Considering transgender health outcomes
Detransitioners’ marginalized experiences with gender-affirming care impart nuanced insight into the psychological and physical effects of transitioning.

Many universities actively strive to become more inclusive by providing student members of the trans community with wellness resources and opportunities for greater representation on campus. Within that same community, however, there are voices that haven’t been mainstreamed like those of their trans counterparts. 

Jungian analyst and psychotherapist Lisa Marchiano says detransitioners “may feel out of step or unseen in an environment that is very-trans-affirming. […] They are sometimes treated as if they, as a group, are anti-trans, which just isn’t true.” 

Marchiano has experience working with young women who have detransitioned. According to The SAGE Encyclopedia of Trans Studies, “to detransition is to reverse a prior transition from one gender or sex to another, typically returning to one’s [natal sex].”

In 2021, the Journal of Analytical Psychology published research from Marchiano on an 18-year-old woman, referred to as Maya, who took testosterone (a male sex hormone) for two years before she was hospitalized for suicidal depression. Maya eventually quit her medication, stopped identifying as trans, and six months later, began psychodynamic talk therapy with Marchiano. 

“For most of the women I have seen,” Marchiano says, “they detransitioned after realizing that transition was not helping them.”

Suffering from ADHD, lack of positive parental attention, low self-esteem, disordered eating, and the “disarticulated grief” of losing her aunt, Maya tried to escape the trauma of her reality by adopting a new body and joining a diversity-defending movement—that serves the mental wellbeing of many people—for a sense of community belonging. In other words, the complex combination of psychosocial problems that initially led Maya to a period of trans identification in impressionable teenagerhood was never addressed. 

“I do think some of [my clients] felt deeply betrayed by the doctors and therapists from whom they sought care [when they decided to medically transition],” Marchiano says. “In some cases, they were rushed or affirmed without any real therapy or exploration, and there is anger about that.”

Affirmation, in the words of psychologist Diane Ehrensaft, is “a method of therapeutic care that includes allowing [people] to speak for themselves about their self-experienced gender identity and expressions and providing support for them to evolve into their authentic gender selves, no matter at what age.” 

Some might question the validity of this approach, as gender identity and personality develop over many years of adolescence and early adulthood, whereas sexual preference can emerge much earlier and become confused with gender identity.   

While the process of detransitioning is an understudied field, a 2020 survey found that majority of its 100 participants detransitioned after realizing they weren’t adequately evaluated prior to receiving medical interventions. The second highest reason to detransition comes from concern about potential after-effects of those interventions. 

Researchers from the Center of Expertise on Gender Dysphoria at the VU University Medical Center in Amsterdam, the Netherlands, discovered that transgender people who start cross-sex hormone (CSH) therapy after the age of 16 may be prone to osteopenia, or weak bones from asymptomatic bone loss.  

A team of Dutch medical specialists and professors observed 34 transgender people over the course of 14 years. They started sex reassignment during puberty, first with gonadotrophin-releasing hormone agonists (GnRHa), then CSH, and lastly a combination of the two. GnRHa suppresses natal sex hormone levels, while CSH stimulates opposite secondary sexual characteristics. 

For instance, female to male transitioners, like Maya once was, take testosterone and, as a result, develop facial and increased body hair, a deepened voice, an enlarged clitoris, and may lose their scalp hair.

To learn about the long-term effects of these injections specifically on bone health, the researchers measured their subjects’ bone mineral density (BMD) from 1998 to 2012. Data findings became available when the subjects turned 22. The pre-treatment BMD scores of individuals from both the transmen and transwomen’s groups decreased to a point where the World Health Organization would classify them as “osteopenic.”

The laying down of new bone is important for normal growth in adolescence. Osteopenia from CSH often progresses to osteoporosis. Osteoporosis is a skeletal disorder that puts people at higher risk of “sudden and unexpected” bone fractures. 

Studies have also linked hormone use to cardiovascular disease, breast cancer, and debilitating acne.

“Detransitioners can feel very uncomfortable and self-conscious about their altered bodies,” Marchiano says. “They may ruminate about the changes […] and may have lost the friends and community they had when they were trans identified.” 

“I hope that universities will offer services and support to this small but very vulnerable population of young people so that they can feel welcomed on campuses,” she concludes.