British Psychological Society paper shows that detransition is incredibly low.

[ItsAllGoingToBeFine]

This was posted on Twitter by Jolyon Maugham.

He has helpfully posted a link to the paper ( shop.bps.org.uk/publications/journals-and-periodicals/counselling-psychology-review-vol-34-no-1-june-2019.html ) but you need to pay to view it.

The abstract states that they randomly chose 303 patient files, followed them up and found one case of detransition. They conclude that as detransition is so low there is no need to slow the "pathway".

I'd be really interested to know how rigourous the methodology is - for example the abstract does not state how many of the random patients were actually tracked down.

I know some folk on here are really good at critically analysing and deconstruction journal articles....

Great if proper research is being done.

Can’t see the article via link because as you say it’s paywalled.

Questions that would

Randomly selected from what/who? Eg who diagnosed these people, using what criteria? How were they referred?
What age were they when they transitioned?
How long after transition was the follow up done?
Are the findings statistically significant?
What sex were the participants?

Is ‘still transitioned’ the best measure of success/wisdom of a fast pathway - eg are people happier/more stable etc?

So I've found it (without paying).

I think it is fairly important that all of the random people they selected to study are current patients - surely detransitioners are unlikely to be current patients?

The authors note later on that long term studies would be interesting, but "are not demanded of other established medical interventions".

They conclude that as transpeople kill themselves a lot the moral and economic thing to do is to ignore detransitioners (massively paraphrasing obviously).

Also what does 'transitioned' mean in the paper? Full surgery? Partial surgery? Hormones? Social transition? Presenting as, full or part time? Internal ID with no external change?

Oh and when discussing lack of long term follow up as a potential limitation they then spend a long time explaining why long term follow up is not possible.

I'm not one of the smart people on this board, and even I can see that this paper is woefully inadequate.

The rate of detransition is known to be low among adolescents taking puberty blockers, and high among those not taking puberty blockers. So there's another two factors to take into account.

OP your last post...
Long term studies are never done on any other medical interventions, what?
Current patients only?

Well that sounds silly.

@ItsAllGoingToBeFine could you post a link to the free version?

What they need to be doing is following through the current cohort of thousands of teenage girls who are transitioning and seeing where they are in 10 years' time.

Long term follow-up is demanded of any medical intervention likely to have a long term impact. For example the standard survival rate for cancers is 5 year followup and that is just the first measure - and that is for treatments that prevent death in the short term.

So actually, the paper shows that detransition is incredibly low, short term.

Which is pretty much what you'd expect just by using common sense, isn't it.

To answer the excellent questions:

Randomly selected from what/who?
Current patients at Nottingham Centre for Transgender Health

Eg who diagnosed these people, using what criteria?
Not stated

How were they referred?
Not stated

What age were they when they transitioned?
Not stated

How long after transition was the follow up done?
Unknown, but the study involved examining files of current (non discharged) clients.

Are the findings statistically significant?
No statistics (other than calculation of percentages).

What sex were the participants?
Not stated.

Also what does 'transitioned' mean in the paper?
A patient of the clinic.

could you post a link to the free version

Sorry, free to me I meant. I have academic access.

So actually, the paper shows that detransition is incredibly low, short term

And that current patients of gender identity clinics are very unlikely to be detransitioners

Long term studies are never done on any other medical interventions, what?

The authors state in their "limitations section"

It would be interesting
to evaluate the long-term outcomes within the
NHS as others have done elsewhere (Dhejne
et al., 2011; Wiepjes, 2018). We say interesting
of course, but note that long-term studies
of decades duration are not demanded of other
established medical interventions. Of course,
as with all long-term studies, drop out will
be high and is perhaps especially so in this
population. Aside from pragmatic concerns
such as contact address and other details
changing over time, there are trans-specific
reasons for loss of follow-up. For example,
Carroll (1999) suggested that patients may drop
out of follow-up due to not having had to think
about transition for many years and understand-
ably not wanting to prolong that period of their
life. Similarly, there are also many barriers
to research participation within these commu-
nities due to lack of trust and worries about
being ‘outed’ (Owen-Smith et al., 2016).

It's interesting that TRAs consider the percent of the trans population that detransitions (say, 2%?) to be so small as to be meaningless. Yet they consider the similar percent of trans persons among the general population (1%?) to be so important as to require in the dismantling of sex-based spaces in society.

'We say interesting
of course, but note that long-term studies
of decades duration are not demanded of other
established medical interventions'

They do long term follow up/ studies on loads of drugs and procedures , I'm sure I've read lots on BBC hardly niche info

Also of interest are the conclusions they draw (note to MNHQ, I am copying a very small part of the full paper, I believe this is fair use):

These rates of detransition within current
NHS treatment protocols at the Nottingham
Centre for Transgender Health are reas-
suringly low. The services, including phys-
ical interventions such as hormones and
surgeries, do not appear to lead to regret
and detransition; at least while people are
still being seen at the Nottingham Centre for
Transgender Health; and we may infer from
this that current protocols are enabling trans
people to live in their desired gender

When considering adaptations one
could make to the protocols to account
for detransition rates, aside from societal
change, there is not an obvious inter-
vention (or given the numbers, need).
In the same way clinicians are encouraged to be cautious about the endorse-
ment of permanent medical interventions;
prolonging assessment may also have
negative effects. Hypothetically, we could
require an extended period of lived expe-
rience in order to identify those who may
detransition, however, it is a case of risk
of detransition versus risk of mental health
problems from being untreated. Imposing
a long wait to the general population
of patients will have negative consequences
whereas timely treatment can bring signifi-
cant benefits. For example, Wilson, Chen,
Arayasirikul, Wenzel and Raymond (2014)
reported that when trans women utilised
trans-related medical care such as hormonal
therapy, this significantly reduced estimated
odds of suicidal ideation, binge drinking,
and non-injection drug use. Using this very
low rate of detransition as a justification
for extending the assessment period would
seem to be unethical to the large majority
who benefit from treatment.
Indeed, not only are the procedures
currently used effective clinically but, for
those of a more brute pragmatic dispo-
sition, they are also effective economi-
cally. For instance, the cost per suicide
in England is £1.7 million (Knapp, McDaid
& Parsonage, 2011) and Terada et al.
(2011) found that 31.8 per cent of patients
with untreated gender dysphoria had
attempted to suicide and self-mutilate.
Consider then that, Bauer, Scheim, Pyne,
Travers and Hammond (2015) noted that
access to medical transition contributes
(alongside increasing social inclusion and
reducing transphobia) to substantial reduc-
tions in prevalence of suicide attempts and
ideation. Therefore, treatment is not only
clearly morally appropriate, but may also
be justified economically.

But i thought some research has been previously blocked? James Caspian's was?

As I understand it, the GIC sees you on a fairly regular basis for a while but eventually the prescription of cross-sex hormones and monitoring is left entirely to the GP.

So the GIC will never know whether you have detransitioned unless you proactively go back and tell them. And why would you want to do that?

Gosh, that's a poorly specified set of methods. Especially with no information on how long since transition, how long at the clinic, and how long most clients stay at the clinic (or indeed how many of the cohort that started with these clients have stopped attending).

They conclude that as transpeople kill themselves a lot the moral and economic thing to do is to ignore detransitioners (massively paraphrasing obviously).

Another question: On what basis do they conclude that transition helps reduce suicide rate? Where is there evidence for this.

Thanks by the way OP. Very interesting topic.

And that current patients of gender identity clinics are very unlikely to be detransitioners

😆

So
We picked and then asked some current trans identified patients if they were in fact current trans identified patients and they confirmed they were current trans identified patients?

I think I may have spotted the methodolical flaw

If they're not actively following up patients no longer in the service, it means nothing.

And what Barracker said!