Re/DeTrans Canada - Detransition Typology

Research and care provider interest in gender detransition has grown in recent years, yet there are limited resources to clinically support the emerging population of individuals who stop or reverse their gender transition. To address this practice gap, the Re/Detrans Canada project developed a typology of four detransition subtypes and their related care needs. Following constructivist grounded theory methodology, this typology was developed empirically by analyzing in-depth narratives of 28 individuals who experienced a change in self-conceptualized identity after initiating a gender transition and who ultimately elected to detransition. Participants were purposively sampled, and interviews were virtual, semi-structured, and ranged between 50-90 minutes. Interviews were recorded, transcribed verbatim, and coded following an iterative, two-stage coding process. Following a thematic and constant comparative method of data analysis, the analysis discovered four discrete detransition subtypes: (1) discrimination and TGD identity dissociation; (2) gender-affirming hormone discontinuation and identity evolution; (3) nonbinary detransition; and (4) socially-mediated detransition.

[kaylinhamilton]

Could you provide the full reference for the article quoted as "forthcoming Salway et al" please? I can't find it anywhere, and it is being quoted in an NYT article, with this video given as the reference link for the quoted figure. Thanks.

[markrussell]

We must begin to acknowledge there is trauma that can result from transition and it is essential to identify an "error rate" (detrans) that might be quantifiable; how else can we then provide the proper care at the right time, let alone claim to be providing informed consent. What is the acceptable error level and what steps can be done to reduce it? This is very important work and it needs to be part of the longitudinal follow-up for an entire cohort that has sought gender affirming care at a specific point in time and compare across different locations. This approach could identify practices in certain locations which work best and which minimize harm. The variance between past studies concerning regret (2% through to 30%) has to be a giant red flag. My one concern here is the discussion point regarding "predicting how individuals will experience gender affirming care", be it medical or surgical. The conclusion (at 18:10 min) is alarming given it is assumed difficult to predict due to the overriding influence of the "external social environment". This is seems to be a serious over simplification. There are far more profound effects which should be easily captured post-intervention including the biological and physical changes that come from Introducing hormones as well as the continuum of surgical options which can each have complications often leading to more surgery. Metoidioplasty, penectomy and mastectomy can all result in some degree of "phantom limb syndrome". This should be identified as opposed to being written off as the difficult to capture due to an "external social environment".

[markrussell]

19:00 min: Why does it come as a shock to anyone that 24% of detrans respondents "failed" to inform their providers they had detransitioned?? I find that response rate high! These poor soles suffer MASSIVE distrust issues. Lets think about this. If you are an adolescent that falls into the "Non-Binary Detransition" topology you are likely someone that felt let down, or worse “coerced into transition”, by the affirmative care model used in medical establishment. You have had breasts removed, voice change and lots of other things one might regret. Why would you expect these individuals to go back to the same health care professionals that in their mind "botched this job" so badly to begin with? They people came for help when they were at their most vulnerable and have now been scared for life. "If" you thought self-harm was a risk before, I would suggest it is now off the charts for this topology.

[markrussell]

I appreciate this is all based on 28 participants but the FIRST recommendation concerning informed consent is the critical piece. My question would when does informed consent shift from being "affirmative care" and slide more into conversion therapy? We can significantly reduce detransition, and especially trans-regret, through properly performed informed consent. Talking to a 14 year old about loosing their ability to have children in the future isnt really informed consent - its abstract and often the individuals have no concept of what this means. Sharing the stories of detransition and the trans-regret of others might make the patient more informed of detransition and possibility they may come to a point of regret but doing this doesn't sound too "affirming".