On the surface at least, the allegations levelled in Michelle Zacchigna’s recent lawsuit raise troubling questions about the medical care offered Canadians considering gender transition.
She says health professionals ushered her along a transgender path that included removing her breasts and uterus, while giving short shrift to other mental-health issues. Realizing she’d made a terrible mistake, Zacchigna later began detransitioning, reverting to the female sex assigned to her at birth.
Yet it’s unclear what to read into her experience.
Was it a rare breakdown in the system, like the infrequent side effects of certain drugs that are otherwise invaluable? Or are there so many “detransitioners” that it suggests the current approach to treating gender dysphoria — the sense that one’s gender identity does not match one’s birth sex — is seriously flawed?
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A small but growing number of studies has been trying to answer that question, producing varying results and heated debate.
But if the research is less than definitive, one theme seems to be gaining traction: people who decide to reverse or halt their shift to a new gender identity need to be treated with more respect and care during a taxing process — no matter their numbers.
“When people say they were harmed, I believe them,” says British Columbia’s Aaron Kimberley, a trans man and former mental-health nurse who founded the group Gender Dysphoria Alliance. “When it comes to medical practices, we can’t sweep any outcomes under the rug and expect harmed people to remain silent for political convenience.”
Kinnon MacKinnon, a trans man and social-work professor at York University, has become one of the world’s leading researchers on detransitioning, despite once dismissing it as irrelevant, and facing fierce criticism for highlighting the phenomenon now.
He declined to comment for this story, but at a York symposium on the topic last November, said health professionals must address the issue, even if it represents just a small minority of transgender people.
“Understanding this experience is really important,” MacKinnon told the conference. “The current model of gender care really needs to adapt in order to acknowledge and address the needs of people who detransition.”
“Detransition is complex and often isolating. People may lose community supports. Some may feel mistrust toward health-care providers … and also grief or mourning for permanent changes to their bodies made by gender-affirming interventions.”
Some critics worry that detransitioning will only become more widespread. They point to a dramatic increase in the number of young adolescents, mostly female at birth, seeking help for gender dysphoria, coupled with the health-care system’s “affirming” approach to self-declared changes in gender identity.
Others are less concerned.
Dr. Michael Irwig, head of transgender medicine at Beth Israel Deaconess Medical Center in Boston, said he believes clinicians need to be aware of detransitioners and how to manage hormone therapy if such patients have had genital surgery.
But reversing or just halting transition seems “uncommon” and when it does happen, regret is not the main driver, the Harvard University medical professor said by email. It’s more likely due to other reasons, such as a non-binary person having achieved certain physical effects, like voice deepening, and wanting to go no further, he said.
Meanwhile, the issue has been seized on by right-wing politicians and activists questioning all aspects of transgenderism. Prominent detransitioner Chloe Cole, for instance, spoke recently to the conservative Heritage Foundation in the U.S. and attended a rally with far-right congresswoman Marjorie Taylor Greene.
Members of the Canadian Professional Association for Transgender Health could not be reached by deadline.
But Dr. Jason Rafferty, a Rhode Island child psychiatrist and co-author of an American Academy of Pediatrics statement on gender health, recently told Reuters that stories about detransitioning people with a lot of anger and regret are over-represented in the media compared to what’s seen in clinics. And the term detransition itself tends to be “very invalidating” for transgender and gender-diverse people, the news service quoted him as saying.
Zacchigna alleges in her lawsuit against eight health professionals that her decision to transition was never challenged, nor was she screened for other mental-health issues. Only after her mastectomy did one psychologist diagnose her with a slew of separate problems, from attention deficit and hyperactivity disorder to being on the autism spectrum, the suit charges.
But how common are such experiences? The research has yet to definitely suss that out.
We can’t sweep any outcomes under the rug and expect harmed people to remain silent for political convenience
Studies conducted at a time when mental-health care “gatekeepers” more rigorously screened patients for medical and surgical transition — and before the affirmative approach took hold in the last several years — suggest the proportion who regretted the change was minuscule. That’s echoed in some recent research — including a 2018 Dutch study that found a regret rate of less than one per cent in people who had undergone “gonadectomies” — removal of ovaries or testes — between 1972 and 2015.
But at the York symposium, MacKinnon pointed to three more recent British studies he believes have strong methodologies. They found that between seven and 10 per cent of transgender people studied had detransitioned.
On a more anecdotal level, Beyond Transition, a new organization formed by Genspect, an international advocacy group skeptical of gender-affirming treatment, has seen a flood of detransitioners ask the group for help — about one a day since last summer, says founder Stella Omalley.
“These are really distressed people and what we found is that they are very, very, very reluctant to go back to the clinics (where they first received gender treatment),” said Omalley, a psychotherapist. “The clinics don’t know the numbers because the detransitioners don’t go back to them.”
A detransition group on Reddit has ballooned from 5,700 members to close to 45,000 since 2019, though it’s unclear how many of those are actual detransitioners.
Other research has tried to profile those who stop or try to go back from gender-identity changes.
A survey published in 2021 by former Brown University professor Lisa Littman looked at 100 people she recruited online. Littman concluded that 60 per cent detransitioned after they became more comfortable identifying with their birth sex, and 23 per cent because they faced discrimination as transgender people. Fifty-five per cent said they didn’t receive adequate assessment by a medical professional before starting to transition.
A study last year of 28 detransitioners by York’s MacKinnon found 67 per cent had no regrets about their previous decision to transition, while 22 per cent wished they hadn’t made the change. Reasons for detransitioning included physical or mental-health concerns, surgery complications, pressure from family to reverse their trans identity and discrimination.
A 2021 analysis by Stanford University psychiatrist Jack Turban of survey data on Americans who still identify as transgender or gender diverse found 13 per cent had detransitioned at some point. But the “vast majority” did so because of outside factors like parental pressure and social stigma.
Omalley says she’s skeptical about studies that find low rates of regret even among detransitioners. She said her experience with psychotherapy suggests that humans are innately reluctant to admit regret about important life decisions – whether it’s a marriage gone bad or gender transition.
All the research does seem to indicate that the large majority of transgender people studied are happy with their change. For many of those who are not, however, and have contacted the Beyond Transition group, Omalley says adopting a new gender identity was simply too hard.
“The most common reason when I get to the nub of it is, they say ‘I was exhausted. I was exhausted at trying to be something that I wasn’t,’” she said. “My distress is at the health professionals whose job it was to tell these vulnerable people ‘This is indescribably difficult.’”
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