Detransition and regret

How common is detransition, why does it happen, and why is it so poorly measured?

“Detransition” is not a single measurable event. It can mean stopping hormones, reversing a social transition, seeking surgery to alter earlier surgical outcomes, resuming life in one’s birth sex, or changing to another gender identity. “Regret” is different again: a person may stop or reverse part of a transition because of family pressure, cost, discrimination, health concerns or changing practical circumstances without judging the original decision a mistake. Conversely, a person may regret irreversible effects while continuing to identify as transgender.

Background

“Detransition” is not a single measurable event. It can mean stopping hormones, reversing a social transition, seeking surgery to alter earlier surgical outcomes, resuming life in one’s birth sex, or changing to another gender identity. “Regret” is different again: a person may stop or reverse part of a transition because of family pressure, cost, discrimination, health concerns or changing practical circumstances without judging the original decision a mistake. Conversely, a person may regret irreversible effects while continuing to identify as transgender.

These distinctions matter because public claims often compare unlike figures. A low surgical-regret figure does not measure people who cease hormones, do not return to a clinic, or regret a social or medical transition without undergoing genital surgery. A survey figure for having “detransitioned at some point” may include temporary changes made for safety or financial reasons. Neither figure, alone, answers how many people ultimately regret medical transition.

The available evidence therefore supports a narrow conclusion: documented surgical regret in older, specialised cohorts has generally been low; treatment discontinuation and temporary detransition are more common than surgical regret; and the prevalence of persistent detransition or regret, particularly among the newer adolescent and young-adult patient population, is not reliably known.

What the documents say

Older surgical cohorts

Wiepjes and colleagues’ Amsterdam Cohort study examined people attending a longstanding Dutch gender clinic from 1972 to 2015. Among people who underwent gonadectomy, the study identified regret in 0.6% of trans women and 0.3% of trans men (Wiepjes et al., 2018). This is an important result, but its scope is often overstated. It concerns a selected group who reached irreversible surgery under historical Dutch clinical protocols; it does not provide a current population-wide rate for all people prescribed hormones, nor for adolescents who began treatment in the 2010s or 2020s.

The long time horizon is both a strength and a limitation. Regret may emerge years after treatment, so short follow-up is inadequate. Yet the patients in this cohort entered care under referral, assessment and surgical practices that differed materially from today’s more varied pathways, including private and informed-consent provision.

Survey evidence on detransition

Turban et al. analysed the 2015 US Transgender Survey, a cross-sectional, non-probability survey of 27,715 transgender and gender-diverse adults. Of 17,151 participants who reported having pursued some form of gender affirmation, 2,242, or 13.1%, said they had ever detransitioned. The study defined this broadly as returning to living as one’s sex assigned at birth, at least temporarily. Most respondents who reported detransition selected external pressures, including family pressure, stigma, employment difficulties and inability to access care. A smaller group selected internal factors such as uncertainty or fluctuation in gender identity (Turban et al., 2021).

This study is valuable precisely because it shows why “detransition” cannot automatically be treated as “regret”. But it cannot establish a national prevalence rate: participation was not random, responses were retrospective, and its broad question did not distinguish clearly between stopping a treatment, a temporary survival strategy, and a lasting reversal of identity or medical transition.

Recent clinic and review evidence

Cavve et al. reviewed records from Western Australia’s public paediatric gender clinic for referrals closed between 2014 and 2020. Twenty-nine of 548 closed referrals were categorised as reidentification with birth-registered sex. However, only two young people had received gender-affirming medical treatment; these two represented 1.0% of the 196 patients who had initiated such treatment. The authors’ outcome was reidentification recorded in clinic notes, not a comprehensive measure of regret or detransition after every form of treatment (Cavve et al., 2024).

Gupta et al.’s 2024 systematic review found only six eligible studies on continuation of gender-affirming hormone treatment. Five reported discontinuation below 10%; one reported 30.8% discontinuation or loss to follow-up. Only two studies reported reasons for stopping. The review’s central finding was not that a single rate had been established, but that the evidence base was too thin and inconsistent to explain discontinuation confidently (Gupta et al., 2024).

The Cass Review reached a similar practical conclusion on measurement. Its final report, published in April 2024 for NHS England, stated that long-term outcomes were not being routinely and systematically collected and that the true number of people detransitioning after hormone treatment could not be determined. It recommended provision for people considering detransition. NHS England’s August 2024 implementation plan accepted that no defined clinical pathway existed and proposed work on incidence, reasons and support needs.

The positions

One position, represented in part by WPATH’s Standards of Care Version 8 and by Turban et al., argues that detransition is generally uncommon, is often temporary, and frequently reflects hostile social conditions rather than an erroneous transition. On this view, conflating every discontinuation with regret creates stigma and risks restricting care for people who continue to benefit from it. WPATH nevertheless recommends a comprehensive multidisciplinary assessment for adults seeking medical or surgical help with detransition (WPATH, 2022).

A more cautious position argues that low reported regret figures should not be treated as proof of low long-term regret. It stresses that older surgical cohorts are not representative of the recent rise in adolescent referrals, that people lost to follow-up may not report adverse outcomes to the original clinic, and that irreversible interventions require outcome monitoring proportionate to their permanence. The Cass Review is a major institutional expression of this position.

There is also substantive disagreement about the Cass Review itself. The Yale Law School Integrity Project’s 2024 critique argued that its claims on detransition and regret were insufficiently supported and that it underused relevant studies. That criticism does not solve the measurement problem: it illustrates that experts may reasonably dispute how evidence should be appraised while still agreeing that better long-term data are needed.

Interpretation

Beyond Gender’s reading is that “detransition is rare” is too confident when presented as a settled population fact. The strongest low figures concern a restricted endpoint, usually recorded regret after surgery, in cohorts shaped by older and more selective clinical systems. They do not measure all clinically relevant outcomes: abandoning hormones, living again in one’s birth sex, distress about infertility or sexual function, seeking revision treatment, or deciding not to return to a gender clinic.

Equally, it is misleading to use the 13.1% figure from the US Transgender Survey as a simple regret rate. The study itself documents multiple external pressures and permits more than one reason. A person forced to alter presentation because of family hostility or economic insecurity should not be counted straightforwardly as evidence that transition was clinically inappropriate.

The central problem is not that every detransitioner proves a general rule, nor that low recorded surgical regret closes the question. It is that healthcare systems have too often measured success at the point of treatment initiation while failing to build independent, long-term, patient-level follow-up capable of identifying benefit, harm, discontinuation, regret and changing needs. For irreversible interventions, especially for adolescents, that is an evidential and ethical failure.

Open questions

Future research should use agreed definitions and report separate outcomes: temporary social detransition, hormone discontinuation, loss to follow-up, reidentification, medical regret, surgical regret and requests for reversal or revision. It should also distinguish adults from adolescents, and patients beginning treatment in recent cohorts from those treated decades ago.

Studies need prospective follow-up over many years, with privacy-protecting linkage across primary care, specialist services, pharmacies, surgery providers and mental-health care. They should actively contact participants rather than assuming that lack of return to the original clinic means satisfaction. Independent research governance is essential, because both overstatement and minimisation of detransition can distort care.

Most importantly, support must not depend on a person endorsing any preferred political narrative. People who continue transition, pause it, regret it, reidentify with their sex, or retain a transgender identity while regretting particular treatment effects all deserve accurate information, respectful care and practical help.

On the timeline

Episodes on this idea

From Gay Man to Transwoman... and Back Again | Michael Kerr

Detransitioning - Discomfort Before Something Greater | Soren Aldaco

detrans.ai: A Counter Narrative | Peter James Steven