The Detransition Rate Is Unknown

Cohn, Jonathan

doi:10.1007/s10508-023-02623-5

Cited by 16 publications

(5 citation statements)

References 94 publications

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“…The growing awareness of detransitioners who deeply regret their transition and feel they were harmed by those who facilitated it attests to our inability to reliably distinguish between those who will derive net benefit from medical transition and those who will be harmed (Butler & Hutchinson, 2020 ; Entwistle, 2021 ; Exposito-Campos, 2021 ; Gribble et al, 2023 ; Jorgensen, 2023a , 2023b ; Littman, 2021 ; Vandenbussche, 2022 ). The overall rates of detransition and regret in people who began medical transition as children are largely unknown; there are no large-scale studies with long-term follow-up on this cohort (Cohn, 2023 ; MacKinnon et al, 2023 ). Studies describing low rates of regret (i.e., 1–2%) focused primarily on people who transitioned as mature adults and/or are from an era when people had to undergo rigorous psychological screening to be eligible for hormonal therapy and surgery (Bruce et al, 2023 ; Dhejne et al, 2014 ; Wiepjes et al, 2018 ).…”

Section: Reversibility Of Puberty Blockersmentioning

confidence: 99%

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

Jorgensen,

Athéa,

Masson

2024

Arch Sex Behav

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In this essay, we consider the clinical and ethical implications of puberty blockers for pediatric gender dysphoria through the lens of “the child’s right to an open future,” which refers to rights that children do not have the capacity to exercise as minors, but that must be protected, so they can exercise them in the future as autonomous adults. We contrast the open future principle with the beliefs underpinning the gender affirming care model and discuss implications for consent. We evaluate claims that puberty blockers are reversible, discuss the scientific uncertainty about long-term benefits and harms, summarize international developments, and examine how suicide has been used to frame puberty suppression as a medically necessary, lifesaving treatment. In discussing these issues, we include relevant empirical evidence and raise questions for clinicians and researchers. We conclude that treatment pathways that delay decisions about medical transition until the child has had the chance to grow and mature into an autonomous adulthood would be most consistent with the open future principle.

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Section: Reversibility Of Puberty Blockersmentioning

confidence: 99%

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

Jorgensen,

Athéa,

Masson

2024

Arch Sex Behav

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“…et al, 2019 [12]; Levine, S., 2018 [13] 2018 [14]; Nassiri, N. et al, 2020 [15]), identity persistence is required for the benefit/risk ratio in human experimentation. At no point does the WPATH-SoC discuss "detransition" care; these are individuals who did not benefit from the gender medicine treatments (see Cohn, J., 2023 [16]; Jorgensen, S.C.J., 2023 [17]; and Clayton A., 2023 [18] for examples). This detransitioner population indicates that measures need to be developed; without this population, all the information provided is fundamentally biased.…”

Section: Who Needs Gender Medicinementioning

confidence: 99%

“…They are not mentioned at all in the letter by WPATH's president. With respect to the WPATH SoC, it repeats that detransition is rare whereas in fact the actual rate is unknown and is likely significant [16]. Suicidality is conflated with suicide, and gender medicine has not demonstrated its effectiveness on addressing suicide [58].…”

Section: Organizational Failurementioning

confidence: 99%

Organizational Safety Failure Case Study: The World Professional Association for Transgender Health Standards of Care

Jensen

2024

Preprint

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An unusual form of safety failure is the sustained failure mode (organizational failure). This is a situation in which workers and/or clients are regularly exposed to dangerous conditions about which the organization is unable to address. Qualitatively, we discuss these characteristics with non-medical examples (I) decisions are made contraindicated by science, (II) scientific inquiry into the effects of those decisions is blocked, (III) reasoned dissent is suppressed and punished, (IV) authority has a conflict of interest, (V) there is insular training of authority, and (VI) clients and/or workers are received with hostility or malignant-condescension by authority. We then take the World Professional Association for Transgender Health’s Standards of Care publication as a case study into the nature of this failure. The size of the US population receiving gender medicine treatments is estimated to be 0.9 million patients, making this a significant issue. We inspect how this population is identified, how the Standards of Care publication is used in practice, evidence based medicine, medical ethics, and we focus on the eunuch chapter 9 for the failure characteristics previously discussed.

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“…While detransition and regret were previously thought to be vanishingly rare, emerging evidence suggests that it may be a much more common outcome. [100][101][102] Recent publications indicate that up to 30% of people who start hormone therapy as minors will discontinue within a few years. [103][104][105][106] By this time, they will already have undergone irreversible physical changes.…”

Section: Current Controversymentioning

confidence: 99%

Supporting autonomy in young people with gender dysphoria: psychotherapy is not conversion therapy

D'Angelo

2023

J Med Ethics

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Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth. Proponents claim that these treatments are well supported, while critics claim the poor-quality evidence base warrants extreme caution. Psychotherapy is one of the only available alternatives to the gender-affirming approach. Discussion of the treatment of gender dysphoria in young people is generally framed in terms of two binary approaches: affirmation or conversion. Psychotherapy/exploratory therapy offers a treatment option that lies outside this binary, although it is mistakenly conflated with conversion therapies. Psychotherapy does not impose restrictive gender stereotypes, as is sometimes claimed, but critically examines them. It empowers young people to develop creative solutions to their difficulties and promotes agency and autonomy. Importantly, an exploratory psychotherapeutic process can help to clarify whether gender dysphoria is a carrier for other psychological or social problems that may not be immediately apparent. Psychotherapy can therefore make a significant contribution to the optimal, ethical care of gender-dysphoric young people by ensuring that patients make appropriate, informed decisions about medical interventions which carry risks of harm and have a contested evidence base.

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The Detransition Rate Is Unknown

Cited by 16 publications

References 94 publications

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

Organizational Safety Failure Case Study: The World Professional Association for Transgender Health Standards of Care

Supporting autonomy in young people with gender dysphoria: psychotherapy is not conversion therapy

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