Risk-Related Outcomes and Gender Detransitioning: Interpersonal Coercion, Structural Barriers, or Identity-Related Reasons?

Background and Purpose: An increasing number of people (particularly young people) are seeking gender affirmation (GA) services. It is well documented that GA services are associated with numerous positive outcomes including enhanced quality of life, improved body image and satisfaction, and increased psychological functioning. With more GA services being delivered, the issue of detransitioning has started to receive media coverage – often sensationalized and used to support transphobic legislation and policy. Research on detransitioning lags behind this increased media coverage.

This study utilizes a large, national sample of TNB people to examine the relationships between a series of psychosocial risks and different rationale for gender detransitioning. Unlike existing research which fails to differentiate reasons for detransitioning, we disaggregate those who detransition into groups based on rationale (i.e., interpersonal pressure, structural barriers, and identity-related reasons) to determine differential risk profiles and demonstrate the complexity of detransitioning.

We anticipated that those who detransition because of interpersonal coercion and structural barriers would demonstrate higher likelihoods for negative psychosocial risks, while those who transition for identity-based reasons would not be significantly different than TNB people who had never transitioned in the first place.

Methods: This study is a secondary data analysis of the 2015 U.S. Transgender Survey – the largest existing dataset of TNB adults that includes questions regarding reasons for detransitioning. The analytic sample of 26,026 TNB-identified adults living in the U.S. includes a range of gender identities with the largest being transwomen (33.0%), transmen (28.9%), and nonbinary individuals who were assigned female at birth (28.5%). The sample is predominantly White (81.9%) with bi/multiracial (5.6%) and Latinx individuals (5.3%) representing the next largest racial categories. It includes respondents who never transitioned (32.2%), who transitioned but never detransitioned (53.8%), and who detransitioned (8.0%). Logistic regression models were constructed using demographic (e.g., age, gender identity, race, education) along with the (de)transitioning variables of interest. Dependent variables include illegal drug use, suicidality, intimate partner violence, homelessness, arrests, and fear of seeing a doctor or using the restroom because of transphobic reactions.

Results: Compared to those who never transitioned those who detransition due to (a) interpersonal coercion were at increased likelihood on all 10 psychosocial risks (OR=1.8-5.1), (b) structural barriers were at increased likelihood on 9 of the 10 risks (OR=1.7-6.9), and (c) identity-related reason were at increased likelihood on none of the risks.

Conclusions and Implications: While future research on detransitioning is needed to better understand the experience, failure to disaggregate detransitioners by the reason runs the risk of drawing erroneous conclusions and furthering a harmful narrative. The results underscore the importance of advocacy to challenge both macro- (structural barriers) and micro-level (interpersonal coercion) forms of transphobia. The results provide support for TNB scholars who argued that transitioning and detransitioning may be part of the process of discernment of one’s gender identity for some TNB people and demonstrates that those who detransition because of identity-related reasons do not appear to be at greater risks than those TNB people who never transitioned in the first place.