What does research say about factors associated with detransitioning?
Today we review some recent studies that examine factors that may be associated with detransition/retransition
Research can help us make sense of people and populations in societies. As academics, we’re trained to look for patterns in data—identifying which elements repeat over time, and to compare and contrast findings across multiple studies.
Detransition is an emerging socio-medical phenomenon. Although it’s been discussed to some extent since the development of transgender medicine decades ago, detransition has taken on new meaning today. We wrote a bit about trying to study detransition in a previous article—discussing measurement decisions and double-standards we see happening in our own fields of research.
When it comes to detransition research, although still in its infancy, we and many other researchers have started to notice some patterns. As one example, a large majority are on the LGBTQ+ spectrum or continue to affirm a relationship to sexual and gender diversity. In today’s article, we offer a brief snapshot of patterns we are starting to see taking shape in the academic scholarship on detransition/retransition.
These include factors such as sex, gender, and sexuality, age, neurodivergence/mental health, and religious beliefs.
Some of the research we share below is based on community surveys or qualitative interviews. Qualitative research centres and interprets the lived experiences and self-understandings of detrans people using text-based data (like interviews). Other studies utilize healthcare administrative data, meaning data created from patient interactions with the medical system.
Important to state clearly is that none of these studies below conclude with banning transition-related healthcare. Moreover, this literature is by no means well established yet, at least not in terms of being very high-quality or conclusive, and these studies are certainly not able to predict the future of trans or nonbinary folks just starting out the transition process.
However, they can help to provide insights on detransitioned people’s perspectives on care received in the past and what they may need in the present or the future.
Sex and gender identity
Birth-assigned sex and gender identity are two of the factors that appear to play a significant role in the experience of detransition.
Based on data from various study types—community surveys, clinical case study reports, total-population, or interview-based studies—people assigned female at birth (AFAB) are disproportionately represented in the group of people who detransition.
In these studies, the portion of AFAB research subjects ranges from 64% to 100%. More importantly, in contrast to those assigned male at birth (AMAB), AFAB people are more likely to cite internal reasons for detransitioning (e.g., a change in gender identity, reidentifying with birth sex, or realizing that gender dysphoria was related to something else).
Studies of patient medical records
A recent study conducted in Norway analyzed patient medical records and found 18 patients who had discontinued gender-affirming treatments. All 18 were AFAB and, of these, 11 had a “cessation of transgender identity.” The remaining seven who stopped treatment were either satisfied or they stopped due to concerns about fertility.
Another Australian study led by Blake Cavve examined reidentification with birth-registered sex/gender after being referred for gender-affirming health care services. The authors found reidentifications largely among AFAB patients. Of the total sample, 29 referrals were closed due to reidentification with birth-registered sex/gender, of which 20 were AFAB and 9 were AMAB. A greater portion of reidentifications occurred during the assessment phase among AFAB folks (so prior to any medical treatments). When reidentification was recorded after medical treatments, this occurred exclusively among AFAB patients.
This study, however, did not report any data on feelings (e.g., satisfaction or regret) or on-going support needs of those who reidentified/detransitioned.
To understand better the emotional and psychological process of detransitioning, we have to look at data from other studies.
Community surveys and interview-based studies
In general, of the studies that found internal factors (e.g., change in identity) for detransition in comparison to external factors (e.g., discrimination or gender minority stressors), participants seem likelier to report negative or ambivalent feelings about their gender transition.
For example, in Ellie Vandenbussche’s community-based detransition survey (92% AFAB), the majority of participants reported internal reasons for detransition and 60% reported feelings of regret about their initial transition.
Similar findings were reported in a survey-based study conducted by Lisa Littman (69% AFAB), in which internal reasons for detransitioning were predominant. Most participants in the study reported either strong or very strong regret about transitioning.
Two qualitative, interview studies conducted by Annie Pullen Sansfaçon (95% AFAB) and Kinnon himself (64% AFAB) found that between a third to a half of participants felt regret about their initial gender transition, while others expressed more ambivalent feelings. In these studies, many of the participants also discussed positive feelings with gender transition and feeling satisfaction with the journey.
It seems clear that there’s no single detransition experience and that the emotions involved can be complex.
Trans women and AMAB people, for their part, are more likely to cite external factors such as discrimination or lack of social support driving detransition. For example, two studies, one led by Jack Turban (55% AMAB) and another by Mariana Gómes-Porras in Spain, found that being AMAB and lacking family support were associated with detransition.
In the qualitative study led by Kinnon and colleagues, detransition narratives that revolved around external factors came almost exclusively from transfeminine, AMAB participants who detransitioned temporarily and then later retransitioned when it felt more safe to do so. Littman’s survey found that 36% of AMAB participants reported feeling discriminated against as a reason for detransition, compared to 17% of AFAB participants.
In general, this is consistent with research showing that AMAB transfeminine people experience higher levels of social stigma and discrimination than other gender diverse populations, which may in turn play a role in their decision to detransition. A history of detransition followed by retransition may not be uncommon among these individuals, as we see this pattern emerging from several studies already.
Nonbinary gender identities are also an important factor in relation to detransitioning experiences, or experiences of simply discontinuing gender-affirming treatments. For example, nonbinary gender identity was associated with a history of detransition in Turban’s analysis and predicted detransition in Gómes-Porras’ study.
Over half of the sample in Kinnon’s qualitative study of 28 Canadians endorsed a nonbinary identity and many reported feeling uncomfortable with binary embodiment or unwanted changes from hormone therapy as reasons for detransition. In Littman’s study, 16% of participants expressed a nonbinary narrative as a reason for detransitioning, and another quantitative survey-based study by Kinnon and colleagues found that nonbinary gender identity was associated with discontinuing gender-affirming medical treatments.
The intersection of being nonbinary and detransitioning deserves more investigation. Some emergent theories to explain this intersection suggest:
Nonbinary folks may have specific embodiment/treatment goals requiring shorter treatment durations;
A relationship between having a fluid identity and shifts in treatment requests;
Some forms of dysphoria could be particular to nonbinary experiences of gender and may not respond as well to binary-based transgender medical interventions;
Increased barriers to accessing gender-affirming care and that transgender medicine is based in transnormativity/transmedicalism and binary assumptions about transitioning.
Age
Studies suggesting a relationship between age at the start of gender transition and detransitioning are more controversial, given the on-going debates and legal battles regarding pediatric gender care.
Furthermore, the data available to date is often mixed and inconclusive, making it difficult to draw any conclusions.
For example, a study conducted in the UK found that, among young people with gender dysphoria referred to an endocrine service who stopped identifying as transgender before or after starting hormone therapy, a higher proportion did so before the age of 16 (9%) than after the age of 16 (4%)—the majority, again, were AFAB. In the study by Mariana Gómes-Porras we mentioned above, being 18 at the start of gender transition was identified as a protective factor for detransition, meaning that starting the process at an older age reduced the chances of detransition occurring.
However, there are other studies that suggest mixed or opposite results. For example, in a Danish study led by Dorte Glintborg, there was a higher rate of discontinuation of hormone therapy among patients who started over the age of 25. Another American study led by Christina Roberts found that participants who started hormone therapy as adults (> 18) had higher discontinuation rates than those who started as minors (< 18).
Stopping hormonal treatments, though, is not the same as detransition. This means that we can’t really say much about detransition from the Roberts and Glintborg studies, since there was no data reported regarding identity shifts, detransition, or regret.
Neurodiversity and mental health
It’s well known that transgender and gender diverse people experience poorer mental health than the general population, and there has long been a known intersection between neurodiversity and gender dysphoria.
This holds true for people who detransition.
For example, in a study conducted in the UK, individuals who stopped attending gender clinic appointments, expressed transition regret, or detransitioned had higher rates of neurodevelopmental disorders and adverse childhood experiences (in comparison to trans adults without these gender clinic outcomes). One of the recent community studies by Kinnon mentioned above found that a diagnosis of autism spectrum disorder (ASD) or schizophrenia was associated with a higher likelihood of discontinuing medical treatment. Interestingly, in this study, attention-deficit hyperactivity disorder (ADHD) was protective from stopping gender-affirming treatments.
In the study led by Vandenbussche, a high percentage of participants reported having been diagnosed with depression, anxiety, post-traumatic stress disorder, ADHD, ASD, eating disorders, and borderline personality disorder (BPD). In another, more recent community-based study led by Lisa Littman, participants reported an average of 3.7 lifetime diagnoses, with depression, anxiety, eating disorders, ADHD, ASD, PTSD and bipolar disorder being the most common.
Almost half of the detransitioners in the Gómes-Porras study had a history of psychiatric diagnoses, including depression and personality disorders. Other case studies have reported experiences of detransition in the context of psychosis or psychotic-type disorders.
However, as we mentioned, we also see elevated rates of these diagnoses in general transgender and/or nonbinary samples.
Religious beliefs
Religious beliefs and spiritual conflicts have also been noted as factors associated with detransition for some.
In an international survey of surgeons providing gender-affirming care, more than half of whom said they had encountered a patient who regretted transitioning, spiritual or religious conflicts accounted for 8.1% of cases. In the study led by Turban that we already discussed above, religious pressure influenced the decision to detransition in 5.1% of participants. And in one of Kinnon’s studies, participants who identified as Christian were more likely to report stopping gender-affirming medical treatment. However, due to study designs, it’s hard to know when in the transition/detransition process a Christian religious identity, or religious conflicts, had an impact.
With more research being conducted on detransition and more people with experiences of detransition coming forward to share their life journeys, patterns and trends are emerging.
At the same time, in analyzing studies on regret/detransition, many authors such as Florence Ashley and colleagues conclude that predicting detransition is a very difficult—perhaps impossible—task. As researchers, it’s also important to underscore again that none of these studies—particularly those discussing age patterns—conclude with banning gender-affirming healthcare altogether.
However, on-going research on these experiences is absolutely critical to understand the full range of sexual and gender diversity and identity development across the lifespan. This research is also important to identify what kinds of supports may be useful to think about adding to gender-affirming healthcare provision, and in the development of more formal detrans care (which currently does not exist).
What we learn about detransition can help improve transition-related care. And as we have already noted in prior writing in the BMJ, trans and detrans people have allied healthcare goals:
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Interesting post - thank you. One point: if detransition is impossible to predict but we know that some people (and the numbers are growing) will be harmed by these treatments, isn’t that an argument FOR banning pediatric ‘gender affirming’ medical interventions? Seems to me that the burden of proof lies with those who advocate for these treatments, not the other way around. And that proof of benefit simply doesn’t exist in the scientific literature (see Cass Review). Kids cannot provide informed consent to experimental treatments.
Well constructed but the premise is flawed, reiterated several ways.
Nobody is assigned female at birth. They are female or male, there are two sexes, 99% of which are known immediately post-partum. Scientistms in writing attempting to provide illusory credence to the ideas use the language and structure (acronyms) of real science - “Assigned Female at Birth (AFAB)” - to create the aura of seriousness - you could call it “impersonating science” as trans individuals “impersonate sex”.
Likewise, nobody detransitions because they cannot transition to a different sex in the first place. The use of the term (in the circles which engineered the pseudo-science around trans) performs “reification”, (normally called repetition), making something seem (truly) real by way of using terminology repetitively. People with a sex delusion can cease impersonation, or become “disillusioned”, but they cannot “detransition”.
Cheryl Lynn has a nice tune about it.
https://youtu.be/fI569nw0YUQ?si=YUGmlLx27gWhB3aK
The fact that women have adopted wholesale delusions leading to extreme body chemical and surgical mutilation is not really new, now is it. The largest consumers of plastic surgery (except I suppose “Hair Club for Men” and tattooing) have been women. It’s just that the justification has shifted. Once they were not female enough, now it seems they are all too female.
One day people female at conception will hopefully find life and meaning being the women that they are rather than constructions that they aren’t.
Perhaps that’s a more meaningful conversation. Less scientism and more thoughtful.