No Quick Fixes: Building Detransition Medicine from the Ground Up
The Medical Panel at the Detrans Awareness Day 2026 outlined the challenges of detransitioner care.
On April 22nd, 1915, an event took place that would change medicine forever. On that day, the German army deployed chlorine gas against French Troops at Ypres, Belgium. A silent cloud of death drifted over the trenches. It blinded the soldiers. Their lungs filled with greenish-yellow fluid that foamed from their mouths. Their skin turned gray. Many suffocated in the first 10 minutes. Those who survived lived with the consequences, diminished lung capacity, chronic bronchitis, blindness, ruined teeth, and other health effects for the rest of their lives.
Industrial warfare was unlike anything the world had seen. Poisonous gases, machine guns, and modern artillery shredded flesh, pulverized bone, and left soldiers disfigured or with silent but devastating brain injuries or what we would recognize today as PTSD. The doctors who struggled to help these men were compelled to reinvent medicine in a radical way. Plastic surgery, reconstructive surgery, trauma surgery, orthopedics, neurology, physical therapy and rehabilitation, psychiatry, and psychology all emerged in response to the war. Physicians providing care to detransitioners face a similar challenge, but with one important difference. The injuries they are attempting to treat are not the result of industrialized war, but of industrialized medicine.
Industrialized medicine emerged partially from an attempt to standardize treatments and best practices, ideally evidence-based (but often not), and through the dynamics of the healthcare market. While there is nothing wrong with attempting to make medicine more efficient or to standardize the quality of care, when things go wrong, when the evidence isn’t there, as it wasn’t in the case of gender medicine, it requires Herculean efforts to right the ship. The medical panel at the Detrans Awareness Day conference, made up of three physicians, Dr. Kurt Miceli of Do No Harm, Dr. Quintin Van Meter, and Dr. Kay Hurd, addressed an audience of detransitioners about the challenge we face and what they intend to do about it.
Challenges to Medicine
The moderator, Dr. Lisa Anllo, who is involved in caring for people who have lost body parts or function to cancer, began the discussion with the sobering truth that there are no quick fixes or getting back what was lost. This means “We must be respectful of the limitations as well as the benefits of further medical interventions”. Put another way, asking people harmed by gender medicine to trust physicians is a tall order, but each panelist is working to earn that trust in different ways.
Dr. Kurt Miceli’s primary concern is data. Data may not seem like such an urgent matter, but hands-on care for detransitioners can only be provided under ICD diagnostic codes. Physicians, healthcare systems, and insurance companies are required to use these alphanumeric codes to clarify and document diagnoses, symptoms, procedures, and health conditions in medical records for billing, epidemiology, and research purposes.
The World Health Organization creates and maintains the codes, but individual countries often create their own clinical modifications. For instance, the Centers for Disease Control and Prevention (CDC) in the US creates diagnostic codes (ICD-10-CM/ICD-10-CM), and the Centers for Medicare & Medicaid Services (CMS) creates procedural codes. The problem, Dr. Miceli explained, is that out of the 70,000 codes in the lexicon, some as esoteric as “space craft collision with injured occupants” or “pecked by a duck,” there’s nothing for detransition, and nothing that reflects the trauma or the distress that may result from gender procedures. Codes for detransition are important for accuracy in records and billing, but also because they will generate the data needed to establish an evidence base for detransition care – something desperately needed, since anyone attempting to provide care now is in uncharted territory.
Although the work of obtaining codes was begun years ago by Dr. Carrie Mendoza and others, it has only recently gained traction. Once codes exist, everything should become much easier for detransitioners. Miceli explained that he and his committee are scheduled to meet with the CDC later in March to make the case for creating these new codes. “Our hope is that when the dust settles, we will at least have codes for desistance, detransition, and also to better understand and delineate social transition”. (Update: From March 2026 meeting Dr. Miceli learned that F64.A Gender Identity Disorder in remission has been accepted, but there may be more added when the ICD-10-CM comes out in October 2026)
Complex, Individualized Care
“Why am I here? Dr. Van Meter began. “Because I’m on the front end of this battle, trying to explain to people before they get into this abyss how to stay out of it and why they should stay out of it.” Dr. Quentin Van Meter is a pediatric endocrinologist in private practice in Atlanta who has devoted his career to caring for kids with hormone problems. With 43 years of experience, the dangers of pediatric transition were immediately obvious to him. He began speaking out against pediatric gender procedures over ten years ago and is still treating the young adults who turned to him for help as children and teens.
Dr. Van Meter explained that the job of a pediatric endocrinologist is to understand how hormones act on the human body: how they initiate puberty and the changes the body undergoes to achieve reproductive adulthood. He realized early on that puberty blockers and cross sex hormones were not just pausing normal development or taking it in a different direction, but making novel and permanent changes that can’t be undone.
When it comes to post-transition care, he believes the most we can aspire to is to “create as much healing as we possibly can.” Addressing the detransitioners in the audience, he was blunt. “We don’t know how to bring you down from where you are in terms of the effects of testosterone in the most beneficial way for you personally, or how to get you off of the estrogen and down to a neutral place where we can then recreate the kinds of changes we can recreate with hormone replacement therapy.” One size doesn’t fit all, and the goals of each person will be different and “unique to their own circumstances in terms of speed or comfort or the way that they would like to come down from where they’ve been.”
Post-Transition Medicine
Dr. Katy Hurd is a family physician, practicing just north of Seattle. She strongly agrees that there are no quick fixes, but, unfortunately, her patients have bought the lie that there are. “They come expecting a solution, come expecting a treatment or a medication that will fix the problem, or what they perceive as the problem, that will take them out of the discomfort and the pain they’re in to a place where they can get to work the next day and be okay.” It doesn’t work that way. However, she says, “The good news is that health and healing are available. It’s a long haul, though—a long-term fix.”
Dr. Hurd first became aware of the problems associated with transition years ago while working in a large, multi-specialty, multi-site corporate medical clinic. That’s when she began to see people arriving at the walk-in clinic suffering from the effects of gender affirming care.
She remembers several patients in particular. There was a 17-year-old nonverbal female with severe autism who had been on testosterone for a couple of years. She was experiencing chest pain. Another woman in her mid-twenties, who had also been on testosterone for several years, was experiencing bilateral leg pain so severe that she could stand for only a few minutes at a time. In both cases, a complete workup came back negative, and Hurd suspected the testosterone was contributing; however, she discovered that there was no way to address it within the healthcare system as it existed then.
Her most extreme case was a man in his early thirties who had undergone bottom surgery a few months earlier (paid for by Medicaid in Washington State). He was experiencing severe pelvic pain and had driven four hours because he wasn’t able to see his surgeon. He had what Hurd described clinically as a “large non-healing wound that was infected with drainage.” They were able to resolve the infection over the course of four more visits, but his pain never abated, and he ended up on chronic pain management.
These experiences touched her deeply and felt personal because she, too, had experienced discomfort with her femaleness – what today would be diagnosed as “gender dysphoria” earlier in her life. It took her a long time to resolve that discomfort, but she says it was worth it. She is certain that, had transition been an option in that period in her life, she would have taken it. With that experience in mind, she intends to set up a dedicated clinic for people who consider themselves post-transition, gender-questioning, or who are mostly content with their transition but want a second opinion, a different perspective, or help with other issues they’re facing.
“We will not be prescribing hormones to change natal sex or referring anyone for surgeries to change natal sex. The ethos of this clinic will be of a place that’s free of judgment, free of ideology, and free of politics. It’s just about human beings and health and wholeness,” whatever it takes for her patients to thrive and flourish.
A decade after the first gas was used in Ypres, nations came together in Switzerland to create an agreement, the Geneva Protocol, to ensure that gas and biological agents would never be used in combat again. The evidence gathered by doctors on the ground and the visibility of victims was crucial in categorizing the use of such weapons as a war crime. How this ignominious episode in history will be remembered remains unclear, but with the determination of detransitioners and physicians like Miceli, Van Meter, and Hurd, it will not be forgotten.
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Anyone who has a strong opinion but hasn't done much homework should read this. Carefully.