Detransitioning Guidelines

Standards of Care for the Health of those Detransitioning from the Transgender Narrative

1. Purpose

These guidelines are written for clinicians who wish to provide support for those individuals who wish to stop attempts to transition to the opposite gender.  These guidelines recognize that much, if not all, of transgender care is based on a conflation of gender and biology, that biologic sex cannot be changed regardless of hormones and surgery, and that attempts at biologic reassignment of gender identity is fallacious and harmful.  For those individuals who have taken steps along the gender reassignment path and have realized that such efforts have not given them the biologic body they believed would solve their dysphoria, and who have recognized that their underlying dysphoria was not with their biologic body nor identified gender in the first place, it is a daunting admission to reject continued participation in the transgender narrative.  For such individuals, who were promised 'lasting personal comfort with their gendered selves,' rejecting this narrative means not only refusing further transitioning medical intervention, which cannot be reversed, it means grieving the biologic body they cannot retrieve and facing afresh the primary dysphoria which was interpreted as gender identity.  It also means, for most, a loss of community, often with severe backlash from those who remain committed to the transgender narrative.

Detransitioning is premised unequivocably in the tenets that there is no such condition as 'being born in the wrong body,' [WPATH, Standards of Care, 7th ver] that gender and biologic sex are separate entities, that interventions performed to change one's biologic sex to match one's self-identified gender non-conformity are not based in medical science, and are misguided and destructive.

Detransitioning care addresses these facets:

a. stopping hormone treatment and managing, when it has occurred and if possible, damage that has entailed

b. not advocating further surgery, even attempts to reverse previous transgendering surgical interventions, unless there is a medical indication, such as, but not limited to, physical dysfunction or recurrent infections; detransitioning does not advocate attempting to recreate the original biologic body that was altered, and sees surgical interventions aimed at correcting identity as furthering the harm that has already been done

c.  providing psychological support for the repercussions of the transitioning experience, the decision to identify with one's biologic body regardless of gender identity, and the need to address the prary issue which was previously translated as one of gender dysphoria.

Guidelines

These guidelines are principled in evidence-based medicine.  As transgender interventions have not been based in this principle but, rather, in narrative, and the consistency and longevity of transgender interventions at present preclude analysis of harm (indeed, there have been no randomized controlled clinic trials for safety and efficacy of hormone interventions, WPATH p 44, 47), it remains for those involved in offering detransitioning treatment to be observant and to treat individually each person who comes forward for care, and to do so with the intention of first doing no harm.  This includes not perpetuating beliefs or interventions based in the beliefs of transgenderism, of not locating a diagnosis of dysphoria in the physical body, of not promoting mutilation of the physical body to remedy psychologic distress, and not redirecting and thereby dismissing psychologic distress as being 'born in the wrong body'.

In giving care, there are three views to consider:

1.  the health of the individual at baseline, before undergoing transgender interventions

2.  the health of the individual concurrent with undergoing transgender interventions

3.  the health of the individual as a consequence of undergoing transgender interventions

It remains for each individual health care provider to meet each individual who is detransitioning and address individual issues as identified, with evidence-based medicine and tremendous empathy.


Addendum:

Below are a list of the risks and Complications as they are known, or at least published, in the WPATH Standards of Care; it must be noted that there simply has not been sufficient time nor rigour of follow-up to document likely risks such as the develop of hormone-related cancers.

Risks of medications  (from the WPATH SoC, table 2 page 40):

• likely and possible increased risk for feminizing hormones of venous thromboembolic disease, gallstones, elevated liver enzymes, weight gain, hypertriglyceridemia, cardiovascular disease, hypertension, type 2 diabetes, prolactinemia
• likely and possible increased risk for masculinizing hormones of polycythemia, weight gain, acne, balding, sleep apnea, elevated liver enzymes, hyperlipidemia, destabilization of certain psychiatric disorders, cardiovascular disease, hypertension, type 2 diabetes

Risks of surgical complications (from the WPATH SoC, page 62):

• breast augmentation: scars, infection
• breast removal:  scars, nipple necrosis
• MtF genital: necrosis of 'labia' or 'vagina', fistulas between bladder or bowel and 'vagina', urethral stenosis, anorgasmia
• FtM genital:  urinary tract stenosis or fistulas, necrosis of 'neophallus'
• aesthetic (eg liposuction, lipofilling, implants, voice modification, rhinoplasty, blepharoplasty): Not mentioned by the WPATH SoC are that all surgeries have the risks of infections and scarring, as well as the unlikely but possible catastrophic events that can occur with general anesthesia and surgery (eg excessive bleeding, blood clots, arrhythmias, death)