CAROL HAD long suspected her everyday life in rural California would be easier if she were a man. Yet she was stunned by how true this turned out to be. As a “butch” woman (and “not a big smiler”) she was routinely treated with slight contempt, she says. After a double mastectomy and a few months on testosterone—which gave her facial hair and a gravelly voice—“people, cashiers, everyone, suddenly became so goddam friendly”.
Yet Carol soon felt wretched as a trans man. At first, the testosterone she started injecting at 34 lifted her mood and energy levels. But after two years she began to suffer awful side effects. Vaginal and uterine atrophy (which can cause tissue to crack and bleed) was “extremely painful”. Her cholesterol levels rose and she had palpitations. She also became so anxious she started having panic attacks.
So she went on antidepressants, and they worked. “It was a light-bulb moment,” she says. “I was like, I needed the antidepressants; I didn’t need to transition.” She realised her gender dysphoria, the painful feeling she was in the wrong body, did not, in fact, make her a man.
Nearly three years ago, after four years as a trans man, Carol became a “detransitioner”: someone who has taken cross-sex hormones or had surgery, or both, before realising this was a mistake. Her experience illustrates the dangers of a “gender-affirmative” model of care that accepts patients’ self-diagnosis that they are trans, now standard practice in America’s transgender medicine field.
No one knows how many detransitioners there are, but anecdotal evidence, and swelling memberships of online groups, suggests the number is growing fast. A recent survey of 100 detransitioners (69 of whom were female) by Lisa Littman, a doctor and researcher, found a majority felt that they had not received an adequate evaluation before treatment. Nearly a quarter said homophobia or difficulty accepting that they were gay had led them to transition; 38% reckoned their gender dysphoria was caused by trauma, abuse or a mental-health condition.
Dr Littman’s study found that only 24% of detransitioners told their doctors transitioning had not worked out. This may help explain why some dismiss the phenomenon.