Attempting a nuanced look at youth detransition

Study summary and some thoughts

In 2020, Canadian social work researcher Dr Annie Pullen Sansfaçon led a qualitative research team that sought to better understand the experiences of youth who had discontinued their gender transition. The study consisted of semi-structured interviews with 20 youth between the ages of 16 and 25. Participants were recruited on social media from across the globe. 

Of the 20 study participants, 3 youth lived in Canada, 11 youth were based in the USA, 2 youth were in France, 1 youth in Belgium, 1 youth in Finland, 1 youth in Indonesia, and 1 youth in the UK. Nineteen of the participants were ‘assigned female at birth’. The majority (13) had undergone some kind of medical transition (e.g. hormones, mastectomy, or hysterectomy). The remaining 7 had transitioned solely socially.

Reasons for transitioning

Eight of the participants indicated that external pressures influenced their decision to transition. This seems to support the hypothesis put forth by researcher Dr Lisa Littman that social influence may play a role in some individuals’ trans identity formation process.

Many participants did not necessarily return to their pre-transition identity — some kept their post-transition name, pronouns or gender expression. However, all had experienced some shift in identity.

A third of the participants felt that their transition was motivated by issues other than gender dysphoria, including depression, trauma, homophobia and discomfort being a woman.

Healthcare support during transition

Many youth felt they did not receive enough support during their healthcare decision-making process, and expressed that they were not sufficiently challenged or encouraged to explore their motivations to transition. Some wished they had been offered alternatives to transition, such as psychosocial supports, or exposure to gender nonconforming role models who were women.

Feelings toward transitioning

The youth had a mixture of positive, negative and mixed feelings toward their decision to transition. Fourteen of the 20 youth reported some positive feelings, such as gratitude for what they had learned through the process. A minority (1 in 4) of the youth reported no negative feelings at all.

In contrast, 12 of the 20 youth reported at least some negative feelings about their transition, including regret and grief, depression, and body discomfort post detransition. Negative emotions appeared more pronounced in those youth who had undergone medical interventions. Some reported missing their pre-transition body. Even those with positive feelings about their transition reported negative feelings related to their bodies.

Many of the youth expressed both positive and negative feelings simultaneously about their transition, indicating overall ambivalence.

Feelings toward detransitioning

Almost all the youth expressed positive feelings toward their decision to detransition. The youth who had not undergone medical transition expressed relief that they had the option of stopping their transition and changing their minds.

However, many youth also expressed ambivalent (i.e. both positive and negative) feelings about detransitioning. For example, 9 youth reported that dysphoria feelings returned during the detransition process. Some youth wondered if they'd ever be able to undo the physical changes they underwent during their transition and feared having their gender misread.

Ambiguous Loss Theory

The study authors used Ambiguous Loss Theory to understand the narratives the youth shared. Ambiguous loss refers to grief where it is not clear what has been lost. Ambiguous loss can be triggered by both internal or external experiences, such social relationship ruptures during transition (external), and continued experiences of dysphoria post detransition (internal). Participants experienced both internal and external ambiguous loss.

Fostering resilience

Ambiguous Loss Theory posits that resilience is achieved through finding meaning despite the ambiguity. Most of the youth appeared to have achieved some level of self-acceptance and growth in making meaning out of their transition and detransition trajectory. The researchers propose that individuals at the start of transitioning would benefit from non-judgemental psychosocial supports, as would those who choose to detransition, to lessen their experiences of negative feelings.

The researchers argue for the necessity of new services or adapting existing services to offer a space for more exploration and better support surrounding informed consent.

Some closing thoughts

Reading this article was mildly infuriating, as at times I felt as though the authors were attempting to defend the gender affirming care these youth received. For example, the youth's feelings of body discomfort post detransition is framed in such a way as to imply that the youth had ambiguous feelings about detransition. To me, this obscures the real culprit here. Their bodies were permanently altered during their transition. The body discomfort is not due to detransitioning, it is due to being medicalized and the changes being irreversible.

To their credit, the researchers do advocate for psychosocial supports before, during, and after transition; however, here again they undercut their own argument by insisting that this should not be mandatory. I had the sense that the authors were internally conflicted about how to address the issues the youth who discontinued their transitions raise.

The full exploratory report, entitled A nuanced look into youth journeys of gender transition and detransition, is available online.