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Published Online: 1 June 2021

Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis

Publication: LGBT Health
Volume 8, Issue Number 4

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.

References

1. Johns MM, Lowry R, Andrzejewski J, et al.: Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. Morb Mortal Wkly Rep 2019;68:67–71.
2. Flores AR, Herman JL, Gates GJ, Brown TNT: How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute, 2016.
3. National LGBTQIA+ Health Education Center, A Program of the Fenway Institute: LGBTQIA+ glossary of terms for health care teams. 2020. Available at https://www.lgbtqiahealtheducation.org/wp-content/uploads/2020/10/Glossary-2020.08.30.pdf Accessed September 26, 2020.
4. Reisner SL, Radix A, Deutsch MB: Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr 2016;72:S235–S242.
5. Knox L: Media's ‘detransition’ narrative is fueling misconceptions, trans advocates say. NBC News, 2019. Available at https://www.nbcnews.com/feature/nbc-out/media-s-detransition-narrative-fueling-misconceptions-trans-advocates-say-n1102686 Accessed December 28, 2020.
6. Mamoojee Y, Seal LJ, Quinton R: Transgender hormone therapy: Understanding international variation in practice. Lancet Diabetes Endocrinol 2017;5:243–246.
7. James SE, Herman JL, Rankin S, et al.: The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality, 2016.
8. Coleman E, Bockting W, Botzer M, et al.: Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend 2012;13:165–232.
9. Hembree WC, Cohen-Kettenis PT, Gooren L, et al.: Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017;102:3869–3903.
10. Levine SB, Davis L: What I did for love: Temporary returns to the male gender role. Int J Transgend 2002;6.
11. Rachlin K: Medical transition without social transition: Expanding options for privately gendered bodies. Transgend Stud Q 2018;5:228–244.
12. Turban JL, Carswell J, Keuroghlian AS: Understanding pediatric patients who discontinue gender-affirming hormonal interventions. JAMA Pediatr 2018;172:903–904.
13. Turban JL, Keuroghlian AS: Dynamic gender presentations: Understanding transition and “de-transition” among transgender youth. J Am Acad Child Adolesc Psychiatry 2018;57:451–453.
14. Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–1288.
15. Klein A, Golub SA: Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT Health 2016;3:193–199.
16. Goldblum P, Testa RJ, Pflum S, et al.: The relationship between gender-based victimization and suicide attempts in transgender people. Prof Psychol Res Pr 2012;43:468–475.
17. Scheim AI, Perez-Brumer AG, Bauer GR: Gender-concordant identity documents and mental health among transgender adults in the USA: A cross-sectional study. Lancet Public Health 2020;5:e196–e203.
18. Testa RJ, Sciacca LM, Wang F, et al.: Effects of violence on transgender people. Prof Psychol Res Pr 2012;43:452–459.
19. Hendricks ML, Testa RJ: A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Prof Psychol Res Pr 2012;43:460–467.
20. Yu C, Zuo X, Blum RW, et al.: Marching to a different drummer: A cross-cultural comparison of young adolescents who challenge gender norms. J Adolesc Health 2017;61:S48–S54.
21. Beckwith N, Reisner SL, Zaslow S, et al.: Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend Health 2017;2:156–164.
22. Turban JL, King D, Carswell JM, Keuroghlian AS: Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics 2020;145:e20191725.
23. Rider GN, McMorris BJ, Gower AL, et al.: Health and care utilization of transgender and gender nonconforming youth: A population-based study. Pediatrics 2018;141:e20171683.
24. Travers R, Bauer G, Pyne J, et al.: Impacts of strong parental support for trans youth: A report prepared for Children's Aid Society of Toronto and Delisle Youth Services. Toronto: Trans Pulse Project, 2012.
25. Ryan C: Engaging families to support lesbian, gay, bisexual, and transgender youth: The Family Acceptance Project. Prev Res 2010;17:11–13.
26. Wiepjes CM, Nota NM, de Blok CJM, et al.: The Amsterdam cohort of gender dysphoria study (1972–2015): Trends in prevalence, treatment, and regrets. J Sex Med 2018;15:582–590.
27. Turban JL, King D, Reisner SL, Keuroghlian AS: Psychological attempts to change a person's gender identity from transgender to cisgender: Estimated prevalence across US States, 2015. Am J Public Health 2019;109:1452–1454.

Information & Authors

Information

Published In

cover image LGBT Health
LGBT Health
Volume 8Issue Number 4May/June 2021
Pages: 273 - 280
PubMed: 33794108

History

Published in print: May/June 2021
Published online: 1 June 2021
Published ahead of print: 31 March 2021

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Authors

Affiliations

Jack L. Turban [email protected]
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
Stephanie S. Loo
National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, USA.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
Anthony N. Almazan
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Alex S. Keuroghlian
National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, USA.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.

Notes

Address correspondence to: Jack L. Turban, MD, MHS, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 04304, USA [email protected]

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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