How did the field of transgender medicine move from general agreement that roughly one percent of trans people detransition, to more recently seeing the establishment of detransition-related care services in the USA and the UK?
Politics are a big part of this story, but the political angle neglects the underlying contested science—and the individual lives—that brought about clinical changes and cultural transformation beginning in the late 2010s.
This is what inspired us to write our forthcoming book, Understanding Detransition. It was just put into production and is expected to be published spring 2027. A huge milestone!
Starting to sketch out ideas for it was why we created this Substack account. When the newsletter first launched, its title brought up confusion among some of our initial readers: The One Percent.
Were we referring to rich elites?
Were we writing about trans people, long thought to be only one percent of the population (or even less)?
Or, were we reproducing a commonly quoted statistic, that only about one percent of people who transition regret it?
Trans-skeptical accounts regularly accused us of reifying the 1% regret rate, basically affirming it as a settled fact.
For some time, we deliberated over changing the title of the Substack to avoid misunderstandings. While our general ethos is of trans-affirmation, our research has also aimed at understanding detransition, identity fluidity, regret, and post-transition ambivalence. The book became about much more than individuals who experience detransition or regret. It is also about how knowledge is created, how science can be shaped by identity, beliefs, distress, and recurring political struggles over how its object is defined.
Ultimately, the book turned into a much bigger project than simply communicating our research results and it took a lot of careful editing to cap it at 90,000 words.
Below is an edited and condensed section that puts into clear view why we decided to keep our Substack’s original name, and why this particular statistic is so central to scientific and political struggles in transgender medicine.
The One Percent
The dominant story of gender transition in the West has long been one of triumphant self-discovery, authenticity, finding comfort in the body, and of lifesaving medical care. It has emphasised the expression of a true gender self after having been born in the wrong body. For years, a single statistic anchored gender transitions in the West: only one percent of those who medically transition ever detransition, regret treatment, or feel harmed by it.
The one percent became more than just a number. The figure did not simply describe outcomes; it organised the field of gender care itself. It guided transgender and nonbinary people contemplating hormonal and surgical interventions. In the case of gender diverse minors, it offered confidence to parents. It brought to life an affective framework, defining which post-transition emotions and medical experiences were legitimate to an emerging coalition of care providers, advocates, and institutions. It became a cornerstone of identity-affirming culture, clinical practice, and LGBTQ advocacy, and it created a script for which post-transition emotions could be spoken about. The one percent, as a rhetorical device, also implied that any stories of those who drifted away from the trans pathway were so statistically insignificant as to be anecdotal, or even deliberate “misinformation.”
Since the late 2010s, a set of surprising accounts began to gain visibility. Depending on who you ask, these experiences are met with hesitation, or they receive disproportionate—sometimes even glorified—focus. They come from individuals who speak of gender identities that are not fixed, of evolving gender journeys, of lives made more complicated by transitioning—not only by social conditions that can constrain gender diversity, but sometimes by the very medical interventions that were promised to alleviate distress.
These are the stories of detransition.
Understanding Detransition contemplates old and new clinical knowledge. It also blends it with contemporary informant interviews, and with our three contemporary research projects—Re/DeTrans Canada, the DARE study, and NORTASUN. Conducted between 2021 and 2024, these original studies collected data from 1,035 people living in the United States, Canada, and Spain. A large majority—nearly 70%—medically transitioned, meaning they initiated at least one hormonal or surgical intervention clinically indicated to treat gender dysphoria before they detransitioned. While robust methodology is crucial to research, as sociologist Arthur Frank notes, “after the methods, there has to be a story.” Our story is empirical and pragmatic: we contextualise our own research—revealing a wide range of detransition experiences and self-understandings—with trans studies, histories of LGBTQ healthcare politics, and philosophy, not necessarily to resolve tensions, but to make the connections impossible to ignore.
Within academic research, detransition has never had a widely agreed upon definition. In this sense, the struggle to define detransition is also part of the story we tell. Historically, gender clinicians applied the word “regret” indiscriminately to a range of unexpected outcomes, often disconnected from their patients’ emotional lives. Later, once detransition experiences became more culturally and clinically visible, a waterfall of euphemisms and new definitions started to flow into the academic literature. This is what sparked our curiosity most: not just that people reported different reasons for detransitioning, but that similar clinical outcomes were being described in radically different ways depending on who was listening. Detransition had become a canvas for competing ideas and values. Part of our work involved asking why. Answering that question required us to write about more than detransition itself, and we ultimately produced a sociology of knowledge and a history of science of the field of transgender medicine. This task laid bare that detransition is not at the margins, and that it’s not a rare anecdote, but central to unresolved uncertainties regarding gender dysphoria—trans medicine’s treatment object.
In conducting research for the book, something remarkable we noticed is that the one percent figure’s resilience has relied on changing clinical dynamics and the historical fluidity of the category today we call “detransition.” By controlling its definition, by redefining whose transness counts and who is considered a detransitioner, the magnitude and meaning of the phenomenon was contained for years before it eventually fractured.
As we argue, when detransitioning began to gain wider recognition, accounts of it were interpreted through competing lenses, organised by coalitions defined by their unique beliefs about transness, dysphoria, transgender medicine, and how detransition should be understood. Here, we draw from philosopher Dan Williams, who argues that many human communities function as belief-based coalitions: groups in which commitment to a specific set of ideas and values becomes a condition of belonging and to the group’s identity. He calls these identity-defining beliefs—convictions so bound up with community connections that questioning them risks social exclusion, while affirming them earns status and trust. Within these coalitions, members are incentivised to promote the interests of the broader collective, affirm shared beliefs, and suppress private doubts. Dissent is sometimes treated as betrayal.
Over the course of several decades, successive paradigms of transgender medicine have redefined transsexuality and dysphoria, which outcomes signal “regret,” and which experiences remain in clinical “zones of abandonment.” The result is a field where limited evidence has become a canvas for competing values, and detransition a site of scientific, clinical, and political struggle. We uncovered that the socio-political dimensions shaping knowledge about detransition can be broadly divided into two coalitions: the identity-affirming coalition and the transition-skeptical coalition. To make sense of how our research fits into the politics of gender care, we had to closely examine these groups as they vie to redefine care via fundamentally different values and beliefs.
To write this book, we took on the role of “double agents.” This is a concept coined by historian Joan Scott to describe actors who operate simultaneously within and against dominant discourses. Double agents make use of existing categories in order to render certain experiences intelligible, while also exposing those categories as historically contingent, politically charged, and dynamic. In this sense, some of our double agent work has involved using the terms “detransition,” “gender evolutions,” and “regret” to study and describe real, observable reality and to tether constructs to data-driven meaning. At the same time, we also interrogate how the meaning, boundaries, and legitimacy of these terms continue to be negotiated in real time by gender clinicians, activists, parents, institutions, trans people, and detransitioners themselves. The book we wrote is both a product of these negotiations and a map of it.
Confronting our own epistemic disruptions was what brought us to connect—in 2022—as scholars trying to make sense of our findings, engaging in self-reflection about our deeply held values, identities, and emotional lives within and outside the research. Our collective position—as a white Canadian transmasculine social scientist and a Spanish non-trans/cisgender psychologist and researcher—afforded us access to a broad range of perspectives, but it also carried the risk of reproducing the same commitments of our networks. Although we cannot control how our work will be taken up, we do take seriously the responsibility of presenting our data honestly, to avoid flattening complex lives in service of predetermined beliefs.
Some scientists distinguish between two attitudes toward academic literature: a “Book of Truths,” a definitive repository of settled facts and knowledge, and a “Book of Conversations,” an open and ongoing exchange of findings and questions.
After a year of writing it, Understanding Detransition became a book of conversations—with our research participants, with other scholars, with LGBTQ community advocates, and with our readers. By closely examining detransition, we wrote a story about science, society, and transgender medicine. It centres people who sought hormonal or surgical treatments for gender dysphoria and later experienced a change in their identity, desires for their bodies, or who expressed negative or ambivalent feelings after transitioning. This story asks how and why these accounts are now being called upon in the contemporary politics of gender care to guide what happens next. It also asks whether our systems of care can accompany people when their lives and identities—and the world around them—change.
But as we underline, the future of transgender medicine does not depend on how often detransition happens, but on which uncertainties are tolerable and whose suffering counts. Ultimately, detransition, in an entirely unique way, reveals the values, identities, emotions, and social relationships that can shape and reshape medical knowledge.
We are looking forward to offering our work in the spirit of these conversations.
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