The Cooptation of Detransition
The Cooptation of Detransition
Let detransitioners speak so we can learn from them. Please.
Chloe Cole was 12 when she began to identify as transgender, 13 when she went on testosterone, 15 when she had a double mastectomy and 16 when she realized she regretted her transition and returned to identifying as her natal sex. Online, she found the word “detransitioner” to describe this new identity, a word she’d never heard, a possibility she’d never been told existed. Detransition—returning to live as your natal sex after medical transition—the common narrative goes, is “very rare,” so rare, no clinician mentioned it to Cole. Once she detransitioned, Cole began to speak out, to warn other young girls who were uncomfortable in their bodies—in their lives, in their minds—that removing their breasts and making permanent bodily changes through testosterone is not always the direct path to happiness TikTok promises it to be.
The most shocking parts of this story should all be above. But they’re not, at least not to me.
The most shocking part is the way a gender-affirming endocrinologist treats Cole on Twitter. He accuses her being “in this for fame and notoriety” and “seeking credibility in data driven trans care.” It’s a strange way for a medical doctor to treat a young patient traumatized by the very kind of care he proffers. There is no acknowledgement that perhaps the medical field bears some responsibility for administering hormones and removing her breasts unnecessarily, or that there’s anything in this field that would benefit from scrutiny. As someone who claims the mantle of detransitioner, she is marked as the enemy.
The doctor, Michael Haller, insists like many of his colleagues that detransition is vanishingly rare—1 in 300 in his own workplace, he claims, admitting he has no data to back it up. But the truth is, without long-term followup of adolescents who medically transition, we truly don’t know. And “we truly don’t know” is a sentence that we should hear over and over again from clinicians in this field. (Amazingly, Haller is quoted in this Washington Post article about whether Libs of TikTok should be suspended from Twitter because it posted Boston Children’s Hospital’s own videos about performing the kinds of surgeries on minors that Cole regrets, which is characterized as harassment. Hard to wrap my head around.)
One way we could cool down the boiling culture war over how to treat kids with gender dysphoria—besides, you know, not being terribly unkind to adolescents on the internet—is to be honest and humble about the research we have about gender-affirming care and pediatric medical gender transition (or, if you like, childhood and adolescent sex changes), and have a frank discussion about detransition.
Instead, many in the field of gender-affirming care are working hard to make sure that detransition is not associated with regret or seen as a negative outcome. There’s a battle for the word, with one cohort insisting it should include people who detransition for external reasons—costs, access, shame and stigma—and another trying to claim it for those who do so for internal reasons: “Oops, removing body parts or changing my body’s makeup wasn’t the appropriate treatment for what ails me. And I cannot change it back.”
Yes, there are many reasons why a person who medically transitioned would stop meds or try to reverse surgeries and return to living as their natal sex, including adverse medical reactions and an intolerant environment, and we should have a word for that phenomenon and collect data about those folks so they can get good health care. But the many detransitioners speaking out on social media don’t want the word coopted by others who would muddy its meaning, or try to deny their existence, because they want their experiences to be heard and understood, to affect healthcare policy here the way it has done in other countries, and have evidence-based, careful, slow, non-ideologically-driven mental health care that embraces the lived reality of detransitioners. That’s often the exact argument used by trans folks: Don’t deny my reality, and don’t deny me healthcare.
Some of those clinicians who assert that gender affirming medical interventions are proven safe and effective are also trying to control the narrative around detransition. Indeed, for another story I was working on, I received a response to a question about detransition from the American Academy of Pediatrics cautioning that I shouldn’t see transition as success and detransition as failure. It’s a false binary. Gender is a journey, they said.
This is a really interesting argument, but having now met several men who had their penises removed only to realize they were gay, or women with no breasts who realized they were depressed, confused and autistic, and not transgender men, I’m gonna go out on a limb and say it’s okay to count regretting the removal of body parts or unwanted permanent corporeal changes* as a failure. And it’s not just about regret, which is not a word all detransitioners would use. It’s about if there were less-invasive, less life-altering alternatives to alleviating gender dysphoria than these medical interventions. Many detransitioners I’ve talked to had to come to a place of radical acceptance about their permanently changed bodies—which is what they needed to work toward before, they realized too late.
It’s important for the medical community to take note of these experiences in an aim to prevent them from continuing to happen. They can’t do that if they deny that they’re occurring. They can’t do that if detransitioners’ voices are usurped and silenced, if they’re not even told when they transition that detransition is a possibility. Many detransitioners have told me that finding the word was a kind of cloud-parting aha moment—much the way some people described finding the word transgender.
“I've been seeing activists and institutions attempting to reframe detransition as a neutral outcome by claiming they are trying to reduce stigma,” Michelle Alleva, a detransitioned woman, told me. “I have a hard time believing this is an altruistic endeavour on their part.” Alleva wants detransitioners to be able to speak freely about their experiences, including critiquing the healthcare system that led to their situations. From what little we know, it seems that detransitioners get worse healthcare than people who want to medically transition. Insurance companies generally will pay for breast removal but not breast reconstruction, for instance, because, ironically, they say the person doesn’t have a stable gender identity.
These situations must be discussed openly, Alleva says, to reduce stigma and raise awareness. “Acknowledging that we exist and that we have needs that were not met (and needs which are still not being met) would be reducing stigma. Someone may detransition and never feel regret, but the fact remains that the treatment ultimately did not serve them. This is medical negligence, not buyer's remorse.”
But rarely are detransitioners allowed a platform. Recently, a group of detransitioners proposed a panel for a conference to be held by the American Academy of Child and Adolescent Psychiatry. It was rejected. AACAP will instead host a panel by the same clinician often claiming detransition due to regret is rare, Dr. Jack Turban.
AACAP is presenting detransition as “gender identity evolution” and “dynamic identities.” Other providers use the word retransition. Here again, is the narrative: no mistakes are being made. This is a fluid situation. (One might ask: if we’re now saying gender identity is fluid, why concretize it with medical interventions?)
Meanwhile, a researcher at York University in Toronto, Kinnon Ross MacKinnon, who is transgender himself, has been studying detransition, using a broad meaning of the word that many detransitioners object to, but also doing something few others in his field are doing: admitting it happens, and that it’s worth studying.
Some detransitoners like Alleva—who medically transitioned and regret—wouldn’t participate in the study, scared off, for instance, by the way MacKinnon put the word regret in quotes and the sense that the study was designed to distract from detransitioners’ quest for recognition, not support it. So MacKinnon couldn’t paint as clear a picture of the phenomenon as he’d hoped. (I hope to interview him in depth later, when his next paper comes out, which he says is about regret.) But at least he admits that transition regret needs to be addressed, and also notes in a recent paper that detransitioners of all stripes are getting really bad healthcare.
Some of that is because the medical community is so shut down on this topic that they seem almost allergic to introspection, allergic to the complex reality of what’s happening.
Haller wrote on Twitter that he’d never had a patient detransition, but considering that in one study only 24% of detransitioners informed their doctors of the change, and considering his behavior toward Cole on social media, Cole told me she worried his patients wouldn’t feel safe contacting him if they did detransition.
Detransition is hard. You lose your community. You face your mistakes and regrets. Clinicians and medical groups, I believe, should create an environment where people can openly share their experiences, and be committed to gathering the data no matter what it shows.
*Yes, that is also how I would describe my aging process, but aging is unavoidable and medical transition is not.
Folks, there's a very obvious reason why these health professionals need to muddy the meaning of detransitioners -- and, it is very obvious to any lawyer who regularly litigates:
They are prepping the jury pool for the medical malpractice/negligence cases that will be piling up in the coming years.
My advice to this community:
1) Consult with good plaintiff's lawyers, class action lawyers/law firms and,
a) ask if there's a path to get a "class" certified of people who have sustained damages due to over-eager/negligent/politically driven medical care/general advice. (There can even be a group of only those with emotional damages, for those who chose not to go through with physical changes, but were negatively impacted through advice. Think big, think outside the box).
2) ask lawyers to analyze what targets, including individuals, make the best defendants. Make a priority list in order of vulnerability & pay-off -- remember to include schools, teachers, medical associations (why not? The Pediatric assoc. is negligently ignoring European changes to this area of medical care), psychologists, nurses and any other non-doctors potential plaintiffs.
3) Fundraise online to pay legal costs up-front (this will help you get a law firm to take a chance, if they know the costs will be covered. This can be for costs up to, but not necessarily including, lawyer's fees).
3) File lawsuits against the whole list.
4) Refuse to settle if they demand a non-disclosure agreement (jury awards are public, so you may have to take it to trial).
5) Hire a top publicists to publicize the settlement, or jury award.
They're less likely to want to settle if there is no non-disclosure. This is why I suggest fundraising online in order to cover the costs of lawyers who may be too jittery, since they're left paying for all expenses unbder the usual retainer agreements (note the standard retainer agreements will have to be modified).
This insanity will only stop when the malpractice insurance companies stop covering these doctors, or make the coverage too expensive. Ditto for actions against schools and anyone else -- if this becomes too expensive, they will stop. That's how our system works: expense + publicity.
The fundraising needs to cover expensive publicists. Jury verdicts/settlements without publicity are not the goal, they only deepen the problem.
For all this it would be best to set up a non-profit. I can think of a few good names, all including "Legal Defense Fund" -- because, after all, we are defending against this onslaught of greed and misplaced zeal.
Go for it, folks! Set up a detransitioners non-profit, fundraise and "Sue The Bastards!" -- All of them. Spare no one.
"Some of that is because the medical community is so shut down on this topic that they seem almost allergic to introspection, allergic to the complex reality of what’s happening." Allergic to coming to terms with their own culpability. As Helen Joyce pointed out, the greatest promoters of incuriosity are those who with the most to lose, specifically parents who encouraged their children to shed body parts in search of happiness as well doctors like Dr. Haller who may have some residual doubt they hope to quash by discounting the detrans' experience.