Getting a better care plan

Prisha Mosley was 24, with visible facial hair and a deep voice, when she realized she was still a woman. A little girl she was babysitting began calling her “Mommy,” even though Mosley had undergone years of medical procedures, including testosterone injections, to appear male.

“I just broke out of the delusion quite suddenly at those words, realizing that that’s who I really was and wanted to be, rather than the medical costume that I had been siphoned into because I was mentally disturbed as a teenager,” she said.

Four years later, Mosley is now a mother. She takes estrogen and progesterone to restore her female hormone levels. But she lives with a list of health problems she attributes to her cross-sex procedures, including polycystic ovary syndrome, Hashimoto’s disease, and insulin resistance. The double mastectomy she underwent at 18 caused nerve pain and left her unable to fully raise her arms. Her pelvic floor also atrophied, causing incontinence and walking problems.

But while Mosley needs care to address her health problems, she struggles to trust medical professionals. She wasn’t warned about the extent of possible side effects from her transition, she said, and she’s involved in an ongoing medical malpractice lawsuit.

“All of this was completely predictable, what my doctors did to me. I just didn’t know because I was a teenage girl,” she said, adding that few healthcare providers understand detransition or know how to help. “Depending on where I go visit, it still says [I’m] transgender in the chart.” She knows other detransitioners who face the same difficulties.

Some groups help detransitioners find psychological therapists, but finding medical help can be more difficult. However, a few possible solutions for detransitioner care are emerging. Resilience Health Network, a U.S. organization founded about two years ago, connects detransitioners to medical providers willing to work with them. The Trump administration has also pushed for more healthcare coverage for detransitioners—though the results so far are limited in scope.

“There’s not a lot of doctors who feel capable or are trained in taking care of these people,” said Jennifer Lahl, director of development at Resilience. She added that many doctors don’t want to treat detransitioners because they’re committed to transgender ideology. Compounding the problem, many medical regulatory associations require professionals to recommend and support sex-rejecting procedures, making them wary of involvement in any reversals.

No one knows exactly how many detransitioners are out there. But the number appears to be growing. Kallie Fell, executive director of the Center for Bioethics and Culture Network, said that when she began researching detransitioners in 2020, a couple of hundred people were starting to share their experiences in the “r/detrans” thread on Reddit. Now, the thread has 25,000 weekly visitors and about 700 weekly posts—and posts can only be made by detransitioners or those questioning their transition, according to the forum’s rules. Some well-known detransitioners, like Chloe Cole, regularly speak on the harms of sex-rejecting procedures. Like Mosley, Cole said she received little help or guidance from her doctors over years of detransitioning.

“The medical community … [has] created a completely preventable and predictable problem by medicalizing the bodies of tens of thousands of people who identify as trans,” Mosley said. “It's no surprise that the system is becoming filled with people that the medical community doesn't know how to handle after injuring us.”

Based in North Dakota, the Resilience Health Network wants to help people like Mosley. Detransitioners can contact the network with a list of their medical needs, and Resilience staff will connect them to physicians willing to treat them. Since its founding, the group has connected roughly 30 individuals and families to doctors. The network also educates physicians on best practices in detransitioners’ care.

As the need for detransition care grows, Resilience is working to recruit more medical professionals across the United States to join its network, according to Lahl. She said Resilience hasn’t widely advertised its services because it needs more physicians: It currently has 50 active members nationwide, most of whom are medical doctors and other healthcare professionals, though a larger number of physicians receive educational resources from the network. Lahl said she knows of at least one patient who drove several hours to reach a doctor affiliated with the network. Resilience especially needs more endocrinologists, because years on cross-sex hormones can leave patients with complex needs.

But even with willing and understanding medical providers, detransitioners’ payment options remain a “hodgepodge,” Lahl noted. Treatment to reverse sex-rejecting procedures often involves visits to a laundry list of specialists, and insurance rarely covers detransitioners’ care. Texas is currently the only state to mandate that healthcare insurance plans covering sex-rejecting procedures must also cover adverse effects, including reversals of surgeries. Insurers and healthcare providers use International Classification of Diseases (ICD) codes to describe and bill medical conditions—but there’s no specific code for detransition. That means the health problems detransitioners face are often treated as isolated issues, and reversal procedures frequently aren’t deemed necessary.

“The system has been designed around transition, not detransition,” said Fell.

Mosley said that insurance doesn’t cover the majority of her medications and hormones, even though she needs them to treat problems brought on by her gender transition.

“I just paid $300 for some hormones to help with the insulin resistance, because I don’t want it to turn into diabetes,” she said. “My liver is twice the size it’s supposed to be. I’m not even being treated for that, because I don’t know what to do, and that’ll be another medication that isn’t affordable.”

The Trump administration has pressured at least some healthcare providers to work with detransitioners. Two major health centers, Ohio’s Cleveland Clinic and Texas Children’s Hospital, recently agreed to fund treatments for detransitioners as part of legal settlements with the Justice Department. The Cleveland Clinic committed to fund $2 million in treatments for detransitioners, regardless of their insurance coverage or ability to pay, though it wasn’t clear how people would access the funds or treatments. Texas Children’s will create a detransition clinic offering free treatments for five years.

Lahl hopes more states will implement laws like Texas’ regarding detransitioners’ insurance coverage, which could force insurers to make changes and cover more procedures: “They’re going to have to catch up and have codes so that you can bill for somebody who has endocrine disruption problems from cross-sex hormones, not because they have an endocrine tumor or something like that.”

But until larger-scale change occurs, detransitioners face an uphill battle to access needed help. “Getting actual ethical care … has been a lot harder than getting the pseudoscience,” Mosley said.