Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis
Abstract
Purpose: There is a paucity of data regarding transgender and gender diverse (TGD) people who “detransition,” or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States.
Methods: A secondary analysis was performed on data from the U.S. Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD adults in the United States. Participants were asked if they had ever detransitioned and to report driving factors, through multiple-choice options and free-text responses. A mixed-methods approach was used to analyze the data, creating qualitative codes for free-text responses and applying summative content analysis.
Results: A total of 17,151 (61.9%) participants reported that they had ever pursued gender affirmation, broadly defined. Of these, 2242 (13.1%) reported a history of detransition. Of those who had detransitioned, 82.5% reported at least one external driving factor. Frequently endorsed external factors included pressure from family and societal stigma. History of detransition was associated with male sex assigned at birth, nonbinary gender identity, bisexual sexual orientation, and having a family unsupportive of one's gender identity. A total of 15.9% of respondents reported at least one internal driving factor, including fluctuations in or uncertainty regarding gender identity.
Conclusion: Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.
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Acknowledgment
We thank the National Center for Transgender Equality for sharing the USTS data with our team.
Disclaimer
Data were collected by the National Center for Transgender Equality. No portions of this article have been previously presented. Funders played no role in study design, analysis, or interpretation of the results. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health.
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Copyright 2021, Mary Ann Liebert, Inc., publishers.
History
Published in print: May/June 2021
Published online: 1 June 2021
Published ahead of print: 31 March 2021
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Authors' Contributions
J.L.T. conceptualized the study. J.L.T., S.S.L., and A.S.K. performed all qualitative coding. S.S.L. and A.N.A. completed all statistical analyses. J.L.T. and A.N.A. wrote the initial article draft. All coauthors edited the article for scientific content and clarity. A.S.K. supervised the design, writing, and revision of the article, as well as provided clinical expertise regarding mental health considerations for TGD communities. All coauthors reviewed and approved the article before submission.
Author Disclosure Statement
Dr. Turban reports receiving textbook royalty payments from Springer Nature. Dr. Keuroghlian stands to receive future textbook royalty payments from McGraw-Hill Education. No competing financial interests exist for any other authors.
Funding Information
This study was supported by grant U30CS22742 from the Health Resources and Services Administration Bureau of Primary Health Care (Dr. Keuroghlian) and R25 grant MH094612 from the National Institute of Mental Health (Dr. Turban).
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