Busting the myths around transition regret and detransition

Not everyone who decides to undergo medical or social transition stays there; some transition back. These “detransitioners” occupy one of the most politically charged positions in the ongoing culture war over trans rights. Politicians, pundits and transphobic influencers all try to use detransitioners’ experiences as “evidence” that most people who undergo a gender transition regret their decision to do so—a claim that is demonstrably untrue. 

To set the record straight, Xtra spoke to healthcare providers and therapists across Canada to answer some of the key questions about transition regret and detransitioning.

Why are are so many people talking about transition regret right now?

“We are hearing about transition regret right now because ideologically motivated anti-trans activists are trying to claim that ‘woke’ healthcare professionals are offering gender-affirming care without concern for safety.” That’s the assessment of Vancouver social worker and LGBTQ2S+ counsellor Imogen McIntyre. 

They tell Xtra, “By magnifying the issue of transition regret, anti-trans activists make the claim that people receiving gender-affirming care were never really trans in the first place, but mentally ill or being lured or coerced.” 

That’s why the emphasis on transition regret in anti-trans discourse goes hand in hand with claims that adults are “grooming” children into adopting trans identities, McIntyre explains, or that children and adults alike are susceptible to a trans “social contagion.”

How many people regret their decision to receive gender-affirming care?

Not many. But exact rates vary depending on which aspect of gender-affirming care we’re talking about.

When people talk about gender-affirming care, they usually have gender-affirming surgery front of mind. Think vaginoplasty and breast augmentation or and phalloplasty and chest masculinization. 

Regret rates for these surgeries are quite low. Numerous peer-reviewed scientific studies have shown, as recently as late last year, that less than one percent of the trans people who receive these surgeries regret their decision to do so. By comparison, somewhere around 14.4 percent of patients who receive other forms of surgery regret their operations.

But gender-affirming care includes other things too: everything from updating your name and pronouns and having others respect your decision, to exploring your gender identity in the safe space of a therapist’s office, to receiving gender-affirming hormone therapy.

Regret rates for these other forms of gender-affirming care seem to be quite low too. One study in the Netherlands, from December 2022, found that of Dutch youth who received gender-affirming hormone therapy, “most … continued this treatment into adulthood.” Research collected by the World Professional Association for Transgender Health in its current Standards of Care for the Health of Transgender and Gender Diverse People has consistently shown that the regret rate to be low amongst adolescents who receive gender-affirming care under the care and supervision of medical professionals, while the satisfaction rate has been quite high.

McIntyre says that in the more than twenty years they’ve worked with the LGBTQ2S+ community, they’ve observed the regret rate for gender-affirming care to be “very low.” By contrast, they tell Xtra, many of the people they have counselled regret not having access to transition sooner. “I have counselled a lot more people with grief surrounding years of their lives when they did not have access to gender-affirming care or were afraid to share their identities with others—people grieving years they feel were ‘lost,’” they say.

What safeguards are in place to ensure gender-affirming care is provided only to those who will benefit from it?

Plenty.

The process of obtaining gender-affirming surgical care, in particular, is neither quick nor easy.

Vancouver Coastal Health (VCH) operates the Gender Surgery Program of B.C., which is the only program providing gender-affirming lower surgery in western Canada. A spokesperson told Xtra that the program performed approximately 65 vaginoplasty, 10 phalloplasty and 10 metoidioplasty procedures in 2023. Those numbers don’t account for the B.C. residents who receive gender-affirming lower surgeries at GrS Montreal.

Like other gender-affirming surgical programs in Canada, the Gender Surgeryl Program of B.C. adheres to WPATH standards. That means patients are assessed for surgical readiness by their referring physician, as well as by a surgical readiness assessor at the Gender Surgery Program. The surgeon who will perform the operation also provides the patient with extensive pre-surgical education so they know exactly what to expect. 

Once someone consents to a surgery, their case is reviewed by everyone from a physiotherapist, to a social worker, to a wound-care nurse. VCH’s spokesperson tells Xtra that each of these specialists “provides additional teaching to guide the patient through the surgical process, ensuring their expectations are consistent with outcomes.”

The whole process takes years to complete. It is only available to adults.

And it’s no faster elsewhere. As Xtra has previously reported, it can take up to eight years for trans and gender-diverse adults in places like Alberta to access gender-affirming lower surgery at GrS Montreal.

What happens if someone regrets their decision to receive gender-affirming care?

The process of reverting to a gender identity congruent with a person’s sex assigned at birth is known as “detransitioning.” What it looks like depends on the type of gender-affirming care someone received.

Social aspects of a transition can be completely undone. People can change their names, pronouns, clothing, hairstyle and so on to what they were before they started to transition or to something else entirely. Transition isn’t a singular event; it’s a process. And it takes any number of forms for people, both when it’s occurring and if it’s being reversed.

Non-surgical medical interventions can be stopped. For example, people can discontinue HRT. It’s true, some of the effects of those therapies may be permanent. A person who takes testosterone will experience an irreversible deepening of their voice. But as McIntyre says, “This is really only a problem if you have a rigid idea about what bodies should look like. Anti-trans activists frame these changes as really tragic, but it’s only tragic to be a woman with a deep voice and extra body hair if you have a really rigid, narrow idea of what a woman can be.”

That said, regretting one’s transition is still a difficult process to go through. And some changes, like surgical interventions, are irreversible. If you are the very rare person who regrets their surgery, you will therefore need to find a way to live with your body.

Do people who detransition always regret their transitions?

Not necessarily.

The idea that detransitioning always equals transition regret usually assumes that there are only two genders, and that a person’s gender identity is necessarily static throughout their lifetime. But neither is the case.

Jay Jonah is a social worker and therapist in Toronto. He tells Xtra that “detransition and transition regret are two separate things…. Not everyone who detransitions experiences transition regret, and not everyone who experiences transition regret detransitions.” So, for example, someone who initially identifies as a trans man but later comes to identify as non-binary might detransition, in that they might reverse some or all of their gender transition. But they may still not identify as cis. 

“Some people detransition because their environment doesn’t feel safe enough,” McIntyre tells Xtra, “or they don’t have access to what they need (medically, socially, financially) to present as the gender they identify with…. Others are happy with the idea that they could have many gender identities and expressions over the course of their life, and detransition actually doesn’t mean regret, but joy about the fluidity of their identity.”

What support do people who detransition or even regret their transitions need?

Both Jonah and McIntyre agree: whether they detransition or regret their transitions, people need safe spaces in which they can be who they are.

“Most trans-inclusive spaces are focused on furthering transition and celebrating milestones,” Jonah reflects. “These spaces often don’t feel welcoming for individuals who are contemplating detransition, pursuing detransition or struggling with transition regret.”

Indeed, with the exception of certain digital communities for detransitioners and some isolated therapists who work with this population, there are few formal supports out there for people who regret their gender transitions. That may need to change.

Jonah says, “The fact is, individuals do detransition for a variety of reasons, not just because of transition regret, and these individuals will need support just as much as any trans individual seeking transition will.”

In McIntyre’s experience, that support looks like reassuring people “that there is no right or wrong way to have a body or be a woman or a man; that their body is valid no matter what changes have occurred or reversed … that it is okay for your gender to change throughout your lifetime—and most people’s do.”