Category: Desistance
-
Around one in six young people treated with cross sex hormones ceased treatment.
An exploratory study1 of adolescents and young adults in Canada and the US found that 16.8% of those receiving “gender affirming medical treatment” (puberty blockers and cross sex hormones) stopped “treatment” within around five years of declaring a “trans” or “non binary” identity.
Of those who discontinued treatment, 37.3% did so for health reasons. 32% ended treatment due to a change in gender identity. 12% were persuaded by health professionals or a partner to explore different ways of approaching their gender dysphoria.
Stopping treatment was associated with having a “non binary” identity. Both continuing and non-continuing cohorts had a mean age of 16.1 when “coming out”, but those discontinuing treatment were slightly older (22.1 vs. 20.9.)
- MacKinnon KR, Jeyabalan T, Strang JF, Delgado-Ron JA, Lam JSH, Gould WA, Cooper A, Salway T. Discontinuation of Gender-Affirming Medical Treatments: Prevalence and Associated Features in a Nonprobabilistic Sample of Transgender and Gender-Diverse Adolescents and Young Adults in Canada and the United States. Journal of Adolescent Health. 2024 Oct;75(4):569-577. doi: 10.1016/j.jadohealth.2024.05.015. Epub 2024 Jun 28. PMID: 38944803. ↩︎
-
A systematic review demonstrated flaws in measurement of regret rates across all studies.
A systematic review of regret rates across 27 studies1 showed that every study had insufficient follow-up time and/or high drop-out rates, which seriously compromise the reliability of the data on regret rates. The review’s authors describe this as a “moderate to high” risk of bias. They also note that definitions of regret and methods of measuring it are variable, and that participants may feel shame or fear of judgement and so conceal their regret. These factors combine to make the regret rate reported in the study unreliable.
- Bustos VP, Bustos SS, Mascaro A, Del Corral G, Forte AJ, Ciudad P, Kim EA, Langstein HN, Manrique OJ. Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plastic and Reconstruction Surgery Global Open. 2021 Mar 19;9(3):e3477. doi: 10.1097/GOX.0000000000003477. Erratum in: Plast Reconstr Surg Glob Open. 2022 Apr 28;10(4):e4340. doi: 10.1097/GOX.0000000000004340. PMID: 33968550; PMCID: PMC8099405. ↩︎
-
High drop-out rates mean reported detransition rates are misleading.
An ethics-focused meta-study of psychosocial outcomes of “gender reassigment”1 found that 20-60% of participants were lost to follow up. Remaining research participants were more likely to report satisfaction with interventions, so reported rates of regret/desistance/detransition in such studies may be highly misleading.
- D’Angelo R. Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry. 2018 Oct;26(5):460-463. doi: 10.1177/1039856218775216. Epub 2018 May 21. PMID: 29783857.
↩︎
- D’Angelo R. Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry. 2018 Oct;26(5):460-463. doi: 10.1177/1039856218775216. Epub 2018 May 21. PMID: 29783857.
-
Time until treatment regret emerges may be eight years or more.
An analysis1 showed that the median time to surgical regret may be as high as eight years. For cross-sex hormone treatment, the time to regret may be almost eleven years (130 months). However, the analysis points out that the lack of thorough follow up in much of the research in this field, and the lack of detailed research into the detransitioner/desister population, mean that accurate figures are very hard to discern.
- Cohn, J. The Detransition Rate Is Unknown. Archives of Sexual Behaviour 52, 1937–1952 (2023). https://doi.org/10.1007/s10508-023-02623-5 ↩︎
-
Cross-sex hormone treatment is stopped within four years by up to a third of patients.
In a study1 of the medical and pharmaceutical records of spouses and children of American military personnel, only 70.2% of those who started cross-sex hormone treatment continued the treatment after four years. Rates were lower for females taking male hormones (64.4%) than for males taking female hormones (81.0%).
- Christina M Roberts, David A Klein, Terry A Adirim, Natasha A Schvey, Elizabeth Hisle-Gorman, Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults, The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 9, September 2022, Pages e3937–e3943, https://doi.org/10.1210/clinem/dgac251 ↩︎
-
36% of patients at Amsterdam gender clinic were lost to follow up.
In a study of all patients at a clinic treating 95% of all trans-identified people in the Netherlands1, 36% of all patients were lost to follow up. This may make reported rates of regret or detransition highly unreliable2. Rates of “regret” in the study itself may be compromised by a definition of “true regret” marked by beginning hormone therapy reflecting the patient’s sex (e.g. testosterone therapy for detransitioning “trans women” or estrogen therapy for detransitioning “trans men.”) The study also notes that some of those experiencing “true regret” had thought that transition would be a “solution” for their homosexuality. Regret was expressed between 46 and 271 months after beginning cross-sex hormone treatment. This may suggest there is a long tail of such regret still to come, even from those who began treatment more than twenty years ago.
- Wiepjes CM, Nota NM, de Blok CJM, Klaver M, de Vries ALC, Wensing-Kruger SA, de Jongh RT, Bouman MB, Steensma TD, Cohen-Kettenis P, Gooren LJG, Kreukels BPC, den Heijer M. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. J Sex Med. 2018 Apr;15(4):582-590. doi: 10.1016/j.jsxm.2018.01.016. Epub 2018 Feb 17. PMID: 29463477 ↩︎
- https://catalogofbias.org/biases/attrition-bias/ ↩︎
-
In one peer-reviewed study of 100 detransitioners, 76% did not inform their clinicians that they had detransitioned
The majority (55%) felt they did not receive an adequate evaluation from a doctor or mental health professional before starting their transition1.
38% believed that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition.
- Littman L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of sexual behavior, 50(8), 3353–3369. [Link] ↩︎
-
Young people who desist from a trans identity are disproportionately likely to grow up to be non-heterosexual
A Dutch paper1 notes that, for gender dysphoric children, the more likely psychosexual outcome in adulthood is a homosexual sexual orientation without gender dysphoria.
Evidence2 suggests that many boys whose childhood gender dysphoria recedes with puberty will grow up to be bisexual or homosexual. Another study of males3 indicates that bisexual/homosexual orientation is far greater than base rates in the general male population, with 63.6% of boys with gender identity disorder being same-sex attracted.
This suggests that a non-heterosexual orientation is particularly likely among gender dysphoric boys.
- Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link] ↩︎
- Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link] ↩︎
- Singh, D. (2012). A follow-up study of boys with gender identity disorder. Doctoral thesis, University of Toronto. [Link] ↩︎
-
Gender-related distress will alleviate for around 80% of pre-teen children once they become teenagers
Evidence from 10 available prospective follow-up studies1 from childhood to adolescence indicates that childhood gender dysphoria will recede with puberty in ~80% of cases. A Dutch paper2 notes that follow-up studies show the persistence rate of gender identity disorder to be about 15.8%, or 39 out of the 246 children who were reported on in the literature.
In one study3 of 54 children referred to a clinic in childhood because of gender dysphoria and then later investigated by a follow-up study, only 21 (39%) still had gender dysphoria.
A different study4 of Canadian boys with gender identity disorder showed that 87.8% desisted, with only 12.2% — fewer than 1 in 8 — persisting in their transgender identity.
An ~80% desistance is not universally found5. Thorough investigations of the claims and counter-claims appear in two 2018 studies67.
- Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 9, 31–41. [Link] ↩︎
- Steensma, T.D. & Cohen-Kettenis, P.T. (2011). Gender Transitioning before Puberty? Archives of Sexual Behavior 40 (4): 649-50. [Link] ↩︎
- Wallien, M.S. & Cohen-Kettenis P.T. (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47 (12): 1413-23. [Link] ↩︎
- Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [Link] ↩︎
- Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M., Jamieson, A., & Picket, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism 19 (2). [Link] ↩︎
- Steensma, T.D. & Cohen-Kettenis, P.T. (2018). A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”. International Journal of Transgenderism. [Link] ↩︎
- Zucker, K. J. (2018). The myth of persistence. International Journal of Transgenderism 19 (2): 231-45. [Link] ↩︎
-
One study showed that, without social transition, nearly two-thirds of pre-teen gender-dysphoric males grow up to be gay or bisexual
A University of Toronto study1 found that 63.6% of boys with early onset gender dysphoria, who received ‘watchful waiting’ treatment and no pre-pubertal social transition, grew up to be gay or bisexual.
Only 12% of the study participants continued to identify as transfeminine.
- Singh, D., Bradley, S.J. & Zucker, K.J. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychology 12. [Link] ↩︎
-
Social transition – changing names, pronouns, clothing and bathroom use – correlates with the persistence of transgender identity
Pediatric transition doctors in the Netherlands who first pioneered the use of puberty blockers in dysphoric children observe that social transition correlates with an increase in young people’s persistence when it comes to gender identity1. This led them to caution against social transition before puberty.
Another paper2 notes that gender dysphoria is more persistent into adolescence where social transition has occurred, and as such asserts that social transition is a “psychosocial intervention [which] might be characterized as iatrogenic” – a medical problem caused by the treatment itself.
There is evidence3 that social transition by the child was found to be strongly correlated with persistence for natal boys, more so than for girls.
- de Vries, A. L., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality 59 (3): 301–320. [Link] ↩︎
- Zucker, K. J. (2019). Debate: Different strokes for different folks. Child and Adolescent Mental Health 25(1): 36-37. [Link] ↩︎
- teensma, T.D., McGuire, J.K., Kreukels, B.P., Beekman, A.J. & Cohen-Kettenis, P.T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 52 (6): 582-90. [Link] ↩︎