Overview

People who seek gender transition, and people who later detransition, report far higher rates of depression, anxiety, self-harm and other psychiatric conditions than the general population. That is one of the most consistent findings in this field. What it means is fiercely contested.

There are two main explanations. The minority stress explanation says mental illness is mostly a consequence of being trans in a hostile society. The diagnostic overshadowing explanation says that, for at least some people, a trans identity is a response to — or a misreading of — pre-existing mental distress, and that once "gender dysphoria" is diagnosed, everything else gets blamed on it. Both can be true for different people. This page looks at the evidence for each, the conditions detransitioners most often say were mistaken for gender dysphoria, and what happened to their mental health during and after transition.

Eating disorders and body dysmorphia are covered in more depth on their own sub-page, body dysmorphia and eating disorders. This page does not cover suicide in depth. For the "transition or suicide" narrative and the evidence behind it, see suicide and transition.

How common is psychiatric comorbidity?

Comorbidity means two or more conditions occurring in the same person. In gender clinics it is the norm, not the exception. And the more recent the group of patients studied, the higher the rates tend to be.

The Finnish clinic study set the tone. Its authors wrote that their patients did not fit "the commonly accepted image of a gender dysphoric minor". They said treatment guidelines needed to consider gender dysphoria "in the context of severe psychopathology and developmental difficulties" (Kaltiala-Heino et al. 2015).

The Cass Review (the 2024 independent review of NHS gender identity services for children and young people in England) found the same shift there. Referrals changed from a small number of mostly young boys to a majority of teenage girls with "additional complex problems including a history of trauma or adverse childhood experiences, depression, anxiety, neurodiversity". This happened alongside a wider rise in anxiety, depression, eating disorders and body dysmorphic disorder among teenage girls in general (Cass 2024; ACAMH editorial 2024). For the population change itself, see demographic shift in trans identification.

Detransitioner surveys point the same way. In Littman's survey of 100 detransitioners, 38% believed their gender dysphoria had been caused by a mental health condition (Littman 2021). In Vandenbussche's survey of 237 detransitioners, 70% said they came to see their dysphoria as related to other issues (Vandenbussche 2022). Both samples were recruited online and self-selected, so they can't tell us how common these patterns are among all detransitioners. They do show the pattern is real and recurring.

Two explanations: minority stress vs. diagnostic overshadowing

The minority stress explanation

The gender minority stress model (Hendricks and Testa 2012) says trans people suffer poorer mental health because of chronic stressors. These include discrimination, rejection and violence, plus internal ones such as concealment and internalised transphobia. On this view, depression and anxiety are downstream of being trans in an unaccepting society. Affirmation and transition should reduce them.

This explanation deserves to be taken seriously. Discrimination and family rejection do harm mental health, and many trans-identified people describe exactly this. But the model has critics within gender studies itself. A 2024 paper in Social Science & Medicine notes that it treats identity as "stable and inherent" and leaves gender dysphoria itself out of the picture. In doing so, it separates distress caused by minority stress from "the suffering that makes people seek gender-affirming care" (Social Science & Medicine 2024). The model assumes the trans identity is fixed and is where the explanation starts. It has no way to ask whether the identity might itself be a response to distress.

The diagnostic overshadowing explanation

Diagnostic overshadowing is when one diagnosis draws so much attention that other conditions are overlooked or put down to it. The Cass Review's interim report warned that once gender-related distress was identified, other problems such as poor mental health — normally handled by local services — were sometimes overlooked (Cass Review interim report 2022). Jorgensen's review of iatrogenic harm (harm caused by medical treatment itself) makes a similar point: "minority stress" is often used to explain away complex psychological conditions instead of investigating them (Jorgensen 2023).

Many detransitioners describe exactly this. Their depression, anxiety or trauma was put down to being trans, and the cure on offer was transition:

I remember my doctors saying I was depressed because I was trans, I was anxious because I was trans, everything was because I "was trans" but everyone ignored the logical thinking that should have happened by awknowledging I had all that before identifying as trans and problems came from bad childhood experiences. —LostSoul1911, detrans female

I was obviously depressed (and now I am even more depressed), had severe anxiety + was autistic with adhd… But as soon as I started talking about myself, this "doctor" said that all my mental pain will go away when I start hormones and change my documents. —thistle_ev, detrans female

There is a psychological logic to why this framing is attractive. One desisted woman (someone who stopped identifying as trans without medically transitioning) described the appeal of an external, fixable cause for misery:

It can feel easier to blame the depression symptoms on gender dysphoria, because if that's the reason for your depression then once you get hormones/surgery/etc you'll be happy. If you always have an external goal of getting the next gender affirming procedure on your list, that's something with relatively clear steps to follow to get there and you don't have to reflect too deeply on your internal state. —marimachadas, desisted female

Put in psychoanalytic terms, a vague and frightening inner pain becomes a concrete, outward problem — the body — with a step-by-step treatment plan. That feels like hope. But it can also stop the exploration that would reveal what the distress is really about. Psychoanalytic case studies of detransitioners describe gender identification serving several unconscious functions. These include escaping feminine expectations, expressing split-off anger, and gaining social belonging (Marchiano 2021). They also describe trauma that only came to light after many months of therapy (D'Angelo 2025).

What the data can and cannot settle

Prevalence figures alone can't tell the two explanations apart. Both predict high rates of mental illness. What matters is timing and outcome:

• Timing. In both Finnish studies and in Littman et al. (2024), psychiatric problems usually came before gender dysphoria or trans identification (Kaltiala-Heino et al. 2015; Ruuska et al. 2026; Littman et al. 2024). That fits poorly with a model where distress follows from being trans. It doesn't rule out the minority stress view entirely, though: someone could feel "different" and suffer for it long before they have words for it.
• Outcome after treatment. If distress were mainly caused by untreated dysphoria, transition should reduce it. In the Finnish national register, psychiatric need did not fall after medical transition. Among those who received feminising treatment, the share in specialist psychiatric care rose from 9.8% to 60.7%; among those who received masculinising treatment, from 21.6% to 54.5%. After adjusting for earlier psychiatric history, all gender-referred groups had roughly 3–5 times the risk of controls, whether or not they transitioned (Ruuska et al. 2026). A summary by LGB Alliance Australia notes that this adjustment suggests pre-existing illness, rather than treatment itself, drives the poor outcomes (LGB Alliance Australia summary). Either way, transition did not resolve it.
• Swedish register data. A long-term follow-up of 324 people who had sex reassignment surgery in Sweden found a 2.8-fold higher risk of psychiatric inpatient care compared with population controls, after adjusting for prior psychiatric illness (Dhejne et al. 2011). The controls were the general population, not untreated gender-dysphoric people, so this shows that problems persist, not that surgery caused them. A later Swedish study initially reported that surgery reduced mental health treatment. After reanalysis, the journal published a correction saying there was no advantage of surgery (Bränström & Pachankis 2019, corrected 2020).
• Systematic reviews. Independent reviews of puberty blockers and hormones in young people rate the evidence for mental health benefits as very low certainty (Miroshnychenko et al. 2025a; Miroshnychenko et al. 2025b; Cass 2024). See evidence reviews.

The evidence is observational and has real limitations. Detransitioner samples are small and self-selected. Register studies can't measure gender dysphoria or stigma directly. But the overall picture does not support the idea that transition reliably treats the psychiatric distress that so often comes with gender dysphoria.

Conditions that can resemble or drive gender distress

Detransitioners often describe a specific condition that they now believe was misread as gender dysphoria. These accounts are retrospective and personal. They don't show that these conditions cause trans identification in general. But they line up with what clinicians report, and they point to what a careful assessment should look for.

Depression and anxiety

Depression changes how a person experiences their body. It brings self-loathing, numbness and a sense of being wrong. When a young person who is depressed hears that this feeling is "dysphoria", gender can become the explanation for all of it. Several detransitioners describe their gender feelings fading once the depression itself was treated. One detrans male wrote that an antidepressant "surprised both me and my doctor when it also cured my GD" (gender dysphoria; OtterWithKids, detrans male). Some women found a hormonal mood disorder — PMDD (premenstrual dysphoric disorder) — behind distress they had put down to gender (coyoteb0nes, desisted female).

I was admitted to a mental hospital for suicidal thoughts and when I came home, all my desires to be trans VANISHED. I realized at the hospital that this "gender dysphoria" I was feeling was just me trying to blame all my issues onto some other thing separate from my mental health. —PocketGoblix, detrans female

OCD and "gender OCD"

Obsessive-compulsive disorder (OCD) is often called "the doubting disorder". It can latch onto any theme, including sexuality ("HOCD", homosexual OCD) and gender. In gender-themed OCD (sometimes "tOCD", transgender OCD), the intrusive thought "what if I'm trans?" causes intense anxiety. That anxiety drives compulsions: checking one's feelings, testing reactions to images, reading trans and detrans forums, and asking strangers for reassurance. A published case report described a young man whose new-onset intrusive thoughts that he was transgender came every 30 minutes to 2 hours. He "tested" his reactions to try to prove the answer one way or the other. The authors warned this presentation would become more common as media coverage grows (OCD case report).

The problem is that the online "egg" framework (the idea that someone can be trans without knowing it yet, like an egg that has not "cracked") treats obsessive questioning itself as evidence of being trans. That makes OCD worse. One desisted male described the trap:

I went from never really thinking about my gender to obsessively 'testing' myself for gender dysphoria every day… the fact that everybody thought (and still thinks) that only a trans person could obsess over their gender made it a vicious cycle. —goonby1990, desisted male

Commenters who recovered often describe the standard OCD approach. They stopped seeking reassurance, learned to treat thoughts as thoughts rather than signals about a "true self", and in some cases used exposure and response prevention therapy (Hedera_Thorn, detrans male). The key difference, as one detrans female put it, is that more reassurance seeking "always and ONLY makes the obsession worse" (lmnop-etc, detrans female). See also egg cracking.

Identity disturbance and borderline personality traits

Identity disturbance — a persistently unstable self-image or sense of self — is a core feature of borderline personality disorder (BPD). It often goes with chronic emptiness, self-loathing, impulsivity and intense fear of abandonment. BPD traits are strongly linked to childhood trauma. In the Finnish detransitioner study, 56% had a BPD diagnosis (Kettula et al. 2025).

Several detransitioners describe transition as the "ultimate" identity change for a self that felt unbearable:

BPD is big on having no sense of identity or rapidly changing identity. It's like how you see a lot of girls with BPD drastically change and dye our hair a lot. It's just changing gender is like the ultimate change of identity. That's how it was for me. —Balecto, detrans female

I also had BPD and an unstable identity, but everything pointed to otherwise-incurable 'gender dysphoria'. —hesbrokn, detrans male

The evidence here needs care. A study of 100 clinic-referred women with BPD found that none met the threshold for gender dysphoria on a validated measure (Journal of Sexual Medicine study). So BPD does not usually produce gender dysphoria. The concern is narrower: when a person with an unstable sense of self meets a social setting that offers gender identity as the answer, a trans identity can become the identity they grab onto. Trans commenters, for their part, report BPD diagnoses being used to deny or withdraw hormones. One trans man said a clinic took away his testosterone because he wondered whether he might have BPD (breadpilledwanderer, trans man (FTM)). Both concerns point to the same need: a clinician who can tell the two apart.

Dissociation and depersonalisation

Dissociation is a disconnection between thoughts, feelings, body and sense of self. Depersonalisation is feeling that you, or your body, are not real or not yours. Looking in the mirror and not recognising yourself, or feeling that your body is a vehicle you happen to live in, can feel very much like gender dysphoria.

I thought I was super attractive as a woman, but my own reflection just felt off and I didn't "recognize" myself. I had a feeling that "this is not what I'm supposed to look like" and I interpreted the feeling as gender dysphoria. Actually the feeling was severe dissociation/depersonalization. —deleted user, r/detrans

Dissociation is often rooted in childhood abuse. One detrans woman described being "completely disconnected from the feelings and memories related to the past abuse" while on testosterone. Years later she had flashbacks of childhood sexual abuse she had not remembered. She concluded: "My gender dysphoria was dissociation" (deleted user, r/detrans). Several detransitioners also describe their whole transition as a dissociated "dream state". One said she can hardly grasp that her breasts are gone because "it feels like it wasn't me who got them cut off" (Grey-Skies-Silflays, detrans female).

The research is mixed. An Italian study found that 30% of gender dysphoria patients had a lifetime dissociative disorder. It also found that hormone treatment reduced dissociative symptoms, and the authors noted "clinical similarities between Gender Dysphoria and dissociation" (Colizzi et al. 2015). That finding can be read either way. Transition may relieve dissociation that comes from dysphoria, or it may temporarily cover dissociation with other roots. The Finnish clinicians who saw detransitioners recommended assessing for dissociation before any irreversible intervention (Kettula et al. 2025).

Eating disorders and body dysmorphia

Eating disorders and body dysmorphic disorder overlap heavily with gender distress, especially in females, and in a Finnish clinic series, 7 of 9 detransitioners (78%) had eating disorder symptoms (Kettula et al. 2025). One desister wrote: "I thought I hated my hips and breasts because I was a man, but I only hated them because I thought they made me look fat" (inmebed, desister). Because the overlap is so close, this topic has its own sub-page: body dysmorphia and eating disorders looks at how these conditions overlap and are told apart, what the evidence on co-occurrence shows, and why distress about sex characteristics is treated by changing the body when distress in body dysmorphic disorder and anorexia is not.

ADHD and hyperfixation

ADHD is over-represented among gender-diverse youth (Becerra-Culqui et al. 2018; Kaltiala-Heino et al. 2015). Detransitioners describe two ways it may contribute. One is hyperfixation: intense, all-consuming interests that can settle on gender and transition. The other is impulsivity, which makes fast, high-stakes decisions more likely. Social difficulties from ADHD, and the depression that often follows, can also leave someone searching for an explanation of why they feel different.

I've come to view gender dysphoria not as a feeling in and of itself, but as an interpretation of a feeling. I felt like shit, and I interpreted it through the lens of transgenderism, and it felt like gender dysphoria. —QueenlyFlux, detrans male

The overlap with autism is similar and often occurs alongside it: black-and-white thinking, intense focus, and difficulty fitting sex-based social expectations.

Psychosis

Psychosis is rarer, and it must be discussed carefully. Most trans-identified people are not psychotic, and being trans is not a delusion in the clinical sense. Still, the Finnish detransitioner study found psychotic symptoms were common in its small sample (Kettula et al. 2025), and a few detransitioners describe identifying as trans, or transitioning, during psychotic or manic episodes. One detrans male described a sudden, almost spiritual "realisation" that he was trans. Later, after a religious psychosis, "when those delusions broke apart, my trans identity followed" (sydney-speaks, detrans male). Another said simply: "I was in active psychosis when i transitioned and still got diagnosed as trans" (eximology, detrans male). The lesson is not that gender distress is psychosis. It is that no irreversible decision should be made during an acute psychiatric crisis.

Escapism and maladaptive daydreaming

Maladaptive daydreaming is excessive, immersive fantasy that replaces real life. Several detransitioners describe building an idealised other-sex persona in daydreams long before they identified as trans. That persona was a better, freer, more attractive self:

I created a male character that was like me in every way except better and more desirable. An escape from sexism, and I can finally be someone I felt was attractive and had control over every setting he was in. —wetfart41968, detrans female

Men describe the same escapist pull. One desisted male realised "it wasn't that I actually wanted to be a woman, it was that I didn't want to be me". He listed facial dysmorphia, internalised homophobia, misandry and trauma among the reasons (ExactSandwich3710, desisted male). In psychological terms, transition promised to kill off a hated self and replace it with an ideal one. The trouble is that the self who did the hating comes along. See internalised misandry and internalised misogyny.

For the full picture (definitions, the clinic research, which way cause runs, and what helps), see dissociation, depersonalisation and gender distress.

Mental health during and after transition

The hormone "honeymoon"

Testosterone is an anabolic steroid with known mood-lifting and energising effects. Many detrans women describe feeling dramatically better in the first months on it, and they took that as confirmation they were trans:

Before starting T at 18, I was very depressed, with suicidal ideation and thoughts of harming myself… Taking testosterone made that go away essentially overnight. I felt happy and energized, and was intensely reassured that I was making the right decision. What was actually happening was that I had just started taking an anabolic steroid, one of the known effects of which is improvements in mood. —Quiet-County-9236, detrans female

Others found the lift faded, or that testosterone made anxiety, anger and depression worse over time (graybutch, detrans female; cold-alarm8, detrans female). One woman said testosterone "chemically kept me out of the pits of depression" for nearly a decade, while she rejected herself "in a severe way (while telling myself I was accepting my true self)" (furbysaysburnthings, detrans female). The early relief can work like a medication effect that gets mistaken for proof of identity. See testosterone in females.

Male experiences

Male detransitioners more often describe estrogen and anti-androgens deepening low mood, fatigue and anxiety:

The longer I was on hormones, the more I felt mournful of myself as a guy. I also felt like crap on hormones (no energy, no libido, no appetite, extremely depressed)… For me, being trans was an easy explanation for all the other problems I faced in life. —deleted user, r/detrans

Another wrote that transition "did not solve any depression I had, it made it a lot worse because now I experienced real dysphoria and depression" (Pitoly, detrans male). Others describe a social side: the extra anxiety of trying to be seen as female on top of unchanged insecurities (OkHurry8168, detrans male). In the Finnish register, the rise in psychiatric care was steepest among those who received feminising treatment (Ruuska et al. 2026). See estrogen and testosterone blockers in males.

After stopping

Stopping cross-sex hormones often brings a hard few months while the body's own hormone production recovers. Several women describe low mood after stopping testosterone that later lifted, leaving them "better off mentally than pre T, but better off than I was while on T" (tabarnak555, detrans female). Some men describe depression lifting quickly once they stopped estrogen (WallaWallaby011, detrans male). Detransition can also bring grief, anger and isolation of its own. Vandenbussche found that only 18% of detransitioners felt they had enough support (Vandenbussche 2022). See testosterone cessation and estrogen cessation.

In the one larger study that measured it, people who stopped identifying as trans reported marked decreases in self-harm and gender dysphoria and increases in flourishing (Littman et al. 2024). The sample was self-selected and excluded anyone who retransitioned, so it shows detransition can go well, not how often it does.

Trans perspectives

Many trans-identified people say transition dramatically improved their mental health, and their accounts should be taken at face value. Trans women describe suicidal thoughts that "just evaporated away" within a day of their first estrogen dose (FewSplit4424, trans woman (MTF)). Others describe being able to hold a job and see friends after years of depression (Salamqnder, trans woman (MTF)). From this angle, depression is untreated dysphoria. As one trans woman put it, any remaining sadness "exists because of the way that other people have treated me" (13_JJ_13, trans woman (MTF)).

Trans commenters also describe the opposite form of overshadowing: clinicians treating their mental illness as proof they are not trans, or using it to delay care (documentremy, trans man (FTM)). Some say frankly that transition fixed some problems but not others. "It fixed some problems, my quality of life is largely better. There's still work we as people have to do" (Good_Ol_Ironass, trans woman (MTF)). Another trans man said transition had made his mental health worse because of social hostility and going through a second puberty alone (Own-Mobile-302, trans man (FTM)).

Many detransitioners describe feeling exactly this early relief themselves, before it faded. Early improvement on hormones doesn't tell anyone, trans or detrans, how they will feel years later. That is why long-term outcome data, and not early mood alone, should guide decisions. The real harm happens when permanent interventions are given without fully informed consent and without first looking at the other possible causes of distress.

What helps

This page does not give medical advice. What detransitioners repeatedly say they needed was someone to look at their whole mental health before and alongside any gender question. Several commenters suggest a simple principle:

In medicine they say "when you hear hoof beats, think horses not zebras". Rule out the most common and easily treated problems first, then look to see if something else may be wrong. —lee_ehrlich, questioning own gender transition

Recurring themes in recovery accounts include:

• Treating the underlying condition directly — depression, OCD, PMDD, ADHD, trauma — rather than through the body.
• Therapy that explores rather than affirms or forbids, such as gender exploratory therapy. Some found body-based (somatic) approaches helpful for dissociation and trauma.
• Stepping back from online gender spaces, especially for those with OCD-type rumination. See echo chambers and online communities.
• Accepting gender non-conformity without a label — see gender non-conformity without labels.
• Connection with other detransitioners, whom 87% of Vandenbussche's respondents wanted to hear from (Vandenbussche 2022).

For longer-term recovery, see healing and recovery. The support directory lists exploratory therapists and detrans peer groups, and the study archive collects the research cited here.

References

• Kaltiala-Heino, R., Sumia, M., Työläjärvi, M. & Lindberg, N. (2015). Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health. source.
• Becerra-Culqui, T. A. et al. (2018). Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics. source.
• Jarvis et al. (2025). Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England. study page, source.
• Ruuska et al. (2026). Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study. Acta Paediatrica. study page, source.
• Littman, L., O'Malley, S., Kerschner, H. & Bailey, J. M. (2024). Detransition and Desistance Among Previously Trans-Identified Young Adults. Archives of Sexual Behavior. study page, source.
• Kettula, K. et al. (2025). Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland. Archives of Sexual Behavior. study page, source.
• Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. study page, source.
• Vandenbussche, E. (2022). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. Journal of Homosexuality. study page, source.
• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page, source.
• Cass, H. (2022). Independent review of gender identity services for children and young people: Interim report. source.
• ACAMH (2024). Editorial: The Cass Review – implications and reassurance for practitioners. Child and Adolescent Mental Health. source.
• Hendricks, M. L. & Testa, R. J. (2012), gender minority stress model, as discussed in: The gender minority stress model and/or cisnormativity? The need for pluralistic theoretical perspectives in improving trans health and medicine (2024). Social Science & Medicine. source.
• Jorgensen, S. C. J. (2023). Iatrogenic Harm in Gender Medicine. Journal of Sex & Marital Therapy. study page, source.
• Marchiano, L. (2021). Gender detransition: a case study. Journal of Analytical Psychology. study page, source.
• D'Angelo, R. (2025). Do we want to know? study page, source.
• Dhejne, C. et al. (2011). Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE. source.
• Bränström, R. & Pachankis, J. (2019; correction 2020). American Journal of Psychiatry — summary of the correction: Correction of a Key Study: No Evidence of "Gender-Affirming" Surgeries Improving Mental Health. source.
• Miroshnychenko, A. et al. (2025a). Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis. study page, source.
• Miroshnychenko, A. et al. (2025b). Gender affirming hormone therapy for individuals with gender dysphoria aged <26 years: a systematic review and meta-analysis. study page, source.
• Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review. AACE Clinical Case Reports. source.
• Gender Identity and Sexual Orientation in Women with Borderline Personality Disorder. Journal of Sexual Medicine. source.
• Colizzi, M., Costa, R. & Todarello, O. (2015). Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real? Psychiatry Research 226(1). source.
• LGB Alliance Australia. New Finnish study (summary of Ruuska et al.). source.