“regret rates” are not the sole measure of outcomes

I’ve seen the statement made many times that “the rate of regret for gender transition is very low”, generally quoted between 1 -3 % or so. This is used as evidence that we should not be so concerned with the problem of detransition. People identifying with a certain gender and wanting to transition is enough proof that transition is right for them, and therefore there is no need for any in-depth screening.If someone identifies with a certain gender and wants to transition then clearly that is the right thing, as evidenced by low regret rates. Also, there is no reason to look at different ways to deal with dysphoria, because we have this great treatment that already works.

However, there are several problems with this which are:

  • The reported measures of regret rates don’t actually measure regret rates.
  • Regret rates are not the sole measure of good / bad outcomes.
  • The demographics of transitioners today are not the same as those in the past.
  • Gender transition improving people’s quality of life, doesn’t mean there aren’t less invasive ways to get the same improvement.

The reported measures of regret rates don’t actually measure regret rates

An example of a study that shows transgender regret rates is here. This study shows a “regret rate” of 2.2%. However what are they actually measuring? What they are actually measuring is the rate of “legal detransition”. They measure what percentage of people who undergo a legal name and gender change then undergo a second legal name and gender change. They don’t measure people who have regrets but don’t detransition legally, or don’t detransition at all. It is also possible to detransition and not regret the original transition.

Regret rates are not the sole measure of good / bad outcomes

Indeed, regret is an important component of good outcomes. Regret is part of a poor outcome, and satisfaction is part of a good outcome. However, it is not the totality of good outcomes. Good outcomes include social adjustment, economic well-being, mental health, and other measures of health. There hasn’t been any research that I know of on long-term outcomes of gender transition (20+ years), partly because most long-term transitioners are lost to follow up.

Because I transitioned 20 years ago, I know many MTF transitioners that were in my cohort or even 5-10 years before. What I see is concerning. I am the only one out of them that has detransitioned, and most of them would not say that they regret their transition and continue to go by feminine pronouns and feminine names. In terms of life outcomes, I would say economically they are mostly doing well. However, socially they are struggling. Most of them are alone. I see a lot of social anxiety, people being unwilling to leave the house. In addition, they still continue to deal with dysphoria and have emotional difficulties.

This is not a good thing, some people would say these difficulties are due to oppression and by reducing this oppression it would reduce or eliminate these difficulties. I definitely believe that oppression is a large factor in some of the things that are awful about being transgender. I oppose those that intend to make the world worse for trans people. However, I do not think it is the sole source of these difficulties.

The demographics of transitioners today are not the same as in the past

These studies of regret rates are often used as reasons that we don’t need to be too concerned about people with cross-gender identities regretting transition. This is combined with the idea that people have a fixed and essential gender identity and aren’t wrong about it. So, if someone identifies as transgender, then they are transgender, and that can’t be changed.

In particular we should be concerned about two groups, adolescent / young adult FTM transitioners and transitioning children. Historically, the ratio of MTF : FTM transitioners was around 3:1. A recent study showed that FTM transitioners are now exceeding MTF transitioners, a large change. Also, there is a recent
showing that many of these are young women dealing with typical adolescent identity issues as seen here. I wrote about this in more detail here There are already more and more female detransitioners and people who take testosterone for a while and then stop. The trouble is we don’t know how to distinguish between the people that are going to be happy with their transitions in the long term and those who won’t. This is a topic that is in great need of further study, and we should proceed with caution until we have it, to make sure we aren’t giving a permanent solution to a temporary problem.

We should also be concerned about transitioning children, as historically 75-90% of children with gender identity issues desisted at puberty. I believe that children that have gender dysphoria that persists into adolescence should be given access to transgender services. I don’t think this point is particularly controversial in the field. However, desistance rates have been declining. This has been celebrated as vindication for the use of puberty blockers, but it seems to me that this is evidence that the experience of puberty itself leads to desistance, and therefore it is important to have these children experience at least some of their natal puberty in order to determine whether they will desist or not.

The wrinkle in all of this is that if someone is to undergo gender transition it is better for them to experience as little of their natal puberty as possible, both for the emotional effects of their puberty, and better physical results from transition. This is one of the things that makes it tricky. I think it would be best to try to figure out how much of the natal puberty they need to experience to determine if they would desist or persist, I don’t know what the answer to this question is.

Also there are those that claim desistance is equivalent to persistence as long as they are well-adjusted. I disagree with this strongly, even if they become well-adjusted trans people. If they could have been well adjusted without this treatment as well that is still a loss. Infertility and a lifetime of dependence on hormone treatment should not be treated lightly. Of course if the choice is between being a well-adjusted trans person and non well-adjusted cis person, we should prefer the well-adjusted trans person.

Gender transition improving people’s quality of life, doesn’t mean there aren’t less invasive ways to get the same improvement.

The research shows that gender transition improves the quality of life of some transitioners, and I do not advocate for eliminating it, or denying access to those who need it. However, this does not mean we shouldn’t continue to look for better ways to work on these issues at the same time. Even though transition does indeed improve people’s quality of life, this is still a community under significant distress. Attempts to help people work on these issues without transition should not be denounced as “conversion therapy”. It is not evil to want people to find better ways to deal with their issues.