Take Detransitioners Seriously

Some people reverse their gender transition. Understanding their experience is crucial.

A square gradient from blue to orange, purple, and pink on top of the blurred black-and-white  picture of a face
Getty; The Atlantic

When Kristin Beck, a decorated Navy SEAL veteran, came out as a transgender woman in 2013, she became a high-profile advocate for the trans community—a role that earned her glowing coverage in left-wing and mainstream center-left media. But unless you’ve been reading right-wing websites in recent months, you might never know that Beck has since detransitioned and gone back to the name Chris Beck. Last month, Beck declared that he had “lived in hell for the past 10 years.” Most of the outlets that reported with enthusiasm on Beck’s initial transition have yet to cover the latest chapter in his life story.

Both of us are trans academics. One of us studies the history of trans activism; the other recently studied detransitioners’ experiences in depth. We strongly oppose efforts, in state legislatures and elsewhere, to target trans children and their families and pass laws restricting treatment options for gender dysphoria, a condition that the American Psychiatric Association’s diagnostic manual defines as impairment or distress over an incongruence between a person’s gender identity and their gender assigned at birth. But trans-rights advocates and mainstream-media outlets should stop downplaying the reality of detransition, lest readers and viewers conclude that it’s a negligible issue. It’s not.

For years, the detransition rate was thought to be in the low single digits. In a landmark study of people in Sweden who changed their legal sex from 1960 to 2010, 2 percent applied to return to their sex assigned at birth. Other studies suggest an even lower detransition rate. But data are relatively scarce, and anyway the cultural context for trans people has since evolved so much and so quickly that older studies may not adequately predict outcomes for today’s far larger, more diverse trans and gender-questioning population.

Gender-nonconforming people deserve compassionate attention in all their complexity. Ignoring detransitioners’ experience isn’t just harmful to them; it also means that doctors and scientists miss out on much-needed data that could improve gender-affirming care for future patients.

People who reverse a previous transition—some of whom call themselves detransitioners; others may identify as nonbinary or refuse labels altogether—do so for a variety of reasons. Some people simply cannot bear the discrimination that openly trans people so often face; society’s transphobia is a major barrier to living happily. But some detransitioners realize, after years of living as a trans person, that they are instead lesbian, gay, or bisexual. Other detransitioners come to discover that what they thought was only gender dysphoria may have instead reflected a more complex picture—perhaps including a neurodivergence, the aftermath of a past trauma, or some other mental-health challenge. Although many detransitioners do appreciate the opportunity for self-discovery that their transition provided, others would not take the same steps if they could go back in time.

To many in the trans and nonbinary community, detransition stories—especially those that involve regret—seem to jeopardize half a century of hard-won gains for civil rights and access to health services. Detransition has become a political cudgel to challenge any and all gender care for young people. This may be one reason right-wing outlets have prominently featured Beck, who has urged trans youth to “slow down” in order to avoid his own fate. Never mind that Beck explicitly states that he is not against trans people or gender-related medical care.

Unfortunately, some people who discuss their detransition on social media are met with suspicion, blame, mockery, harassment, or even threats from within the LGBTQ communities in which they previously found refuge. Some trans-rights advocates have likened detransitioners to the ex-gay movement or described them as anti-trans grifters. In fact, many detransitioners continue to live gender-nonconforming and queer lives. No one benefits from the anger and suspicion that gender-care issues currently inspire. Detransitioners who face social rejection, coupled with shame and isolation, may come to view anti-trans activists as their only allies—even when those activists portray them negatively, as damaged goods rather than as human beings who have survived medical trauma. Meanwhile, clinicians who receive threats of violence for assisting trans youth are vulnerable to developing myopic positions and overly optimistic clinical practices that ignore detransitioners’ accounts.

Opponents of gender care for youth aren’t just capitalizing on stories like Beck’s; they are also weaponizing scientific uncertainty. The existing research has major gaps. Much of the recent evidence is based on follow-ups conducted about two years or less after a patient initiates a transition. But the few studies that have examined detransition suggest that the average time to detransition can be about four to eight and a half years. And detransitioners may avoid returning to the same clinician who helped them start the process; some discontinue medical care altogether. So any studies that rely exclusively on understanding detransition from patient medical records will underestimate this outcome.

The need to know more about detransition is all the more urgent amid a surge of new patients lining up at gender clinics. This increase in caseloads follows two major changes that have reshaped this field. The first is that more and more doctors have stopped acting as gatekeepers, and for good reason.

For many decades, lengthy, invasive, and stigmatizing evaluations preceded access to hormonal therapy and surgeries. The original model of transgender medicine sought to assess how likely patients were to blend into cisgender society as heterosexual people. Physicians based their judgments on patients’ physical appearance, sexual orientation, and mental-health status. In other words, a trans woman who looked female in a doctor’s opinion, was attracted to men, and had no other diagnosed mental-health issues was more likely to be approved for hormone treatment and surgery. Trans activists successfully—and rightly—challenged these paternalistic restrictions, spurring a transformation in medical practice. Many doctors and clinics today expedite the medical-transition process based on the principle of patient autonomy rather than letting doctors control trans people’s bodies. Some gender-care providers’ websites now express a willingness to prescribe hormones during a patient’s first visit.

The second major change involves greater social acceptance of gender-nonconforming people—and an accompanying expansion of the pool of potential patients for gender care. In the past decade or so, most American insurance providers have begun covering at least some gender surgery based on a dysphoria diagnosis. Most research on the effects of medical and surgical interventions involves patients whom doctors have deemed to have that condition.

But more and more, the prevailing popular definitions of terms such as trans and nonbinary do not necessarily include a dysphoria diagnosis. For many people, gender identity can be fluid, but no one needs a doctor’s permission to be trans. Trans and nonbinary people who do not have dysphoria can still seek out, and benefit from, medical treatment that better aligns their body with their gender identity.

The growth of trans, nonbinary, and queer culture, along with the normalization of gender transitions, now provides a haven in which body modifications achieved through medical interventions are accepted and even celebrated. But researchers don’t yet have enough data to know whether today’s patients will detransition at higher or lower rates than the patients who were approved for treatment in decades past. A British study, published last year, of more than 1,000 young people indicates that some trans people express shifting desires about the kind of care they need; two other, smaller studies show that seven to 10 percent of patients who were assessed for gender-related medical services later changed their gender or otherwise met qualifications for detransition. A study of 68 trans youth seeking medical gender care in the U.S. found that 29 percent of these patients shifted their treatment requests with respect to hormones, surgeries, or both. Nonbinary youth were more likely than trans girls or trans boys were to shift their treatment requests. Another U.S. study published last year found that, for reasons that remain unknown, 30 percent of patients who begin gender-related hormone treatment discontinue it within four years.

Some recent research upholds a lower detransition rate. Researchers in the Netherlands found that only 2 percent of trans young people discontinued gender-affirming hormones within about four years of going on puberty blockers. Interviewed by Reuters, the lead author, Marianne van der Loos, explained that the youth had mental-health support and diagnostic evaluations for an average of one year prior to starting treatments. Ultimately, nothing is certain from these data except that more information is necessary, and that our community needs to talk about this issue. For patients to give informed consent to medical treatment, they need to know about the range of possible outcomes. Meanwhile, doctors and clinics need guidelines and services to support people who wish to detransition, but to our knowledge no formal standards are widely accepted across the gender-care field.

Even if the 2 percent figure holds, the absolute number of detransitioners is likely to increase dramatically as more trans and nonbinary people elect medical and surgical treatments. Will the LGBTQ community support or shun these people? Can researchers design gender care that affirms trans people’s identities without viewing detransitioners as collateral damage in the fight for fair treatment? A transition can be beneficial to some people but “hellish” for others, as it was for Beck. These are not opposing political viewpoints. They simply reflect a wide range of real outcomes of medical interventions that can fundamentally transform a person’s body and their life.

The LGBTQ community today must still contend with attacks on gender and sexual diversity—but is also at a moment of unprecedented cultural, institutional, and political strength. Those of us who believe in LGBTQ-inclusive health care and bodily autonomy must recognize that some of our hard-earned wins may have introduced new uncertainties. Upholding the dignity and diversity of trans, nonbinary, and gender-nonconforming populations should not be at odds with a data-informed medical approach that seeks to maximize positive outcomes for all. Gender-affirming care must be available to those who need it. But our community must also advocate for the research to help transitioning patients thrive in the long run—regardless of their individual outcome.