New Study Shows Stopping Medical Transition is Not the Same as Detransition
Of those who discontinued medical treatments such as hormone therapy, a new study found that 80 percent continued to endorse a trans identity.
by Evan Urquhart
The highly contentious issue of detransition has become, in recent years, a spur for increased restrictions on trans people’s healthcare. Among the most contentious questions is how frequently young people who once identified as trans decide to detransition, with activists promoting high estimates and the mainstream endorsing the view that detransition is relatively infrequent. The rapacious appetite of anti-trans activists and the journalists who love them for any sort of numbers that can be used to exaggerate the rate of detransition had resulted in studies on discontinuation of treatments such as hormone therapy having been increasingly used as stand-ins for detransition rates, including in some mainstream news outlets.
Although this conflation of discontinuation with detransition has never been never scientifically justified, a new study in the Journal of Adolescent Health casts further doubt on efforts to conflate discontinuation with detransition. It found 16 percent of trans people discontinued treatment (typically hormone therapy), but that 80 percent of those who did continued to identify as transgender.
The study’s first author is Kinnon McKinnon, who has become one of the leading researchers on detransition. “This is one of the first community studies to offer preliminary insights into the diversity of TGD young people in Canada and the US, including the wide variety of reasons that a minority of youth and young adults may discontinue gender-affirming medical treatments,” McKinnon told Assigned Media via email.
Reached using a combination of online outreach measures, the study surveyed 9,674 LGBTQ+ young people in Canada (75.5 percent) and the US (24.5 percent) on their experiences, with a focus on experiences of family and community support for their identities. Of the larger group of respondents, 731 young people reported ever having started gender-affirming medical treatments, with 16 percent of them reporting stopping or reversing treatment. (Sixteen percent is higher than most estimates of detransition rates, but lower than the high estimate for discontinuation, 30 percent, based on a study of prescriptions for those accessing gender-affirming care through the US military.)
Unlike earlier studies of discontinuation, this study asked participants about their reasons for discontinuing treatment and found that detransition was far from the most common. In fact, over one third (37 percent) of those who reported discontinuing treatment told researchers they wished they hadn’t stopped. Meanwhile, 32 percent described a shift in gender identity as having been a motivating factor. The most commonly given reason for discontinuing treatment was health issues, named as a factor by 37 percent of those who discontinued treatment.
If a significant percentage of those who discontinue gender-affirming treatments wish they hadn’t, why are they discontinuing? Hints to possible answers to that question can be found in the study, which found that espousing a Christian identity and growing up Christian was significantly associated with discontinuing treatment, while having a supportive family and household income above $100,000 were both inversely correlated. This suggests that trans people with social support and financial security are less likely to discontinue treatment.
Several other factors that were correlated or inversely correlated with discontinuing treatment, including nonbinary identity. One fascinating tidbit is that identifying as having ADHD was among the inversely correlated factors, meaning that people with ADHD were less likely to discontinue hormone therapy than others. There was no significant association between discontinuing treatment and being on the autism spectrum.
The study was consistent with other findings that suggest accessing gender-affirming treatments are uncommon even among people who identify as transgender or nonbinary, a fact that tends to dispute activist talking points that people are being pressured to transition, or that they are transitioning too easily or quickly. Fewer than 20 percent of this study’s respondents who identified as trans or nonbinary had ever started gender-affirming treatments.
Not addressed by this study were the number of young people who might want to access gender-affirming treatments but hadn’t yet done so, a point highlighted by McKinnon who wrote, "The results offer a glimpse into the wide diversity of trans and nonbinary young people in Canada and the US, with a majority in this sample affirming nonbinary identities. These results suggest many TGD young people do not access GAMT. However, from the present analysis, we don’t know the percent of participants who did not start who may have desired access or who were in the process of starting, but had not yet started."
The reasons why a relatively low percentage of gender-diverse people access any form of medical transition have not been well explored, but lack of access, lack of support, and the increasing acceptance of non-medical pathways, particularly among those who identify as nonbinary, may be among the factors. This paper provides more data to support the mainstream understanding of medical transition as relatively rare and unlikely to result in detransition, and hints at far greater complexity in the experiences of people who discontinue gender-affirming treatments than is typically acknowledged.
Evan Urquhart is the founder of Assigned Media.