Studies of Detransition Need to Be Longitudinal as Well

Criticism of the research on transition and regret often introduces anecdotes and qualitative studies about detransition that themselves do not attempt to meet the high standard of longitudinal data being proposed for transition research.

by Evan Urquhart

Let’s start with something that should uncontroversial: A person who makes a criticism should apply it equally to positions they favor and positions they do not. This seems foundational, does it not? If a criticism is valid, it should apply equally in many contexts. If it is used in one context only to be whisked away in another, that should seriously undermine the criticism and those making it. Now: On to the topic of detransition!

Researcher Kinnon MacKinnon is studying a topic many people seem highly interested in: Detransition. According to a Reuters article about his work, MacKinnon has spoken to 40 people who have detransitioned, and he says about a third of those he spoke with also expressed regret. (This is what’s known as a qualitative study, the sort of thing you do to get the lay of the land on a topic, opening up avenues for future research.)

The Reuters piece also expresses some concerns about the much more robust research into transition outcomes, including the rare outcome of regret.

The above paragraph somewhat downplays the research that has been done, which has found very consistently low rates of regret. However, it is true that youth transition, specifically, has not had enough time to produce large-scale longitudinal studies yet. (This is, of course, very normal in medicine, which usually studies adults first because of fewer ethical issues, then offers adult treatments to kids with the condition, then eventually studies the kids.) At any rate, the criticism is that large-scale longitudinal studies have not been done, and this is true.

So, what sort of studies would be necessary, if we were to fully evalute detransition, holding it to the same standards as transition research?

Since detransitioners who experience regret are, by definition, a population of patients who have changed their minds once, it seems self-evidence that they could change their minds… again. And, aecdotally, retransition seems quite common among people who detransition, including those who experience regret. How common is retransition? To share a line of criticism with Reuters: No one knows, because it’s never been studied. However, any study of detransition ought to approach the topic with the possibility of retransition firmly in mind. A person who expresses regret after two years of transition may come to regret their decision to detransition two years after that! In focusing on a population who are prone to such regrets, no scientific treatment of the topic should take as a given that the detransition is the final word!

A proper longitudinal study that looks at detransition therefore would not end when detransition happened. It would have to allow for the possibility that the detransition is a phase, and explore whether, in the fullness of time, many who detransition would wind up being trans for the majority of their lives. Therefore, any such study would need to continue to follow up with people who detransition over several years. At a minimum, a subject should be followed up with for as many years after their detransition as it took for them to regret their transition, and only counted as a true detransitioned person after their detransition has persisted at least that long.

The bias that has clouded this issue is that any transition should be viewed with skepticism, but each detransition should be viewed as permanent and final, with no follow up required. This makes no sense. While it is certainly important to study detransition, longitudinal data must be acquired to ensure that detransition is actually happening. Such data should ensure that the detransitions are more permanent than the original transition, or the risk is that people who only briefly detransition will be captured along with people whose detransitions are more stable. This would give an incomplete and misleading picture of the phenomenon, but as so little research has been done thus far it should be easy for researchers in this area to ensure that future studies of detransition avoid this obvious pitfall.