No, I will not help Sundog make a documentary on trans “regret”

This afternoon I received an unsolicited email in my work account from an employee of Sundog Pictures. An excerpt follows:

I’m currently working on an idea alongside Channel 4 following transgender individuals who have come to regret their sex changes and are keen to undergo further treatment / operations to reverse the change. The doc will be insightful and sensitive and will look at the way in which transgender individuals are treated in society and whether the process before someone is permitted an operation is robust enough.

I’m currently looking for real life cases to include in my pitch document and was wondering whether you might be able to recommend people I could speak to, or places I could contact to find individuals who are currently thinking about a reverse sex change. Any help would be really appreciated.

Given the email account used, I feel that I can safely assume that I was contacted because of my academic work, which looks at discourses of trans healthcare provision. Sundog seem to hope that I will (without compensation) draw upon my community contacts and research findings to recommend participants for their television programme.

I couldn’t think of anything more inappropriate.

There’s a lot to be said about research ethics and a duty of care towards participants, but plenty has been written about that elsewhere (the BSA Statement of Ethical Practice offers a decent broad overview). So in this post I focus on the huge problems that come with the proposed topic of the documentary: that of trans “regret”.

The numbers

The mainstream media take an undue interest in trans “regret”. It’s very easy to come across such stories on daytime television and in both tabloid and broadsheet newspapers. The popularity and frequency of such stories suggests that it’s not too unusual for people who have undertaken a physical transition from male to female, or from female to male, to consider or undertake a “reverse sex change”.

In reality, research has shown time and time again that the actual rate of regret is extremely low. For instance, only 2% of respondents in the Trans Mental Health Study (the second-largest trans study undertaken in the UK) reported “major regrets” about the physical changes experienced during transition. Reported regrets from participants included:

“…not having the body that they wanted from birth, not transitioning sooner/earlier, surgery complications (especially loss of sensitivity), choice of surgeon (if surgery required revisions and repairs), losing friends and family, and the impact of transition on others.”

It’s clear therefore that “regret”, when it occurs, is likely to stem from societal and surgical issues rather than the process of physical transition in and of itself. The Trans Mental Health Study also demonstrates a clear link between physical transition and wellbeing in terms of mental health, body confidence and general life satisfaction.

With so few trans people regretting physical transition – and even less considering some kind of “de-transition” – it’s no surprise that sometimes the same individuals are trotted out time and time again to re-affirm a discourse of regret.

What’s missing from this story?

It’s pretty clear from the email I received that that the author has not done their research. Given the existence of organisations such as Trans Media Watch and All About Trans who are entirely keen to offer advice, this does not exactly inspire confidence.

For a start, transition is conflated with “sex change”, a term that is not only most frequently associated with transphobic tabloid headlines, but is also broadly meaningless. At what point can we talk about a “sex change”? When an individual undertakes hormone therapy? Chest surgery? Genital surgery? What about individuals who transition socially, but only undergo some (or even none!) of these processes? It’s not the kind of language that suggest an “insightful and sensitive” documentary can be made.

There’s a couple of more fundamental mistakes in the proposal, however. The first is the question of “whether the process before someone is permitted an operation is robust enough”. My own initial research findings suggest that if anything, the process in question is too robust – in that patients requiring surgery are typically required to wait many years before treatment is available.

The World Professional Association for Transgender Health Standards of Care require patients to undergo at least 12 months of hormone therapy prior to genital surgery. In reality, patients in England and Wales face a substantial waiting list (sometimes lasting years) before they are able to attend an NHS Gender Clinic, where two separate clinicians are required to approve a regime of hormone therapy before it can be undertaken. An additional two opinions are needed at a later date before a referral for genital surgery can take place. There are many, many opportunities and a great deal of time for patients to consider and re-consider their option – and that’s even before we take into account the horrific scale of the current crisis in surgery provision for trans women.

The current system is not constructed to facilitate transition so much as prevent the very possibility of regret. The result is increased suffering – in terms of the mental and physical health impact upon individuals who are forced to wait many years for hormones and surgery, whilst fearing (sometimes with good reason) that they will be denied treatment on spurious grounds. It’s no surprise that the Trans Mental Health Study found that “not transitioning sooner/earlier” is a major cause of “regret”, as individuals who have waited until breaking point to transition soon discover that there is still a long, long road ahead of them.

The second fundamental problem with Sundog’s proposal is their idea that trans people who aren’t too happy with their transition might be “keen to undergo further treatment / operations to reverse the change”. This is a very binaristic notion that both stems from and reinforces the notion that transition is a one-way process, from one (binary) gender to the other. In reality, there are many people for whom transition is a complex, ongoing process. For instance,  an individual who initially transitions from male to female might later feel that their identity is better understood as genderqueer, and may allow or pursue further physical changes to reflect this.

The wider political context

Given the tiny proportion of trans people who “regret” transition and the realities of service provision, the choice of a documentary about the subject appears at best to be somewhat misguided. However, the impact of insensitive coverage on this topic is such that I believe that I believe this documentary could be actively harmful, particularly as Sundog’s email asks “whether the process before someone is permitted an operation is robust enough”.

This is in part because the way in which discourses of regret are handled makes it harder for trans people to get treatment. Gender clinics in the UK require urgent intervention to make life easier for individuals who transition, not harder. Media hysteria over the possibility of regret reinforces the current system’s approach, which is to require people to demonstrate over and over again that they are trans before there is any hope of treatment.

But it’s also because discourses of regret are employed by those who campaign against trans liberation, including conservative commentators and anti-trans radical feminists who would deny funding for transition on the NHS altogether. Writers such as Julie Bindel are all too keen to use any example of individual regret to argue that transition is unnecessary mutilation, undertaken by sad, sick individuals who might have done otherwise if only they’d been given the option of, say, some form of reparative therapy.

The focus on the medical process is therefore politically loaded. Yes, some people do de-transition, and their stories are important and of worth. But these stories have yet to be told by the mainstream media in a non-sensationalised manner, in a way that doesn’t reinforce (intentionally or otherwise) a pernicious anti-trans agenda. Sundog’s proposal appears to feed right into this agenda.

This proposed documentary should not be regarded as a curiosity piece taking place in a cultural vacuum. It draws upon and will contribute to damaging and inaccurate tropes about transition. Ill-informed media accounts ultimately play a part in creating and maintaining a situation where “regret” frequently stems from the responses of friends and family, delays to transition and other negative experiences that come with transitioning in a transphobic society.

I hope therefore that any future attempts to examine trans health issues in this way will involve better research into the topic at the initial stages, and a greater sensitivity to both the personal and political consequences of exposing trans lives to media scrutiny.

29 thoughts on “No, I will not help Sundog make a documentary on trans “regret”

  1. It’s worth noting that the dissatisfaction rate for surgery for trans women – “regret” being a tabloid word associated with “sex change” and weight loss surgery – is considered excellent outside of trans healthcare.

    (I’m guessing Sundog forgot trans men exist)

    Satisfaction rates of more than 95% are the kind of thing private hospitals will gleefully put on press releases, with 85-90% still considered good.

  2. What an outstanding well researched blog! i did not know the actual percentage of those who regret SRS but always felt that the numbers of those who regret not transitioning or like me waiting soo long to even begin to transition are considerably higher!

    • Thanks! I’m a researcher, so it’s what I do 🙂

      There are so many of us who wish we could have transitioned earlier – and don’t do in part because everyone keeps telling us how much we might regret it.

      • I agree most of us wished we did as for myself am glad I did it anyway no matter how long it took me to come to terms with gender dysphoria which is a task in itself. Such media coverage makes it difficult

        • I think it also reinforces a linear narrative of “regret” – there are plenty of reasons why people might decide transition wasn’t right for them without implicating the entire NHS pathway or private practitioners such as Dr Curtis.

      • The thing of it is the feelings inside of me grow and more insistent that i am getting to a point where i simply have to move forward even if i will regret it later……………..sigh. Take care of you Ruth and please keep writing. it is a true privilege to read your work. I have done some research (for my thesis 14 years ago). I did the 1st research on my area of study ever done so i know a little about research and your work is outstanding!

        • I can only speak for myself, but finally making the step to move forward has been such a positive (if scary) experience. I wish I had begun earlier, but the past is non-existent, and there will never be a better time than the now. In fact, things are working out so well that the timing is suspiciously good (I have the right partner, the right circle, I live in a liberal city, my workplace has a strong LGBT policy). All things in their due time, perhaps? This experience has certainly given me more faith… which is very useful when it comes to dealing with the horrible bile spewed by the radfem atheist crowd and the fundamentalist Christian crowd alike. I’m only amused that they don’t see the ugly similarity…

          • I feel a lot of empathy, if you don’t mind my saying. I am still so early in my transition, with no medical options as yet laid down for me, that it would be all too easy to backtrack and pretend I never took the steps I have done. I am sure if I persist I will meet people who will try and tell me that would be in my best interests. You have helped me to keep my resolve up. It is only by being honest and true with ourselves that we ever see the light. xxx

          • It is indeed. 😦 But more frightening still is the thought that I might lose heart and try to bury it all again. I know that will never work and I am very grateful you are there to remind me. xxx

  3. It’s worth noting that “detransition” often includes NB people who merely don’t bother with the GRC process – even if there’s a clear /re/transition and even ongoing medical treatment.

  4. I couldn’t agree more. Such documentarys are sensational and harmful to huge numbers of trans people with no access to transition related health care, and those facing a gauntlet of “gatekeepers” that provide nothing but additional obsticals to surgical procedures that are common for other populations, in addition to the genital surgerys that are unique to trans folk.

  5. Did you explain all this to them when you declined their offer? Not that they’d necessarily have listened, but they need to hear it from someone.

  6. I think one reason some people are so fixated on “regret” and “de-transition” is that it fits their narrative that people who are trans aren’t a real thing or are mentally ill. “See? That person realized how ‘wrong’ they were. That proves that I was right.” Too many don’t want to understand that there’s nothing inherently wrong with being transgender, that if people were left alone and stigma not applied, that most people who are trans would be just fine. Instead, since they themselves have never felt this way, being transgender is just a “conceit” and not a real thing. Therefore they point to whoever they can find who “regrets” transition as proof that trans-ness is false.

  7. Pingback: On Regret | Action for Trans* Health

  8. It’s amazing and DISGUSTING how ANYTHING AND EVERYTHING has been politicized. I blame the communists for it (They are masters of manipulation), but I also blame the “liberals” for being so gullible and filled with hate for others who don’t toe the “politically correct” line.
    For the love of God, just be good people and stop (Literally) “making a federal case” out of your lives.

    • Hello! You must be an American. If you hadn’t noticed, this blog isn’t written from the States and isn’t about the States, because not everything in the world is about your country and the way you do things. Federal, indeed…

      Anyways, I doubt you’re going to agree with me on anything, but I can guarantee you that when less of my peers find themselves contemplating suicide due to the awful treatment they receive (perhaps from people like you!), and when less of my peers have been abused or beaten up or threatened in the streets or raped, I will make less of a fuss about these issues.

  9. Regret is not uncommon. So why if you work in this field would you censure the reality of many who transition and then detransition? It seems quite dishonest that you would only represent part of the picture. I have many transgender friends and many who have detransitioned. It is not just uncommon and there is nothing wrong with talking about this reality.

    • Hi Anon,

      There are many reasons people might “detransition”/”retransition”. I’m actually planning a follow-up blog post on this, with the aim of prioritising the voices of those who have had these experiences – I recognise that my post here underplayed those stories/experiences.

      However, I stick by the central points of this post, which are only supported by research evidence:

      – Experiences of regret are a *lot* less common as the mainstream media (or, for that matter, some of the conservative blogs now linking to me) like to think.

      – Experiences of regret are a *lot* more complex and varied than the mainstream media discourse (typified by Sundog’s approach) makes out.

      • What a cop-out!

        “Oh, it’s too complex and varied because reasons”

        Give a straight answer or don’t answer at all, you’re showing some obvious bias.

        • What kind of answer would you like? One that aligns with your own bias, or one that pretends that “detransition” is a straightforward issue when it’s not?

  10. “Writers such as Julie Bindel are all too keen to use any example of individual regret to argue that transition is unnecessary mutilation, undertaken by sad, sick individuals who might have done otherwise if only they’d been given the option of, say, some form of reparative therapy.”

    Reparative “therapy” being the darling of the Christian Right as well as the radical feminists, of course… I remember a diagram I saw of the traditional political left-right spectrum, in which the line was bent into a near circle with the extreme right and extreme left suspiciously close to each other… though never shall the twain meet, or own up to the fact that they are merely ironic mirror images of each other’s self-righteousness and mean-spiritedness. 😦

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