What if I Regret Gender Transition?
So, we’ve discussed the issue of Trans Regret, the myth used to control trans people and trans bodies for most of a century here in the US. But as I posted about this, I did have folks ask me about the associated ideas—namely, real gender transition regret and folks who detransiton/retransition. As I mentioned in my previous blog, many of the folks who come to me do so with the fear that they will have those regrets, that they will detransition, and what that will mean for their social lives, family ties, bodies, careers, and etc. This is an important and complicated topic, and one that has a lot of political and emotional valence in the trans community. Therefore, it often becomes a “we don’t talk about it” idea, and when we don’t talk about things, it doesn’t do anyone any good!
We tend to have the most fear around the things we don’t understand. So really, there’s the fear of regretting transition, the reality of regretting transition/parts of transition, and of course, the cultural narrative of regret. Each of these is its own large, nuanced topic, worth of consideration and care. But I find that when you understand the reality of regret and what it entails, the fear of regret diminishes.
So let’s get some air around regret. (I will cover detransition in a future post.)
Gender Affirmation Regret
I mentioned in my previous post that the rate of regret for gender affirmation procedures is very low, but not 0. Again, there is no action that you can take on this earth that has a 0% regret rate, and many of the things we do in life have a very high rate of regret, yet are still championed and even expected in many circles. Think marriage, university degrees, grad school, moving to new places, not moving to new places, career choices, and more. So I think it is worth pointing out that the outsized emphasis on regret around gender affirmation is an expression of deeply seated cultural transphobia.
That said, there are certain aspects of transition that make the fear of potential regret especially potent for many folks. Some of these that I have identified are:
“Coming out” to friends, family, and work (and therefore the potential of having to walk back your coming out, telling folks that you’re not actually trans after all, which boils down to shame around admitting you were “wrong”)
Feeling shame around the idea of changing your name or pronoun more than once
Fear around permanent medical changes
Fear around fertility loss, and/or inability to chest feed (for trans masculine top surgeries)
Fear that you are doing it “for the wrong reasons”
I am sure that folks will think of other things, but I want to address these reasons because they are the ones I have experienced personally OR common ones that clients bring to me. I would roughly sort these into “Social Regret,” “Medical Regret,” and “Imposter Syndrome.” This post will cover the first two forms of regret, as imposter syndrome is multi-faceted and has also been covered by my Trans Enough blog series.
Social Regret
This category covers the first two of the fears listed above; coming out (especially coming out more than once) and changing name/pronoun more than once. I put these in a single category because they both hit on the same issue—in the current U.S. culture, we have very little space for gender exploration, gender questioning, and gender journeys. There is no reason why it should be a problem to explore, to try on various identities, modes of being in the world, pronouns, labels, etc. Even the need for “coming out” is so baked into the idea that there is something exceptional or strange about shifting identities, or even just about the idea that what people perceive or project about you isn’t true to your experience.
Honestly, why is that considered exceptional when it’s related to gender or sexual identity? It’s very well known that we see one another through our own worldviews and frameworks, that we don’t know other’s interiority. This idea comes up in many different ways through most traditional forms of therapy. Yet we have this whole ritual of “coming out,” because folks around us assume we’re something, and as a culture, we assume things like identity labels or expressions can’t change over time.
Annoying, but I know we can’t change the whole culture overnight. So what do we DO with both our own fears around these interactions, and the fears and projections of others?
First—remember that coming out is an option, not a requirement. There are many different ways to handle this process, and you don’t have to “come out” in a way that doesn’t work for you. Here are some examples.
Instead of stating an identity, ask people for what you need from them. For example, “Can you please use they/them pronouns when referring to me?” (If the “why” questions arise, remember you’re allowed to set your own boundaries around this. Responses can be as simple as, “It just feels good to me” or “It’s important to me.”)
Sadhbh O’Sullivan wrote a simple, easy-to-read article about the tensions around coming out and why it’s not a great framework for modern queer identities. They bring up the idea of “Inviting in,” which makes much more room for different relationships and comfort levels, for safety and non-linear journeys.
Even with a medical transition, you are allowed to have boundaries and to respect your own boundaries. I’ve had clients who medically transitioned and when family members brought up their changing look, they just acknowledged the observation and moved on. This may not work in every family, but again, you are allowed to have your boundaries.
Next, there’s a certain amount of self-work that you may need to do in order to permission yourself to explore your gender, regardless of anyone else’s take on the matter. That may take the shape of seeking therapy, working with a gender doula, seeking spiritual support, reading books, or (most likely) a combination of supportive modalities. If the idea of your gender being a journey rather than a destination brings up shame, guilt, and fear, I deeply encourage you to interrogate why. Especially if you are deeply supportive of these things for others, but you yourself feel like a fraud. That’s a good piece of data that suggests that you may need to work out your relationship to yourself, your self-compassion, and your self-worth.
Please note - if you need to work on these things before you explore gender or transition, that’s fine! It’s okay to need time. But you can also work on these things actively while you are exploring, questioning, and transitioning your gender. These do not have to happen in linear time, but may be ideas that you dip in and out of as you travel your own path.
I don’t know who needs to hear this, but changing your name or pronoun more than once is fine. Yes, that means for you, you specifically, you reading this! YOU can change your name and pronoun as many times as YOU need to. There may be people who can not walk that path with you, and it’s okay to grieve that. But their inability to walk with you does not mean that your path is any less legitimate. Your journey is yours.
Medical Regret
And now we turn toward medical regret. Full disclosure—I work with multiple clients who have experienced medical regret around gender affirmation. I love and support these beautiful humans and their complex journeys. Many very difficult and challenging emotions come up around medical regret, and I think that it is very common that when we see someone else regretting a thing, we are seized with fear that we, too, may have to experience that pain and struggle.
So lets demystify medical regret.
First of all, the medical literature on regret* matches up with my personal experiences with clients—that this is a complicated issue and that how it bears out in life is very different from how folks seem to imagine it (*This is an article that include a literature review, and therefore gives a good overview of the research on this topic). See, some folks regret some of the medical steps of their transition because their gender identity shifts and changes over time. What felt vital at one point may not feel so vital at another. Someone who understood themselves to be a woman, may later understand themselves to be non-binary trans-feminine. Someone who understood themselves to be non-binary, may later understand themselves to occupy a binary gender identity.
So if your identity shifts and changes, then you can make the right choices for yourself at a certain time, but those choices may not be correct for a future iteration of yourself. That’s fine. That’s life. Shifting and changing over time is a sign that you are alive. Having compassion for previous versions of yourself and for their choices is an essential skill for navigating the ups and downs and twists and turns of being a human on this planet. If you walk down certain paths and you end up regretting those paths, that is tough. It can bring up a lot of grief for younger you, current you, and even future you. It can bring up many challenging feelings. But ultimately, it is a sign that you are a living being on this planet…and I think that’s a good thing!
Next would be a lack of social support, decreased opportunities, and other symptoms of cultural transphobia. As I mentioned before, there are times when folks in your social support network can not come with you on your gender journey. For some people, this means losing, or potentially losing, mental, emotional, and financial support. There’s no easy response for this. Ideally, I would like everyone who is in this situation to have robust networks of support that they could depend on to rebuild a life that allows for the fullness of their identity. There are many trans and queer people who are trying to create these structures, but even if all material needs were met, and even if folks could be accepted into existing social circles, it doesn’t change the fact that losing a significant number of family and friends is a terrible thing to experience.
If this is your fear, I invite you to take inventory in your life. Who do you honestly think will reject you if your identity shifts and changes? Who are you afraid of rejecting you? Do those people currently support you (mentally, physically, materially, emotionally)? Who does support you? Is that amount of support enough to sustain you through this process? Can you call in new forms of support (like a therapist, new friends, monetary support, etc)? Can you open up, even a little bit, to the idea that you deserve unconditional love?
You deserve to be accepted in your fullness. That may not be possible where you are right this minute, but it is possible. And also, love doesn’t have to look just one way. Some of my fiercest advocates didn’t always perform perfect politics…but they were on my side when I needed it. And they made all the difference.
The last form of medical regret I will touch on here is what I will call “outcome regret.” This type of regret can be relatively minor—for example, wishing that your scar tissue was different or that you had sought larger hips or gotten a different shape on your nose, etc. But outcome regret can also apply to much more serious forms, such as regretting a top surgery because you want to breastfeed a child, regretting a bottom surgery due to chronic genital pain or other medical complications, or even just realizing after the fact that the surgery wasn’t what you wanted or needed in the way you thought it was. This is a very complex and personal topic—there’s no way for me to adequately address it in a few paragraphs.
To some extent, avoiding this form of regret is about having freedom. Freedom to research procedures, to choose a doctor you’re comfortable with, freedom to really question if this is the right procedure for you and to feel your agency and power when selecting it. In the US medical system, this kind of freedom is a privilege that comes with money, able-bodiedness, thin-bodied privilege, and often, racial privilege. For this reason, the medical system in the U.S. is coercive to many of its citizens, and trans identity complicates this further.
I often see outcome regret among folks who were a part of a coercive system, or who were not given the space to feel into what steps were right for them. For example, if a state requires surgery for a person to obtain updated identity documents, someone who doesn’t actually want surgery may feel that they have no choice.
Similarly, when we have medical models of care that prescribe that anyone with a certain identity label must want a certain set of procedures, we are creating conditions of regret. Assuming that someone who identifies in a certain way must want x, y, or z procedure is a good way to confuse folks who may not actually feel that way. And just as it is damaging to force folks to wait for months or years to access specific types of care, it is damaging to rush people through a one-size-fits-all form of gender medicine.
So how do you avoid this type of regret? I recommend two things: gather as much information as you can about the procedures that you are seeking, and get in touch with your interior world/your body to feel into what your body needs.
For gathering information; there are many ways to do this, and you want to make sure that the information you’re gathering is of high quality. Although I am working on generating my own resources on these topics, you can visit my resources page and see the sources I have vetted.
Getting in touch with your own body is harder, and a topic worthy of many future blog posts. To start on this path, I recommend looking into movement practices that work for you. Try searching for somatic exercises and/or mindfulness exercises. I can help with this in one on one work, and it will be built in to future classes as well :). I also highly recommend the book “Anchored: How to Befriend your Nervous System Using Polyvagal Theory” by Deb Dana for this process. (Note: this is an affiliate link for my bookshop dot org store)
I will speak more on befriending your body, but for now I want to just say—the narrative that our bodies are bad, wrong, or need to be corrected is deeply outdated. Our need to change our hormone profiles or the shape of our flesh comes from our bodies. Our gender is an embodied thing, and our bodies are our allies in this journey, not our antagonists. Building this connection can be extremely helpful in medical decision making, and can also help you be more resilient to regret.
Fertility Loss & Chest/Body Feeding Capacity Loss
Terminology note: I’m using “chest/body feeding” here to describe feeding your kiddo from the glands in your chest through your nipples. Folks have different terms for this process, and there is no universal wrong or right term. Please use the terms you are comfortable with.
One particular area of anxiety around potential regret is around reproductive health - specifically fertility loss and chest/body feeding. A good resource for the basics on chest/body feeding questions is on the gender confirmation center’s website. This resource goes over the different chest surgery options, as well as different options for feeding children post-surgically.
Please remember—there are many ways to feed a child, and there is support for you if you want to carry and feed a child post-top-surgery. The bottom of the article linked above does have resources. Some of the clients who have come to me have expressed feelings that they need to or have to keep their chest tissue to chest feed a child because they are the only person in their relationship with that capacity. It makes sense that folks would feel this way! But remember - many couples/polycules have babies, including couples/polycules where there are no uteruses or milk ducts at all. You will be the best parent you can be to your child if you are honoring yourself, your body, and your needs by pursuing the steps that are important to you.
With that said, if you are comfortable doing so, it is completely valid to wait until after chest feeding is complete to obtain top surgery. You will have to feel in to what choice is right for you, but please remember that it should be your choice, and your choice alone. No one else lives in your body, no one else lives your unique life.
Fertility conversations vary a great deal depending on if you are seeking estrogen and androgen blockers or testosterone. The full conversation on this topic will require more space than I can give it in this blog, but this is a great resource from UCSF. The short version is this: for those on testosterone, there is a track record of folks stopping hormones for six months, getting pregnant, carrying a child, and delivering a healthy baby. You can freeze your reproductive cells if you would like, as well. For those on estrogen, there is some evidence that estrogen damages reproductive capacity, and there is some evidence that you can take medications that restore spermatogenesis.
I counsel my clients to freeze reproductive cells (sperm or eggs) if they feel strongly that they want biological children someday or that they will regret not having an option. I also remind them that there are no guarantees of fertility in life. Even without HRT, biological children may not be something that your body can do. Different bodies have different capacities for this process, regardless of medical intervention.
Further, there are many options that allow you to engage your parental energies and capacities that don’t involve bringing a biological child into this world. Adoption is a complex issue, and if it is something that interests you, I urge you to do a great deal of research on how to do it ethically and how to care for that child specifically through the trauma of adoption. But there are other ways to engage as well. For example, our local LGBT center has a program that places unhoused queer and trans youth in willing homes so they can thrive. I myself have a gaggle of queer and trans youth that I am consistently mentoring and showing up for, and that feels amazing.
With full respect to the fact that reproduction is an incredibly personal topic, I just gently offer this—the world and the community need you to be the amazing person that you are. You don’t have to bring a baby into the world to raise a child, or to impact a young person. There are options. But only you can make the choices around these sensitive issues.
Regret - A Conclusion, For Now
This is already the longest blog I have written so far, and I haven’t even touched on detransition/retransition yet! But this topic is deep, complex, and often quite messy. The false narrative of Trans Regret does nothing to account for the real, lived reality that these journeys entail. If you need more support working through these questions, you can contact me for support, or sign up for my mailing list, as I will be offering classes and workshops that explore these topics in extreme depth.
Much of this boils down to knowing your options, staying in touch with yourself, and making your choices from a place of embodied self-sovereignty and not from a place of outside pressure or fear. I trust you to know yourself better than anyone else. And if you need more support, seek it.
I love you.