What is Detransition?
In the last few years, we have heard more and more about “detransitions”, “detransitioners” or “desisters”. But what do these words mean exactly? And what are we talking about when we talk about detransition?
What is Transition?
To define what a detransition is, we first must understand what a transition is.
Sometimes, people feel disconnected to their sex/gender assigned or observed at birth. Some of these individuals develop gender dysphoria or an incongruence between their gender identity and their sex characteristics or gender role in society.
To address gender dysphoria, some people seek out healthcare services to facilitate a medical gender transition, from male to female, female to male, or female/male to nonbinary. Some transgender or nonbinary people opt for non-medical, social transition only, such as changing their name, pronouns, and/or gendered clothing. Others may wish to physically transition in addition to social transition. For some people, gender-related medical interventions may involve medications, such as anti-androgens or agents to suppress puberty (often referred to as ‘blockers’). Additional medical interventions include hormonal treatments such as estrogen or testosterone to facilitate masculinization or feminization of the body. Some people also seek surgeries which can include top surgeries (i.e. double mastectomy, breast augmentation), bottom/lower surgeries (i.e. phalloplasty, vaginoplasty, gonadectomy, hysterectomy, oophorectomy, orchiectomy) or other surgeries like facial feminization, Adam’s apple reduction, hair restoration surgery, etc. Some less invasive procedure can also be performed like laser hair removal or facial fillers.
What is Detransition?
The term detransition is often used to describe the discontinuation or reversal of prior transition processes. A detransition can be medical, such as stopping or switching hormonal treatments, pursuing surgical reconstruction or surgeries to reverse as far as possible the effects of transition. It can be legal if the person chooses to change their sex/gender markers back or change their name. And it can be social: changing the gender expression, changing the pronouns or name used, changing the label used to describe their gender identity, or identifying with their birth sex/gender.
Although detransition is sometimes thought of as a process consisting of returning to a pre-transition state (whether in terms of identity, gender expression or body), this is rarely the case, as it may be physically impossible to completely reverse the effects of gender-related medical interventions like vocal changes from testosterone. It is not possible to reverse, or return to a pre-transition state, following surgeries like double mastectomy or vaginoplasty.
People who detransition sometimes label themselves as “detrans”. This term is rarely thought of as a gender identity but rather a process or life experience. Sometimes detrans is used alongside another personal descriptor, such as detrans lesbian, detrans male, or detrans nonbinary. Some individuals may use the term detransitioner. Some people who never physically transitioned but who transitioned socially may refer to themselves as desisters or detransitioners. What is important to keep in mind is that the choice of a label is individual. These terms should not be used to describe someone unless they would use it themselves.
Depending on someone’s needs and the steps undertaken during their transition, a detransition can take many forms. Here are a few different composite case examples that emerged from our research studies and our consultations with detrans folks:
- A woman transitioned to a trans man. She took testosterone, had a mastectomy, and hysterectomy and bilateral oopherectomy which all had the effect of masculinization. After a few years of transitioning she felt her mental health was worsening and she was hospitalized for a suicide attempt. In hospital, she was diagnosed with borderline personality disorder and referred to dialectical behavioural therapy where she learned distress tolerance skills. Reflecting back, she felt transitioning had worsened her mental health, and she also experienced a shift in identity after realizing she was a masculine lesbian.
- After six years of taking estrogen, and worrying about not passing, a person who initially identified as a binary trans woman felt tired and began questioning their transition. They had also encountered some bullying in the workplace and worried about their health with being on E long-term. Over the course of about a year as they engaged in self-reflection and discussing with a therapist, they realized a nonbinary/genderqueer identity and discontinued E.
- A person was assigned female at birth and transitioned as a trans man. She took testosterone and had a double mastectomy, changed her legal name and sex marker. After some time, she felt she felt uncomfortable in a male social role and felt reverse dysphoria from chest surgery/mastectomy. She also didn’t want to take testosterone for the rest of her life. She stopped testosterone therapy, changed her name and pronouns back and now doesn’t think about gender. She wants to do a reconstructive surgery and voice training to feminize her voice.
A nonbinary trans woman took estrogen hormone therapy and expressed a feminine gender. Their transition didn’t go as planned and did not live up to their initial expectations. They experienced a lot of transphobia and multiple assaults, difficulty finding a romantic partner, and also felt restricted in a feminine social role. Their perspective on gender also changed after realizing they felt just as uncomfortable in a female role as they had in a male role. They missed some aspects of the masculine gender role/gender expression. They decided to stop estrogen and to adopt a more androgenous gender expression which can be adapted to the situation (safe environments vs unsafe ones). They do not really identify with any gender anymore and prefer to use gender neutral pronouns.
Why do People Detransition?
Though research on detransition is currently limited, existing research suggests there are many complex reasons that people may decide to detransition. A few studies have explored some of these reasons. External and/or internal factors can be at play in the decision to detransition:
- Physical or mental health concerns of using hormones (possible side effects)
- A change in gender/sexual identity (shifting from binary trans man to butch lesbian or to nonbinary)
- A feeling of pressure to perform their new gender which feels uncomfortable
- A change in one’s perspective on gender identity (redefining or deconstructing gender identity and identifying with biological sex, for example)
- Disappointment with the physical transition outcomes (not liking the changes, not having enough changes, not being able to achieve physical goals such as “passing”)
- Disappointment with the mental health outcomes (not feeling better, happier, or more at ease in one’s body)
- To preserve fertility
- Understanding one’s sexual orientation/sexuality differently
- Social challenges as a trans person, discrimination, harassment due to being trans
- External pressure from a partner or family member(s) to stop the transition or lack of support in their transition
- Post surgery distress or complications
- Barriers to access gender-related medical care (costs, lack of insurance coverage, tedious process, etc.)
- Discovering dysphoria was intersecting with a mental health issue or neurodivergence.
- Often, it is a combination of several factors that lead someone to decide to discontinue their transition.
How a Detransition Happens?
Often, a detransition starts with questioning the initial transition, their identity, or taking stock of whether the transition has improved quality of life. Some people return to identifying with their sex or rejecting their past gender identity while others continue to identify as non-binary or transgender. If the person feels they no longer need or want to transition, they can take different steps:
- Social detransition steps: the person can choose to stop claiming the identity they endorsed during their transition, asking people to use different pronouns, changing their name back to their birth name, keeping the same transitioned name, or even choosing aa new name. They can also change their gender expression. Some or all of these steps can be undertaken, but some people also choose to keep the same social identity or gender expression throughout and after their detransition, changing only the way they think of themselves internally.
- Legal detransition steps: some people change back to their birth name and/or gender marker. In some countries, a neutral gender marker “X” exists so it can also be an option if the person no longer identifies with the gender to which they transitioned.
- Medical detransition steps: in many cases, detransitioning means ceasing and/or reversing medical interventions. Discontinuing hormonal treatment is common. However, if someone already had gonadectomy (removal of the tests or ovaries) there is a need to continue taking hormonal therapy, so some people may switch to a sex-concordant hormone therapy. If the person not only wants to stop the medical transition but also wants to reverse the effects of the transition, they can choose to take hormonal treatments, to have reconstructive surgeries and/or to have various interventions like laser hair removal, vocal feminization surgery, or voice training.However, detransition-related care can be difficult to access because they are not always funded by insurance and there are considerably fewer surgeons trained in these procedures