What exactly is gender dysphoria?

That is an excellent question. Different people understand the term in different ways. Gender dysphoria is a subjective experience for which we have no objective test. The latest version of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR), defines it as a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, and lists a number of criteria that must be met to receive a formal diagnosis. The DSM-5-TR is generally followed by healthcare professionals in North America, while much of the rest of the globe uses the World Health Organization (WHO)’s International Classification of Disease (ICD), which uses the term gender incongruence instead. In the ICD 11, gender incongruence is not considered a mental health disorder and is defined as a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender… Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

What does detransitioning mean?

Following the lead of community members who have gone through this experience, we are defining a detransitioner as someone who has discontinued or reversed a gender transition, medically, legally, and/or socially. A related term is desister, which often refers to an individual who has socially or legally transitioned but has not undergone medicalization and has decided to discontinue or reverse their transition. Someone who has detransitioned may or may not experience a shift in gender identity after starting to transition, or after stopping transition. A person might discontinue/reverse a gender transition for a variety of reasons, including physical or mental health concerns, surgical complications, postoperative pain, unsupportive parents or romantic partners, employment discrimination, or difficulty accessing healthcare appointments. Not all who detransition regret their transition, but many do regret some or all aspects of the process. Some who detransition may later decide to retransition, i.e. resume their gender transition. Other individuals who have undergone a medical, legal or social transition may experience regret but choose not to detransition, for example in order to not further disrupt their life. While not technically detransitioners, these individuals may feel disillusioned with all or some of their transition.

What is the gender affirmative model of care?

According to US-based developmental and clinical psychologist Diane Ehrensaft, the gender affirmative model (GAM) “defines gender health as follows: the opportunity for a child to live in the gender that feels most real and/or comfortable for the child and the ability for children to express gender without experiencing restriction, criticism, or ostracism. In the model, the role of the mental health professional is a facilitator in helping a child discover and live in their authentic gender with adequate social supports. We as mental health professionals are their translators—striving to understand what they are telling us about their gender in words, actions, feelings, thoughts, and relationships” (The Gender Affirmative Model, Eds. Diane Ehrensaft and Colt Keo-Meier, 2018).

In practice some clients have reported feeling that transition was the only treatment option offered under the GAM, without consideration of other mental health issues that may have contributed to their gender dysphoria. More recently, a number of detransitioners have started speaking out about negative experiences with the gender affirmative model of care they received, which often led to medical interventions such as hormones or surgery. In Canada, a 2022 study out of York University found that “many [detransitioners] have said their gender identity remained fluid well after the start of treatment, and a third of them expressed regret about their decision to transition from the gender they were assigned at birth. Some said they avoided telling their doctors about detransitioning out of embarrassment or shame. Others said their doctors were ill-equipped to help them with the process. Most often, they talked about how transitioning did not address their mental health problems” (Reuters, 2022).

What is informed consent?

According to the World Professional Association for Transgender Health (WPATH), some healthcare providers use an informed consent model of care; informed consent consists of prioritizing trans and gender diverse adults as the primary decision maker in their healthcare, with the healthcare provider acting as an advisor (WPATH Soc8, 2022). Different systems of care/healthcare providers use different criteria for informed consent. Informed consent models have been used for some time for hormone prescription in many North American settings. Some providers may follow an informed consent model of care for adults as well as minors. Other healthcare professionals have expressed concern over whether minors can truly provide informed consent for issues related to fertility and sexual function in adulthood.

What is gender exploratory therapy?

Gender exploratory therapy is a process of psychotherapy where the therapist does not solely act as a gender advisor or facilitator but instead attempts to create a neutral space for clients to explore their experiences and their motivations, as well as addressing any co-occurring mental health issues. Gender exploratory therapists “believe that individuals who are exploring gender identity or struggling with their biological sex should have access to therapists who will provide thoughtful care and tend to legitimate mental health concerns, without pushing an ideological or political agenda. Gender exploratory therapy is an approach that treats identity development as a complex, gradual process that can be influenced by a variety of factors and mental health issues” (Gender Exploratory Therapy Association).

Gender exploratory therapy as an approach to treating gender dysphoria is not new. In fact, it is a standard psychotherapeutic process that empowers the client to deepen their self-understanding and gain confidence and ownership in their decision-making, whatever that decision might be.