A few weeks ago, I drove to a town on the south coast of the UK to interview someone I will call ‘Alex’. Twenty years ago, when in middle age, Alex underwent a medical gender transition from female to male (complete with hormone treatment, hysterectomy, removal of vagina and ovaries, and phalloplasty – that is, the creation of a prosthetic penis). Alex now bitterly regrets transitioning and wants to live as a woman again, but is now, in every way, indistinguishable from other sixtysomething, balding males, and despairs of ever being able to do so.

Alex told me a harrowing story of childhood sexual abuse and lifelong post-traumatic distress disorder (PTSD). He had seen a television programme about people who had transitioned and identified with the people on it. He went to a support group for trans people, and decided to transition. He told me that he thought that he would become a different person, and that the trauma that had dogged him all his life would go away. It did not. Later that same week I had a conversation with Felicity, also in her sixties, who transitioned even longer ago than Alex did, when she was in her thirties. She has no regrets about transitioning, but cautions anyone who thinks that it will make them a different person, and solve all their problems. She worries about young people in particular undergoing difficult and challenging medical treatment and surgeries.

When, several years ago, I began to research people who regretted transitioning, I knew that evidence was emerging of people doing so in greater numbers than anyone who worked in the field of transgender medicine had seen before. In November 2014, I met up with Dr Miro Djordjevic, a surgeon from Belgrade who does a lot of sex-reassignment surgery. He told me that he was worried because he had recently been asked to do several ‘reverse’ operations for people who regretted their gender transitions and were ‘detransitioning’. All were adults who had been born male, and had had their testes and penises removed. They now wanted a phalloplasty operation to create a semblance of a penis, as it is not possible to replace gonads and genitalia which have been removed. (In the case of Alex, there is no way that a vagina can be replaced.) Djordjevic told me the growing phenomenon of ‘reverse’ reassignment surgery had never been researched and it needed to be. I began my preliminary research into the phenomenon as part of an MA at Bath Spa University, which it later prevented me from continuing, citing fear of criticism for allowing research on a subject seen in some quarters as ‘politically incorrect’. Still, while undertaking the initial research, I was shocked to discover that growing numbers of detransitioning young women were telling similar stories to each other. They discovered trans either through the internet and/or their peer group, and felt they were drawn into it as it seemed to answer their concerns about being a female in society. The ever-growing range of gender identities appealed to them, and many had histories of mental-health problems, sexual abuse and self-harm. In trans, they found a group in which they were accepted and even celebrated, especially so in the wider context of identity politics They felt powerful, often for the first time in their lives.

At the same time, the rise of the ‘affirmation’ model of transgender healthcare (which was later entrenched in the UK in the Memorandum of Understanding against Conversion Therapy being made policy in 2018) meant that patients, even under-18s, could obtain medical gender-reassignment pretty much on demand, and, in some cases, without parental consent. Small wonder, then, that by 2019 there are now groups of detransitioners, mainly young women, forming coalitions and support groups, and, in the UK, even a charity, in order to support themselves. The thing that has most disturbed me in all of this – apart from the way that Bath Spa University prevented crucial and important research from being done – has been the sheer scale of the denial, vilification, ignorance and, at best, silence that has come from trans-activist groups and their supporters on the subject of detransition. In any other field of medical practice, if evidence began to emerge of a practice that so many patients were saying had caused them harm there would be an inquiry into it. There is so little research into the long-term outcomes of gender reassignment – and most of it predates mass use of the internet, and the subsequent huge rise in young people presenting at sex-reassignment clinics. It is acknowledged by experienced clinicians that over 90 per cent of patients are lost to follow-up. We know that detransitioners very rarely go back to the clinics that treated them.

One trans support-group spokesperson has said ‘we are not comfortable with detransitioners’. Once dismissed as such a small percentage of those who had transitioned they didn’t matter, the feeling now seemed to be that they were ‘difficult patients’. When ‘informed consent’ was the model for treatment – we inform you of the consequences and potential side effects of treatment, and as long as you are not mentally ill, you consent – there were bound to be those who regretted transition. Now that ‘affirmation’ is the order of the day, and trans has become a political movement, it comes as no surprise that there are many, many more who regret making such a life-changing decision. James Caspian is a psychotherapist. To support his legal challenge against Bath Spa University, visit his fundraising page here