I found an old quote off of one of my posts on the tumblr “ftm detransition tag,” and that it had been picked up (gleefully? lovingly?) by an anti-transition radical feminist who has also posted about testosterone being a deadly drug. (According to her blurb, she might be an ex-trans-person herself, for what that’s worth.)
(I’m indebted to Susan’s wiki outline for this, weirdly enough: I don’t think I’ve ever seen it laid out at all, with subheadings and differentials and checklists and so on.)
There’s preventing regret, an implicit social responsibility and an official medical and patient responsility. This prevention inhabits all stages of the process: doctors are supposed to consider regret at each new step in transition, and most of all when they are evaluating patients for surgery. Trans people must scrutinize themselves for regret and potential regret. They must also constantly field concerns about regret as a community.
There’s proving the absence of potential regret, which still forms part of some standards of care, particularly those related to the RLE.
There’s defining likely indicators of regret, which is something clinicians and trans people are supposed to do in unequal collaboration.
There’s regret due to negative consequences of transition: lost family, lost job, lost marriage.
There’s regret due to the perceived inadequacy of treatment or subjective judgments about the potential of treatment.
There’s regret due to transitioning too quickly or without sufficient support.
There’s regret due to transitioning too slowly, transitioning in fits and starts, or transitioning late.
There’s regret due to being transsexual, i.e. having been “born in the wrong body.”
There’s regret due to transitioning into a male or female identity that doesn’t fit an ambiguous or complex internal landscape.
There’s regret due to mistaking a different trans status for transsexuality, e.g. transitioning when you are actually satisfied with cross-dressing.
There’s regret due to ideology, such as religious belief.
There’s regret due to internalized prejudice, such as homophobia, sexism, or transphobia.
There’s regret due to having made a terrible mistake about one’s gender identity.
There’s that population of regretters, people who made a terrible mistake about their gender identity or were victimized by doctors who made a terrible mistake about their gender identity. They seem to make up the smallest population of regretters, and are by far the population that has the least amount of contact with care providers (who claim not to encounter them), but they form the archetypal demographic for “regret.”
There’s the assumption that we must protect these people from themselves.
There’s the assumption that we must protect ourselves from these people.
There’s the assumption that this population will become a more real terrifying reality as transsexuality becomes more commonplace and accessible: that they are coming, increasing.
There’s retransition to mitigate negative consequences of transition.
There’s regret due to the failure of retransition.
There are trans people who have stopped transition or even reversed somewhat and then started again–Jan Morris and Renee Richards are two examples; Richards even had a mastectomy at one point.
There are trans people who have gone back into the closet and then re-emerged, sometimes years later.
There are trans people who agonize over their decision for years or decades, in part because of fears of regret.
There are clinicians with evolving attitudes towards control, support, and authority.
There are official standards with evolving attitudes towards regret.
I’m looking back at old posts on Feministe and comparing them to the stuff I’m producing now, and there’s more refinement. I also remember just about having panic attacks every time I posted something.
I have found a webpage with advice for detransitioning. The webpage is under construction. It’s also a small, never-finished supplement on “Susan’s Place,” a website dedicated to providing information to trans people in transition. (Some of the claims on the website are controversial.)
It is a little shocking. Not in itself–it is written in clear, level-headed, clinical prose, laying out different reasons for detransition and different factors to consider when planning the journey back. But I don’t remember seeing any such précis when I detransitioned. I felt almost completely alone. Nothing about it seemed straightforward, either. I didn’t feel like I was in process, or that I was considering anything. I felt like I was quitting.
I felt desperate above all else. I was still not sure that I would be able to become a woman again, let alone a normal woman, and so I was extremely anxious to establish feminization, to gain ground. I was also defensive about my female identity–I felt suspect, insane, and I was eager to assure myself and everyone else that I was really a woman, that this was real.
I fel isolated. I had some support from counselors, and a great deal of support from friends and family. But I didn’t feel as though I was part of any group–I felt, rather, as though I was formally distancing myself even from the tiny community I had joined. I felt unique in the worst way.
I felt pessimistic–I was in despair. I believed that I would never be normal again, that I would never be attractive again, that I would never look like a woman again. I believed that I would never pass. Part of this is down to my therapist–she underestimated my body’s ability to shift back, and effectively locked me into the point on the presentation spectrum where she had first met me. Part of it was simple transphobia. Part of it was simple unhappiness. I don’t think I would have been confident in my ability to do anything.
I also feel as though I was left to my own devices. Nobody challenged this decision, or tried to oversee it in any way, apart from offering a very bare-bones level of support. The care providers I worked with at Kaiser didn’t seem to think of themselves as having much of a role. They didn’t seem to see me as going through anything, only stopping the process I had embarked on earlier.
This wiki describes detransitioning very much as a process. Not only that, but as an affirmative decision with pros and cons. Susan also describes detransition as a difficult process that requires a great deal of careful thought and planning–not something one can just rush into:
Detransition has to be done considering the consequences just the same as when having chose [sic] to transition in the first place.
Nothing could have been further from my approach–or what I gleaned from the reactions of the people around me.
I don’t know if Susan’s approach is right, or even if it would have been more helpful to me. I know that I wouldn’t have responded well to any demands that I slow down or delay.
It might have helped me to see some of the pragmatism reflected here:
While on paper it is best to try and prevent regret of transition, in the effort to try to be more true to self identity wise, it’s easy to overshoot the mark using stereotypes of dress and/or behavior to gauge progress.
On the other hand, it might have made me even more miserable to hear that my gender from there on out would be a performance–that no matter what I was, I was building a gender. I was desperate to establish that I was still genuine, not artificial or studied.
And this is interesting:
The choice to detransition back to the gender role assigned at birth can be a much more difficult task then starting transition was. Depending on the progress made, it can be impossible to revert without loss of privilege previously enjoyed. (because one can’t “take back” coming out)
I don’t know if I agree, either. Detransition itself might be a difficult process given its ambiguity and infrequency, but it offers a safer harbor. People who detransition transition back into cis identities and bodies: the privilege inherent in this status can’t be understated.
Moreover, I disagree with her statement that one can’t erase coming out. I encountered a lot of support in my decision to burn my manhood down and never look back. I think some of the people around me, my parents in particular, were happy to pretend it had never happened. Some of my family had trouble acknowledging my transition while it was happening, and processing the changes to my body and my presentation as drastic or decisive. Some of the ease of back-shifting is also related to our attitudes towards gender. We think of gender as permanent and binary, and so we choose.
And then it just trails off:
(discuss why happens and how to manage)
Most of the page is devoted to retransitioning, which Susan distinguishes from detransitioning. Retransitioning is adjusting your transition, either by adjusting your target gender:
Retransition, while technically a way to resume transition in progress, is where one changes path to fit a unique identity. Most of the time this means an androgynous identity and/or expression, where acceptance of the grey zone between male and female is preferred to attempting to act a role in the name of appeasing society.
…or by modifying your strategy for better success:
Stopping transition from lack of social support may be from any number of factors that may not be apparent at first glance. Not “passing” as ones gender nay be bad choice in clothing style and/or colors, need to change hair style, or facial hair removal. Subtle mannerisms such as walking style (hips vs shoulders) and how voice is used (statements vs question tones and emphasis of beginning of words vs a flowing effect) can shape how gender is perceived.
I’d never heard these terms used this way before; usually retransition and detransition are used interchangeably, and I use them that way myself. I’m not sure there’s any standard here. I’m not sure what to think about this distinction.
That article on LGBT.co.uk, mentioned another controversy in the UK, about a doctor, Richard Curtis, who is being sued by a patient for wrongfully allowing her to transition. The suit alleges that the doctor was committing malpractice by prescribing hormones and offering a referral for a mastectomy to this patient given his interactions with her. The response to this suit included a twitter feed, #TransDocFail, in which trans patients had the chance to excoriate doctors and other healthcare providers for being transphobic. Cis readers were duly shocked at the anecdotes, which involved anything from misgendering to insults to a flat refusal to use the patient’s legal name ever. One post-op patient was refused documentation from her GP that she had undergone surgery.
I didn’t see any references to tweets about this particular problem, though: the feed was set up for patients to share transphobia stories, not for patients who felt their doctors had wrongly allowed them to transition. There’s nothing wrong with that, politically or strategically, but it’s interesting. It’s also interesting that the shift in theme doesn’t seem to be reactive–that is, collecting complaints about doctors who exclude trans people from treatment or offer it only on humiliating, frustrating terms was not a response to this story about a regretter who is suing her doctor. It wasn’t an effort to turn attention to a far more common, more serious form of medical mistreatment of trans people.
Even though there is a current debate in the trans community about what to do about Everyone’s Worst Nightmare (Resolved: Haven’t We Been Through This?). This patient isn’t only the embodiment of cis fears about trans as a destabilizing influence. This patient embodies care-provider fears about the risks of proxy: what if they sue? Between the vindictive litigation and the false gender positive, this patient stands in the gender anxiety that underlies both clinical and lay attitudes towards trans people: what if they’re all dangerously insane?
I’m being flip here; I don’t mean to be. I’m not commenting on the justice of the suit or the justice of worries about this lawsuit in the context of NHS provision of treatment/access.
But it’s interesting. Between the complaints that the media loves to run with stories about trans regretters and the fact that the media loves to run with stories about trans regretters, it’s interesting that this story has become about the abuses of the medical profession and especially its tendency to make transition needlessly difficult for trans people.
That isn’t a story that gets much play. Most people don’t know that much about the process; most people haven’t thought very much about what its consequences are; most people believe that trans people should have to submit to some proofs and checks before being allowed to transition. I don’t think more than a tiny minority of cis people would question the idea that trans people should be allowed to transition–or the implicit converse, that some may therefore be rejected and that all will thus be delayed. Informed consent would probably match with terms like willy-nilly and taxpayers. Or maybe lawsuit.
It’s even more rare that these barriers are framed as a moral issue–when they are discussed, it’s usually in articles that purport to show readers what it’s like to be a transsexual person, and presented as simple fact alongside the procedural details of surgery and the parents’ list of childhood portents. To be transsexual is to have a doctor. Even though stories like those populating the hashtag are really common, and even though many transsexual people are rejected, I don’t know if I’ve seen much reference to the fact that delays are common, that access is cut off.
This doctor is being sued for being too helpful, too permissive:
The allegations include commencing hormone treatment in complex cases without referring the patient for a second opinion or before they had undergone counselling, administering hormone treatment at patients’ first appointments, and referring patients for surgery before they had lived in their desired gender role for a year, as international guidelines recommend. One patient allegedly underwent surgery within 12 months of their first appointment. He is also accused of administering hormones to patients aged under 18 without an adequate assessment, and wrongly stating that a patient seeking gender reassignment had changed their name.
And then there’s this woman:
One of the most serious cases concerns a female patient who regrets switching to a male role. She underwent hormone treatment and had her breasts removed. The woman is one of the complainants in the current GMC investigation.
It’s interesting that the other allegations are not specified this way: it’s not clear whether those people regretted transitioning. If your doctor offers you the correct treatment without making sure it’s correct, can you say that you have been harmed?
The article also references the WPATH SOC (formerly known as the HBSOC):
Patients seeking breast or genital surgery should have “persistent, well-documented gender dysphoria”, be over the age of consent, and have the mental capacity to consent to the treatment. They should live full-time in their desired gender role for at least a year before surgery, to see how they cope with work, family, friends and relationships. But the guidelines are not legally binding but flexible directions which can be modified to suit a patient’s needs.
That quote comes from an article about the recent Trans Mental Health Study, the largest ever undertaken in Europe, which asked respondents whether they felt regret. The responses highlight some of the problems with defining regret as a concept. Can you regret a problem that had no real solution, like the best way to come out to a hostile family? Can you regret something that was out of your hands entirely, like your surgery results? Can you regret something that was out of anyone’s hands, like your genetic makeup? Can you regret abuse or mistreatment–can you regret being the victim of someone else’s crime? Does regret over lost time or lost relationships count as trans regret?
It wouldn’t seem so. I’m sure this isn’t the picture of “trans regret” that the Daily Mail readership carries around in its head. I know it isn’t the “trans regret” that controls are supposed to fix at a minimum.
These responses made up the overwhelming majority of “regrets” cited by study respondents, the overwhelming majority of whom (I feel clumsy saying ‘overwhelming majority’ over and over again, but it’s not sufficient in context to say ‘most’) did not regret the decision to transition or the decision to undergo any particular medical procedure or take any particular legal or social step towards openly living in their new identity.
Several quoted respondents use “regret” to mean “miss,” or “mourn:” they miss the prestige manhood offered them, the prestige (ostensible) cis status offered them, they miss parents, friends, professions. They miss acceptance. They also miss things they never had: a male childhood, a female adolescence. They mourn safety and kindness. They mourn loved ones who have declared them dead. Some of them “regret” sad necessity, like non-disclosure about trans status.
No one seems to regret any quality or detail of man or womanhood, or any part of their body–although they do miss sensation in the case of post-op “regret.”
Nobody regrets transitioning. Nobody misses their old gender. Nobody mourns their old body. Nobody feels remorse about not waiting several more years. Nobody regrets the permission they were granted or the support they finally received.
I wonder, sometimes, whether I regret it myself. On one level, I hold the purest, least-ambiguous claim to regret: I quit, after all, and have never looked back. I also wouldn’t say that I regret becoming a woman again. I do not wish I were still a man, and I doubt very much that I will ever become one a second time. My personal regret does not encompass revulsion or alienation. I am not sure I minded being a man. I know that there were some things, some times, I enjoyed very much. There are some parts of manhood that I regret as in miss or mourn.
I may regret the way in which I came back. I regret that I didn’t allow myself to retain anything, even most of my memories. I regret that I didn’t allow myself to miss or mourn anything about being male, or any part of my male body. I regret that I was so uncompromising–so draconian–in my attitude towards what I had done. It wasn’t only that I was consumed by shame: shame consumed any sense of happiness or even humor out of those few years. It was all gallows.
And now that I’m trying to write this book, shame stands in the way. I have trouble evaluating any of this, even the internal parts, because so much of my identity was subsumed in regret. This was not what I wanted.
And so I will have to ask not only how common people like me really are, but how deep those feelings truly run, what anchors them in fact. I may have been forced into a performance of regret just as one is forced into a performance of gender. Regret became as much of an identity as male ever was, as female ever has been, and because it felt so suspect and so crucial, I may have devoted more energy to maintaining it than either gender I claimed.
I miss or mourn my sense of my identity as something that dignifies me. I miss or mourn my sense of identity as something I have a right rather than an obligation towards. I miss or mourn my ability to honestly love, freely enjoy, both body and identity, instead of holding onto both identity and body as a kind of shield against judgment. I miss or mourn the assurance that I was not wanting.
And I miss, or mourn, the person I was before regret entered my life.
One of the more difficult parts of this gathering stage is the definition of regret, which is amorphous–more described in its absence. Re-transitioners are a tiny group–a tiny minority within a tiny minority. They’re also a misunderstood minority within a misunderstood minority.
Rationales for transition–and the threshold motivation for transition–have an evolving definition within the gatekeeper community. When Harry Benjamin wrote his treatise on transition, his threshold was essentially a terminal case: someone who could not function within society, someone who might well commit suicide without access to treatment. That definition has softened over the years, in part because the original proofs of that desperation can only be found through clinical inhumanity. Deep and intractable need continues to be a property of transsexuality as a clinical and community definition and a proof of the validity of transsexuality as a human condition.
The definition of transsexuality operates within a sense of assigned gender as profound: losing gender is almost like losing a part of your body or brain. Gender is a social language; the amorphous refuse to speak to the rest of us, the transgender tell us lies, and the transsexual mutilate their own apparati. Whatever your reasons for that willful self-destruction, they had better be good. Activists and community members have challenged this assumption, but it is still current. To the extent that transsexuality is regarded as gender instability, it is regarded as frivolous, unserious, irresponsible when it is not insane. It must be both justified as necessary and dignified as sensible.
Still, what is that need based on? When a patient describes that need, what psychological referents do they rely on? How deep does it go?
The varying answers to these questions mean that there are varying wrong answers: just as people disagree on the properties of transsexuality, so do they disagree about the properties of regret.
My therapist believed that she had only seen one other patient who had ‘gone back,’ transitioning back to a male identity and ceasing or reversing the transition process. She believed that her patient was in fact a transsexual woman–at least, experienced significant dysphoria as a man and significant comfort as a woman–and that her patient had transitioned back due to family and social pressure. She named conservatism, especially religious conservatism, as a factor.
In other words, I am alone among her patients: the only one who really made a mistake when I claimed to be transsexual and embarked on the long process that would turn me into a man on the outside. My need was not desperate or profound or intractable. It was not even there.
(I’m going to have to start drafting the “So, what the hell were you thinking?” section right away. Put a pin in it.)
That makes me a rarity. In her experience, which is much more extensive than mine, it makes me unique.
I could challenge her methodology. The gatekeeping model, wherein the therapist scrutinizes the patient’s case for transition from multiple angles, introduces certain complications into the relationship. Patients may feel pressured to hide parts they feel don’t fit, and may feel a more generalized sense of vulnerability and mistrust. She may have encountered regret–not decisive but present, even in a patient who made the right decision–that she could not see. The gatekeeping position also means that the relationship is not normally therapeutic: patients see therapists because they want to solve emotional problems; trans patients see therapists in the context of transition because they want permission to transition. Even when emotional complication is not a barrier to that access, it is beside the point. The therapist may not even be particularly interested in exploring deeper or parallel emotional issues. I have to say that mine did not seem terribly concerned, although she may have seen me as well-adjusted and generally happy.
There are valid reasons for this partial relationship. Trans patients may not want or need therapy per se, and may feel this attention to be intrusive. Given that there are few ways to go forward without approval from a counselor, you could argue that it would be unethical for a therapist to act as a therapist towards a patient whose participation is coerced. Moreover, the overwhelming majority trans people report zero regret: it is a factor to guard against, not a factor that trans people hold in common. Based on what trans people say about their process, most trans people do not need therapy for emotional problems resulting from transition, because most trans people do not experience emotional problems in transition.
This conflict between traditional therapeutic motivation and the role of the doctor in transition exists in the original. Harry Benjamin’s thesis was a reversal of the idea that transsexuality was sick and that transition could only be a deepening of the sickness. He argued that a transsexual person–someone “trapped in the wrong body”–only required transition to bloom into emotional and mental health. A patient in transition wouldn’t need counseling to deal with difficulty or stress because there would be no difficulty or stress, only joy forevermore. There is plenty of space in his model for supervision, for interference. Apart from the open-hearted charity he tried to attach to his humane advance, curing a grateful patient of a consuming disease, there isn’t much space for emotional support.
There was thus no space for regret. Any dubious or complicated feelings were grounds for disqualification. Doctors were encouraged to root them out and fix them before the patient was allowed to transition; patients were encouraged to be absolutely sure prior to transition. Each stage of transition involved a delay while the patient became accustomed to the preceding change. Regret was defining: you either wanted it completely, or you didn’t need it at all.
This definition does not match my experience. I believe that complication is common, and only natural. The overwhelming majority of trans people are right to transition: transition is necessary for them and has a strong positive effect on their wellbeing. But no matter how necessary, no matter how supported, transition is difficult. Even someone who never feels regret will deal with a significant amount of stress and emotional turmoil when assuming a new identity and a new body. The trans people I know, none of whom regret transitioning, none of whom feel alienated from their new identities, all report that transition was a traumatic and overwhelming process at times.
I encountered only a few people who believed that they should not have transitioned. I’m the only one whose cross-gender identity was apparently mistaken. One was transgender: androgynous or butch, very invested in feeling masculine. That person believed that they had gone too far by transitioning into a male identity and body: they missed the sense of themselves as queerly gendered. The other person transitioned and had complicated feelings about their new body, but did not feel mistaken in claiming a male identity. I was the only one who fled, the only one whose rejection of my male identity and body was decisive.
Three people, three regrets.