Going Forward and Turning Back – Transition and Detransition

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Going Forward and Turning Back – Transition and Detransition

6.3.2 Detransition (social and medical)

Detransition is the process whereby an individual who underwent medical gender affirmation no longer identifies as transgender and seeks to stop or even reverse the medical alterations that have taken place. Social detransition refers to ceasing or reversing changes in name, pronouns, appearance, or social identity, while medical detransition involves discontinuing or attempting to reverse hormonal or surgical interventions. Although the rate of detransition and regret has been reported to be very low, these estimates come from studies with significant methodological limitations and were likely undercounting true regret rates (Cohn, 2023). In any case, as many of these estimates came from studies before the implementation of the affirmation model, they may not generalize to the current cohort, who are both clinically and demographically different and treated using an affirmation approach that includes little conventional psychological evaluation.

A recent study of 175 case reports from a UK adult gender clinic observed that 6.9% of those treated with gender-affirmative interventions went on to detransition within 16 months, while an additional 3.4% showed patterns suggestive of detransition, yielding a probable rate of detransition in excess of 10%. In addition, 21.7% disengaged from clinic treatment, although some patients re-engaged with the gender service at a later date. Based on the pattern of patient engagement at their clinic, the authors concluded that the rates of detransition may be higher than previously reported (Hall et al., 2021). Another study of adolescents and adults found that as many as 30% discontinue gender-affirming hormonal treatment within four years (Roberts et al., 2022).

A further study of 68 patients identified as trans or gender minority from a UK clinic (Boyd et al., 2022) showed that 12.2% either detransitioned or documented regret, while 20% stopped hormonal treatments for a variety of reasons. A study of 100 adolescents and young adults who had transitioned and then detransitioned found that biological females transitioned at a younger age than their male counterparts, and the average time to detransition was shorter for females (Littman, 2021). Comparing these rates with the significantly lower rates reported in older studies suggests that, as the researchers noted, “the detransition rate found in this population is novel and questions may be raised about the phenomenon of overdiagnosis, overtreatment, or iatrogenic harm as found in other medical fields” (Boyd et al., 2022, p.15).

Even prominent affirmative therapists, such as Dr. Edwards-Leeper and Dr. Anderson (2021), have drawn attention to the rising numbers of detransitioners presenting to their clinics. These young people appear typical of the new cohort in that they are predominantly female and present with complex co-occurring mental health issues. They report being immediately affirmed in a transgender identity and rushed to medicalize, but later came to regret their decisions. Individual patients, particularly adolescents and young adults, often pin excessive hope on transition, believing that transition will solve what are, in fact, ordinary social stresses associated with maturation, or mental health comorbidities. In this way, transition can prevent them from mastering personal challenges at the appropriate time or directly addressing issues that require attention. When the hoped-for vanishing of other mental health or social difficulties does not occur, disappointment, distress, and depression may ensue. The steps along the transition pathway, while potentially lessening gender dysphoria in the short term, may lead to additional sources of emotional and psychological pain that create regret in the longer term.

Detransitioners report that trauma (including sexual trauma), difficulty accepting oneself as homosexual, dysphoria rooted in misogyny, peer influence, social media use, and online communities all influenced their development of a transgender identification and desire to transition (Littman, 2021; Littman et al., 2024; Vandenbussche, 2021). Littman’s study (2021) showed that 60% of participants (n = 100) reported that their decision to detransition was motivated, at least in part, by the fact that they had become more comfortable identifying as their biological sex, and 38% had concluded that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition. Another study of 237 desisters and detransitioners found that half of the respondents had not experienced relief from gender distress as a result of transition, with 70% reporting that they detransitioned after realising that their gender dysphoria was related to other issues (Vandenbussche, 2021). These are notable findings that should not be ignored, especially considering the current cohort of trans-identifying youth, largely females, who are presenting at gender clinics at a younger age (Sun et al., 2022). But two important factors mean that detransitioners have so far been a population largely invisible to clinicians.

Firstly, detransitioners often experience an understandable loss of trust in medical professionals and therapists, meaning that the clinicians involved in their treatment may never be made aware that a patient has experienced regret. Seventy-six percent of the participants in Littman’s study (2021) did not inform the clinicians involved in their treatment that they had detransitioned, and the Cass Review (2024) noted “that people experiencing regret may be hesitant to engage with the gender services that supported them through their initial transition.” Secondly, studies show that transition regret may take up to 8–11 years to materialize (Dhejne et al., 2014; Wiepjes et al., 2018), while some of the adverse health effects that are perhaps most likely to provoke feelings of regret may only manifest after clinicians have concluded routine follow-up care or, in some cases, have lost contact with the patient altogether. Because few, if any, clinics are conducting systematic long-term follow-ups with their child and adolescent patients, the doctors who counsel, prescribe, or perform hormonal and surgical treatments are unlikely to ever become aware of the later life impacts, however severe. Without monitoring clinical and psychosocial outcomes of these young patients as they age into adulthood, professionals involved in social and medical transition may experience no challenge to their affirmative beliefs.

There are large gaps in the knowledge about detransitioners, and, as the current cohort ages approach the 8–11 year mark at which transition regret normally manifests, it seems likely that there will be an increase in the number of people detransitioning (Irwig, 2022). Medical and mental health professionals who deliver care to gender-distressed patients, especially those with previous and co-existing mental health problems, have an ethical obligation to learn all they can about detransition, so that they can inform patients and parents that these dramatic treatments carry a risk of life-altering regret. Professionals should take note that clinicians working with detransitioners point to the Littman (2021), Vandenbussche (2022), and Littman et al. (2024) studies as reflective of their clients’ experiences. Both studies show that detransitioners from the recently transitioning cohorts feel they were rushed into medical gender-affirmative interventions without the benefits of a conventional therapeutic process. Young and vulnerable patients may be focused on the immediate (Levine, 2018), unable to consider the future, downplaying medical risks, and struggling to understand the health risks of medical transition on the body, as well as many other variables like future relationships, intimacy, and fertility. Medical transition carries lasting consequences, including the possibility of detransition and regret; clinicians should weigh these carefully and offer more helpful interventions.

Taken together, the diverse outcomes of transition highlight both its potential to alleviate some suffering and its capacity to generate new forms of distress. While some individuals report significant relief following social and/or medical transition, others experience devastating regret. Some detransition in an effort to reverse those decisions, whereas others believe they have passed the point of no return and cannot undo the medical interventions they have undergone. Many come to recognize that transition did not address underlying psychological or social difficulties. These divergent experiences underscore the need for careful, individualized, and non-medicalized treatment pathways.

Gender dysphoria does not arise in a vacuum but interacts with developmental history, family dynamics, cultural narratives, and comorbid conditions. To move forward responsibly, clinicians and policymakers must grapple with these complexities rather than relying on reductionist models that privilege a single pathway. The following section examines the critical factors that clinicians must consider: the comorbidities that frequently accompany gender dysphoria, the sociocultural forces that influence its expression, and the broader conflicts that emerge in treating this vulnerable population. In doing so, it highlights the continuing importance of humility, open inquiry, and clinical discernment in responding to a condition whose causes and courses of treatment remain deeply contested.

Dr. Stephen Levine is a Clinical Professor of Psychiatry at Case Western Reserve University School of Medicine in Cleveland, Ohio

Dr. Joseph Burgo is a Psychotherapist and Beststelling Author

Amanda Miller, Researcher, Genspect

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Detransition Awareness Day 2026: Life Beyond Transition

Join Genspect for a day of listening to Detransitioners speak about the practicalities of life beyond transition.

If you are a detransitioner and would like to attend Detrans Awareness Day in Washington, DC, on March 12th, funding support is available. Please email beyond@genspect.org to apply. You can also support this historic event by joining online or making a donation to support detransitioners.