It's established that detransition is an unusual outcome, and the nationwide right-wing anti-trans detransitioner dragnet has established that the number of people who detransition and then go on to believe that transition should not be available is effectively zero. So we are talking about a fraction of the patient population "people who transition."
But the gatekeeping model isn't just not helpful to detransitioners. It isn't just ineffective in preventing detransition. It's counterproductive.
What's less traumatic? What's less frightening and humiliating? What's less likely to lead to despair in that small fraction of patients who decide they need to stop/go back?
Option A: "You can transition if you want. Try HRT and see if you like the effects. If you're not sure, you can try a lower dose and ramp up gradually. If you want to stop, you can stop at any time. Some effects will gradually reverse themselves as your body readjust. Some may be permanent. But either way, you'll be fine. We affirm your right to make all decisions related to your transition, and we trust you to protect your own emotional wellbeing throughout this process. We're here to support you."
Option B: "You're about to make irreversible changes to your body, so we need to make sure you're making the right decision. What if you're delusional? Or immature? Or just a pervert? What if you haven't fully considered the potentially catastrophic effects of transition? You know this is mutilation of a healthy body, right? So are you sure? Are you sure? Are you really really sure? You can never go back! Point of no return! Last chance! Final countdown!"
Like, the point of this is obviously not to protect the dignity and peace of some hypothetical patient who got all the way through transition and then is like oh oops.
If that were the case, the emphasis would be completely different. It would not be stuck on let's make sure you're not about to fuck your life all the way up.
If there were any empathy or actual concern, any intrerest in detransitioners or their actual relationship to this gatekeeping process, the problem with this approach would be immediately clear. The problem with treating patients like they're not competent would be clear.
The spectre of transition regret exists to torment trans people and justify external (cis) control of transition. It's brutal because it's intended to brutalize. It's meant to create learned helplessness through shame, to punish everyone who transitions for the sin of self-determination.
And that harms all transitioning patients, but to the extent that eventual detransitioners are within that group, it directly harms them as well. It makes them more psychologically vulnerable in the aftermath, and it makes it much harder for them to trust themselves as they navigate detransition. Informed consent / autonomy helps everyone.
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