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Archives of Sexual Behavior (2021) 50:3353–3369
https://doi.org/10.1007/s10508-021-02163-w
ORIGINAL PAPER
Individuals Treated forGender Dysphoria withMedical and/orSurgical
Transition Who Subsequently Detransitioned: ASurvey of100
Detransitioners
LisaLittman1
Received: 5 October 2020 / Revised: 17 September 2021 / Accepted: 20 September 2021 / Published online: 19 October 2021
© The Author(s) 2021
Abstract
The study’s purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medi-
cal 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 clini-
cians 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.
Keywords Gender dysphoria· Detransition· Transgender
Introduction
Detransition is the act of stopping or reversing a gender tran-
sition. The visibility of individuals who have detransitioned
is new and may be rapidly growing. As recently as 2014, it
was challenging for an individual who detransitioned to find
another person who similarly detransitioned (Callahan, 2018).
Between 2015 and 2017, a handful of blogs written by indi-
vidual detransitioners started to appear online, private support
groups for detransitioners formed, and interviews with detran-
sitioners began to appear in news articles, magazines, and
blogs (Anonymous, 2017; 4thwavenow, 2016; Herzog, 2017;
McCann, 2017). Although few YouTube videos about detran-
sition existed prior to 2016, multiple detransitioners started
to post videos documenting their experiences in 2016 and the
numbers of these videos continues to increase.1 In late 2017,
the subreddit r/detrans (r/detrans, 2020) was revitalized and in
four years has grown from 100 members to more than 21,000
members. A member poll of r/detrans conducted in 2019 esti-
mated that approximately one-third of the members responding
to the survey were desisters or detransitioners (r/detrans, 2019).
The Pique Resilience Project, a group of four detransitioned
or desisted young women, was founded in 2018 as a way to
share the experiences of detransitioners with the public (Pique
Resilience Project, 2019). In late 2019, the Detransition Advo-
cacy Network, a nonprofit organization to “improve the well-
being of detransitioned people everywhere” was launched (The
Supplementary Information The online version contains
supplementary material available at https:// doi. org/ 10. 1007/
s10508- 021- 02163-w.
* Lisa Littman
Lisa.Littman@gmail.com
1 The Institute forComprehensive Gender Dysphoria
Research, 489 Main Street, Warren, RI02885, USA
1 A search of the word “detransition” in YouTube can be filtered by
date of upload. https:// www. youtu be. com/ resul ts? search_ query=%
22det ransi tion% 22& sp= CAI% 253D22.
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3354 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
Detransition Advocacy Network, 2020) and the first formal, in-
person conference for detransitioned people was held (Bridge,
2020). In the face of this massive change, clinicians have called
for more research into the experiences of detransitioners (Butler
& Hutchinson, 2020; Entwistle, 2021; Marchiano, 2020).
Although there were rare published reports about detran-
sitioners prior to 2016, most of the published literature about
detransition is recent (Callahan, 2018; D’Angelo, 2018; Djordje-
vic etal., 2016; Kuiper & Cohen-Kettenis, 1998; Levine, 2018;
Marchiano, 2017; Pazos Guerra etal., 2020; Stella, 2016; Tur-
ban & Keuroghlian, 2018; Turban etal., 2021; Vandenbussche,
2021). The prevailing cultural narratives about detransition are
that most individuals who detransition will retransition and that
the reasons for detransition are discrimination, pressures from
others, and nonbinary identification (Turban etal., 2021). How-
ever, case reports are shedding light on a broader and more
complex range of experiences that include trauma, worsened
mental health with transition, re-identification with natal sex,
and difficulty separating sexual orientation from gender identity
(D’Angelo, 2018; Levine, 2018; Pazos Guerra etal., 2020).2
Detransitioners and desisters, in their own words, have provided
additional depth to the discussion, describing that:
(1) Trauma (including sexual trauma) and mental health con-
ditions contributed to their transgender identification and
transition (Callahan, 2018; Herzog, 2017; twitter.com/
ftmdetransed & twitter.com/radfemjourney, 2019)
(2) Their dysphoria and transition were due to homopho-
bia and difficulty accepting themselves as homosexual
(Bridge, 2020; Callahan, 2018; upperhandMARS, 2020)
(3) Peers, social media, and online communities were influ-
ential in the development of transgender identification
and desire to transition (Pique Resilience Project, 2019;
Tracey, 2020; upperhandMARS, 2020)
(4) Their dysphoria was rooted in misogyny (Herzog, 2017)
Two recently published convenience sample reports provide
additional context about the topic of detransition. First, Turban
etal. (2021) analyzed data from the United States Trans Survey
(USTS) (James etal., 2016). The USTS contains data from
27,715 transgender and gender diverse adults from the U.S.
who were recruited through lesbian, gay, bisexual, transgender,
queer (LGBTQ), and allied organization outreach. The USTS
included the question, “Have you ever detransitioned? In other
words, have you ever gone back to living as your sex assigned
at birth, at least for a while?” with the multiple choice options
of “yes,” “no,” and “I have never transitioned.” For the 2,242
participants who answered “yes,” Turban etal. analyzed the
responses to the multiple choice question, “Why did you de-
transition? In other words, why did you go back to living as
your sex assigned at birth? (Mark all that apply).” Although
most of the offered answer options were about external pres-
sures to detransition (pressure from spouse or partner, pressure
from family, pressure from friends, pressure from employer,
discrimination, etc.), participants could write in additional rea-
sons that were not listed. Turban etal.’s sample included more
natal males (55.1%) than natal females (44.9%). Roughly half
(50.2%) had taken cross-sex hormones and 16.5% had obtained
surgery. The findings revealed that most (82.5%) of the sample
expressed at least one external factor for detransitioning and
15.9% expressed at least one internal factor (factors originat-
ing from self).
The second study by Vandenbussche (2021) recruited
detransitioners from online communities of detransitioners and
analyzed data for the participants who answered affirmatively
to the question, “Did you transition medically and/or socially
and then stopped?” The sample of 237 participants was pre-
dominantly natal female (92%), and from the U.S. (51%) and
Europe (32%). Most (65%) had transitioned both medically and
socially. Participants selected from multiple choice options to
indicate why they detransitioned with options covering a range
of experiences. Respondents also had the option to write in
additional reasons. Frequently endorsed reasons for detransition
included realizing that their gender dysphoria was related to
other issues (70%); health concerns (62%); observing that tran-
sition did not help their dysphoria (50%); and that they found
alternatives to deal with their dysphoria (45%). In contrast to
Turban etal. (2021), external factors such as lack of support,
financial concerns, and discrimination were less common (13%,
12%, and 10%, respectively). Many in the sample described that
when they detransitioned they lost support or were ostracized
from lesbian, gay, bisexual, and transgender (LGBT) communi-
ties, suggesting that many of the participants in Vandenbussche
(2021) would not have been reached by the recruitment efforts
of the USTS (James etal., 2016).
The objective of the current study was to describe a popula-
tion of individuals who experienced gender dysphoria, chose
to undergo medical and/or surgical transition and then detransi-
tioned by discontinuing medications, having surgery to reverse
the effects of transition, or both. In contrast to Turban etal.
(2021) and Vandenbussche (2021), this study focused only on
2 The debate about the terminologies used to describe an individual’s
sex (including “assigned sex at birth,” “biological sex,” “natal sex,”
“birth sex,” “sex,” etc.) is far from settled. Although some profession-
als have argued for the use of “assigned sex at birth,” others argue that
this terminology is misleading and not consistent with the events that
occur at birth and prior to birth (Bouman etal., 2017; Byng etal., 2018;
Dahlen, 2020; Griffin etal., 2020). Supporting the unsettled nature of
the discussion, I received conflicting comments from the reviewers of
this manuscript about my selection of natal sex terms–one reviewer
asked that I justify my preference for natal sex over the other termi-
nologies; another reviewer expressed support for my use of natal sex. I
prefer to use “natal sex” and “birth sex” because they are accurate and
objective. Further, I propose that “natal sex” and “birth sex” might be
seen as reasonable, polite compromise terms between “biological sex”
and “assigned sex at birth.”
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3355Archives of Sexual Behavior (2021) 50:3353–3369
1 3
individuals who transitioned and detransitioned medically, sur-
gically, or both. For the purpose of this study, medical transition
refers to the use of puberty blockers, cross-sex hormones, or
anti-androgens and surgical transition refers to any of a variety
of surgical procedures (common surgical procedures include
mastectomy, genital surgery, and breast augmentation). This
study does not describe the population of individuals who
undergo medical or surgical transition without issue nor is it
designed to assess the prevalence of detransition as an outcome
of transition. Instead, the goal was to identify detransition rea-
sons and narratives in order to inform clinical care and future
research.
Method
Participants andProcedure
During the recruitment period, 101 individuals who met the
study criteria completed online surveys. Inclusion criteria were
(1) completion of a survey via Survey Monkey; (2) answer-
ing that they had taken or had one or more of the following
for the purpose of gender transition: cross-sex hormones, anti-
androgens, puberty blockers, breast surgery, genital surgery,
other surgery; and (3) answering that they had done any of the
following for the purpose of detransitioning: stopped taking
cross-sex hormones, stopped taking anti-androgens, stopped
taking puberty blockers, had any surgery to reverse transition.
One survey was excluded for nonsense answers leaving 100
surveys for analysis. The sample included more natal females
(69.0%) than natal males (31.0%) with respondents who were
predominantly White (90.0%), non-Hispanic (98.0%), resided
in the U.S. (66.0%); had no religious affiliation (63.0%), and
support the rights of gay and lesbian couples to marry legally
(92.9%) (see Table1). At the time of survey completion, the
mean age of respondents was 29.2years (SD = 9.1) though natal
females were significantly younger (M = 25.8; SD = 5.0) than
natal males (M = 36.7; SD = 11.4), t(98) = − 6.56, p < .001.
Prior to transitioning, natal females were more likely to report
an exclusively homosexual sexual orientation and natal males
were more likely to report an exclusively heterosexual sexual
orientation.
A 115-question survey instrument with multiple choice,
Likert-type, and open-ended questions was created by the
author and two individuals who had personally detransitioned.
The author had met both detransitioners by way of introduc-
tions from colleagues. The author and both individuals who
had detransitioned created questions for the survey, provided
feedback, and revised the survey questions collaboratively
with a focus on content, clarity, and relevance to a variety of
transition and detransition experiences. The survey instrument
included two questions that were adapted from an online survey
of female detransitioners (Stella, 2016). Once completed, the
survey was uploaded onto Survey Monkey (SurveyMonkey,
Palo Alto, CA) via an account that was HIPAA-enabled.
Recruitment information with a link to the survey was posted
on blogs that covered detransition topics and shared in a pri-
vate online detransition forum, in a closed detransition Face-
book group, and on Tumblr, Twitter, and Reddit. Recruitment
information was also shared on the professional listservs for
the World Professional Association for Transgender Health,
the American Psychological Association Section44, and the
SEXNET listserv (which is a listserv of sex researchers and
clinicians) and the professionals on the listservs were asked
to share recruitment information with anyone they knew who
might be eligible. Efforts were made to reach out to communi-
ties with varied views about the use of medical and surgical
transition and recruitment information stated that participation
was sought from individuals regardless of whether their transi-
tion experiences were positive, negative or neutral. Potential
participants were invited to share recruitment information with
any potentially eligible person or community with potentially
eligible people. The survey was active from December 15, 2016
to April 30, 2017 (4.5months). The median time to complete a
survey was 49min; 50% of the surveys were completed between
32 and 71min. There were no incentives offered for participat-
ing. Data were collected anonymously, without IP addresses,
and stored securely with Survey Monkey.
Participation in this study was voluntary. Electronic con-
sent was obtained from all participants in the following man-
ner. The first page of the online survey informed respondents
about the research purpose, potential risks and benefits, that
participation was voluntary, and provided contact information
for the researcher. Survey questions were only displayed if the
participant clicked “agree” which indicated that they read the
information, voluntarily agreed to participate and were at least
18years of age.
Measures
Demographic andBaseline Characteristics
Information was collected about participant age, natal sex, race/
ethnicity, country of residence, educational attainment, socio-
economic status, religion, attitudes about legal marriage for
gay and lesbian couples, and where they first heard about the
study. The term sexual orientation in this article is intended to
refer to the natal sex of the participant and the natal sex of the
individuals with whom they are sexually attracted. Participants
were asked to select one or more labels for how they identified
their sexual orientation prior to transition with options inclu-
sive of participant sex (e.g., asexual female, bisexual female,
heterosexual female, etc.). These responses were coded to be
consistent with participant natal sex and were categorized into
homosexual, heterosexual, bisexual, pansexual, asexual, and
multiple. The multiple category included respondents who
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3356 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
Table 1 Demographic and
baseline characteristics
*May select more than one answer
a Natal females were more likely to express an exclusively homosexual sexual orientation prior to transition
(χ2 = 5.15. Thep-value is .023). Natal males were more likely to express an exclusively heterosexual sexual
Natal female N (%)
N = 69
Natal male N (%)
N = 31
Race/ethnicity*
White 62 (89.9%) 28 (90.3%)
Multiracial 6 (8.7%) 3 (9.7%)
Other 4 (5.8%) 0 (0%)
Asian 1 (1.4%) 1 (3.2%)
Hispanic 1 (1.4%) 1 (3.2%)
Black 0 (0%) 0 (0%)
Country of residence
USA 46 (66.7%) 20 (64.5%)
UK 8 (11.6%) 1 (3.2%)
Canada 5 (7.2%) 4 (12.9%)
Australia 2 (2.9%) 2 (6.5%)
Other 8 (11.6%) 4 (12.9%)
Education
Bachelor’s or graduate degree 29 (42.0%) 18 (58.1%)
Associates degree 3 (4.3%) 1 (3.2%)
Some college but no degree 28 (40.6%) 9 (29.0%)
High school graduate or GED 8 (11.6%) 2 (6.5%)
< High school 1 (1.4%) 0 (0%)
Other 0 (0%) 1 (3.2%)
Socioeconomic status compared to others in country of residence
Above average (somewhat or very much) 19 (27.5%) 12 (38.7%)
About average 20 (29.0%) 7 (22.6%)
Below average (somewhat or very much) 27 (39.1%) 12 (38.7%)
Prefer not to say 3 (4.3%) 0 (0%)
Categorized sexual orientation (by natal sex) prior to transitiona
Homosexual 18 (26.1%) 2 (6.5%)
Heterosexual 6 (8.7%) 12 (38.7%)
Bisexual 15 (21.7%) 8 (25.8%)
Pansexual 4 (5.8%) 1 (3.2%)
Multiple 20 (29.0%) 5 (16.1%)
Asexual 6 (8.7%) 3 (9.7%)
Religious affiliation
No religious affiliation 41 (59.4%) 22 (73.3%)
Liberal Christian 5 (7.2%) 3 (10.0%)
Liberal Jewish 5 (7.2%) 0 (0%)
Conservative Christian 1 (1.4%) 2 (6.7%)
Liberal Muslim 1 (1.4%) 0 (0%)
Conservative Jewish 0 (0%) 0 (0%)
Conservative Muslim 0 (0%) 0 (0%)
Other 16 (23.2%) 3 (10.0%)
Legal marriage for gay and lesbian couples
Favor 65 (97.0%) 26 (83.9%)
Oppose 1 (1.5%) 5 (16.1%)
Don’t know 1 (1.5%) 0 (0%)
Source where participant first heard about study
Detransition blogs 26 (37.7%) 15 (48.4%)
Other social media 37 (53.6%) 11 (35.5%)
A person they know 3 (4.3%) 3 (9.7%)
Other 3 (4.3%) 2 (6.5%)
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3357Archives of Sexual Behavior (2021) 50:3353–3369
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selected more than one response where responses indicated
more than one pattern of sexual attraction (e.g., lesbian female
and heterosexual female). Other questions about baseline
characteristics included questions about diagnosed psychi-
atric disorders and neurodevelopmental disabilities, trauma,
and non-suicidal self-injury (NSSI) before the onset of gender
dysphoria.
Gender Dysphoria Onset andTypologies
Participants were asked how old they were when they first expe-
rienced gender dysphoria and whether this was during child-
hood, at the onset of puberty, during puberty, or later. Respond-
ents were categorized as having early-onset gender dysphoria if
they indicated that their gender dysphoria began “during child-
hood” and late-onset gender dysphoria if their gender dysphoria
began “at the onset of puberty” or later. To evaluate typologies,
participants were characterized by Blanchard’s (1985, 1989)
typology as homosexual (if the sexual orientations listed prior
to transition were exclusively homosexual) or non-homosexual
which includes heterosexual, asexual, bisexual, pansexual, and
multiple responses.
Transition
Participants were asked for their age and the year that they
first sought care to transition, sources that encouraged them to
believe that transition would be helpful to them, and whether
they felt pressured to transition. The friendship group dynamics
that were identified in previous work were assessed by asking
respondents whether their friendship group mocked people
who were not transgender, whether people in their pre-existing
friend group transitioned before the participant decided to tran-
sition, and how participant popularity changed after announc-
ing that they would transition (Littman, 2018). Questions were
asked about participant experiences with clinicians, the social,
medical, and surgical steps they took to transition, and the dura-
tion of time spent taking each medication.
Detransition
Participants were asked for their age and the year that they
decided to detransition, how long they were transitioned
before deciding to detransition, their reasons for wanting to
detransition, what sources encouraged them to believe that
detransition would be helpful to them, and whether they felt
pressured to detransition. Participants were also asked which
social, medical, and surgical steps they took to detransition and
whether they contacted the doctor or clinic that they used for
their transition to tell them that they detransitioned.
Transition andDetransition Narratives
In this article, “narratives” denote participant interpretations of
their experiences and rationales surrounding their decisions to
transition and detransition. To associate each participant sur-
vey with a set of relevant narratives, the data were reviewed
with horizontal (beginning to end) passes and vertical passes
for selected questions (these questions are listed in the sup-
plemental materials). Surveys were coded as belonging to zero
or more of the following narrative categories: discrimination,
nonbinary, retransition, trauma and mental health, internalized
homophobia, social influence, and misogyny. Each narrative
and the responses that were associated with them are detailed
below. Example quotes were selected with care taken to avoid
quoting a participant more than once per narrative. Narratives
are ordered and reported with the more commonly accepted
narratives first and the newer narratives next.
The discrimination narrative was defined as when some-
one detransitioned due to experiencing discrimination or
external social pressures. The nonbinary narrative consisted
of answering that their current identification was “nonbinary/
genderqueer” or providing open-text responses that described
aspects of discovering or maintaining a nonbinary identifica-
tion. Although there were no questions in the survey specifi-
cally asking about retransition, the retransition narrative was
identified if participants expressed that they had retransitioned
or resumed transition in any of the open-text responses in the
survey. The gender dysphoria was caused by trauma or a men-
tal health condition narrative was identified by selection for the
answers, “what I thought were feelings of being transgender
were actually the result of trauma,” “what I thought were feel-
ings of being transgender were actually the result of a mental
health condition,” “I discovered that my gender dysphoria was
caused by something specific (ex. trauma, abuse, mental health
condition)” or open-text responses consistent with these rea-
sons. The internalized homophobia/difficulty accepting oneself
as a lesbian female, gay male, or bisexual person narrative
consisted of descriptions that the respondents’ discomfort and
distress about being lesbian, gay, or bisexual was related to
their gender dysphoria, transition, or detransition, or that they
assumed they were transgender because they did not yet under-
stand themselves to be lesbian, gay or bisexual. The social pres-
sure to transition narrative was identified with an affirmative
orientation prior to transition (χ2 = 13.05. The p value is < .001). Natal sex differences were not significant
for individuals expressing pre-transition sexual orientations of bisexual, pansexual, multiple, and asexual.
For bisexual sexual orientation, χ2 = 0.20. For pansexual sexual orientation, χ2 = 0.29. For multiple sexual
orientations reported, χ2 = 1.88. For asexual sexual orientation, χ2 = 0.02
Table 1 (continued)
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3358 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
answer to whether they felt pressured to transition with an open-
text response indicating that the pressure came from a person
or group of people. The misogyny narrative was identified for
natal female respondents with open-text responses using the
word “misogyny” or expressing a hatred of femaleness.
Gender Identification atStart ofTransition andatSurvey
Completion
Participants were asked how they identified their gender when
they started their transition and at the time of survey comple-
tion. They were given options of female, male, nonbinary/
genderqueer, trans man/FTM, trans woman/MTF, none of
the above, and other. Responses were coded by natal sex and
categorized as transgender, birth sex, nonbinary, and other.
Answers that were combinations of the above categories were
reported as combinations such as “birth sex and nonbinary.”
Self‑Appraisal ofTransition andDetransition
One question asked if participants believe they were helped and
another if they were harmed by their transition with options
of “very much,” “a little,” or “not at all.” These results were
categorized into exclusively helped, exclusively harmed, and
both helped and harmed. Participants were asked which of
the following reflected their feelings about their transition: “I
am glad that I transitioned,” “I wish I had never transitioned,”
“Transitioning distracted me from what I should have been
doing,” “Transition was a necessary part of my journey.” Par-
ticipants were asked to rate their regret about their transition
(“no regrets,” “mild regrets,” “strong regrets,” and “very strong
regrets”) and were asked to indicate their satisfaction with their
decisions to transition and detransition (“extremely satisfied,”
“very satisfied,” “somewhat satisfied,” “somewhat dissatisfied,”
“very dissatisfied,” and “extremely dissatisfied”). Satisfaction
options were collapsed into “satisfied” and “dissatisfied.” In
addition, participants were asked if they knew then what they
know now, would they have chosen to transition.
Data Analysis
After data were cleaned, statistical analyses were performed
using google sheets. Results are presented as frequencies,
percentages, medians, means and standard deviations. t tests
and chi-square tests were performed for selected variables and
were considered significant for p < .05. Qualitative data were
obtained from the open-text answers to questions that allowed
participants to provide additional information. Selected open-
text responses were categorized, tallied, and reported numeri-
cally. Salient respondent quotes and summaries from the quali-
tative data were selected to illustrate the quantitative results and
to provide relevant examples.
Results
Before Transition
Mental health diagnoses and traumatic experiences before the
onset of gender dysphoria. Table2 shows data about psychiatric
disorders, neurodevelopmental disabilities, NSSI, and trauma
that were reported as occurring prior to the onset of gender
dysphoria. Because these conditions and events occurred before
participants began to feel gender dysphoric, they cannot be con-
sidered to be secondary to gender incongruence or transphobia.
Gender dysphoria onset and typology. Most participants
(82.0%) were living with one or both parents when they first
experienced gender dysphoria at a mean age of 11.2years
(SD = 5.6). The mean age of gender dysphoria onset was
not statistically different between natal females (M = 11.3;
SD = 5.4) and natal males (M = 11.0; SD = 5.9), t(96) = 0.25.
By Blanchard typologies, 26.1% of natal females were exclu-
sively homosexual and 73.9% non-homosexual while 6.5%
of natal males were exclusively homosexual and 93.5% non-
homosexual (Blanchard, 1985, 1989). Slightly more than half
of the respondents (56.0%) experienced early-onset gender
dysphoria and slightly less than half (44.0%) experienced late-
onset gender dysphoria. Although late-onset gender dysphoria
in natal females was largely absent from the scientific literature
prior to 2012 (Steensma etal., 2013; Zucker & Bradley, 1995;
Zucker etal., 2012a), 55.1% of the natal female participants
reported that their gender dysphoria began with puberty or later.
Because the information about the timing of gender dysphoria
onset was obtained from participants reporting on their own
experiences, it can be assumed that these cases were indeed
late-onset rather than early-onset gender dysphoria that was
concealed from parents and other people.
Transition reasons. Table3 shows data about the reasons
that individuals wanted to transition and the most frequently
endorsed were: wanting to be perceived as the target gender
(77.0%); believing that transitioning was their only option to
feel better (71.0%); the sensation that their body felt wrong the
way it was (71.0%), and not wanting to be associated with their
natal sex (70.0%). Most participants believed that transition-
ing would eliminate (65.0%) or decrease (63.0%) their gender
dysphoria and that with transitioning they would become their
true selves (64.0%).
Sources of transition encouragement and friend group
dynamics. Participants identified sources that encouraged them
to believe transitioning would help them. Social media and
online communities were the most frequently reported, includ-
ing YouTube transition videos (48.0%), blogs (46.0%), Tumblr
(45.0%), and online communities (43.0%) (see supplemental
materials). Also common were people who the respondents
knew offline such as therapists (37.0%); someone (28.0%) or a
group of friends (27.0%) that they knew in-person. A subset of
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3359Archives of Sexual Behavior (2021) 50:3353–3369
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Table 2 Mental health
diagnoses and traumatic
experiences prior to the onset of
gender dysphoria
*May select more than one answer
a Natal sex difference for one or more pre-existing diagnoses (100-none of the above) was not significant
[χ2(1, 100) = 1.76]
b Natal sex differences for NSSI before the onset of gender dysphoria was not significant (χ2 = 1.52)
c Experiencing a trauma less than one year before the start of gender dysphoria was statistically different
[χ2(1, 100) = 11.19, p < .001] with natal females > natal males
Natal female N (%)
N = 69
Natal male N (%)
N = 31
Diagnosed with a mental illness or neurodevelopmental disability*a
Depression 27 (39.1%) 5 (16.1%)
Anxiety 22 (31.9%) 5 (16.1%)
Attention deficit hyperactivity disorder (ADHD) 10 (14.5%) 2 (6.5%)
Post-traumatic stress disorder (PTSD) 10 (14.5%) 1 (3.2%)
Eating disorders 10 (14.5%) 0 (0%)
Autism spectrum disorders 9 (13.0%) 1 (3.2%)
Bipolar disorder 9 (13.0%) 0 (0%)
Obsessive compulsive disorder 6 (8.7%) 3 (9.7%)
Borderline personality disorder 5 (7.2%) 0 (0%)
Schizophrenia or other psychotic disorders 1 (1.4%) 0 (0%)
None of the above 28 (40.6%) 17 (54.8%)
Other 7 (10.1%) 2 (6.5%)
Non-suicidal self-injury (NSSI)b
Engaged in NSSI before the onset of gender dysphoria 19 (27.5%) 5 (16.1%)
Traumac
Experienced a trauma less than one year before the start
of gender dysphoria
33 (47.8%) 4 (12.9%)
Table 3 Transition reasons
*May select more than one answer
Natal female N (%)
N = 69
Natal male N (%)
N = 31
Reasons for transition*
I wanted others to perceive me as the target gender 53 (76.8%) 24 (77.4%)
I thought transitioning was my only option to feel better 50 (72.5%) 21 (67.7%)
My body felt wrong to me the way it was 50 (72.5%) 21 (67.7%)
I didn’t want to be associated with my natal sex/natal gender 51 (73.9%) 19 (61.3%)
It made me uncomfortable to be perceived romantically/sexually as a member of
my natal sex/natal gender
49 (71.0%) 18 (58.1%)
I thought transitioning would eliminate my gender dysphoria 43 (62.3%) 22 (71.0%)
I felt I would become my true self 42 (60.9%) 22 (71.0%)
I identified with the target gender 40 (58.0%) 24 (77.4%)
I thought transitioning would lessen my gender dysphoria 45 (65.2%) 18 (58.1%)
I felt I would fit in better with the target gender 36 (56.5%) 20 (64.5%)
I felt I would be more socially acceptable as a member of the target gender 38 (55.1%) 11 (35.5%)
I felt I would be treated better if I was perceived as the target gender 35 (50.7%) 14 (45.2%)
I saw myself as a member of the target gender 31 (44.9%) 18 (58.1%)
I thought transitioning would reduce gender-related harassment or trauma
I was experiencing
35 (50.7%) 5 (16.1%)
I had erotic reasons for wanting to transition 9 (13.0) 12 (38.7%)
Other 9 (13.0%) 3 (9.7%)
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3360 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
participants experienced the friendship group dynamics identi-
fied in previous work, including belonging to a friendship group
that mocked people who were not transgender (22.2%), having
one or more friend from the pre-existing friend group transi-
tion before the participant decided to transition (36.4%), and
experiencing an increase in popularity after announcing plans
to transition (19.6%) (Littman, 2018). Most did not have this
experience (68.7%, 61.6%, and 62.9%, respectively).
Pressure to transition. More than a third of the participants
(37.4%) felt pressured to transition. Natal sex differences in
feeling pressured to transition were significant by chi-square
test with natal females > natal males χ2(1, 99) = 4.22, p = .04.
Twenty-eight participants provided open-text responses of
which 24 described sources of pressure (17 described social
pressures and 7 described sources that were not associated with
other people). Clinicians, partners, friends, and society were
named as sources that applied pressure to transition, as seen in
the following quotes: “My gender therapist acted like it [tran-
sition] was a panacea for everything;” “[My] [d]octor pushed
drugs and surgery at every visit;” “I was dating a trans woman
and she framed our relationship in a way that was contingent on
my being trans;” “A couple of later trans friends kept insisting
that I needed to stop delaying things;” “[My] best friend told me
repeatedly that it [transition] was best for me;” “The forums and
communities and internet friends;” “By the whole of society
telling me I was wrong as a lesbian;” and “Everyone says that
if you feel like a different gender…then you just are that gender
and you should transition.” Participants also felt pressure to
transition that did not involve other people as illustrated by the
following: “I felt pressured by my inability to function with
dysphoria” and “Not by people. By my life circumstances.”
Experiences with clinicians. When participants first sought
care for their gender dysphoria or desire to transition, more than
half of the participants (53.0%) saw a psychiatrist or psycholo-
gist; about a third saw a primary care doctor (34.0%) or a coun-
selor (including licensed clinician social worker, licensed pro-
fessional counselor, or marriage and family therapist) (32.0%);
and 17.0% saw an endocrinologist. For transition, 45.0% of
participants went to a gender clinic (44.4% of those attending a
gender clinic specified that the gender clinic used the informed
consent model of care); 28.0% went to a private doctor’s office;
26.0% went to a group practice; and 13.0% went to a mental
health clinic (see supplemental materials).
The majority (56.7%) of participants felt that the evalua-
tion they received by a doctor or mental health professional
prior to transition was not adequate and 65.3% reported that
their clinicians did not evaluate whether their desire to transi-
tion was secondary to trauma or a mental health condition.
Although 27.0% believed that the counseling and information
they received prior to transition was accurate about benefits
and risks, nearly half reported that the counseling was overly
positive about the benefits of transition (46.0%) and not nega-
tive enough about the risks (26.0%). In contrast, only a small
minority found the counseling not positive enough about ben-
efits (5.0%) or too negative about risks (6.0%) suggesting a bias
toward encouraging transition.
Transition
Participants were on average 21.9years old (SD = 6.1) when
they sought medical care to transition with natal females seek-
ing care at younger ages (M = 20.0; SD = 4.2) than natal males
(M = 26.0; SD = 7.5), t(97) = − 5.07, p < .001. Given that the
majority of natal males were categorized as Blanchard typology
non-homosexual, the finding that natal males sought medical
care to transition at older ages than natal females is concord-
ant with previous research (Blanchard etal., 1987). The aver-
age year for seeking care was more recent for natal females
(M = 2011; SD = 3.8) than natal males (M = 2007; SD = 6.9),
t(96) = 2.78, p = .007, and thus, there may have been differ-
ences in the care they received due to differences in the culture
surrounding transition and the prevailing medical approaches
to gender dysphoria for the time.
At the start of transitioning, nearly all (98.0%) of the par-
ticipants identified as either transgender (80.0%), nonbinary
(15.0%), or both transgender and nonbinary (3.0%). Partici-
pants identified which social, medical, and surgical steps they
had taken to transition. Table4 shows these steps, separated by
natal sex where appropriate. Most respondents adopted new
pronouns (91.0%) and names (88.0%), and the vast major-
ity (97.1%) of natal females wore a binder. Most participants
took cross-sex hormones (96.0%) and most natal males took
anti-androgens (87.1%). The most frequent transition surgery
was breast or chest surgery for natal females (33.3%). Genital
surgery was less common (1.4% of natal females and 16.1%
of natal males). Natal females took testosterone for a mean
duration of 2.0years (SD = 1.6). Natal males took estrogen for
a mean duration of 5.1years (SD = 5.9) and anti-androgens
for 2.8years (SD = 2.6). The minority of patients who took
puberty blockers took them for a mean duration of less than a
year (M = 0.9years; SD = 0.6).
Detransition
Before deciding to detransition, participants remained transi-
tioned for a mean duration of 3.9years (SD = 4.1) with natal
females remaining transitioned for a shorter period of time
(M = 3.2years; SD = 2.7) than natal males (M = 5.4years;
SD = 6.1), t(96) = − 2.40, p = .018. When participants decided
to detransition they were a mean age of 26.4years old (SD = 7.4)
though natal females were significantly younger (M = 23.6;
SD = 4.5) than natal males (M = 32.7; SD = 8.8), t(97) = − 6.75,
p < .001. The mean calendar year when participants decided to
detransition was 2014 (M = 2014; SD = 3.3), but the difference
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3361Archives of Sexual Behavior (2021) 50:3353–3369
1 3
between natal females and natal males was not significant
(M = 2014, SD = 3.3; M = 2014, SD = 3.5), t(95) = 0.52.
Respondents detransitioned for a variety of reasons and most
(87.0%) selected more than one reason. The most frequently
endorsed reason for detransitioning was that the respond-
ent’s personal definition of male and female changed and they
became comfortable identifying with their natal sex (60.0%)
(see Table5). Other commonly endorsed reasons were concerns
about potential medical complications (49.0%); transition did
not improve their mental health (42.0%); dissatisfaction with
the physical results of transition (40.0%); and discovering that
something specific like trauma or a mental health condition
caused their gender dysphoria (38.0%). External pressures
to detransition such as experiencing discrimination (23.0%)
or worrying about paying for treatments (17.0%) were less
common.
Encouragement and pressure to detransition. Participants
were asked to select sources that encouraged them to believe
that detransitioning would help them. These included blogs
(37.0%), Tumblr (35.0%), and YouTube detransition videos
(23.0%) (see supplemental materials). At some point in their
process, 23.2% felt pressured to detransition. There was no sig-
nificant difference between natal females and natal males for
feeling pressured to detransition, χ2(1, 99) = 1.11. Of the 21
open-text responses provided, 14 respondents expressed social
pressure to detransition; three expressed internal pressure to
detransition and four provided responses that were neither
Table 4 Steps taken for social, medical, and surgical transition
*May select more than one answer
N (%)
Social transition*
Pronouns 91 (91.0%)
Different name 88 (88.0%)
Clothes/hair/makeup 90 (90.0%)
Legal name change 49 (49.0%)
Gender/sex changed on government documents 36 (36.0%)
Voice training 20 (20.0%)
Natal female
Wore a binder 67 (97.1%)
Medical transition*
Cross-sex hormones 96 (96.0%)
Puberty blockers 7 (7.0%)
Natal male
Anti-androgens 27 (87.1%)
Surgical transition*
Face/neck surgery 5 (5.0%)
Natal female
Breast/chest surgery 23 (33.3%)
Genital surgery (to create a penis) 1 (1.4%)
Natal male
Breast implants 5 (16.1%)
Genital surgery (to create a vagina) 5 (16.1%)
Table 5 Reasons for detransitioning
*May select more than one answer
Natal female N (%)
N = 69
Natal male N (%)
N = 31
Reasons for detransitioning*
My personal definition of female or male changed and I became more comfortable
identifying as my natal sex
45 (65.2%) 15 (48.4%)
I was concerned about potential medical complications from transitioning 40 (58.0%) 9 (29.0%)
My mental health did not improve while transitioning 31 (44.9%) 11 (35.5%)
I was dissatisfied by the physical results of the transition/felt the change was too much 35 (50.7%) 5 (16.1%)
I discovered that my gender dysphoria was caused by something specific (ex, trauma,
abuse, mental health condition)
28 (40.6%) 10 (32.3%)
My mental health was worse while transitioning 27 (39.1%) 9 (29.0%)
I was dissatisfied by the physical results of the transition/felt the change was not enough 22 (31.9%) 11 (35.5%)
I found more effective ways to help my gender dysphoria 25 (36.2%) 7 (22.6%)
My physical health was worse while transitioning 21 (30.4%) 11 (35.5%)
I felt discriminated against 12 (17.4%) 11 (35.5%)
I had medical complications from transitioning 12 (17.4%) 7 (22.6%)
Financial concerns about paying for transition care 11 (15.9%) 6 (19.4%)
My gender dysphoria resolved 10 (14.5%) 5 (16.1%)
My physical health did not improve while transitioning 9 (13.0%) 2 (6.5%)
I resolved the specific issue that was the cause of my gender dysphoria 6 (8.7%) 4 (12.9%)
I realized that my desire to transition was erotically motivated 1 (1.4%) 5(16.1%)
Other 19 (27.5%) 6 (19.4%)
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3362 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
or unclear. Regarding social pressure to detransition, seven
participants expressed that the pressure came from partners,
parents, or other family members as shown in the following
example quotes: “I was threatened that if I did not immediately
detransition I would NEVER see my […] children again,” “My
father very much wanted me to desist,” and “Parents constantly
encouraging me to detransition.” Five participants expressed
societal pressure to detransition as expressed in the following
quotes: “I did not pass, I was mocked in public, I could not get
a job. It was not ok to be trans” and “Well, I mean basically the
entire world was against me transitioning, so yeah.” One par-
ticipant felt pressured by doctors and another one from a blog.
Detransition steps. Table6 shows data about the social, med-
ical, and surgical steps participants took to detransition. Nearly
all participants medically detransitioned by ceasing cross-sex
hormones (95.0%). Social detransition steps were also common
and included returning to the use of previously used pronouns
(63.0%) and birth names (33.0%) and changing one’s clothes
and hair presentations (48.0%). Surgical detransition steps were
less common (9.0%).
Finding better ways of coping with gender dysphoria. Partic-
ipants were asked to select responses that that they considered
to have been better ways for them to cope with their gender dys-
phoria. Responses included community (44.0%), mindfulness/
meditation (41.0%), exercise (39.0%), therapy (24.0%), trauma
work (24.0%), medication to treat a mental health condition
(18.0%), and yoga (14.0%).
Transition andDetransition Narratives
Several transition and detransition narratives emerged from the
data. A sizable minority of participants (41.0%) expressed more
than one narrative in their responses.
The discrimination and external pressures to detransition
narrative was described by 29.0% of participants. Examples
include: “I had to detransition in order to get a job”; “I was
afraid of being homeless and unable to support myself”; “I felt
much happier with myself but I couldn’t go anywhere without
being afraid. I passed okay but not perfectly. I was stared down
and sneered at in the women’s clothes section, I wouldn’t dare
use a public toilet because I’d find either violent men or women
who wished an encounter with a violent man on me.”
A nonbinary narrative was expressed by 16.0% of partici-
pants. Some described that they discovered their nonbinary
gender identity during their transition, as in the following
quotes: “I still was uncomfortable with my body and figured I
should stop and make sure I really wanted to keep going. I didn’t
and I decided I must be nonbinary, not FTM”; “Transitioning
didn’t do what I thought I wanted it to. I had transitioned to the
wrong gender. I still felt wrong. Then, I realized I was not male,
but genderqueer. I detransitioned to suit my true identity.” And
others described a consistent nonbinary identification, as in the
following quote, “I identified the same way that I did before.
I had gotten what I wanted out of HRT and was ready to stop
taking it.” (Cross-sex hormones are sometimes referred to as
“hormone replacement therapy” and abbreviated as HRT).
Three participants (3.0%) expressed the retransition nar-
rative in open-text answers indicating that they had retransi-
tioned, including the following quotes: “I am now transitioning
for a second time”; I retransitioned after 5years of detransi-
tioning”; and “Anyway, I retransitioned over 10years after
detransitioning.”
Most participants (58.0%) expressed the gender dysphoria
was caused by trauma or a mental health condition narrative
which included endorsing the response options indicating that
their gender dysphoria was caused by something specific, such
as a trauma or a mental health condition. More than half of
the participants (51.2%) responded that they believe that the
process of transitioning delayed or prevented them from deal-
ing with or being treated for trauma or a mental health condi-
tion. The following are example quotes that were in response
to why participants chose to detransition: “I slowly began
addressing the mental health conditions and traumatic experi-
ences that caused such a severe disconnect between myself and
my body…”; “I was starting to become critical of transition
because I felt that many people were doing it out of self-hatred
and started to realize that applied to me as well”; “I was deeply
uncomfortable with my secondary sex characteristics, which I
now understand was a result of childhood trauma and associat-
ing my secondary sex characteristics with those events.”
Despite the absence of any questions about this topic in the
survey, nearly a quarter (23.0%) of the participants expressed
the internalized homophobia and difficulty accepting oneself
as lesbian, gay, or bisexual narrative by spontaneously describ-
ing that these experiences were instrumental to their gender
dysphoria, their desire to transition, and their detransition. All
Table 6 Social, medical, and surgical detransition steps
*May select more than one answer
N (%)
Social detransition*
Previous pronouns 63 (63.0%)
Clothes/hair/makeup 48 (48.0%)
Birth name 33 (33.0%)
New name (not birth name) 24 (24.0%)
None of the above 2 (2.0%)
Medical detransition*
Stopped cross-sex hormones 95 (95.0%)
Stopped puberty blockers 4 (4.0%)
Started hormones consistent with natal sex 14 (14.0%)
Natal male
Stopped anti-androgens 17 (54.8%)
Surgical detransition*
Surgery to reverse changes from transition 9 (9.0%)
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3363Archives of Sexual Behavior (2021) 50:3353–3369
1 3
of the participants in this category indicated that they were
either same-sex attracted exclusively or were same-sex attracted
in combination with opposite-sex attraction (such as bisexual,
pansexual, etc.). The following responses were written in as
“other” for the question about why participants transitioned:
“Transitioning to male would mean my attraction to girls would
be ‘normal’”; “being a ‘gay trans man’ (female dating other
females) felt better than being a lesbian, less shameful”; “I felt
being the opposite gender would make my repressed same-sex
attraction less scary”; “I didn’t want to be a gay man.” Some par-
ticipants described that it took time for them to gain an under-
standing of themselves as lesbian, gay, or bisexual as seen in
the following: “At the time I was trying to figure out my identity
and felt very male and thought I was transgender. I later discov-
ered that I was a lesbian…”; and “Well, after deep discovery, I
realized I was a gay man and realized that a sexual trauma after
puberty might [have] confused my thought. I wanted to live as
a gay man again.” Several natal female respondents expressed
that seeing other butch lesbians would have been helpful to
them as shown by the following: “What would have helped me
is being able to access women’s community, specifically lesbian
community. I needed access to diverse female role-models and
mentors, especially other butch women.”
The social influence narrative was identified where par-
ticipants added information to the question about if they had
felt pressured to transition and the response described pres-
sure from a person or people. One-fifth (20.0%) of participants
expressed that they felt pressured by a person or people to tran-
sition. Example quotes for social influence were described in
a previous section.
Of the natal females, 7.2% expressed the misogyny narra-
tive. Example quotes include: “…I realized how much of it
[dysphoria] may have been caused by internalized misogyny
and homophobia”; “Finally realizing there’s nothing wrong or
disgusting or weak about being female”; and “My transition
was a desperate attempt to distance myself from womanhood
and femaleness due to internalized lesbophobia and misogyny
combined with a history of sexual trauma.”
After Detransition
Disposition. At the time of survey completion, most par-
ticipants had returned to identifying solely as their birth sex
(61.0%) with an additional 10.0% identifying as their birth sex
plus another identification. Fourteen percent of the participants
identified solely as nonbinary with an additional 11.0% iden-
tifying as nonbinary plus a second identification. Eight per-
cent of the participants identified solely as transgender with
an additional 5.0% identifying as transgender plus another
identification. Four percent of the responses did not fit into the
above categories and were coded as “other.” Figure1 illustrates
the distribution of participants’ current gender identification
(post-detransition). Only 24.0% of participants had informed
the doctor or clinic that facilitated their transitions that they
had detransitioned.
Self-appraisal of past transgender identification. Table7 pre-
sents the data for responses endorsed by participants to reflect
how they feel currently about having identified as transgender
in the past. The statements most frequently selected included:
“I thought gender dysphoria was the best explanation for what I
was feeling” (57.0%), “My gender dysphoria was similar to the
gender dysphoria of those who remain transitioned” (42.0%),
“What I thought were feelings of being transgender actually
were the result of trauma” (36.0%), “What I thought were feel-
ings of being transgender actually were the result of a mental
health condition” (36.0%).
Self-appraisal of transition and detransition. When asked to
select which statement best reflects their feelings about their
transition, nearly a third (30.0%) indicated that they wish they
had never transitioned while 11.0% indicated they were glad
they transitioned. Some (34.0%) selected the statement that
transition “was a necessary part of [their] journey” but others
(21.0%) indicated that the process of transitioning distracted
them from what they should have been doing. Responses about
whether transition helped or harmed them were also compli-
cated. While 50.5% selected answers consistent with being
both helped and harmed, 32.3% indicated that they were only
harmed and 17.2% indicated that they were only helped. The
majority of respondents were dissatisfied with their decision to
transition (69.7%) and satisfied with their decision to detransi-
tion (84.7%). At least some amount of transition regret was
Fig. 1 Distribution of participants’ current gender identification (after
detransition) (n = 100). Notes: The sum of the numbers appearing
in the “Birth Sex” circle indicates the number of participants who
returned to identifying with their birth sex (71)—either as birth sex
alone (61) or birth sex in addition to a second identification (10) rep-
resented in the overlap between two circles. For example, eight par-
ticipants identify as their birth sex and as nonbinary. The sum of the
numbers appearing in the “Nonbinary” circle indicates the number
of participants who identify as nonbinary (25)—either as nonbinary
alone (14) or nonbinary in addition to a second identification (11).
The sum of the numbers appearing in the “Transgender” circle indi-
cates the number of participants who identify as transgender (13)—
either as transgender alone (8) or transgender in addition to a second
identification (5). Four participants had responses that did not fit the
categories above and were coded as “other”
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3364 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
common (79.8%) and nearly half (49.5%) reported strong or
very strong regret. Most respondents (64.6%) indicated that
if they knew then what they know now, they would not have
chosen to transition.
Discussion
This study was designed to explore the experiences of individu-
als who obtained medical and surgical treatment for gender
dysphoria and then detransitioned by discontinuing the medica-
tions or having surgery to reverse the changes from transition.
The findings of this study, however, should not be assumed to be
representative of all individuals who detransition. Although this
study further documents that detransitioners exist, the preva-
lence of detransition as an outcome of transition is unknown.
Only a small percentage of detransitioners (24.0%) informed
the clinicians and clinics that facilitated their transitions that
they had detransitioned. Therefore, clinic rates of detransition
are likely to be underestimated and gender transition special-
ists may be unaware of how many of their own patients have
detransitioned, particularly for patients who are no longer under
their care.
This research demonstrates that the experiences of individu-
als who detransition are varied and the reasons for detransition
are complex. Nearly all participants identified as transgender or
nonbinary at the start of their transition and most sought transi-
tion because they did not want to be associated with their natal
sex, their bodies felt wrong the way they were, and they believed
that transition was the only option to relieve their distress. Some
were helped by transition and only detransitioned because they
were pressured to do so by people in their lives, society, or
because they had medical complications. Some were harmed
by transition and detransitioned because they concluded that
their gender dysphoria was caused by trauma, a mental health
condition, internalized homophobia, or misogyny—conditions
that are not likely to be resolved with transition. These findings
highlight the complexity of gender dysphoria and suggest that,
in some cases, failure to explore co-morbidities and the context
in which the gender dysphoria emerged can lead to misdiag-
nosis, missed diagnoses, and inappropriate gender transition.
Some individuals detransitioned because their gender dyspho-
ria resolved, because they found better ways to address their
symptoms, or because their personal definitions of male and
female changed and they became comfortable identifying as
their natal sex.
The study sample was predominantly young natal females,
many of whom experienced late-onset gender dysphoria which
mirrors the recent, striking changes in the demographics of gen-
der dysphoric youth seeking care as well as the youth described
by their parents in Littman (2018) (see also Aitken etal., 2015;
de Graaf etal., 2018; Zucker, 2019). Concerns have been raised
that this new cohort of gender dysphoric individuals is unlike
previous cohorts. Professionals have started to call for caution
before treating this cohort with interventions with permanent
effects because the etiologies, desistance and persistence rates,
Table 7 Self-appraisal of past transgender identification
*May select more than one answer
Natal female N (%)
N = 69
Natal male N (%)
N = 31
Self-appraisal about identifying as transgender in the past*
I thought gender dysphoria was the best explanation for what I was feeling 39 (56.5%) 18 (58.1%)
My gender dysphoria was similar to the gender dysphoria of those who remain transitioned 32 (46.4%) 10 (32.3%)
What I thought were feelings of being transgender actually were the result of trauma 31 (44.9%) 5 (16.1%)
What I thought were feelings of being transgender actually were the result
of a mental health condition
28 (40.6%) 8 (25.8%)
Someone else told me that the feelings I was having meant that I was transgender
and I believed them
25 (36.2%) 10 (32.3%)
I still identify as transgender 20 (29.0%) 10 (32.3%)
I believed I was transgender then, but I was mistaken 16 (23.2%) 6 (19.4%)
I was transgender then but I am not transgender now 15 (21.7%) 7 (22.6%)
I formerly identified as transgender and now identify as genderqueer/nonbinary 12 (17.4%) 5 (16.1)
My gender dysphoria was different from the gender dysphoria of those who remain transitioned 11 (15.9%) 4 (12.9%)
I was never transgender 8 (11.6%) 3 (9.7%)
I thought I had gender dysphoria but I was mistaken 4 (5.8%) 4 (12.9%)
I never had gender dysphoria 1 (1.4) 2 (6.5%)
N/A as I did not identify as transgender in the past 0 (0%) 1 (3.2%)
Other 18 (26.1%) 5 (16.1%)
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3365Archives of Sexual Behavior (2021) 50:3353–3369
1 3
expected duration of symptoms, and whether this new popula-
tion is helped or harmed by gender transition is still unknown
(D’Angelo etal., 2021; Kaltiala-Heino etal., 2018). The natal
females and natal males in this sample differed on several
dimensions, including that natal females were younger than
natal males when they sought transition, when they decided
to detransition, and at the time of survey completion. Natal
females were more likely than natal males to have experienced
a trauma less than one year before the onset of their gender dys-
phoria and were more likely to have felt pressured to transition.
Compared to natal males, natal females remained transitioned
for a shorter duration of time before deciding to detransition.
Additionally, natal females transitioned more recently than
natal males, so their experiences may vary due to changing
trends in the clinical management of gender dysphoria and the
cultural settings in which they became gender dysphoric.
The study findings covered a wide range of detransition
experiences that are consistent with the diversity of experiences
described in previously published clinical case reports and case
series. Overlap of findings include: transition regret; absence
of transition regret; re-identification with birth sex; continued
identification as transgender; improvement or worsening of
well-being with transition; retransitioning; detransitioning
due to external social pressures; nonbinary identification; and
recognizing and accepting oneself as homosexual or bisexual
(D’Angelo, 2018; Djordjevic etal., 2016; Levine, 2018; Pazos
Guerra etal., 2020; Turban & Keuroghlian, 2018; Turban etal.,
2021; Vandenbussche, 2021). The population in this study is
similar to the population in Vandenbussche in that both were
predominantly natal females in their mid-20s. Because the cur-
rent study recruited in 2016–2017 and Vandenbussche recruited
in 2019, the similar mean age of participants may reflect the
age of individuals who can be reached in online detransitioner
communities. Several findings in this study were consistent
with Vandenbussche’s findings, including similar reasons for
detransition (realizing that their gender dysphoria was related
to other issues, finding alternatives to address gender dyspho-
ria, gender dysphoria resolved, etc.). Although these two stud-
ies were recruited in different years, had different eligibility
criteria, and included participants from several countries, it is
possible that there may be some overlap of study populations.
The current study findings provide additional insight into the
complex relationships between internalized homophobia, gen-
der dysphoria, and desire to transition. Contrary to arguments
against the potential role of homophobia in gender transitions
(Ashley, 2020), participants reported that their own gender dys-
phoria and desire to transition stemmed from the discomfort
they felt about being same-sex attracted, their desire to not be
gay, and the difficulties that they had accepting themselves as
lesbian, gay or bisexual. For these individuals, exploring their
distress and discomfort around sexual orientation issues may
have been more helpful to them than medical and surgical tran-
sition or at least an important part of exploration before making
the decision to transition. This research adds to the existing
evidence that gender dysphoria can be temporary (Ristori &
Steensma, 2016; Singh etal., 2021; Zucker, 2018). It has been
established that the most likely outcome for prepubertal youth
with gender dysphoria is to develop into lesbian, gay, bisexual
(LGB) (non-transgender) adults (Ristori & Steensma, 2016;
Singh etal., 2021; Wallien & Cohen-Kettenis, 2008; Zucker,
2018). And, temporary gender dysphoria may be a common
part of LGB identity development (Korte etal., 2008; Patterson,
2018). Therefore, intervening too soon to medicalize gender
dysphoric youth risks iatrogenically derailing the develop-
ment of youth who would otherwise grow up to be LGB non-
transgender adults. Participants who detransitioned because
they became comfortable identifying as their natal sex and
because their gender dysphoria resolved further support that
gender dysphoria is not always permanent.
The data in this study strengthen, with first-hand accounts,
the rapid-onset gender dysphoria (ROGD) hypotheses which,
briefly stated, are that psychosocial factors (such as trauma,
mental health conditions, maladaptive coping mechanisms,
internalized homophobia, and social influence) can cause or
contribute to the development of gender dysphoria in some indi-
viduals (Littman, 2018). Littman also postulated that certain
beliefs could be spread by peer contagion, including the belief
that a wide range of symptoms should be interpreted as gender
dysphoria (and proof of being transgender) and the belief that
transition is the only solution to relieve distress. The current
study supports the potential role of psychosocial factors in the
development of gender dysphoria and further suggests, by par-
ticipant responses that transitioning prevented or delayed them
from addressing their underlying conditions, that maladaptive
coping mechanisms may be relevant for some individuals. The
potential role of social influence is demonstrated as well. First,
when respondents were asked to describe how they currently
feel about having identified as transgender in the past, more than
a third endorsed the option, “Someone told me that the feelings
I was having meant that I was transgender, and I believed them.”
Second, a subset of participants experienced the unique friend-
ship group dynamics reported in Littman where peer groups
mocked people who were not transgender and popularity within
the friend group increased when respondents announced their
plan to transition. Additionally, respondents identified several
social sources that encouraged them to believe that transitioning
would help them including: YouTube transition videos, blogs,
Tumblr, and online communities. And finally, 20.0% of partici-
pants felt pressured to transition by social sources that included
friends, partners, and society. More research is needed to further
explore these hypotheses.
The current study and the Turban etal. (2021) analysis of the
USTS data share some similarities and differences. Similarities
include the use of convenience samples, targeted recruitment,
and anonymous data collection. The findings of Turban etal.
(including external pressures to detransition and transgender
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
3366 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
identification after detransition) are a subset of the array of
experiences described in the current study. The current study
differed from James etal. (2016) and Turban etal. in that it
enrolled participants based on the criterion of detransition
after medical or surgical transition regardless of how they
currently identified, recruited from communities with diverse
perspectives about transition and detransition, used a precise
definition for detransition that specifies the use of medication
or surgery, and included answer options that were relevant to
many different types of detransition experiences. In contrast,
the USTS only enrolled transgender-identifying individuals
regardless of whether they medically or surgically transitioned,
recruited from communities likely to have similar perspectives
about transition and detransition, and provided multiple choice
answer options that were relevant to a narrower range of detran-
sition experiences (James etal., 2016). Further, the definition
used by the USTS for “detransitioned” (having “gone back to
living as [their] sex assigned as birth, at least for a while”) is
quite vague. Although Turban etal. provide valuable informa-
tion about the subset of transgender-identifying people who
may have detransitioned, the current study provides a more
comprehensive view of individuals who detransition after
medical or surgical transition.
Over the past 15years, there have been substantial changes
in the clinical approach to gender dysphoric patients notable
for a shift from approaches that employ thorough evaluations
and judicious use of medical and surgical transition (the watch-
ful waiting or Dutch approach, the developmentally informed
approach, and the medical model of care) to approaches with
minimized or eliminated evaluation and liberal use of transi-
tion interventions (the affirmative approach and the informed
consent model of care) (Cavanaugh etal., 2016; de Vries &
Cohen-Kettenis, 2012; Meyer etal., 2002; Rafferty etal., 2018;
Schulz, 2018; Zucker etal., 2012b). This trend is prominent in
the U.S. where the American Academy of Pediatrics endorsed
the affirmative approach in 2018 and Planned Parenthood cur-
rently uses the informed consent model to provide medical tran-
sition in more than 200 clinics in 35 states (Planned Parenthood,
2021; Rafferty etal., 2018). It is plausible that an unintended
consequence of these clinical shifts may be an increase in peo-
ple who detransition. Many participants in this study believe
that they did not receive an adequate evaluation by a clinician
before transition. The definition of “adequate evaluation” was
not provided in the survey and may be open to respondent inter-
pretation. But given the complexities of the gender dysphoria
described in the current study, one might consider a low bar
of “adequate” to be the exploration of factors that could be
misinterpreted as non-temporary gender dysphoria as well as
factors that could be underlying causes for gender dysphoria.
The most recently emerging approach to gender dysphoria is
called the “exploratory approach” which is a neutral psycho-
therapeutic approach to help individuals gain a deeper under-
standing of their gender distress and the factors contributing to
their dysphoria (Churcher Clarke & Spiliadis, 2019; Spiliadis,
2019). The study’s findings suggest that an exploratory type of
approach may have been beneficial to some of the respondents.
Future research is needed to determine which patients are best
treated by which approaches long term.
Patients considering medical and surgical interventions
deserve accurate information about the risks, benefits, and
alternatives to that treatment. In this sample, nearly half of the
participants reported that the counseling they received about
transition was overly positive about the benefits of transition
and more than a quarter reported that the counseling was not
negative enough about the risks. Several participants felt pres-
sured to transition by their doctors and therapists. If these types
of clinical interactions are verified, exploration is needed to
determine the extent to which this situation occurs and what
measures might be taken to ensure that clinicians provide
patients with their options accurately and dispassionately.
There are several obstacles to obtaining accurate rates of
detransition and desistance, including stigma and the low num-
bers of detransitioners who inform their clinicians that they
detransitioned. One approach to bypass some of these barri-
ers would be to incorporate non-judgmental questions about
detransition and desistance into nationally representative sur-
veys that collect health data. For example, the Behavioral Risk
Factor Surveillance System contains an optional module about
sexual orientation and gender identity that includes two ques-
tions to explore gender issues (Downing & Przedworski, 2018).
By changing one existing question, “Do you consider yourself
to be transgender?” into two questions, “Have you ever, at any
point in your life, considered yourself to be transgender?” and
“Do you currently consider yourself to be transgender?” and
by adding a follow-up question if answers indicate past but not
current transgender identification, “Did you ever take puberty
blockers, cross-sex hormones, anti-androgens, or have any sur-
gery as part of your transition?”, valuable information about
desistance, detransition, and current transgender identifica-
tion could be obtained. These types of questions may also be
of use in clinical practice and electronic medical records. The
information gained about rates of detransition and desistance
would enhance transgender healthcare by aiding informed con-
sent processes at the start of any medical or surgical transition.
One of the strengths of this study is that it is one of the larg-
est samples of detransitioners to date. Other strengths include
the use of a precise definition for detransition, enrollment of
detransitioners regardless of their post-detransition gender iden-
tification, recruitment from communities with likely divergent
views about transition and detransition, and collaboration with
two individuals who had detransitioned which helped to cre-
ate a survey instrument with questions relevant to a variety of
detransition experiences and enhanced the recruitment efforts.
There are several limitations to this study that should be
considered when interpreting the findings. Like Vandenbussche
(2021), James etal. (2016), and Turban etal. (2021), this study
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
3367Archives of Sexual Behavior (2021) 50:3353–3369
1 3
used a cross-sectional design, anonymous surveying, and a con-
venience sample and therefore shares the same limitations that
are inherent to these methodologies. These limitations include
that conclusions about causation cannot be determined, iden-
tities of participants cannot be verified, and the findings of
this study may not be generalizable to the entire population of
people who detransition or to people outside of the countries
where participants were from. Although this study reached out
to communities with differing perspectives about transition
and detransition, targeted recruitment and convenience sam-
ples always introduce the limitations associated with selection
biases which should be addressed in future research. Finally,
many of the participants in this study had less than ideal out-
comes to their medical and surgical transitions, and it is possible
that these experiences may have colored some of the responses.
Additional research is needed to determine the prevalence of
detransition as an outcome of transition and to identify and meet
the psychological and medical needs of the emerging detran-
sitioned population. Because many individuals who detransi-
tion re-identify with their birth sex, are no longer connected to
LGBT communities, and don’t return to gender clinics, future
research about detransition needs to expand recruitment efforts
beyond gender clinics and transgender communities. The devel-
opment and testing of non-medical interventions for gender
dysphoria could provide valuable options to be used as alterna-
tives or in conjunction with medical and surgical treatments.
Because of the potential for some to experience trauma, men-
tal health conditions, internalized homophobia, and misogyny
as gender dysphoria, research needs to be conducted on the
evaluation process before transition to find approaches that
respectfully and collaboratively explore factors that might
contribute to gender-related distress. There continues to be
an absence of long-term outcomes evidence for youth treated
with medical and surgical transition and a lack of information
about the trajectories of youth experiencing late-onset gender
dysphoria–research is needed to address these gaps. Continued
work is needed to reduce rigid gender roles, increase repre-
sentation of gender stereotype nonconformity, and to address
discrimination and social pressures exerted against people who
are transgender, lesbian, gay, bisexual, and gender stereotype
non-conforming.
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 under-
estimated because most of the participants did not inform the
doctors who facilitated their transitions that they had detransi-
tioned. 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 detran-
sitioners return to identifying with their birth sex, some assume
(or maintain) a nonbinary identification, and some continue
to identify as transgender. Some detransitioners regret transi-
tioning 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 com-
munities, 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 experi-
ences 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 sup-
port and treatment for the long-term medical and psychologi-
cal 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 evalua-
tion, counseling, and informed consent for individuals who are
contemplating transition.
Acknowledgements I would like to thank the two individuals with
personal experience of detransitioning who helped to create the survey
instrument and assisted with recruitment; and Dr. Anna Hutchinson,
Dr. Roberto D’Angelo, and the peer-reviewers for providing feedback
on earlier versions of this manuscript
Funding No funding was received for conducting this study. Open
access fees were provided by the Institute for Comprehensive Gender
Dysphoria Research.
Declarations
Conflict of interest The author has no relevant financial or non-finan-
cial conflicts of interest to disclose.
Consent to Participate Electronic consent was obtained from all par-
ticipants included in the study. On the first page of the online survey,
participants were informed of the research purpose and potential risks
and benefits of participating, that their participation was voluntary, and
were presented with a way to contact the researcher. The research survey
questions were displayed only if the participant clicked “agree” which
indicated that the participant read the information, voluntarily agreed
to participate, and were at least 18years of age.
Ethical Approval The research was determined to be Exempt Human
Research by the Program for the Protection of Human Subjects of the
Icahn School of Medicine at Mount Sinai in New York, NY. All proce-
dures were performed in accordance with the ethical standards of the
Program for the Protection of Human Subjects at the Icahn School of
Medicine at Mount Sinai and with the 1964 Declaration of Helsinki and
its later amendments or comparable ethical standards.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
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3368 Archives of Sexual Behavior (2021) 50:3353–3369
1 3
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
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