Gender Dysphoria -- Transitioning, Detransitioning, Retransitioning

"The mainstream gender-affirming  care system largely presumes that gender identity/expression is immutable and that TGD [transgender and gender-diverse] people will engage in only one gender transition."

"While this may be the reality for many TGD people, this presumption can create environments in which multiple transitions, gender fluidity, and detransitions are misunderstood or even stigmatized."

"[Detransition] has been conceptualized as stopping, shifting or reversing aspects of an initial gender transition, often motivated by a shift in how one understands their sex/gender [although there is no universally agreed-upon definition]."

"Some people who detransition may self-label as 'detrans' for short."

"Irrespective of their current gender identity, those undergoing a detransition often retain 'atypical' sex characteristics from prior hormonal and surgical treatments, leading to vulnerability to gender minority stressors and, potentially, an experience of 'reverse dysphoria'." 

York University research team 

A woman who wished to keep her identity hidden de-transitioned after years of testosterone therapy she started at age 15, and a double mastectomy she had at 18. She's experienced "a lot of pain and regret." Photo by Michelle Berg /Saskatoon StarPhoenix

 

"I feel so alienated now, and super-isolated from the rest of the queer community" reported one of the study's subjects. Another said: "I lost every adult and friend in my life when I chose to detransition. I lost everything I had socially." It is obviously a very lonely journey to be  taken.

 

"Conservatives want us to speak to them to 'prove' that transitioning is 'evil'. Liberals want to silence us for fear that we'll somehow 'influence' trans people to detransition", said another.  "We're in a horrible space and it's nearly more painful detransitioning for me than it was just suffering through an identity that didn't fix my problems like everyone said it would."

 

A new form of stigma -- detransphobia -- is being exposed through the largest study of detransitioners in Canada and the United States in decades, revealing that the medical community is abandoning people who had undergone transition and in time made a decision to reverse that gender journey, finding themselves ignored by the very surgeons who had altered their bodies, while the communities that once embraced them, now choose to ostracize them. 

 

 Close to 1,000 people were included in the survey, to reveal that many who halt or reverse a gender transition end up feeling disappointingly poorly supported by LGBTQ groups and gender-affirming care practitioners, leaving them wistfully regretting their doctors' distancing themselves, wishing instead that they "took a more neutral approach to care".  The study was published in the International Journal of Transgender Health and funded by the Social Sciences and Humanities Research Council.

 

The ritual of name changing and pronouns, the halting of hormone therapy or seeking out reversal surgeries like breast reconstruction following a double mastectomy for masculinizing female-to-male chest surgery are difficult decisions to make in a total makeover of what had preceded that detransitioning process. Findings from earlier research are inconsistent with estimates for detransition ranging from less than one percent to as high as 30 percent. 

 

For some individuals, detransitioning may lead to a reversal - retransition -- particularly if their detransition was 'involuntary, forced' as a result of family pressure, discrimination or "the climate of fear around trans people". In other instances, the pressures are internal; a shift in identity of a realization that their gender dysphoria was related to some other issues "such as trauma or internalized homophobia".  

"According to the detransphobia model, individuals who shift their gender after an initial transition may encounter social rejection and barriers to accessing support within SGM [sexual and gender minority] communities due to misrecognition, gender identity fluidity and detransition-related stigma."

"Many shifted from  transgender to gender non-confirming lesbian, gay or detrans identities, and, in hindsight, wished they had access to providers who took a more neutral approach to care."

"[That backs previous research] and carries implications for gender-affirming care delivery."

York University research team 

The research team itself was comprised of a majority of LGBTQ researchers who stated that no formal health-care guidelines exist that would be of assistance to address the medical and psychological needs to detrans individuals when stigma from LGBTQ communities can also occur. The study is that of an anonymous survey taking place between 2023 and 2024, of 957 individuals from ages 16 and up in the U.S. (704)  and Canada (253) self-identifying, with experiences of detransition -- along with one-on-one interviews with 42 selected participants.

 

Gender detransitioning - going back to living as the gender one was assigned at birth, or identifying differently - is generating more and more headlines these days. Nouvelles Montreal

 

79 percent of participants were born female, a reflection of the surge in biological girls referred to gender clinics. Another Canadian study found that of 174 youth aged 15 and younger who were referred for puberty blocks to 10 gender clinics in the country, 82 percent were born female. Some 42 percent of the total reported a history of discontinuing, then later resuming transition.

 

Challenges to access medial care or financial support to cover detransition procedures such as voice training in response to voice deepening or laser hair removal for body and facial hair;  side-effects from testosterone therapy used in female-to-male transitions were mentioned by many of the study participants. "I was turned down by four surgeons and ghosted by the one who did the mastectomy", one participant said of the search for a breast reconstruction surgeon.

  

Some participants spoke of a wish to secure the services of "non-trans-affirming care providers" on the basis of past therapists appearing too eager to encourage their transition in the first place, or to retransition following detransitioning, "despite no expressed desire to do so". "I had no confidence in my providers when I stopped transitioning" , explained one study participant. 

 

A new research website launched by a multidisciplinary team led by York University Professor Kinnon MacKinnon aims to provide resources, support and data-driven information about gender detransition/retransition. York U Yfile

 

The Structural Dominance of White Supremacy

"Self-identification is sufficient for trans students and employees to be addressed by their chosen name and pronouns and to be recognized according to their gender identity."

"Staff shall maintain privacy and confidentiality of trans students and will not disclose a student's gender identity to the students' parent/family/guardian, employees or other students without the student's explicit prior consent and unless the student requests it."

Durham District School Board, Ontario

"How many different pronouns must a teacher memorize? If 23 students all have different pronouns and the teacher gets one wrong, would that be grounds for a complaint?"

"I was a little disturbed to see that you would keep things private with the student and not let parents know."

"[Students requesting a change of gender might be best advised to] seek counselling to find out whether or not something else may be interfering with what the child is actually going through."

Linda Stone, trustee, Durham District School Board

Linda Stone, a trustee for the Durham District School Board, is pictured in a Nov. 2021 school board meeting as she questions the district's policy of "affirming" children's gender transitions without informing parents. These comments were cited by fellow trustees in ordering her censure. Photo by YouTube/Durham District School Board

"Transphobia has no place in our schools or school boards", a fellow trustee wrote in a tweet following the Ontario school board's censure of one of its trustees. Trustee Linda Stone was barred from attending board meetings after having publicly questioned the stated policy of the district in accommodating a student's decision to switch genders, the while maintaining it as a secret from their parents.

Henceforth trustee Stone is barred from all board meetings and committee hearings for all of 2023. The board's statement concerning the "harmful impact" of Stone's comments, urging the community to "begin to  heal", came down solidly in favour of silencing anyone who questions their decisions or recommends other, alternative courses of action. Needless to say, trustees are voted into office through a democratic proces by the public choosing who will represent their interests in a school district, among them parents of children attending public schools.

Throughout the Province of Ontario, including Canada's largest city's Toronto District School Board, it is forbidden to question Trans policies accommodating the issue of transgender choices and accommodation. Teachers who express any shadpw of skepticism, asking questions, making recommendations, are sent home on paid leave, not to return to the classroom.

 

DDSB public school trustee Linda Stone is interviewed by Rogers TV Durham on the opening of two new schools in Oshawa   Facebook

 

In the case of the removed trustee, a 55-page report commissioned from an outside investigator concluded that Trustee Stone was guilty of espousing "racist" and "transphobic" viewpoints causing "objective harm" to the transcommunity. She had questioned the district's policy of concealing a child's gender transition from parents. The school board's official "accommodation guidelines" are that a student can change gender simply by declaring so and staff are explicitly forbidden from questioning the new identity or failing to provide appropriate "affirmation". 

Trustee Stone's comments were said to have spurred a few complaints to the board -- of Ms.Stone violating the "equiity and diversity initiative" of the district. The report by the investigator focused on her "antitrans" Twitter history where she retweeted a post from a mother that her daughter's U13 rugby team played against an opponent with "two large boys in it", referring to trans girls.

Another occasion saw her posting a link to testimony from Chloe Cole, a California teen who campaigns against trans surgery for minors following her own double mastectomy while in high school. It was that tweet which reflected the comment in the report that Trustee Stone was circulating "antitrans language", perpetuating "harmful narratives around transgender people." Trustee Stone was said to be "racist" when she opposed changes to district policies claiming the district was infiltrated with "systemic racism" enabled by "the structural dominance of white supremacy".

Another Ontario school trustee, Mike Ramsay, was censured for critiquing the presence of "anti-racism" ideology in the school curriculum -- and that, despite that he is himself Back. Trustee Stone had posted a tweet condemning the teaching of critical race theory; in fact she was re-posting a tweet that originated with Mike Ramsay. 

Another incident in Waterloo, Ontario saw teacher Carolyn Burjoski registering her concerns at a school board meeting, over school library books she identified as glossing over the long-term consequences of gender transition surgery and hormone treatment. One book entitled The Other Boy, had the main character say "it's cool" when informed gender transition would render permanent sterilization. The teacher was issued with a "stay-at-home" order.

In Truth, There Are Consequences

"Michelle's stated desire to become transgender was never challenged and it was treated to the exclusion of her other serious mental health issues, closing the door to alternative treatment options."

"[The defendants] permitted Michelle to self-diagnose as transgender and prescribe her own treatment without providing a differential diagnosis or proposing alternative treatments."

"Michelle came to believe that her biological sex of female did not match her true gender identity of male."

"She further came to believe that this mismatch between her biological sex and gender identity was causing her feelings of depression, self-harming behaviour and unease in her body, a mental-health condition commonly known as gender dysphoria."

"However, as a result of what she read on the internet, she became convinced that she was a transgender man, and that once she embraced this new identity, her depression would subside." 

"Michelle has struggled to come to terms with the permanent changes from her hormone treatments and hysterectomy surgery have caused; a low voice, male-pattern balding, facial hair, an enlarged clitoris, a flat chest, and the inability to ever become pregnant."

"All of this has caused her to suffer from a worsening of her depression."

Statement of claim; legal suit,Ontario Provincial Court

Michelle Zacchigna, 34, of Orillia, Ont., when she was taking testosterone, left, and after she stopped, right. Photo by Courtesy of Michelle Zacchigna

Orillia, Ontario resident 34-year-old Michelle Zacchigna has launched a malpractise suit against no fewer than eight health professions. Included among them are doctors, psychologists, a psychotherapist, and a counsellor. The defendants operate out of a number of clinics and institutions in southern Ontario. Four of the defendants filed notices of intent to defend against the suit in Ontario Superior Court; statements of defence have yet to be filed.

 

"I've been under the impression that all medical malpractice suits are challenging. Doctors win the majority of cases in Canada", observed the women in conversation with news media. "It's very much a David and Goliath undertaking." 

Ms. Zacchigus narrates her early years of social difficulties forming relationships with fellow students in elementary school. She was often the subject of bullying at school. Which led her by age eleven to begin behaviours known as self-harming; cutting her arm with a knife as example, behaviours that carried forward into adulthood. At age 20 she attempted suicide and was referred for psychotherapy by her family doctor. She was treated for social anxiety and clinical depression.

None of which helped her out of her unhappy and depressed state. She dropped out of university as a result of her mental health decline. While she was in therapy she came across an online community focused on gender noncomformity. What she gleaned from the site was an insight into her dysphoria; the first indication she felt of having been born in the wrong body. Before this she had not identified as male.

"Michelle received these formal diagnoses for the first time nine years after she was formally referred to the [therapist] following her suicide attempt in 2008, and eight years after she first 'came out' as transgender in 2009."

"[The psychologist] did not analyze or consider whether Michelle met the diagnosis for gender dysphoria in her assessment reports."

Statement of claim for lawsuit

At this point she began attending a support group in Toronto for people thinking of gender transition. There a counsellor informed her of opportunities she could access to proceed through a medical transition and she was invited to apply for medical intervention in 2010. A recommendation letter written by the counsellor outlined a medical history failing to match fully her past medical history, according to the claim. Nor were alternatives recommended or encouragement to seek confirmation of her own diagnosis of gender dysphoria.

All this in a background where professional medical governing bodies, institutions such as school boards and dysphoria-counselling clinics have cautioned teachers, doctors, academic administrators, as well as friends, family members and even parents not to question people  -- including underage children -- convinced they are occupying incorrect genders and plan to transition to complete their journey through life in psychological comfort.

Her regular therapist recommended her for transition treatment, indicating that she was an 'ideal candidate for hormone therapy'. The supervising psychologist of the therapist supported the recommendations and at a Toronto health centre Ms. Zacchigna was prescribed testosterone hormone therapy following three appointments. The MD working out of the health centre then became her family physician.

"On or about November 20, 2020, Michelle began to question whether she had ever been transgender, or if she had ever met the criteria for gender dysphoria."

"Since that time, she has commenced a process of detransition toward living life as a woman again."

"The Defendants failed to investigate or failed to adequately investigate and/or confirm that Michelle's stated desire to transition to the male sex was rooted in a diagnosis of gender dysphoria resulting from other factors in Michelle's mental health including her history of clinical depression, anxiety, developmental disabilities, and social difficulties."

Statement of claim, lawsuit

According to the lawsuit claim neither her mental health nor counselling records were consulted; no screening "for any other mental health diagnoses or development disabilities" were considered. She underwent testosterone therapy for three or four years. Then, in 2012 her breasts were removed by a surgeon in Florida on the recommendation of her doctor; a procedure she paid for. She became 'disenchanted' with testosterone four years later. "She no longer cared about the ongoing masculinization of her body".

 

A psychologist diagnosed her in 2017 with several conditions, including attention defiicency, hyperactivity disorder, borderline personality, clinical depression, autism spectrum disorder, and traits of post-traumatic stress disorder, according to the statement of claim. Her family doctor referred Ms. Zacchigna in 2017 to another doctor for possible hysterectomy surgery. A year later she underwent a partial hysterectomy. 

 

She now seeks $350,000 in general damages to compensate for pain, suffering and loss of enjoyment of life, as well as an undetermined amount for past and future loss of income, past and future medical treatment, along with other expenses and costs. It might seem to the casual onlooker that she could experience some difficulty persuading a judge and jury of the implication that she experienced 'loss of enjoyment' through a life fraught with psychic insecurity and unhappiness, much less loss of income.

Under current medical practise, patient insistence that they know best what they feel and how they feel and why they feel should be honoured. Doctors are pretty well forbidden from questioning the wisdom of choice of patients, suspected mental instability aside. In fact, mental instability might be viewed as par for the course for anyone seeking gender transition. Health professions committed to the concept of 'the patient knows best' have become enablers out of conviction.

“I will live the rest of my life without breasts, with a deepened voice and male-pattern balding, and without the ability to get pregnant. Removing my completely healthy uterus is my greatest regret,”