• Lisa Littman

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition

Abstract

The study’s purpose 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. Recruitment information with a link to an anonymous survey was shared on social media, professional listservs, and via snowball sampling. Sixty-nine percent of the 100 participants were natal female and 31.0% were natal male. Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned. There are many different reasons and experiences leading to detransition. More research is needed to understand this population, determine the prevalence of detransition as an outcome of transition, meet the medical and psychological needs of this population, and better inform the process of evaluation and counseling prior to transition.



Introduction

Detransition is the act of stopping or reversing a gender transition. The visibility of individuals who have detransitioned is new and may be rapidly growing. As recently as 2014, it was challenging for an individual who detransitioned to find another person who similarly detransitioned (Callahan, 2018). Between 2015 and 2017, a handful of blogs written by individual detransitioners started to appear online, private support groups for detransitioners formed, and interviews with detransitioners began to appear in news articles, magazines, and blogs (Anonymous, 2017; 4thwavenow, 2016; Herzog, 2017; McCann, 2017). Although few YouTube videos about detransition existed prior to 2016, multiple detransitioners started to post videos documenting their experiences in 2016 and the numbers of these videos continues to increase.Footnote1 In late 2017, the subreddit r/detrans (r/detrans, 2020) was revitalized and in four years has grown from 100 members to more than 21,000 members. A member poll of r/detrans conducted in 2019 estimated that approximately one-third of the members responding to the survey were desisters or detransitioners (r/detrans, 2019). The Pique Resilience Project, a group of four detransitioned or desisted young women, was founded in 2018 as a way to share the experiences of detransitioners with the public (Pique Resilience Project, 2019). In late 2019, the Detransition Advocacy Network, a nonprofit organization to “improve the well-being of detransitioned people everywhere” was launched (The Detransition Advocacy Network, 2020) and the first formal, in-person conference for detransitioned people was held (Bridge, 2020). In the face of this massive change, clinicians have called for more research into the experiences of detransitioners (Butler & Hutchinson, 2020; Entwistle, 2021; Marchiano, 2020). 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).Footnote2 Detransitioners and desisters, in their own words, have provided additional depth to the discussion, describing that:

  1. (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. (2)Their dysphoria and transition were due to homophobia and difficulty accepting themselves as homosexual (Bridge, 2020; Callahan, 2018; upperhandMARS, 2020)

  3. (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. (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 USTS included the question, “Have you ever detransitioned? In other words, have you ever gone back to living as your sex assigned at birth, at least for a while?” with the multiple choice options of “yes,” “no,” and “I have never transitioned.” For the 2,242 participants who answered “yes,” Turban et al. analyzed the responses to the multiple choice question, “Why did you de-transition? In other words, why did you go back to living as your sex assigned at birth? (Mark all that apply).” Although most of the offered answer options were about external pressures to detransition (pressure from spouse or partner, pressure from family, pressure from friends, pressure from employer, discrimination, etc.), participants could write in additional reasons that were not listed. Turban et al.’s sample included more natal males (55.1%) than natal females (44.9%). Roughly half (50.2%) had taken cross-sex hormones and 16.5% had obtained surgery. The findings revealed that most (82.5%) of the sample expressed at least one external factor for detransitioning and 15.9% expressed at least one internal factor (factors originating from self).



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