Detrans Awareness Day – when transitioning was not the right choice

Detransitioners are people who once believed in the promise of medical transition and later came to regret those interventions and attempt to reverse course. For most of us, the idea of medical transition is strange, even unsettling. But for someone who is deeply unhappy in their body, or in their life, it can become a bewitching idea, a little voice in your head that tells you that you could become a different person, with a different name, and a different body. If that were truly possible, would you take it? I think I might be tempted.

Detransitioners

The detransitioners, however, were offered something far more consequential. When they were at their most vulnerable, they went to doctors, experts in the field, seeking relief from their distress, and they were told that medical transition was the appropriate treatment for gender dysphoria. They were prescribed hormones that permanently altered their bodies. Women described how their voices deepened permanently – some report persistent throat pain as a result – and how their bodies and faces became more angular. They grew facial hair and body hair. The list of surgical interventions is long and shocking: mastectomies, hysterectomies, oophorectomies (removal of the ovaries), phalloplasties and/or metoidioplasties are just some of the irreversible, complex surgical procedures that they went through.

Men

The men told similar stories in reverse. Their bodies have also been altered in ways that now feel alien to them – their hips are curvy, and they have breasts. Many had penectomies and vaginoplasties. When you consider the scale of these interventions, it becomes clear why people who have transitioned can be so resistant to the idea of detransition. And yet, over time, just as night follows day, many have come to regret these interventions and now believe that their distress might have been addressed without such profound physical change.

It was this human reality that brought more than 70 detransitioners to Washington DC for Detrans Awareness Day on March 12, the largest gathering of its kind. Genspect is an international organisation, based in Ireland and led by me, an Irish psychotherapist. We brought detransitioners from across the world to the centre of US policymaking to meet with senior representatives. It is astonishing to me that such an event barely registered in the Irish mainstream.

The vast majority of people think that medical transition is a well-researched intervention supported by a solid evidence-base. It’s nothing of the sort”

The detransitioners spoke openly, gave testimony, and engaged directly with clinicians, researchers and policymakers. Chairman Ferguson from the Federal Trade Commission opened the event and spoke directly about the issue, and Admiral Brian Christine from the Department of Health and Human Services closed the day with an inspirational speech that assured the detransitioners that the HHS was focused on this issue. Admiral Christine joined us for the evening and made sure to listen to the detransitioners.

The vast majority of people think that medical transition is a well-researched intervention supported by a solid evidence-base. It’s nothing of the sort. There is no high-quality, long-term evidence to support medical transition as a treatment for gender dysphoria. There will always be people who are happy with their treatment – there are millions who swear by homeopathy; millions more who believe herbalism is the best treatment. Steve Jobs, no fool by most people’s standards, placed significant early faith in diet and alternative therapies as a way to manage the cancer that eventually killed him. A large number of people who had lobotomies were satisfied with the treatment. Yet ethical, effective medical treatment is grounded in scientifically gathered outcomes, not patient approval, and robust long-term outcomes remain absent in the case of medical transition.

Cori Cohn

As Cori Cohn, a man who medically transitioned at 19 years of age and now, in his early 50s, has come to regret it, has said, medical transition is like swimming to the other side of the river but never actually reaching it. Most people who regret their medical transition learn to live with it. Many of the people who come to our Beyond Trans meetings, a support service run by Genspect for detransitioners and those questioning transition, have medically transitioned, regret the whole thing, but have made the decision to live with their medically modified bodies as they can’t quite face the massive effort involved in trying to reverse the process.

Again and again in the Beyond Trans meetings that Genspect runs, people say that transition is easy but detransition is very difficult”

The detransitioners have made the brave decision, despite the many irreversible changes made to their body, their voice and their face, to declare the whole thing a disaster, halt medical transition and try to revert to living as their birth sex. This is an indescribably difficult process to go through. Again and again in the Beyond Trans meetings that Genspect runs, people say that transition is easy but detransition is very difficult. You can never step in the same river twice. Transition is a misnomer – nobody can become the opposite sex – but so is detransition – it’s not possible to reverse these medical interventions, one can only mitigate against them.

Lesson

If there is a lesson here, it is a simple one. Medicine must be guided by evidence, not by belief. Doctors should be careful and cautious; optimistic wishful thinking is for salesmen, not clinicians. The people we met in Washington DC are living with the consequences of a medical approach that offered a false solution. They deserve our attention.