I can’t wait to reverse my sex change

As the NHS commits to help people reverse gender-altering surgery, we talk to one patient who says it can’t happen soon enough

Ritchie Herron has been experiencing a living nightmare for six years.
The 37-year-old civil servant, who in 2018 underwent radical gender surgery to complete his physical transformation to live as a woman, is one of a growing number of patients who have come to deeply regret undergoing medical interventions to change gender. 
Herron’s distress has been compounded by the NHS response to his desire to “detransition”, which has appeared clumsy and ill-suited to the situation in which he found himself. He claims that the inadequacy of the health service’s approach was highlighted by the fact that the main clinician assigned to oversee his care was a gynaecologist – a specialism which would clearly “not [offer] the right expertise” for someone seeking to overturn their transition to the female gender.
In recent days, however, Herron has been feeling some hope. Last week the NHS announced that it was planning to launch a new service for transgender patients wanting to return to the gender of their birth.
The development has given Herron optimism that “detransitioners” like him may finally now get the “right care” for the physical and mental pain with which many have been suffering for years.
Previously unseen data obtained under freedom of information laws gives the clearest indication yet of the number of “regretful” transitioners who changed their gender at the Tavistock child gender identity service, which was recently closed by the NHS for being “inadequate”. According to that data, at least 64 Tavistock patients detransitioned between 2010 and 2020 alone.
For Herron, the nightmare began six years ago when he underwent a vaginoplasty, which involves rearranging tissue in the genital area to create a vaginal opening. The surgery was the culmination of gender treatment that stemmed from an initial conversation with a therapist in which Herron said he “did not want to be a gay man”. Herron has spoken of how he “said to my therapist ‘I cannot see myself as a man with another man, but I can see myself as a woman with a man’, and she said ‘yes, that is because you are trans’.”
The eventual surgical procedure went ahead, he says, despite him previously expressing repeated doubts to the NHS gender service he was under in the north of England, about having the operation. The surgery itself was a brutal experience in which he lost almost three pints of blood. After regaining consciousness he knew he had made a monumental mistake almost immediately. 
Herron’s first thought, he says, was, “Oh God what have I done?”
In the years that followed, his regret at the extreme changes made to his body only grew, as he grappled with the dire physical and psychological consequences. His health difficulties were myriad, ranging from bone density problems and incontinence to skin conditions and numbness affecting his entire crotch area. He was near suicidal as he struggled to come to terms with the horrifying predicament he was in – for which he initially blamed himself.
Finally, in 2022 he decided that his only hope for survival was to stop living as “Abby” and return to being “Ritchie”.
But, says Herron, there was nowhere for people like him to turn to for help. Returning to the gender clinics at which he had originally been treated, he says: “I told them that I thought I had regret and they told me that I didn’t.
“Instead they said I had OCD and that what I was feeling was all part of my OCD. This made me very angry because I felt like they were just trying to cover their own backs.
“All I really wanted was an acknowledgment that I’d made this huge mistake, but no one would let me say that.” The gender clinics also lacked the expertise to treat the medical problems experienced by detransitioners, he adds.
A common feature of transitioning is hormone therapy, with oestrogen or testosterone used to suppress the release of “unwanted” hormones from the testes or ovaries. NHS advice states that “the hormones usually need to be taken for the rest of your life, even if you have gender surgery”. But there is evidence that the long-term use of hormones increases the risk of conditions such as osteoporosis.
“I asked the specialists a very normal and fundamental question – which is, ‘what hormones should I be on and what is the safest amount for me to take?’” says Herron. “But you can’t get any straight answers.
“I was literally told by my endocrinologist – if I want to be Abby, take oestrogen, and if I want to be Richard, take testosterone. This is despite the fact that I have all the signs of osteoporosis. It feels like they’re waiting for me to break all the bones in my body before they’re going to do anything.
“In my opinion the gender clinics don’t have the right expertise or the expertise that they have is very captured [by trans activists].”
Herron says the inadequacy of the NHS’s provision for patients in his position was highlighted by the fact that one of his clinicians was a gynaecologist. “I was seeing a woman’s doctor – a gynaecologist – and it just felt really weird because again it’s not the right expertise,” he says.
“I didn’t have a vagina – it was an inverted penis. I don’t belong in women’s services but there was nowhere else to put me.”
So when the NHS revealed that it planned to establish a service specifically for “individuals who choose to detransition”, Herron says he could not have been happier. “We definitely need this,” he says. “I cannot wait for the clinic to open. I would use the service straight away once it’s up and running.
“What is most significant about this service is it actually acknowledges detransitioners and that hasn’t ever happened before in the NHS. It’s a huge step forward.”
The NHS announcement came in the wake of the Cass report, a major review of NHS child gender services which found there was “remarkably weak” evidence for medical interventions in gender care. Dr Hilary Cass, the author of the review, said that NHS England should ensure there is provision for people considering detransition, while recognising that they may not wish to re-engage with the gender clinics they were previously under. The NHS has said that it will explore what measures would be necessary to create a “defined clinical pathway” for detransitioners. 
Experts, however, warn that such a service would face major challenges. Stella O’Malley, a psychotherapist who in 2022 founded a detransition service called “Beyond Trans”, which now has 250 users globally, says that one of the problems will be a lack of knowledge among doctors when it comes to the prescription of appropriate hormone treatments.
“We’ve been running for over two years now and what we’ve found is that medical complications is by far the largest issue for those using our service,” she says. “But we have no information to offer them and the medical professionals who we ask are afraid to give their opinions.
“The individuals we are helping are people who have for instance stopped all hormones and they were failing and in pain because you need hormones to live. So the NHS detransition service needs to educate doctors urgently about a massive gap of knowledge about this.”
Dr Anna Hutchinson, a psychologist who blew the whistle on the Tavistock child gender service, agrees. “What the new service needs to provide is endocrinology because a lot of current endocrinologists, namely hormone doctors, don’t want to touch this area,” she says.
“Some detransitioners – or perhaps more aptly, regretters – have to make really difficult social decisions about how to live their lives as some of them may never pass again for their natal sex. The challenge of the service will be helping people to make those decisions, exploring the pros and cons of options for them from a psychosocial and also a medical perspective.”
O’Malley warns that the NHS is going to face an uphill battle to regain the support of detransitioners: “This is a traumatised cohort that is extremely suspicious of all services. Their levels of trust have been broken down and there’s a lot of anger. For them, it’s almost like going back to the scene of the attack, going through the NHS.”
The new service, she says, will need to have “a very definitive separation from any sort of gender clinic”.
Herron agrees, saying: “People who have detransitioned don’t want to go back to gender clinics. We need to make sure this service is run by professionals and not influenced by these activist groups through various consultations.”
He adds: “They need to have clinical psychologists who follow established models of care and an informed medical approach that is not theoretical.”
A new service may be able to offer some surgical procedures as well as hormone and psychological therapy. Hutchinson says that those who have changed their gender from male to female could have their breasts removed as part of a detransitioning process. Patients – such as Herron – who have had a vaginoplasty, might be able to have a phalloplasty to partly reconstruct a penis, “but it would be nothing like your original male anatomy and I’m not sure I know of any detransitioner who has done that”, she adds.
Indeed, O’Malley and Hutchinson believe that there is unlikely to be a significant demand for reversals of surgical changes.
“An awful lot of those in our group have said they are saying goodbye to all medical intervention,” says O’Malley. “It feels, for many, too soon or too quick for them to go back into surgeries.”
On Herron’s part, he certainly has “no plans to undergo any more experimental surgery”. He is also conscious that some of the changes that detransitioners like him have undergone are irreversible. But he is optimistic the service will still be able to help him.
“I might be lucky to slow things down, but I do worry that things may be a bit too late for me because it’s been over a decade with no testosterone,” he says. “But maybe they can help me with my urology problems, the pain and the lack of sensation I have. And maybe they can advise me on the hormone side of things and curb the onset of osteoporosis and the emerging autoimmunity issues that I have.”
Currently there appears to be no clear timeframe for the new service, with NHS England only committing to “establish a programme of work to explore the issues around a detransition pathway by October 2024”.
Herron believes there is certainly an “urgent need” for an NHS detransition clinic because so many are “suffering in silence”. 
But he is equally clear that the establishment of the service must not be rushed: “It needs to be set up properly with the right expertise. I don’t want this to just be an attempt to brush people off who have regret.”