Some people transition, then change their minds and detransition. What is it? And is it harmful?

Some people who have transitioned decide to transition back. The reverse process of a previous transgender transition is called detransition. There is also double detransition, which is also referred to as “multitransition”. These are several transgender transitions.

People who are close to this topic, and people who hear about it for the first time, often have many questions about how doctors could allow this to happen - and what the risks are for human health. We decided to talk about this in more detail.

Unfortunately, there are no good data for Russia. But about 8% of respondents to the US Transgender Survey (2015), which included 27 thousand people who had transitioned, reported detransition. Moreover, for 62% of them the detransition was temporary.

A person can stop taking hormone therapy for a while or change their wardrobe back for a certain period.

Sometimes detransition is part of a person's gender search, finding identity, which is also called a gender journey. In this case, a person can make several transitions, and this is called “multitransition”. But sometimes this is not connected with the person’s desires, but with external circumstances: for example, a person finds himself in an environment where transition is viewed negatively, and he makes a detransition, after which, when he comes out of pressure, he continues the transition.

The reasons why a person detransitions can be very different:

• pressure from parents, other family members, partners, friends, religious authority;
• social discrimination, threat to life and health;
• difficulties in finding employment;
• financial difficulties (in Russia, appropriate hormonal therapy and surgical interventions are not covered by the compulsory health insurance fund);
• medical contraindications (during the person’s life, they could develop diseases that are a contraindication to the hormonal therapy chosen for the transition);

Transfeminine transitioners were more likely (11%) to report detransition than transmasculine transitioners (4%).

The frequency of detransition varied among people of different races and nationalities (higher among people of a “non-titular” nation). And this also reflects the social reasons for detransition: the higher the level of stigmatization and discrimination on various grounds, the higher its likelihood.

Only 0.4% came to the conclusion that the initial direction of transition was not suitable for them in principle. According to other data, from 0.3% to 2.2% express regret about any stages of the transition.

They also talk about several reasons:

• initially unsuitable transition scenario (body changes are not what they wanted);
• awareness of one's non-binary identity ;
• unrealistic expectations, disappointment from changes that have occurred (or not occurred);
• poor surgical results;
• the presence of a disease that initially influenced self-identification and diagnosis (for example, acute psychiatric conditions);
• social pressure from a patriarchal society, confrontation with gender stereotypes with which a person may agree.

Some older people who have transitioned worry that they won't be cared for properly as they age and will have to rely on a health care system they don't trust. Sometimes they report that they now have a different sense of self and no longer want to be socialized into that gender.

There is currently no evidence of negative health effects associated with detransition. All risks are individual and depend on those gender-affirming procedures that were carried out previously, and those procedures that will be carried out in connection with detransition.

The only exceptions are the usual risks associated with surgery and standard adverse reactions to taking hormonal drugs. In other words, the risk certainly increases with more procedures, but no new risks are added.

Yes. Some changes that occur during hormonal therapy are reversible .

• With feminizing hormonal therapy (that is, aimed at acquiring female characteristics), the mammary glands become enlarged and, quite often, fertility is lost.
• With masculinizing hormonal therapy (that is, aimed at acquiring male characteristics), the voice changes and the clitoris enlarges. Facial and body hair growth, scalp baldness (androgenetic alopecia) and loss of fertility can sometimes be irreversible.

Some of these changes can, if desired, be corrected surgically (reduce mammary glands), with the help of exercises and/or surgically (change the pitch and timbre of the voice), with the help of cosmetic procedures (hair removal) and medications (to cope with alopecia).

If a person has had their gonads removed, then discontinuing gender-affirming hormone therapy may not be enough and will require hormone replacement therapy—taking sex hormones in accordance with the sex assigned in documents at birth.

If masculinizing mammoplasty (removal of mammary glands) has been performed, and a person expresses a desire to restore the configuration of the breasts, implants can be installed.

If there have been surgeries that change the appearance of the genitals, other plastic surgeries can be performed.

It must be taken into account that the decision on any surgical interventions, both during transtransition and detransition, is made solely by the patient, and there is no single action scenario for everyone.

Loss of fertility due to hormonal therapy can become irreversible - and it always occurs during organ-removal operations on the gonads (removal of the ovaries or testicles).

Therefore, it is recommended to think about cryopreservation of sperm, eggs, embryos or ovarian tissues before starting gender-affirming medical procedures.

Unless they are related to pressure and lack of medical care. But, as a rule, the opposite happens.

Oddly enough, we need to stop putting pressure on people who are thinking about transitioning.

In Russia, the outdated International Classification of Diseases (ICD-10) is still in force, which includes the diagnosis F64.0 - transsexualism ( an incorrect and outdated term ). Because of this, people often face medicalization, that is, attempts to portray their endeavors as a medical problem, and restrictions based on the personal judgments of institutionally empowered people.

According to existing evidence , such strategies only make the situation worse. This increases the risk that a person will encounter an unsuitable transition scenario and disappointment. Stigma and stress will increase further, making detransition (as well as suicidal behavior) more likely.

The experience of other countries shows that it does not work that way.

In Norway, from 2008 to 2021, only five people made the reverse transition (despite the fact that, according to various sources , in 2017 there were from 20 to 260 thousand transpeople in the country). Meanwhile, it is this country that has the highest total indicator of the quality of life of transpeople - 23 out of 30 points. For comparison, in Russia - 5 out of 30. Procedures for legal gender recognition and access to medical gender-affirming interventions there are based on a person’s self-determination, and do not require observation by a psychiatrist or diagnosis .

In Russia, more people spoke about detransition in various media alone (for example, here , here or here ) than in all of Norway over 13 years, that is, in reality there may be much more such cases.

The decision about a transgender transition and its individual scenario (each of the manipulations and actions performed) can and should be made by the person himself - without any pressure from doctors or loved ones. If a person takes responsibility for his decision, this helps him have fewer regrets later.

Doctors also need :

• maintain a balance between medical assistance and non-imposition of one’s position. It is necessary to implement a partnership model of doctor-patient interaction;
• inform the patient about all the possibilities of gender-affirming procedures and be ready/willing to jointly develop a flexible scenario for further actions;
• obtain informed consent for interventions, if necessary, using audio, video and multimedia materials, tests, feedback questionnaires (this significantly reduces the frequency of dissatisfaction and disappointment from interventions);
• inform about available psychological help, support groups, peer consultations (this increases the representation of different experiences, including the experiences of non-binary people).

Compassion, lack of judgment and any assessment of his/her actions.

Detransition can be as difficult or even more difficult than primary trans transition due to social misunderstanding, isolation, fear, shame, trauma and lack of information for those navigating this path. It happens that people going through detransition lose the social support that they had during the first transition, which leads to feelings of loneliness and helplessness.

Eva Tsvetkova , endocrinologist, specialist in medical information and scientific communication, host of the scientific and medical telegram channel “Endonovosti”