Trans/Detrans Question

[Chantarelle]

If I am understanding correctly, the effects of puberty blockers can be reversed. Puberty blockers plus cross sex hormones however, not easily so. My question: do you believe that a pre-pubescent child is insightful enough to decide whether or not he or she is one day going to desire biological children or regret transitioning?

[Unholy]

My question: do you believe that a pre-pubescent child is insightful enough to decide whether or not he or she is one day going to desire biological children or regret transitioning?

I mean, it's a question, but I don't think it's the right question.

But the answer is roughly 1% of trans people on the whole express regret, but not all of that 1% consistently maintain that answer and not all of that 1% de-transition.

And some of the ones that de-transition aren't having gender issues, they just aren't always cosmetically satisfied with the surgeries and want something better.

Some de-transition because they suffered so much transphobia they could not take the abuse any more. Didn't mean they weren't trans or had regret, it meant literal bigotry forced their hand so they made choices for their survival.

I find this is a loaded question though. Because on the whole, it is not pre-pubescent children transitioning fully. 16-17 is the youngest age you generally see with INCREDIBLY rare exceptions, and the regret rate is still really low.

But frankly every time I have had a conversation with someone about transitioning who made it about the kids and so-called regret, they were surprisingly indifferent to the fact that trans kids who are denied care have a high suicide ideation and high suicide attempt rate. That's a problem with people who have access to transitioning care as well, but the problem is so much less when trans youth get the treatment they need that I for one think that a >1% regret risk (where there's healthcare available to address that concern) is not a remote concern compared to the 27.7% who attempt suicide without hormone treatment.

I'd rather a trans child be alive and help them with gender issues than have a dead trans child because they didn't get the support they deserved. Any ethical person should.

[Vekseid]

I think it's fair to ask.

Who among us haven't made extremely rash decisions as a child?

I've seen more than a few complains of pronouns getting confused with proper nouns and children getting in on the genderfluid bandwagon. Inasmuch as it is a permanent decision, it needs to be approached with oversight and care.

There have been a few cases on E here where members have switched back to their original tag when they concluded they were comfortable with the sex they were assigned at birth.

However.

For all the caution to be advised, no one can deny the benefits of early transition for those who need them.

It is cheaper, less invasive, healthier, and more complete. They look better, feel better, can more easily pass. In every conceivable point of measurement, the outcome is better if they transition sooner.

Except, of course, if they come to regret their decision.

Unholy points out that this is exceedingly rare.

As flighty as kids are, this does calm down a bit by the time they are old enough to comprehend this. Enough so that maintaining a trans identity for multiple years is not going to be some fad for them. Two years for a ten year old is a fifth of their life.

This, combined with oversight, counseling, and education, I do not believe there is any reason to be overly alarmed about this, personally.



Though, I am curious as to why you focus on the reproductive aspect of this. I feel like if that is the concern, then women sterilizing themselves with steroids to compete in sports is a much more common problem we may want to focus on.

[Oniya]

Though, I am curious as to why you focus on the reproductive aspect of this. I feel like if that is the concern, then women sterilizing themselves with steroids to compete in sports is a much more common problem we may want to focus on.

And why 'biological children'?  If someone who can't have kids wants to be a parent (whether gay, trans, or infertile-cis), there are kids out there in need of loving homes, through whatever tragedy led them to not be in one.  Does it matter whose genetic material created them if someone is willing to raise them?

[Keelan]

Though, I am curious as to why you focus on the reproductive aspect of this. I feel like if that is the concern, then women sterilizing themselves with steroids to compete in sports is a much more common problem we may want to focus on.

And why 'biological children'?  If someone who can't have kids wants to be a parent (whether gay, trans, or infertile-cis), there are kids out there in need of loving homes, through whatever tragedy led them to not be in one.  Does it matter whose genetic material created them if someone is willing to raise them?

Puberty blockers, hormone replacement, and reassignment surgeries can *all* impact fertility (the third most obviously, the first least so), and children as established do not have very good long-term-planning skills. Even for people transitioning as an adult fertility can be a concern that impacts medical decision making. While adoption is an option, there is absolutely a natural urge for your *own* biologically-related children that must be contended with, as evidence by the homosexual couples who seek donors or surrogates, and by the individuals both male and female that are devastated to discover that they are in fact infertile.

As loss of fertility is absolutely a known effect of the treatments, as children are not necessarily thinking about having children of their own at the time these treatments are being discussed, and as it is a normal human desire to want to have children as you age, I would consider it absolutely a reasonable concern. Not just for the purpose of discussion, but for the informed consent of those seeking treatment, and for parents and guardians of potentially transgender minors to keep in mind for their informed assent.

I'd also point out that it's not a great comparison to compare it to female athletes impacting fertility using (abusing) anabolic-androgenic steroids, considering that - as it's overwhelmingly done illicitly for non-medical reasons as a form of cheating - it's already frowned upon and discouraged long before you get to fertility issues.

Also because for female athletes, it's much more likely that you'll develop fertility issues in the form of functional hypothalamic amenorrhea, which is also already treated as a major health concern.

[Chantarelle]

I mean, it's a question, but I don't think it's the right question.

In your opinion what would be the right question?

But the answer is roughly 1% of trans people on the whole express regret, but not all of that 1% consistently maintain that answer and not all of that 1% de-transition.

I don’t think it’s fair to not give worthwhile thought to the suffering minority (detrans) within the suffering minority (trans). I recently watched a jubilee conversation between trans and detrans persons, I actually listen to a lot of trans and detrans stories and I’m empathetic to both.

The various studies often contradict and leave me still questioning, as many studies have a high lost to follow-up rate combined with the fact that adequate time has not been given to obtain a complete picture. Even the long term studies that have been done contradict.

I find this is a loaded question though. Because on the whole, it is not pre-pubescent children transitioning fully. 16-17 is the youngest age you generally see with INCREDIBLY rare exceptions, and the regret rate is still really low.

The recommended age for allowing transition has been lowered to 14. https://apnews.com/article/gender-transition-treatment-guidelines-9dbe54f670a3 In your opinion is there any age where the decision to transition a child justifies concern? I believe the UK had to reform its stance on transitioning youths but only after damage had already been done to so many.

But frankly every time I have had a conversation with someone about transitioning who made it about the kids and so-called regret, they were surprisingly indifferent to the fact that trans kids who are denied care have a high suicide ideation and high suicide attempt rate.

Like I said, I am empathetic to both groups. I don’t want to see anyone suffer. Likewise, however, every time I’ve had a conversation with a transgender person about the reality that regret is an actual thing that is occurring within their community, they are off the bat dismissive based on the fact that (as perhaps studies suggest) those are only a minority. I just don’t think that helps and in a very real way I think that way of thinking only hurts the lgbtq+ community.

Though, I am curious as to why you focus on the reproductive aspect of this. I feel like if that is the concern, then women sterilizing themselves with steroids to compete in sports is a much more common problem we may want to focus on.

Because those are adult women making the choice.

And why 'biological children'?  If someone who can't have kids wants to be a parent (whether gay, trans, or infertile-cis), there are kids out there in need of loving homes, through whatever tragedy led them to not be in one.  Does it matter whose genetic material created them if someone is willing to raise them?

For some it does. For many people having biological children is important. To experience pregnancy, to carry a child or to know that your body participated in the creation of another human being. To those ppl, it would be a terrible tragedy, no?

[Keelan]

The recommended age for allowing transition has been lowered to 14. https://apnews.com/article/gender-transition-treatment-guidelines-9dbe54f670a3 In your opinion is there any age where the decision to transition a child justifies concern? I believe the UK had to reform its stance on transitioning youths but only after damage had already been done to so many.

Link is broken. Full link here: https://apnews.com/article/gender-transition-treatment-guidelines-9dbe54f670a3a0f5f2831c2bf14f9bbb

[Chantarelle]

Link is broken. Full link here: https://apnews.com/article/gender-transition-treatment-guidelines-9dbe54f670a3a0f5f2831c2bf14f9bbb

Gracias. ❤️🙏

[Oniya]

In your opinion what would be the right question?

I believe the 'right question' referred to would be the one in the linked headline:  How common is transgender treatment regret, detransitioning?, which Unholy (and the attached article) goes on to address.

[Chantarelle]

I believe the 'right question' referred to would be the one in the linked headline:  How common is transgender treatment regret, detransitioning?, which Unholy (and the attached article) goes on to address.

Ah, I see.

[Azy]

I don't think a 14 year old child has the ability to really think about long term consequences.  The frontal lobe of the human brain, which is the part used for reason and judgment, doesn't fully develop until the age of 25, which is considered the reason for teenagers doing a lot of stupid shit. 

On the other hand, I don't think that the suffering and suicides of young trans people should be ignored.  It's a tricky balance.  There definitely needs to be mental health professionals involved.  I think speaking to a therapist who specializes in that area is already a requirement of transitioning, even for adults.  The right questions would need to be asked.   

Though the good news when it comes to fertility, at least for F to M, is that as long as the parts aren't removed through surgery, biological children can still happen. 
https://www.cnn.com/2017/07/31/health/trans-man-pregnancy-dad-trnd/index.html

[Vekseid]

It takes a lot more than just speaking to one. You need to get approval, prescriptions, and a treatment plan. It needs to be maintained with rigor.

It isn't something they can just walk into. "I want to be a boy today."

For some it does. For many people having biological children is important. To experience pregnancy, to carry a child or to know that your body participated in the creation of another human being. To those ppl, it would be a terrible tragedy, no?

And some people feel they were born in the wrong body.

Or they were born in the right one and mutilated at birth.

They want to experience what it is to feel as they truly believe themselves to be.

Their transition to this desired state lessens no one else.

To deny them the ability to be who they wish, when the technology exists, when no one else suffers for it, is, frankly...

Well. I would use the word... vile.

As much as you may believe you want to bear children, they also believe in who they really are.

What, then, is wrong with you both achieving your separate goals, both so integral to your own sense of self-fulfillment?

Eventually there will come a day where this is no longer an argument. There are transwomen, on this forum, who desperately wish they could bear children.

Right now that is scarcely conceivable.

But it will happen someday.

What will your argument then be?

[Azy]

It takes a lot more than just speaking to one. You need to get approval, prescriptions, and a treatment plan. It needs to be maintained with rigor.

It isn't something they can just walk into. "I want to be a boy today."

That's what I meant.  One of the few real people I met on a dating site told me he did want to transition into a woman, and had to see a therapist for a year to be approved and start hormone therapy and all that.  He did change his mind for personal reasons.  The breasts he grew from the hormones were still there, but he said all other physical changes reversed over time. 

For some people having biological children of their own is important.  Some gay couples do use surrogates and one of them is the biological father.  I know a gay couple who considered that when they decided they were ready for children, but in the end they adopted, and don't regret it.  The one man's parents are being assholes because the kids aren't their biological grandchildren, and no one is surprised, but it's their loss really. 

The other guy's sister was a surrogate for a hetero couple with major fertility issues.  It was important enough to them to spend thousands of dollars.  But who knows what the future will bring. 

https://www.cnn.com/2022/09/05/world/synthetic-embryos-stem-cells-scn/index.html

So far it has only been done in mice, but science has brought us some pretty interesting stuff. 

[Chantarelle]

It takes a lot more than just speaking to one. You need to get approval, prescriptions, and a treatment plan. It needs to be maintained with rigor.

It isn't something they can just walk into. "I want to be a boy today."

Many detransitioners would argue that they were rushed through the process. The whole reason the UK had to change protocols is precisely because children were being rushed into things without appropriate gate keeping.

Their transition to this desired state lessens no one else.

To deny them the ability to be who they wish, when the technology exists, when no one else suffers for it, is, frankly...

Well. I would use the word... vile.

Again, I am speaking about children, too young to consent to anything else life-changing (I’d presume we’d largely agree). It isn’t adults making decisions that concern is being aimed at.

[MattMatt]

This is a very tricky subject and I am far from an expert on this. Still, I think this discussion is interesting and that's why I'm participating.

As others have mentioned, teens are mentally immature, so they often make hasty decisions that they may later regret. That is why I think it is important that for a period of time (I would say a year) there needs to be a dialogue with a therapist. It is important for someone to make every consideration before undergoing permanent treatment with major consequences. This allows an expert and the person to consider whether this treatment is right for the teenager.

What if there is a situation where after the dialogue where the therapist is convinced that the treatment is not right for the teen but the teen really wants it?
Then the situation becomes very difficult. I think it is wise that the teenager enters into the same dialogue with another therapist in this situation. However, if I understand correctly, it is healthier for someone to undergo this treatment as early as possible. Because of this, it may be unhealthy for the teen to go to another year of therapy. On the other hand, the therapist's opinion may be correct and it is better for the teen not to undergo this treatment so that later regrets can be avoided. I don't know what's the best choice here. If you asked me I'd say we should listen to an expert's opinion over a teenager's. But as mentioned before I am not an expert on this and could be wrong.

[Chantarelle]

This is a very tricky subject and I am far from an expert on this. Still, I think this discussion is interesting and that's why I'm participating.

It is a very tricky subject, I agree.

It is my understanding that there are three types of counseling models used in the treatment of transgendered persons: therapeutic, accommodative, and affirmation…the UK is beginning to move away from the affirmation model and instead are using a modified therapeutic form of counseling to help resolve childrens gender/sex confusion so that cross-sex hormones and surgery is unnecessary.

Another thing I feel no one talks about much is how profitable transitioning is for pharmaceutical companies and the stake they share by continuing to divvy out these medications. Medicalization is oftentimes a lifelong path.

[Vekseid]

Many detransitioners would argue that they were rushed through the process. The whole reason the UK had to change protocols is precisely because children were being rushed into things without appropriate gate keeping.

'Many'.

Certainly, there needs to be gatekeeping, but this is weasel wording.

Again, I am speaking about children, too young to consent to anything else life-changing (I’d presume we’d largely agree). It isn’t adults making decisions that concern is being aimed at.

I'm not claiming it isn't life-changing.

If it is right for them, there is no better time to do it. After puberty everything about it becomes worse.

[Unholy]

In your opinion what would be the right question?

Oniya addressed this--she is correct. Asking the rate of regret is a far better question.

I don’t think it’s fair to not give worthwhile thought to the suffering minority (detrans) within the suffering minority (trans). I recently watched a jubilee conversation between trans and detrans persons, I actually listen to a lot of trans and detrans stories and I’m empathetic to both.

I am sympathetic to those who have regrets. I am saying that they are such a minority within a minority that it is medically irresponsible to deny trans youth care over it.

There's so many checks and balances in the system to keep uncertain people out that the >1% regret statistic suggests those checks and balances are already working as intended.

Most medical procedues are going to have a regret rate.

Those rates are almost always greater than, well, one percent.

The various studies often contradict and leave me still questioning, as many studies have a high lost to follow-up rate combined with the fact that adequate time has not been given to obtain a complete picture. Even the long term studies that have been done contradict.

Yes, this is an issue to some degree, but this is an issue in many long term studies.

More studies should be done, sure, but there's also still plenty of good research already out there for those willing to look.

The recommended age for allowing transition has been lowered to 14. https://apnews.com/article/gender-transition-treatment-guidelines-9dbe54f670a3 In your opinion is there any age where the decision to transition a child justifies concern? I believe the UK had to reform its stance on transitioning youths but only after damage had already been done to so many.

14 is still a rare as hell age to be allowed to transition. Generally that's only going to be allowed in a very serious circumstance where there may be danger denying gender-affirming care. Medical professionals are often loathe to allow more than puberty blockers before 18, and there's a lot of hoops to leap through for HRT.

I'd say anything 13 and under should probably wait. Gender is something even cisgender children explore and question, and I think it's important to let that happen normally in a positive environment (where you let them be themselves and see what happens) so you can see development of a more concrete and stable gender identity.

Like I said, I am empathetic to both groups. I don’t want to see anyone suffer. Likewise, however, every time I’ve had a conversation with a transgender person about the reality that regret is an actual thing that is occurring within their community, they are off the bat dismissive based on the fact that (as perhaps studies suggest) those are only a minority. I just don’t think that helps and in a very real way I think that way of thinking only hurts the lgbtq+ community.

I presented statistics for my views. The numbers are fairly obvious which concerns have a far more serious risk if not addressed.

Yes, some people regret transition. Yes, some go back. Some don't. No one's actually denying that. I'm saying its incredibly rare compared to the very common and dangerous consequences of denying gender-affirming care.

If you regret it, you regret it. People who regret are valid, but should not be used as an excuse to deny other patients needed medical care.

The current safeguards in the process seem to currently be more than enough.

Because those are adult women making the choice.


For some it does. For many people having biological children is important. To experience pregnancy, to carry a child or to know that your body participated in the creation of another human being. To those ppl, it would be a terrible tragedy, no?

I will say that reproductive issues are a serious concern that the trans community has a lot of views on, though not in relation to regretting transition. Most for whom it's a concern would say they want more trans-positive reproductive care.

A lot of trans individuals don't regret transition but absolutely do want biological children of their own, which is fair to want when you're starting a family.

There's ways that's already often addressed--surrogacy, adoption, and generally people transitioning young are from more affluent families (transitioning is expensive, and cost alone bars many trans people from the treatment they need), and affluency allows some options for storing genetic material for later use in life. Freezing sperm seems to be cheaper on the whole than freezing eggs, so I think there's some imbalance in options there between transwomen and transmen, but depending on things sometimes insurance can partially cover egg freezing.

So yes, transitioning can affect reproductive options, but some transmen and transwomen often choose to delay full transition until they can have biological children, then finish the process.

It's a bit rare to meet someone extremely young who is fully transitioned. Adults often find it hard to get clearance for that, let alone minors.

[Unholy]

Apologies, last thing I wanted to post got cut off when I hit post by accident before I could finish typing.

I think if you have concerns about children making big decisions they'll regret you have to ask yourself a lot of questions. Some of the biggest being:

* "Am I willing to risk this child's life so they can have children later?"
* "Do I trust parents to make responsible medical decisions for their children?"
* "Do I feel like the current reproductive options that address infertility are sufficient to address potential reproductive regret?"

But here's the thing: those are things that get generally addressed when allowing someone who isn't 18 to transition, though. It's not a decision made lightly and these are things already generally considered in these situations for trans youth in current medical practices.

[Oniya]

Again, I am speaking about children, too young to consent to anything else life-changing (I’d presume we’d largely agree). It isn’t adults making decisions that concern is being aimed at.

I'm not sure how things work in the UK, but in the US, the medical system requires parental consent prior to a certain age, with exceptions made for 'emancipated minors'.  Hell, there are cases of kids looking for ways to get standard vaccinations without parental consent, and having to fight red tape.  Intersex or androgen-insensitive infants may have their genitals surgically altered to 'more acceptable' - usually female - appearances, which is entirely adults making a life-changing decision for that child.

For medical care that is not deemed 'life saving', the parents have a lot of say in the matter, so there are, in fact, adults making decisions. 

[Azy]

This is the kind of topic that I don't think should be generalized in any way.  Not all trans people I know transition, and the unfortunate thing is that transphobia is usually a big part of the reason.  Some feel like they need to no matter what.  Things like this need taken on a case by case basis, and what each individual needs. 

[Chantarelle]

I want to thank you all for engaging in my question, it’s given me food for thought but my health has turned poor and my energy must be spent elsewhere for the time being. Take care.

[Azy]

This showed up on my feed.  It's a conversation about this topic and others between trans people, and those who de transitioned. 

https://www.youtube.com/watch?v=dl0LZZFos-g