60%的人对出生性别感到舒适：对100名停止变性者的调查揭示了他们停止的原因

接受过医学和/或手术过渡治疗的性别不安患者随后停止过渡：对100名停止变性者的调查

Authors: Lisa Littman
Journal: Archives of Sexual Behavior
Year: 2021
Source: pubmed.ncbi.nlm.nih.gov/34665380/

Summary

Lisa Littman surveyed 100 detransitioners about why they transitioned and why they stopped. Most were found through detransition blogs, forums and social media, and some through professional mailing lists. Reasons varied: 60% had become comfortable with their birth sex, 49% worried about medical complications, 38% came to see their gender distress as rooted in trauma or mental illness, and 23% mentioned discrimination. About half felt strong regret. 55% felt they were not properly assessed before transition, and only 24% told their clinicians they had detransitioned. That suggests clinic records miss many detransitioners. The study gives a voice to a hidden group, but the people chose to take part, their answers couldn't be checked, and it is a one-time snapshot from 2016 to 2017. It cannot show how common detransition is or what causes it.

Key findings

在100名去过渡者中，69%出生时为女性，31%出生时为男性。平均而言，他们过渡生活了3.9年，并在26岁时决定去过渡。
最常见的原因是对自己的出生性别更自在（60%）、担心可能的医疗并发症（49%），以及认定自己的性别痛苦是由某种特定的原因造成的，如创伤、虐待或心理健康状况（38%）。
23%的人因为歧视。另有23%的人说，对同性恋身份的羞耻感或难以接受自己是女同性恋、男同性恋或双性恋，在他们过渡并随后去过渡的过程中起了作用。
55%觉得医生或心理健康专业人员在过渡前没有对他们进行恰当的评估。近一半的人说，咨询对益处的描述太正面，对风险不够诚实。
约80%感到有些后悔，约一半（49.5%）感到强烈或非常强烈的后悔。有些人说过渡曾对他们有帮助，他们停止只是因为压力或医疗问题。
只有24%的人告诉了帮助他们过渡的临床医生自己已经去过渡，因此基于诊所记录的去过渡率很可能偏低。
出生时为女性的人比出生时为男性的人更年轻，过渡的时间也更短（平均3.2年对5.4年）。

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.

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.

Methodological limitations

Volunteers found mostly through detransition networks: The survey was posted on detransition blogs, a private detransition forum, a closed Facebook group, Tumblr, Twitter and Reddit, as well as professional mailing lists (WPATH, APA Division 44 and SEXNET). Many people heard about it through detransition blogs, so those with bad experiences and ties to those groups are probably over-represented.
Nothing could be checked: The survey was anonymous, didn't record IP addresses, and relied only on what people reported. Who they were, what treatment they had, their diagnoses and timelines couldn't be checked, as the author admits.
Small and similar group: There were 100 people, 90% White, 98% non-Hispanic and mostly from the US. That limits how far the results apply to others.
Looking back, at one point in time: People described their reasons and feelings from years earlier, after about 4 years of transition on average. The author notes that bad experiences may have 'colored some of the responses', and this design can't show what caused what.
Home-made questionnaire: The 115-question survey was written by the author with two detransitioned people. No tested questionnaires were used for gender distress, regret or mental health, and wording such as whether gender distress was 'caused by something specific (ex. trauma, abuse, mental health condition)' may nudge people toward certain answers.
No comparison group: Without people who continued transitioning, we can't know whether features like poor assessment, social media influence or past trauma are special to detransitioners.
Can't say how common detransition is: The author says the study wasn't designed to measure this. The 24% who told their clinicians shows clinics undercount, but not by how much.
Old data: The survey ran from December 2016 to April 2017 but was published in October 2021. Clinical practice, the sites used to recruit and the people detransitioning may have changed since.
Questions shaped by the author's earlier idea: The author had earlier proposed 'rapid-onset gender dysphoria' (Littman 2018), the idea that gender distress can appear suddenly under social influence. The survey included questions testing that idea, such as on social media and friends, which may have shaped what was asked and how answers were read.
Who paid: The author works for The Institute for Comprehensive Gender Dysphoria Research, which also paid the publishing fees. There was no outside funding and no conflicts were declared.
Written answers sorted by one person: The author alone read and sorted people's written answers, with no second person checking that they'd sort them the same way.

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Summary

Key findings

Abstract

Conclusion