Detransition

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Detransition , or more rarely retransition , denotes the abandoning of identification with another gender and the complete or partial reversal of the gender transition in social, legal or physical terms.

So far, there is very little information from therapists and doctors from which there are indications of how common the phenomenon of detransition can be overall. Simultaneously with the increase in people who are going the path of a transition, there are reports in the media about a growing number of people who have decided to go into a transition and report on their path in life and the motivations.

The topic of detransition regularly causes controversy due to the different views of transgender, Christian , conservative and radical feminist interest groups on transsexuality in general.

term

Concept and characteristics of a detransition

Effects of two years of hormone replacement therapy in man-to-woman transition
Scar from a skin graft in preparation for phalloplasty in a trans man

The term “transition” describes the process in which a person who identifies himself as transsexual , transgender or transidentical changes his or her appearance so that he or she corresponds to a different gender. In German usage, the term “gender reassignment” (which is no longer used by therapists and those affected) or “ gender reassignment ” or “gender reassignment” is often used incorrectly . One can distinguish between the social, legal and physical-medical transition. The social transition can include changing clothes and hairstyle as well as changing the first name and personal pronoun (for example, "he" instead of "she") (not yet confirmed by a court ). The legal transition in Germany corresponds to the personal status adjustment of the first name to the gender affiliation experienced and the change to the gender assignment under personal status law according to the requirements of the Transsexual Act , which no longer contain medical requirements since 2011. Gender reassignment measures from a physical and medical point of view are hormone replacement therapy and gender reassignment operations , which not all trans people undergo, however. In hormone replacement therapy, sex hormones of the desired sex, i.e. testosterone or estrogens , are administered; so-called hormone blockers are also used in trans women. Gender reassignment operations are at Trans men especially the mastectomy , hysterectomy and phalloplasty , when trans women especially breast augmentation and the vaginoplasty (i.e. applying a Neovagina), but optionally also a so-called Facial Feminization Surgery , wherein the male face shape is feminisiert.

The prefix "-de" for "Detransition" stands for the undoing of the transition. The synonymous term “retransition” is used less often. In English, people who undergo a detransition are referred to as " detransitioners "; a German term has not yet emerged. From a social and legal point of view, the maiden name and the pronouns that match the gender at birth are used again in the event of a detransition. In addition, many detransitioners choose clothing that corresponds to their original gender; In some cases, however, they still do not dress according to gender or in unisex clothing. In particular, men who lived as trans women at times are opting for more typical shorter male hairstyles again. If facial hair has developed in a woman who has temporarily lived as a trans man as a result of hormone therapy , this cannot be reversed, as can the deepening of the voice caused by testosterone . When hormone therapy is discontinued, the body reverts to its original fat distribution and in former trans men menstruation usually resumes after a while, unless they have undergone a hysterectomy. However , even if no sex reassignment surgery has taken place, fertility may be affected by hormone treatment. Sex reassignment surgery on the genitals can usually not be reversed. There have been reports of isolated cases of phalloplasty in men who had their testicles and penis removed while they were trans women .

Differentiation of a detransition from desistance

In the context of children and adolescents who seek treatment from gender specialists, possibly taking puberty blockers and hormones of the gender they experienced, but who do not opt ​​for gender reassignment operations in the course of individual therapy, the term " desistance " (German: Distancing) if they decide not to pursue their gender transition any further and stop treatment. In the discussion on frequency, the frequency of abstaining in childhood with that after the onset of puberty is mixed for each item. There are also doubts as to whether the information provided by the frequently quoted author Kenneth J. Zucker was determined according to recognized scientific standards. They are also known as " desisters ". The antonym to desistance is the so-called persistence , which describes the fact that children and adolescents persist into the belief that their gender identity does not correspond to the gender of their birth until adulthood.

Differentiation of a detransition from remorse after a transition

A detransition is the response to remorse felt after a transition. However, repentance does not always have to lead to detransition. Some trans people say they regret their gender reassignment and would not have it done again, but have nevertheless decided to continue living in the assumed gender.

Frequency and motivations

So far, there are only a few studies that deal with the question of how many of those identified as transgender will regret or reverse their transition at a later point in time. In principle, the proportion of those who undertake a detransition is given as very low at 1% to 2%. The number of children and adolescents who were treated for gender dysphoria but then decide not to take any further steps in the transition, on the other hand, can be rated as high at over 60%.

Frequency of desistance

For a study published in 2008, researchers interviewed adolescents and young adults who were being treated for childhood gender dysphoria at their Amsterdam clinic. Of the 77 former patients, 54 returned. Of them, 21, i.e. around 39%, stated that they still suffered from gender dysphoria; almost all of them were gay or bisexual . The 33 Desisters (around 61%), however, were predominantly heterosexual , half of the male Desisters homosexual. Overall, however, gender dysphoria in childhood is indicative of a homosexual or bisexual orientation. When compared with the persisters , it turned out that they had shown less severe signs of gender dysphoria at the first treatment.

A later study, for which children and adolescents who first contacted the Amsterdam clinic between 2000 and 2008, were able to record a similar result: of 127 of these former patients, 47 (around 37%) were classified as persisters; years later they asked for hormone treatments and gender reassignment surgery. 80 former patients (around 63%), however, did not return to the clinic, which is the only one in the country that offers treatments for gender identity disorders, and were therefore classified as desisters .

Another nine studies even showed that the proportion of desisters is between 60% and 90%. According to the studies, it was mostly found later that the children and adolescents with gender dysphoria are lesbian or gay .

Frequency of repentance and detransition

In 1993, the psychiatrist Friedemann Pfäfflin of the Ulm University Hospital published a study on remorse after a sex reassignment operation, in which he referred to 295 patients who had undergone such procedures in the past 30 years, including patients who had been treated by him, as well as cases that had already been discussed in the scientific literature. He came to the conclusion that trans men in his study group showed no remorse and only less than 1% of the operated on, whose cases were treated in the literature. In the case of trans women, however, the proportion of repentants was between 1% and 1.5%.

In 1998 around 1,100 people (800 trans women, 300 trans men) had undergone gender reassignment surgery in the Netherlands . For a study on remorse after such an operation, the researchers were able to win ten of these people, nine trans women and one trans man. As a result, at least 0.9% of all operated on in the Netherlands felt remorse after the operation. On average, 1.4 years after the procedure, they developed feelings of remorse. Seven of the ten people had decided to live permanently in their birth gender again. With the exception of one former trans woman interviewed, all of them stated that if they were confronted with the question again, they would no longer opt for gender reassignment surgery. Six people blamed a wrong diagnosis for the regretted decision; three even accused the practitioners of incompetence. Other reasons were social isolation , disappointing surgical results and the sudden decrease in the need to live as a woman. Seven of the ten people had doubts about their decision before the sex reassignment surgery.

The most comprehensive study on the topic of detransition examined all 767 people (of which 289 were born as women and 478 as men) who had applied for a sex reassignment operation in Sweden between 1960 and 2010. 681 of these people ultimately underwent gender reassignment surgery; some of the applicants had withdrawn the application. At the time of the study, 15 of the 681 people, i.e. around 2.2%, had submitted an application to have the gender reassignment reversed. The number was made up of five people born as women (2%) and ten people born as men (2.3%). The proportion of people who regretted their gender reassignment increased significantly between 1960 and 2010. Women born as women applied for a return to the sex of birth on average after 7.5 years, born as men on average after 8.5 years.

A survey of 46 surgeons who attended the World Professional Association for Transgender Health (WPATH) conference in 2016 or the United States Professional Association for Transgender Health ( USPATH ) conference in 2017 and treated a total of 22,725 transgender patients revealed that 49 % of them never had a patient to tell them about regrets after sex reassignment surgery. In total, 62 of the patients (around 0.27%) turned to their former surgeons about repentance, 13 of them regretting breast surgery and 45 regretting surgery on the genitals. Reasons given for repentance, according to the doctors, were a change in the perception of one's own gender identity, a lack of family or social support, problems in romantic relationships and chronic pain after the operation.

A specialist in psychiatry at the University Hospital Basel stated in 2018 that less than 1% of trans people who had undergone surgery would take steps again to detransition surgically. A detransition is only carried out in the clinic approximately every two years. However, the Serbian urologist Miroslav Djordjevic, who is one of the few who surgically support former transwomen in their detransition, speaks of an increasing number of such patients. Between 2012 and 2017 he would have had 14 inquiries and carried out seven such operations in a clinic in Belgrade .

controversy

The issue of detransition has become a political one, especially in the Anglosphere . Various interest groups argue about the factual basis of detransitions and about the consequences that can be drawn from the experiences of detransitioners and desisters .

The most frequent request from those who have been de-transitioned is that, in the psychological work with the patient, deeper causes for the desire to transition should be explored before irreversible measures such as hormone replacement therapy are agreed. In the case of children and adolescents in particular, due to the high rates of desistance, alternative treatment methods should be considered, even if the child expresses the desire to transition early. The sexologist Ray Blanchard , who is well-known in the field of transsexuality , also assumes that detransition rates can be reduced if doctors practice a certain gatekeeping and, for example, require the patient to have lived in the opposite sex for two years before a gender reassignment operation. Transgender activists such as Julia Serano are opposed to the “ Gatekeeper System ” (German: Schleusenwärter-System), which they claim to have inherited , in which doctors can ultimately decide whether a person should choose to transition based on the intensity or previous duration of their gender dysphoria qualified, from. According to them, the meanwhile prevailing gender-affirmative therapy , in which the desire to transition is not questioned or assessed from the start, is unjustifiably questioned. The fear, fueled by reports of detransitions, that people will be tempted to identify themselves as transgender, arises, according to Serano, from the transphobic view that transsexual bodies are damaged and that cisgender people must therefore absolutely be prevented from mistakenly undertaking gender reassignment measures . In addition, the detransitioners who decide to detransition simply because of the transphobia that confronts them during their time as transgender should be mentioned in the reporting. Many of the detransitioned were never really transgender.

People previously identified as transgender also express the desire for more research and better psychological support in the event of a detransition. Researchers who deal critically with the topic of transsexuality, however, are often exposed to strong criticism and are hindered in their scientific work; this also applies to investigations into transitions. In autumn 2017, for example, it became known that the British psychotherapist James Caspian had been prevented from doing research on detransition as part of a postgraduate course at Bath Spa University . Originally, Caspian wanted to examine in particular people who had sex reassignment operations reversed; However, after he had not found enough affected persons willing to talk, he expanded the topic of his work to include people who had identified themselves as transgender, but who had now retransitioned socially to their original gender. When he presented his research venture, it was rejected by the university because it was politically incorrect and could trigger criticism on social media, which would cast the university in a negative light. Caspian went to the High Court to review the rejection of his proposed research; however, the case was dismissed by the Administrative Court , a subdivision of the High Court, in February 2019 for reasons of admissibility .

While a large part of the press is reluctant to report on detransitions, Christian and politically conservative media in particular have an increased interest in publicizing studies and experience reports from detransitioners in order to present transsexuality generally negatively and to speak out against trans-friendly legislation . Some former trans people explicitly oppose their reports being misused for such a conservative agenda or total condemnation of gender transitions. However, many retired people also report that they have no choice but to appear in the conservative media in order to draw attention to the issue, as newspapers and broadcasters with a left and liberal focus would refuse to report on them.

Gender-critical radical feminists see their point of view confirmed by detransitions that the gender roles imposed on them by the patriarchy should only be strengthened through transitions and, in particular, butches that do not correspond to the gender roles, i.e. masculine lesbian women, are to be pressed into a heteronormative system. However, approaches of gender-critical radical feminism are also being adopted by many young women who temporarily lived as trans men, as it encourages them to behave and dress styles that are not gender-compliant, without requiring them to adapt their biological gender to this gender role.

proof

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