Why I Didn't Participate in the ReDetrans Canada Study
Why I Didn't Participate in the ReDetrans Canada Study
Some background, some criticism, and a highlight of one major limitation
A couple of days ago, a paper examining some of the results of the “ReDetrans Canada” study was published, “Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments.” I feel compelled to explain why I personally chose not to participate in this study despite my likely eligibility.
Background Information
In the fall of 2021, I came across a call-out for detransitioners (and “retransitioners”) to participate in a Canadian study with the stated purpose of “develop[ing] more understanding and supports for people who detransition or retransition.” This sounded good to me to begin with, but I started to have concerns when I noticed they had retweeted this.
On the surface, I’m sure that appears fine to most people. To a detransitioner who has been called “transphobic” for merely suggesting that the health care system has failed me, it is a giant red flag. It suggested that the authors intended to take an ideological slant.
Regardless, I followed the Twitter account for the study, because, hey, I do actually want to see research on detransition conducted, and I was genuinely thinking about participating. So to try and alleviate my concerns, I sent an email to the head researcher on October 8, 2021.
Good afternoon Kinnon,
I'm contacting you in regards to the Re/Detrans Canada study. I'm a 33-year-old detransitioned woman and could offer some insight to my own experiences. I think research on underrepresented populations is very important; I participated in the TransPULSE survey almost a decade ago. I have some clarifying questions first, though.
Particularly, I'm wondering about the scope of this study. My experience won't be universal, but medical transition wasn't a pleasant experience for me. I have to live the rest of my life as an infertile woman without breasts. I spent many years of my life focussing on body modification when I had never been psychologically assessed; I could have spent those years building resilience and learning to cope with developmental disabilities that I didn't even know I had until years after I was prescribed testosterone. Do you intend to cover measures that could have prevented me from wrongly accessing medical transition in the first place? Or is the scope of the research solely on supports that could be offered now that I am reidentifying as my biological sex?
After detransitioning, I had fallouts with several of my friends after I started talking about safeguarding measures (e.g., psych assessments) as opposed to immediate affirmation by medical professionals; and about how I oppose the wording of Bill C-6 because it could potentially ban gender exploratory therapy as "conversion therapy" or even talk therapy to support someone in their detransition. These people called me transphobic. Your newly created Twitter account retweeted someone praising your research for being "from a perspective that isn't transphobic."
If my (or others') opinions about how to prevent transition regret are considered by some to be "transphobic," and you're aiming to not be "transphobic," what assurances can you give me that my lived experiences and suggestions will be accurately represented in your research? In other words, how do I know that my story is safe with you?
Finally -- have you contacted Detrans Canada? They're likely to be a good resource. Their contact info can be found here: https://detranscanada.com/get-involved/
Thanks for your time. I appreciate that you are willing to look into the population of detransitioned and reidentified people when there is so little research on us. I offer my blog as a resource as well: https://somenuanceplease.substack.com.
Thanks again,
Michelle
Kinnon got back to me the same day, but did not answer any of my questions. Instead, they suggested my questions would be answered if I spoke to someone on the phone or via Zoom. I imagine this was in part to screen out people who contacted them in bad faith. Perhaps it was even to avoid having any direct quotes published online (which, to be fair, I am doing now.) However, considering I was already hesitant to engage with people I was pretty sure assumed me to be a bigot, it wasn’t very helpful for me in determining whether to continue.
The next step related to participating in the study is to arrange for a quick 5-minute phone call to check inclusion criteria and also to answer any questions that you have. You have already identified a number of really important questions, so the phone call (or zoom if you prefer), may be longer than 5 minutes.
[…]
The objective of this study is primarily to describe people’s experiences, processes/challenges with respect to detransitioning, and to give detransitioners a chance to provide recommendations to healthcare providers. It’s an exploratory study and we do hope to develop a larger, survey-based study later on.
I ultimately did not respond to this email. I decided I was going to think about it. However, about a week later, I was pointed to a then-recently published paper authored by several of the same researchers who were conducting the ReDetrans study, entitled “Preventing transition ‘regret’: An institutional ethnography of gender-affirming medical care assessment practices in Canada.”
I think Grace put it succinctly:
The paper claimed that the fear of patient regret “drives clinicians to apply strategies to mitigate the perceived risk of malpractice legal action when treating trans people” and that “attempts to prevent detransition […] may create unethical, paternalistic, and dehumanizing practice conditions.”
In the full thread following the screenshot above, Grace also points out that the authors say that, legally, “professionals’ actions must demonstrate a reasonable level of knowledge, competence, and skill expected of ordinary professionals in their field,” but also denigrates the WPATH Standards of Care as a “transnormative ‘gatekeeping model.’” That leaves us with the question: if the best-known standards of transgender health care are insufficient, which standards of care are professionals required to demonstrate adherence to in order to meet their obligations to their patients?
The paper ended with one of the conclusions that “more research into the diverse experiences of people who detransition is necessary to respond to the widely held, cisnormative misconception of this as ‘life-ending’, and to assuage clinicians' fears.”
To me, it seems clear that the authors were launching this new study on detransition with this purpose in mind. Based on their findings that “there is scant evidence that detransition is caused by medical failure” and “scant evidence that detransitioning is a negative phenomenon,” they hypothesize that the seriousness of stopping or reversing medical transition is overblown and pursue research they hope will back up this claim.
I believe this is one of the reasons that the ReDetrans study expressly included “retransitioners.” Those who stopped transitioning but restarted later would obviously be less likely to report negative experiences with transition. It is unclear how many of the 28 participants were “retransitioners” or how long any of them had been “detransitioned.” Perhaps this will be revealed in the future.
On the Study Itself
It seems that the paper that has just been released is only the “first” paper, with more to come in the future based on the results. I found little to criticize about the paper itself. I certainly have a lot of criticisms about how it is already being interpreted by ideologues, though. I’ll get to that another day.
There were 28 participants, and 27 of them pursued medical transition. They note that “42 individuals expressed interest in the study and were invited for eligibility screening via telephone or Zoom. Of those who initially contacted the study, 14 did not partake because they: (1) were unresponsive to follow-up emails; (2) did not live in Canada; or (3) had never discontinued or reversed a gender transition and were therefore ineligible.”
(Presumably, I counted among the 14 who did not partake.)
Only six (21%) participants exclusively identified as “female.” (None exclusively identified as “male.”) Seventeen (61%) identified as nonbinary, two (7%) identified exclusively as trans, and three (11%) were “undecided” about their gender identity. This suggests to me that at least 79% of the participants still believed in the unscientific concept of a “gender identity” that can be separate from one’s sex, which surely skews the results in terms of political opinions and interpretations of one’s experiences.
The supplemental materials where the breakdown of identities can be found says, “This complex overlap in participants’ gender identities after detransition is similar to the sample of 100 medical detransitioners presented by Littman (2021).” In Littman’s study, though, 61% of participants identified exclusively as their “birth sex.” So while identity post-transition is, indeed, “complex,” I would say the samples are actually dissimilar.
I believe the ideological differences may be one of the reasons for the difference in reports of regret. The study reports that of the 27 participants who pursued medical transition, six (22%) reported regret and three (11%) were ambivalent. Contrast these results with Littman (2021), in which 80% of participants experienced some regret (options were no regret, “mild regret,” “strong regret,” and “very strong regret”), with about half (49.5%) reporting “very strong regret.” In Vandenbussche (2021), 60% of participants reported that they needed help in learning to cope with feelings of regret. However, Vandenbussche (2021) included “desisters” (i.e., people who socially detransitioned and never pursued medical transition).
There isn’t too much further to say. Some of the language of the study is, as predicted, ideologically-based. For example, if I had participated, I would have been opposed to being referred to as “AFAB” (“assigned female at birth”). I appreciated that surgeries were referred to in plain language (i.e., “double mastectomy” rather than “top surgery”). I’m annoyed that Turban et al (2021) continues to be referred to as if the USTS is a legitimate source of information on detransition.
I take issue with this line that refers to the results of Hall et al (2021). “Of these 12 [who detransitioned], 4 patients were rereferred to the clinic, suggesting interest in resuming medical transition following detransition (eg, retransition).” I know of quite a few detransitioners who were referred back to gender clinics when attempting to access post-transition care, particularly people who are trying to access reversal surgeries or who need exogenous hormones after gonadectomy. People who do not “specialize” in gender medicine are reluctant to become involved with detransitioners, even if our care is relatively straightforward. Therefore, I disagree that being rereferred suggests interest in retransition. This is merely an assumption.
Things that are familiar to my own experience and that of the detransitioners I’m in contact with:
“participants avoided clinicians and detransition-related mental health care despite reporting psychological distress”
“disengagement [from psychosocial and medical supports when ceasing hormones] may occur for several complex reasons, such as having poor access in the first place, or feeling shame and anticipating stigma”
“clinicians may be insufficiently prepared [to deal with patients stopping or changing hormones]”
“[detransitioners have] widely divergent perspectives on past gender-affirming medical interventions and how those relate to current gender identities”
“those with ambivalence or regrets may require formal psychosocial supports offered from an affirming and nonjudgemental approach”
(I am unclear about the word “affirming” here; presumably they mean affirming of feelings of ambivalence or regret)
“participants sourced peer-based medical advice and support from online detransition networks to address unmet clinical care”
The conclusions seem sound enough to me.
“We responded to calls for qualitative research on detransition, analyzing in-depth narratives spanning decades of life experiences and dynamic gender transitions. We found accounts of people ceasing or reversing gender-affirming treatments with sub-optimal care, warranting more robust clinical practice knowledge. Future research studies should examine clinicians’ knowledge of detransition and determine sources of stigma. This study’s results show that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming medical interventions.”
My final criticism, though, is with the limitations of the study. At least two of the authors are known transgender activists who have appeared in national newspapers. One of them is open about believing that exploratory talk therapy (which I personally believe might have prevented transition regret for me) qualifies as “conversion therapy.” Four of the authors, if I’m recalling correctly, were involved in that paper which paints strategies for preventing regret and detransition as unethical.
Imagine you are me for a second. Imagine you spent ten years of your life believing you were something you weren’t. Ten years of your life surrounded by activists who egged you on, who told you “if you think you’re trans, you are.” Ten years of your life where negative transition outcomes were hidden from you (removed from TransBucket and from Reddit communities) because they cause “distress” to a “vulnerable minority.” Ten years of your life in which you pursued a medical treatment that people repeatedly told you would be “life-saving,” but ultimately did nothing for you. Ten years and now you are a woman without breasts and a deep voice and without a way to have children and have no idea what the rest of your life is going to look like.
Would you want to tell your story to the same people who are working to downplay your experience?
Those of us who have desisted entirely from gender ideology tend not to be fond of interacting at length with people who are still true believers. One major limitation of this study is that it has been clear from the outset that the researchers have a bias, and those of us within the “detrans community” who have separated from the ideology do not trust the activists who continue to push it.
It’s like if a group of Scientologists decided they wanted to do a study on why people were leaving Scientology. After all the crap that the “apostates” were put through, why in the world would they willingly re-engage? What reason would they have to trust that the people conducting the study would frame their stories in an appropriate manner? And if most of the participants still believed in the religion (and, indeed, some of them even re-converted), exactly how useful is any data about regretting their time within the cult?
I have more to say on this, particularly with regard to the infuriating commentary that went along with it, but I’ll save it for a future entry.