Gender detransition: A critical review of the literature (PMC, 2023)
Gender detransition: A critical review of the literature is a systematic literature review by Pablo Expósito-Campos, Karmele Salaberria, José Ignacio Pérez-Fernández, and Esther Gómez-Gil. The article was published in 2023 in the journal Actas Españolas de Psiquiatría and is freely accessible via PubMed Central.
The authors searched seven databases for publications from 2010 through 2022. They included 138 documents, of which 37 percent were empirical studies. More than a third of all publications date from 2021.
Key points
At least eight different terms are used for detransition, with varying definitions. The reported prevalence depends on the criteria used. Stopping medical care or treatment is more common (1.9 to 29.8 percent) than regret or detransition (0 to 13.1 percent). Regret or detransition is reported less often after surgery (0 to 2.4 percent) than after hormone treatment (0 to 9.8 percent). The study describes more than fifty psychological, medical, and sociocultural factors that play a role, as well as sixteen possible predictors, many of which have not yet been empirically tested. The authors found no guidelines for care or legal procedures.
Why people stop
The authors divide the reasons mentioned into categories. Psychological factors include doubts about one's own identity, expectations that were not met, mental health problems that did not improve after transition, and the discovery that the distress had another cause, such as trauma. Medical factors include health problems, side effects, concerns about fertility, and disappointing surgical outcomes. Social factors include a lack of support, discrimination, loss of relationships, and financial difficulties. Detransition therefore does not always mean that someone no longer feels transgender; the study consequently distinguishes between detransition with and without a change in identity. People who stop often report depression and anxiety and need medical information, psychological support, and contact with peers, such as can be found online in the Detrans Community.
Limitations and recommendations
The authors themselves point to weaknesses in the evidence. Many studies follow people for only one or two years, while research from Sweden, Spain, and the Netherlands describes detransition four to 23 years after the start of medical transition. Attrition is high: 36 percent in a Dutch study and more than 40 percent in others. In a survey by Lisa Littman, 76 percent of participants had not informed their original provider. The authors did not apply strict selection criteria and did not assess the sources according to quality. They also mention the risk that detransition may be used to question the legitimacy of transgender identities. They recommend conducting a thorough psychological assessment before medical treatment, discussing detransition when providing information for informed consent, and systematically collecting data.
Why it is included in this archive
The authors describe detransition as complex, heterogeneous, and still poorly understood. The review is therefore a useful starting point within science and debate.