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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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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