Harmed by Medical Transition

The four stages of detransition

With #DetransAwarenessDay approaching on Thursday, March 12th, this essay shines a light on the four stages of detransition – a process far more complex than is commonly understood.

Many people assume that detransition is a single, decisive event. It is not. The truth is more unsettling. While a small minority of people undergo medical transition and later arrive, sometimes many years afterward, at the sudden conclusion that it was a mistake and move swiftly to reverse course, this is not how detransition usually unfolds. More often, it emerges slowly, unevenly, and at great personal cost.

For most, detransition begins as an unsettling thought-worm lodged inside the mind. I remember one detransitioner describing how she would wake in the middle of the night, every night, sobbing uncontrollably. By morning, she would resume her trans life as though nothing had happened, only to be challenged again by reality in the deep and dark hours of the night.

Detransition is often unfathomable for many – hence the pernicious slogan ‘Death before Detransition.’ Over time, and often against considerable psychological resistance, individuals begin to confront a possibility that is almost too awful to contemplate – that they have made a profound and irreversible mistake.

Even the word detransition fails to fully capture this experience. As one individual said to me, “Transition is the wrong word, and detransition is also wrong.” Nevertheless, at Genspect, we use this term while recognizing both its limitations and the strong feelings it provokes. Some people describe their experience as “relinquishing a trans identity,” “rejecting the trans delusion,” or “escaping the cult.” Others reject the concept entirely, believing it oversimplifies something far more complex. Whatever language a person uses, we recognize this as a legitimate human response to the harms of medical transition, and we support individuals wherever they are within it.

Because this experience unfolds across multiple dimensions, it is best understood as occurring across four distinct but interconnected stages, each representing a different aspect of a person’s attempt to reclaim coherence, embodiment, and agency after medical transition. These stages overlap, stall, and shift direction as individuals reconsider their identity, their bodies, and their future.

These include psychological detransition, which involves a shift in beliefs and internal self-understanding; social detransition, which involves changes in presentation, roles, and relationships; legal detransition, which involves reversing formal identity markers such as name and sex designation; and medical detransition, which involves reducing, stopping, or managing the physical consequences of medical interventions. These domains are not steps in a sequence, and individuals may experience one, several, or all of them. Many remain within a single stage without ever entering others. Taken together, they provide a framework for understanding detransition as a complex human experience that reaches into the mind, the body, and the structures that govern social and legal recognition. In this sense, detransition is best understood not as a simple reversal, but as a re-engagement with reality, embodiment, and personal agency at a pace and depth unique to each individual.

For clinicians, lawyers, policymakers, and other professionals, understanding these stages is essential. Without this framework, individuals harmed by medical transition risk being misunderstood, dismissed, or left without appropriate care and legal recognition. Each domain presents its own psychological, physical, and practical realities. Failure to recognize this complexity can prolong suffering and obstruct recovery.

The four stages outlined below provide a descriptive framework for understanding the varied realities of detransition. They are not prescriptive, but intended to help individuals, families, and professionals recognize and respond to this experience with greater clarity.

1. Psychological Detransition

Psychological detransition happens on the inside. It is the internal, cognitive, and emotional process through which a person begins to move away from the belief that medical transition is their best – or only – path. It may involve no longer identifying as transgender, or no longer believing that they are, in essence, the opposite sex. Alternatively, it may involve recognizing that medical transition is not working out as they had hoped. This can happen regardless of whether anything changes externally. A person may continue living socially or medically as trans while internally, something fundamental has shifted. Psychological detransition is, first and foremost, a shift in self-understanding.

Psychological detransition often begins when the promises of transition fail to match lived experience. Something does not resolve, and they feel unsettled by this. Doubts emerge unbidden, often long before the person consciously allows themselves to acknowledge them. Many people have ruefully described to me how they first started to “hate watch” Genspect and similar material, drawn to it despite themselves. They watched in secret, unable to fully admit, even to themselves, that their life plan had begun to fracture.

We often meet people in our Beyond Trans support group meetings who describe themselves as “detrans curious.” They are beginning to question, but they are also afraid to question. They understand, at some level, the implications of their thoughts, and it is frightening. This is a vulnerable group, and the elevated rate of suicidality is always on my mind when working with them, especially in this context. Many feel overwhelmed by what they experience as forbidden or heretical thoughts. They dread the reactions of others and fear the loneliness of losing their community. They may also fear upsetting their children, their students, their patients, or damaging their professional identity if they detransition physically.

Many describe feeling trapped, psychologically paralyzed, unable to act on what they are beginning to understand. A person can remain in this stage for years. Some remain in it for life.

Ideological detransition sits within this psychological process, but the two are not the same. Not everyone who psychologically detransitions was ever deeply ideologically committed to gender identity beliefs. Some people pursued medical transition as a way to cope with distress, vulnerability, social influence, or clinical guidance, without ever fully internalizing the broader conceptual framework. For them, psychological detransition is less about rejecting an ideology and more about slowly coming into a clearer understanding of themselves. Others, however, do undergo a more explicit ideological shift. They begin to critically re-examine the belief system that once gave meaning and justification to their transition, and eventually relinquish it. Ideological detransition is, therefore, one possible part of psychological detransition, but it is not universal.

For those who do experience ideological detransition, it often begins with some difficult-to-answer questions. The person may no longer feel convinced that they were “born in the wrong body,” or that they possess an innate “gender identity” that overrides biological sex, or that medical transition is a necessary or evidence-based solution to psychological distress.

It is important for the wider public to understand that psychological change does not always lead to immediate or complete reversal of social, medical, or legal transition. Some detransitioners change their beliefs while continuing certain aspects of transition. Many profoundly regret the entire endeavor. For example, a person may come to believe it is not literally possible to change sex, yet continue taking cross-sex hormones or using preferred pronouns. They believe they have passed the point of no return, that they have permanently altered their bodies, and that there is no way back. They have psychologically detransitioned, but they are fearful of making further major decisions – these decisions have not worked out well for them in the past, and so they find it difficult to trust themselves. Others cannot face attempting further medical or legal interventions that would dramatically alter the course of their lives. As one detransitioner said to me, “I just want off the crazy train.”

2. Social Detransition

Social detransition refers to changes in how a person identifies and presents in their social world. It involves stepping away from a transgender identity and beginning to live, once again, in alignment with their biological sex. This may include changing their appearance and discontinuing practices such as binding, tucking, or padding. Some return to their given name, others choose another name altogether. Most begin using sex-based pronouns, although many liberate themselves from participating in compelled speech and tell people to use whatever pronouns they wish.

Social detransition is often one of the most emotionally and relationally complex aspects of the process. It requires renegotiating relationships with family, friends, colleagues, and wider communities. It can feel embarrassing to ask people to participate in their detransition, having once requested the reverse process, and many detransitioners seek to avoid this. Some worry about how others will react, particularly if they had previously asserted their identity with conviction or insistently requested that others affirm it. They fear rejection and often feel ashamed. Many are cast out from the LGBTQ+ community, and the loss of belonging is felt keenly.

Social detransition can be emotionally exhausting. Many dislike the performative basis of wearing signifiers such as make-up or long hair to demonstrate that they are female. They know they are female, and they know they have been harmed by medical transition, but they do not want to yield to the pressure to perform womanhood. Many female detransitioners have body hair, facial hair, receding male-pattern baldness, and a masculinized voice, and their ability to present to the world as female is severely compromised. They do not want to shave twice a day or undergo painful and sometimes ineffective electrolysis.

Many also fear that gender dysphoria may return if they feel pressured to alter their natural presentation. For example, women who have consistently presented in a more butch or masculine way since childhood may feel deeply uncomfortable trying to “wear femininity,” as it can reawaken feelings of dysphoria that they do not want to exacerbate. For these individuals, detransition is not about adopting stereotypes of femininity, but about accepting themselves as they are.

For some, social detransition happens gradually. They may first confide in a small number of trusted people before making wider changes. Others begin by altering their presentation without explanation. Some adopt a more androgynous presentation, allowing them to live more comfortably without feeling pressure to conform to sex stereotypes. Some never fully detransition socially, choosing instead to live in a space of ambiguity to avoid confrontation or distress. Others socially detransition in some circles but remain trans-identified in others – their name and pronouns change depending on the context.

Social detransition can occur with or without medical detransition. For many, it represents an attempt to restore coherence between their internal reality and their external life, even when medical changes cannot be fully reversed.

3. Legal Detransition

Legal detransition refers to formal changes to a person’s legal identity. This may include reverting the sex marker on official documents back to their biological sex, returning to their birth name, or changing a previously chosen legal name. These changes affect passports, driver’s licenses, medical records, educational qualifications, and other forms of identification that shape a person’s ability to move through the world.

Legal detransition varies widely in meaning and timing. For some, it is an administrative step. For others, it carries deep emotional significance.

Legal detransition may occur early, later, or not at all, depending on personal circumstances, safety, financial constraints, and legal barriers. In some regions, reversing a legal sex marker is relatively straightforward. In others, it is extremely difficult, as administrative systems were designed to accommodate legal transition but have no clear provisions for reversal. This can leave individuals in a state of permanent legal ambiguity.

In Ireland, for example, an individual who legally transitions must declare their intention to live in the acquired gender for the rest of their life. This declaration can weigh heavily on detransitioners who no longer feel able to do so and are uncertain about the legal implications of reversing course.

This reality becomes especially visible in public settings such as airports, where identification documents are routinely checked against a person’s physical appearance. This will arise frequently in March, as up to 70 detransitioners travel to Washington, DC, for Detrans Awareness Day. Many will not present in accordance with the sex marker on their passport, and airport authorities will need to navigate this discrepancy. By the end of March, officials in DC may well find themselves unusually well educated in the practical realities of detransition.

Legal identity can lag behind psychological and social reality by many years. Until documents are corrected, individuals may face confusion, scrutiny, or administrative obstacles in everyday activities such as travel, employment, and accessing services. Legal detransition, where possible, represents an attempt to bring official recognition back into alignment with material reality.

4. Medical Detransition

Medical detransition involves reducing, stopping, or attempting to reverse the effects of medical interventions such as cross-sex hormones, puberty blockers, or surgeries. For some, this means discontinuing hormones. For others, it involves managing the long-term consequences of interventions that cannot be undone.

Some individuals detransition medically because of adverse side effects, declining health, or concern about long-term bodily function. These concerns can lead to psychological change and bring about a cascade of psychological, social, and legal detransition. “It’s like putting petrol into a diesel engine,” many have said. “The body seizes up.” This can create many questions for the individual, beginning with the most basic: if I am meant to be female, why is my body harmed by estrogen?

Others reach this stage after a psychological or ideological shift. They no longer wish to continue medical treatment, but stopping can be physically and emotionally complex. Hormone dependence, surgical changes, and permanent alterations to the body mean there is often no clear path back to a pre-transition state. Male detransitioners, for example, must stop estrogen while living with breast growth, sexual dysfunction, infertility, and changes to their skin, fat distribution, and emotional regulation, knowing that some of these effects may never fully reverse. Many who have undergone vaginoplasty are especially afraid to take testosterone, as they do not want the return of libido. They also fear hair growth in unwanted areas.

Some believe they are past the point of no return and feel unable to medically detransition, even if they no longer believe in the rationale that led them there in the first place. For example, a female whose puberty was blocked, who then took testosterone for many years, and underwent mastectomy, hysterectomy, oophorectomy, and phalloplasty, may fear reintroducing estrogen into a body that is no longer equipped to process it as it once did. Quite simply, these detransitioners are afraid to medically detransition. It would be an experiment upon an experiment. Others are determined to reverse course, only to be confronted with serious challenges when reconstructive surgeries fail. This can lead to mental collapse as the medical nightmare feels unending and unsolvable.

One detransitioner said, “I had to stop digging. I just take low-level hormonal treatment so my body can function. I don’t know what else to do.” Medical detransition is not a single act, but an ongoing process of coming to terms with a changed body.

Detransition: A Non-Linear, Individual, and Complicated Process

Detransition is not a checklist, and it is not a hierarchy. It is a deeply personal process that unfolds unevenly, often over many years, and under conditions of profound mental pain. A person may be psychologically or ideologically detransitioned while remaining socially or legally transitioned, while another may stop medical treatment long before they fully understand what has happened to them. Some remain in one stage indefinitely. These are individuals who trusted medical authorities and were harmed, sometimes irreversibly. Their task now is to live with the consequences and to restore coherence between their mind, their body, and their life. It is inappropriate to pressure, encourage, or hassle detransitioners toward any particular stage. This is not a linear recovery, and it cannot be forced. These are patients who have been harmed by medical transition, and their recovery must proceed at their own pace, guided by their own readiness and their own hard-won understanding.

If you are a detransitioner and would like to attend Detrans Awareness Day in Washington, DC, on March 12th, funding support is available. Please email beyond@genspect.org to apply. You can also support this historic event by attending in person, joining online, or making a donation to support detransitioners.