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Previously uninsured, under the ACA she was able to purchase insurance through the Washington Health Benefit Exchange.This covered her testosterone injections, and it likely would have covered her chest reconstruction, commonly called "top surgery," too."I'm not saying everyone needs 10 years of therapy, but for me it was the right choice. Since day one, it's been nothing but the perfect choice for me." Today, the standard of care has changed.According to guidelines issued by the World Professional Association for Trans Health, health-care providers should ask for a letter from a therapist before medical intervention, but therapists themselves aren't required to see clients for any particular length of time. "There has been a lot of anger in the past about gatekeeping," Kaplan said.But eight months ago, right when she was preparing for top surgery, Jackie changed her mind."Everybody says that gender is a social construct, but we also act like it's somehow an innate part of a person's identity," she said.

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The United States Census Bureau doesn't collect data on gender identity (or sexual orientation), but a 2016 study from the Williams Institute at UCLA Law estimates that there are 1.4 million trans adults in the United States, or about 0.6 percent of the adult population. By all accounts, detransitioners make up a tiny percentage of that already small population: A 50-year study out of Sweden found that only 2.2 percent of people who medically transitioned later experienced "transition regret." (The rate of cosmetic surgery patients who are dissatisfied with their nose jobs, by comparison, is estimated at about 17 percent, according an analysis published in the .) There have, however, been almost a dozen studies of looking at the rate of "desistance," among trans-identified kids—which, in this context, refers to cases in which trans kids eventually identify as their sex at birth.

Canadian sex researcher James Cantor summarized those studies' findings in a blog post: "Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans-kids still want to transition by the time they are adults.

Instead, they generally turn out to be regular gay or lesbian folks." The exact rate of desistance varied by study, but overall, they concluded that about 80 percent trans kids eventually identified as their sex at birth.

It's such a fraught issue that many people I interviewed requested anonymity.

(All the names of detransitioners have been changed.) Others refused to speak on the record, afraid of the potential fallout.