender to argue that detransition is rare — and temporary — and that the solution to detransition is more affirmation, not less. Some claim that detransitioners were never trans in the first place. Others insist that detransitioners still fall under the trans umbrella today (so much for self-identification!).

Affirming clinicians increasingly speak of “gender fluidity”, “gender journeys” and “dynamic desires for gender-affirming interventions” (a near-perfect ideological specimen but, alas, a real mouthful).  Thomas Steensma and Annelou De Vries, who champion early interventions like puberty suppression for gender-questioning kids, disparage the concept of “regret” as “too binary”. “[R]egret is a complex and heterogeneous concept,” according to some of the United States’ leading gender clinicians. When asked about the possibility of her patients regretting the decision to transition in the future, Johanna Olson-Kennedy mused:

What does that actually mean? Does that mean that someone has additional breast tissue that they would not want at a later point? But they could get that breast tissue removed if they absolutely need to.
- Johanna Olson-Kennedy

Or maybe a patient had her breasts removed — at the tender age of 15, say, like the main character in the New York Times’ story — but “if you want breasts at a later point in your life, you can go and get them.” Clinicians rebrand “detransition” as “retransition”, an attempt to portray transition — which involves intervening on a healthy body in ways that introduce injury and induce an endocrine condition — and detransition as ethical equivalents, rather than acknowledge the possibility of medical harm.

The reality is that an unknown but growing number of young patients regret pharmaceutical and surgical interventions they received under an affirmative-care model that does not take the possibility of medical harm, regret, and detransition seriously.

Affirming clinicians, researchers, and their allies in the press want to protect the anything-goes model of care at all costs. But transport the problem of medical harm and regret from “gender-affirming care” to any other area of medicine and the abuse detransitioners attract stands out starkly. This is how Scientologists treat Suppressive Persons, not how medicine treats patients harmed by its practitioners. 

Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.