Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada

Abstract

Background Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice. Aims To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition). Methods Between October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants’ social networks. Interviews ranged between 50–90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants’ experiences of, and recommendations for, gender care. Results Participants were between the ages of 20–53 (71% were between 20–29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers’ “informed consent” procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports. Conclusions To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.

Do gender assessments prevent regret in transgender healthcare? A narrative review.

“…Faith is a dubious foundation for clinical practices. Instead of relying on gender assessments, we recommend that clinicians focus on supporting patient decision making, improving informed consent practices, educating themselves on the realities and needs of detransitioners, and adapting their services to better meet their needs (MacKinnon, Gould, et al, 2023;MacKinnon, Kia, et al, 2022). In a companion article, we argue that gender assessments are detrimental to detransitioners and discuss how informed consent practices can be improved to better serve their needs (Ashley et al, 2023).…”

“…Ceasing hormone therapy or seeking to reverse a gender-affirming surgery are not in-and-of-themselves undesirable outcomes. Some individuals discontinue hormone therapy because they have reached their embodiment goals or desire to embody their gender without being on hormone therapy permanently (MacKinnon, Gould, et al, 2023). Some individuals stop hormone therapy temporarily for social reasons, medical reasons, or because of other goals like wanting to conceive a child (Cárdenas, 2016;Falck et al, 2021).…”

“…Retransition is sometimes motivated by a shift in gender identity such a reidentifying with one's gender assigned at birth, which is often termed detransition. While detransition is often presented as an inherently undesirable outcome, many people who detransition express neutral or positive feelings toward their initial transition (MacKinnon, Gould, et al, 2023). In a composite case study, Jack Turban and Alex Keuroghlian described a young adult who had discontinued testosterone and "did not regret her social affirmation or any physical changes that occurred during this process," instead identifying hormone therapy as "an important part of her identity formation" and expressing gratefulness "that her psychotherapist carefully facilitated her process of introspection through her transition period" .…”

“…These observations are consistent with the perspective of some detransitioners. A recent qualitative study of a heterogeneous sample of people who shifted or reversed their gender transition found that many participants endorsed informed consent models of care, were critical of the binary and linear nature of gender assessments, and at times expressed displeasure at the long wait times and barriers to transition put in place to prevent regret (MacKinnon, Gould, et al, 2023). Participants felt that gender assessments were "less about support and ensuring they had good outcomes, and more about enforcing binary trans identities and placing limitations on treatment options."…”

Sampling with Sisyphus: Introducing a community-driven study designed to reach hidden sexual and gender minority populations with experiences of gender detransition (Preprint)

“…In the past several years, detransition has garnered significant attention in the mainstream media and academic literature as an emerging socio-medical phenomenon in need of further research and care provision [1][2][3]. Detransition is an umbrella term inclusive of stopping, shifting, or reversing the social, legal, and/or medical interventions taken for an initial gender transition [4,5].…”