How To Prevent Detransition In Five Simple Steps (Part 1)

When detransition is not being exploited to deny trans existence, its discussion inevitably flows to its prevention. So let's talk about it.

What do you think of when you hear ‘detransitioner’?

The Right, likely. Grift and pantomime for clout, such as that of a certain doll or the world’s most Korean and Christian man. Coercion; forced detransition.

What do you think of, say, when you consider willing and genuine detransition? If you could look at Chloe Cole past her rhetoric, her ideological allegiance, her utter lack of compassion for those outside of it—what do you see?

Is it regret? Self-hatred? Pity, maybe? A correction of a shameful (stupid, even) mistake? A bizarre decision you struggle to imagine yourself—or anyone—making? A web of uncanny, discomfiting choices, written in flesh?

Maybe, if you’re trans yourself, you might also see your own fears. Not necessarily forced detransition—that wouldn’t make you like her. No, maybe you look at your past doubts and wonder if you could’ve been her, under different circumstances. Or maybe, it’s merely the thought of something that brought you great joy—your transition, the alteration of your body, your freedom—being broken, hated, turned inside-out. Like a shredded garment.

Perhaps you’re just unnerved to see it undone.

Detransition, in the eyes of the masses, is an undoing. That implies discontent, and since this discontent is over transition—something not only voluntary but often hard-won—it also implies that transition itself was a mistake. Seemingly, a preventable one.

And so there is only one conclusion: detransitioners must be prevented. I must be prevented. I am a stain on the medical, social, and queer establishments that have created me, whether you look at it from the Right or the Left. The ‘reverse’ dysphoria I feel is, by all accounts, utterly preventable. Naturally, then, we must attempt to prevent it.

The belief about detransitioners is that they need medical gatekeeping to prevent them from having transitioned—a more robust system of checks that would’ve helped them realise they were never trans. Or perhaps, that they need the topic of transness altogether excised from the zeitgeist. For instance, a known detrans grifter Maia Poet tweeted she is retrospectively grateful to her parents for having hyper-surveilled her after she came out as trans. She still socially transitioned and continued to identify as trans for twelve years afterwards, so it can’t have helped in the way she wanted, but she’s still grateful for, uh. Something. Whatever it is that was accomplished, which, it seems, was not a lot.

Incidentally here (‘this man’) Maia is misgendering a detrans person. Whether Maia simply cannot be bothered to read or she considers gender a cudgel to wield, is anyone’s guess.

Well, no one was expecting cutting social commentary or lucid solutions from Ms. Israeli Sellout Poet, so never mind her. Let us put the grift aside.

That is the knee-jerk response, isn’t it? Make fun of the loud and stupid and obviously wrong ones?

That has its place, but let me assure you, detransitioners exist outside of TV and Twitter. Most are disinterested in sharing a pedestal with Maia or Chloe, regardless of what they believe. Let us even put myself aside as a singular subject. Let us examine what is normally either cynically weaponised by the Right, or else timidly swept under the rug. Because if you allow the idea that willing detransitioners truly exist—and they do, I assure you; if I turned my screen off, I’d be looking at one—then you must also allow the possibility of, well…

Transition regret.

Allow yourself compassion for a detransitioner—a random, regular person—that is staring at rock bottom and finding that their transition took them there. If I were them, I’d surely ask what could’ve been done to prevent that. What could’ve been done so that I never existed such as I am.

A very rock-bottom kind of question, I know. But the only way out is through.

So what is the most effective way to prevent detransition? What has been done to that end? How is transition handled, and what does that mean for detransition?

1. The Doctor Will See You Now

Over the past few months, I’ve spent a good chunk of my god-given procrastination allowance on scrolling online detrans communities that explicitly ban transphobia. You may call that biased, but I’ve found that detrans spaces which make no such explicit attempts are swiftly overrun by Gender Criticals. Not even detrans ones; the topic is hot-button and embarrassing enough to encourage unmitigated manipulation of the audience. It’s a bit like browsing spaces for discussion of cosmetic surgery. When an issue is too unseemly to be spoken of in polite society, the snake oil salesman can peddle whatever the hell he wants. By contrast, trans-positive detrans spaces tend to be smaller, less fraught, and more diverse in issues discussed and feelings expressed.

(To be clear, I will not quote anyone here. While their accounts were told neither in privacy nor in confidence, online messages in small communities carry a presumption of anonymity and non-disclosure, which I intend to maintain.)

Indeed, a sizeable number of even explicitly trans-positive detransitioners express some desire for a prior intervention. A therapist or psychiatrist that would’ve entertained alternatives, or questioned why their patient wanted to transition. It’s not uncommon, when queried by people unsure of surgery or HRT, for such detransitioners to advise waiting until total certainty is achieved. Unlike GCs, though, they often lament the lack of medical professionals that will neither attempt to do conversion therapy nor consider detransition an untouchable topic.

(As I’ve alluded to before, it is difficult enough in many places to find a therapist that even knows Trans 101. ‘Advanced stuff,’ like detransition, is beyond contemplation. It’s not that skilled-enough professionals don’t exist, but that there is no resource for finding them.)

There is a common denominator among such detrans people. They are often—though not always—young transitioners, having done so either in high school or shortly after. They’re usually from countries that have an informed consent model of transition care. Under this model, a doctor does not diagnose with gender dysphoria—or indeed anything at all—but merely provides assistance in alteration of sexual characteristics. That’s the idea, anyway; reality varies and often does not quite match that ideal, but by and large, the doctor’s job is then mainly to explain what the patient is signing up for. What intervention or investigation exists, if any, is minimal or perfunctory.

From a purely technical perspective, these detransitioners are asking for something that wasn’t this doctor’s job to do. But it is a fairly heartless argument to make. “Well, if your dysphoria wasn’t actually dysphoria, you should’ve gone to a therapist instead!”—rather silly, isn’t it? Easily refuted with: “If I knew then what was wrong with me, I wouldn’t be here.” And anyway, just because that is how the system works does not necessarily mean that is how it should work.

There is a wrinkle here, though. Informed consent may be the norm in, say, the USA—for now, anyway—but it is not worldwide. In most places you ought to receive a gender dysphoria (or transsexualism, if the updated DSM is yet to be adopted) diagnosis before access to medical transition is permitted. So how does the diagnostic model hold up when it comes to detransition?

2. Hoops and Hoops and Hoops

As I mentioned in my first essay, I am a young-ish transitioner from a country that very much does not practice informed consent. I started transitioning medically at 19, which is young for an adult transitioner but post-pubertal nonetheless. However, transitioning in adolescence would’ve been functionally impossible for me. Even if my parents were supportive and I somehow found a doctor to prescribe me blockers/hormones—the latter of which is monumentally unlikely, as it was illegal—it would still basically mean social death. So, in effect, I transitioned as young as was humanly possible.

The procedure to acquire legal access to hormone replacement therapy was pretty antiquated during my time. Internment in a psychiatric ward, a prior real-life test, the nine yards. (For the unaware, a ‘real-life test’ is a requirement to have lived as your desired gender for several years prior to any medical transition.) I was diagnosed rather thoroughly both for presence of gender dysphoria and an absence of alternative explanations, such as schizophrenia, BPD, autism, and, put colloquially, mummy or daddy issues—having a ‘broken family’ was a strike against the transsexualism diagnosis. Anxiety or depression was also a no-no. Under this particular model, literally any other condition is a contradiction to transsexualism. You are to be deeply distressed about your genitals and assigned gender stereotype, and absolutely nothing else at all.

Because yes, naturally the pathologisation of gender entails reliance on stereotype and archetype. What makes a man or a woman, after all? When the goal is to have transsexualism as the last possible resort, it’s not enough to merely wish for a different set of genitals or breasts or to describe oneself as a man or woman—gender must be dissected. And that dissection, inevitably, leads to ‘bitches be crazy.’ Man like car, woman like kitchen. Man fucks woman, subject verb object. Et cetera.

Of course, declaring any ‘irregular’ thoughts about gender to be the sole purview of a perfect and utterly healthy citizen, is just cruel. Gender conformity is a violently enforced social protocol. Therefore people that run up against it—trans or not—are highly likely to be made maladjusted. To deny them care on that basis alone is inhumane. If you are found too ‘wrong’ to be transsexual, you will then be told to go treat whatever is wrong with you—your symptom, not your cause. Gender will not be entertained.

Now, that the psychiatric treatment of gender dysphoria is inhumane, dated, and deliberately difficult and arcane, is not news. It is designed to prevent transition first and foremost and also secondly and thirdly, and only lastly to enable it. Some young people in the US may feel enough distance from such treatment as to not understand what it truly entails. To some it is buried history. Most, though, even when unaware of what such procedures are or were, understand they are/were bad. Nebulously bad or specifically bad (mostly the former), but bad nonetheless.

So here’s the first question: does this work? Does this ensure those that truly need transition can do it, and none that don’t, can’t?

I can obviously just point to myself and be done with it, but one person can be anything from an anomaly to a fun fact, just not a tendency. So let’s work through this.

Obviously such procedures do not prevent all transition. Do they reduce the number of transitioners? It is impossible to count for sure, but certainly such procedures generally exist in societies that are not amenable to trans people, and therefore some plainly do not survive long enough to try. It does not matter whether they would’ve eventually detransitioned or not; severe psychiatric procedure does not coexist with widely available, comprehensive therapy. It does not matter because no one will ever find out.

What of those that do survive, though? One extreme conclusion to make is, if you can survive without something, you do not need it. I’m not particularly interested in a survival-only existence as I do not live in a cave and hunt mammoth. (And even prehistoric people made jewellery and painted cave walls with art, so clearly they cared about things beyond sheer necessity, too.) So that aside, how do the lives of those that actually engage with the procedure pan out?

Naturally, one of the results of such procedures is the delaying of access. Some things, like hormones, you can get on the sly, but surgeries you simply cannot receive without either the doctor’s permission or a great—and I do mean great—deal of money. The procedure is designed to take several years before any access can be granted at all, assuming you go through it swiftly and successfully. The more stringent the procedure, the fewer doctors can do it; a degree of waiting is involved even before it begins. In my country’s case in particular, transition is fully paid for by the patient—there is neither state nor insurance coverage, at all, for anything. Even doctor visits in government-sponsored institutions are de facto paid because you need to grease some palms for someone to bother. No, there’s no suing the doctor that won’t treat you without the agreed-upon bribe; you can’t afford it and you won’t win. Therefore there’s also risk of further depression and suicide as great financial burden falls on people that, as a rule, have below-average funds, poor employability, and no family support. But assuming you soldier through, the overall result is a transition timeline that spans about a decade or two. The bulk of social transition will happen in the first five years, whereas surgical interventions, due to cost and laborious approval processes, fall on the last years.

This can be seen as a boon to detransitioners. Delay in access means more time to change your mind, hypothetically. The fact that surgeries are generally impossible until many years in transition means—hypothetically—there’s less chance you’ll end up with changes that cannot be reversed or amended without further surgical intervention, or at all.

As I’ve mentioned in my previous essay, I do believe such calculus to be heavily hindsight-skewed, favouring present lack of regret and dysphoria over past misery and the humiliation of the psychiatric grinder. It’s a little like getting hit with a hammer to the head and then falling madly in love with the doctor treating you. Sure, in hindsight it softens the blow of the head trauma, but you still wouldn’t recommend anyone walk around with a sticker on their back saying ‘Hit Me.’

I can understand, however, how a detrans person who never went through any of that, now deep in dysphoria blues, could find such an argument empty air. Infuriating, even. Perhaps they’d even say they’d gladly be a bit miserable for a couple years so long as they didn’t have to deal with all this now. Grass, greener, et cetera. So let us say this really is a possible advantage of the procedure—

If it actually makes you less likely to go through with transition once you begin the procedure and uncover doubts creeping in.

Does it?

3. A Patient Is A Person

There’s an elephant in the room, though not many notice it. To a cis person it may well be invisible. You might’ve spotted it when I first flippantly described the procedure I went through and mentioned a real-life test. Most people cannot be reliably and consistently integrated into society as the ‘opposite’ gender until they have some kind of physical intervention. Especially not in places that are highly transphobic, where being visibly trans is either not an option or a very dangerous one. But clearly, people do pass this ‘real-life test’ somehow. Is it really only the most androgynous among us that are allowed to transition under such procedure?

Well, no. Although doctors will be more charitable if you already seem like a ‘lost cause’ to your birth sex. Nothing wasted and so on. But like I said, you can always get hormones on the sly. It’s not even hard or prohibitively expensive.

That’s not the only issue with the procedure. How do you reconcile putting all this time and money into a (marginalised) diagnosis with (often precarious) employment? Why are trans patients supposed to have a singular script for their lives and genders, whereas cis people are permitted variance?

In the end, how do you prove to someone else that transition is right for you? Is it really all the silly quizzes and the identically heart-wrenching stories? Eh. Not exactly. In my experience, the doctor makes half their mind up the moment they look at you. And most every patient seems like a regular cis person—a fertile woman, a boy that can be made a man—and so the knee-jerk response is to help you stay that way, no matter how you feel. So there are two options: memorise a rote script of suffering and hope for the best, or, much more reliably and painlessly—

Already look like a transsexual.

Put plainly, the current diagnostic model of transition only works when you’re already transitioning. To access transition you must’ve already done so. Yes, we all simply pretend. Yes, people just memorise whether they’re supposed to like cars or kitchens and how they should describe their sex lives. Of course they do. People seeking transition are human.

You can wag your finger however much you want and insist that people must follow protocol, and whatever happens as a result of disobedience is their own damn fault. The empirical fact is, protocol as written is un-follow-able. Because it is un-follow-able, no one actually follows it.

The result of a system whose first and foremost purpose is to make as few people transition as possible, is very simple: everyone lies. No one trusts doctors. No one in their right mind would go to a doctor that controls their legal gender marker based on the patient’s tales of masturbation, and then bare their true gender feelings with an expectation of help. Even the doctors themselves do not care how you really feel or whether you’re lying. They know the system is faulty, they know none of this is human or nice, but they also don’t understand why anyone would transition and they don’t care to. They have a hundred more patients, a thousand more protocols that are also neither human nor nice. This is psychiatry, and you are an annoying and rare brand of crazy, one that’s both utterly perverse and—they know—not actually crazy, not hallucinating or threatening suicide (and if you do: you can’t, remember?). What you’re doing is wasting a bed and their time. So all they want is their bribe, maybe a dissertation subject, and for you to cooperate and be gone.

What actually decides access to transition? A little bit of luck, a little bit of social acceptance in one’s immediate social circles, but chief among all: money.

If we must prevent the possibility of detransition at all cost, surely financial disincentive still works? Not the way you’d want it to. The only thing cost barriers ensure is that the rich can do whatever they want on a whim, and the poor can’t have even that which they desperately need. That is the only social balance money can buy.

And what decides eventual detransition?

The truth is, at least for me, it wasn’t regret. I’ve lived a long while in trans circles shaped by such transmedicalism. And if I’ve learned one thing, it’s this:

Transition regret was everywhere.

It is not at all unique to detransitioners. Certainly wasn’t in my circles. Many trans people who were also my contemporaries and fellow countrypersons had something or other they regretted about their transition. Some had even found the whole process extremely traumatic. They regretted not allowing themselves any femininity/masculinity that ‘contravened’ their desired gender. They got haircuts, clothes, friends, surgeries—anything related to gender, which is everything—only and solely because of the need to transition under very strict guidelines. Sometimes consciously, sometimes not. We lie to the doctors, yes, but that does not mean we are untouched by the transition procedure at our heart. The procedure is long and complex, and thus at a certain point, it occupies a lot of your attention and time. You live and breathe the sex questionnaires and psych visits whether you want to or not. And, as I’ve established, no one in the whole hospital cares how you truly feel about your gender—so for a while, you may stop caring too. It’s a matter of survival. Not just in the sense of access to transition, but in the very banal calculus of things that will and won’t get you beat up in an alley. At some point it’s only human to mentally check out.

In other words, everyone was fucking miserable. Trans, detrans—everyone.

People transition because they want to. Because everyone wishes to be an architect of their own fate and body, insofar as they can, and for some that involves choosing which way their body grows and ages. How it occupies the mould of sex. And when barriers are put between you and your agency, what follows is not obedience. You are human; you are not an algorithmic machine; you do not simply obey, you choose. So what do most people choose when they want something very badly and are told they cannot have it? They resist, of course. Resist, lie, scheme. And resistance to stringent protocol takes a lot out of you.

If doubt starts whispering in your head and you’re not listening, will you even hear it?

Put plainly, there’s no space for gender feelings in survival mode. What the diagnostic procedure causes is precisely that. It does not matter whether one’s need to transition is caused by some sort of True Transsexualism or trauma or misogyny or self-delusion or a secret millionth thing. You want it, and there’s no resource, no space, and no help for you to dissect that need. No time, either, because everything costs years—be it in money, in waiting, or your own life. You have an acute need and a difficult path to it. That is all.

And when all is said and done, and now you want to detransition? You’ve spent years to transition in the first place. You’ve invested great effort and great money, even if you’re not yet ‘done.’ You’ve likely lost family members and friends. Sunk cost is a hell of a weight, and sunk cost is precisely what the diagnostic model—a prevention model—engineers in spades.

4. A Dream of Utopia

So the informed consent model has no oversight, and the diagnostic model is a horrible grinder. Informed consent seems to be the patented harm reduction choice of the two. But surely those are not the only things that can exist? Surely we can dream of more than just ‘less harm’? Can there not be some sort of prior screening by an actually humane doctor who understands both trans and detrans needs? No quizzes about masturbation or kitchens or cars or whether you demanded to be called ‘boy’ or ‘girl’ at age four—just a robust way to determine whether you actually have gender dysphoria or not?

Let us say it is possible. When detrans people ask for qualified, humane, non-transphobic aid in helping them through their feelings on sex/gender, they are not asking for the impossible. Their need is one that must be answered in a just and caring world; it is already being answered for trans people, so why should the detrans be any different? And from there, you might think, it follows that it’s possible to attempt a system whose aim is some reasonably brief and minimally invasive pre-screening, which would filter out would-be detransitioners and enable trans people to pursue their transitions.

It is possible to attempt that. But.

All systems of restriction and access have a problem: there’s a power dynamic at play. Transition is often a pretty acute need. Doctors can make mistakes, they’re only human. Who is to decide what is real gender dysphoria? What if the doctors are not so humane? What if they enjoy holding power more than they enjoy helping? ‘Just don’t hire them’ isn’t really an answer—if we knew how ‘not to hire bad people,’ we’d have already colonised Pluto.

That doesn’t mean no system of restriction has its place. Access to weapons has similar problems, but most people would agree it’s probably not right for them to know nuclear codes anyway. Obviously no one worth listening to would compare detransition to guns or nukes, but let’s say, for the sake of the argument, that the possibility of detransition is so utterly undesirable that, if a prevention system could exist, it must.

The question remains: what makes gender dysphoria real?

The answer is very simple. Ultimately, it will always only be real because you said so. Because the patient said so—not the doctor.

If you’re a medical professional, you know how much of your diagnostic work relies on patient testimony. How you must at times cajole them into being honest, or to decode what exactly ‘bubbling pain in the liver’ means. Those unfamiliar with the medical world often imagine there’s always some kind of screening that can determine with certainty if the patient is lying or misguided or unsure. And yes, even if John insists he never put that Christmas ornament up his arse, the X-Ray will show it one way or another. But in many cases, it’s not that simple, and patient testimony is crucial.

When it comes to psychology and psychiatry, this issue could not be more acute. Often there is nothing else to go on at all. That doesn’t mean therapists are just useless soundboxes—but neither are there Top 10 Signs My Patient Is Actually A Narcissist. Nor are there actually body language experts that will totally tell you you’re being delusional; peddlers of simple and exact solutions are, as a rule, charlatans.

In short, therapists and psychiatrists are not mind readers. They are only analysing what you are saying about your own mind, and what you’re doing about it. They can aid you in interpreting yourself, but at the end of the day, you’re still the one doing it.

And here’s the kicker: no single issue faced by detransitioners is something trans people do not experience. Some detrans people first transition as a form of self-harm after sexual assault; but childhood sexual trauma is common among trans people who are happy in their transitions, too. Many detrans women felt pushed out of their gender by internalised misogyny and the impossibility of envisioning happy lives as women; but all those that are brought up or grow up as girls experience misogyny, including trans men and trans women. Detrans people often cite only wanting to transition after they learn of the possibility of transition and not from early childhood, as if that is evidence—but many trans people do not seek transition until they learn of its existence, too.

Trans people doubt their transitions all the time. Feel unhappy with their transitions, at least sometimes. And they self-harm via detransition too—a lot. The idea that none of this happens, or only happens very rarely, is a fiction recited for the sake of self-defence and attaining civil rights in a hostile world. Spending any time in trans spaces will tell you the truth is much more nuanced. And even so, even still, only some of those people detransition. And only some of those do so completely of their own free will, and not out of despair or a successful right-wing pipeline.

For every seemingly telltale sign of future detransition, there are numerous counterexamples. In fact a trans person can have all those signs at once, and nonetheless remain trans. Diagnostic criteria for a condition requires a list of symptoms, and if no number of those can be definitive? That means there can be no diagnosis. No (medical) condition.

In other words, resources, attention, and qualified aid can all accommodate detrans people exactly as it does trans people. Procedure cannot. Just like it can’t satisfactorily accommodate trans people. It is a dead end to treat the matter of gender as if it is a disorder, an ailment of the individual, rather than an exercise of agency against a society which enforces sex/gender.

Additionally, I have so far spoken in extremes. Real and not-real trans people; detransitioners that utterly regret their transition and wish it never happened. It was necessary for the argument. But many detransitioners do not have such black-and-white feelings about their past. Some are nonbinary and unhappy with either ‘man’ or ‘woman’; some do not maintain that their gender dysphoria wasn’t actually real; some even reject the label ‘detrans’ on principle, even though they have verifiably detransitioned. I have not mentioned any such case because I wished to argue that even the most ‘textbook,’ most acutely regretful case of detransition has little to gain and much to lose in a gatekeeping-first transition system. However, I must also point out that the ‘textbook case’ is the only case that can envision any gain at all. It isn’t real, but it’s a lovely mirage. To the rest of us, there isn’t even that.

5. I Have Bad News—Or Do I?

Yes, what I am saying is that detransition is inevitable. I’m saying its negatives can be curtailed by therapeutic and medical care that accommodates for detrans people—as much is true for trans people—but, regardless of how preventable detransition may seem, there is no way to simply solve it. Detransition can only be vanished by going back in time and making medicine freeze at the turn of the twentieth century, before such things as exogenous hormones were invented. Even a full ban on transition would be just a costly inconvenience, but ultimately not a magic bullet. People do banned things because they want to all the damn time. Oh, and I guess we’d also have to sterilise every single female horse.

So does that mean detransitioners are necessary collateral damage?

Only if you think detransition is inherently, inevitably, invariably undesirable and bad.

When you discover you want to detransition, it can be hard to accept for a myriad of reasons. Sunk cost, fear of ostracisation, shame, or even because you have no idea what detransition can look like and you don’t know what to do. And then there’s dysphoria and dealing with the wider society’s disgust and I-told-you-so’s. Some amount of what one might call a ‘bad time’ is unavoidable.

But why? What makes wanting to detransition—not resigning to it; wanting it—bad? What makes it socially reviled and pitiable? What makes going through it feel so difficult? How is the shame of detransition engineered—and what for?

See you in Part 2.