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Rapid-Onset Gender Dysphoria and Detransition: A Study of 78 Young Adults

Detransition and Desistance Among Previously Trans-Identified Young Adults

mental healthtransition outcomesdetransitiontraumagender dysphoriaqualitative researchrapid-onset gender dysphoria
Authors
Sasha Ayad, Lisa Marchiano, Kenneth J. Zucker
Year
2023
Journal
Archives of Sexual Behavior

Methodological Limitations

  • Severe sampling bias: The sample was recruited exclusively from social media, Internet sites, and word of mouth, with 45% of participants coming from the r/Detrans subreddit. The authors acknowledge they 'cannot know whether our informants were representative of detransitioners and desisters' and cannot know how they differ from those who have not detransitioned.
  • Extreme demographic skew: 91% of participants (71 of 78) were natal females, severely limiting generalizability and statistical power to examine sex differences. The authors note 'the small number of males meant that statistical power to test for such differences was very low.'
  • Exclusive reliance on retrospective self-report without corroboration: The authors note their 'study relied exclusively on detransitioners' and desisters' self-reports' and that 'informants were surveyed only once, but they reported on their own feelings and behavior across a wide range of time, from childhood through early adulthood.' They acknowledge that 'retrospective reports...can be inaccurate for various reasons, including memory limitations and motivated distortion.'
  • Potential for motivated distortion in recall: The paper explicitly states that 'exaggerated memories of childhood gender nonconformity and dysphoria may be encouraged in both clinical and peer contexts' and that 'validity of this variable is especially problematic because it relies on childhood memory.'
  • ROGD measure is circular and self-confirming: Participants were provided with Littman's own definition of 'rapid-onset gender dysphoria' (a controversial and non-DSM concept originated by the first author) and asked whether it applied to them. This is not an independent diagnostic assessment but a self-endorsement of a researcher's theory.
  • Survivorship bias in well-being outcomes: The study only includes those who successfully detransitioned and remained non-trans-identified for at least 6 months. Those who detransitioned and retransitioned, or who had negative outcomes after detransition, would be systematically excluded.
  • Lack of comparison groups: There is no control group of currently transgender-identified individuals, no group of cisgender individuals with similar mental health histories, and no group of detransitioners with different outcome trajectories.
  • Potential confounding of cause and effect in mental health improvements: The authors acknowledge that 'our study cannot resolve whether detransition and desistance caused these changes in our participants. It is possible, for example, that improvement in psychological functioning preceded detransition, or that detransition and improvement were both caused by a third factor.'
  • Social desirability and identity consolidation effects: Participants who have committed to detransition may rationalize their experiences to reduce cognitive dissonance. The authors note participants 'invested a great deal of their lives in their gender transitions' yet report dramatic improvements, which may reflect post-hoc justification.
  • The study was modified mid-recruitment due to 'sabotage attempts,' introducing potential selection effects: After initial anonymous online recruitment, the protocol was changed to require videoconference screening interviews. The 7 individuals who were eligible but did not complete surveys after receiving links (8.8% of eligible participants) may differ systematically from completers.
  • The ACE comparison is methodologically flawed: The authors compare their sample's ACE scores to CDC population data without accounting for the fact that their sample was selected for having psychiatric difficulties and trauma histories, and that ACEs are known to be elevated in LGBTQ populations generally.
  • Autogynephilia/autoandrophilia measures have poor validity: Cronbach's alpha for the autogynephilia scale was only 0.58 (below conventional acceptability), and the authors note 'autoandrophilia is neither well researched nor well supported.' Despite this, they use these measures to classify participants by typology.
  • The informed consent findings are based on retrospective, potentially biased recall: Participants who have come to believe their transition was a mistake may systematically misremember or negatively evaluate the information they were provided. Only 27.1% informed their clinician of detransition, suggesting potential ongoing clinical relationships that could affect recall.
  • The study conflates detransition and desistance in ways that may obscure important differences: The title and throughout the paper combine these phenomena, yet they are defined differently (desistance is 'waning of gender dysphoria prior to medical gender transition' while detransition involves reversal of transition steps). The sample includes both groups without clear stratified analysis.
  • Conflict of interest regarding ROGD concept: First author Lisa Littman originated the concept of 'rapid-onset gender dysphoria' in a highly controversial 2018 paper, and this study appears designed in part to validate that concept. The Institute for Comprehensive Gender Dysphoria Research (Littman's affiliation) appears to be an organization she founded to promote this perspective.

Key Findings

  • The vast majority of participants (91%) were natal females, and most reported that their psychological health improved dramatically after detransition, with large decreases in self-harm and gender dysphoria and increases in well-being.
  • Fewer than 17% of participants met diagnostic criteria for childhood gender dysphoria, while 53% believed 'rapid-onset gender dysphoria' applied to them—suggesting many developed gender dysphoria suddenly during or after puberty without prior history.
  • Participants had very high rates of psychiatric diagnoses (95% had at least one lifetime diagnosis) and self-harm (79%), with most mental health issues predating their transgender identification.
  • The most common reason for initial trans-identification was confusing mental health issues or trauma reactions for gender dysphoria; reasons for detransition were primarily internal (own thought processes, realizing causes were more complicated) rather than external pressures like family or discrimination.
  • Most participants (68%) had taken medical transition steps including hormones, and 28% had undergone surgery, yet the majority felt inadequately informed about risks and alternatives during the informed consent process.

Abstract

Persons who have renounced a prior transgender identification, often after some degree of social and medical transition, are increasingly visible. We recruited 78 US individuals ages 18-33 years who previously identified as transgender and had stopped identifying as transgender at least six months prior. On average, participants first identified as transgender at 17.1 years of age and had done so for 5.4 years at the time of their participation. Most (83%) participants had taken several steps toward social transition and 68% had taken at least one medical step. By retrospective reports, fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. In contrast, 53% of participants believed that "rapid-onset gender dysphoria" applied to them. Participants reported a high rate of psychiatric diagnoses, with many of these prior to trans-identification. Most participants (N = 71, 91%) were natal females. Females (43%) were more likely than males (0%) to be exclusively homosexual. Participants reported that their psychological health had improved dramatically since detransi- tion/desistance, with marked decreases in self-harm and gender dysphoria and marked increases in flourishing. The most common reason given for initial trans-identification was confusing mental health issues or reactions to trauma for gender dysphoria. Reasons for detransition were more likely to reflect internal changes (e.g., the participants' own thought processes) than external pressures (e.g., pressure from family). Results suggest that, for some transgender individuals, detransition is both possible and beneficial.

Summary

This study surveyed 78 young adults in the U.S. who previously identified as transgender but stopped doing so for at least six months, finding that most were natal females who had undertaken social and often medical transition. Participants reported high rates of pre-existing mental health conditions, with the most common reason for initial trans-identification being confusion of mental health issues or trauma for gender dysphoria, and the most common reasons for detransition being internal psychological changes rather than external pressures. After detransition, participants reported dramatic improvements in psychological well-being, including reduced self-harm and gender dysphoria and increased flourishing, suggesting that for some individuals, detransition can be beneficial.

Conclusion

We surveyed a sample of young adults who previously identified as transgender but had detransitioned or desisted. Most participants were born female. Mental health issues, including prior diagnoses and a history of self-harm, were especially common. A history of gender dysphoria during childhood was reported by a nontrivial minority of participants. A slight majority believed their histories were consistent with rapid-onset gender dysphoria. Factors most associated with detransition were internal factors, reflecting psychological change, rather than external factors, such as family or social pressure. Detransitioned participants reported that they had become much less gender dysphoric, and much happier, than they were during their period of trans-identification.