The Detransitioner’s Dilemma: The Road From “Sunk Cost” to “Radical Acceptance”

I was having lunch with a friend, a respected internist, and asked him whether his trans patients posed any particular medical concerns. I asked because I had received an email from a Canadian physician who, I thought, perfectly summarized his position. “I love my few transgender males,” he wrote. “They all have other mental health issues. Lovingly I explain to them that I will always treat them with respect, but that I would not be intellectually honest or medically compassionate if I also did not treat them medically as someone who has every cell in their body female.”

The letter made me think of the recent research on the long-term, potentially harmful effects of administering estrogen to transgender women who have every cell in their body male—effects such as increased risks of cardiovascular and cognitive problems.¹ I also wondered what such information portended for doctors who are treating young transgender people who, in the manner of all young people, are not thinking about their future health. 

My friend agreed with the Canadian’s position on treatment, musing about the origins of his patients’ determination to transition—given, he said, how much they had endured, psychologically, socially, and medically, to do so. “Why would anyone put themselves through all that, even take on possible medical risks down the line, if there wasn’t some deep-seated need or yearning?” he said. Then he added, “Of course, I am speaking from only a few anecdotes.” 

Anecdotes are powerful. Humans think in anecdotes, tell stories of anecdotes, draw conclusions from anecdotes, and make social policies based on anecdotes. In this case, they led my friend to infer that most if not all trans people must have an inborn identity as being the other sex and will suffer any misery required to feel right in their own bodies. What might disconfirm that understandable inference? One thing would be the existence of “detransitioners” who put themselves through hormonal and surgical procedures and later changed their minds. After all, if transgender people are impressive because of all they are prepared to undergo in order to live as the other sex, consider how impressive it is for detransitioners to admit they had made a devastating mistake. 

The vast majority of people who invest time, money, surgery, and commitment into any activity will justify it rather than admit that it wasn’t worth it—let alone that it was harmful. Most people will pile on new costs to the “sunk costs” of the lost investment, rather than tolerate embarrassment, shame, and a massive plummet of self-esteem, and that’s just if they buy the wrong overpriced car or still think vaccines cause autism. What if that investment was a mastectomy at age 13 or loss of your reproductive ability at age 15? What if you became estranged from your parents in a fury because they tried to caution you? What if you lost your beautiful soprano voice, never to be regained? 

Consider how impressive it is for detransitioners to admit they had made a devastating mistake.

Let’s stipulate that these questions are enormously complex to study empirically. The vast majority of transgender people report initial satisfaction, even exhilaration, and say they have no complaints or regrets. Indeed, “post-surgical euphoria” is common, though short-lived. Further, it is difficult to determine how many detransitioners there are (as a percentage of those who undergo extensive hormonal and/or surgical interventions), partly because some get off the medical train but retain the new gender identity, and partly because large numbers stop seeing their original specialists and thereby drop from view. (This is a widespread problem in assessment of all medical procedures because unhappy patients—”that laminectomy did not end my back pain as you promised”—tend to abandon their physicians rather than return and complain. Thus the doctor can cheerfully, if mistakenly, conclude that all went well.) Indeed, one study of 100 detransitioners found that 76 failed to inform their clinicians that they had detransitioned.² No wonder endocrinologist Michael S. Irwig titled his paper “Detransition Among Transgender and Gender-Diverse People—An Increasing and Increasingly Complex Phenomenon.”³

And an increasingly important one, because the trans phenomenon primarily affects young people, whose adolescent identities—and brains—are still works in progress. UCLA’s Williams Institute School of Law reported in August 2025 that while only about one percent of Americans aged 13 and older (2.8 million) identify as transgender, three fourths are under 35 and one fourth are between ages 13 and 17. If even a few percent of that one percent are changing their minds, that’s tens of thousands of young people, and their experiences offer crucial information for practitioners and policy makers. Detransitioners are speaking up at conferences, online, and in lawsuits against their medical practitioners who permanently altered their bodies, but like whistleblowers everywhere, their bravery is often dismissed, and they pay a high social price for deviating from transgender orthodoxy. Most lament how many members of the LGB and trans communities that once welcomed and celebrated them now shun and vilify them. 

To better understand the factors that lead young people to identify as transgender, and then to detransition, data analyst M. Lal and psychiatrist Stephen B. Levine analyzed the stories told by 37 detransitioners—25 biological females and 12 biological males—on publicly available video testimony.⁴ Their scholarly goal was to identify the main factors (they call “pathways”) into transition and those that eventually led them to change course. Of course this group is not representative of all detransitioners, as if such a sample could ever be created, but their stories corroborate much of what is already known about the young people who find themselves caught in the gender-affirming world and later struggle to get out. Most of the group had originally transitioned in their mid-teens, and detransitioned in their 20s and some even their late 30s. 

To know how and why these women and men abandoned their trans identities, we need to know how they adopted them to begin with. Consistent with almost all other studies, Lal and Levine found a high prevalence of concurrent conditions long known to accompany gender dysphoria in young people: psychological disorders (notably autism spectrum disorder, ADHD, eating disorders); sexual abuse; childhood neglect and a history of abusive relationships; and, sadly, homophobia. When young people take a deep dive into the internet to find explanations of their symptoms and suffering, they encounter communities that actively persuade adolescents who are uncomfortable with their bodies, or who have emotional disorders, that they are “really” trans and their problems would vanish with puberty blockers and cross-sex hormones. Many of Lal and Levine’s participants explicitly described the message they heard over and over: “if you are uncomfortable in your body, you are transgender.” 

Well, no, you probably aren’t. There are many reasons adolescents (or anyone else) might feel uncomfortable with their bodies. Shall I count the ways? But the normal discomforts, pleasures, and surprises of puberty are magnified for young people on the autism spectrum, who, Lal and Levine found, misattributed the concrete thinking styles, sensory processing difficulties, and social deficits typical of autism to having gender dysphoria. One explained how having a transgender identity provided “a structured, rule-based community” that alleviated his social isolation. Another said that the dysphoria label “perfectly fit” his “severe OCD, undiagnosed autism, and a general sense of alienation.” Participants with ADHD spoke of how transitioning provided a focused goal for their hyperfixations, soothing their unflagging restlessness. 

A second route to transitioning, for nearly half of this cohort, was the motive not to become the opposite sex but rather to escape the sex they were. Many had been sexually abused: One young woman’s distress over her developing breasts “was just from sexual abuse,” she said, yet when she told that to her physician, she was given puberty blockers immediately. Another described his transition as “surgical self-harm” to destroy the “boy whose presence was only worthy of contempt” from his father. 

In a gloomy reflection of the state of male-female relations today, a significant number of the participants wanted to transition as a way of opting out of the heterosexual dating market. “[My] eating disorder and dysphoria came from the same place,” said one young woman. “If I had less fat, I would look less female.” Several of these women wanted to create a nonsexual, androgynous body rather than a masculine one, to escape the feeling that their body “was on display—like it was somehow ‘there for boys’ or ‘there for men.’” 

For their part, several biological males described transition as a “flight from manhood” and a way to suppress what they felt was an overactive libido. (Note to boys: That’s normal, guys—you’re teenagers.) One said he wanted a “sexual lobotomy” to destroy the “brainwashing” that male sexuality was inherently evil. Some wanted to distance themselves from cultural claims of “toxic” masculinity and the “predatory” male; one associated a “caricature of maleness” with being “brutish” and concluded that “I can’t possibly be that.” Another said he had absorbed “a lot of rhetoric about how much men suck.” 

Finally, a third route to transitioning was homophobia, another factor that turns up repeatedly in studies of adolescents in gender clinics. Eleven biological males transitioned primarily to escape the stigma associated with being gay; one said that he “100%” wanted to avoid the shame of homosexuality. Several biological females felt that living as a trans man was preferable to living as a masculine lesbian; one transitioned in an effort to bypass the complexities and stigma she associated with being lesbian. 

The vast majority of people who invest time, money, surgery, and commitment into any activity will justify it rather than admit that it wasn’t worth it—let alone that it was harmful.

The bottom line? Not one of the participants in this study said “I always knew I was born in the wrong body.” On the contrary, Lal and Levine give us a picture of 37 teenagers, hitting puberty while suffering from serious mental issues and troubled family dynamics, confused about their bodies and about their sexuality, some scared of men (if female) and others scared of women (if male), some scared of having heterosexual desires and others scared of having homosexual desires, all going online to seek answers and reassurance. Fully 28 of the 37 participants said that their willingness to transition was driven by peers online, with one likening the spread of transgender ideology to a “mimetic virus.” Another said his identity “metastasized” after going on the online message board Reddit, and one noted that she “didn’t even know what transgender was” until she went on the internet. 

And while the internet is brimming with transgender activists making the direct case to vulnerable teens that they are “trans,” it is also full of strange byways that can seduce young people indirectly. Some of the straight females said their wish to transition stemmed from an intense immersion in the “Boys’ Love” (BL) subculture, “a genre of Japanese fiction,” write Lal and Levine, “typically created by women for a female audience (distinguished from homoerotic media created by and for gay men). Identifying as a gay man allowed them to experience romance and sexuality while bypassing the vulnerability and objectification they associated with their female bodies.” What began as a mildly kinky game solidified into an identity when online communities validated this fascination as evidence of a “hidden trans identity.” 

Once the transition process began, participants felt “validation euphoria,” joy and relief caused by having discovered what appeared at first to be the key to their distress. This relief was heavily reinforced by what some participants called “love-bombing” from online communities and gender-affirming peer groups. Sometimes the love-bombing came at the price of parent-hating, often fostered by adults online and in person to protect the transitioner’s new identity from parental scrutiny and doubt. Sometimes the animosity was already present: One participant admitted to engineering a “test” of her parents’ commitment to her trans identity in order to justify cutting ties with them, which she had long wanted to do. Another transitioned as a way to rebel against her mother’s demands that she conform to narrow notions of femininity, including the mother’s micromanagement of her daughter’s hair and makeup. 

A solution to my symptoms, plus freedom from my parents? A teen dream. The ensuing exhilaration suppressed any lingering doubts … for a while. 

Although most practitioners and supporters of gender-affirming treatment regard validation euphoria as evidence that justifies medical interventions (“my daughter/son is so happy now, it must have been the right decision”), they are assuming that what is true at first will last indefinitely. But research across many kinds of medical treatments should give us pause. For example, in the pre-Viagra years, when insertion of a penile prosthesis was a leading treatment of erectile dysfunction, the men in one study initially reported “renewed masculine self-esteem” and relief from the humiliation and marital guilt they had felt; no surprise that most said they would have the surgery again. And yet, in follow-ups ranging from one to four years after the procedure, the men “tended to be negative or disappointed about postoperative pain, penis size, postoperative sexual frequency, and prosthesis malfunctions.” And the longer the postoperative period, the more hesitations the men reported about whether they would undergo the operation again.⁵

What, then, does it take to refuse to sink under the weight of such sunk costs? To say “this was a bad decision,” let alone to detransition? At first, participants said, the psychological cost of acknowledging error was prohibitively high and too painful to bear, given the irreversible sacrifices they had already made, including estrangement from their families, loss of healthy tissue, and continuing medical complications, medications, and treatments. One woman described feeling “like a zombie” and “numb” while on testosterone, yet said she stayed on it because of the psychological and physical investments she had already made in her new identity. 

But over time, the burden became too great. A young man said that his peer-generated animosity toward his parents caused a “Luciferian destruction” of his life that he yearned to put back together. For 15 participants, severe or life-threatening medical complications, including pulmonary embolisms, demanded immediate reevaluation. One came to feel that her new male identity was a parasitic “AI in a human female body” that was “ruining” her life. Many reported that cross-sex hormones were exacerbating their distress rather than alleviating it; indeed, one participant had a psychotic breakdown, which he attributed to an extreme physiological reaction to cross-sex hormones. One said that her “body almost felt like it was just going into complete shutdown” after starting puberty blockers. Some were horrified by seeing their medically altered bodies: the sight “really screw[ed] with my head,” said one, and another described “reverse dysphoria,” feeling like a “man trapped in a woman look-alike body” as a result of estrogen and surgery. Two described their distress upon realizing that their altered bodies were attracting partners seeking sex with pre-teens or specifically with transgender partners. 

A major instigator of detransitioning was finally having to face the long-term physical costs of transition. For biological males, this often meant accepting the permanent loss of sexual function. One described the sensation in his post-surgical genitals as a “really cruel deep pain.” Another reflected that his search for his “true self and … a better life” had instead resulted in his having “done nothing but self-isolate and hate myself,” with the lasting consequences being “chronic pain, a lack of an endocrine system, and fertility taken away.” Biological females mourned the irreversible loss of fertility and the potential to breastfeed. One said she had dismissed the importance of having breasts at age 13 but felt the tragedy of their loss acutely as an adult. Four biological women had had backgrounds in vocal performance, and the permanent voice deepening caused by testosterone was a major source of grief. One said she felt like “The Little Mermaid,” the fairy-tale character who sacrifices her voice in exchange for human legs. Another called the drop from soprano to tenor the “most radical side effect” of her transition. A third said she had become “pretty much tone deaf.” For so many, the physical desexualization they actively sought as overwhelmed adolescents—going through gender transition to suppress libido and reproductive potential—became a primary source of grief as maturing adults. 

As the physical and emotional costs of transitioning piled up for these young people, regret and rage followed: anger over the rapid initiation of hormones and surgery, inadequate psychiatric evaluations, and abandonment by their doctors when they expressed doubts and concerns about their care. Over and over the detransitioners repeated the wish that their doctors had provided more clinical “pushback” in diagnosis instead of routinely and immediately pressing them to begin puberty blockers, cross-sex hormones, and eventually surgical interventions. 

Unhappy patients tend to abandon their physicians rather than return and complain.

Yet once out of immersion in the transgender world, realizing that their lived experience did not align with the gender-affirming ideology of their online and social peers, most of the participants in this study said they have been able to rebuild their social and sexual lives. For many, stopping hormonal treatment restored libido or altered their arousal patterns; gay men and lesbians felt sexual and relational clarity. And as the participants matured, they were better able to separate their preexisting psychological disorders and emotional problems from the transgender explanation for them. Having realized that transitioning did not resolve those problems, these participants were able to seek proper treatment. 

Despite the medical and social hardships of detransitioning, most of the participants in Lal and Levine’s study described the profound relief of doing so. They spoke often of the process of “radical acceptance”—abandoning the pursuit of an idealized body and living with the reality of their biological sex. This resolution, many said, brought them peace with their bodies at last. One participant said that she started healing the moment she stopped taking the testosterone. “For the first time,” she added, “I’m actually happy with my life.”