Recovery from Transition: Psychotherapy with Detransitioners
By Stella O’Malley, MA
Abstract
This article examines the growing population of individuals who detransition or experience regret following medical transition, with particular attention to the psychological, clinical, and ethical challenges they face. Drawing on clinical experience, peer-reviewed research, qualitative studies, and media accounts, it highlights a persistent shortage of evidence-based therapeutic support for this group. The article argues that professional reluctance to engage in exploratory or non-affirmative care, shaped by political, institutional, and reputational pressures, has contributed to significant gaps in care. It reviews emerging evidence on detransition, including reported mental health comorbidities, social isolation, and physical complications associated with hormonal and surgical interventions, while acknowledging substantial limitations in the current research base. The article concludes by calling for cautious, developmentally informed, and psychologically grounded approaches to gender dysphoria, alongside urgent investment in longitudinal research and competent therapeutic support for individuals navigating detransition.
Keywords: Gender dysphoria, detransition, desistance, psychotherapy, gender-affirming care, mental health outcomes, clinical ethics
Recovery From Transition
Over the past decade, gender dysphoria has emerged as one of the most complex and sensitive issues facing young people, families, and clinicians. Since at least 2017, a sharp rise in adolescents seeking support for gender-related distress has drawn increasing clinical and public attention.1-3 Central to this trend has been overwhelming demand for thoughtful, well-informed therapy—and a corresponding shortage of services willing to support those whose distress is not resolved through transition.
This demand for appropriate services has outpaced what individual practitioners can offer. Some organizations are now advocating for a nonmedicalized, evidence-based approach to gender dysphoria, including support for those questioning or reversing medical transition (e.g., Genspect).4 The stated goal of such organizations is to ensure that individuals struggling with identity are met with curiosity, compassion, and clinical integrity rather than being rushed toward a medical pathway. In other words, they argue that gender nonconformity should not lead to medical intervention, maintaining that children should be free to explore and express themselves without being labeled transgender or subjected to irreversible treatments.5
Moving Beyond a Medicalized Approach to Gender Dysphoria
Background for this paper was gathered through the Beyond Trans initiative,6 a program that offers daily online support groups and therapeutic services for families, detransitioners, transgender individuals, and those experiencing distress following medical transition. To date, these services have reportedly reached over 400 detransitioners and more than 1,200 parents affected by these issues.
Clinicians facilitating these groups routinely encounter individuals who feel isolated, regretful, and abandoned by the systems meant to support them. Despite growing need, access to psychological care remains limited, as professionals offering exploratory or non-affirmative care to detransitioners face political pressure and professional risk. High-profile controversies involving researchers who examined detransition and regret have reinforced this climate of caution.7-9 Kenneth J. Zucker, one of the most prolific researchers in childhood gender dysphoria, published extensively on this topic,10-12 yet his leadership of the Centre for Addiction and Mental Health gender identity clinic later became the subject of institutional controversy and legal settlement.13
Clinical work with individuals who have detransitioned reveals the complexity of this process. The decision to detransition often follows years of psychological struggle, with many individuals experiencing heightened suicidality during this uncertain stage. Social rejection and isolation are common, compounding the emotional burden.14
Long-term outcome data for both transition and detransition remain limited, underscoring the need for prospective, longitudinal research that tracks mental health trajectories over time.15 Detransition appears to be increasing, possibly due to the rise in medical transitions or the influence of the gender-affirming model, which is patient-led and centers on self-identification, often resulting in medical intervention.16 However, limited research, shaped by broader reluctance to study detransition, makes it difficult to determine prevalence or causal pathways.15
Increasing Numbers of Detransitioners
The Reddit forum r/detrans17 had fewer than 1,000 members in 2019; as of this writing, it has over 57,000. This pattern likely reflects increased visibility rather than reliable prevalence data in a field where detransition remains understudied. Media reports now frequently feature detransitioners whose accounts often involve regret, isolation, and irreversible medical outcomes. These experiences warrant greater attention from clinicians, researchers, and policymakers alike.
Existing quantitative research on detransition is limited by small sample sizes, reliance on self-selected participants, short follow-up periods, and institutional or ideological constraints that have discouraged systematic investigation of regret, reversal, and adverse outcomes.18-23
Vandenbussche (2022)14 surveyed 237 detransitioners and desisters—92% female and 8% male—recruited from online communities. Desisters are individuals who no longer identify as transgender and have not undergone medical transition, whereas detransitioners have medically transitioned and later reversed course. The study found that 70% attributed their gender dysphoria to underlying issues such as mental health difficulties, trauma, or internalized homophobia, and many reported that they had been inadequately informed about the treatments they received.
Psychoanalyst Lisa Marchiano (2021)24 documented the case of “Maya,” a distressed adolescent with an eating disorder who underwent medical transition and later detransitioned. In the same article, she referenced “Livia,” a woman who regretted transitioning after undergoing a mastectomy at 20 and a hysterectomy at 21. Reuters25 profiled Max Lazzara. At 14, Max began questioning her gender identity and found affirmation through online communities. By 16, she had started testosterone, and at 18, she underwent a mastectomy. Although she initially felt relief, her mental health later deteriorated, resulting in renewed suicide attempts, substance abuse, and disordered eating. In 2020, she came to identify as a lesbian, ceased testosterone, and now regrets that medicalization was offered as the solution to her distress.
Meanwhile, the New York Times26 recounts the story of Grace Powell, who, as a teenager, believed transition would resolve her distress related to puberty, bullying, and depression. She began cross-sex hormones at 17 and later underwent a double mastectomy, yet underlying issues, including past trauma, were not explored before her transition was affirmed. She has since detransitioned and expressed regret. Paul also profiles Kasey Emerick, who grew up in a conservative Christian community and transitioned to escape the stigma of being a lesbian. After five years living as a trans man, Emerick realized her mental health had worsened, detransitioned in 2022, and faced intense online backlash.
Littman (2021)27 found that 55% of 100 detransitioners reported inadequate evaluation before transitioning, 38% linked their dysphoria to trauma, abuse, or mental health issues, and 23% cited homophobia or difficulty accepting their sexual orientation as contributing factors in both transitioning and detransitioning. Similarly, Vandenbussche (2022)14 reported that 52% of detransitioners and desisters expressed a need to cope with internalized homophobia. These findings highlight the importance of addressing underlying psychological issues in therapy rather than reinforcing the belief that medical transition is the only path forward. However, internalized homophobia is only one of many challenges detransitioners face—unacknowledged comorbidities also pose significant barriers to recovery and well-being.
Challenges Facing Detransitioners
Working with detransitioners can be among the most meaningful, and at times harrowing, aspects of clinical practice in this area. These individuals typically view their medical transition as a form of self-harm and deeply regret the hormonal and surgical interventions they underwent, highlighting the potential risks of medicalization.
In the Beyond Trans support groups, participants frequently report deep regret regarding hormonal treatments, mastectomies, vaginoplasties, hysterectomies, and other irreversible procedures. Detransitioners remain a minority within a minority, yet their perspectives are essential to fully understanding the realities of gender dysphoria.
Consistent accounts reported by detransitioners underscore the urgent need to approach gender dysphoria with caution, compassion, and a focus on long-term well-being.27-28 Internalized and externalized homophobia is a recurring theme in clinical work with this population. Many young people who later identify as gay, lesbian, or bisexual describe struggling to accept their same-sex attraction and now regret pursuing medical transition as a way to “trans the gay away,” a phrase commonly used online to describe this phenomenon.
Physical complications from medical transition are a constant source of distress for group participants. Long-term follow-up studies of cross-sex hormones and surgical interventions document risks including bone density loss, cardiovascular complications, sexual dysfunction, and chronic pain.15,18-19,22,27 Combined with deep regret over harmful medical interventions and sadness over lost years, these challenges create an almost unbearable burden. The age range of participants is striking, spanning from 18 to 85 years.
As awareness of detransition grows, so too must the willingness of clinicians and researchers to listen without defensiveness or ideological bias. Those who come to regret medical transition are not anomalies or statistics; they are individuals whose experiences expose critical gaps in clinical practice, healthcare systems, and cultural assumptions.
The field owes it to these individuals to take their experiences seriously. This includes investing in robust psychological support, ensuring proper assessment and informed consent, and creating space for identity exploration without rushing toward medicalization. Above all, it requires compassion—not only for those who transition but also for those who choose a different path.