Sampling with Sisyphus: Introducing a community-driven study designed to reach hidden sexual and gender minority populations with experiences of gender detransition (Preprint)

Abstract

BACKGROUND The myth of Sisyphus teaches about adversity and resilience in the face of challenges on the path of life. Discontinuation/detransition following an initial gender transition are emerging experiences requiring of sensitive and community-driven research in North American contexts. Yet, there are significant complexities and costs that researchers must confront to collect reliable data to better understand this emerging population, including a lack of a uniform definition. OBJECTIVE This paper presents the sampling, survey design, and recruitment methods of a new study to guide future researchers studying detransition-related phenomena. We present a novel protocol for identifying and removing bots/scam/ineligible responses from survey datasets and share preliminary descriptive socio-demographic results of the sample. This analysis does not present gender-affirming healthcare outcomes on satisfaction/regret with gender transition. METHODS To attract a large and heterogenous sample, 3 different study flyers in English, French, and Spanish were created. Between 12/1/2023 to 4/30/2024, flyers were distributed to > 615 sexual and gender minority (SGM) serving organizations and gender care providers in the United States and Canada, and via social media advertisements totaling more than $7400 CAD. Though many social media promotions were rejected or removed, study advertisements reached over 7.7 million accounts. Study website visitors were directed from 35 different traffic sources, with the top five being Facebook (46%), direct link (29%), Reddit (13%), Instagram (6%), and X/Twitter (3%). A systematic protocol was developed to identify scam/nonsense/ineligible responses and conduct virtual screening with select participants. RESULTS Out of 1,377 completed survey responses and after applying the exclusion and screening protocol, 962 (70%) were determined to be eligible and included in the analytic dataset. The mean age of the sample was 25.9 years (median age = 24). A majority of participants were racially white, living in the US (73.5%), and assigned female at birth (78.8%). Most participants reported having a sexual minority identity, with over half the sample indicating plurisexual orientations, such as bisexual, pansexual, or queer identities. Twelve percent were straight/heterosexual. When asked about gender-diverse identities after stopping/reversing their gender transition, 33.6% considered themselves nonbinary, 43.8% reported being transgender, and 41% said they were detransitioned. CONCLUSIONS Despite challenges encountered during study promotion and data collection phases, a heterogenous sample of nearly 1000 eligible participants was obtained, presenting opportunities for future analyses to better understand these diverse, largely SGM experiences. This study is among the first to introduce an innovative strategy to sample a hard-to-reach, politicized, and equity-deserving group that currently lacks a consistent definition. Future analyses will prioritize characterizing and better defining discontinuation/detransition to build theoretical and care provider-orientated knowledge. CLINICALTRIAL Not applicable