Gender detransition in Spain: Concept and perspectives

Dear Editor,

The publications by Becerra Fernández¹ and Pazos Guerra et al.² demonstrate the growing interest that gender detransition has aroused among teams working in Spanish gender identity clinics (GICs). Although it is not a genuinely new phenomenon,³ the experiences of these people have received little attention in the scientific literature until recently. The scarcity of information in Spanish has prevented the establishment of a consistent and shared definition of the concept, hampering understanding and communication between health professionals dedicated to this topic. My aim is to offer some suggestions and reflections that contribute to consolidating a common language for the investigation and development of this quandary.

The first issue that I would like to address is of a morphological nature, and has to do with how the English term “detransition” is translated into Spanish. Since in our language the prefixes de- and des- are often used interchangeably to indicate the negation or the opposite of something, “detransition” could be translated either as “detransición” or as “destransición”. The cited authors opt for the first option, which is a textual translation of the term in English. However, as it is a neologism, perhaps the most correct thing would be to use the prefix des-, which is not only the variant most frequently used in medicine, but also coincides with the most correct form at the etymological level (from the Latin dis-).⁴

The second issue is of a conceptual nature, and alludes to the differences that exist between gender detransition and another related, but qualitatively different, phenomenon: desistance. According to the data, between 60% and 90% of boys and girls diagnosed with gender dysphoria (GD) stop showing the criteria established for this condition when they reach adolescence.⁵ The term “desistance” is the one that has been used in the specialised literature to refer to this phenomenon of remission of GD, and constitutes one of the most significant factors in the study of its evolutionary trajectories.⁶ Contrary to what happens in desistance, gender detransition does not necessarily imply remission from GD, since some people who detransition may continue to meet the criteria to receive such a diagnosis (for example, strong desire to be of the other sex, strong desire to get rid of one’s own sexual characteristics, strong desire to possess the sexual characteristics of the opposite sex)⁷ long after having decided to detransition.⁸ In contrast, the concept of desistance is used to designate those cases in which the GD subsides without having initiated any type of gender transition, while detransition occurs when stopping and reversing a previously started process of gender transition (social, legal and/or medical). It is important not to confuse the two concepts or use them interchangeably, as they denote different realities.

Thirdly, it would be convenient to establish a specific criterion that would allow for distinguishing between “genuine” cases of gender detransition and other types of situations that are similar in appearance, but with a different origin. My suggestion is that, instead of interpreting any interruption of a transition process as a detransition (without delving into its particular causes), this concept be reserved exclusively for those cases in which there is a cessation or modification of the identification with the gender transitioned to. This criterion offers us the possibility to differentiate those people who wish to stop and reverse their transition processes because their main motivation for transitioning (their gender identity) has changed, from those who are forced to stop their transition processes for reasons beyond their control (unwanted side effects, lack of social/family support, etc.) or who stop because they have already achieved the desired physical changes,⁹and not for reasons of an identity nature.

Gender detransition could then be defined as the abandonment and reversal of the transition process as a result of the cessation of or a change in identification with the gender to which the person initially transitioned. This way of characterising gender detransition is more precise and provides us with greater conceptual clarity. For example, in their article, Pazos Guerra et al.² speak of detransitions with or without “identity desistance”, that is, associated or not with a “change in the initially manifested feeling of identity”. In my opinion, this description mixes the concepts of desistance and detransition and can lead to misunderstandings, a situation that could be avoided if, instead of this, we establish the cessation of identity as a key factor to identify a detransition. In this way, moreover, it would not be necessary to specify whether or not the detransition is accompanied by a change of identity, since this is already implicit in the very definition of the concept. Furthermore, a person’s desire to reverse their transition process could hardly be understood without first acknowledging the underlying identity motivation.

What the study of gender detransition highlights is that the relationship that exists between the diagnosis of GD and transgender identity is not isomorphic.¹⁰ The diagnosis of GD is the result of a rigorous and essential psychological evaluation process within teams working at GICs, while transgender identity is the result of a subjective process of self-determination. This explains why some people who detransition continue to experience GD, or why there are people who meet the criteria for GD but do not identify with the opposite gender and seek alternative pathways to transition to deal with it. Since identities are part of individual subjectivity and can fluctuate over time, decision-making in clinical contexts should not be guided solely by identity considerations. On the contrary, it is important to approach these processes from a holistic and biopsychosocial perspective that takes into account the intensity of the GD and its progression, as well as its developmental context and any other possible associated psychological difficulties or psychosocial vulnerabilities.

Conflicts of interest

The author declares that he has no conflicts of interest.

Acknowledgements

To José Ignacio Pérez, Karmele Salaberria and Isabel Esteva, for their comments and suggestions on earlier versions of the manuscript.