(159) Challenges of Sexual Life After Detransition: Trauma, Disenfranchised Grief, and Unmet Needs

Introduction Many previously trans-identified individuals who discontinue both social and medical transition report experiencing regret, as well as grief reactions to medical trauma, and encounter barriers to accessing care for medical needs and psychological distress. Among the consequences that are seldom fully appreciated by consumers prior to initiation of gender medicine is loss of sexual function related to permanent effects of hormones and surgery. In females this includes vaginal atrophy and dyspareunia, clitoral pain, loss of breasts, and difficulty passing again as female due to voice changes and excess facial/body hair. There may also be infertility, and lifelong treatment with replacement hormones. Reconstructive surgeries are not covered by insurance as gender medicine is, or else providers are unwilling to take their cases, and many wish to avoid additional medical trauma. Adding to their distress is the experience of disenfranchised grief due to stigma/isolation from former allies in LGBT community, as well as denial of responsibility and abandonment by medical and mental health providers who previously facilitated their transition. Objective I will make the case that psychosexual rehabilitation for detransitioners should be made available for those who need it but must include validation of grief, and compassion for the trauma that many have experienced within a healthcare system that has betrayed their trust. Lack of awareness of the harms vs. the preferential telling of “success” stories of gender medicine, or outright stigma against detransitioners only compounds distress. My hope is to remove the barrier of silence in our field about iatrogenic harm in gender medicine and to increase cultural competence among sex therapists and sexual medicine providers in treating this population. I hope also to stimulate research and the creation of standardized pathways to care in assisting with sexual rehabilitation despite irreversible effects of previous medical interventions. Methods Given the lack of formal research on sexual health outcomes after detransition, I will use case examples of iatrogenic harm associated with medical intervention that was later regretted, which will be presented as anecdotal evidence of specific adverse effects of gender medicine as well as identifying unmet needs that could be targeted for intervention. Results There are clearly predictable and irreversible changes that adversely impact sexual function following discontinuation of gender medicine that includes hormonal treatments as well as surgeries. Effective treatment must be culturally informed in which validation of iatrogenic harm and disenfranchised grief is paramount. Potential research on sexual function and rehabilitation among detransitioners is suggested and the need for creating new pathways to care that include sexual medicine and reconstructive plastic surgery. Conclusions Many detransitioners struggle alone with significant emotional and medical trauma. They deserve to be offered compassionate and trauma-informed care that is not currently available to them, despite predictable harms that can occur without adequate preparation for the possibility of regret associated with irreversible side effects of gender medicine, including loss of sexual function. Psychosexual recovery is a long-term process that will not restore what has been lost, but nonetheless can be facilitated via access to trauma informed psychotherapy as well as existentially focused sex therapy to promote post-traumatic growth and healing. Referrals to sexual medicine and reconstructive surgery providers are also potentially important to assist in healing and recovery. Disclosure No.