No data on retransition

In Italy, paths to gender affirmation are still long and tortuous, but thanks to landmark court rulings between 2011 and 2015, it is now possible for people to update their legal gender through a court process, without needing to undergo surgery first.

There is no data available on this, and no tracking of registry changes. The only official research on transgender people in Italy, conducted by the National Institute of Health with the National Office for Racial Discrimination (Unar) and presented in 2022, looks at lifestyle and access to health services.

With the current situation, you have plenty of time to reflect on your identity.

Still, it is clear that gender affirmation pathways take a long time: “We are talking about an average of six months to a year for intake in public centers,” explains Asia Cione, a transgender activist and outreach worker. “Then, there is the psychotherapeutic course, the wait for the psychodiagnostic certificate needed to start hormone replacement therapy (HRT), another six months to be able to file the application in court and finally the hearing for the registry change. After that, there is also a long wait for surgery. We are talking about an average of three years. It is not fair for those who have to go through this ordeal, and the path needs to be streamlined, but with the current situation you have plenty of time to reflect on your identity."

For Cione, stigmatizing retransitions means stigmatizing the transition paths themselves: "The path is hard, and sometimes people don’t complete it, not because they are not sure of their choice but because they cannot bear the psychological stress it causes.”

According to a 2015 U.S. study, out of about 28,000 transgender people, just 8% said they had temporarily retransitioned, stopping taking hormones or returning to using pronouns assigned at birth. Of these, 62% had already returned to identifying and living in their chosen gender by the time they responded to the survey.

The same study also found retransitions occur more frequently among people experiencing racial discrimination and among transgender women (11%, compared with 4% of transgender men). This suggests that those who already experience other types of discrimination experience greater difficulties in living as a transgender person, resulting in additional discrimination.

Only 0.4% of the 28,000 people surveyed said they made this decision because they did not feel their chosen gender was their own; all the others did so because of family pressure, because of the discrimination they experienced or because of social and work difficulties.

We're talking about a path that is solely personal.

Marianna Coppola, a doctoral student in communication sciences at the University of Salerno and a clinical psychologist with expertise in LGBTQ+ issues, says that it's important to think about the misleading and dangerous view of retransition that positions it as a failure of the transgender person and the support system associated with gender reaffirmation pathways: “It is a legitimate way, for those few cases, of experiencing one’s identity. It is a possible evolution of a path,” she explains. “If we consider it a setback, we give a negative meaning to a path that is solely personal.”

PostTrans is a website and community dedicated to proudly telling stories of women who have retransitioned. Elie Vandenbussche, one of the site’s founders and a social science researcher, did a study of 237 retransitioners from around the world. That research found that 44% did so because of dissatisfaction with social changes, and another 44% because they developed a different political view.

Dissatisfaction with social changes could mean, for example, the difference in how society treats a person perceived as a man or a woman. On the other hand, retransitions that relate to a change in political view may concern the concept of gender identity itself, which still remains highly debated and ideologically polarized, despite abundant scientific literature and the many experiences of transgender people. For the remaining 10% surveyed, the discrimination they experienced was the main reason for their choice.

Unmet expectations

“One person I assisted started this journey about five years ago,” says Serena Scribano, a social worker with the Libellula Association. “She told us that living as a trans woman was complicated, that she could not fit into the working world and encountered many problems.”

Scribano, also a trans woman, is sure of her own choice, but is familiar with the difficulties involved: “I like to say that freedom repays an entire existence. But at the same time, I wonder if I will ever stop paying the price for my freedom.”

Sex education in school, she says, would have helped her a great deal, because she lacked the knowledge that she and the people around her could exist. “We would have lived better lives, instead of unhappy childhoods. There are inner scars that you never completely erase, that you carry with you forever. The sense of humiliation, exclusion and inadequacy that one feels as a child conditions a person’s existence forever, even if they have made it, in spite of everything.”

For Gioele Lavalle, president of the GenderX association, which organizes listening groups for young transgender people, most who decide to retransition do so because expectations about changing their physical appearance are disregarded. “The work a transgender person does on themselves is not only about exploring their gender, but more about breaking down their internalized transphobia.”

I really hope someone will break the ice regarding this issue.

Internalized transphobia refers to a persistent but less visible form of transphobia, that often leads to a lack of complete acceptance of one’s identity. It can be especially present in the requirement to meet socially recognized physical standards, which must correspond to the gender with which the person identifies. People with strong internalized transphobia usually aim for what is called passing — that is, “passing themselves off” as cisgender people.

“I am not a cis person, nor do I aspire to be one,” Lavalle says. “The only time I suffered my transgender identity was when my sister had children, a possibility I was deprived of.” Lavalle began his journey of gender affirmation 25 years ago, when it was mandatory to undergo sterilization operations in order to have his legal documents reflect his gender. He doesn't regret the decision, but he would like to see the idea of the pregnant body untethered from femininity. “It would be useful for Italy to start talking about transgender men who can be pregnant bodies. I really hope someone will break the ice as soon as possible regarding this issue.”

In 2018, the Swedish government admitted that forced sterilization was a form of violence, and allowed transgender people who experienced it to seek compensation from the state.

If we understand the beginning of the gender affirmation journey as the moment when people begin to ask questions about their identity, then there are half-transitions: “In this case, there is no real detransition,” explain Marianna Coppola and Giuseppe Masullo, associate professor of general sociology at the University of Salerno and authors of the book Invisible Affections. “People who stop in the middle don’t get to the social dimension of transition," they write — that is, they don’t come out as transgender people, which is a very difficult step in the gender affirmation journey, and they don’t start hormone therapies. “Those who have the support of parents, social contexts and support networks have a higher probability of not suspending the path, compared to those who are hindered, left alone and without any form of psychological, emotional and social support.”

For Marianna Coppola, it's impossible to talk about a true retransition — even for those who experiment with changing pronouns or begin a hormone therapy and then discontinue it and return to their old pronouns — without having gone ahead with legal changes or surgery.

Getting to know oneself and experimenting

The greatest criticism, especially from those who advocate the existence of a gender theory that aims to “confuse” the identity of young people, has been raised regarding the possibility of beginning a gender affirmation journey at puberty or before it begins.

In particular, there is opposition to the use of puberty blockers for those who feel gender incongruence or gender dysphoria (that is, they don't not see themselves in the gender they were assigned at birth, and the physical traits that society typically associates with that gender) from a very young age.

Blockers are prescribed only in the presence of dysphoria, and aim to give people time to find their identity while avoiding the risk of experiencing body discomfort that can come with the development of secondary sexual characteristics.

We need to decide which aspect to prioritize.

According to a U.S.-Canada study of more than 300 transgender people who began transitioning in adolescence or earlier, only 2.5% did not continue with hormone therapy, while most maintained their chosen gender identity.

“There is a need for more information and listening to the stories of transgender people: many of them, having had the option of not allowing their bodies to develop in the somatic direction of biological identity, would have preferred to take blockers and avoid many psychological issues in adolescence and adulthood,” Coppola says.

Another concern often raised is that the possible long-term health risks of puberty blockers are unknown — even though they are actually no more experimental than many other drugs. To date, there are no possible scientifically confirmed side effects; on the contrary, most experimental trials have shown their safety and efficacy. In addition, some studies show that by taking blockers, suicidal thoughts, which are more common among young trans people, tend to decrease. We need to decide which aspect to prioritize: the mental well-being of trans adolescents, or the potential long-term side effects of blockers — which have not yet been proven.

On pathways to gender affirmation, there will probably never be a definitive ethical answer. Perhaps the real choice is between living in a society that fears regret and wants to restrict self-determination, or in one that provides all the tools needed to know oneself and experience one’s identity.