Detransition
Detransition is the cessation or reversal of a transgender identification or gender transition, whether by social, legal, or medical means. Some individuals detransition on a temporary basis. Estimates of the rate at which detransitioning occurs vary. Reasons for detransitioning also vary, and may include health-related concerns, finding that transition did not alleviate gender dysphoria, an unaffirming social environment, financial concerns, the realization that the individual's gender dysphoria was a manifestation of another condition, or political, religious, or philosophical disagreements with the transgender movement. Academic research into detransition is underdeveloped. Professional interest in the phenomenon has been met  with contention, and some scholars have argued there is censorship around the topic. In politics and popular culture, detransitioning is a contentious topic. Some who detransition report feeling a loss of support by their LGBT friends and family. Various sides in the debate over detransitioning have reported harassment from other individuals. Background and terminology. "Transition" is the process of a transgender person changing their gender presentation and/or sex characteristics to accord with their internal sense of gender identity. Transition commonly involves social changes (such as clothing, personal name, and pronouns), legal changes (such as legal name and legal gender), and  medical/physical changes (such as hormone replacement therapy and sex reassignment surgery). "Detransition" (sometimes called "retransition") is the process of halting or reverting a transgender identification or gender transition. Like transition, detransition is not a single event. Methods of detransitioning can vary greatly among individuals, and can involve changes to one's gender expression, social identity, legal identity documents, and/or anatomy. "Desistance" is a general term for any cessation, and it is commonly applied specifically to the cessation of transgender identity or gender dysphoria. Those who undertake detransition are known as "detransitioners". Detransition is commonly associated with "transition regret", but  regret and detransition do not always coincide. The term "detransition" is controversial within the transgender community. According to Turban et al., this is because, as with the word "transition", it carries an "incorrect implication that gender identity is contingent upon gender affirmation processes". The term has also been conflated with transition regret, and thereby become associated with a politically motivated push to restrict the access of transgender people to transition-related healthcare. Occurrence. Formal studies of detransition have been few in number, of disputed quality, and politically controversial. Frequency estimates for detransition and desistance vary greatly, with notable differences in  terminology and methodology. Detransition is more common in the earlier stages of transition, particularly before surgeries. It is estimated that the number of detransitioners ranges from less than one percent to as many as five percent. Studies have reported higher rates of desistance among prepubertal children. A 2016 review of 10 prospective follow-up studies from childhood to adolescence found desistance rates ranging from 61% to 98%, with evidence suggesting that they might be less than 85% more generally. These studies have been criticized on the grounds that they count as 'desistance' cases where the child met the criteria for  gender identity disorder as defined in the DSM-III or DSM-IV, but would not have met the updated criteria for gender dysphoria in the DSM-5, established in 2013. Prior to the DSM-III in 1980, there was no diagnostic criteria for gender dysphoria, so research on desistance rates published prior to 2000 might report inflated numbers of desistance, as gender-nonconforming children without gender dysphoria were included in studies. Additionally, the evidence offered has been criticized for citing studies which have been labelled conversion therapy for discouraging social transition and trying to prevent a transgender outcome. The diagnostic criteria  for gender dysphoria used in the studies only required gender-nonconformity, and did not require a child to state a transgender identity or a desire for medical or social transition. Most childhood desisters go on to identify as cisgender and gay or lesbian. A 2019 poster presentation examined the records of 3398 patients who attended a UK gender identity clinic between August 2016 and August 2017. Davies and colleagues searched for assessment reports with keywords related to regret or detransition. They identified 16 individuals (0.47%) who expressed regret or had detransitioned. Of those 16, 3 (0.09%) had detransitioned permanently. 10  (0.29%) had detransitioned temporarily, to later retransition. A 2019 clinical assessment found that 9.4% of patients with adolescent-emerging gender dysphoria either ceased wishing to pursue medical interventions or no longer felt that their gender identity was incongruent with their assigned sex at birth within an eighteen-month period. A 2021 study examining the case notes of 175 adults discharged from a UK gender identity clinic between September 2017 and August 2018 found that 12 (6.9%) met the researchers' criteria for detransitioningthat is, they returned to living as their assigned gender. Six individuals were found to have experiences that "overlap  with detransitioners, but were not counted as such for this study due to displaying gender identity confusion" during treatment. Those who undergo sex reassignment surgery have very low rates of detransition or regret. A 2005 Dutch study included 162 adults who received sex reassignment surgery, 126 of whom participated in follow-up assessments one to four years after surgery. Two individuals expressed regret at follow-up, only one of whom said that they would not transition again if given the opportunity. 98.4% expressed no regrets about transitioning. A 2021 meta-analysis of 27 studies concluded that "there is an extremely  low prevalence of regret in transgender patients after [gender-affirmation surgery]". Studies of regret or detransition in different populations have found different (average or median) elapsed times before these occurred: a 2018 study found 10 years and 10 months on average to regret (but not necessarily detransition) from start of hormonal therapy, and a 2014 study of those who had surgery found a median lag of 8 years before requesting a reversal of legal gender status. A 2021 UK study found evidence that supports detransitioning occurring on average 4–8 years after transitioning. Informed consent and affirmation of self-diagnosis (both  newer but increasingly employed models for transgender healthcare) have been criticized for failing to meet the needs of those who eventually detransition. Criticisms have been made regarding the "persistence-desistance" dichotomy as ignoring reasons why a person's gender identity may desist outside of simply being cisgender in the first place. For example, an assertion of a cisgender identity may be treated with validity and as an invalidation of a previously stated transgender identity; however, an assertion of a transgender identity may only be treated with the same validity if it is held throughout one's life. An individual may  repress or realize their identity at any point in their life for a variety of reasons; some individuals' gender identities are fluid and/or may change throughout their lifetime, and some individuals whose identities are non-binary are effectively excluded due to a study's assumption of a gender binary. Reasons. The 2015 U.S. Transgender Survey collected responses from individuals who identified as transgender at the time of the survey. 8% of respondents reported having ever detransitioned; 62% of that group were living as a gender other than the one assigned to them at birth at the time of the survey . About 36% reported having detransitioned due to pressure from parent, 33% because it was too difficult, 31% due to discrimination, 29% due to difficulty getting a job, 26% pressure from family members, 18% pressure from a spouse, and 17% due to pressure from an employer. In a 2021 study of 237 detransitioners, recruited via online detransitioner communities and who no longer identify as transgender, the most prevalent reasons to detransition were the realization that gender dysphoria was related to other issues (70%), health concerns (for 62%), and that transitioning didn’t help their gender dysphoria (50%). In a 2021 study  of 2,242 individuals recruited via community outreach organizations who detransitioned and who continue to identify as transgender or gender diverse, the vast majority said detransition was in part due to external factors, such as pressure from family, sexual assault, and nonaffirming school environments; another highly cited factor was "it was just too hard for me." Motives for detransitioning commonly include financial barriers to transition, social rejection in transition, depression or suicidality due to transition, and discomfort with sexual characteristics developed during transition. Additional motives include concern for lack of data on long-term effects of hormone replacement therapy, concern for  loss of fertility, complications from surgery, and changes in gender identity. Some people detransition on a temporary basis, in order to accomplish a particular aim, such as having biologically related children, or until barriers to transition have been resolved or removed. Transgender elders may also detransition out of concern for whether they can receive adequate or respectful care in later life. A qualitative study comparing child desisters to persisters (those with persisting gender dysphoria) found that while persisters related their dysphoria primarily to a mismatch between their bodies and their identity, desisters' dysphoria was more likely to be, at least  retroactively, related to a desire to fulfill the other gender role. Cultural and political impact. There are no legal, medical, and psychological guidelines on the topic of detransition. The Standards of Care by the World Professional Association for Transgender Health (WPATH) do not mention detransition, though 37 WPATH surgeons have expressed a desire for detransition guidelines to be included, and former WPATH president and longtime chair of WPATH's SOC revision team, Eli Coleman, has listed detransition among the topics that he would like to see included in the eighth edition. Some researchers perceive there to be an atmosphere of  censorship around studying the phenomenon. Various sides involved in the dispute over detransitioning say they have been harassed and have described each other as threats to transgender rights. A study in 2021 involving detransitioners found that many of them felt they lost support from the LGBT+ community and friends. Controversy surrounding detransition within trans activism primarily arises from how the subject is framed as a subject of moral panic in mainstream media and right-wing politics. Detransition has attracted interest from both social conservatives on the political right and radical feminists on the political left. Activists on the right have  been accused of using detransitioners' stories to further their work against trans rights. On the left, some radical feminists see detransitioners' experiences as further proof of patriarchal enforcement of gender roles and medicalized erasure of gays and lesbians. Other feminists have expressed disagreement with this opinion, referring to those who hold these beliefs as trans-exclusionary radical feminists. This attention has elicited in detransitioners mixed feelings of both exploitation and support. In August 2017, the Mazzoni Center's Philadelphia Trans Health Conference, which is an annual meeting of transgender people, advocates, and healthcare providers, canceled two panel discussions on detransition  and alternate methods of working with gender dysphoria. The conference organizers said, "When a topic becomes controversial, such as this one has turned on social media, there is a duty to make sure that the debate does not get out of control at the conference itself. After several days of considerations and reviewing feedback, the planning committee voted that the workshops, while valid, cannot be presented at the conference as planned." In September 2017, Bath Spa University revoked permission for James Caspian, a Jungian psychotherapist who works with transgender people and is a trustee of the Beaumont Trust, to  research regret of gender-reassignment procedures and pursuit of detransition. Caspian alleged the reason for the university's refusal was that it was "a potentially politically incorrect piece of research, [which] carries a risk to the university. Attacks on social media may not be confined to the researcher, but may involve the university. The posting of unpleasant material on blogs or social media may be detrimental to the reputation of the university." The university stated that Caspian's proposal "was not refused because of the subject matter, but rather because of his proposed methodological approach. The university was not satisfied  this approach would guarantee the anonymity of his participants or the confidentiality of the data." In May 2017, he took the matter to the High Court, which concluded his application for a judicial review was "totally without merit". The outcome was also considered by the Office of the Independent Adjudicator for Higher Education, who determined the university's conclusion was reasonable. Caspian appealed to the High Court for judicial review again in 2019; the judge ruled against him, saying, "I entirely accept that there are important issues of freedom of expression. I just do not accept that, on the facts  of this particular case, there is an arguable case made out," and adding that the application was too late. Caspian claimed that he was "refused permission for a Judicial Review on points of procedure" and that the judge "was clearly sympathetic to the case but felt that his hands were tied by legal procedure;" in February 2021, he appealed to the European Court of Human Rights. Some detransitioners re-transition and say there is a parallel with the ex-gay movement.