Kinnon MacKinnon, a Canadian researcher, was only faintly surprised this spring when the website for an upcoming conference did not list his talk alongside the dozens of others. He was slated to discuss one of the most fraught topics in medicine: patients who transition to a different gender but later change their minds, known as detransition.
The Pediatric Endocrine Society, which organized the conference, said that his presentation was kept under wraps because of safety concerns; there had been protests against gender medicine at the previous year’s gathering. When he gave the talk in a Chicago hotel ballroom, the audience was asked to submit questions anonymously, on notecards. No recording was allowed. The room, though full, was eerily quiet.
Dr. MacKinnon, a 39-year-old assistant professor of social work at York University in Toronto, is transgender, and he presented alongside another trans researcher. As he took the microphone, he joked: “They really get the trans people in to talk about the easy topics, eh?”
He’s gotten used to trying to defuse tension — at scientific meetings and gender clinics, and in TikTok posts — as detransition, a once-obscure topic, has vaulted into the U.S. presidential campaign and an upcoming Supreme Court case.
A small group of detransitioners — mostly young women who underwent medical treatment to live as trans men, but later regretted it — have become the public faces of Republican-led bans on gender medicine for minors. In frequent testimonies in statehouses and appearances in right-wing media, they have described sometimes irreversible procedures they received while adolescents, arguing that they were misled or neglected by their doctors.
Activists defending youth gender medicine have argued that such experiences are exceedingly rare, and that patients are much less likely to regret their transitions than to regret common medical procedures, like knee surgeries.
And the medical establishment has been slow — and sometimes reluctant — to acknowledge the risk that patients’ feelings might change down the line. As a result, little research exists on how often detransition happens or why, even as a growing number of people share their personal stories online.
Dr. MacKinnon spoke to The Times in early October, shortly after presenting his latest data, from a study funded by the Canadian government on more than 900 people who have detransitioned, at the conference of the World Professional Association for Transgender Health in Lisbon. These are edited excerpts from the conversation.
Could you tell me a bit about your own experience transitioning, that time period and what’s changed?
I started transitioning in 2009. I was roughly 24 when I started my social transition and 25 when I began testosterone.
Prior to beginning my doctoral work, which was in 2014, I was a trans YouTuber and did some modeling for the surgery practice that did my top surgery. I was pretty active on Instagram, mainly documenting my journey as a trans powerlifter. That feels like another lifetime ago. I wear much more of an academic-researcher hat today.
Perhaps this is a reflection of more anti-trans sentiment in our culture, but I find that online spaces can feel really negative now. In the earlier days, I felt a lot more positivity in online trans communities, and they were perhaps more hidden.
In 2010, was detransition discussed much in the trans community?
No, it certainly wasn’t. When I began my process, it was shortly after a period in which there were severe restrictions placed on gender-affirming health care in Canada. There were very strained relationships between the health care system and the transgender community.
The result of that, I think, was a feeling that acknowledgment of regret or the potential for detransition may actually risk somebody’s access to treatment.
When did you first start thinking about detransition as a research topic?
My Ph.D. project looked at how clinicians assess whether trans adults are ready for hormones and surgeries. Worry about regret was one of the main considerations that doctors would use to deny access, and I studied how trans people experienced these assessments as gatekeeping.
But in 2017, I was at a conference and a speaker was giving a talk about how science and activism can clash. She gave the example of detransition — that detransition was occurring and that trans activists were trying to prevent study of the topic. I was in disbelief because I hadn’t seen any examples of detransition happening among my friends or in the scientific literature. It was uncomfortable, but it also piqued my interest.
A few years later, I got funding for a pilot study where we interviewed 28 people who detransitioned. I thought that what we would largely find is individuals who faced too much discrimination. And that was true for some people. But for the majority, their sense of identity shifted over time.
I was initially very skeptical of my own data. It was unexpected.
You presented data in September on your latest research, the largest study to date on detransition. What did it find?
That detransition is a very complex and diverse experience.
The study included more than 900 people in the United States and Canada who had detransitioned, two-thirds of whom had undergone medical transitions.
One group detransitioned due to more internally driven factors, such as worsening mental health through transition, or reconceptualizing their identity, or treatment dissatisfaction. This is also the group that has the highest regret. That one is 90 percent assigned female at birth.
Another group of people who detransitioned was more positive. They had a change in identity, but they were satisfied with their treatment, and stopped because they were happy with where they were at.
And then another group detransitioned because of a lack of support and discrimination. And we did find that about 6 percent of our sample reported detransition because of state legislation in the U.S.
Political activists often talk about detransition in extremes: It’s either a very rare outcome or a tidal wave that’s coming. What is actually known about the rate?
These debates about the number really detract from the question that I think is more important, which is: How do we develop a better health care system, one that can support people through transition as well as if detransition occurs?
In terms of the numbers, the highest-quality studies suggest that it could be between 5 and 10 percent of people detransition due to a change in their identity.
Now, if you’re talking about people who just stop hormones, that estimate in North America would be between 16 and 30 percent. But there’s a lot of reasons why trans people may choose to stop hormones — because of side effects, or just simply because they’re happy with where they’re at. It really bothers me when people take these higher figures and say that this is an avalanche of people detransitioning.
Other people cite a detransition rate of 1 percent. You just started a Substack with another researcher called “The One Percent.” Where did that number come from?
I call it the “1 percent regret relic” because I think it’s a relic of studies from an older era. Those studies don’t usually refer to a feeling of having wished that you made a different decision. There has never been a consistent definition of regret used throughout this literature.
Also, the people who are accessing gender-affirming care today are very different. The older literature was mostly adult trans women who were assigned male at birth. What we see today is a larger majority of younger trans men who were assigned female at birth. There’s also a lot more gender fluidity and nonbinary identity.
The way that we think about transitioning today is very, very different than we thought about it 30 years ago, even 10 years ago. It raises questions about how much these older studies apply.
Your first study on detransition was published in 2022, the same year as the first state ban on gender care for youth, in Arkansas. How has the intensifying politics affected your research?
I know of no study examining these kind of outcomes that has ever concluded by recommending an outright ban on treatments. I oppose the bans, and it’s certainly a worry of mine that my research will be taken out of context.
Over the past few years, because of how political everything’s gotten and because it’s mostly right-wing media talking about detransition, it’s been extremely difficult. It feels like I’m trying to drive a lifeboat to people who are stranded after a shipwreck and I’m myself getting tossed around in very rough waters.
The large majority of people who have detransitioned who I’ve spoken to do not support complete bans, and many feel alienated by and misrepresented by the public discourse. But certainly some of them do feel that they fell through the cracks and deserved better.
Most of the people who are having these experiences are L.G.B.T.Q. You don’t have to look very far back in the history books to see that medical systems can help us, but they can also cause us harm.
There has been a recent wave of malpractice suits filed against doctors by patients who have detransitioned. Do you think it’s valid for these doctors to be sued?
Trans people have brought malpractice lawsuits against their surgeons. So this is not just specific to detransition. If there is evidence of malpractice happening and when someone is really badly injured, I think that they deserve to have their day in court.
That said, the detransition lawsuits have to be understood within a broader trend of socially conservative efforts to put restrictions on gender-affirming health care. The stories are real. But at the same time, they’re being positioned with a very clear political strategy.
You post a lot on TikTok — including sharing your own experiences with complex medical issues, like fertility. Why?
Trans medicine doesn’t know everything. I feel a responsibility to younger people to share research as well as my own experiences around fertility, and what we know about the consequences of testosterone and estrogen.
Before I transitioned, it was standard practice to do a hysterectomy and oophorectomy, or removal of the ovaries. I wouldn’t have my child if I went through those procedures. There’s a paper published from a Dutch sample of trans adults who transitioned as children, and 35 to 44 percent reported infertility regret.
That’s not to say that everyone needs to have children. But how you feel with regards to future parenthood may change.
Some people say that there is too much focus on detransition in the media. How do you respond to that?
I would say that detransition is a human experience that we are starting to see emerge in our society. We have an obligation to try to understand it.
In some ways, it’s very similar to how ideas about trans people got constructed a few decades ago. In the ’90s, you would see trans people on talk shows like “Jerry Springer,” and it was extremely sensationalized. Trans people were used essentially for a kind of entertainment value. Over time, there have been much more balanced representations of who we are.
I think we’re going through that phase right now with detransition. It’s extremely sensationalized and polarized. It’s not as much focused on, what is the humanity?
