Is Detransition the "Worst Possible Outcome"?
Some thoughts on how I've observed people trying to control the narrative around detransition
I saw these tweets recently (the screenshot shows two comments on TikTok), and I haven’t been able to stop thinking about it since. I want to take apart the original exchange first.
The first comment: “Transphobes want to stigmatise detransitioning.”
I have a hard time following the logic on this — and maybe it’s because I don’t have the context of the TikTok video it was written in response to — but hypothetically, why would “transphobes” want people to stay transitioned? If a person is intolerant of trans people, you’d think they would welcome people detransitioning.
As a detransitioner, and as someone who was part of the trans community for ten years, the stigma is coming from inside the house. It’s actually trans activists who stigmatize detransitioning — e.g., on Reddit, there are tons of examples of (trans) people claiming that the stories shared on /r/detrans are fake and shouldn’t be taken seriously.
There is an accepted narrative about detransition within “mainstream” trans activism:
detransition is “extremely rare”;
the percentage of transition “regret” is somewhere between 0.05 and 2%;
most people detransition because some form of “external pressure” (i.e., they didn’t make a “mistake”); and
for nearly everyone who transitions, life is wonderful because you are embodying your authentic self, and the only problem is that society won’t just let you live peacefully.
That last point is the most important to the narrative. It is not only detransition that the community stigmatizes. The community stigmatizes any negative experience with transition (except experiencing discrimination from others). Talking about botched surgery is discouraged. Some of the less pleasant side effects of hormones are rarely discussed — I was years into my transition by the time I learned that testosterone could cause my vagina and uterus to atrophy.
Sometimes the reasoning given for this stigmatization is that they don’t want “one bad story” to scare others out of transitioning. The problem we are now facing is that it’s not just “one bad story.” It’s thousands. Not just people who ended up detransitioning, but also people who remain “transitioned” and are angry with what the health care system has become. How can we campaign for the best health care possible when the community shames people out of talking about negative experiences?
Now let’s be clear on where I’m coming from. The general reaction people had regarding my detransition was mostly fine (with a few exceptions), but suppression of my experiences (e.g., by shutting me down as being “transphobic”) began when I started talking about how, in my view, there was a massive problem with trans health care. The argument invariably comes down to “it’s fine for almost everyone, so if you don’t shut up, you just hate trans people and want them to die.”
If every person who had a bad experience with transition is being told that they need to be quiet because they’re a tiny minority, how could we ever possibly know if they’re not actually a tiny minority?
So here’s the problem with the “narrative” on regret and detransition:
Trans activists believe that regret and detransition are rare because trans activists discourage people from talking about regret and detransition. Many of the people who realized transition was a mistake don’t come back to the community.
I first heard the 1% statistic just before I transitioned in 2010. It was compared against a 40% regret rate for knee surgery. I want to point something obvious out. Why does a person regret knee surgery? Generally because the pain didn’t improve, it didn’t improve enough to be worth it, or because the pain worsened. But if a person regrets a surgery that reconstructed their genitals, it’s a very different, more complicated psychosocial experience than simply feeling pain or not — so much of it rides on validation and perception that it makes sense that someone would not want talk about a bad experience. It also makes sense that some people might explain away any negative feelings as a coping mechanism to avoid feeling shame. (Ever heard of the sunk-cost fallacy? It’s why I kept identifying as trans for so long.)
…All that to say, I don’t believe the 1% statistic for a second. I don’t think it was correct when it was quoted to me in 2010, and I think it massively underestimates regret and detransition today. (A recent peer-reviewed paper concluded that “detransitioning might be more frequent than previously reported” so I’m not pulling that out of my ass.)
The few studies that do exist on regret and detransition fall short of explaining the full story. (Most focus primarily on surgery regret.) It is because regret and detransition is so stigmatized that both professionals and other trans people know so little about it. Who wants to go back to the same medical professionals you feel have failed you? Who wants to return to a community that angrily demands you take full responsibility for a medical treatment that was wrongly sold to you? Who wants to be around people who file your medical trauma under ‘acceptable collateral damage’?
Of course the perception of people inside the community is going to be that people only detransition because of “external pressures.” Those are the people who stay in touch with the community — because their experiences were not suppressed and discouraged.
What about the 2015 US Transgender Survey, which asked a question about detransition motives? Well, let’s look at it. The following quote is from the Turban et al. study that used data from this survey.
Respondents who reported a history of detransition were asked, “Why did you de-transition? In other words, why did you go back to living as your sex assigned at birth? (Mark all that apply)” and provided with the following options:
“pressure from a parent,”
“pressure from spouse or partner,”
“pressure from other family members,”
“pressure from friends,”
“pressure from my employer,”
“pressure from a religious counselor,”
“pressure from a mental health professional,”
“I had trouble getting a job,”
“I realized that gender transition was not for me,”
“I faced too much harassment/discrimination,”
“It was just too hard for me,” or
“not listed above (please specify).”
The way this question is written makes it very clear that they were primarily expecting to get answers related to “pressure” and what are sometimes called “external factors.” Of the options given, only one option is clearly an internal factor (“I realized that gender transition was not for me”).
However, the primary reason that this survey cannot be used to draw conclusions about the number of people detransitioning and their motives is because the 2015 US Transgender Survey was distributed amongst the trans community. It didn’t seek responses from people who detransitioned and never reidentified as transgender.
Because the USTS exclusively surveyed people who currently identified as TGD, our study is restricted to the examination of detransition among people who subsequently identified as TGD.
In other words, the population of people with the primary “internal” reason for detransition — no longer identifying as transgender — were not included. It seems misleading, then, to claim that the primary motivation for detransition is external factors, when (1) almost all of the options provided were external factors and (2) your survey population didn’t include a specific group of people who would give conflicting data.
(It’s also interesting how many people will reference this study to claim that most people detransition due to “external pressures,” but won’t use the study’s 13.1% figure of people with “a history of detransition.”)
Why are bad experiences with gender medicine stigmatized, suppressed, discouraged, etc., by the trans community? As part of the push to “depathologize” being transgender, activists are now pushing for an informed consent model as an alternative to the diagnostic process. This removes all of the “gatekeeping” measures that were in place to try and manage regret and other negative experiences with transition.
So this is the dilemma for trans activists: if too many people report negative experiences with transition, health care providers will be forced to reassess whether the current model of care is ethical.
It is in their interest to keep this model, so it is in their interest to downplay negative experiences. The idea that a trans identity could be socially influenced is stamped out. The possibility that a young person might wrongly interpret symptoms of developmental disabilities or other mental health disorders as “gender dysphoria” must be suppressed. They repeat over and over that getting it wrong is very rare, and many of the people claiming to be detransitioners are just liars.
This is why I keep finding myself at odds with trans activists. Fully understanding all of the possible outcomes, including the negative ones, is essential to informed consent. You are not for “informed consent.” You are for getting what you want immediately when you want it — regretters be damned.
Ultimately, the stigmatizing of negative experiences — removing the ability to provide true informed consent when choosing medical transition — harms every single person who transitions. You were all failed by professionals and by the community just as much as I was.
And so we come to the response: “The more we think of detrans folks as ‘worst possible outcome’ the more stigma is added to this experience.”
I have a lot of thoughts on this sentiment — because I agree to some degree, but I’m familiar with the commenter’s perspective on how health care professionals should respond to the possibility of transition regret, so I don’t think we actually agree.
I’ll try to explain my thought process.
Transition is a medical treatment. We measure whether a treatment “worked” in three broad ways: the person improves; the person stays the same; or the person worsens. “Regret” introduces other elements. A person might regret a treatment because their health ultimately worsened; but it’s also possible that their health improved, but they ultimately felt that the risk was not worth the reward.
Not every single person who detransitions necessarily feels “regret” and not every person who feels regret detransitions. I understand that “regret” and “detransition” are two separate experiences and shouldn’t be conflated. Detransition might not necessarily be considered a bad outcome by an individual person.
Choosing to detransition shouldn’t be met with shaming. It shouldn’t be seen as a “bad” choice to make. But I don’t think that’s what they’re saying here. It’s not that detransition should be considered a neutral choice to make; they think that detransition itself should be considered a neutral outcome.
If transition did not improve someone’s life — or it ultimately ended with feelings of regret — it was not a successful treatment. That is not a neutral outcome; from a medical standpoint, a failed treatment is a negative one, regardless of a patient’s personal feelings on the matter.
Aaron commented: “to be concerned about transition regret is to ‘stigmatize detransitioning.’”
That about sums the conversation up, but they are doing some mental gymnastics to avoid saying exactly that.
When they say that “transphobes stigmatize detransitioning,” they are saying that the people they consider to be “anti-trans” paint detransition as a universally horrible experience filled with regret and self-loathing. And sure, some people do, but the underlying point that they — and people who make the same point with less histrionics — are making is that transition regret can be traumatic, and if it can be avoided, it should be.
But when they suggest that detransition should be destigmatized, they are not saying, “Let detransitioners speak openly about what problems there are in the health care system” — as evidenced by our being told repeatedly that our doing so is “weaponizing our experiences” — they are saying, “Detransition is a neutral experience which doesn’t necessarily have to be regretful.”
Which is true on its face, but it’s the context that frustrates me — trans activists are reframing transition from being a treatment for a medical condition to being a service that trans-identified people are entitled to. If transition is no longer a treatment, there is no condition to improve, stay the same, or get worse.
If something doesn’t necessarily have to be regretful — and is otherwise simply a neutral service — that means they can continue to file those of us who do experience regret to the side. If a service provides you exactly what you wanted, complaining about receiving exactly what you wanted makes you the bad guy. Activists want to frame medical transition as something transactional, like other forms of body modification (e.g., tattoos, piercings). But this is not how health care should work! Health care should be holistic and individual. One size does not fit all.
Ultimately, when they say, “destigmatize detransition” they mean “stigmatize regret.” They mean “remove the medical connotations from both transition and detransition.” Because without that removal, “detransition” is a word that describes halting or reversing a treatment because it failed to provide the patient with enough long-term benefits to continue — for whatever reason. It is a failure by definition.
Which brings me to Robin’s take on this:
Without a doubt, suicide is the worst possible outcome of transition. It bears repeating that one of the only long-term transition studies showed that the suicide rate was 19x higher than the general population at 10-15 years after surgery.
It is an interesting question… If we’re looking at successful versus unsuccessful transitions, do the people who ended up taking their lives count as “unsuccessful”? Are they counted among the regret rate? One might respond, “Well, suicide is a very complicated topic. We can never truly know whether or not it was caused by one single thing.” And I would say, “Absolutely! Let’s also apply that to the claim that kids will kill themselves if they don’t transition.”
I kept thinking about this exchange because it was so bizarre to me. How does one frame a failed treatment as anything but a bad outcome?
Well, they don’t see it as a failed treatment. They see it as having been provided a service that didn’t meet expectations. It’s not a bad outcome; it provided what you asked for. There is no problem with the system; the problem is you.
I do, however, see it as a failed treatment. It was prescribed by doctors and facilitated by mental health therapists. These are not people who simply dole out a service. They are people who help us maintain health and who treat the sick and unwell. They take an oath to “first, do no harm.” I should have been able to trust them to make decisions that would enable my long-term health, even if they advised against what I wanted.
Maybe I still would’ve transitioned if it was advised against. Who knows? Perhaps if negative outcomes of transition were more widely talked about, I would have been deterred from going forward instead of expecting transition to solve all my problems. But it’s pointless to imagine myself into a different culture. Instead I am focusing on what can be done to change the culture now.