A typology of detransitioners
A look at the work of Pablo Expósito-Campos
In 2021, Spanish PhD candidate Pablo Expósito-Campos published a typology of detransition in the peer-reviewed Journal of Sex & Marital Therapy. Expósito-Campos attempts to create a typology that unifies the different meanings of the term - he labels the two main types of detransition core and non-core detransitions.
Core detransitions
In Expósito-Campos’ typology, core detransition describes the process of an individual halting or reversing their transition because they no longer identify as transgender and have re-identified with their birth sex. Various different reasons could lead to an individual doing so: transition may not have resolved their gender dysphoria, for example. He also highlights the prevalence of autistic traits among some trans-identified individuals, as well as those who eventually detransition. He points out that given that gender identities might be fluid over the life span, some core detransitioners may later choose to retransition.
Non-core detransitions
The second type of detransition that Expósito-Campos identifies is what he terms non-core or secondary detransition, where the decision to detransition is not motivated by a change in transgender identity but rather due to external circumstances out of their control (e.g. health complications or lack of social support). He includes under non-core detransitions those individuals who go from a binary trans identity to a non-binary trans identity, and who in this process, decide to stop medical transition. Expósito-Campos suggests that the retransition rate may be higher among non-core detransitioners, since their original motivation to transition - they identify as transgender - is still intact.
Expósito-Campos deliberately excludes desisters from his typology. He defines desisters as those who stop having gender dysphoric feelings or who leave behind a transgender identification prior to engaging medical interventions, as he believes that desistance is a distinct experience from detransition warranting its own separate examination. He also claims that desisters typically experience remission of gender dysphoria, while detransitioners do not and may continue to deal with gender dysphoria long after undergoing medical interventions to address it.
In separating out core detransitions from non-core detransitions, Expósito-Campos acknowledges that these categories are not always discrete. For example, a person might go through a non-core detransition, and then later change their self-perception by reidentifying with their birth sex, which is more in line with a core detransition.
Clinical relevance
Expósito-Campos argues that a person’s self-identification should not be the sole deciding factor in determining appropriate treatment, since self-identity is variable and can change over time. He also argues that exploratory therapy should be made available to clients, alongside biomedical interventions to address the various contributing factors that might lead a person to experience gender dysphoria.
While Expósito-Campos notes that some studies have found that gender affirming therapies benefit some clients who experience gender dysphoria, he also points out that these results are not universal. Other studies have found no significant improvement in mental health and psychosocial functioning. Given the current state of evidence, clinicians are encouraged to be honest with their clients about the potential risks, benefits and longterm consequences of gender affirming treatments.
Expósito-Campos emphasizes the importance of comprehensive exploratory assessments as a potential preventative measure, though he acknowledges that it may not be sufficient to entirely prevent the occurrence of detransition. However, the assessment process may help to determine the different psychosocial factors that could have contributed to an individual developing gender dysphoria and therefore lead to a more thoughtful decision-making process.
He also highlights that requiring comprehensive exploratory assessments should not be seen as a call to restrict access to gender affirming treatments, and he is careful to point out that a decision to detransition should not be seen as a clinical failure, since detransitioners can go on to live fulfilling and meaningful lives.