“I want to have my breast [implants] removed because of my osteoporosis, it’s very painful to have large, heavy breasts. But I can’t even get any help. I don’t want to spend $8,000... to have my breast [implants] removed... a lot of detransitioners are struggling getting insurance coverage for ‘reversal surgeries’. And to be honest, I want the public to know that, in certain cases, full detransition is impossible.”—A Massachusetts detransitioner

 

Currently, insurers in Massachusetts are legally required to cover hormones, surgeries, and other interventions that fall under “gender-affirming care."

This is required for MassHealth by administrative guidance from the Office of Medicaid and has been since 2014, and is required for private insurance by state and federal non-discrimination laws according to administrative guidance by the Division of Insurance.

However, treatments for those who want to “detransition”—those who realized they made a mistake, changed their mind, and want to halt or reverse their previous transition as much as possible for whatever reason—are not currently required to be covered. These individuals need care to cope with the effects of what they see as the previous harmful treatments, and this care should be covered as well.

 

Detransitioners and researchers report specific medical needs of detransitioners.

• A 2021 study found the most common medical need reported by detransitioners (49%) was for medical advice for “stopping/changing hormonal treatment,” followed by “help for complications related to surgeries or hormonal treatment” and “information and access to reversal surgeries/ procedures” (Vandenbussche, 2021). Detransitioners and researchers report specific medical needs of detransitioners.

• Another 2021 study into detransitioners’ reasons for detransitioning found 49% of them were concerned about the medical complications from their transitions (Littman, 2021).

• A 2023 study reported findings of “iatrogenic gender dysphoria associated with hormonal or surgical treatments” (MacKinnon et al., 2023).

 

Rates of complications and side effects for “gender-affirming” hormonal and surgical interventions are very high, leaving individuals needing further care. These side effects persist in people who change their mind and detransition.
Complications and side effects include:

• High incidence (some studies show 94%) of pelvic floor disruption and urinary symptoms (about 87%) including storage symptoms (69%), sexual dysfunction (53%), anorectal symptoms (46%), and flatal incontinence (40%) among females who use testosterone (da Silva et al., 2024).

• Significantly elevated health risks, including a 30% higher risk of stroke, 20% higher risk of myocardial infarction, and 220% higher risk of venous thromboembolism (van Zijverden et al., 2024, Bouck et al., 2023).

• Increase in risk for auto-immune diseases, including a 6-fold increase in the risk of multiple sclerosis (Pakpoor et al., 2016) among males who undergo cross-sex hormone treatments.

​

Detransition and its incidence, while still understudied, is now recognized as increasingly common.

• A 2022 study of young people using US military healthcare records found a 30% rate of discontinuation of hormones after 4 years (Roberts et al., 2022).

• A 2022 study of UK patient healthcare records found a 20% hormone discontinuation rate (Boyd et al., 2022).

• A 2023 meta-analysis reviewed the research and found rates of discontinuation of care/medical treatment, regret, and detransition of up to almost 30% (Expósito-Campos et al., 2023).

• Studies using other research methods, such as self-reported surveys, are likely to underreport detransition. Studies may be unreliable due to short follow-up time, loss of sample in subsequent follow-up, and use of an inappropriate measurement instrument (Cohn, 2023).

• Studies with short follow-up duration (e.g., 1-2 years, “the honeymoon period”) fail to capture detransition (Expósito-Campos et al., 2023) as detransitioners report an average of around 4 or 5 or even up to 10 years before detransition (Littman, 2021; Vandenbussche, 2021; Wiepjes et al., 2018).

• Many studies also show high loss to follow-up in later data collection waves (e.g. Hall et al., 2021 found 6.9% of the sample detransitioned, but an additional 21.7% disengaged).

• Studies based on surveys of clinicians suffer from the fact that most detransitioners likely do not report their detransition to their doctors (e.g. Littman, 2021 found only 24% of those in her sample did so).

 

Estimates of “desistance” (a person who has not undertaken any medical interventions to change sex traits discontinuing to identify with the opposite sex) can also shed light on detransition.

• A review of the 11 studies published through 2013 on desistance rates found that a majority (61- 88%) of gender dysphoric youth desist (Cantor, 2019).

• The Endocrine Society agrees that “the large majority (about 85%) of prepubertal children with a childhood diagnosis did not remain [gender dysphoric]/gender incongruent in adolescence.”

• More recent studies using data from the Netherlands and Germany similarly found high rates of desistance, around 65% (Rawee et al., 2024; Bachmann et al., 2024).

• Yet, there is no way to know which minors will desist and which will persist with gender dysphoria, as “we cannot predict the psychosexual outcome for any specific child” (Hembree et al., 2017).

​

Detransition is likely to be increasingly common moving forward.

• Youth presenting with gender dysphoria have increased sharply in recent years, up 20-fold according to some studies (Twenge et al., 2024; Zucker, 2017; Wiepjes et al., 2018; Delahunt et al., 2018), and their characteristics have changed significantly from past cohorts in age, sex, and mental health comorbidities (Aitken et al., 2015; Kaltiala-Heino et al., 2015; Littman, 2017).

• Medical standards have loosened from thorough evaluations and safeguards to informed consent in the US (Irwig, 2022; Littman, 2021). Reuters contacted 18 US gender clinics and found zero that performed “anything like the months-long assessments [the protocol originators] adopted”. Some gender clinics, including Planned Parenthood, dispense opposite-sex hormones like testosterone after a single 30-minute visit, without any requirement for a letter from a mental health professional. Boston’s flagship clinic also significantly cut its assessment time to two hours and abandoned plans to collect long-term follow-up data.

• Meanwhile, systematic reviews of the evidence have found the evidence base for pediatric gender medicine insufficient, leading other countries’ health authorities to roll back their practices because of the risk of iatrogenic harm and detransition (see e.g. Finland, Sweden, Denmark, Germany, and the UK).

• The current evidence for efficacy and/or safety of different aspects of medical intervention has been found in evidence reviews to be of ‘low’ and ‘very low’ quality or certainty (Brignardello- Petersen & Wiercioch, 2022; Hembree et al., 2017; National Institute for Health and Care Excellence [NICE], 2020a, 2020b), ‘insufficient’ (Haupt et al., 2020, p. 2), and ‘insufficient and inconclusive’ (Swedish National Board of Health & Welfare, 2022, p. 3). Low/very low quality (or certainty) means ‘the true effect may be/is likely to be substantially different from the estimate of the effect’ (Balshem et al., 2011, Table 2; Cohn, 2023).

• Similarly, individual experts in the US and internationally, including the founder of the first US gender clinic, the former director of transgender medical societies USPATH and WPATH, and the clinicians who pioneered these protocols, are calling for increased caution.

• Other experts, including those who underwent such treatments themselves before detransitioning, state that dysphoria can arise from “difficulty reconciling being gay” and worried that there would be “no gay people left at the rate [the gender clinic] was going."

• Research irregularities have plagued the process that produced the basis of US practice in this area. Researchers have failed to report pre-registered variables included in the original study protocol (publishing data for only 25% of the intended variables). Other researchers have held back publicly-funded research from publication for political reasons. Political appointees have pushed to lower the age limits in medical guidelines for political reasons over the objections of researchers and clinicians. WPATH itself commissioned systematic reviews of the evidence, but then interfered with and prevented publication of many of them.

• The American Academy of Pediatrics has avoided addressing the proposals of its members to perform a systematic review of the evidence in advance of updating its recommendations for treatment of gender dysphoria, and has even resorted to suppressing discussion of such proposals. In the UK, many clinics serving adults refused to participate in an NHS review of the evidence behind its medical protocols by withholding data on adult outcomes so that pediatric practices could be evaluated. Studies that have attempted to examine the changing character of the cohorts presenting with gender dysphoria have faced political opposition, resulting in attempts at suppression of research and “corrections” despite acknowledgement by journal publishers that no false information was ever published. Even in the first study that originated the Dutch protocol, the scales used to measure dysphoria were inexplicably switched mid-study, suggesting that the measured reduction in dysphoria following hormonal intervention was simply an artifact of the measures used.