82 % des détransitionneurs toujours identifiés trans citent une pression extérieure — les autres furent exclus

Facteurs menant à la « détransition » chez les personnes transgenres et de genre divers aux États-Unis : une analyse à méthodes mixtes

Enquêtes Détransition & regret

Authors: Jack L. Turban, Stephanie S. Loo, Anthony N. Almazan, Alex S. Keuroghlian
Journal: LGBT Health
Year: 2021
Source: https://doi.org/10.1089/lgbt.2020.0437

Summary

Using the 2015 U.S. Transgender Survey, the authors looked at why trans-identified adults said they had ever gone back to living as their birth sex. About 13% of those who had ever transitioned said yes. Most gave outside pressures such as family, harassment or work, while about 16% gave inner reasons such as doubts about their gender. Going back was more common among people born male, nonbinary or bisexual people, and those with unsupportive families. People who had never taken hormones or had surgery were much more likely to report it. The authors conclude that detransition is mostly driven by stigma. However, the survey only included people who still identified as trans, so it cannot describe people who stopped identifying as trans. It describes temporary or pressured detransition among people who remain trans, not detransition in general or regret.

Key findings

Sur 27 715 personnes ayant répondu à l'enquête, 17 151 avaient déjà fait une transition d'une manière ou d'une autre, et 2 242 (13 %) d'entre elles ont dit avoir déjà détransitionné, même temporairement.
83 % de ceux qui avaient détransitionné ont donné au moins une raison extérieure, le plus souvent la pression de la famille et la stigmatisation dans la société.
16 % ont donné au moins une raison intérieure, comme un changement d'identité de genre ou un sentiment d'incertitude ; cela représente 2 % de l'ensemble de ceux qui avaient fait une transition.
Avoir détransitionné était plus fréquent chez les personnes nées hommes (environ 10 points de pourcentage de plus), les personnes non binaires, les personnes bisexuelles et celles dont la famille n'était pas soutenante.
Ceux qui avaient détransitionné étaient bien moins susceptibles d'avoir déjà pris des hormones (26 points de moins) ou subi une chirurgie (17 points de moins), ce qui suggère que de nombreuses détransitions étaient sociales plutôt que médicales.
Comme l'enquête n'incluait que des personnes s'identifiant actuellement comme trans, elle ne peut pas saisir les détransitionneurs qui s'identifient maintenant à leur sexe de naissance, ce que les auteurs reconnaissent.
Les réponses écrites (800 personnes) ont montré que « détransition » recouvrait de nombreuses choses, y compris se présenter brièvement dans son sexe de naissance lors de visites à la famille.

Abstract

Purpose: There is a paucity of data regarding transgender and gender diverse (TGD) people who "detransition," or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States. Methods: A secondary analysis was performed on data from the U.S. Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD adults in the United States. Participants were asked if they had ever detransitioned and to report driving factors, through multiple-choice options and free-text responses. A mixed-methods approach was used to analyze the data, creating qualitative codes for free-text responses and applying summative content analysis. Results: A total of 17,151 (61.9%) participants reported that they had ever pursued gender affirmation, broadly defined. Of these, 2242 (13.1%) reported a history of detransition. Of those who had detransitioned, 82.5% reported at least one external driving factor. Frequently endorsed external factors included pressure from family and societal stigma. History of detransition was associated with male sex assigned at birth, nonbinary gender identity, bisexual sexual orientation, and having a family unsupportive of one's gender identity. A total of 15.9% of respondents reported at least one internal driving factor, including fluctuations in or uncertainty regarding gender identity. Conclusion: Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.

Conclusion

Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.

Methodological limitations

People most likely to have inner reasons were left out: The survey only included people who currently identified as trans or gender diverse. Anyone who detransitioned and stopped identifying as trans was excluded, so inner reasons such as realising one is not trans are badly under-counted. The authors admit this, and Cohn (Arch Sex Behav 2023) highlights it.
Loose definition: Detransition meant ever 'going back to living as your sex assigned at birth, at least for a while'. This includes briefly presenting as one's birth sex, such as when visiting family, and is not the same as stopping or reversing medical treatment.
Mostly non-medical transitions: Those who reported detransition were far less likely to have used hormones or had surgery. So the results say little about people who detransition after medical treatment.
Recruited through community groups, not at random: The survey recruited through more than 400 trans community and advocacy groups. People were younger, better educated, more often white and less often straight than in random samples, so the rates found may not apply more widely.
Old data: The data were collected in 2015, before the big rise in teenagers, mostly born female, seeking care. They may not apply to today's patients.
Pre-set answers and authors' sorting: Most reasons came from pre-set 'pressure' options plus 800 written answers sorted by the authors. 'It was just too hard for me' was counted as neither outside nor inner, and the authors' approach treats inner doubts as possibly caused by outside stigma.
Looking back, unchecked: Reasons were recalled at one point in time, with nothing to confirm them and no information on when or for how long people detransitioned.
Regret not measured: The authors stress that detransition is not the same as regret, but they did not measure regret. Their statement that regret is rare relies on other studies (e.g. Wiepjes 2018) that have their own problems with losing track of patients.
Authors' viewpoint: The authors are prominent doctors and researchers in gender-affirming care. They frame detransition mainly as a response to stigma that doctors can 'ameliorate', which shapes how inner reasons are sorted and understood.

detrans.ai

Summary

Key findings

Abstract

Conclusion