Detransitioners abandoned by medical and trans communities

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A surgeon removed Amy’s breasts the day she turned 16.

There was no “psych evaluation,” she said, no mental health assessment before the double mastectomy to explore why she felt so unhappy and miserable with her body.

When her worried parents asked the surgeon if their daughter was old enough to consent, they were assured that the surgeon had worked on even younger patients seeking female-to-male masculinizing chest surgery.

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Amy hoped her chest or “top” surgery would be the end of her problems. Then her mental health spiralled.

Now 18, and in her final year of high school in Southern Ontario, Amy is reverting to her birth gender. She is detransitioning and seeking breast surgery to get her pre-transition body back, “some form of reconstruction to emulate what I could have had.”

Like most provinces, gender-affirming surgery is a publicly funded service in Ontario. Amy’s mastectomy was covered by the Ontario Health Insurance Plan, except for $3,000 in extra fees for chest contouring, to sculpt the remaining breast tissue into a chest more resembling a male. But Amy said she was advised by her family doctor that she couldn’t make a referral for breast reconstruction because it would be considered cosmetic surgery.

“It’s not like I had breast cancer or something,” Amy said she was told. “I guess the way the government sees this is that I chose this,” said Amy, whose real name is not being used to protect her identity because under today’s gender-affirming approach to care, detransitioning is a highly stigmatized “patient outcome.”

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Amy lost friends when she detransitioned. “I guess before I was cool or something.” Some accused her of being transphobic, others just quietly stopped talking to her. When she reached out to her youth gender clinic and told them she was detransitioning, “they dropped me,” she said.

“They basically told Amy there was nothing they could do for her,” her mother said.

True rates of people stopping, shifting or reversing a gender transition are unknown. But research into the phenomenon suggests that people who once identified as transgender and who now want to stop cross-sex hormones or reverse surgical interventions are often left to navigate difficult circumstances on their own, without needed medical or psychological support.

“Access to reconstruction is limited,” said Kinnon MacKinnon, an assistant professor at York University’s School of Social Work. People don’t know where to find surgeons who specialize in reconstruction or how to find insurance to cover it.

Detransitioners have described experiencing stigma and shame from doctors and therapists, and a new kind of gender dysphoria because of their hormonally or surgically altered bodies. But those in the field said some surgeons may be more judicious and wary out of fear of further regret or liability. Some detransitioners are suing their doctors, alleging their desire for extreme interventions was never challenged and alternative options never offered. What if the person re-transitions?

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The National Post reached out to six detransitioners across the country. All were born female and suffered from gender dysphoria and mental health issues. Many experienced regret and felt they were too young and distressed to be allowed to consent to such life-altering interventions. Four agreed to tell their stories publicly.

“Nobody knows how to help you because this is new territory,” said Sarah of British Columbia. She asked that her last name not be used to protect her family.

Sarah began identifying as transgender when she was around 15, while being treated for depression. She said it’s hard to remember the exact time and dates. “Being on antidepressants and going through a lot in my life, everything was a huge blur for me.”

I’d have these moments where I would just look in the mirror and start to cry. What did I do to myself?

Sarah

After puberty blockers, she began taking testosterone at 17, followed by a double mastectomy at 18. It was surgery “I didn’t have to pay a dime for,” she said. Abused as a child, not by her parents, she dreaded puberty and being looked at as a girl and in ways that made her feel deeply uncomfortable. “So, I thought, ‘If I was a man, nobody would look at me this way or treat me this way.’”

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The first time she looked in the mirror after her breasts were removed, she felt right “with the man that I saw,” she wrote on a crowdfunding page to raise money for reversal procedures. Two years later, she began to have doubts that she tried to brush off, fearing it was too late. “I tried to ignore it,” she said. “But I’d have these moments where I would just look in the mirror and start to cry: ‘What did I do to myself, and how will I come back from this?’”

She began to detransition at 20.

Now 23, she has body hair “everywhere, like an Italian dude.” Nearly $41,000 raised crowdfunding is gone, spent on laser hair removal that didn’t work as well as hoped. That meant electrolysis to remove individual hairs, which means having to grow out her facial hair because the hair needs to be visible for it to be removed. “I’m way too anxious and uncomfortable with working at the moment,” Sarah said. She’s getting by on a small income and is on a waitlist for therapy for depression.

Between 65 to 80 per cent of gender dysphoria diagnoses today are in people born female. But under the gender-affirmative approach, the focus is on starting, not halting or reversing interventions. There are no guidelines or care “pathways” to advise doctors how to support people who detransition.

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Studies have also found that detransitioners would have benefitted from more “robust” discussions about the risks and benefits of gender-affirming interventions before they agreed to puberty blockers, hormones or surgery. “I wasn’t asked about why I wanted to be a boy or challenged with that,” one participant told a Canadian research team. “I didn’t receive really any in-depth questioning. It was like, ‘OK, you think you’re a boy and that’s cool. We can do that for you.’”

Critics say detransitioning is getting outsized attention because the majority of people who pursue gender transition do not alter course. Stories in the media of detansitioners have been attacked for feeding anti-trans rhetoric and bolstering lobbyists pushing for laws restricting or banning gender-affirming care for minors. Transgender health care has been described as lifesaving by the Canadian Paediatric Society and numerous other medical groups.

Trans youth have also struggled to find doctors and have faced lengthy waits for care that can worsen gender dysphoria. One study of 433 trans people in Ontario 16 and older found that one-quarter reported getting hormones from friends, relatives or strangers. At the time of the study, a single clinic in Ontario approved sex reassignment surgeries. Five people reported attempting surgical procedures on themselves.

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A systematic review published in August found that rates of regret after gender-affirming surgery are lower (one per cent) than regret rates for other plastic surgeries (19.5 per cent for bariatric surgery) or major life decisions like having a child (seven per cent).

But as referrals to gender clinics surge and qualms over gender-affirming care for minors grow, the number of detransitioners is increasing. Some say the phenomenon has less to do with who is transitioning and more to do with sheer numbers.

While still small (100,815 people reported being transgender or non-binary in Canada in the 2021 census, or about 0.33 per cent of the country’s population), a historic number of people have transitioned in the last decade.

A portion is now reversing their shift to a new gender identity.

Doctors working in gender clinics didn’t respond to requests for interviews from the National Post. Ontario’s health ministry did not respond to requests for comment before deadline. Toronto’s Women’s College Hospital, which has a surgical program devoted to transition-related surgical care, also did not respond by deadline when asked if the program also provides reversal surgeries for those seeking to detransition.

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“Safeguarding medicine requires accepting the possibility of being wrong,” New Hampshire emergency physician Aida Cerundolo wrote in The Hill. “But gender-affirming care is rooted in a clinician’s assumption of always being right — an expectation that exists nowhere else in medicine.”

Long-term studies on detransitioning are scant. According to more recent estimates, detransition is thought to occur in seven to 13 per cent of people who initiate a transition. Reasons include pressure from family or romantic partners, complications from hormones or surgery, employment discrimination or harassment, and violence experienced as a visibly trans person. Some realize their gender dysphoria was related to other issues.

For others, gender identity and expression can be more fluid than previously thought.

I think the transgender community is a bit of an echo chamber and I felt like I had to do it

Emily

Emily, 23, came out as transgender when she was 14. Like others interviewed for this story, she asked that her real name not be used to protect her identity.

“I had some trauma growing up that made me quite uncomfortable with my adult woman body.” When she came out as trans, “it very much felt like I received immediately the affirmations that I was seeking.”  She went straight to cross-sex hormones when she was 15 or 16, and had a double mastectomy “when I was freshly 18,” the Nova Scotia woman said. She was sent out of the province to a private clinic in Montreal, though surgery was covered by Nova Scotia’s health insurance program.

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At first, she was happy not to have to wear a binder anymore, happier to breathe normally.

At 20, “I realized that I’d made a mistake.”

“I hated my chest. At the time I hated anything that could tell somebody that I was a woman. I think I was just afraid of my body and what people maybe wanted to do to it. At the risk of sounding harsh, I think the transgender community is a bit of an echo chamber and I felt like I had to do it.”

Her nipple grafts didn’t take well. “They don’t look like human nipples.” She has no nerves or sensation. She knew that was a risk going in. She saw “tonnes of photos” of top surgeries and very few looked like male chests. “I just wanted to be flat.”

At 20, during her first year at university, “I just had this eureka moment. I didn’t even know detransitioners were a thing. But I felt like I woke up and I’ve burnt down my whole house. Why did I do that? Who let me do that and why?”

She immediately began dressing like a woman again and told her parents she felt she’d made a mistake. “It was the most isolating thing I ever experienced in my whole life. The LGBT community I once called home, I definitely didn’t feel supported by them.” She was made to feel that it was going to be hard to go back, “and look like a woman again.”

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“I had to distance myself from that community because it wasn’t conducive to me getting where I needed to be.”

Gender-affirming hormones can result in irreversible changes. The effects of testosterone include irreversible voice deepening, clitoral enlargement, body and facial hair, and balding on the top and front of the scalp. Both testosterone and estradiol (for male-to-female transition) can permanently decrease fertility “to an extent that is not yet fully known,” according to the Canadian Paediatric Society’s position statement on gender-affirming care.

“It is essential for prescribers of (gender-affirming hormone therapy) to explore adolescents’ desires regarding future genetically related offspring, and when indicated to refer for fertility preservation before initiating therapy,” the authors wrote.

Yet talking to a young teen about one day having babies can be an abstract concept, doctors conceded in discussions leaked earlier this year between providers of gender-affirming care. Discussing the potential loss of fertility and options to preserve fertility with a 14-year-old is “always a good theory,” one prominent Canadian endocrinologist said, because many will go on to cross-sex hormones that will leave them sterile. But, “I know I’m talking to a blank wall,” he said. “And the same would be for a cisgender kid, right? They’d be like, ‘Ew, kids, babies, gross.”

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There isn’t always regret. “Transition can be part of a learning process and sometimes qualified as a success, with no feelings of regret and, at times, even a sense of satisfaction,” reported a University of Montreal-led team that interviewed 20 youths aged 16 to 25, three from Canada, who detransitioned or stopped their transition.

“Some still enjoy the changes that occurred because of their transitions and regard the outcomes — whether medical, social or legal — as positive,” the researchers said. “I’m OK identifying as female and not having breasts,” one participant said. “Like, I am happier this way. And I did make the right choice, just under weird circumstances.”

Sarah, who struggles with nerve damage from the mastectomy that sometimes feels “like I’m being stabbed under my arm or the sides of my chest,” was asked, when she reached out to her old gender clinic, whether she felt transitioning to identify as male was a necessary step in her gender journey. “I almost laughed,” she said. “I thought that was an insane question to ask. I said no, that if anything I should have been mandatorily put into therapy. But therapists are scared to even ask questions because they’re afraid of losing their licence if somebody gets offended and it’s deemed conversion therapy.

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“They need to start asking questions. They need to not be afraid.”

A little over half, 12 out of 20 participants in the Montreal study, did express regret, as well as sadness and grief for their pre-trans body. “I wish I could’ve gotten to the place I am now without that ever happening to me,” one woman said.

In an online survey of 237 detransitioners, including Canadians, people described feelings of being ostracized by the community that once embraced them, and negative encounters with doctors who either didn’t believe them, didn’t listen to them, refused them care “or simply did not have the required knowledge to help them during their detransition process,” the researchers wrote.

Families, too, can struggle to understand. “I just can’t believe you would go through all this transitioning not to be this way,” Sarah sometimes heard. A Christian, some thought she’d been Bible-thumped out of it.

Amy went off testosterone, cold turkey, one month after her 17th birthday.

She’s always been a black-and-white, all-or-nothing thinker, she said. In pre-school, she once wore her Snow White costume to school two weeks straight. “She said she was Snow White,” her mother said. “She was your typical little girl. We didn’t start having issues until her body started changing.”

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She was an early bloomer, which made her feel uncomfortable, different from her peers, unsafe as a girl. She is on the autism spectrum. She’s also had “some pretty bad trauma in the past that affected me, a lot.” She struggled with depression and severe anxiety in school. She remembers telling a doctor when she was 11 that she didn’t want to grow up because she wasn’t comfortable in her body. “She told me, ‘Are you sure you’re in the right body?’ She asked me if I wanted to be a boy and told me about some medications that would turn me into one. My mom freaked out and we never saw that doctor again. But it stuck.”

At 13, she still hated her body but didn’t feel that she was a guy. Then the pandemic hit. Virtual schooling, alone with her thoughts, “I was miserable.” She thought about her diagnosis of gender dysphoria. Maybe the doctors were right, she thought. “Maybe I am a boy.”

A referral was made to a gender clinic. Amy was put on puberty blockers, followed by testosterone injections. Two months after starting testosterone she was hospitalized after a suicide attempt. The gender clinic arranged for her to have her testosterone injections while in hospital and made sure that hospital staff were using the proper male pronouns.

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Three months after her suicide attempt, Amy was referred for top surgery. When her mother pushed back, telling Amy she would be “mutilating” her body, child protection services were called.

Amy had her mastectomy in the summer of 2022. In addition to losing her breasts, she has thick body hair and male pattern baldness from the hormone therapy. Her voice deepened. She has vocal cord damage from trying to make her voice higher. “It hurts to speak most of the time.” She has bone pain and an Adam’s apple and is wide through the shoulders. She may never be able to have children.

The mastectomy didn’t fix her dysphoria. She felt worse, developing an eating disorder that eventually hospitalized her when her weight plummeted to 36 kilograms (80 pounds). “I was told while I was in the hospital that maybe it was just because I was trans, and that youth who are gender dysphoric have eating disorders, and that once I finish my transition I’ll feel better.”

She said bottom surgery was suggested (bottom, or sex-reassignment genital surgery, is restricted to people 18 and older in Canada). “I didn’t feel like that was the right answer. I felt like nothing fixed me,” she said. Terrified of needles, her mother took over injecting the weekly testosterone shots into Amy’s belly. “I couldn’t tell her I was scared and that I’d been thinking, ‘I don’t know if this is right,’” Amy said.

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I was told this is lifesaving, that ‘your kid is going to kill herself if you don’t let this happen’

Amy’s mom

Amy broke down during a visit home from the hospital, confiding in her mother: “This is all a mistake. I don’t know why, but I think that I might have been a girl this whole time.”

Her mother said she blames herself. “I was told this is lifesaving, that ‘your kid is going to kill herself if you don’t let this happen’,” she said, her voice breaking. “Or, ‘you don’t have a say because (Amy) is of age and we deem her competent.’

“If I had listened to myself and fought the system … But my fear was that they were going to take my kid away.”

The purpose of gender-related care is to treat a diagnosable problem. According to the latest iteration of the Diagnostic and Statistical Manual of Mental Disorders, psychiatry’s bible of mental illness, gender dysphoria is defined as an incongruence between a person’s experienced or expressed gender “and the one they were assigned at birth.”

But many children presenting with gender dysphoria have other complex mental health issues they need help untangling from their gender distress, said Pamela Buffone, of the Canadian Gender Report.

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“I’ve met families with autistic daughters who only find out they’re autistic at the age of 21, after they’ve gone through gender transition and realized that wasn’t the answer.

“But there’s more questioning of young people who say, ‘You know what, I’d really love my breasts back. Could you help me with this?’ They get more questions than a young girl who goes into a gender clinic and says, ‘I think I’m a boy or non-binary and I really want these things removed,’” Buffone said.

“That is a fast track and a green light. All you need to do is declare your gender identity and everyone affirms you. No one is asking questions. That’s the dynamic that we have in Canada right now.”

My 13-year-old brain just thought that it was cool and that unless you looked a certain way then you were kind of a failure as a female

Jane

Jane was 12 when she started puberty and “really, abruptly, developed a bunch of problems with my mental health.” The Saskatoon woman, now 24, was anxious, depressed and, by 13, “resenting the fact I was female.”

“My 13-year-old brain just thought that (transitioning) was cool and that unless you looked a certain way or were a certain way then you were kind of a failure as a female, and I felt like I was,” she said. “I just wanted not to have to deal with that.”

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She started to identify as non-binary. “I was on the Internet a lot, and it was becoming popular and trendy at the time.” The way she heard people describe it sounded “kind of like me. I didn’t feel like I could be a girl properly and I knew I couldn’t be a boy, so I thought that I could just be nothing, maybe.”

She identified as non-binary for a year. It still didn’t feel right; it wasn’t solving her problems. “And then, when I was 15, I decided, ‘Screw it, I’m going to try and become a man.”

From a website, she found a “trans-friendly doctor” who prescribed hormones.

Jane remembers when her voice started changing. “I was excited at the time.” She started to grow hair on her belly next to where she injected the testosterone. She grew more hair on her legs, arms and arm pits. She changed her name. Socially, she was living as a male, but she’d dropped out of high school because of overwhelming anxiety and depression, and kept herself mostly isolated.

“I didn’t know at the time, but I’m diagnosed now with autism and ADHD. I was finding it really difficult to comprehend schoolwork. I just couldn’t handle being in that environment anymore.”

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Her mother said it was difficult to watch Jane’s physical transformation. “Whatever I said wouldn’t stop her. She thought that was the only way to go for happiness. But I could see she wasn’t happy as soon as she was a man, either. Because you’re not a full man. You don’t have a penis. You still have small hands. You’re not really a man.”

Jane chose to have a mastectomy at 19. She’d been binding her breasts “pretty severely and I figured the logical thing is to get them removed. They were distressing to me. My body wasn’t fitting into that image of myself as a man.”

They found a surgeon through the same route they found the hormones. “I had an appointment and consultation and then, a few months later, I had the surgery.” It was paid for by the province.

Once the drainage tubes in her armpits were removed and the incisions started to heal, “I was really happy that my breasts were gone,” Jane said.

The surgery was in February 2019. “By summer, I started to regret it. Not just the surgery, but my transition altogether. I tried to shut out any negative thoughts because I thought that I couldn’t do anything about it, that I couldn’t go back.”

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But then she started to let herself think those thoughts and feel those feelings of regret, “and I started to wallow in it.” For months it was all she could think about. “I started reading a lot of stuff about transitioning and stuff critical of how the system kind of works. I found myself agreeing with a lot of it. And the more I wallowed the more I found it unbearable to keep going.”

Jane said she was too young at 15 and in “such a bad place mentally,” to consent to gender-affirming interventions. But she felt embarrassed to tell anyone she was now feeling differently.

“I didn’t want to say, ‘I’ve made a mistake. What do I do?’”

She immediately sought reversal top surgery. “I was deeply insecure about the way I looked and my voice and not having any breasts. I wanted to remedy whatever I could as soon as possible.”

“Except we couldn’t get coverage,” her mother said. “We couldn’t even get to see any doctors to do her breasts. As soon as you said they weren’t cut off for cancer, they all declined her, every single one of them.”

It took four years to find a surgeon willing to do surgery for $10,000, which they paid for using money from her father’s pension. He’s in remission from lung cancer. “The only reason the surgeon agreed to see me in the first place is we didn’t mention I had the mastectomy due to transition,” Jane said. She had surgery in February this year. She now identifies as lesbian.

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Her mother searched the Internet for support for detransitioners. “Nobody knew anything about anything.” Jane found some support online, but said the groups “are kind of secretive, because they would get harassed” by the trans community.

Today, “I feel like it’s not really a factor in my life anymore. Initially, it was a huge part of my life when I was detransitioning, and now it’s not something I think about. It doesn’t haunt me anymore. I’m perceived just as female. I have a weird voice. But I look female. I didn’t grow a beard. I didn’t go completely bald. So, I pass as a woman easily.

“I know that’s not the case for a lot of people who detransition.”

In an email to National Post, the Saskatchewan Ministry of Health said that, as with any request for public funding, “coverage is determined on a case-by-case basis,” taking into consideration “the patient’s individual clinical circumstances, their physician’s medical opinion and the service being requested.”

The ministry said it is currently unaware “of any coverage requests for breast reconstruction due to de-transitioning or medical transitions previously incurred.”

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Emily, of Nova Scotia, went on birth control in the hope it would slow down hair growth in unwanted places and “speed up the reversing.” She battled a roller coaster of emotions and dropped out of university because she needed money for laser hair removal. She joined a two- to three-year waitlist for women seeking breast reconstruction following mastectomy for breast cancer, but it wasn’t clear to her whether it would be covered for someone detransitioning. “I decided I couldn’t last that long,” Emily said. “It was so important to me to get that back.”

In 2022, she paid $9,000 for surgery at a private Halifax clinic. “I wish I could say I’m happy with my chest,” she said. But because of the scars from the mastectomy, the placement of the nipples and the way the nipple grafts healed, “it doesn’t look good.”

She’s gone through speech pathology to try to make her voice higher, learning exercises like making her mouth smaller or raising her tongue towards her palate to sound more feminine.

She said she felt regret and anger. Mourning is the biggest feeling. “I lost a part of myself that I didn’t need to lose.

“I still sometimes feel like a kid who still believes in magic. When am I going to wake up, and when is everything going to be normal again? It’s been years and I still feel that way.”

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