DETRANSITION IS NOT SALVATION.

Isabel Braga, MD phD

Original: https://revistapahnorama.com.br/2026/09/08/destransicao-nao-e-salvacao-e-o-que-sobra-quando-a-pressa-venceu-a-crianca/  ·  English translation of the published text. No facts added.

The point the debate pretends not to hear

Detransition became a trophy on one side and a taboo on the other. Both miss the target. Those who celebrate detransition as a “victory” treat an already altered body as a piece of rhetoric. Those who deny that it exists treat the patient who turned back as a moral desertion.

To detransition is not the best outcome. It is damage control. The right course, when it was still possible, was not to push the child or adolescent toward a blocker, cross-sex hormone and a scalpel. Anyone already on the path needs honest care — endocrinology, mental health, reconstruction when it can be done.

That does not turn regret into a first-line treatment plan. The decent question is not “how to celebrate those who came back.” It is “how to stop manufacturing that queue.”

What the drugs are, without poetry

Part of the “gender-affirming” arsenal in minors was not born for a restless adolescence. It was born for prostate cancer, precocious puberty and chemical castration.

GnRH analogues (leuprolide and relatives) knock down sex hormone. On the American label, the classic indication of the depot in adults is advanced prostate cancer. Class effect: hot flushes, fatigue, loss of bone density, metabolic worsening, mood instability. Post-marketing reports include depression and, very rarely, suicidal ideation — causal frequency not measured.

Cyproterone acetate: a prostate anti-androgen and a drug for hirsutism; depression, liver, dose-dependent meningioma. Bicalutamide: prostate; hepatotoxicity. Spironolactone is not an oncology drug; its risk is potassium and blood pressure. Testosterone and estradiol are not “cancer medicine”; they are cross-sex hormone with acne, polycythemia, clot, infertility.

The University of York reviews commissioned for the Cass Review said what should have stopped the routine protocol: high-quality evidence of a psychic benefit of the blocker and the hormone in a minor — almost none. The most consistent signal of the blocker is bone and stature compromised during use. Fertility, a developing brain, outcome at thirty: not scored with rigor.

The sentence said to the mother: “If you do not let them transition now, your child will kill themselves.”

That sentence operates as clinical blackmail. Not as data.

First the Brazilian ground — because the panic is sold as if the country had no epidemiology of its own.

The Ministry of Health Epidemiological Bulletin (vol. 55, no. 4) closed 2021 with 15,507 suicide deaths: 12,072 men and 3,431 women. Overall rate: 7.5 per 100,000, 42% above 2010 (5.2). Ages 5 to 14: 224 deaths (101 boys, 123 girls) — 11th cause of death in that band. Ages 15 to 19: 1,075 deaths (733 men, 342 women) — third cause. Ages 20 to 29: fourth cause. In proportional mortality, suicide weighed 6.90% of deaths at 15–19 and 3.41% at 5–14.

The rate per 100,000 in 2021, in the same bulletin, draws the classic profile and the recent deviation. Men: the peak is in the elderly (18.1 at 70+). Women: the peak is in the adolescent — 4.5 per 100,000 at 15–19, above any other female band. Girls 5–14: 0.9. Boys the same age: 0.7. Male 15–19: 9.3. That is: the country already lives an epidemic of adolescent suffering, especially female at the tip of relative mortality, without needing a diagnosis of incongruence for that to exist.

A long series confirms the rise. Ecological analysis 2000–2022 (PLOS One, corrected rates): suicide at 10–19 went from 2.10 to 4.62 per 100,000 (+120%). The largest percentage burst was at 10–14 (+140%). In girls 10–14, +176% (0.61 to 1.68). From 2012 the curve for girls in that band accelerated (APC 10.59%) and, after 2018, overtook that of boys.

Folha/SUS: suicide in girls 10–14 rose 221% from 2000 to 2021, against 170% in boys; admission for self-harm and care for depression exploded in the same female band (+663% in depression).

From 2014 to 2023, a national compilation pointed to 134,810 deaths, mean rate 6.44/100,000; 2023 at the series ceiling in some cuts (7.86). The South leads (10.19), Centre-West 7.71. Men are ~78% of the dead.

Fiocruz (youth briefing, 2022–2024 data): the 15–29 cut with a rate well above the mean; Indigenous youth 62.7/100,000; Indigenous man 20–24 reaches 107.9; Indigenous woman 15–19, 46.2.

Anyone who speaks of “saving the trans child” and ignores the Indigenous child, the 12-year-old girl with an attempt and the boy from the interior with a gun in the house is choosing the poster, not the death.

None of this, in the SIM, comes broken down by “gender identity.” Brazil does not score suicide of a transitioned child. Anyone who asserts a national TGD rate in DATASUS is inventing.

Ideation is not the same numerator as death

Ideation and attempt in young people with dysphoria or a trans identity are, in fact, much higher than in the general population. A meta-analysis of 137 studies (about 131,000 TGD youth) estimated ideation at 48.8% and attempt at 26.2%. USTS 2015, an adult convenience sample: 40.4% lifetime attempt; ideation in the year 48.3%. That is real suffering. It does not authorise the leap “therefore the hormone prevents the coffin.”

Completed death is another numerator. GIDS/Tavistock: of the order of 4 suicides in about 15,000 young people in a decade (~0.03%). Louis Appleby, the British government’s official suicide reviewer, audited 2018–19 to 2023–24: 12 suicides in six years — 6 under 18, 6 over. Three years before 2020–21: 5 deaths. Three years after: 7. In minors: 3 and 3. Appleby: the data do not support an “explosion” after restricting the blocker; those who died were at distinct points in the system, including after discharge, with multiple classic risk factors. The BMJ summarised: there is no evidence of a wave caused by pulling back the drug.

Finland, Ruuska et al., BMJ Ment Health 2024 — the design activism cites least. All under-23s referred to a specialist gender-identity service, 1996–2019: n=2,083, against 16,643 matched controls. 55 deaths in the study set, 20 suicides (36% of deaths). Crude suicide proportion: 0.3% in those referred vs 0.1% in controls. Rate: 0.51 suicides per 1,000 person-years in those referred vs 0.12 in controls. All-cause mortality: 0.81 vs 0.40 per 1,000 person-years. Adjustment for specialist-level psychiatric treatment: HR of all-cause mortality 1.0 (CI 0.5–2.0); HR of suicide 1.8 (CI 0.6–4.8) — not significant. Authors’ conclusion: clinical dysphoria does not predict death when mental illness is counted; the predictor is psychiatry; medical reassignment showed no measurable impact on that risk.

Denmark, Erlangsen et al., JAMA 2023 — 6.66 million people born in the country, 1980–2021; 3,759 people identified as trans (record or legal change). 92 attempts, 12 suicides, 245 other deaths. Standardised attempt: 498 vs 71 per 100,000 person-years (aIRR 7.7). Death by suicide: 75 vs 21 (aIRR 3.5). Non-suicide death: aIRR 1.9. All-cause mortality: aIRR 2.0. Almost 43% of trans people had a psychiatric diagnosis vs 7% of the rest. The ratios stayed high through 2021, though absolute rates fell in all groups. It is a national register of adults and youth, not proof that a blocker in a child reduces the 75.

Sweden, Dhejne et al., PLoS One 2011 — post-surgery cohort 1973–2003. All-cause mortality aHR 2.8; suicide aHR 19.1 (CI 5.8–62.9); attempt aHR 4.9; psychiatric admission aHR 2.8. That is after surgery, in another generation, another criterion. It serves one thing only: complete transition does not equalise risk to the population. It does not serve to sell GnRH to a minor as a bulletproof vest.

Cass, report and interviews: there is no adequate evidence that the affirmative package reduces suicide. York: low quality for the psychic outcome of blocker and hormone. England closed GIDS and restricted GnRH to trial. Sweden, Finland, Norway, Denmark tightened the same screw. It was not hatred. It was audit.

To tell a mother that early transition “improves suicide” is, in the present state of the science, a claim that does not stand up in deaths. It may coincide with a drop in ideation on a 12-month questionnaire in a clinic without a decent control. It may be the relief of being heard. It is not evidence that GnRH saves a life. Using the hypothetical corpse of the child as an argument for a prescription is bad medicine and bad ethics.

Old desistance, new pipeline

Before the Dutch protocol became an assembly line, cohorts of pre-pubertal children referred to clinic — without hormone — showed the opposite of the current dogma: most left dysphoria by adolescence. Steensma and colleagues: persistence around a quarter of those who could be followed; desistance larger. Many of those boys grew up gay, not “girls trapped in the wrong body.”

What changed was not human biology. What changed was the protocol. A child enters a blocker and, in modern series, almost all go on to cross-sex hormone. Cass recorded the cruel detail: the earlier the block, the greater the chance of going on to the cross-sex drug. The medicine sold as “time to think” works, in practice, as a rail.

Hence the statistical trick. Clinics publish 1% to 8% discontinuation of medicine in two to six years and shout “almost no one regrets it.” They follow little. They lose those who vanish. They call “desistance” only those who return to the same reception to hand back the bottle. Littman and Vandenbussche, samples biased the other way, show people who do not return to the clinic that medicalised them.

The published range of “detransition,” depending on definition, runs from near zero to 30%. The true long-term number, in the new casuistry — natal girl, late onset, autism, trauma, social network — nobody has. To assert 1% with confidence is propaganda. To assert 80% for those who have already taken hormone is also propaganda.

Why detransition is not the plan

Those who undo the path carry what the path did. A deepened voice does not return. Mastectomy does not reimplant a real breast. GnRH followed by the cross-sex drug injures sperm and ovum. Bone lost in the adolescent window may not recover whole. Cyproterone and estradiol leave a bill in mood and clot.

USTS 2015 / Williams Institute, convenience sample: those who had “de-transitioned” at some point had more ideation and more attempt, lifetime and in the last year, than those who never stopped. Attempt in the year: about 12% vs 6.7%. It is not mortality. It is not a cohort. It is the only large cut that isolated the subgroup — and it looks worse, not better, inside a sample that was already far above the 0.6% annual attempt rate of the American population at the time. Littman (n=100) and Vandenbussche (n=237) describe depression, trauma and abandonment of care; they do not publish a death rate. A national register of “detransitioned” dead: not scored anywhere.

Clinical translation: the detransition queue is not the cure queue. It is people with the same comorbidity that inflated attempt before, now with an altered body, a broken network and, often, shame at returning to the clinic that prescribed. To treat that as “proof that transition kills” is as lazy as treating 1% discontinuation in two years as “proof that no one regrets it.”

To treat detransition as a solution is to ask the patient to pay twice: once on the way out, once on the way back. The decent solution is earlier. Slow assessment. Treat depression, anxiety, OCD, autism, abuse, anorexia. Distinguish homosexuality from dysphoria. Do not threaten the family. Do not call exploratory psychotherapy “conversion.” Conversion is coercing identity. Exploration is what one does with any adolescent who wants an irreversible act.

For those who have already transitioned and want to stop: receive them without humiliation and without turning the case into content. An endocrinologist. Mental health. Reparative surgery if it fits. None of that rewrites the past. It only prevents the third error — abandonment.

Curitiba, earmarks and the rest of the staging

On Brazilian ground, the debate becomes a bill and an NGO. In Curitiba there is an old and competent LGBTI+ advocacy ecosystem — Grupo Dignidade, Aliança, ABRAFH — with a localised federal covenant of R$200,000 to confront violence, not a “trans-child NGO” named in the Chamber earmark ledger that could be pinned down. Minha Criança Trans is a national network, an affective tie to the capital, a mapping partnership with a ministry in São Paulo; a specific Curitiba earmark for that agenda, in what was searched, was not scored. And a Globo film that focuses on the mother, not the child. The Children’s Fund exists and is generic. Anyone who wants the CNPJ opens the budget book. Without that, “every trans-child NGO feeds on earmarks” is rumour, not audit.

What to do with the fear

The adolescent who speaks of dying deserves to be taken seriously. Always. The evidenced path to reduce death in a young person with depression, trauma and isolation is not an off-label GnRH analogue. It is to treat the illness, remove a lethal means, not leave them alone, CAPS, a family that neither assaults nor idolises. CVV 188 exists all year.

Affirmative haste sold itself as compassionate. Death records do not endorse it. The detransition that is beginning to appear is not proof that “transition never helps anyone.” It is proof that a castration drug and a cross-sex hormone were applied to a generation without the trial that would be required for any other irreversible act in a minor.

Detransition is the field hospital after the offensive. The offensive is what should not have left barracks.

Whoever loves the child holds the scalpel. They do not threaten them with their own funeral.

Isabel de Fátima Alvim Braga — This article interprets published studies and official bulletins. It is not a treatment protocol.

Numbers and sources

The percentages below are those published in the cited sources — they are not “the true universal rate.” Where the evidence is weak, that is written.

1. Ministry of Health, Epidemiological Bulletin vol. 55 no. 4: Brazil 2021 = 15,507 suicides (12,072 M / 3,431 F); rate 7.5/100,000 (was 5.2 in 2010, +42%). Ages 5–14: 224 deaths; 15–19: 1,075. Rates/100,000 2021: F 15–19 = 4.5 (female peak); M 70+ = 18.1; M 15–19 = 9.3.

2. Soares et al. / PLOS One 2025 (2000–2022, corrected rates 10–19): 2.10 → 4.62/100,000 (+120%). 10–14: +140%. Girls 10–14: 0.61 → 1.68 (+176%); APC +10.59% from 2012.

3. Compilation 2014–2023: 134,810 deaths; mean 6.44/100,000; South 10.19; Centre-West 7.71; men ~78%. Fiocruz youth: Indigenous 62.7/100,000; Indigenous man 20–24 = 107.9; Indigenous woman 15–19 = 46.2.

4. Folha / SUS data: suicide girls 10–14 +221% (2000–2021) vs +170% boys; treated depression +663% in girls 10–14.

5. Meta-analysis JAMA Pediatrics (2025): 137 studies, ~131,000 TGD youth; ideation 48.8%; attempt 26.2%.

6. USTS 2015: lifetime attempt 40.4%; ideation in the year 48.3%; attempt in the year ~12% in those who had detransitioned vs 6.7% in those who never stopped.

7. GIDS: ~4 suicides / ~15,000 / decade (~0.03%). Appleby, GOV.UK 19/7/2024: 12 suicides in 6 years (6 <18, 6 ≥18); 5 before vs 7 after 2020–21; minors 3 and 3. No explosion after restriction.

8. Ruuska et al., BMJ Ment Health 2024: n=2,083 referred <23 vs 16,643 controls (1996–2019). Suicide 0.3% vs 0.1%. After psychiatry: mortality HR 1.0 (0.5–2.0); suicide HR 1.8 (0.6–4.8, n.s.).

9. Erlangsen et al., JAMA 2023 (Denmark 1980–2021): 3,759 trans; 92 attempts, 12 suicides. Attempt aIRR 7.7; suicide death aIRR 3.5; all-cause aIRR 2.0.

10. Dhejne et al., PLoS One 2011 (Sweden, post-SRS): suicide aHR 19.1; attempt 4.9; all-cause death 2.8 — adult post-surgery, not minor, not detransition.

11. Cass / York (ADC 2024): evidence on blocker and hormone in minors of low quality; bone/stature signal; suicide reduction not concluded.

12. SIM / Ministry reply to the Chamber: 5,696 deaths ages 10–19 (2020–2024); 2024 preliminary 859.

13. Steensma et al.: persistence ~27% in the located pre-pubertal child cohort — another era, no routine GnRH.

14. York/Cass discontinuation: GnRHa 0–8%; UK n=1,089: 8.3% left incongruence; 5.3% stopped the drug and returned to natal sex.

15. van der Loos et al., Lancet Child 2022 (n=720): 98% continued hormone after blockade.

16. JAH 2025 (n=1,050 USA): 4% stopped hormone without resuming; 0.5% documented reidentification.

17. J Sex Med 2025 review: stopping GnRHa 1–7.6%; stopping GAHT 1.6–9.8%; request changes before the drug 0.8–7.4%.

18. Methodological critique (Expósito-Campos and related): published detransition 0–30% depending on definition.

19. FDA label Lupron Depot / Eligard: advanced prostate; warnings on bone, metabolism, mood.

20. Cyproterone: meningioma and hepatotoxicity; use in transition off-label.

21. Transparency: covenant 979937, Grupo Dignidade × MDHC, R$200,000 (2025–26) — LGBTQI-phobic violence in Paraná, not a municipal earmark for a trans-child NGO in the Curitiba ledger.

22. Comtiba/PMC: FMCA 2026, R$15 m, cap R$200,000/CSO — generic childhood.

23. Nexo 2026: ~76.8% of the 2026 federal LGBTQIA+ budget came from earmarks (R$20.7 m of 26.9); Paraná R$700,000 in that cut.