Wednesday is Detransition Awareness Day, but the healthcare system is unaware of detransitioners 365 days a year. A growing number of individuals regret having received irreversible “gender-affirming” interventions, with many having had their gender distress erroneously attributed to a transgender identity. Despite their continued medical struggles, detransitioners are invisible within the system of medical diagnosis codes, rendering them and their iatrogenic condition nonexistent.
The healthcare system recognizes patients treated for gender nonconformity with multiple International Classification of Diseases diagnosis codes that allow clinicians to accurately document these visits, making them, like all billed clinical encounters, amenable to tracking and research.
But no code exists for patients who regret their gender transitions and need help detransitioning to wean off cross-sex hormones or initiate replacement hormones for sex organs that have been removed (such as replacement estrogen for surgically absent ovaries). Clinicians have no established guidelines to safely treat these patients, and some are not even aware such patients exist.
Currently, any encounters related to detransition must be submitted under codes that do not accurately reflect the reason for the visit, making detransition an untraceable phenomenon.
An ethical medical system shouldn’t promote treatments while camouflaging bad outcomes. In addition to ample research questioning the benefit of “gender-affirming” interventions for children, it is especially troubling that there is no way to be certain which children will maintain a gender-nonconforming identity into adulthood, increasing the possibility of misdiagnosis and harm.
Though detransitioners’ suffering is not always obvious, some have lost important bodily functions such as the ability to breastfeed due to a “gender-affirming” mastectomy or fertility due to “gender-affirming” uterus and ovary removal or castration.
To add insult to injury, they have lost something that should make every clinician uneasy: confidence in a medical system that doesn’t even acknowledge their existence.
Equitable healthcare for detransitioners has been framed as “anti-trans” by activists who turn a blind eye to the ethical double standard. While some states deem “gender-affirming” care medically necessary and coverable by federally funded Medicaid, reversal of “gender-affirming” procedures to affirm a biological gender identity is usually excluded.
It’s no wonder that patients suffering harm from gender interventions are swept under the rug since acknowledging them pulls the rug out from under the established narrative. “Gender-affirming” clinicians promote the idea that a patient’s self-diagnosis of gender incongruence at any age is sufficient to establish a gender-nonconforming identity, opening the door to life-altering interventions. Recognizing patients harmed by these interventions throws cold water on this theory.
The “gender-affirming” surgeon and president of the World Professional Association for Transgender Health quelled all speculation regarding how detransitioners are perceived by saying the quiet part out loud in a discussion forum: ”[A]cknowledgement that detransition exists even to a minor extent is considered off limits for many in our community.”
Yet Hippocratic Oath medicine doesn’t allow for picking and choosing who gets good care and who doesn’t. A doctor’s promise to “do no harm” applies to all patients, regardless of gender identity.
DEMOCRATS HAVE TURNED WOMEN’S HISTORY MONTH INTO A JOKE
Though state legislation that would have required insurance companies to cover detransition services failed last year, similar legislation in the future, if successful, would necessitate a way to accurately code medical encounters related to detransition.
It is a sad state of affairs when acknowledgement of any patient is relegated to one day of the year. It is even worse when patients are ignored by the healthcare system altogether.
Aida Cerundolo, M.D., is an emergency medicine physician and fellow at Do No Harm.