Ex-patient politics in the age of iatrogenesis
What do online deprescribing and detransition communities have to do with each other? A lot, it turns out.
Ex-patients are receiving unprecedented attention in American politics. Recognising difficult treatment outcomes that can confound mainstream clinical knowledge, a recent US Health and Human Services event on overprescribing in psychiatry included speakers who described iatrogenic harms such as post-SSRI sexual dysfunction. In March, Detrans Awareness Day featured detransitioners, with US government representatives vowing to make detransition care a national priority.
Decades without recognition from mainstream psychiatry, many who have struggled to stop psychiatric medications turn to online communities for support. These spaces provide practical withdrawal advice and peer connection. In response to growing public concern about medication withdrawal and unanticipated harms, such as post-SSRI sexual dysfunction, the American Society of Clinical Psychopharmacology recently released consensus statements on deprescribing. The long-awaited guidelines aspire to standardise deprescribing as an ethical and comprehensive aspect of clinical care.
On his substack, Psychiatry at the Margins, Awais Aftab shared that he wants
mainstream psychiatry to take ownership of deprescribing and tapering… to make it routine, boring, to back it with solid evidence about which dose reduction and discontinuation techniques produce the best outcomes…
Likewise, in transgender medicine, a similar issue has been raised: there are many guidelines to initiate and maintain hormonal care, but none to discontinue it. The World Professional Association of Transgender Health in its most recent standards of care (2022) elected to forego a chapter on detransition despite earlier speculation that such a chapter might be rolled out. Kinnon and colleagues have co-authored several papers describing healthcare access barriers associated with hormonal discontinuation, gaps that may be driving detransitioning patients to seek peer supports and information online—on places like reddit. Some detrans online networks bend sharply toward gender critical and trans-skeptical beliefs, giving a similar scorched earth vibe as the anti-psychiatry lens common in the online deprescribing world.
Last week, a team of authors published an article in the Journal of Pediatrics titled “Anticipatory Guidance for Discontinuation of Gender-Affirming Hormonal Care in Adolescent Patients.” This article underlined as its rationale for deprescribing/discontinuation as responding to healthcare “regulatory changes” (e.g. political restrictions on pediatric gender medicine). It barely nods to treatment discontinuation that may be indicated due to treatment side effects, health concerns, identity shifts, or gender expression changes. Disappointing, but not surprising.
When some of the first detransitioners began to organize, writing blogs, giving presentations, and conducting peer-led surveys in the late 2010s, mainstream trans care had no epistemic or clinical framework to receive them. They had already been made invisible by cultural scripts about transness before they even arrived.
The rest of this post tells a story about how an experience once dismissed as practically anecdotal—only one percent—became entangled in one of the biggest political realignments of the 2020s.
The dominant narrative of gender transition in the Anglosphere has long been about triumphant self-discovery, authenticity, finding comfort in one’s body, and of lifesaving medical care. In recent decades, this story has hinged on a powerful statistic: that fewer than one percent of people who medically transition ever detransition.
The one percent became more than just a number. It guided transgender and nonbinary people contemplating hormonal and surgical interventions. It reassured clinicians and parents, while also informing policy. The one percent brought to life a broader affective framework, defining which post-transition emotions and experiences were legitimate to an emerging coalition of identity-affirming clinicians, advocates, and mainstream institutions. The one percent, as a rhetorical device, also implied that those who drifted away from the transition pathway were so statistically insignificant as to be anecdotal, or even deliberate misinformation. It became a statistic of affirmation, while limiting space for ambivalence, uncertainty, negative affect, or studying discontinuation care.
The statistic did not simply describe outcomes; it organised the field of gender care itself.
The narrative of affirmation, fuelled via legacy media, presented gender transition as a linear, teleological journey from suffering toward feeling at home in one’s true gender: an innate self separate from the social world, separate from trauma, sexuality, distress, and neurodivergence. Scaffolded on an “informed consent” healthcare model that disincentivised mental healthcare, clinical assessments, and long-term outcome tracking, identity-affirmation above all else contributed to an environment where anomalies to the reigning paradigm became difficult to see in the academic literature.
But they have become increasingly visible online, in legal challenges, and in lawsuits brought by young people through the 2020s.
From Isolated Blogs to a Detrans Movement
In 2016, Carey Callahan began to question her gender transition, stopping testosterone and moving from a trans man identity to reidentify as a woman. Her therapist helped connect her with another detransitioner who was forming a small, private support group. At the time, Callahan and her peers worked to build a community of mutual aid to “process the impact of growing up female.” Together, they would become some of the first detransitioned women to publicly write about their detransitions, sharing their perspectives online and with journalists. Callahan recalled: “I was writing this blog… and pretty much everyone in my original support group, we were all writing blogs.”
Within this newly forming online network, detransitioners also began conducting informal surveys to document their experiences when few clinicians would. In 2016, another detransitioned woman named Cari Stella ran a survey on Tumblr, collecting online data on the experiences of 203 female detransitioners. In this network, she found that the most common reasons endorsed for detransitioning were finding alternative ways to cope with gender dysphoria and political or ideological changes to their sex/gender belief systems. Feeling adrift in transition and with trans orthodoxy, some had turned to radical feminist or gender-critical ideologies to process their grief and anger at unjust experiences as young people born female, experiences they felt were not always acknowledged by mainstream trans discourse. One research participant who was interviewed for the Re/DeTrans Canada study, who was once involved with early detrans women’s groups before later retransitioning to a transmasculine identity, said:
I was feeling negative and defeated about the whole process of transition. I had this feeling like… is this even something that I could stop? So I started Googling. I wound up finding a bunch of blogs from the women I later got involved with, about detransition, about how it [transition] was the capitalist system making money off our trauma as women. And I’ve always been kind of an angry leftist. So that was attractive to me.
By 2017, some scholars and seasoned gender clinicians began to pay attention to detransition not merely as a clinical outcome to be measured in terms of a statistic, but as a socio-medical process in its own right. Drawing from their clinical insights as a long-time gender care provider, psychotherapist julie graham presented on four different types of detransition/retransition experiences at Fenway Health’s Advancing Excellence in Transgender Health. Carey Callahan and a few other detransitioners also delivered a panel at the United States Professional Association of Transgender Health conference, which was said to be well-attended and generally positively received.
What this new attention revealed, however, was not renewed clinical thinking. Callahan’s next set of panels that were originally accepted by the Philadelphia Trans Health conference were ultimately cancelled after extensive deliberations among the conference planners. Not helping towards fostering a trans-detrans allyship, conservative and religious actors had also began to take notice of detransition stories.
What started to unfold revealed a major schism: different stakeholders all began to work from fundamentally different assumptions about transness and gender care. Within a fracturing coalition, they all began producing radically different accounts of what detransition is, why it happens, and what to do about it.
Anomalies: Detransition and Identity-Affirming Medicine
Detransitioners were not yet a movement, though. They were, for the most part, isolated and distressed individuals trying to make sense of their lives that the clinical world and identity-affirming LGBTQ non-profit advocacy—focused on affirming the true gender self—had no ontological space for.
It was through their online visibility, and through their process of making sense of their post-transition disappointments, medical complications, and rejection from mainstream trans spaces that bridges were built to a burgeoning wave of trans-skeptical clinical reformers who themselves had began to organise.
It was through those connections that detransitioners were introduced to a network of transition-skeptical clinicians, journalists, and to the distressed “Rapid-Onset Gender Dysphoria” parent community who questioned trans-affirmation, scrutinizing the research that was supporting it. Together, detransitioners’ negative feelings about their own transition, increasingly shared online, began to feed the transition-skeptical coalition with affective testimony to affirm their own identity-defining convictions that young people were in danger of being harmed by trans healthcare. In response, their emerging questions about pediatric transitioning and detransition narratives were increasingly interpreted by the identity-affirming coalition as trans-hostility and as an existential threat to the ethos of identity-affirming healthcare.
The first significant break in the trans-affirming media landscape of the 2010s occurred on June 28, 2017, with lesbian journalist Katie Herzog’s publication of The Detransitioners: They Were Transgender, Until They Weren’t in The Stranger. After hearing Callahan’s voice on the radio, Herzog’s curiosity was piqued. She profiled detransitioned individuals who felt, in retrospect, that their gender dysphoria had been a manifestation of other issues—trauma, internalised misogyny, or mental distress—they felt that gender-affirming clinicians had never adequately attended to. The backlash was immediate and visceral. “People were burning, literally burning, stacks of the paper and sending me videos on Twitter,” Herzog recalled. “There were stickers all over Seattle calling me a transphobe, pictures of my face.” The hostility extended into her professional and personal life; Herzog lost friends she had known for a decade: “Last night I dreamt about a bunch of my old friends. It’s been eight years and I still actively dream about these people. That pain will never go away.”
In 2018, four American women who self-identified as desisted or detransitioned founded the Pique Resilience Project, speaking openly about how they felt that their transness and dysphoria intertwined with complex trauma, distress, and internalised misogyny. They were soon joined by other groups, such as The Detransition Advocacy Network in the UK and Post-Trans, in Belgium.
The detrans movement reached a symbolic turning point on November 30, 2019, in Manchester, England, when the first formal in-person symposium for detransitioned people took place. Organised by Charlie Evans, a detransitioned woman who had launched The Detransition Advocacy Network, the sold-out event drew over 200 attendees—including Keira Bell, who would soon bring a landmark judicial review complaint regarding Tavistock’s Gender Identity Development Service (GIDS) in the UK.
The initial trans-skeptical movement’s coalition was notably diverse, reflecting what other scholars have found in analysing the transnational anti-gender and the gender critical movement in the United Kingdom. At the launch of The Detransition Advocacy Network in England in 2019, Evans observed: “You’ll notice that we don’t all agree here and that we’re not united in our views on gender identity or political alignments.” This diversity notwithstanding, the detrans presenters on the panel that day shared a common experience: feeling unable to access recognition, support, or justice within the identity-affirming paradigm.
Soon after, academic researchers began to take notice, publishing papers about detransition beyond a simple prevalence rate. Sociologist Rowan Hildebrand-Chupp published a theoretical article in 2020 titled “More than ‘canaries in the gender coal mine’: A transfeminist approach to research on detransition,” which signalled a significant shift. In it, they insisted that detrans research should aim to support detransitioners, not prevent detransition from ever occurring. Seeming to recognise the epistemic threat that detransitioners presented to identity-affirming trans discourse at the time and the emergent cis/trans binary, Hildebrand-Chupp urged that “we allow detransitioners to exist in the irreconcilable gap between our concepts of trans and cis.” Going further, they also proposed that detransition could be understood as three interrelated facets:
the act of detransitioning
negative transition experiences, and
the detransitioner identity.
Reflecting the infusion of the era’s cultural identitarianism, detransitioners (or, detrans people) began to form as a new kind of person, sometimes also being evoked as symbolic of various culture war issues.
Belgian undergraduate student researcher and detransitioned woman, Elie Vandenbussche, built on Hildebrand-Chupp’s ideas in her survey of 237 detransitioners, published in 2021. Vandenbussche had co-founded a support network for detransitioned women called Post-Trans, which was one of the recruitment sites used to collect data for her survey. Drawing on Hildebrand-Chupp’s dimension of the detransitioner identity, she elaborated that “[B]ecoming a detransitioner involves a fundamental shift in one’s subjective understanding of oneself, an understanding that is constructed within these communities.” Vandenbussche pointed out that detrans identity construction was being negotiated within online peer support networks, including her own. A new gender variant identity category had unfolded in real time. Yet, most of its affirmations would come from transition-skeptics, rather than proponents of identity-affirmation.
By the beginning of the 2020s, Callahan had built a patient-advocacy organisation aimed at gender care reform with a transsexual woman named Corinna Cohn. They called it the Gender Care Consumer Advocacy Network (GCCAN). Cohn, had medically transitioned male-to-female as an older adolescent in the early 1990s, developing gender-critical beliefs and values later in adulthood. By the 2020s, and as a gender critical activist, Corinna began to go by the name “Cori,” identifying for some time as a “disenchanted transsexual” until later dropping that descriptor, too.
Cohn described the original intent behind GCCAN:
Our idea was to create a patient advocacy organization that could work with clinicians to identify opportunities for them to improve their level of care, to advocate for patients who had been harmed by carelessness of clinicians or therapists... I had hoped that we would be able to build bridges [with trans activists]... The [trans] community had no thirst for that, had no appetite for that. I did not realise that there was such profound defensiveness.
But ideological differences within the leadership soon produced a fracture. Callahan resigned from the board. Following subsequent additional member departures, GCCAN’s focus shifted toward supporting legislative bans on gender-affirming healthcare in the United States, with Cohn as its most visible face. Cohn, galvanised by what he saw as providers’ refusal to self-regulate and by reading the new WPATH standards (version 8) as “almost more of a manifesto than a standard of care, designed to eliminate accountability for providers,” concluded that legislation was the only available lever: “We had to stop providers from doing this to children because they weren’t going to change themselves.” But for Carey Callahan, what happened to GCCAN was a microcosm of a broader co-optation and the winds of political change: “I did not understand [Cohn] was as ideological as they actually ended up being.”
The Costs of Becoming Symbolic
The political utility of detransition to critique trans-affirmation and self-determined gender identity in society had been recognised early by gender-critical activists. Irish psychotherapist Stella O’Malley, who later founded the transition-skeptical parent advocacy organisation, Genspect, recounted on Cohn’s podcast that introducing detransition to a mainstream audience was a pivotal moment in her goal to “get the kids out of the burning house [of transgender medicine].” O’Malley featured a detransitioned young woman in the 2018 Channel 4 documentary Trans Kids: It’s Time to Talk, helping to solidify transition regret as a central pillar of the emerging gender-critical movement for a mass UK television audience.
The costs of co-optation, though, fell unevenly on detransitioners. The tragic and complex story of Elisa Rae Shupe illustrates the stakes with clarity. In 2016, Shupe was the first American to be legally recognised as nonbinary. But by 2019, Shupe had become a prominent detrans activist who was critical of medical transition. She later retransitioned, publicly denounced her previous anti-transition statements, and leaked a trove of correspondence exposing the inner workings of the right-wing network dedicated to rolling back transgender rights—providing concrete evidence of how detransitioners were recruited and deployed to lend personal testimony in support of transition-skeptical advocacy efforts. Reflecting on what had transpired, Shupe identified with her diagnosis of borderline personality disorder (BPD), a distressing condition that can affect a person’s interpersonal relationships, their thoughts, mood and emotion regulation, and can lead to impulsivity, risk-taking, and major changes in identity. Shupe came to believe that the characteristics of her distress had made her exploitable by actors who saw her as a weapon, sharing:
I’m about as cancelled as you can get at this point. The left has used me up, they got their nonbinary mileage out of me... The right side, they got to hold me up and parade me around as the famous desister, the detransitioner… Now in my position of going back under the trans umbrella, I’m pretty sure they aren’t going to be writing any more articles about me.
On January 27, 2025, Shupe died by suicide. Eulogising Shupe’s complicated story after her death, trans journalist Evan Urquhart said that “the restlessness, risk-taking, and self-destructiveness of her BPD [borderline personality disorder] is what allowed Elisa to strike one the most significant blows against the anti-trans movement.”
As the detransition movement has grown and negative accounts of gender-affirming healthcare have became more visible in the digital age, the question of who owned its politics have become increasingly contentious. Most of the early detrans organisers had not set out to become instruments of conservative legislation. Many, instead, were gender nonconforming lesbian, bi, and queer people who actively sought to distance themselves from conservative or religious groups. While the early detrans women’s movement was infused with a radical feminist analysis of sex, gender, and gender dysphoria, Callahan imagined GCCAN as a democratic patient advocacy organisation providing mutual aid to all consumers of gender medicine—trans and detrans alike. For Callahan, GCCAN aimed to inspire clinician education and change, wanting to reform substandard care rather than create outright prohibition.
But it was not long before a new ecosystem of reformers started to significantly alter the legal and medical landscape. In the UK, detransitioned lesbian Keira Bell (along with the mother of a child who was on the waiting list for treatment) brought a lawsuit against the Tavistock’s GIDS clinic after receiving puberty blockers at 16, followed by testosterone, and undergoing a double mastectomy as a young adult. Bell and her legal team argued that she had not been capable of giving informed consent as a minor and that clinicians had failed to explore the psychological origins of her distress. In December 2020, the High Court ruled in Bell’s favor, declaring it “highly unlikely” that a child under 16 could be competent to consent to puberty blockers. The judges remarked about the Tavistock’s data collection practices, noting that the clinic did not track long-term outcomes or detransition. Although the Court of Appeal overturned the judgement in September 2021—ruling that clinicians, not judges, should assess a young person’s decision-making capacity—the reputational damage was already done. The case publicly confirmed the beliefs that had initially ignited the transition-skeptical ROGD parent movement and animated gender-critical activism: there seemed to lack a solid long-term evidence base for pediatric transgender medicine.
In the US, and elsewhere, similar legal cases emerged. Chloe Cole, a detransitioned woman who underwent a double mastectomy at age 15, testified that the medical system failed to protect her from a decision she felt she was too young to make. Cole became the American movement’s leading voice for legislative restrictions and a right-wing influencer who regularly speaks at conservative events. Beginning in the 2020s, detransition lawsuits began to move through the US court system and in January 2026, the first of these cases to reach a jury delivered a landmark verdict: Fox Varian, who underwent a double mastectomy at 16, was awarded $2 million in damages against her psychologist and plastic surgeon for deviating from acceptable clinical practice and failing to obtain meaningful informed consent.
Historian of science Thomas Kuhn described a “paradigm debate” when a field confronts accumulating anomalies that the reigning paradigm cannot explain. Under the identity-affirming ethos, detransition, dramatic epidemiological changes, and persistent post-treatment distress have functioned as anomalies to prescribing hormonal and surgical treatments for adolescent gender dysphoria. The gender care field is now deep into what Kuhn would call the crisis phase, and the reinvention is being contested from every direction simultaneously: by transition-skeptical clinical reformers, by trans advocates and affirming clinicians, by grieving and distressed parents, and by detransitioners themselves—many of whom resist being cast as symbols of either side.
Kenneth Zucker, who lost his clinical position at the Centre for Addiction and Mental Health in Toronto in 2015 during the last major paradigm debate over pediatric gender care, observed the cyclical nature of these transformations:
Mid-December [2025] will be the 10-year anniversary of my execution and the closing of the clinic... I think what’s happened over the last 10 years is fascinatingly dialectical… Our clinic closed on the grounds that we were too cautious when it came to little kids. We weren’t transitioning them or affirming them. Three years ago now, the Tavistock gets shut down, not because they were too cautious, but because they were too permissive.
While the socio-political context that led to the closure of Tavistock’s GIDS in the UK, and restrictions on pediatric trans care is not easily explained by clinical practice debates alone, the events that have unfolded have ignited important questions, and broad societal suspicion, regarding what is generally well-intentioned healthcare for a minority population.
But with each paradigm shift, clinicians, parents, and patient advocates have been forced to wrestle with uncomfortable uncertainties about transness, sexuality, distress, and biomedical treatments whose long-term outcomes were not adequately tracked. The age of trans-affirmation—the belief that identity-affirming biomedical interventions would save trans lives and lead to social justice and authenticity for trans and gender variant people—has collided with disappointments of epic proportions and ascendent right-wing power.
Kirsty Rackliff has argued that the current polarised discourse around gender care forces detransitioning people into one of two narratives: they must be either “damaged victims” to transition-skeptics or “non-victimised allies” to the trans rights movement.
Through these narrow frames, detransitioned experiences and their clinical implications become instrumentalised by whichever coalition can most effectively claim them for their preferred clinical paradigm and model of transness. And the science of hormonal discontinuation remains rarely researched and absent in trans care protocols. Yet, recent studies of treatment trajectories in Canada, the UK, and Norway suggest that it is not only one percent of gender variant youth and young adults who ultimately stop hormonal treatments alongside post-transition identity changes or health concerns, but perhaps closer to 5-16%. If so, those once dismissed as “the one percent” may not represent an anomaly to transgender medicine, but one of its defining unresolved questions.
For resources developed by our network of researchers who have conducted original projects on detrans/retrans/gender-fluid LGBTQ people’s care needs, see below or get in touch:
Detrans Support: A research-based and community-driven resource
Common themes running through research studies about detransitioning/retransitioning is desiring more supports and a need for greater awareness and understanding.
How can mental health professionals support detransitioning people?
Despite the growing public and academic discussion about detransition, there is very little guidance for mental health professionals working with this population.
What do people need after detransition?
If you have been reading this newsletter for a while, then you probably know that detransition is not simple. For many, it’s shrouded in misunderstanding from all sides of the political spectrum. As researchers, we’re interested in more than just knowing why detransition happens and under what conditions. We also want to know what detrans people need fr…
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Reading this article, on a topic that I don’t specialize in, but that is important to know more about - clicking on the links in the text, learning more. Thank you for helping us widen our views on the immense complexity of gender and trans topics.
I’m curious… did you reach out to Cori for his perspective when writing this piece?