Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis

Abstract

Purpose: There is a paucity of data regarding transgender and gender diverse (TGD) people who ''detransition,'' or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States. Methods: A secondary analysis was performed on data from the U.S. Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD adults in the United States. Participants were asked if they had ever detransitioned and to report driving factors, through multiple-choice options and free-text responses. A mixed-methods approach was used to analyze the data, creating qualitative codes for free-text responses and applying summative content analysis. Results: A total of 17,151 (61.9%) participants reported that they had ever pursued gender affirmation, broadly defined. Of these, 2242 (13.1%) reported a history of detransition. Of those who had detransitioned, 82.5% reported at least one external driving factor. Frequently endorsed external factors included pressure from family and societal stigma. History of detransition was associated with male sex assigned at birth, nonbinary gender identity, bisexual sexual orientation, and having a family unsupportive of one's gender identity. A total of 15.9% of respondents reported at least one internal driving factor, including fluctuations in or uncertainty regarding gender identity. Conclusion: Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

“…Frequently endorsed reasons for detransition included realizing that their gender dysphoria was related to other issues (70%); health concerns (62%); observing that transition did not help their dysphoria (50%); and that they found alternatives to deal with their dysphoria (45%). In contrast to Turban et al (2021), external factors such as lack of support, financial concerns, and discrimination were less common (13%, 12%, and 10%, respectively). Many in the sample described that when they detransitioned they lost support or were ostracized from lesbian, gay, bisexual, and transgender (LGBT) communities, suggesting that many of the participants in Vandenbussche (2021) would not have been reached by the recruitment efforts of the USTS (James et al, 2016).…”

“…Although there were rare published reports about detransitioners prior to 2016, most of the published literature about detransition is recent (Callahan, 2018;D'Angelo, 2018;Djordjevic et al, 2016;Kuiper & Cohen-Kettenis, 1998;Levine, 2018;Marchiano, 2017;Pazos Guerra et al, 2020;Stella, 2016;Turban & Keuroghlian, 2018;Turban et al, 2021;Vandenbussche, 2021). The prevailing cultural narratives about detransition are that most individuals who detransition will retransition and that the reasons for detransition are discrimination, pressures from others, and nonbinary identification (Turban et al, 2021).…”

“…Although there were rare published reports about detransitioners prior to 2016, most of the published literature about detransition is recent (Callahan, 2018;D'Angelo, 2018;Djordjevic et al, 2016;Kuiper & Cohen-Kettenis, 1998;Levine, 2018;Marchiano, 2017;Pazos Guerra et al, 2020;Stella, 2016;Turban & Keuroghlian, 2018;Turban et al, 2021;Vandenbussche, 2021). The prevailing cultural narratives about detransition are that most individuals who detransition will retransition and that the reasons for detransition are discrimination, pressures from others, and nonbinary identification (Turban et al, 2021). However, case reports are shedding light on a broader and more complex range of experiences that include trauma, worsened mental health with transition, re-identification with natal sex, and difficulty separating sexual orientation from gender identity (D'Angelo, 2018;Levine, 2018;Pazos Guerra et al, 2020).…”

“…(1) Trauma (including sexual trauma) and mental health conditions contributed to their transgender identification and transition (Callahan, 2018;Herzog, 2017; twitter.com/ ftmdetransed & twitter.com/radfemjourney, 2019) (2) Their dysphoria and transition were due to homophobia and difficulty accepting themselves as homosexual (Bridge, 2020;Callahan, 2018;upperhandMARS, 2020) (3) Peers, social media, and online communities were influential in the development of transgender identification and desire to transition (Pique Resilience Project, 2019; Tracey, 2020; upperhandMARS, 2020) (4) Their dysphoria was rooted in misogyny (Herzog, 2017) Two recently published convenience sample reports provide additional context about the topic of detransition. First, Turban et al (2021) analyzed data from the United States Trans Survey (USTS) (James et al, 2016). The USTS contains data from 27,715 transgender and gender diverse adults from the U.S. who were recruited through lesbian, gay, bisexual, transgender, queer (LGBTQ), and allied organization outreach.…”

“…The objective of the current study was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the effects of transition, or both. In contrast to Turban et al (2021) andVandenbussche (2021), this study focused only on 2 The debate about the terminologies used to describe an individual's sex (including "assigned sex at birth," "biological sex," "natal sex," "birth sex," "sex," etc.) is far from settled.…”