Feature image by Zackary Drucker of the Gender Spectrum Collection.
Detransition. By now, you may have heard the term in the news, or uttered by people like J.K. Rowling. As transgender people experience unprecedented rates of visibility in the U.S, increasing attention has been paid to “detransitioners” — a term that broadly describes people who diverge from their assigned gender and then return to living as the gender they were assigned at birth. The existence of detransitioners brings up various anxieties around trans healthcare: for instance, trans healthcare is increasingly taking a ‘gender-affirming’ stance of respecting and trusting a patient’s gender identity without judgment, but some, including some detransitioners, argue that medical professionals should challenge patients who choose to transition, rather than affirming them. (A guide to what gender-affirming care looks like can be found here.)
Detransition is a complicated topic, not least because detransitioners’ stories are often weaponized by anti-trans activists. J.K. Rowling recently referenced detransition in one of her anti-trans blog posts, and right-wing groups and fundamentalist Christian groups like The Christian Institute use it to discredit transness and transition. Statistics indicate that transition care has an overwhelmingly high satisfaction rate: Cornell University found that between 0.3% and 3.8% of people expressed regret about a variety of transition-related procedures, and that most regret was connected to “lack of social support after transition” or “poor surgical outcomes using older techniques”. Trans people may also detransition due to transphobia, or to stay safer in dangerous conditions such as homelessness, before transitioning again later.
That being said, research into both transition and detransition remains limited, and the factors that influence detransition shouldn’t mean that we stop listening to detransitioners’ experiences. This is especially the case given that many simplified detransition narratives completely ignore what detransitioners say about their own lives. Much coverage around detransition is has been designed to spread anxiety around the concept of trans people and enforce cis perspectives on gender.
Detransition narratives have become a key weapon of choice for those who wish to deny autonomy to all people who seek transition-related care. Here are some ways in which this works.
‘Detransitioner’ isn’t a neutral term
Describing yourself as a ‘detransitioner’ is a political choice, and one that some people deliberately avoid – in part because of its association with anti-trans sentiment. Some people might simply say they’ve gone off hormones, while Brian Belovitch, who was formerly a trans woman, says he ‘retransitioned’. (I use ‘detransitioner’ in this article for consistency, and to refer to those who’ve used the term to describe themselves.)
Detransition also often refers to an individual crossing from one binary gender to another, erasing the existence of genders outside the male-female binary. Some people who’ve had gender-affirming care may not have been made aware of any possibilities outside male and female. “If I was young today,” Belovitch told Paper Magazine, “I would probably fall in the middle somewhere as genderqueer or gender nonconforming…had I had the knowledge or a supportive family or supportive mentors”. The lack of knowledge about, and acceptance of, non-binary and genderqueer identities means that some people may feel pushed into a binary identity, or may believe they must be cis, when actually they would be happiest as a non-binary or genderqueer person.
Detransition stories are often more complex than they first appear
Detransition is more complicated than just the simple story of what is perceived to be a mistake. While some conceive of their transitions as unwanted and traumatising, others do not. Ellie, a person from the U.K. who underwent testosterone therapy and top surgery before detransitioning, told the BBC that “all those physical changes I experienced during my transition helped me develop a closer relationship with my body — they’re just part of my journey.” Belovitch similarly has made clear that he doesn’t regret his time as a trans woman.
Many existential questions are prompted by detransitioners that all of us can learn from: How do you deal with the difficulty of inhabiting an identity where you may feel radically separated from your past self? How do you make decisions for your future self, when you can’t predict your future feelings about gender? What if social transphobia, and familial rejection, hamper your ability to live happily — or live at all — as a trans person? These questions are deeply connected to how inhospitable the US is for trans people, and how our conception of gender as static, permanent and embodied in a specific way contributes to this problem.
Conversations with detransitioners made clear that detransition does not have simple roots, and that life after detransition tends to be given less attention than the decision to detransition itself. Alex, who preferred to use a pseudonym to maintain anonymity, detransitioned because of constraints on what their family is comfortable with. They shared with me that most people don’t understand their situation, but that total understanding shouldn’t be the goal: “Those who need to know will know! I’d like a world where we could have sojourns across and around gender with little attention paid to such journeys…It’s an imperfect world and we all need to negotiate our own way through it.”
Detransition is inextricable from transphobia
To be clear, I don’t mean that detransitioning is transphobic. I mean that detransition, and the coverage of it, cannot be separated from the fact that cis people are valued over trans people, that cis bodies are seen as superior to trans bodies, and that the stories of those who have bad experiences with transition are seen as more relatable, more sensible, than stories of those who have bad experiences with cisness. Those who seek to ban puberty blockers in the name of ‘safety’ do not care that forcing a person to undergo their ‘natural’ puberty can itself be violent.
But detransitioners, too, are capable of being transphobic: take the detransitioners who write for Feminist Current, headed by high-profile opposer of Canadian trans rights legislation Meghan Murphy, or prominent UK detransitioner Keira Bell, who has attacked the ‘transgender movement’ in a statement for an organisation which is trying to ban trans girls from using women’s school toilets. Nobody should be challenging detransitioners on their personal decisions, but challenging them on transphobic rhetoric should be par for the course — such as in the case of Thain, a detransitioner profiled by the BBC whose freely available, openly transmisogynistic writing was not mentioned.
Responsible reporting around detransition must simultaneously uphold the autonomy of detransitioners, while foregrounding how inhospitable life is for trans people, and refusing to allow anti-trans activists to weaponize detransition against those who want and need to transition. Transphobic public figures conveniently leave out the data that demonstrates the hostility inflicted upon trans people, in an effort to delegitimize transition.
The ‘damsel trope’ is prevalent in these stories
Most of the detransitioners in recent coverage are young, white, slim, and assigned female at birth (AFAB). In the worst examples, a shocked, voyeuristic attention is paid to their bodies. There may be close-ups of their faces, fetishistic asides about their ‘female’ features — small legs, delicate arms, tiny hands — and hushed mentions of mastectomies or hysterectomies. Most strikingly, the subjects of these articles are often painted as helpless, as being shuttled through trans healthcare on a kind of conveyor belt. There’s rarely any real recognition of the agency they would have been obligated to exercise at various points in the transition process.
There’s a common trope in these stories that existence as a woman is so terrible that transitioning is a kind of escape hatch out of womanhood. Not only does this ignore the vast majority of women who don’t transition, it foregrounds AFAB people as passive victims. Misogyny is pervasive and powerful, but the idea that misogyny means that AFAB people can’t be trusted to make informed decisions about their gender — or that sufferers of various gendered traumas, such as sexual assault and eating disorders, can’t make informed decisions about their gender — is both baseless and sexist. Social possessiveness over AFAB people’s femininity, and their ability to bear and nurse children, is also textbook sexism.
There’s a lack of knowledge of the terrain
New York Magazine recently raised concerns in a detransition-related article about the permanent damage some detransitioners had suffered from binding their breasts. Those effects aren’t caused by standard binding; they’re caused when people who can’t afford proper binders or surgery bind unsafely. It’s strange not to emphasize that a lack of access to transition care, rather than transition care itself, is the root of that problem. The same article worries about medical professionals “handing out testosterone like candy,” without wondering about whether any of its subjects acquired testosterone outside of the medical system (it mentions one person getting testosterone through Planned Parenthood, and another getting it, somewhat vaguely, “through the mail”).
There’s a lack of knowledge in detransition coverage about how some aspects of transness work, such as waiting times, or costs. Reference is rarely made to the established phenomenon of lesbians who take testosterone and continue to identify as lesbians. There’s little investigation about what gender dysphoria feels like, or where people learn about transness, or what the trans healthcare system is like for most people. Without the right information on this stuff, coverage crosses over from exploration into fearmongering.
Gatekeeping isn’t the solution; it’s the problem
A lot of trans people depend on transition-related healthcare for survival. Scrapping trans-related healthcare, or restricting it further, would put many of our lives in danger. But the trans healthcare system absolutely needs urgent reform. Katelyn Burns recently reported on how inconsistent standards of care are failing trans patients who undergo surgery; people who receive substandard surgical outcomes are wary of talking about it, in case other surgeons refuse to take them on — or their experiences are used by anti-trans activists to scare other trans people into avoiding surgery. An open letter to the World Professional Association for Transgender Health argued that surgeons are falsifying their success rates, failing to give informed consent for experimental surgeries, and providing insufficient aftercare.
Gatekeeping, however, doesn’t address these problems — it just makes trans people suffer and worsens the uneven power dynamic between trans people and healthcare providers. Avery, whose name I’ve changed to respect their anonymity, is a nonbinary person who stopped their testosterone therapy to maintain an ambiguous gender presentation. They criticized the risks posed by gatekeepers, who can bar access to healthcare to people who don’t perform transness in a certain way. “I hesitated stopping testosterone because I was worried I wouldn’t be able to get back on it. I’ve heard of people who don’t want testosterone at all considering taking it just to get access to top surgery,” they explained. “The idea that a minuscule number of people regretting transition is enough to mean every other trans person should be denied/restricted access to medical care is bad enough. But there’s also no space for expressing doubts or exploring options when you’ve waited years for an appointment and will have to wait another 6 months or more if you don’t convince the gatekeeper you’re trans enough.”
Gatekeeping also poses a danger in the current political climate. The Trump administration has continually attempted to roll back healthcare protections for trans people, including a recent attempt to encourage healthcare discrimination against trans people by re-interpreting the Affordable Care Act, which would have made it easier for healthcare to be denied to trans people on the basis of religious belief. When trans people have reason to fear that their access to transition care may be cut off, gatekeeping crosses the line from paternalism into active endangerment.
Improving conditions for detransitioners must also mean improving them for trans people
What would the world look like if both trans people and detransitioners were afforded the dignity and complexity they need? Misogyny would be dismantled, and womanhood would be a far more hospitable territory; racism would also have been destroyed, and with it the deep enmeshment of anti-Blackness and anti-transness. (Amrou al-Kadhi talks about transphobia’s racist history here, as does C. Riley Snorton in the excellent Black on Both Sides.) We’d have far more proactive and compassionate care for the various traumas that can impact our development: assault, abuse, neglect. The idea that being cis is better than being trans would be discarded. And as Alex said above, we’d be able to make journeys across and through gender without divergence from cisness being seen as a threat or a fault.
If this sounds like the ideal world for trans people, that’s because the ways in which detransitioners are mistreated cleave closely to, or are identical to, the ways in which all trans people are mistreated. The ideal living conditions for detransitioners and for trans people are the same — they require a world in which social care, community care, and bodily autonomy are paramount, where people can present and identify and undergo transition to whatever degree they please without suffering for it, and where oppression on the basis of gender, class, race and anything else ceases to exist. That world doesn’t start with greater waiting times, or greater social fear about people mistakenly transitioning, or greater power given to doctors so that they can protect us from our desires. It starts from the ground up: committing to care for each other, to listen to each other, and to unmake the collective oppressions that prevent us from living freely.
Thank you, this was a great article!
What a fantastic piece! I’ve had some (but not all) of these same thoughts on the “detransition” narrative, and I appreciate so much the author pulling together diverse thoughts in an organized manner, adding new insights I wouldn’t have come to on my own, and above all foregrounding a complex and compassionate understanding that honors all parts of our community.
Many years ago, as a baby cis bi doing trans-related activism in the 90s, a trans woman my own age told me a story about someone who had re-transitioned, and argued that trans people shouldn’t attack them, but should celebrate them and their ability to make choices and see how it connects to all of us. I’ve never forgotten that.
This write is clearly an heir to that clear-eyed activist. I hope they do many more pieces for Autostraddle!
Oh that’s beautiful!
This is excellent, thank you!
Where else would a ‘regret’ rate of under 4% be used to argue that a procedure or medication should be completely discontinued? Even accounting for the fact that transition care needs to do more to help patients affirm non-binary identities (which can include medical intervention or not), this is just such a low, low percentage. There are probably higher rates of regret (and much worse complications) for breast implants and Lasik surgery, and no one is trying to completely ban them.
Thank you for this.
Super clear and thoughtful article. Thanks!
Great article – although having spoken to a detransitioner the rate is much higher than 3.8%. Apparently the figure is collated from hospitals that carry out surgeries and the feedback they receive from their patients. But the vast majority of detransitioners do not contact their surgeons – the re-engagement is very low x
Unfortunate that you did not speak to more detrans people for this piece, doubly unfortunate that you would block detrans people and prevent them from commenting their thoughts on a piece about their own experiences. One of your last points is that we must listen to each other, are you sure you have listened to detransitioners before you wrote this?
How do you personally feel about a small minority of ‘detrans’ people advocating that transition-related health care should be less accessible despite an overwhelming majority of trans people who’ve medically transitioned not regretting it?
As a trans woman, I agree that those who transition (which doesn’t necessarily mean body modifications) and then realize that transition isn’t working for them and *choose* to detransition should be definitely be respected. Detransition is often a far harder decision.
As for those who detransition but still identify as trans, it’s often done in the face of society’s bigotry, or to try to save a relationship with spouse (as in the tragic case of Christine Daniels) or family
“Normal” binding using real binders absolutely carries risks– even if it’s “just” pain. The fact that some people use stories about binding problems to justify anti-trans narratives doesn’t change the fact that binding is inherently shitty. There isn’t any truly safe way to bind regularly– just harm reduction practices. Any trans resource worth its salt will tell you this directly
A study in 2016 of about 1800 transmasculine ppl (Health impact of chest binding amongtransgender adults: a community-engaged, cross-sectional study) found over 97% had health issues from binding. 87% of those in the study were using a commercially available binder (a.k.a. those recommended as safe) and less compressive methods (like bras, layering, etc.) were also common. They found that number of days binding was associated with symptoms but not amount of time per day– refuting commonly passed-around advice about reducing binding problems.
Another study in 2018 (Chest Binding and Care Seeking Among Transmasculine Adults), I think using the same data set, reported 46% had shortness of breath (bad enough) but 2.8% reported rib fractures and 7% had serious scarring from binding. 39% reported severe pain (above a 7 out of 10) and 21% of ppl who bound said it limited their daily activities. 14% had to seek medical care for binding-related problems.
It doesn’t do any service to trans & GNC ppl to pretend that binding is perfectly safe and healthy just b/c it works for dysphoria. The accessibility of surgery as well as validating trans ppl’s identities regardless of whether somebody chooses to medically transition are important in many ways exactly because they allow ppl to stop binding and stop having to make the choice to face the consequences of binding just to live their lives. Nobody finds binding pleasant even if it helps their dysphoria. I don’t know why the political context of somebody’s story suddenly means the experiences of hundreds and thousands of trans ppl are fake.
I personally had to quit binding after medical issues so this is pretty important to me. I was forced to find other ways to tackle my dysphoria day to day but many ppl out there struggle through pain, breathing problems, and more because nothing else works for them. Acting like having medical problems from binding is a conspiracy made up by TERFs and that if you do it “right” you somehow are immune to the effects of constricting your chest cavity for years is disrespectful to me & all the trans ppl I know who either had to stop binding or seek surgery (sometimes before they were ready or had the right finances or support) to relieve the pain.
Apart from that, great article! So thank you too, dani <3
Hi, I’m the author, and thank you for your input. I also use a binder, and you’re entirely right that binding has health risks and is a harm reduction strategy – and I didn’t wish to imply that saying so is a transphobic strategy, merely that having to push ribs back in to be able to breathe isn’t representative, and that the NYM piece very much presents that as the norm. But you’re entirely right that binding is ideally a stopgap measure, and that prolonged binding is usually indicative of a lack of access to essential care.
Thank you for saying this, as someone who used to bind until I had top surgery, I was uneasy about that part as well. The research you mentioned is really interesting.
Interesting points, thanks for sharing!
Could anyone tell me what surgery binding refers to? I’m not familiar and google was no help.
It’s not a surgery; it’s when trans men, transmasculine people, and other people with breasts use a binder – a piece of compression clothing – to compress/flatten their chest.
Thanks! I was not aware that that’s called surgery binding, I’ve only ever come across just binding or chest binding and thought this was something distinct.
Hi @lesbionic (great username by the way) – I think you might be getting caught up in some tricky sentence structure, so I used parentheses here to clear it up:
“they’re caused when people (who can’t afford proper binders or surgery) bind unsafely.”
So “bind” here is the verb that goes with the subject “people”. I hope that helps!
“Binding” is using tight clothing or other means to flatten the bosom so as to appear to not have breasts.
Appreciate where this article is coming from. Especially the points about how a better world for detrans and trans is actually the same world. I do have to say though, therapists and doctors given the freedom to challenge when necessary is probably a good thing. Not saying there needs to be blanket bans or universal waiting periods, but each case needs to be treated individually and some patients might not actually be helped right away with hormones or surgery. They might be harmed, and pumping the breaks on those even if it’s contrary to that patients wishes at the time could be beneficial long term. It sounds like a regression in to the past when trans people had to fight tooth and nail to get medical treatment, but it should go hand in hand with the better world laid out in the article. Dr.s who are not afraid to either refer patients to surgery or counsel them against it are in everyone’s best interest. Especially that 1-3% which we seem a little too eager to write off.
As Dani has written, doctors ought to have conversations with people about the possibilities of non binary identity. There also ought to be ways of measuring non binary people’s decisions to end hormone treatment that they don’t actually regret so that they won’t be included in ‘detransition’ stats.
But where is it that doctors actually offer people hormones and surgery ‘right away’ instead of responding to their patients’ requests? All of the trans people I know brought it up to the doctor themselves. They went through every possible consequence or side effect. No one was given the chance to do any kind of surgery right away because there are waiting lists.
As one of the people who is ‘a little too eager’ to write off 1-3% regret rates, I would ask if you have the same attitude towards hip and knee replacements, which have regret rates of 1-5%. Obviously we have issues with all health care institutions not giving people enough information about certain surgical consequences/risks beforehand, but the conversations about non-trans-related care aren’t subject to the same level of scrutiny. In the New York Times this week there is an arguably very irresponsible article advocating bariatric surgery, despite it having far more risks and much more significant rates of regret.
In the end, 97+ percent of people who medically transition don’t regret it, and yet the public is much, much more suspicious of the concept of transition care than literally any other kind of health care, including procedures with higher rates of regret. What reason, other than transphobia, can account for this? What if we simply talked about that regret statistic in the way we talk about people who regret non-politicized kinds of surgery?
I feel like this might be regionally specific but calling that a ‘return’ to the past feels quite tactless from a UK trans context. I’m fighting tooth and nail to get care. I’ve been out for 2 years, and it will be another 3 before I can access an NHS gender clinic. I have to perform my gender, perfectly, for a psychiatrist who will then decide if I am trans enough for his liking. Where’s the room for uncertainty? Where’s the room for asking for help? Surely you’ll get a lower rate of regret when people don’t feel the pressure to lie and perform heteronormative gender roles in order to access care, and can be open with their doctors.
An informed consent model is increasingly used for trans related procedures, where the benefits, risks, side effects, and potential complications are discussed with the patient after the patient has sought out the procedure. Alternatives are discussed, as well as the possibility of regret. Each case is treated individually, and moves at a patient’s desired pace.
This diagnostic model is also used for many cis people and non trans-specific procedures. For example, a cis person deciding to get breast augmentation, or a cis person deciding to get Platelet-rich plasma injected for knee tendon/ligament damage.
I am not trying to be harsh, but think you ought to interrogate your assumption/framing that informed consent is okay for cis people (often for procedures with higher rates of regret) but not trans people.
Thanks for this great article!
A few percent of childfree-by-choice women end up regretting it, so obviously the solution is to force every to woman have at least 3 kids just in case! 🙄 This is a similar situation where I have sadly seen arguments to that effect. Fortunately that’s slowly dying out as well.
You start off with opinion based narratives and devolve from there. Trans people are like christians — you don’t listen to the people who tried it and left and you don’t listen to the people who never found it’s evidenceless claims convincing in the first place and you claim that both groups are somehow trying to harm you. You want your feelings to guide policy, instead of empirical research. That is insanity.
You pretend that there isn’t an uptick in suicide and cancer associated with transitioning.
If you’re not pro science and inquiry and willing to invite discourse into the grey areas of your theories THEN YOURE A RELIGION AND I DONT NEED YOUR RELIGION GUIDING POLICY. PERIOD.
england needs Islam to resolve your crossdressing problems.
you kids are all soulless. empty. lost.
quick! quick! censorship for the crossdressing kids!!
chill out bubbles.
Detransitioner is not a political term… I identify that way because I have intense regrets over transitioning, and not for social reasons at all. Once the masculinzing effects of T fully set in and I had my mastectomy, I realized it was a horrible mistake. I’m not trans, I was just suffering from body hatred from sexual abuse… I miss my old body so much, and I cry for it everyday. I’m begging you to stop demonizing people like me. We just want to feel whole again…
I am a detransitioner and its been harder than being a trans person. The trans person treats me like a villian and medical care is not always covered. Its like you aren’t allowed to realize you made a mistake and you aren’t trans. You caused your own dysphoria. Still I realized I can’t chane my sex only my presentation.