In its campaign against transgender rights, the Trump administration has been spotlighting stories of people who have regretted transitioning. A recent Federal Trade Commission event, titled “The Dangers of ‘Gender-Affirming Care’ for Minors,” included testimony from six people who had come to believe their gender transition hurt them more than it helped. The Department of Education marked “Detrans Awareness Day” in March. The following month, the White House ordered the National Institutes of Health to conduct more research into transition regret (even though it has gutted $800 million in grant funding for L.G.B.T.Q. research).
I am a researcher who studies detransition — what happens when people who have undergone a gender transition decide to stop or reverse it, often halting medical treatments like hormones. I am also transgender, having begun my own medical transition with testosterone 15 years ago, when I was a 25-year-old graduate student. Under the guise of protecting children from medical harm, the Trump administration is oversimplifying detransition and using it as a political cudgel against transgender health care.
My personal experience, that of most trans people I know and a large body of research, show medical transition can help many resolve their gender dysphoria and improve their quality of life. (I live a fulfilling life as a trans man and am the proud father of a 5-year-old.) But it’s also true that a subset of people reverse course after already changing their bodies with hormones or surgeries.
Early studies, from the 1970s until the 2000s, suggested detransition among adults was rare; about 1 percent to 6 percent reversed the process or expressed regret. But some recent studies among young people have suggested it could now be higher, 5 percent to 10 percent — an increase that has come amid a sharp rise in the number of young people seeking care at gender clinics.
The focus of my research is on why people detransition and what the field of trans health care can learn from these experiences. In conducting what I believe to be the largest study ever designed to understand detransition, surveying nearly 1,000 people about the factors that contributed to their decision, my research team heard from many people whose stories were not all that different from the speakers at the F.T.C. panel. They felt let down by treatments, sometimes terribly so. This fact should encourage medical providers to take detransition seriously, to learn more about how to support people with these experiences.
At the same time, the Trump administration’s rhetoric on detransition is dangerously myopic. We found that many people detransition not out of regret, but because they feel forced by societal factors like negative attitudes toward transgender people, attitudes that are being amplified by the Trump administration. I believe that acknowledging the full complexity of detransition — that it can unfold with ambivalence, regrets, resilience and even satisfaction — is the best path toward better care.
My study, which will be published in the coming months, found that respondents fall into four different camps.
One group, 29 percent of our respondents, detransitioned primarily because of external factors, such as lack of familial support, feeling discriminated against or an inability to get the treatment they need. This group generally did not regret transitioning and were satisfied with treatments they’d received. Most began transitioning again once external barriers were removed, a process some researchers call an “interrupted gender transition.”
A second group, representing about 20 percent of respondents, cited changing gender identity, but generally did not feel regret about their earlier transition. Many felt strongly that they flourished through their transition, even if they ultimately evolved in their identity and gender expression. One survey participant, who started with a masculinizing transition, recalled wondering if her original choice to take testosterone was “the wrong decision.” Ultimately, she decided it wasn’t. The experience had allowed her to mentor other queer and trans people. She liked her slightly deepened voice. “I am pretty happy with where I am, gender transition-wise,” she said.
A third, similarly sized, group cited external factors like discrimination, as well as mental health challenges and changes in identity motivating their detransition. They reported some moderate regret.
The fourth group, 33 percent of participants, said they detransitioned because of an identity change, mental health-related factors and dissatisfaction with treatment. They were much more likely to express strong regret with the decision to transition. Some felt that they had not been adequately informed about the risks of medical treatments. It’s this group whose experiences have become central to policy debates around pediatric gender-affirming health care in the United States and abroad.
There were several factors that distinguished this group from the others. They were more likely to start treatment at a younger age and to begin a medical transition more quickly after realizing their trans identity. Ninety percent were born female. (This is notable because researchers have seen an increase in the proportion of trans youth assigned female at birth.) And although fewer than 30 participants in our study reported having surgery as a minor, more than half of them were in this group.
So what should we make of this?
Nothing in my team’s research, or any other studies on detransition, should lead to the conclusion that policymakers ought to issue blanket bans on gender-affirming care, or that health care providers should ever try to change a person’s gender identity or expression by engaging in so-called conversion therapy. Nor can my research tell us how representative the experiences we document are of the broader trans population.
But as one of the first large-scale efforts to look at detransitioners in the United States and Canada, my study also does not fit tidily with some of the original arguments for pediatric trans care. For decades, trans medicine has operated under the assumption that gender identity was fixed from childhood and that the goal of gender-affirming care is to align a person’s body with a deeply felt internal sense of gender. Transitioning was a one-way street, often ending with surgery. But many recent studies, including my own, show that gender identity for some youth can evolve.
Today, many young people experience their gender flexibly — thinking about it in new ways that are often surprising to researchers, including me. Gender-questioning and less rigid expectations surrounding transition may also mean that some people feel more able to change course once they’ve started down one path. Identities outside the gender binary are common.
There are some health providers and trans people who would rather not research or discuss detransition. Their fears are heightened by threats that the Trump administration could punish providers — it has already subpoenaed more than 20 doctors and clinics.
Restrictions on gender-affirming care have also caused many people to stop or reverse their desired transitions, creating the type of involuntary detransition found in my own research. The administration’s actions, including a ban on trans people in the military, indicate not just concern about pediatric care or medical regret, but a wholesale rejection of trans and nonbinary people.
The reality is that many people are helped by transitioning and celebrate the joy (and banality) of life as a transgender person. But some people feel disappointment. Some people’s lives have undoubtedly been improved, while others were made more difficult by gender treatments that have never before in history been prescribed at this volume, or with a backdrop of mounting resistance to gender diversity in society.
It is the job of health researchers to produce knowledge that can guide care in ways that maximize benefit to patients, minimize harm and promote health and well-being. That is what I, and other L.G.B.T.Q. researchers have made a commitment to do, even when faced with the cruel rhetoric and dangerous policies of the Trump administration.
Kinnon R. MacKinnon is an assistant professor at York University specializing in the study of transgender care and L.G.B.T.Q. health.
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