Study finds detransition often reflects evolving identities, highlighting the need for flexible, trauma-informed care

As access to gender-affirming care has expanded in recent years, public and clinical understandings of gender transition and detransition have remained limited and highly politicized. Anecdotal reports of detransition have become a flashpoint in culture war debates and international policy battles, while the actual experiences of people who have stopped, shifted, or reversed an initial gender transition remain under-researched.

A groundbreaking new study led by 91亚色 Professor , , emphasizes the need for a nuanced, evidence-informed understanding of detransition experiences among 2SLGBTQ+ individuals. Drawing on survey data from 957 participants in the U.S. and Canada, the research reveals that detransition is far from a homogenous experience.

鈥淭his particular topic is very contentious and debated along political lines. People with these experiences tend to feel marginalized and misrepresented by both sides,鈥� says MacKinnon, a social scientist at 91亚色鈥檚 School of Social Work. 鈥淥ur study aimed to build knowledge that was more empirically driven, to try to understand from people鈥檚 own knowledge how they experienced gender transition, and their ongoing care needs.鈥�

Funded by the Social Sciences and Humanities Research Council and co-authored by Naail Khan and Katherine Newman, 91亚色 PhD candidates in the Department of Psychology, the DARE (Detransition Analysis, Representation, and Exploration) study identifies four distinct pathways of detransition and offers a more nuanced framework for understanding why people decide to detransition. These findings may not be generalizable to the larger TGD population, especially those who do not detransition. Detransition is a minority experience within the TGD community, currently estimated at between one to 30 per cent.

鈥淚n Canada and the United States, there has been very little robust research into detransition in the last 30 years,鈥� says MacKinnon. 鈥淭his is one of the first large-scale, community efforts to study detransition and gender fluidity since gender-affirming health care was widely scaled up about 10 to 15 years ago.鈥�

Understanding the study

Data collection for the SSHRC Insight Grant-backed study began in December 2023. Over the following year, 957 individuals were surveyed and 42 interviewed. Participants ranged from 16 to 74 years old. The average age was 26. The mean age at which most began to identify as TGD was around 15. A large majority (78.8 per cent) were assigned female at birth (AFAB), and nearly three-quarters were based in the U.S.

Participants had all detransitioned or retransitioned after a social and/or medical gender transition. The time between initially realizing a TGD identity and starting to detransition ranged from several months to over a decade. While reasons for detransition varied, the study found that gender identity and expression can be fluid over time, particularly for 2SLGBTQ+ youth. Some described their transitions and detransitions not as mistakes, but as part of a longer developmental journey. Others felt let down by gender-affirming health care or accessed care that may have deviated from recommended standards of care.

Four distinct detransition pathways

Survey results offer new insights into socio-demographic profiles and characteristics of individuals who have detransitioned or retransitioned (resumed transitioning after a temporary detransition). Using self-reported reasons, MacKinnon and co-authors identified four distinct pathways using Latent Class Analysis (LCA).

Class A (33 per cent of participants): Predominantly young, AFAB (89.87 per cent) individuals, who began transition early and later reported high decisional regret, mental health challenges and dissatisfaction with care. Most (85.4 per cent) no longer identified as TGD at the time of the survey. Participants in this group had the highest average number of lifetime gender identities, reported high adverse childhood experiences (ACEs) and strong decisional regret with transition. Over half of those who accessed gender-related surgery as minors were in this group; fewer than half reported receiving decision-making supports before they started to transition.

Class B (19.5 per cent): Participants whose gender identity evolved with little to no regret, and who expressed satisfaction with transition and care received. Most (62.3 per cent) still identified as TGD but had evolved in their gender identity/expression after their initial gender transition.

Class C (19 per cent): This group experienced a combination of internal struggles (neurodivergence, mental health, trauma and identity shifts) and external pressures (discrimination, romantic rejection, lack of support). Participants in this group reported high adverse childhood experiences (ACEs), moderate regret and mixed satisfaction with care. In this class, 29 per cent reported wanting to detransition but were feeling unable to take steps.

Class D (28.5 per cent): Detransition was involuntary, driven primarily by external pressures like discrimination, family rejection, difficulty with accessing gender-related treatments, and more. About 95 per cent reported a current TGD identity, and most (71 per cent) had retransitioned, suggesting this group had a temporary detransition. This group reported high treatment satisfaction and the lowest decisional regret, with a majority reporting access to decision-making supports prior to starting to transition. Best conceptualized as an 鈥渋nterrupted鈥� transition. Trans women were more often in this group.

Beyond regret: gender fluidity, social context and complexity

Survey findings show that detransition can occur with or without decisional regret. While roughly half of those who accessed gender-related medical treatments reported decisional regret or ambivalence, many expressed ongoing satisfaction. For some, detransition reflected changing identity; for others, it was a forced interruption due to external or systemic barriers. A significant number retransitioned, illustrating that treatment needs can evolve across time and context.

Recent longitudinal research found that 20 to 79 per cent of gender-diverse young people experience shifts in gender identity over time. These changes are not necessarily signs of regret or pathology but may reflect typical child and adolescent identity developmental processes. This underscores the importance of care models that are responsive to evolving identities and the dynamic ways young people can experience gender. 

More resources are required from health-care funders to improve high-quality research and ensure that gender care delivery follows recommended standards of care, particularly for gender-diverse children and youth. This would include training clinicians on the diversity of TGD experiences, including detransition and retransition, and updating guidelines like the World Professional Association for Transgender Health (WPATH) Standards of Care to reflect evolving research.

Gender-affirming care must be flexible, compassionate, trauma-informed and evidence-based. Providers must adopt non-stigmatizing, informed practices that reflect the reality that gender identity and treatment needs can evolve. By better understanding gender dysphoria, gender fluidity, and detransition, clinicians and health-care systems can offer safer, more comprehensive supports. Integrating a nuanced view of gender fluidity into care models will improve patient trust, reduce harm and ensure inclusivity across the full spectrum of 2SLGBTQIA+ experiences.

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If you have been following recent coverage about gender-affirming health care, . From   to transgender , many have taken an interest in people who underwent a medical gender transition and chose to return to their former identity.

The  of gender transitioning and detransitioning has also come with a helping of sensationalization and . But a divided media landscape that presents detransitioners as either 鈥溾�� or victims of 鈥溾�� hurts all gender-diverse people, including those who are detransitioning.

We are  and   who study gender-affirming health care, and we are among a  who are  (detrans, for short 鈥� a label adopted by some with this lived experience). We also know many people who have detransitioned personally, whose first-hand perspectives have helped us to improve how we approach this topic.

Detransition is not new, but we are seeing new gender-diverse experiences

Detransition is not new. Providers of gender-affirming medicine have long been aware of adults who medically transitioned and later returned to live in their former 鈥済ender role鈥� or showed signs of regret.

Dr. Harry Benjamin, the endocrinologist who was among the first to offer gender-affirming medical interventions in the United States, wrote about one such case in his 1966 book, .

In 1992, German clinicians Friedemann Pf盲fflin and Astrid Junge published a  of followup studies published over the previous 30 years, reporting 25 cases of 鈥渞ole reversal鈥� or regret among adults who had undergone surgery. Later, in 1998, Dutch clinicians Abraham Kuiper and Peggy Cohen-Kettenis published a  of 10 adults who returned to their original 鈥済ender role鈥� or expressed feelings of regret after surgery.

Pioneers of gender medicine were interested in understanding these stories because regret, along with suicide, was considered an outcome  at all costs.

The logic of  was part of what inspired  practices and the requirement that : male-to-female or female-to-male. Using strict measurement criteria, they estimated that detransition was rare:  to .

But today, gender is no longer thought of as binary. And while there is evidence that  has  in , debates about numbers can distract from a more delicate conversation about the real need for LGBTQ+ communities, organizations and gender-affirming care providers to develop a .

Although detransition may not be new, what is new is a small but emerging gender-diverse population in our society who  and/or medically as  or  who are now  with their , or moving from a binary trans identity (trans man or woman) .

Understanding detransition can help us to enrich gender care

We have long known that  for some LGBTQ+ people. New  shows that it is not uncommon for trans and  young people to report  over time 鈥� dynamically moving between binary trans girls or trans boys, to non-binary, or to . In some cases, these identity-shift patterns can influence .

However, when a person鈥檚 gender identity or their desire for how they want to express their gender changes after already completing medical or surgical interventions, this may contribute to feelings of decisional regret. This poses  for providers of gender-affirming medical interventions.

Many people who detransition are . But because detransition and regret are being  about trans people and gender-affirming health care, organizations and care providers serving sexual minorities and gender-diverse communities may feel that offering outward support for detransitioners is politically risky.

But if organizations and care systems fail to offer formal recognition and support, where can detransitioners turn to for help?

Discussion of anything but positive outcomes from gender-affirming hormonal or  was long  in mainstream culture and in the trans community. As a result, regret went underground, to online social media networks and . Apart from a small number of therapists working privately with this population, there are few support services.

Detransitioners鈥� voices

Some detrans people have decided to go public and tell their , to  and to . As social scientists who study gender-affirming health care, we understand what motivates these pursuits: a desire to be understood, and to seek validation and justice.

Detransitioners鈥� voices, though, may be strategically positioned toward , rather than to improve research or to develop comprehensive detransition-related care services. This positioning may further contribute to stigma and division between trans and detrans people.

It is our view that detransition should be rigorously studied to build a more robust understanding of gender identity development, and to improve gender care 鈥� so that nobody鈥檚 needs or lived experiences are neglected.

We wrote about some of these ideas and recommendations in the medical journal , including what we know about detransition so far. We also developed an  to communicate the most up-to-date research and care guidance.

Identity evolution and detransition are LGBTQ+ experiences

In our own emerging research with detransitioning people, we have observed that these experiences  and the broader LGBTQ+ community. Indeed, some who understand themselves as detrans may also identify as , bisexual, queer, butch, gay, ; and many continue to experience .

Some might only  due to , external pressures and transphobia, and re-affirm a trans identity in the future.

Regardless, detransition can bring about , . &苍产蝉辫;鈥�&苍产蝉辫; 鈥� detransitioners experience regret over past medical interventions. Other feelings may be present as well, including .

Identity shifts can be hard to predict. However, in hindsight, some detransitioners do feel that they were influenced by their cultural environment to  and behaviours through the  or to  without considering alternatives. At the same time, some detrans people recount that environments that suppressed or  only meant that later on, in detransition, it was hard to disclose to loved ones and care providers that their identity had changed.

In any case, gender fluidity does not negate the reality of detrans people鈥檚 authenticity in their own gender-diversity. While we understand that some of this information is new and may be uncomfortable to embrace, a gender-affirmative stance must hold space for the full breadth of gender diversity being reflected in our society today.

Rigorous, on-going research that is inclusive of these experiences is fundamental to being gender-affirming. Gender fluidity and detransition deserve further understanding and formal care services, not controversy.

Co-written by Assistant Professor , School of Social Work, 91亚色, Professor of Social Work , and Universit茅 de Montr茅al, Predoctoral researcher in Psychology , Universidad del Pa铆s Vasco / Euskal Herriko Unibertsitatea.

This article is republished from .

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Under the pretext of protecting children, Pierre Poilievre, leader of the Conservative Party of Canada, has to the use of puberty blockers for gender-diverse children.

鈥淚 think that we should protect children and their ability to make adult decisions when they鈥檙e adults,鈥� Poilievre said.

Poilievre is one among many politicians to wade into debates surrounding gender-affirming health care in recent years. Alberta Premier Danielle Smith has , including prohibiting puberty blockers for children aged 15 and under.

But the growth of politicization and misinformation on this issue 鈥� on top of already over the 鈥� probably pose a bigger threat to gender-diverse people than puberty blockers.

who study the and gender-diverse people who have accessed gender-affirming health care. and also a parent. And who also research 鈥� the process of discontinuing or reversing a gender transition.

We both personally know countless people who have been helped by transitioning, as well as others who were that can have .

We have noticed that what is presented as 鈥渇act鈥� in these debates has distorted real complexities of gender-affirming health care, creating a rift between conservative and progressive information outlets. The result has left many in the dark about what is really at stake. Conservative leader Pierre Poilievre speaks to the media about puberty blockers and trans children.

Fertility and gender-affirming medicine

Take the New 91亚色 Times as an example. Two opinion columnists recently wrote about gender-affirming care for minors, making drastically different remarks about the fertility implications of this care.

Opinion columnist asserted that it is a 鈥渕istaken belief鈥� that infertility routinely results from treatments for gender-diverse children, while , writing about detransition, claimed that hormonal therapy causes 鈥渙ften irreversible鈥� infertility.

But the reality of fertility and gender-affirming treatments is in the details. Research on fertility outcomes is lackluster to begin with, but outcomes are highly sensitive to whether .

For children who start puberty blockers followed by cross-sex hormones without ever undergoing natal puberty, because reproductive maturity is not achieved, and saving sperm or eggs for the future is with current assisted reproductive technologies. However, for transgender people who begin cross-sex hormones after undergoing at least some natal puberty, fertility does not seem to be permanently affected.

indicates that for those who went through natal puberty, taking cross-sex hormones alone is .

Puberty blockers

The history of transgender medicine and reproductive rights has been fraught with injustice. When puberty blockers , transgender adults were being coercively sterilized. In 2014, the Netherlands struck down a policy requiring .

Pediatric gender medicine is a , and while the it also .

In fact, fertility is not the only issue at stake with puberty blockers. There are uncertain , as well as 鈥� issues clinicians and researchers are paying close attention to.

A team of Dutch clinicians who were among the first to offer transgender children puberty blockers that these drugs may not be just a 鈥減ause button鈥� to explore identity, as originally intended. Instead, they should be thought of as the first step of a medical gender transition, because a .

But there are also major , which could hurt transgender girls more than boys. Testosterone鈥檚 effects on the body can be difficult to reverse, so undergoing a masculinizing puberty could render transfeminine kids more . Irreversible body changes from puberty can not only heighten distress and reduce social acceptance, but also contribute to a need for future surgeries.

Given that puberty may occur as early as for some children, this is a high-stakes medical decision never taken lightly by families or clinicians. by saying that 鈥渨e should protect the rights of parents to make their own decision with regards to their children,鈥� because, given the age of the child, parents are typically involved in the decision to start puberty blockers.

However, there is 鈥� in either direction.

Detransition debate

Puberty-blocking drugs are not the only politicized topic in gender-affirming health care. .

On one side, opponents of gender-affirming care distort studies to argue detransition has and draw from testimonies of regretful detransitioners as a 鈥�.鈥�

Proponents retort by dismissing detransition either by alluding to its and , or by .

As a result, the public is exposed to two different sets of 鈥渇acts,鈥� none of which reflect the heterogeneity that we and others have encountered in 鈥� different for detransitioning; a range of emotions including ; expansive patterns of . All of it must be studied for gender-related medical care to continue being evidence-informed.

But threats, or outright restrictions, from politicians will not advance this care. What is badly needed from governments is investments in higher quality research and systems of care so treatments can be accessed in the safest possible terms. There are currently gaps in the affecting access, quality, and safety.

Guidelines, dilemmas and the need for high-quality research

This area of health care already developed through a review of the evidence and . But that does not mean the science is settled or that the medicine has no room for improvement.

Gender-affirming care is riddled that have . The changing landscape of transgender health care, and are all low-hanging fruit for opportunistic politicians like Poilievre.

On the polarization of these topics, anthropologist and medical doctor 鈥� who 鈥� wrote:

But by not being able to tolerate some of the unknowns, or banning treatments outright, we miss a crucial opportunity to advance knowledge that is needed to help gender-diverse children and their families.

Debate should not centre on whether to ban blockers, but on how to build a high-quality health and social care system that can support all gender-diverse people. Doing so depends on our collective ability to tolerate complexity.

As published in the

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Study draws attention to insufficient clinical care and support for those who discontinue or seek to reverse prior gender-affirming interventions

TORONTO, July 25, 2022 鈥� Medical education, research and clinical guidelines are all available to support the initiation of gender-affirming care for transgender people, but a 91亚色-led qualitative study has found these resources are sparse when patients discontinue or reverse gender-affirming medical or surgical interventions 鈥� referred to as detransition.

The study results published today in the journal indicate that individuals detransition for various reasons including physical and mental health concerns or an evolving gender identity, such as shifting from trans men or trans women, to non-binary or re-identifying with their birth sex.

鈥淎 majority of respondents reported little decisional regrets regarding prior gender-affirming interventions, however participants frequently discussed stopping gender-affirming hormones 鈥榗old turkey鈥� without medical supervision, facing provider stigma, and experiencing clinicians who lacked detransition-related clinical knowledge,鈥� says , lead author of the study.

鈥淚 actually just stopped talking to them [clinicians]鈥� I felt like they were going to be mad at me [for detransitioning],鈥� said one study participant who quit taking testosterone and seeing her therapist. 鈥淚 had like almost no supports when that was happening.鈥� Although during her initial medical transition she had positive relationships with her healthcare providers and therapist, she felt guilt and shame about detransitioning, and was worried that her clinicians would misinterpret her initial transition as a mistake and subsequent detransition as regret.

鈥淩ather than relying on clinicians who were often a source of distrust, many turned instead to online detransition networks and social media. Often, they did not have a clear understanding of what health implications to expect when stopping gender-affirming hormones,鈥� points out MacKinnon.

Medical detransition was often experienced as physically and psychologically challenging. Some individuals initiated the process after gonadectomies or lower surgeries, which meant switching from masculinizing to feminizing hormones or vice-versa.  

鈥淭he first doctor I went to 鈥� and the second doctor 鈥� both didn't have a clue what was going on 鈥� I feel like more information [is needed] around specifically people who need to get off testosterone to go back onto another [hormone],鈥� said another study participant who now identifies as female. In her initial transition process as a transgender young person, her gender dysphoria had been treated with testosterone and both oophorectomy and hysterectomy. However, when she was seeking medical support to detransition and switch from testosterone to estrogen, she felt her medical providers were unprepared to meet her needs.

Aside from physical and mental health concerns, factors motivating detransition included surgical complications and post-operative pain, unsupportive parents or romantic partners, and employment discrimination. In the last two years, the COVID-19 pandemic and related lockdowns was an additional impediment, causing difficulty accessing clinical appointments or gender-affirming surgeries.

For the study, 28 adults between the ages of 20-53 鈥� the majority of whom were assigned female at birth 鈥� were interviewed about their experiences of detransition, including their healthcare encounters when discontinuing or reversing gender-affirming medical or surgical care.

MacKinnon and other researchers from Simon Fraser University, University of British Columbia, University of Michigan, and University of Toronto who worked on this study, conclude that further research and clinical guidance is required to address the unmet needs of those who discontinue or seek to reverse prior gender-affirming interventions.

91亚色 is a modern, multi-campus, urban university located in Toronto, Ontario. Backed by a diverse group of students, faculty, staff, alumni and partners, we bring a uniquely global perspective to help solve societal challenges, drive positive change and prepare our students for success. 91亚色's fully bilingual Glendon Campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education. 91亚色鈥檚 campuses in Costa Rica and India offer students exceptional transnational learning opportunities and innovative programs. Together, we can make things right for our communities, our planet, and our future.

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Gloria Suhasini, 91亚色 Media Relations, 647-463-4354, suhasini@yorku.ca

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