Transition, transitioning back, de-transition and regret

This is an important and often upsetting topic. I want to brainstorm about it and get feedback about these ideas.  I am trying to talk about these ideas in a cooperative consultative way so I am entirely open to constructive criticism.

Mostly, I don’t hear or see people talking about it unless they are using it to take a political or clinical position against gender transition or to denigrate people who transition back. People will use quotes from articles like the one below to support their positions:

International research suggests that 3-18% of them come to regret switching gender.  http://www.guardian.co.uk/society/2004/jul/31/health.socialcare

I want to point out that 100-3 is 97% and 100-18 is 82%.  So 82-97% of people don’t regret surgery following their numbers.  The vast majority.  I’m still interested in those 3 -18% but don’t want to lose sight of the vast majority who are happier and their quality of life has improved.

I am interested primarily in determining if there are ways to identify people for whom surgical and perhaps hormonal transition are the wrong direction. I believe that medical and social transition is vital for some people and am not open to dismissing it as delusional.  At the same time,  if there are ways to identify people for whom a therapist or doctor should say  no, or not yet or have you thought about X?  Are there experiences that therapists misunderstand or mislabel or simply miss.  Essentially, can we do better?

The people who see it as politically or clinically wrong tend not to be that helpful on this front, but are often the only voices out there.  When a biased idea is the only game in town, it can be a significant problem for a community.  I have seen a couple of balanced blogs about this issue and will make reference to them as this goes along.  It also turns up in the news periodically when something terrible happens like Christine Daniels/Mike Penner’s suicide.

Of course, there are people who regret transition. While I do not mean to make light of this, I have to say there are people who regret having children, who regret not having children, who regret marrying the person they married, who regret the choice of college they attended, who regret that they did not attend college, who regret bariatric surgery—who regret very significant choices in life.  What was known about bariatric surgery or Lasik surgery at the time a person made the decision is quite different now and increasing numbers of people regret those decisions.

Often people who start hormonal transition and change their mind are thrown into the pile of regretters and detransitioners as well.  There are also people who would make a different decision now than they did last year, five years ago, ten years ago, etc.  That’s a different concept.  There are people who are fluid and move back and forth between genders.  If a person’s gender identity doesn’t fit the frame that some people may apply, it doesn’t make them people who are unhappy about their choices.  It is not a heterogenous group.

Not all of people who regret transition are truly people who made a wrong decision for them at the time they made it.  Sometimes people make the right decision at a particular time for all the right reasons and then ten years down the road, they are older, more experienced, more educated, or the world has changed and they would make another decision today.  A wise friend elaborated this concept for me recently and it’s something hadn’t applied in this context.  I regularly use this idea in therapy when people are critical of choices they made as children and as youth.  They are looking at those choices as though they had all the knowledge and wisdom they have developed over their lifetimes.  They were six, fifteen or nineteen, not forty or sixty yet they are judging their youthful experiences as if they should have known at six, fifteen or nineteen what they now know at forty or sixty.

To my knowledge, there is NO actual reputable research on regret or de-transitioning. I have seen some people pull out statistics out of context and use them as proof that GCS/SRS is an inappropriate intervention.  Available research gets distorted.  Similarly, people will often pull Renee Richards out as an example of a person who regrets transitioning.  As an avid tennis fan, I have watched, read and listened to everything I could find on Renee Richards for decades and think people have focused on statements she made at different times and statements taken out of context.

Dr. RICHARDS: Well, I guess that’s right. I mean, I’ve always been competitive, and I’ve always been unafraid of taking on new challenges. But it was a very difficult decision, and when people talk about, oh, well, Renee Richards has all these regrets, they only think that it’s the regrets about the sex change, and that’s really not what the regrets are about. The regrets are about that decision to try to take the battle to the courts to be allowed to play and then actually playing as a professional. http://http://www.npr.org/templates/story/story.php?storyId=7277665

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There are a number of explanations about regret and these are broad, sweeping sorts of statements that need more explanation. &nbsp; I’m going to focus on genital surgery–which has improved over the past decade.  It is also possible people who regretted the surgery in the past wouldn’t, if they had it today.

The point of surgery is to decrease gender dysphoria and improve or further consolidate gender identity.  It is not to fix anything else. Regretting transition and regretting the consequences of transition are two different things. In most change, there is some loss.  Whatever the status quo or homeostasis was before transition will be gone and people have to adjust, like getting married or moving in with someone, there will always be loss with change, even good change. Sometimes people cannot anticipate the losses or the degree to which the losses will burden them.

Off the top of my head, these are some reasons that people regret surgery or detransition.

1) People who expected that the surgery would change everything that was wrong in their life, only to discover that what it changed was what was between their legs.

2) It doesn’t make discrimination go away. It won’t fix their social life. It won’t make some people accept them as women or as men. (One’s parents are not likely to change their mind and accept a person as a son or daughter if their child changes their body.)

3) People who are having the surgery to keep a partner or spouse and not doing it for themselves.

4) People who did not like the aesthetics of the surgery. &nbsp;They were disappointed in how they look.

5) People lost function. &nbsp;Orgasm. Peeing was hard.  Remember that surgery has improved greatly over time.

6) People who had complications post operatively.  (By and large most people who did have post-op complications, still do not regret transitioning.)

7) People who lost family, friends, community.

8) People who lose partners. &nbsp;Partners say it is okay with them for a person to transition and then the partner discovers they didn’t know themselves well enough to honestly say that or the partner changes their mind.

9) People who do not realize that it can be difficult to find a partner.

10) People who didn’t really understand the outcome of the surgery. &nbsp;I find this one particularly disturbing because true informed consent mean they DO understand the outcomes of surgery.

11) The individual was not transgender.  There were mental health issues that were undiscovered or intentionally kept from whomever did the evaluation.  The assessor missed something or no evaluation was done.  The big one is body dysmorphic disorder. Another one is trauma co-occuring with other mental health issues. The trauma one is hard to talk about because a trauma history could be used against people inappropriately.  Any mental health issue can be, though.

Examples of trauma related issues might be dissociative disorders, where a male bodied person was multiply raped or molested as a child and the only way the person can make sense of this is that they must be a woman, where a female bodied person transitions to male in an effort to protect themselves against male violence. The latter two issues do not mean that the person will necessarily regret transitioning.  Transitioning may be the exact thing they need to do to make sense of their lives and to be able to move on and live. This would be more an issue where providing information and clarity about a person’s thought process is important.

12) The person did not know that non binary identities, for instance, genderqueer (as an umbrella term) was an option.  They thought they had to have the whole process.  Maybe when they had the surgery, there was no other choice other than the binary.

13) The person lost social status or privilege and struggles with that loss. There are privileges that no one should have and rights that we should all have.  When people transition, they lose privilege. Losing privilege is a significant experience.  Becoming a visible minority is a big deal.

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About gendertherapist

Psychotherapist in San Francisco. I am a gender specialist.
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