Transition Decisions of Transgender and Nonbinary Persons Exposed to Gender Identity Conversion Efforts

Introduction: Recently, transgender and nonbinary (TNB) persons’ de-transitioning experiences have garnered significant attention. It has been suggested gender-affirming practices rush TNB persons to pre-maturely transition without fully understanding the consequences and leading to higher de-transitioning rates. This argument has been used to withhold gender-affirming mental and physical health resources. However, growing literature has demonstrated that many TNB persons described as de-transitioners do not transition back to a gender identity aligned with their assigned sex. Rather, facing interpersonal (e.g., parents) or structural (e.g., employment discrimination) pressures, some TNB persons, who still identify as TNB, may choose to recalibrate their transition to adapt to the realities of their environment. This implicates non-affirming experiences as a culprit in TNB persons’ decision to recalibrate their transition despite still identifying as TNB. Gender identity conversion efforts (GICE) are increasingly being recognized as a mechanism of non-affirmation aimed at influencing the person to change their gender identities. Yet, the relationship between GICE exposure and transition-related experiences of TNB persons remains unexamined. In this study, we examine how GICE exposure among TNB persons may contribute to differences in transitioning experiences.

Methods: This study is a secondary data analysis of the 2015 U.S. Transgender Survey (N=26,026). Using multinomial logistic regression models, we examined how TNB persons’ GICE experiences are associated with differing gender identity transition trajectories. Demographic characteristics, age, gender identity, race, education, and employment status were examined as covariates. The average participant was 31 years old. Most participants identified as transgender women (33.0%) and transgender men (28.9%). Further, most identified as White (81.9%), biracial/multiracial (5.6%), or Latinx (5.3%).

Results: Overall, 13.5% of TNB participants experienced GICE during their lifetime. Regarding transitioning status, 38.2% did not transition whereas 53.8% never de-transitioned. Among those who recalibrated their transition, 4.8% did so due to interpersonal pressures, 2.0% due to structural pressures, and .4% due to a genuine shift from a TNB to a cisgender identity. GICE exposure was associated with a 97% increase in the risk of gender recalibration due to interpersonal pressures relative to never de-transitioning (RRR=1.97; p=.001). GICE exposure did not predict the risk of structural pressure-based gender recalibration or gender recalibration due to a shift from a TNB to a cisgender identity relative to never de-transitioning.

Conclusions: Our findings indicate TNB persons exposed to GICE are more likely to have reversed their transition due to interpersonal pressures than to have never de-transitioned, underscoring the potential harm of the practice on transition trajectories of TNB persons. Our findings further highlight that GICE-exposed TNB persons are not more likely to have recognized that they are not truly TNB than to have never de-transitioned. While our findings are not causal, they indicate non-affirming practices such as GICE may play a deleterious role in TNB persons’ transitional decision-making. Alongside giving further credence to conversion effort bans, our findings stress the need for a more nuanced understanding, recognition, and respect for TNB persons’ non-linear transitioning trajectories. Otherwise, we risk vilifying gender-affirming practices and pathologizing adaptive transitioning decisions of TNB persons.