Detransition: Cambridge Study (2)

Finally there seems to be some recognition of the phenomenon of people who detransition. I come to different conclusions than the authors and I have some questions but this study is worth looking at. You can read the full paper here:

Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic- retrospective case-note review | BJPsych Open | Cambridge Cor

The researchers looked at rates of detransition in patients treated at a UK Gender Clinic. The method they chose was to look at all the patients discharged from the clinic over a year, via the patient case notes. Here is the abstract:

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Pay attention to this. We are about to introduce a more ”streamlined” service for Gender Identity Clinics (GICs) but we do not know how many people detransition. What struck me, over and over again, was how much this report laments the lack of data in this field.

This was the methodology. They looked at all patients discharged in a period of a year. They then looked at a number of variables to see if there were any common factors in those who they determined were ”detransitioners”. This is important because they aimed for a consensus view about who met the criteria to be counted as a detransitioner. The criteria was forged, I would argue, by those who believe in “Gender Identity Ideology”.

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As you can see they use a definition which is about “living in a gender role”. I flag this because a Butch Lesbian may discontinue medical intervention but may still be deemed to be living in a ”masculine” role. She may not see it this way but see herself as a woman who is not confined by sex stereotypes. Similarly a gay male may detransition and still have atypical interests for his sex. Are these two, potentially, discounted because of their ”Gender role” ?

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Leaving aside this question we turn now to how many of these, discharged, patients were originally flagged as potential detransitioners. The figure they agreed on was 12 people who, it was agreed by consensus, met the criteria:

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The numbers were whittled down to 12 from an original sample of 21. If the criteria they used is erroneous and those 21 would meet a broader definition of ”detransition” the figure would be 12%. This does not include the three suicides. Even excluding the suicides the percentage is nearly double the % calculated by the studies authors. In one scenario a person may not wish to abandon their identity as a ”Transman” which may be the source of their community. Given the negative responses to those openly expressing regret and coming out as a ”detransitioner”, from the LGBTQ+ community, some may remain in the closet. All of which is to emphasise the point that the definition of regret /detransition is significant in determining who counts and, crucially, who doesn’t.

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Other detransition studies:

The paper highlights that other studies have set the rate of detransition from anywhere between 1% and 8%. They reference the source for both those figures. The 8% figure is from a United States, Trans Equality Survey, from 2015. That survey was funded, in part by the Arcus Foundation.

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Arcus Foundation are huge funders of organisations disseminating Gender Identity Ideology as are the other foundations listed, above, as supporters. I wrote about Arcus Foundation here:

ARCUS FOUNDATION GRANTS

The survey explained the phenomenon of detransition thus:

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The common rationale for the phenomenon of post transition regret, or detransition, is to locate the reasons in a lack of social acceptance. An alternative framing is the realisation that it is impossible to change sex it is possible that living with the psychological, and medical, consequences may create an intolerable burden.

The other study referenced, by the authors, is this one from 2019. The methodology was to access a random sample of patient notes to examine whether the patients expressed any regret. The authors are keen to point out detransition can be seen as part of an exploration of their identity. This is a frequent rationale and sometimes described as part of a ”Gender Journey”. This sits oddly with the push to irreversible medicalisation and injunctions to listen to the patient when they demand access to treatment. Note the conclusion, if so few detransition there should be no reason to slow down the treatment pathway. 👇. Richards, the co-author, works at a Gender Clinic.

Another source (not quoted) also found only 1% detransitioned. The methodology appears similar. A years worth of clinical notes were scanned for words indicating regret or detransition. This study has similar limitations to the one I am looking at here. It’s only a snapshot, the authors define what they regard as ”detransition” and there is also a lack of recognition that dissatisfied patients would, potentially, be unlikely to notify the Gender Clinic.

Their findings are listed below:

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Back to the Cambridge Study.

Here is a table giving an overview of the kind of co-morbidities the patient group are also wrestling with 👇. As you can see there are high rates of mental health issues; over 80% in the under 25, male group. Looking at the pattern for accessing mental health services many of these co-morbidities appear to be going untreated. Rates of self-harm are notable in the female, under 25’s. Nearly 90% of the younger females also had at least one adverse childhood experience.

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In the table above it is the females over 25 who have the highest percentage of suicide attempts. Buried in the report is a reference to three, completed, suicides. There is no further information about the sex of the people who committed suicide and no intelligence as to whether this was attributed to the medical treatment they accessed. If these were linked to post-transition regret that would be another three to consider.

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Below, more information is supplied about those who met the threshold to be defined as detransitioners. One, a male, had completed Genital Reassignement Surgery, which, I presume means removal of the testicles/penis. Again, I would imagine re-identifying as your natal sex would be especially challenging in this circumstance. All the females had accessed double mastectomies.

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The authors of the study do recognise the limitations of their research, as well as the dearth of studies in the field. They do recognise that there is much loss to follow up and no consistent way of tracking those who detransition. They also recognise that GICs are dealing with a 40% increase in referrals and they are treating a new, adolescent female, demographic specifically designed to meet the needs of older, males. However, like the earlier studies they are reluctant to let go of a more streamlined service, for which read lower levels of gatekeeping and faster progress through the system.

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The authors also question the use of notions of regret in this community; using the kind of language associated with those who talk of ”Gender Journeys”. Such language masks the fact that there is no way to reverse surgeries like double mastectomy or GRS, or even Testosterone usage. This sophistry seems designed to obscure rather than illuminate.

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Note also 👆that they recommend including “trans” people in research and service development but not detransitioners.
So, in summary, more research is needed, loss to follow-up remains a problem, GICs need to be compelled to evaluate all those who have accessed medical interventions. The definition of detransition remains contested. For those who choose not to return to the GICs there has to be a mechanism to track their outcomes. Sadly, there is also now a need for a service for detransitioners; some of whom may need to rely on synthetic hormones, for life, having no means to produce these naturally.

Another important acknowledgement of the studies limitations points out that research shows regret can take years following treatment. Even the authors acknowledge they may have underestimated rates of regret/detransition.

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You can read part one of this series here:

Littman and Detransition

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