Increasing numbers of detransitioners call into question the “affirmation only” approach

Increasing numbers of detransitioners call into question the “affirmation only” approach

While the spotlight of media and social media is directed at all the good news stories of happily transitioned children who feel “seen” and “loved for who they really are”, there is a growing number of detransitioners whose stories are only now beginning to be heard. Just a few years ago, these women were too few and too traumatised to speak publicly about their experiences. Now, they are beginning to organise, growing in confidence and finding their voice.

Their transition stories are variations on a strikingly repetitive theme: undiagnosed mental issues, trauma, peer group “encouragement” to transition, with no questions asked by the therapists who prescribed medication. Their detransition stories are also similar: unresolved ongoing mental issues now compounded by medical and surgical damage to their bodies, feelings of bitterness towards the therapists who failed to safeguard their welfare and experiences of rejection from the “trans community” they formerly called home. Collectively, these personal testimonies offer a devastating challenge to the currently fashionable “affirmation only” approach to gender transition.

The experiences of NSW woman “Tanya”, related by the Daily Mail just this week, tells a story very similar to that of the hundreds, even thousands, of young women around the world who now live with the consequences of decisions they regret:

“Tanya, not her real name, changed genders at the age of 18 while dealing with bi-polar, autism, anxiety and depression … [she] took the hormone testosterone for 18 months and was later supported by the trans community with crowdfunding to raise money for breast removal.

“Three years after her journey to manhood began, Tanya admitted herself into a mental hospital on the verge of suicide. 

“Ms Hunter said her daughter begged her to help save her from what she had become.

“By then, the testosterone that had pumped through her veins had wrought irreversible effects on Tanya's body.

“Her voice had deepened, her hairline receded and she had a significant redistribution of body fat. 

“Tanya's female body had become masculine, including a massive increase of body and facial hair. 

“She now suffered ongoing vaginal atrophy and dryness, causing her significant pain and requiring constant medication.

“… There will be a tsunami of kids like our daughter,' she warned.”

Rachel”, a 31-year old detransitioned lesbian woman who lived for five years as a man, was interviewed last month about her detransition. Her message to young women thinking of transitioning is that gender dysphoria is not the cause of their problems, it’s the symptom of deeper issues:

“Your discomfort in your body is coming from trauma, abuse, depression, sexual orientation issues, circumstantial issues and the sexism in our culture … These people who are trying to treat gender dysphoria, they are missing the whole point of going down deeper and treating the real root of the issue.”

The UK psychotherapist, James Caspian, concurs that increasing cases of regret and detransition are the inevitable consequence of the current enthusiasm for unquestioning “gender affirmation”. Even if medical transition works out well for some, when no care is taken with individual diagnosis, when patients are rushed onto hormones and surgery without any investigation of the aetiology of their distress, the risk of prescribing medical solutions for non-medical problems increases. According to simple logic, the “affirmation only” approach to gender transition will eventually produce a cohort of patients who regret their transition decision and rise up to condemn these practices. We can already see this happening.

Caspian first became aware of female detransitioners about five years ago when he was contacted by a group of women from the US who had desisted from trans identification. At the time, they did not wish to speak publicly. They contacted Caspian only because he was preparing to research patients seeking “gender reversal surgery” (at the time, almost all natal males requesting phalloplasty) and these women just wanted him to know that there was also a significant group of female detransitioners who were not necessarily seeking to reverse previous “gender affirming surgery”.

Only a few years later, female detransitioners appear to be growing in number, forming associations and offering support and information to others escaping the trans movement, which they liken to a cult. Judith Hunter, “Tanya’s” mother, describes how her daughter was “beguiled, groomed and kidnapped” by the transgender community.

“It is like being brainwashed in a cult and if you don't go along with it you are punished.”

Another detransitioner, “Tracey”, reports experiences of hostility, even threats of violence from the trans community that had previously affirmed her, from the moment she began to voice her doubts about her trans identity:

“Questions and doubts came in a tumble. It was very rapid, which was kind of scary because I felt like everything unravelled really quickly, and I think that’s somewhat common. I became really aware that I was going to lose all my friends, lose my whole community as soon as I said I was not trans. I moved cities before I told anyone.”

Rather than receding politely into the shadows, detransitioning women are becoming increasingly vocal in their criticisms of those who encourage gender transition and who refuse to recognise the harms being caused by this.

Last September, Sinéad Watson from the Gender Dysphoria Alliance, published an open letter written on behalf of detransitioned women, calling on Stanford University to censure Dr Jack Turban for his public advocacy and skewed research in support of the “affirmation-only” approach:

“I am writing to you on behalf of a group of detransitioned women regarding your fellow Dr Jack Turban. We are deeply concerned with Dr Turban’s disparagement of psychiatric intervention and exploratory psychotherapy, his singular endorsement of affirmative therapies for people with gender dysphoria, and his dismissive and derogatory treatment of those of us who detransitioned due to transition regret.

“We are but a few of many that have been the victims of this type of cavalier attitude. We all suffered from gender dysphoria at one point (and some still do), and were led to believe that our best chance of treating our dysphoria was to medically transition. As it turned out, this was not the case. As a result, we now have to live with bodies and voices that have been irreversibly changed (in some cases damaged) by hormones and surgeries, when what we needed was a compassionate and thoughtful exploration of our gender distress through talk therapy. Some of us will now never be able to have children and many of us live with great distress and regret every day.

“Not only did physicians like Dr Turban fail us by sending us down a singular path of transition, they are now letting us down once again by disparaging our experiences and even our existence, when they should be providing us with support to help us heal from our unnecessary medical transitions. The fact that Dr Turban is a psychiatrist at Stanford and uses his credentials to promote his reckless approach is especially troubling, as he has been granted a large and influential media platform. As we see more and more distressed young people following in our footsteps of a rushed medical gender transition, in a few years, we fear that the consequences of Dr Turban’s activism will be catastrophic and visible to all.”

“Rachel”, who lives with schizophrenia, is similarly critical of therapists who facilitate access to treatments that permanently alter to the bodies of patients who are clearly mentally ill:

“It seems really wrong to be encouraging someone who is mentally ill to literally cut up their body. It seems like an abuse of power.”

It is becoming increasingly clear that any consideration of balanced, evidence-based ethical care for gender questioning youth must take into account the negative outcomes reported by detransitioners. So it is particularly concerning that research into detransitioning is still being blocked for political reasons.

Caspian first proposed that the issue of detransitioning was worthy of academic study in 2017. He was surprised when his research proposal was rejected and even more surprised by the reason given; Britain’s Bath Spa university felt that “politically incorrect” research would offend some people and might attract negative social media comment, thereby impacting the reputation of the university. In other words, the university was afraid of activist backlash. While Caspian continues his fight for academic freedom, first through the UK courts and eventually to the European Court of Human Rights, the research that promises to substantiate and quantify the grievances of detransitioners has hardly left the starting blocks (one early study can be found here).

Australian data on young people transitioning is patchy and, since gender clinics typically do not follow up with patients, data about rates of desistance and/or detransitioning is simply unavailable. The Trans20 study, which is one of the few attempts to investigate long-term outcomes for gender dysphoric children treated with the affirmative model of care, is designed by the same group of academics that produced the world’s first Australian Standards of Care and Treatment Guidelines for Trans and gender diverse children and adolescents. They do not attempt to disguise their bias. So convinced are they that the “affirmation only” approach is correct, they have omitted a control group on the grounds that:

“[I]t is not ethically possible to incorporate an untreated control group in the Trans20 study design. This is because withholding treatment for the purposes of forming a comparison group may cause patients significant distress and therefore pose significant risk of harm to individuals.”

A study that presupposes happy results of the treatment being studied is obviously guilty of circular logic. Assuming best outcomes, all the Trans20 study might demonstrate is that children who are confirmed in a trans identity from a young age and encouraged to persist in trans identification over the significant years of their development, might manage to survive with persistent dissociation from their natal sex with pharmacological and medical support. In other words, the Trans20 study is a marketing tool for the “medical affirmation” product. What this study will not tell us is whether the children thus “affirmed” and medicalised would have been better off with the talk therapy which has an established track record of reorienting 80−95% of dysphoric children to their biological sex.

To act ethically, you need to have solid facts. Until medics recommending transition fully understand the potential downsides, they cannot possibly equip their patients with the information they need to provide informed consent. For this reason, both qualitative and quantitative research is urgently needed into the experiences of detransitioners. We need universities to brave the backlash of the vested interests that have marked this off for political reasons as a “no go” zone and actually investigate the hard questions.

If, as the testimonies of detransitioners suggest, there are some problems with the “affirmation only” approach, then we can expect the evidence of this to eventually mount to the point that it becomes impossible to ignore. The only question is, how long will this take? How many young women’s lives and bodies need to be ruined before we begin to reassess the claims that “affirmation” and medicalisation is the best (indeed, the only!) model of care for gender dysphoric people?

Women’s Forum Australia is an independent think tank that undertakes research, education and public policy advocacy on issues affecting women and girls, with a particular focus on addressing behaviours and practices that are harmful and abusive to them. We are a non-partisan, non-religious, tax-deductible charity. We do not receive any government funding and rely solely on donations to make an impact. Support our work today.

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