Last year, in February 2023, the first lawsuit in Canada alleging medical malpractice for the provision of gender-affirming care was launched by a 34-year-old who claimed that the transition-related healthcare she’d received in her early 20s led her down “an irreversible journey she regrets,” according to the National Post. Rather predictably, this troubling news about an individual navigating a complex and distressing experience was accompanied by a wave of breathless editorializing from the international “gender critical” movement, who claimed the woman’s case as evidence of their signature narrative: that a collusion of brainwashed doctors and overzealous trans activists are leading hordes of tragically deluded individuals into futures of permanent and tragic “mutilation.”
Transition regret and detransition have become something of a fixation for gender critical activists in the past half decade, which has led to an explosion of collective anxiety over growing numbers of individuals seeking out gender-affirming care in many countries around the world, including Canada, the U.S. and the U.K. The sensationalized—and legitimately sad—stories of famous youth detransitioners such as Keira Bell and Chloe Cole have become a rallying cry and cause célèbre for anti-trans voices, evoking the dominant culture’s archetypal terror of malevolent forces come to steal away society’s youth.
Like the Pied Piper luring the children of Hamelin to a land of no return, the villain of the gender critical movement’s transition-regret narrative is a shadowy figure whose motives are nefarious yet vague—a villain whose evil preys upon the innocent and tends toward the corruption of children. Prominent self-described gender critical and “anti-woke” celebrity journalist Michael Shellenberger, for example, makes reference to doctors and trans activists as “a pseudoscientific cult performing what is the equivalent of witchcraft on children.”
Such rhetoric may ring earnest to naive ears, but many of us who have spent lifetimes being labelled dangerous outsiders to decent society recognize the unmistakable echo of a sexualized moral panic. This kind of rhetoric follows historic patterns in its implication of secret conspiracies to harm children via ritualized violence. This same echo can be found in contemporary “Pizzagate” rhetoric, the Satanic Panic of the 1980s, the anti-gay movement of the 1970s and so on throughout history.
Earlier this spring, the release of the U.K.’s Cass Review, a government-mandated independent review of gender-affirming care for children and youth, poured proverbial gasoline on such “regret” narrative. Though the review is cautiously worded, its author, British physician Hilary Cass, essentially lays out significant criticisms of current approaches to gender-affirming care for children, expressing concerns over not only the use of medical procedures such as puberty blockers and hormone therapy, but also around allowing young people to socially transition at all.
Notably, the review has been fiercely criticized by healthcare practitioners and scholars who have pointed out alleged methodological gaps and cultural bias—particularly a lack of any significant engagement with the history of societal transphobia or transphobic prejudice among healthcare practitioners.
Yet the gender critical media sphere has seized upon the Cass Review as incontrovertible proof that a tsunami of transition regret is cresting upon us, with the frequently anti-trans publication Spiked crowing that “the scandal of gender-affirming care has been brutally exposed” and rather ominously declaring: “The NHS has been experimenting on confused, vulnerable kids. Heads must roll.” More concerningly still, a similar review is set to be implemented for adult trans clinics in the U.K. in the near future—presumably with the goal of rescuing grown-ups from the apparently unimaginable horrors of transition regret as well.
It seems clear that mainstream society is overdue for a sober and thoughtful conversation on gender transition and the possibility of regret therein. Unfortunately, “sober and thoughtful” are the last adjectives I would ascribe to the public discourse that we are currently witnessing on this topic outside of trans community (and it must be said that within trans community, things aren’t great either). To put it bluntly, the mainstream “transition regret” conversation is heavily affected by implicit transphobia, ignorance of trans history and collective denial of trans lives. Until we reckon with those realities, we will never be able to resolve the debate.
What are we talking about when we talk about regret? Ostensibly, we are talking about the extent to which any individual who decides to transition wishes they could undo or reverse that decision based on its negative consequences. The “gender critical” narrative paints a picture of transition regret as a sort of terrifying hellscape, conjuring images of mutilated bodies and horrifically warped genitals, using language that often seems drawn directly from the horror genre. The infamous right-wing culture warrior Jordan Peterson, for example, has frequently referred to gender-affirming care providers as “butchers,” and referred to a “bloody trans contagion” that is “causing a tidal wave of young women to cut off their breasts.”
Yet a cooler-headed assessment reveals that transition regret, while a real and serious issue, is a far more complex phenomenon than commonly acknowledged, and its realities are too often obscured by sensationalism and societal transphobia. In the first place, “satisfaction” and “regret” in regard to transition are not discrete categories; one can feel dissatisfied or regretful about some aspects of one’s transition while feeling positive about others. For example, one might feel regretful about changes to one’s hairline as a result of testosterone treatment while being happy about changes to one’s vocal tenor.
Indeed, the very small amount of formal research that exists on detransitioners’ experiences seems to indicate that this is the case a significant amount of the time. Most of the individuals in a landmark qualitative study on the topic of detransition study published in JAMA did not “return” to their original gender identity after detransitioning, but rather came to see themselves as more gender-fluid or non-binary. While some reported regret over medical transition, the majority did not.
“Regret is a natural byproduct of being human and therefore unable to predict the future.”
“Regret” is also a highly time-based phenomenon. One may experience transition regret for a limited time after which such feelings resolve; similarly, some individuals detransition and then retransition later on. Indeed, some detransitioners may only do so as a result of transphobic social pressure or other practical reasons. Overall, it’s important to note that despite widely varying research parameters, every major scientific study on the topic to date has found that those who report transition regret are a very small minority compared to those who don’t. Reported regret rates usually range between less than one percent and three percent (an outlier study suggests that 13 percent of trans people may detransition at some point in their lives. However, it is important to note that this study does not differentiate between transition for external reasons, such as societal discrimination and familial pressure, and transition as a result of dissatisfaction with medical procedures).
All of the above indicates that regret, while a serious and important consideration in the complex evolution of trans rights in society, is not the apocalyptic nightmare of the “gender critical” imagination. Rather, it is a natural byproduct of being human and therefore unable to predict the future.
Any major life decision brings with it the risk of regret: Getting married, for example, has a notoriously high regret rate of 40-50 percent, and between five percent and 14 percent of parents reportedly regret having children. Nearly a third of Canadian mortgage holders regret signing on to their mortgage, and 77 percent of Canadian post-secondary graduates regret taking out student loans (why don’t we outlaw those?). Elective surgeries not related to gender vary widely in regret rates, but are generally either comparable to or much higher than gender-affirming surgeries.
Yet when it comes to these apparently highly regrettable life decisions, the protective fervour of the “gender critical” crowd is nowhere to be found. I suppose it’s impossible to know for sure why, but one can’t help but turn to simple prejudice against trans people—and the desire to see less of us in society—as a potential explanation.
What would it mean to consider the possibility of regret thoughtfully, accounting for the full range of evidence available and the many contextual complexities of each case? It seems to be the case that the majority of people who transition do not have regrets, and even some of those who detransition have no regrets or manageable regrets.
There are those like Cole and Bell, who express high levels of regret, yes, and they certainly deserve empathy and care, but does the distress of a few warrant restricting the freedom of all? Particularly when such restrictions threaten to have seriously negative consequences for an entire population? Let us remember that for most of the history of trans medicine, access to gender-affirming care was heavily restricted, gatekept and stigmatized, resulting in generations of trans people experiencing humiliation and harm at the hands of healthcare providers. This is a history entirely disregarded by “gender critical” activists and many well-meaning centrists, perhaps because they are unaware of it, but perhaps also because they don’t care.
The advancement of human freedom requires us to accept risk, because making choices is inherently risky. We can mitigate that risk not by eliminating choice entirely, but by supporting individuals and communities to have open conversations about what the risks and benefits of each choice looks like—and by not shaming or stigmatizing regret as something that has to haunt someone for the rest of their days. This concept is referred to as the “dignity of risk” in disability rights and disability justice—that is, the importance of treating vulnerable people as full human beings by supporting their right to engage in decision-making despite the possibility of regret. Sometimes people make decisions that they don’t feel good about in the end, and I simply cannot believe that the answer to this problem is taking away the freedom to choose.
Dignity implies responsibility. So too does freedom. The fact is that all people who transition—as well as all people who make big decisions to pursue meaningful change in their lives—are responsible for our own choices to a certain extent. This includes acknowledging and accepting the possibility that we may not be fully satisfied with our bodies post-transition.
Young children, of course, have a limited capacity to understand risk, and adolescents may be more inclined to make risky decisions than adults, but the common-sense approach here is surely to manage transition care as a staged process over time, carefully followed by parents and health professionals rather than setting up a conflict between young people and adults that may ultimately damage trust and mental health.
The potential for regret, in the end, is the inheritance of all people—it is the flip side of personal sovereignty. If we cultivate our collective capacity to understand it wisely, without panic or reactivity, then we are far more likely to create a healthy environment for anyone at any stage of transition or detransition. Safety and dignity cannot be achieved through repression, nor through hysteria, but through empowerment and wisdom. Let’s hope that empowerment and wisdom prevail.
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