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60% Became Comfortable With Birth Sex: Survey of 100 Detransitioners Reveals Why They Stopped

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

mental healthdetransitiontraumamedical ethicsgender dysphoriarapid-onset gender dysphoriasurvey
Authors
Lisa Littman
Year
2021
Journal
Archives of Sexual Behavior

Methodological Limitations

  • Convenience sample with significant selection bias: The study recruited participants exclusively from online detransition communities, blogs, social media platforms (Tumblr, Twitter, Reddit), and professional listservs, which likely attracted individuals with negative transition experiences rather than a representative sample of all people who detransition.
  • Self-reported data without verification: The study relied entirely on anonymous self-reported surveys without any ability to verify participants' identities, medical histories, or whether they actually underwent medical or surgical transition. The author explicitly acknowledges that 'identities of participants cannot be verified.'
  • Small sample size of 100 participants with limited demographic diversity: The sample was predominantly White (90.0%), non-Hispanic (98.0%), from the U.S. (66.0%), with no religious affiliation (63.0%), and overwhelmingly supportive of gay marriage (92.9%), limiting generalizability.
  • Cross-sectional design preventing causal conclusions: The author explicitly states that 'conclusions about causation cannot be determined' due to the cross-sectional design, yet the Discussion section repeatedly implies causal relationships between psychosocial factors and gender dysphoria development.
  • Potential recall bias and retrospective reinterpretation: Participants were asked to recall events and mental states from years prior, with mean time transitioned of 3.9 years and mean age at detransition of 26.4 years. The author notes that 'many of the participants in this study had less than ideal outcomes to their medical and surgical transitions, and it is possible that these experiences may have colored some of the responses.'
  • Survey instrument developed without validated measures: The 115-question survey was created by the author and two individuals who had personally detransitioned, without use of standardized or validated psychological instruments. The two collaborators were recruited through 'introductions from colleagues,' raising potential selection bias in survey design.
  • Leading question framing and potential confirmation bias: Questions about whether gender dysphoria was 'caused by something specific (ex. trauma, abuse, mental health condition)' may prime participants to attribute their experiences to these factors. The author acknowledges having a pre-existing hypothesis about 'rapid-onset gender dysphoria (ROGD)' and designed questions to test this hypothesis.
  • Overrepresentation of natal females (69%) compared to known transgender populations: While the author frames this as mirroring 'recent, striking changes in the demographics of gender dysphoric youth,' this demographic skew may also reflect that online detransition communities disproportionately attract natal females, limiting representativeness.
  • Exclusion of participants who may have had positive detransition experiences or who partially detransitioned without regret: The recruitment emphasized seeking individuals who 'discontinued medications, had surgery to reverse the effects of transition, or both,' potentially excluding those with more nuanced or positive experiences.
  • Conflict of interest regarding institutional affiliation: The author lists affiliation with 'The Institute for Comprehensive Gender Dysphoria Research,' and open access fees were provided by this same institute. The institute's name and the author's previous work on 'rapid-onset gender dysphoria' suggest a specific theoretical orientation that may have influenced study design and interpretation.
  • Lack of comparison group: There was no comparison group of individuals who transitioned and did not detransition, or who detransitioned without regret, making it impossible to determine whether the reported characteristics are unique to detransitioners or common among all transitioned individuals.
  • Potential for social desirability bias within recruited communities: Participants recruited from specific online communities may have been influenced by the dominant narratives in those spaces, particularly given that 37.7% of natal females and 48.4% of natal males first heard about the study from 'detransition blogs.'
  • The author acknowledges that 'the prevalence of detransition as an outcome of transition is unknown' and that clinic rates are 'likely to be underestimated,' yet the Discussion section makes policy and clinical recommendations based on this unrepresentative sample.
  • Methodological inconsistency in narrative coding: The author states that surveys were coded for narratives through 'horizontal (beginning to end) passes and vertical passes,' but does not report inter-rater reliability or systematic coding procedures, raising concerns about the objectivity of narrative categorization.

Key Findings

  • Most detransitioners (69%) were natal females, and the most common reason for detransitioning was becoming more comfortable identifying as their natal sex (60%), not external discrimination.
  • A majority (55%) felt they did not receive adequate evaluation from doctors or mental health professionals before starting transition, and nearly half said counseling was overly positive about benefits while downplaying risks.
  • Many participants attributed their gender dysphoria to underlying factors such as trauma, mental health conditions (38%), or internalized homophobia (23%), suggesting alternative causes were not fully explored beforehand.
  • Social media and online communities played a significant role in encouraging transition, with YouTube videos (48%), blogs (46%), and Tumblr (45%) being major influences; 20% felt socially pressured to transition by friends, partners, or clinicians.
  • Only 24% of detransitioners informed their clinicians that they had detransitioned, indicating that official clinic rates likely underestimate the true prevalence of this outcome.

Abstract

The study's purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the effects of transition, or both. Recruitment information with a link to an anonymous survey was shared on social media, professional listservs, and via snowball sampling. Sixty-nine percent of the 100 participants were natal female and 31.0% were natal male. Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned. There are many different reasons and experiences leading to detransition. More research is needed to understand this population, determine the prevalence of detransition as an outcome of transition, meet the medical and psychological needs of this population, and better inform the process of evaluation and counseling prior to transition.

Summary

This study by Lisa Littman surveyed 100 individuals who medically and/or surgically transitioned for gender dysphoria and subsequently detransitioned, finding diverse reasons for detransition including becoming comfortable with natal sex (60%), medical concerns (49%), and realizing gender dysphoria was caused by trauma or mental health conditions (38%). The majority (55%) felt they received inadequate evaluation before transitioning, and only 24% informed their clinicians of their detransition, highlighting the need for more thorough pre-transition assessment and better understanding of this understudied population.

Conclusion

This study described individuals who, after transitioning with medications or surgery, have detransitioned. The prevalence of detransitioning after transition is unknown but is likely underestimated because most of the participants did not inform the doctors who facilitated their transitions that they had detransitioned. There is no single narrative to explain the experiences of all individuals who detransition and we should take care to avoid painting this population with a broad brush. Some detransitioners return to identifying with their birth sex, some assume (or maintain) a nonbinary identification, and some continue to identify as transgender. Some detransitioners regret transitioning and some do not. Some of the detransitioners reported experiences that support the ROGD hypotheses, including that their gender dysphoria began during or after puberty and that mental health issues, trauma, peers, social media, online communities, and difficulty accepting themselves as lesbian, gay, or bisexual were related to their gender dysphoria and desire to transition. Natal female and natal male detransitioners appear to have differences in their baseline characteristics and experiences and these differences should be further delineated. Future research about gender dysphoria and the outcomes of transition should consider the diversity of experiences and trajectories. More research is needed to determine how best to provide support and treatment for the long-term medical and psychological well-being of individuals who detransition. Findings about detransition should be used to improve our understanding of gender dysphoria and to better inform the processes of evaluation, counseling, and informed consent for individuals who are contemplating transition.