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

Detransition and Desistance Among Previously Trans-Identified Young Adults

Surveys Detransition & regret Rising diagnoses & social influence

Authors: Lisa Littman, Stella O'Malley, Helena Kerschner, J. Michael Bailey
Journal: Archives of Sexual Behavior
Year: 2024
Source: pmc.ncbi.nlm.nih.gov/articles/PMC10794437/

Summary

This study surveyed 78 American young adults, mostly born female, who had identified as trans, often taking medical steps, and later stopped. They reported high rates of mental health diagnoses, many from before they first identified as trans. Most said they had first mistaken mental health problems or trauma for gender distress. Their reasons for detransitioning were mostly internal, such as their own changing thinking, rather than pressure from family or discrimination. Most reported much less gender distress and self-harm, and feeling much better about life, after detransitioning. The authors conclude that for some people, detransition is both possible and helpful. But these were volunteers looking back once on their own experience. The study describes this group well, but cannot show how common detransition is, or that detransitioning caused the improvements.

Key findings

Of 78 people, 71 (91%) were born female; on average they first identified as trans at age 17 and did so for about 5 years.
Most (83%) had taken social transition steps and 68% medical steps: 40% hormones only, 23% hormones and surgery, and 5% surgery only.
Looking back, fewer than 17% recalled childhood gender distress that met today's diagnosis, while 53% felt 'rapid-onset gender dysphoria' (gender distress that appears suddenly in the teen years) described them.
Mental health problems were common: 79% had ever self-harmed, including 71% before, 64% during and 23% after identifying as trans.
The most common reason given for first identifying as trans was mistaking mental health problems or reactions to trauma for gender distress; reasons for stopping were more often internal than outside pressure.
Of those who got cross-sex hormones, 66.7% felt they were not properly told about the risks, and only one person said they were told about other options.
Only 27.1% of all participants told their transition doctor that they had detransitioned.
The authors admit their study cannot show how common detransition is or what predicts it.

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.

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.

Methodological limitations

Volunteers from online networks: People were found through social media, detransitioner forums and groups (45% from r/detrans, 10% from the Pique Resilience Project). They may over-represent people with bad transition experiences and strong views. The authors say they cannot know whether the group is typical.
No comparison group: There is no group of people who stayed trans, people who re-transitioned, or detransitioners found through clinics. So the results cannot be compared with anyone else.
One survey, looking back: Everything, including childhood distress, self-harm and wellbeing before, during and after identifying as trans, was recalled in one survey. No medical records or other people's accounts were used.
Memory can be shaped by current views: The authors note childhood memories are especially unreliable. How people feel about their transition now may colour how they remember past distress and their medical care.
Cannot show cause and effect: Feeling better after detransition may reflect time, growing up, other treatment, or improvement that started before detransition. The authors admit they cannot tell whether detransition caused the changes.
Leaves out those who changed back: People had to have stopped identifying as trans for at least six months. This excludes those who detransitioned and then re-transitioned, and may favour people doing well after detransition.
Small group, mostly female: With 78 people and only 7 born male, the figures are rough, and comparisons between the sexes mean little.
'Rapid-onset' was self-rated: People were shown the first author's own definition of 'rapid-onset gender dysphoria', a disputed idea not in the official diagnostic manual, and asked whether it fitted them. This measures agreement with a description, not an independent medical judgement.
Some questionnaires were weak: Several sets of questions were adapted or newly made for this survey. Some did not hang together well, such as the questions on sexual arousal at imagining oneself as a woman and the six questions on gender distress while trans-identified.
Survey had to restart: The first anonymous survey was dropped after people publicly claimed to have sent fake answers. Only people checked by video call were included. This protected the data but may have put some eligible people off.
Two different groups mixed: The study combines people who stopped identifying as trans without medical steps and people who reversed medical transition. Most results do not separate them.
Rough comparisons with the public: Self-harm and childhood hardship rates are compared with general-population figures from other studies, not with a matched group.
Authors' involvement: Co-author Stella O'Malley founded Genspect. Co-author Helena Kerschner is a detransitioner who co-founded the Pique Resilience Project, which helped design the survey and find people. Lisa Littman coined 'rapid-onset gender dysphoria'. Publishing fees were paid by the Institute for Comprehensive Gender Dysphoria Research, the first author's organisation. The paper declares no funding and no conflicts of interest.

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Summary

Key findings

Abstract

Conclusion