In the wake of last week’s BBC2 documentary, and a follow-up piece in the Sunday Times, there is once again focus on the alleged huge numbers of people who undergo gender surgery and later regret it. There’s no doubt that regretters do exist, and that’s deeply worrying, but it is hard to get any decent information on what that means. When presented with examples there are some questions you need to ask.

Firstly you need to know when the person transitioned. Back in my day, there was huge pressure on ever trans person to commit 100% to full medical transition, otherwise you got no treatment at all. That was partly because the doctors believed that only full conformance to one or the other binary gender stereotype was an acceptable outcome. It was also partly because they felt that insistence on full medical transition would weed out people for whom transition wasn’t appropriate. Maybe it did, but I suspect it also led to people accepting treatment that they didn’t really want or need. Thanks to a lot of pressure from trans activists, treatment is a lot more humane now.

You also need to know where in the world they lived. Hopefully most countries have reasonably strict safeguards, but it wouldn’t surprise me to find that someone out there was encouraging transition because it was good business. And of course there is Iran, where forced transition is an alternative to being executed for homosexuality.

You need to know where in the process people backed out. The anti-trans brigade would have you believe that every regretter had had their penis chopped off (because that’s the fear they are trying to tap into). In practice many people who back out do so long before they get that far. That shouldn’t be counted as a failure of the process. That’s just the patient deciding what is best for them at the time, which is how things should work.

And finally you need to know why they back out. Some people do so because their personal circumstances change and their lives are no longer their own. I have, for example, heard of someone who pulled out of transition to care for an elderly relative. Some people do so because they decide that the price they would have to pay — in terms of loss of job, family and so on — is simply too high to pay. And some take fright at the social discrimination that they face when beginning transition. With all these people, they have not decided that transition is wrong per se, it is just something that they can’t do because of their personal circumstances, or because of social prejudice. If society was less unpleasant to trans people they might all have stayed the course.

Last night on Twitter I got into conversation with Dr. Stuart Lorimer who is one of the UK’s leading gender specialists. Over a 15 year career he reckons to have treated over 4,000 patients. Of those, he says, only around 10-15 have backed out of the transition process and gone back to their birth gender. That already puts the level of regretters at less than 0.5%. When questioned he said that a fair proportion of those were people who had backed out for the sorts of reasons I outlined above, and who might well try again if their personal circumstances changed. He said that no more than 25% of them had de-transitioned post surgery. That makes the level of actual failures of the process under 1 in 1000.

Obviously we’d all like there to be no failures of process at all, but there’s also an awful lot of patients who stayed the course and whose lives are far happier because of it.

You can see my conversation with Dr. Lorimer here.

Of course if you are a TERF then you probably believe that you need to deny treatment to 999 people in order to save the one who might have surgery and regret it. And that’s probably because you don’t care about those 999 because you have already decided that they are monsters.