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Is Detransition Common Among Trans Kids and Adults?

What some of the real stats tell us.

One of the questions I was most asked as my kid started navigating gender, even among family, was: What if they change their mind?

Well, … let’s talk about that.

First, you have to understand that nothing is happening in terms of transition that can’t be reversed until a child is heading into puberty and some trans kids will start hormone replacement therapy.

You may hear a lot of misinformation that suggest puberty blockers are hormones and they’re not reversible, and that simply is not true.

Read about how puberty blockers are prescribed.

Puberty blockers are reversible, and any risks that do exist (like with bone density, for example) are discussed frankly and in depth prior to treatment starting, and general health and bone density are monitored throughout.

Prior to puberty blockers, which are generally prescribed when a child is 10 to 11, gender-affirming care consists solely of social transition.

What does social transition mean?

Social transition is allowing a kid to explore gender in whatever way feels good to them.

When my kid was five, for example, they cut their hair short. They were always allowed to wear the clothes that were most comfortable to them and made them feel happy, and most often those items were more traditionally masculine.

Though, as target did with toys back in 2015, a lot of retailers have started questioning the need to separate children’s items by gender, especially clothes.

My trans kid did not change pronouns until closer to puberty, but also didn’t often correct people when they used he/him/his.

His experience is not every kid’s experience.

Social transition for trans kid’s who know early that their gender does not align with their assigned sex at birth may include wearing clothing that aligns with their gender, cutting or growing their hair and using different pronouns as young as they can vocalize the need for these changes.

There is no medical component to social transition. That is worth repeating: There is no medical component to social transition.

All that is involved with social transition — which is the only gender-affirming care that happens with children before puberty — is that family, friends, educators, everyone, affirms them in their gender.

But what about when medical intervention starts?

So much of the mainstream media coverage of trans kids focuses on the potential for regret, and many cis writers who cover the topic treat gender-affirming care for trans youth as though it’s a topic to debate, a thought exercise.

The problem in that approach is two-fold: 1. They get a lot of things wrong. 2. They dehumanize trans kids.

Gender-affirming care around both puberty blockers and hormone replacement therapy is highly individualized care, necessarily so. Some kids are ready for hormone replacement therapy earlier than others; some kids don’t choose hormone replacement therapy until later, or choose to remain on a low dose. Some choose not to pursue hormone replacement therapy at all.

Because so much of the coverage of gender-affirming care starts from the assumption it’s practiced as one-size-suits-all, people unfamiliar with trans kids assume these patients are marched through affirming care like cars on an assembly line: social transition to puberty blockers to hormone replacement therapy to gender affirming surgery.

In reality, gender affirming care sometimes loops back on itself. Progresses, then halts. Progresses then slows then halts then starts again. Progresses then halts entirely. The pace is wholly determined by the trans kid in collaboration with their family and a team of health care providers.

My kid cut their hair short but didn’t change pronouns. Then, they tried out a new name, but a short time later went back to the name we gave him at birth. A few months later, he tried another name that stuck. But, he didn’t want his name legally changed until a couple of years after that. He took the opportunity to change pronouns when he changed schools. Puberty blockers and hormone replacement therapy were easy choices.

In all of this, conversations were happening with me, with his therapist and with his providers at his gender clinic, and at each step, everyone was on the same page, understood the risks and weighed the benefits.

When detransition statistics enter the conversation, they’re most often incorrect.

Those who don’t want to support trans kids often insist that detransition is almost inevitable and that a majority of trans kids regret transitioning.

One of the studies most often cited, however, — wherein 84 percent of kids were thought to be desisters — has been shown to be very problematic because the researchers did not differentiate between kids who showed genuine gender dysphoria and those who simply socially transitioned or presented more masculine or feminine. In short: general gender nonconformity was treated the same as gender dysphoria.

Additionally, close to half of the study participants who didn’t follow up were categorized as desisters.

When these same researchers revisited this flawed study in 2013, they found that intensity of gender dysphoria was actually a very good predictor of who would transition.

In 2015, another study showed trans children and cisgender children were virtually indistinguishable in their understanding of their gender.

Researchers noted:

“Using implicit and explicit measures, we found that transgender children showed a clear pattern: They viewed themselves in terms of their expressed gender and showed preferences for their expressed gender, with response patterns mirroring those of two cisgender (nontransgender) control groups. These results provide evidence that, early in development, transgender youth are statistically indistinguishable from cisgender children of the same gender identity.”

More recently, and more telling, are the results of a five-year longitudinal study out of Princeton University’s Trans Youth Project. This study followed 317 transgender youth for five years after they socially transitioned to provide a preliminary estimate of how many trans kids eventually desist and retransition.

The findings were clear: Only 2.5 percent of kids identified as cisgender at the end of five years.

A large majority — 94 percent — identified as trans girls or trans boys, and 3.5 percent identified as non-binary at the end of five years.

Researchers explained:

“These results suggest that retransitions are infrequent. More commonly, transgender youth who socially transitioned at early ages continued to identify that way.”

Wait, are you saying detransition never happens and it’s no big deal?

No.

Detransition absolutely does happen, and sometimes happens after irreversible gender-affirming care has been provided. Parents of trans kids and the trans community do not ignore this fact, mainly because understanding reasons for detransition strengthens gender-affirming care.

But, detransition remains extraordinarily rare, as evidenced by some of the recent research, and the reasons trans people sometimes choose to detransition are not without nuance.

For example, a 2021 study on factors leading to detransition among trans adults asked more than 27,000 trans people in the U.S. if they had ever detransitioned, as well as some of the driving factors of the decision.

Of the more than 17,000 participants who reported pursuing gender-affirming care, broadly defined, 13.1 percent indicated they had a history of detransition. Importantly, 82.5 percent of those individuals who detransitioned reported at least one external driving factor, including pressure from family and societal stigma.

Internal driving factors like fluctuations in or uncertainty regarding gender identity was reported by 15.9 percent of respondents.

Researchers concluded:

“Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.”

Some of what we learn from detransition data is that earlier care and more general acceptance and support of trans kids can make a difference in adult outcomes.

The top five external driving factors from the above study were:

  • Pressure from a parent: 35.6 percent
  • It was just too hard for me: 33.6 percent
  • Pressure from community: 32.5 percent
  • I had trouble getting a job: 26.9 percent
  • Pressure from other family members: 25.9 percent

Puberty blockers that prevent development of unwanted secondary sex characteristics and are commonly used in gender-affirming care for trans kids mean that trans adults are less likely to have to navigate sometimes expensive gender-affirming medical care that can make transition difficult or impossible.

Building a more supportive world, generally, that is less reliant on stringent binary codes around gender would likely also improve outcomes.

Learn more about separating fact from myth when talking about detransition.

The real takeaway is that recognizing detransition exists should not be the main argument against providing gender-affirming care, especially when we’re talking about trans kids.

Instead, detransition data can be helpful in understanding how to improve gender-affirming care.

Have questions or want to contribute content to Complicit|Accomplice? Let’s talk.

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