Endocrine Abstracts

Background: Medical gender transition is a personal and complex process that can have irreversible health consequences. Detransition is the process of stopping and/or reversing partially or totally and temporarily or permanently the social, legal and/or medical changes achieved during gender transition. The current prevalence of detransition is unknown, most likely underestimated.

Aim: To determine the prevalence and describe the sociodemographic and health characteristics and factors associated with medical detransition in persons over 14 years of age with Gender Incongruence under follow-up in the Transsexual Care Unit (TCU) of a Spanish reference hospital from 1999 to February 7, 2024.

Material and methods: Cross-sectional descriptive study that included 18 transsexual people who stopped cross-sex hormone therapy (CHT). Data were obtained by review of medical records and semi-structured telephone interviews directed to those with loss to follow-up. Qualitative data were expressed as absolute value and percentage and quantitative data as range (minimum-maximum).

Results: The prevalence of medical gender detransition was 0.75% (18/2396). 14 cases (77.7%) started follow-up in the TCU in the last 6 years (2018-2024). Detransition occurred after 1-300 months from the start of medical gender transition. 11 cases (61.1%) were partial detransitions (maintained the legal and social changes) while 7 (41.2%) were total. All partial detransitions were secondary or without identity desistance while total detransitions were primary or with identity desistance. To date, 88.8% have maintained the decision to detransition, so they were considered permanent. 50% were transsexual men with onset of the identity feeling at 4-30 years of age and first visit to the TCU at 14-43 years of age. 72.2% without family support and 100% had previous psychomorbidity. 3 cases had sex reassignment surgery (SRS). 3 and 2 cases required hormone replacement therapy and non-genital reversal surgery, respectively. The psychological factor was present in 13 cases (predominantly non-binary gender identity followed by satisfaction with the changes already achieved) followed by medical (7 cases), cultural (3 cases) and social (3 cases) factors.

Conclusions: Detransition is a complex process that requires assessment in specialized multidiscipslinary teams. In our series, all the detransitions presented previous psychomorbidity and 76.5% associated psychological factors. We recommend prioritizing psychosocial and identity assessment before beginning the medical transition. There is a need for health guidelines on gender detransition.