Detransition

Archives of Sexual Behavior
https://doi.org/10.1007/s10508-023-02716-1
ORIGINAL PAPER
Detransition and Desistance Among Previously Trans‑Identified Young

Adults
Lisa Littman1 · Stella O’Malley1 · Helena Kerschner2 · J. Michael Bailey3
Received: 17 February 2022 / Revised: 24 September 2023 / Accepted: 25 September 2023

© The Author(s) 2023
Abstract
Persons who have renounced a prior transgender identification, often after some degree of social and medical transition,
are increasingly visible. We recruited 78 US individuals ages 18–33 years who previously identified as transgender and had
stopped identifying as transgender at least six months prior. On average, participants first identified as transgender at 17.1
years of age and had done so for 5.4 years at the time of their participation. Most (83%) participants had taken several steps
toward social transition and 68% had taken at least one medical step. By retrospective reports, fewer than 17% of participants
met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. In contrast, 53% of participants believed that “rapid-onset
gender dysphoria” applied to them. Participants reported a high rate of psychiatric diagnoses, with many of these prior to
trans-identification. Most participants (N = 71, 91%) were natal females. Females (43%) were more likely than males (0%) to
be exclusively homosexual. Participants reported that their psychological health had improved dramatically since detransi-
tion/desistance, with marked decreases in self-harm and gender dysphoria and marked increases in flourishing. The most
common reason given for initial trans-identification was confusing mental health issues or reactions to trauma for gender
dysphoria. Reasons for detransition were more likely to reflect internal changes (e.g., the participants’ own thought processes)
than external pressures (e.g., pressure from family). Results suggest that, for some transgender individuals, detransition is
both possible and beneficial.
Keywords Detransition · Desistance · Gender dysphoria · Transgender · Rapid-onset gender dysphoria · DSM-5
Introduction articles (Callahan, 2018; Entwistle, 2021; twitter.com/ftm-

detransed and twitter.com/radfemjourney, 2019; YouTube,
Persons who have renounced a prior transgender identifica- 2022); and detransitioners have organized to bring aware-
tion have become increasingly visible during the past dec- ness to their experiences and advocate for their needs (e.g.,
ade (Littman, 2021). Often these individuals have changed Detrans Voices, 2022; Gender Care Consumer Advocacy
their minds after taking steps toward social and medical Network, 2022; Pique Resilience Project, 2019; Post Trans,
gender transition and may be referred to as “detransition- 2022). Detransition has received attention from prominent
ers.” Detransitioner communities have emerged online (e.g., bloggers and journalists (4thwavenow, 2016; Anonymous,
r/detrans, 2019, 2020); hundreds of detransitioner testi- 2017; Boyce, 2021; Herzog, 2017; Tracey, 2020; upperhand-
monies can be found on YouTube and other social media MARS, 2020) and even from mainstream media (McCann,
platforms, in online blogs, book chapters, and in published 2017; Smith, 2021). This publicity has been heightened by
cases in which detransitioners appear to have received inad-
* Lisa Littman equate oversight before they were provided serious medical
[email protected] interventions, such as the lawsuit filed by Kiera Bell (Top-
ping, 2020). Clinicians and researchers have documented a
1
The Institute for Comprehensive Gender Dysphoria growing number of detransitioners seeking psychological
Research, 11 S. Angell Street, #331, Providence, RI 02906,
USA and medical support (D’Angelo et al., 2021; Marchiano,
2 2020; Vandenbussche, 2022). Because of both controversy
Cincinnati, OH, USA
and recency regarding detransitioners, little is known about
3
Department of Psychology, Northwestern University, them (Valdes & MacKinnon, 2023).
Evanston, IL, USA
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Vol.:(0123456789)
It is important to distinguish several terms common in However, a recent study found that approximately 30% of
both scientific literature and lay parlance, and to clarify how transgender adolescents and adults discontinued cross-sex
we use them. Gender dysphoria is discomfort with one’s hormone treatment within four years after commencing treat-
current gender (most often the same as one’s sex at birth), ment (Roberts et al., 2022).
regardless of the causes or manifestation of the discomfort. Research reviewed so far has focused on patients who were
Transgender identification represents the commitment that treated prior to the recent dramatic surge of gender dysphoria
one’s “true gender” is not aligned with one’s birth sex. Felt in the West that has occurred during the past 15–20 years
“true gender” may be opposite one’s birth sex or some other (Aitken et al, 2015). This surge has been associated with
gender (e.g., nonbinary). Gender transition includes both changing demographics—especially an increase among ado-
social and medical steps taken to align one’s overall pres- lescent females (Zucker, 2019). It is plausible that the recent
entation with one’s felt “true gender,” typically after some and older cohorts differ in their detransition rates. To our
period of transgender identification. Social steps can include knowledge, only two studies have explored the prevalence
changes in dress and appearance, name, and posture/move- of detransition in recent clinical samples. The first study, a
ment. Medical steps can include cross-sex hormones and retrospective case-note review, identified a detransition rate
surgery. Detransition is the reversal of gender transition for of 6.9% from the 175 adult patients consecutively discharged
any reason, although for many it includes abandonment of from a national Gender Identity Clinic in the UK (Hall et al.,
transgender identification. Detransition may be preceded or 2021). The second study audited the data from 68 patients
accompanied by the feeling that one regrets gender transi- with a diagnosis of gender dysphoria from a primary care
tion (“regrets”). Desistance refers to the waning of gender population in the UK. Of the 41 patients who began hormonal
dysphoria prior to medical gender transition. treatments, 20% stopped taking them, and 9.8% were catego-
This article reports on a sample of young adults who had rized as detransitioning (Boyd et al., 2022).
identified as transgender but changed their minds, most of Empirical problems preclude accurately estimating the
whom had taken steps toward social and medical transition. prevalence of detransitioners outside of a few settings. Stud-
We hoped to illuminate aspects of their gender dysphoria and ies of transition regret have been small and have not used con-
gender transition, as well as their detransition and (for most) sistent outcome indices. Importantly, detransitioned patients
the resolution of their gender dysphoria. Before reporting our are especially likely to be lost to follow-up.
study, we provide some context in the scientific literature and
the broader culture. Motivations for Detransition and Desistance
Controversies About Detransition and Desistance An important distinction is between “core” and “non-core”
detransition (Exposito-Campos, 2021). In core detransition,
At least three main issues have been especially controversial an individual stops identifying as transgender due to an inter-
regarding detransition and desistance: their frequencies, the nal shift in how they conceive of themselves. In contrast,
motivations of detransitioners and desisters, and the possi- non-core detransition is not motivated by internal doubts, but
bility that a recent phenomenon called rapid-onset gender by external stressors such as transgender-related discrimina-
dysphoria (ROGD; Littman, 2018) may disproportionately tion, family pressure, and financial or health barriers to gen-
contribute to both phenomena. We review these controversies der related medical treatments (e.g., hormone replacement
below, focusing on the limited empirical evidence. therapy). Although all varieties of desistance and detransi-
tion warrant further attention, core detransition has been
Prevalence of Detransition and Regret especially controversial. Individuals who mistakenly view
themselves as transgender, or who decide they are no longer
Advocates for gender transition have tended to assert that transgender, may be unnecessarily burdened with harmful
detransition is rare (e.g., Knox, 2019; Stonewall, 2019). consequences of irreversible hormonal and surgical inter-
Much of the published data used to estimate detransition ventions. This is especially concerning because the fastest
prevalence come from studies of sex-reassignment-surgery growing subgroup of gender dysphoric individuals seeking
outcomes. In general, these studies have found post-surgery medical treatment comprises adolescents and young adults
regret to be low (Dhejne et al., 2011; Lawrence, 2003, 2006; (Aitken et al., 2015; Zucker & Aitken, 2019).
Pfäfflin, 1993; van de Grift et al., 2017; Wiepjes et al., 2018). Three recent studies using convenience samples explored
Similarly, one prospective study examined regret of hormo- reasons for detransition. Littman (2021) recruited 100 indi-
nal treatment among 55 young transgender adults who had viduals (69% natal females) who had medically or surgically
undertaken puberty suppression and then cross-sex hor- detransitioned, regardless of current gender identification.
mones and found no evidence of regret (de Vries et al., 2014). The most common reason participants gave for detransition
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(60% of participants) was that they had become more com- of gender dysphoria is universally accepted at present (Bailey
fortable with their natal sex. Other reasons included: medi- & Blanchard, 2017; Zucker, 2019). Childhood-onset gender
cal concerns (49%); the belief that gender dysphoria was dysphoria occurs in both natal males and natal females. It
an expression of other problems (e.g., trauma or mental ill- typically begins early in childhood and is associated with
ness; 39%); the belief that gender dysphoria was caused by both extreme childhood gender nonconformity and adult
participants’ inability to accept their own homosexual feel- homosexuality. Autogynephilic gender dysphoria affects only
ings (23%); and the experience of discrimination as trans males and is associated with autogynephilia, a natal male’s
persons (23%). The majority (55%) believed they had been sexual arousal by imitating females (especially by cross-
inadequately evaluated, medically or psychologically, before dressing) or imagining himself as a female. Both childhood-
they transitioned. onset gender dysphoria and autogynephilic gender dyspho-
A second study recruited male and female detransition- ria have been studied for several decades (Blanchard, 1989;
ers using the question, “Did you transition medically and/ Zucker, 2005; Zucker & Bradley, 1995).
or socially and then stopped?” (Vandenbussche, 2022). In contrast, the third kind of gender dysphoria, ROGD,
Of the 237 participants, 92% were natal females. Reasons was unknown until recently (approximately the past decade)
endorsed for detransition overlapped considerably with those (Littman, 2018). Because ROGD is a new and controversial
in Littman’s (2021) study. For example, the most frequently idea, there has been little empirical research on it. The lim-
endorsed reason for detransition was that gender dyspho- ited research conducted so far (e.g., Diaz & Bailey, 2023a,
ria “was related to other issues” (70%), followed by “health b; Littman, 2018) is consistent with the following conceptu-
concerns” (62%). Other common reasons included feeling alization: Adolescents and young adults without a childhood
that transition did not help (50%), finding other ways to deal history of gender dysphoria and often with preexisting emo-
with gender dysphoria (45%), disliking the social changes tional problems come to believe that they have gender dys-
accompanying transition (44%), and experiencing a change phoria. This belief typically progresses rapidly to adoption of
in “political views” (43%). “Resolution of gender dysphoria” transgender identity and the conviction that gender transition
was endorsed by 15% of Littman’s subjects and by 34% of is urgent. ROGD is facilitated by social contagion, evidenced
Vandenbussche’s. Only 10% of this sample endorsed “dis- by the common occurrence of multiple affected youths in
crimination” as a reason for detransition. the same peer group. The syndrome appears to be especially
The third study differed substantially in both method and common among natal females, who comprise approximately
results from the other two reviewed in this section. Turban 75–80% of potential cases studied so far. ROGD may in some
et al. (2021) analyzed data from a survey of 27,715 “transgen- cases represent the confusion of underlying emotional and
der and gender diverse” adults that included several ques- developmental difficulties as gender dysphoria. Finally, the
tions about detransition. Participants were recruited “through surge of gender dysphoria cases during the past decade is
community outreach organizations” for a survey advertised plausibly due to ROGD, although this possibility is highly
as being “for all trans people age 16 and up” (https://www. contentious (Ashley, 2020; French National Academy of
ustranssur vey.org). Thus, persons no longer identifying as Medicine, 2022; Shrier, 2020; WPATH, 2018).
transgender would be excluded. Instead, currently transgen- The literature on treatment regret has focused on persons
der persons were asked the following questions: “Have you who likely experienced either childhood-onset or autogy-
ever de-transitioned? In other words, have you ever gone back nephilic gender dysphoria. This is because these persons
to living as your sex assigned at birth, at least for a while?” were treated before ROGD was noticed, and perhaps before
This study also differed from the other two in finding among ROGD existed at detectable levels. Thus, the generally posi-
detransitioners a slight majority of natal males (55%) rather tive results of these studies (i.e., low rates of regret) may not
than a large majority of natal females. Finally, and in con- apply to those fitting the ROGD profile. Indeed, if ROGD is
trast to the other studies, participants categorized as having due to the misattribution of emotional and developmental
detransitioned overwhelmingly endorsed “external” (82.5%) difficulties to an underlying transgender status, these cases
rather than “internal” reasons (15.9%) for detransition. Exter- may have especially high rates of regret.
nal factors included social pressure such as “pressure from To study detransition/desistance across the different
family and societal stigma.” Internal factors included “fluc- types of gender dysphoria, it is necessary to distinguish the
tuations in or uncertainty regarding gender identity.” different types accurately. Childhood-onset gender dyspho-
ria is relatively easy to diagnose during childhood. After
Gender Dysphoria Typology and Detransition/Desistance then, however, assessment relies on retrospective reports,
which can be inaccurate for various reasons, including
At least three types of gender dysphoria have been proposed memory limitations and motivated distortion, especially
in the clinical and research literature, although no taxonomy exaggeration of childhood signs of gender dysphoria
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(Lawrence, 2012; Littman, 2018). An additional compli- their experiences before, during, and after transgender
cation is distinguishing between natal males with autogy- identification.
nephilic gender dysphoria and natal males whose gender During the recruitment period, 78 individuals who met
dysphoria results from ROGD, as we have described it. inclusion criteria completed online surveys. The following
To family members and friends, autogynephilic gender inclusion criteria were used: 18–33 years of age; residing in
dysphoria may appear sudden, because the autogynephilic the USA; previous identification as transgender for at least
person has probably neither appeared gender nonconform- 6 months; lack of current identification as transgender, with
ing nor discussed sexual fantasies with them. cessation of transgender identification at least six months
With these caveats in mind, childhood-onset gender dys- prior to participation. “Transgender” was defined as includ-
phoria is supported to the extent that a gender dysphoric per- ing all gender identification that is not consistent with one’s
son provides consistent and persuasive evidence of extreme natal sex (including nonbinary, agender, enby, transgender,
gender nonconformity during childhood. In these cases, etc.). Ninety individuals were screened for eligibility with
childhood gender dysphoria is often but not always recalled. videoconference interviews, and five were ineligible. Three
Autogynephilic gender dysphoria is indicated if a natal male exclusions were due to transgender disidentification being
admits being sexually aroused by cross-dressing or by the too recent, one individual was not within the eligible age
idea of having the body of a woman. ROGD is indicated for range, and another individual still identified as transgender.
a natal female if childhood-onset gender dysphoria is absent, Eighty-five eligible individuals were provided with personal-
a rapid adolescent or young adult onset is evident. (The appli- ized one-time-use links to the online survey with assigned
cation of ROGD to natal males is more problematic, due to study identification numbers embedded into the surveys. The
the possibility that males with apparently rapid onset have large majority (91.2%) of eligible individuals who received
autogynephilia.) Additionally, evidence of social influences these links submitted responses.
(e.g., experience with peers or social media advocating
transgender identification) is more consistent with ROGD Procedure
than either of the other two types.
Recruitment information was shared by email and social
media with requests that individuals share the information
The Present Study with any person or community where there may be eligible
individuals. Efforts were made to reach communities with
The present research explores the retrospective experiences differing perspectives about gender dysphoria, desistance,
of an Internet-recruited sample of formerly trans-identifying transition, and detransition. We contacted various organiza-
young adults. The following domains were assessed: moti- tions, individuals, and forums including: Pique Resilience
vations for the decision to adopt transgender identity; the Project, subreddits r/detrans and r/actual detrans, multiple
course of mental health, psychological well-being, and gen- individuals who have detransitioned, several individuals who
der dysphoria before, during, and after transgender identifi- are transgender, psychologists, psychiatrists, and therapists
cation; experiences with medical and social transition; and who work with gender dysphoric individuals and/or detransi-
motivations for relinquishing a transgender identity. We also tioned individuals (including professionals who have worked
included measures intended to illuminate the extent to which at gender identity-affirming clinics), professional listservs
our detransitioners and desisters can be understood as having for researchers and clinicians, the LGBT centers of two large
had childhood-onset, autogynephilic, or rapid-onset gender universities, journalists, and more. Recruitment was open
dysphoria. from 3/5/20 to 8/19/20 for a total of 5.5 months. The pur-
pose of the study was described in the recruitment informa-
tion, and participation was voluntary. Electronic consent was
obtained before participants could view the survey questions.
Method Data were collected through the Qualtrics Survey Platform
without IP addresses.
Participants The study was initially launched as an anonymous online
survey that included screening questions that ended the sur-
Using social media, Internet sites, and word of mouth, we vey if participants provided answers that were inconsistent
recruited persons ages 18–33 who had previously identified with eligibility. Shortly after recruitment began, individu-
as transgender for a duration of least six months, stopped als began posting tweets to invite other people to take the
identifying as transgender, and had not identified as transgen- survey with the goal of creating invalid results. This was
der for at least six months. Participants were surveyed about followed by multiple tweets of individuals boasting that
they submitted fake responses to the survey. In response to
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the sabotage attempts, the study was modified to increase Sexuality

the security by adding a videoconference screening inter-
view and the use of personalized one-time-use links to the Sexual Orientation Sexual attraction to males versus females
survey. The current study includes only participants who was assessed using the 7-point Kinsey scale with responses
completed videoconference screening interviews. ranging from “exclusively sexually attracted to males” to
“exclusively sexually attracted to females” (Kinsey et al.,
1948). Numerically for the Kinsey scale, 0 represents exclu-
Measures sive other-sex attraction, 3 represents identical attraction
to both sexes, 6 represents exclusive same-sex attraction,
A survey instrument including 114 questions was created and 1, 2, 4, and 5 represent intermediate degrees of rela-
with the input of 11 professionals (including both research- tive attraction to males and females. An additional option
ers and clinicians) and 3 detransitioners. In our descrip- assessed absence of attraction to either cisgender males ver-
tion of the survey instrument below, we have prioritized sus cisgender females. Participants were asked to rate their
general information about the content domains. More spe- sexual attraction at three time points; before they identified as
cific information about some measures is provided in the transgender, while they were identifying as transgender, and
Results. after they stopped identifying as transgender. In this paper,
we restrict analyses to their most recent self-reported sexual
orientation.
Demographics
Autogynephilia/Autoandrophilia Three items intended to
Participants answered demographic questions about their measure autogynephilia for natal males (Blanchard, 1989)
age, natal sex, race/ethnicity, educational attainment, politi- or autoandrophilia for natal females were included. (Cur-
cal beliefs, and religiosity. rently, autoandrophilia is neither well researched nor well
supported.) Two items were the same for both natal sexes:
“Did you ever experience sexual arousal by dressing as the
Development and Onset other sex in private?” and “Did you ever experience sexual
arousal when fantasizing that you had the body of the other
Participants recalled the ages when they began to identify as sex?” The third item differed appropriately for natal males
transgender and when this identification stopped. Duration of and females: “Did you ever feel sexually aroused by the idea
trans-identification was computed using these ages. of being a woman? [for natal males]” and “Did you ever
Eight items adapted from DSM-5 criteria (American Psy- feel sexually aroused by the idea of being a man? [for natal
chiatric Association, 2013) asked participants to recall symp- females].” Items were scored dichotomously and summed
toms of gender dysphoria experienced from age 3 through so that scores ranged from 0 to 3. Cronbach’s alpha for the
11 years. Coefficient alpha for the composite scale was 0.81. autogynephilia and autoandrophilia scales was 0.58 and 0.76,
Participants were provided with a definition of rapid-onset respectively.
gender dysphoria (Littman, 2018) and were asked whether
the term fit their own experience. This item appeared as, “The Mental Health
term ‘rapid-onset gender dysphoria’ has been used to describe
a situation where someone who did not have gender dyspho- Psychiatric Diagnoses Participants were asked to indicate
ria during their childhood, appears to suddenly develop gen- which of 13 psychiatric diagnoses they were given over
der dysphoria during or after puberty. Does this description the course of their lifetime and which of these psychiatric
fit your experience?” Participants responded either “Yes,” diagnoses they received before they started to identify as
“Don’t know,” or “No.” For some analyses reported herein, transgender. Psychiatric diagnoses listed included anxiety,
this response was made numeric (with “Don’t know” consid- attention deficit hyperactivity disorder (ADHD), autism
ered intermediate between “Yes” and “No”). spectrum disorder, bipolar disorder, borderline personality
Several items inquired about experiences, thoughts, or disorder, depression, eating disorders, history of pulling out
feelings that happened over the course of three months prior hair, obsessive compulsive disorder (OCD), post-traumatic
to becoming gender dysphoric or trans-identified. stress disorder (PTSD), schizophrenia or psychosis, selective
Several items asked about participants’ sociopolitical atti- mutism, Tourette’s, and “other.” The diagnoses were chosen
tudes. These included questions about the attitudes of par- because we expected that some (e.g., “anxiety” and “depres-
ticipants’ families, participants’ current attitudes in general, sion”) were especially likely to be elevated among gender
and participants’ attitudes about gay, lesbian, and transgender dysphoric persons, and others (e.g., “schizophrenia or psy-
rights. chosis”) were otherwise important to assess. Some of these
13
diagnoses, as listed (e.g., “schizophrenia or psychosis” and due to parental mistreatment) before age 18 years. Items were
“anxiety”), did not strictly correspond with DSM-5 diagnoses summed to create a composite score, and Cronbach’s alpha
(American Psychiatric Association, 2013). for this scale was 0.73.
Recalled negative experiences prior to transgender iden-
Gender Dysphoria Participants answered six items reflecting tification were also assessed using 9 items (e.g., “Before you
DSM-5 criteria for gender dysphoria (American Psychiat- started to identify as transgender, did you experience bully-
ric Association, 2013), both for the period they identified ing?”). With one exception (“Witnessing the abuse of a fam-
as transgender and for the period after they stopped iden- ily member (including sibling, parent, cousin, etc.”)), these
tifying as transgender. Cronbach’s alphas for these scales items did not focus on within-family maltreatment. Items
were 0.69 and 0.77, respectively. Additionally, a single item were summed to create a composite score, and Cronbach’s
assessed recalled severity of gender dysphoria symptoms on alpha for this scale was 0.71.
an eight-point scale from, “0” (participants didn’t notice or
barely noticed any distress) to “7” (participants’ stress was so Friendship Group Dynamics Several items asked about
severe that it strongly interfered with their ability to function potential friendship group dynamics potentially relevant to
in their daily life). Participants rated this item for three time the onset of transgender identification. For example, one item
periods: before identifying as transgender, during the period asked: “At the time you started to identify as transgender, did
of transgender identification, and after transgender identifi- you belong to an online friend group or community where
cation ceased. The gender dysphoria-related items were not one or more friends became transgender-identified around
intended to provide a formal diagnosis, and two requirements the same time?”.
were not assessed: whether symptom duration had lasted for
at least six months and whether individuals were distressed Internet Usage The Problematic and Risky Internet Use
or impaired by their symptoms. Because of these omissions, Screening Scale (PRIUSS) (Jelenchick et al., 2014) is
our estimates for gender dysphoria diagnostic status represent a 23-item scale that assesses excessive and emotionally
upper bounds (i.e., the maximum number of participants who unhealthy Internet usage. The scale was used to retrospec-
could have met the criteria). tively assess problematic Internet usage for two time periods:
during the first six months of transgender identification and
Self‑Harm Participants indicated whether they had engaged the six months prior to the survey. This scale does not focus
in self-harm (e.g., cutting, burning, or picking) for three peri- on the content of Internet preoccupations (e.g., transgender-
ods: before, while, and after identifying as transgender. related), only on problematic Internet behavior per se. Com-
posites were formed by summing all items for the relevant
Flourishing The Secure Flourishing Measure (VanderWeele, time. Coefficient alpha for the earlier time was 0.95, and it
2017) was used to assess participant recalled general well- was 0.93 for the more recent time.
being at two points in time: while transgender identified, and
after transgender identification. This measure consists of 12 Participants’ Ratings of Psychosocial Influences Participants
questions answered on a scale of 0–10. Higher scores indicate were asked to rate the importance of 39 potential psychoso-
higher levels of well-being. Cronbach’s alphas for the two cial influences on their transgender identification on a scale
time periods were 0.86 and 0.84, respectively. from 1 (not at all important) to 5 (extremely important). We
consider these questions individually in the Results.
Possible Psychosocial Influences
Several kinds of psychosocial experiences have been identi- Transition Experiences

fied as potential causes of gender dysphoria, including the
misinterpretation of psychological distress as gender dyspho- Participants indicated which steps they had taken toward
ria (Littman, 2018, 2021). These include negative life experi- social and medical transition. Furthermore, participants
ences during childhood and adolescence, peer influence, and who had used cross-sex hormones provided information
Internet-related preoccupation. about where they obtained them and their experiences of the
informed consent process.
Recalled Childhood and Adolescent Negative Experi‑
ences Recalled childhood and adolescent trauma was
assessed using ten items from the Adverse Childhood Expe- Detransition and Desistance
riences (ACE) scale (Felitti et al., 1998). These items are
answered dichotomously and concern a variety of negative Participants indicated whether they felt most “authentic”
life events potentially experienced in the family (primarily before, during, or after transgender identification (or in more
13
than one of those periods). They also rated their likelihood gender transition. (This is a narrow and stringent sense of
of future transgender identification on a 5-point scale from “detransition” because it does not include cessation of social
“Extremely likely” to “Not at all likely.” transition.) Most participants (68%, N = 53) had taken at
least one medical step toward transition and thus may be
considered “detransitioners.” Of this group, 23% (N = 18)
Results had undergone both some hormonal treatment and surgical
intervention, 40% (N = 31) had only undergone hormonal
After exclusions, participants included 78 individuals: 71 treatment, and 5% (N = 4) had only had surgery. (We provide
natal females and 7 natal males. Although we were keenly more detail about specific treatments below.) The minority of
interested in possible differences between natal females and participants (32%, N = 25) who had not received either hor-
males, the small number of males meant that statistical power monal or surgical interventions may be considered “desist-
to test for such differences was very low. Thus, below we ers.” All participants had taken at least one social transition
indicate only when such tests were statistically significant. step, and 83% had taken three or more.
Regarding where they learned of the study, 45% (N = 35)
of participants indicated the r/Detrans subreddit, 32% Development and Onset
(N = 25) some other social media source, 10% (N = 8) the
Pique Resilience Project, 8% (N = 6) from an acquaintance, Gender Nonconformity
and 5% (N = 4) indicated some other, unnamed, source.
Participants’ current age ranged from 18 to 33 years, Participants completed a questionnaire regarding childhood
(M = 24.89, SD = 4.33). The large majority of those who indi- gender nonconformity and dysphoria (with items correspond-
cated their ethnicity identified as “white” (N = 63, 81%); 10% ing to diagnostic criteria for DSM-5 Gender Dysphoria in
(N = 8) identified as multi-ethnic, 6% (N = 5) as “Asian,” and Childhood), assessed for ages 3–11 years. Table 1 provides
3% (N = 2) as “Hispanic.” Regarding education, 36% (N = 28) the endorsement frequencies of the eight items, in descend-
had acquired a college or graduate degree, 5% (N = 4) an ing order. In general, the most frequently endorsed items
associate degree, 45% (N = 35) had attended college with- assessed gender nonconformity: behaving as the other sex
out earning a degree, and 13% (N = 10) had obtained a high and rejection of sex-typical behavior. The least commonly
school degree or equivalent. Only one individual had not endorsed items focused on gender dysphoria, dislike of one’s
graduated from high school. body and desire to be the other sex.
We examined participants’ past and present general socio- Figure 1 presents the frequency distribution of summed
political attitudes. In general, these tended to be liberal. For scores across the eight items. The most common score
example, 70% (N = 40) of those who responded indicated (24.4%, N = 19) was 0, indicating endorsement of none of
that their childhood family environment was moderately or the items. Only 7.7% (N = 6) obtained the highest possible
very liberal, compared with 23% (N = 16) who described their score, 8. The remainder of the sample was spread evenly
family as moderately or very conservative. A similar pattern across the scale, with points of rarity at 1 (only one item
emerged in their descriptions of their own, adult politics, with endorsed) and 7 (all but one item endorsed). Because we did
68% (N = 52) describing themselves as moderately or very not ask about two diagnostic requirements (duration of at
liberal, compared with 13% (N = 10) as moderately or very
conservative (and these were all moderate). Consistent with
social liberalism, most participants indicated that religion Table 1 Diagnostic criteria endorsed for DSM-5 Gender Dysphoria
in Childhood
was not very important, with 82% (N = 64) agreeing that it
was not at all or slightly important, compared with only 18% Item N (%)
(N = 14) who agreed that it was at least moderately important. participants
endorsed
Attitudes toward gay and transgender rights are especially
pertinent, and participants’ attitudes about these were espe- Strong preference for sex-atypical toys 44 (56.4)
cially liberal: 86% (N = 67) strongly supported gay marriage Strong rejection of sex typicality (i.e., masculinity for 39 (50.0)
rights, and 91% (N = 71) supported transgender rights. Only boys, femininity for girls)
one person expressed opposition to either of these, opposing Desire to dress as other sex and/or resistance to dress- 35 (44.9)
ing as natal sex
transgender rights.
Strong preference for cross-sex roles in play 32 (41.0)
Strong preference for playmates of other sex 25 (32.1)
Detransition and Desistance Status
Strong desire for other sex’s physical attributes 23 (29.5)
Strong dislike of sexual anatomy 21 (26.9)
The survey defined “detransition” as stopping the usage of
Strong desire to be other sex 20 (25.6)
cross-sex hormones and/or having surgery to reverse previous
13
reinterpreting past feelings and behaviors to be consistent

with gender dysphoria or transgender identity; (3) labeling of
feelings and experiences as “gender dysphoria” or “transgen-
der;” (4) considering past and current feelings and experi-
ences as proof of being transgender; and (5) acquiring the
belief that transition would be the solution to one’s problems.
On average, participants endorsed 4.22 (SD = 1.23) of the five
items. Furthermore, the number of items endorsed was posi-
tively related to the numeric scale of whether respondents
thought that rapid-onset gender dysphoria applied to them,
r(78) = 0.23, p = 0.044.
Table 2 provides data on timing of when participants
both started and stopped identifying as transgender. Perhaps
surprisingly, age of first transgender identification was only
weakly related to degree of childhood gender dysphoria,
r(78) = −0.17, p = 0.15—although the direction of the asso-
ciation was in the intuitive direction, with greater childhood
Fig. 1 Frequency distribution of summed scores of DSM-5 diagnostic gender dysphoria predicting earlier transgender identifica-
criteria for gender dysphoria in childhood tion. Nor was participant’s degree of agreement that their
gender dysphoria was “rapid-onset” significantly associated
with age at trans-identification, r(78) = 0.01, p = 0.96. The
least six months and distress or impairment), at most 16.7% length of time during which participants were transgender-
(N = 13) of participants could have met diagnosis of DSM-5 identified was significantly related to the degree to which they
Gender Dysphoria in Childhood (endorsement of at least six identified with “rapid-onset,” r(78) = −0.24, p = 0.03, with
of eight items). endorsement of “rapid-onset” associated with shorter dura-
tion of transgender identification. Duration of transgender
Rapid Onset identification was also positively related to childhood gender
dysphoria, r(78) = 0.25, p = 0.03.
One survey item explained the term “rapid-onset gender
dysphoria” (ROGD) and asked participants whether they Sexual Orientation
believed it applied to them. Fifty-three percent (N = 41) of the
sample answered “yes,” 23% (N = 18) did not know, and 24% Attraction to Males versus Females
(N = 19) answered “no.” After transforming this into a three-
point numeric scale (from 0 = “No” to 2 = “Yes”), we exam- Figure 2 presents the frequency distributions of current Kin-
ined its correlation with the self-reported childhood gender sey scores, separately for male and female participants. Kin-
dysphoria scale. This correlation, r(78) = −0.57, p < 0.0001, sey scores of 0 represent exclusive attraction to the other sex,
indicated that those who reported greater childhood gender and scores of 6 exclusive attraction to one’s own sex; scores
dysphoria were much less likely than those who reported of 1–5 represent intermediate degrees of preference. Natal
less childhood gender dysphoria to believe that rapid-onset females’ attraction patterns were strongly female-biased, with
gender dysphoria applied to them. 43 participants indicating greater attraction to women than to
Participants were asked whether, while becoming gen- men, and 16 indicating greater attraction to men. The most
der dysphoric or transgender-identified, any of five poten- common Kinsey score among natal females was 6, indicat-
tial changes happened over the course of three months or ing exclusive attraction to women. This score was endorsed
less: (1) adopting the belief that “gender dysphoria” was the by 43% (N = 29) of female respondents who answered this
only explanation for preexisting feelings and emotions; (2) question.
Table 2 Time course of trans- Mean (SD) Range

identification and desistance
Age first identified as transgender (years) 17.12 (3.82) 6–28
Length of time identified as transgender (years) 5.35 (3.31) 1–14
Age stopped identifying as transgender (years) 22.46 (4.21) 15–32
Length of time since identifying as transgender (years) 2.42 (2.24) 0.5–12
13
Fig. 2 Frequency distributions of Kinsey scores for natal females and natal males
Attraction patterns of natal males were also female- Mental Health Before, During, and After
biased, with 3 of 7 participants indicating exclusive Transgender Identification
attraction to women. Importantly, no natal male endorsed
exclusive or near-exclusive attraction to men (i.e., Kinsey Psychiatric Diagnoses
scores of 6 or 5, respectively), suggesting that none of
these participants would be considered homosexual by Table 3 presents the frequencies that participants said they
Blanchard’s taxonomy. had received the 13 psychiatric diagnoses before their
In samples not recruited for being gender dysphoric, transgender identification. The table also includes the life-
there is typically a correlation between recalled gen- time frequencies of these diagnoses. (Lifetime diagnoses
der dysphoria/nonconformity and adult sexual orien- include all prior diagnoses.) The rate of any diagnosis was
tation (Bailey & Zucker, 1995). In the current sample, quite high, with only 5% (N = 4) of participants having none
the correlation between recalled childhood gender dys- of the 13 diagnoses queried during their lifetime. The mean
phoria and adult sexual orientation (i.e., Kinsey score) numbers of diagnoses from this list reported by participants
was r(68) = −0.06, p = 0.60 for females and r(7) = 0.89,
p = 0.007 for males. In both cases, higher recalled gender
dysphoria was associated with greater male attraction, Table 3 Frequency of psychiatric diagnoses before trans-identifica-
although this correlation was statistically significant only tion and during lifetime
for males. Diagnosis Before trans-iden- Lifetime N (%)
tification N (%)
Anxiety 47 (60.26%) 62 (79.49%)

Autogynephilia and Autoandrophilia
ADHD 19 (24.36%) 32 (41.03%)
Autism spectrum disorder 7 (8.97%) 17 (21.79%)
On average, males agreed with at least two of the three
Bipolar 9 (11.54%) 17 (21.79%)
autogynephilia items, and females one of the three
Borderline personality disorder 3 (3.85%) 8 (10.26%)
autoandrophilia items, MM = 2.29 (SD = 1.25), MF = 1.06
Depression 49 (62.82%) 62 (79.49%)
(SD = 1.16), d = 1.02, p = 0.009. Only one item differed
Eating disorder 18 (23.08%) 23 (29.49%)
significantly: 6/7 males had experienced sexual arousal
Hair pulling 8 (10.26%) 8 (10.26%)
while cross-dressing, compared with 15/71 females, χ2(1,
OCD 14 (17.95%) 15 (19.23%)
N = 78) = 13.51, p = 0.0002. Among natal females, there
PTSD 12 (15.38%) 30 (38.46%)
was a substantial negative correlation between autoandro-
Schizophrenia 4 (5.13%) 9 (11.54%)
philia and Kinsey score, r(68) = −0.39, p = 0.0009, indi-
Selective mutism 1 (1.28%) 2 (2.56%)
cating that higher autoandrophilia scores were especially
None of the above 7 (8.97%) 4 (5.13%)
common among respondents more attracted to males.
Other 4 (5.13%) 11 (14.10%)
13
were 2.46 (MD = 2; SD = 1.97) before transgender identifica- was associated with markedly less self-harm, with 71%, 64%,
tion, and 3.65 (MD = 4; SD = 1.98) lifetime. The most com- and 23% of participants saying they had self-harmed before,
mon diagnoses, both before transgender identification and during, and after transgender identification. Treating the
during the lifetime, were anxiety (60.26% before transgender dichotomous variable of harm as numeric (which is defensi-
identification and 79.94% lifetime) and depression (62.82% ble for proportions that are not extreme; see Hellevik, 2009),
before transgender identification and 79.49% lifetime). the contrast between self-harm after transgender identifica-
tion was significantly lower than the average of the other two
Self‑Harm Participants also indicated whether they had periods, paired t(77) = 8.85, p < 0.0001, which did not differ,
engaged in self-harm during each of the three periods paired t(77) = 1.09, p = 0.28.
(before, during, and after transgender identification), and the
frequency distributions for all participants are presented in Gender Dysphoria We assessed gender dysphoria across
Fig. 3. The lifetime rate of self-harm was high, 79% (N = 62). time in two ways. In the first, we asked participants whether
Natal females were more likely to have any history of self- they agreed with six statements derived from DSM-5 criteria
harm (83%; N = 59) compared with natal males (43%; N = 3), for Gender Dysphoria in Adolescents and Adults (e.g., “Did
Fisher’s exact test = 0.03. Compared with both earlier peri- you feel a strong desire to be the opposite natal sex?”). These
ods, the period after cessation of transgender identification questions were asked both for the period during trans-identifi-
cation and for the period since trans-identification ended. The
frequency distribution for this variable is presented for these
two periods in Fig. 4. There was a marked decrease in gen-
der dysphoria from trans-identification, M = 4.51 (SD = 1.59)
to after trans-identification, M = 0.98 (SD = 1.52), d = 2.27,
paired t(77) = 16.65, p < 0.0001.
Strength of gender dysphoria was also assessed using a sin-
gle item with responses ranging from 0 (no distress over natal
sex) to 7 (distress severe enough to interfere with ability to
function in daily life). Figure 5 shows frequency distributions
for responses to this item for three periods: before trans-iden-
tification, during trans-identification, and after trans-iden-
tification. Dysphoria rose considerably in the sample after
participants began identifying as trans and dropped drasti-
cally after trans-identification ceased. To analyze these trends
Fig. 3 Frequency distributions of self-harm for all participants for the properly, we conducted the following within-subjects analy-
periods before, during, and after trans-identification ses: Two orthogonal polynomial variables were constructed
Fig. 4 Frequency distributions of the number of DSM-5 gender dysphoria participants met during trans-identification and after detransition/
desistance
13
Fig. 5 Frequency distributions of participants’ self-rated strength of gender dysphoria before, during, and after trans-identification
(Judd et al., 2017). The first, linear contrast, representing the ishing increased by 2.55 points on a 10-point scale, d = 1.49,
decline in dysphoria from before trans-identification to after paired t(57) = 9.26, p < 0.0001.
trans-identification, was 2.8 points, t(60) = 10.7, p < 0.0001.
The second, quadratic contrast, comparing dysphoria dur- Possible Psychosocial Influences on Transgender
ing trans-identification to the average of the periods before Identification and Gender Dysphoria
and after trans-identification, was 2.3 points, t(59) = 14.4,
p < 0.0001. Thus, participants’ trans-identification phase was Participants were asked to rate the importance of 39 potential
especially dysphoric, and their post-trans-identification phase psychosocial influences on their becoming trans-identified
especially non-dysphoric. on a scale from “not at all important” (which we assigned
a value of 1) to “extremely important” (5). Mean ratings
Flourishing Participants completed the Secure Flourishing are presented in Table 4 in descending order of magnitude.
Measure to assess general well-being, for two time periods: The item most closely related to conventional understand-
while they identified as transgender and after they stopped ing of gender dysphoria, “Being born in the wrong body,”
identifying as transgender. Figure 6 shows the frequency obtained a mean rating of 2.89 (SD = 1.44), substantially
distributions of self-reported Flourishing during and after lower than the highest-rated item, “Interpreting the feelings
participants’ trans-identification. On average, participants of trauma or a mental health condition as gender dysphoria”
reported that after transgender identification ended Flour- (M = 3.96, SD = 1.33) and also lower than 22 other poten-
tial influences. Endorsement of “Being born in the wrong
Fig. 6 Frequency distribution of Flourishing for the periods during trans-identification and after detransition/desistance
13
body” was negatively correlated with the self-endorsement of of participants responded that the majority of their offline
rapid-onset gender dysphoria, r(74) = −0.37, p = 0.001. Even and online friends became transgender-identified (34.6% and
participants who did not believe that ROGD applied to them 38.5%, respectively) and participants acknowledged that their
rated “Interpreting the feelings of trauma or a mental health offline and online friendship groups engaged in mocking peo-
condition as gender dysphoria” as slightly more relevant than ple who were not transgender-identified (42.3% and 41.0%,
“Being in the wrong body” to their transgender identification respectively).
(ratings of 3.7 versus 3.6, respectively), although that differ- Hypotheses regarding social contagion of gender dyspho-
ence was not statistically significant. ria have emphasized the idea that trans-identification often
follows immersion in certain Internet sites with intense dis-
Trauma A common belief among clinicians who favor cussion of transgender phenomena, such as Tumblr (Litt-
ROGD theory is that traumatic events can contribute to the man, 2018). Participants completed the PRIUSS for two time
occurrence of gender dysphoria (Evans & Evans, 2021; With- periods. Participants’ scores for the six-month period after
ers, 2020). Participants completed the Adverse Childhood they started to identify as transgender M = 34.03 (SD = 24.03)
Experiences (ACE) checklist, a 10-item scale assessing the were substantially higher than those for the six-month period
experiences of 10 putative traumatic factors prior to age 18. prior to the survey, M = 19.34 (SD = 14.72), d = 0.83, paired
These items pertained to experiences within the home fam- t(76) = 7.86, p < 0.0001. Furthermore, the average of earlier
ily. The mean score was 3.94 (SD = 2.34), which is relatively scores was substantially higher than the recommended cutoff
high. For example, in a large representative study conducted for “problematic Internet usage,” and the average of later
by the CDC, only 15.2% of women and 9.2% of men had scores was substantially lower than that cutoff. Participants’
scores as high as 4, the median and approximate mean of the scores correlated substantially across the two time periods,
current sample. r(77) = 0.61, despite the large drop in average scores, sug-
Participants also indicated whether they had experienced gesting persistent individual differences in Internet usage.
any of nine negative experiences likely to have been expe- The correlation between participants’ earlier PRIUSS score
rienced more recently—although prior to transgender iden- and the degree to which they endorsed the idea that rapid-
tification—and not necessarily within the home. Table 5 onset gender dysphoria applied to themselves was low,
provides the frequencies for these items. The mean num- r(77) = −0.03, p = 0.77, counter to predictions.
ber of these experiences reported by participants was 3.60
(SD = 2.20). Transition Experiences
The correlation between the self-reported number of
adverse childhood experiences and the number of more recent Social and Medical Transition Steps We asked participants
negative experiences was high, r(77) = 0.59. Table 6 presents about social and medical steps they had taken during their
correlations for these two negative experiences scales with transition. Table 7 presents these steps, separated by natal
several potentially relevant variables. ACE scores were sig- sex where appropriate. On average, participants had taken
nificantly associated with duration of trans-identification 3.62 of the social steps (SD = 1.05), and all had taken at least
(higher ACE scores predicting longer duration), belief that one. Most participants had used a different name, different
“rapid-onset gender dysphoria” applies to oneself (higher pronouns, and had modified their appearance (clothes, hair,
ACE scores predicting less agreement), and number of men- makeup). Most natal females had used a binder to give the
tal disorders before trans-identification (higher ACE scores impression of a flat chest. Nearly half had used a prosthetic
predicting more disorders). penis (i.e., packer). Among natal males, the use of prosthetic
breasts or female genitals (i.e., gaffs) were comparatively
Peer Influences Previous work identified unique friendship rare. The mean number of social steps taken by natal females,
group dynamics associated with the onset of transgender 3.61 (SD = 1.02), was greater than this number for natal
identification. These included friendship groups mocking males, 2.86 (SD = 1.07), t(76) = 2.05, p = 0.043. Regard-
people who were not transgender-identified or LGBTIA ing medical transition steps, all natal males and most natal
and friendship groups where more than 50% of the friend- females had used cross-sex hormones (estrogen and testos-
ship group became transgender-identified (Littman, 2018). terone, respectively). Almost a third of natal females had
Participants in the current study were asked if, at the time undergone breast removal, a small number had their uterus
of transgender identification, they belonged to a friendship or ovaries removed, and none had received phalloplasty. No
group where one or more members of the group became natal males had undergone gender-affirming surgeries.
transgender-identified around the same time. The majority More than half (66.7%, N = 52) of the participants sought
(60.3%) answered in the affirmative (with 24.4% referring to medical care to obtain cross-sex hormones and the major-
offline friendship groups, 14.1% referring to online friend- ity of those seeking cross-sex hormones (92.3%, N = 48)
ship groups, and 21.8% referring to both). More than a third received them. Four participants sought but did not receive
13
Table 4 Ratings of importance of potential psychosocial influences on becoming transgender-identified and gender dysphoric
Potential influence Mean Importance (SD)
Interpreting the feelings of trauma or a mental health condition as gender dysphoria 3.96 (1.33)
Internal feelings of misogyny (or misandry) 3.87 (1.31)
Wanting to avoid how women (or men) are treated in society 3.83 (1.38)
Exposure to other people’s misogyny (or misandry) 3.78 (1.37)
Self-hatred and wanting to be a completely different person 3.78 (1.49)
Wanting to avoid sexual expectations or oversexualization 3.77 (1.39)
Not fitting in with members of their natal sex 3.69 (1.21)
Maladaptive coping mechanism 3.69 (1.42)
Needing to figure out one’s identity 3.65 (1.16)
Trying to cope and avoid painful feelings 3.61 (1.37)
Identifying with opposite-sex characters in books, movies, video games, etc. 3.51 (1.50)
Believing that they were not good enough in the roles and behaviors expected of their natal sex 3.37 (1.48)
Tumblr 3.34 (1.42)
Believing that one was not feminine enough (if female) or masculine enough (if male) 3.25 (1.44)
Not being interested in the things that most other members of natal sex were interested in 3.23 (1.36)
Social influence 3.18 (1.43)
It was an important part of identity development at the time 3.18 (1.30)
Wanting to avoid feeling vulnerable to sexual predators 3.16 (1.70)
A person known offline (in real life) 3.16 (1.53)
Sexual trauma 3.15 (1.65)
YouTube transition videos 3.10 (1.58)
Sexual harassment 2.97 (1.53)
Being born in the wrong body 2.89 (1.44)
Love of or fascination with masculinity (if female) or femininity (if male) 2.88 (1.41)
Difficulty accepting self as lesbian (if female), gay (if male), or bisexual 2.86(1.65)
Social contagion 2.84 (1.51)
A community of people met online 2.83 (1.33)
A person met online 2.79 (1.49)
YouTube transgender celebrities 2.78 (1.58)
A group of people known offline (in real life) 2.70 (1.68)
Desire to belong to a friend group 2.66 (1.46)
A dating, romantic or sexual partner 2.66 (1.64)
Perceptions of self and society that are related to being a person with Aspergers 2.64 (1.76)
Perceptions of self and society that are related to being a person with autism 2.64 (1.85)
Wanting to avoid the homophobia that would be experienced for being lesbian (if female), gay (if male) or bisexual 2.55 (1.58)
Being bullied 2.48 (1.36)
Sexual excitement when fantasizing about being the other sex 2.42 (1.59)
Experiencing homophobic bullying 2.29 (1.25)
Negative reaction to pornography 2.28 (1.45)
Falling in love or liking (romantically) someone who is not attracted to people of one’s own natal sex 2.24 (1.59)
Peer pressure 2.18 (1.48)
A school-based club or organization (like a GSA or University LGBT advocacy club) 2.15 (1.45)
Reddit 2.14 (1.47)
Wanting to be part of a social movement 2.06 (1.34)
A therapist 2.03 (1.42)
The desire to remain in an existing friend group 1.96 (1.44)
Positive reaction to pornography (liking or being influenced by pornography) 1.86 (1.30)
Cosplay community 1.83 (1.40)
Exposure to high levels of hormones prenatally 1.81 (1.15)
Not wanting to be part of the “oppressor group” 1.80 (1.22)
13
Table 4 (continued)
Potential influence Mean Importance (SD)
Thinking that their parents would be homophobic toward them 1.71 (1.23)
A speaker who gave a presentation at school 1.51 (1.19)
A Group therapy setting 1.48 (1.15)
DeviantArt 1.44 (0.88)
A family member 1.29 (0.71)
A religious community 1.20 (0.76)
A gaming community 1.04 (0.21)
Community or friends at a summer camp 1.02 (0.15)
Mean importance score derived from scale 1 = “not at all important;” 2 = “somewhat important;” 3 = “moderately important;” 4 = “very impor-
tant;” 5 = “extremely important.” Responses of “N/A” were excluded. N/A responses were those that did not apply to a participant and so could
not be rated for importance
Table 5 Additional negative experiences recalled prior to trans-iden- Informed Consent Asked who provided cross-sex hormones,
tification participants had most often consulted primary care physi-
Traumatic experience Number reporting Percentage cians (41%), followed by psychiatrists who treat adults (19%),
experience reporting experi- endocrinologists (18%), psychiatrists who treat children and
ence adolescents (10%), social workers (12%), and nurse practi-
Peer exclusion 61 78.2 tioners (8%). About 40% of participants had obtained cross-
Bullying 50 64.1 sex hormones at a clinic specializing in gender issues, with
Sexual harassment 44 56.4 the remainder going to a general health clinic (27%), a private
Homophobic bullying 36 46.2 practice (14%), planned parenthood (5%), a private gender
Sexual abuse 27 34.6 clinic (1%), or other sources. Participants who started cross-
Witnessing abuse of a family 24 30.8 sex hormones continued to take them for a mean duration of
member 2.59 years (SD = 2.03).
Abuse by dating partner 17 21.8 Most (61.5%, N = 32) participants had obtained cross-sex
Rape 15 19.2 hormones from clinical practices using the “informed con-
Attempted rape 7 9.0 sent” model of care. The other participants indicated either
that the practice did not use informed consent (23.1%, N = 12)
or that they were uncertain whether it did so (15.4%, N = 8).
cross-sex hormones. Reasons included parental refusal With respect to the adequacy of informed consent, most par-
(N = 3); participant decision not to obtain cross-sex hormones ticipants were informed about both risks (89.6%) and ben-
(N = 2) and refusal of the clinician to prescribe cross-sex hor- efits (77.1%) of cross-sex hormones. However, many believed
mones (N = 1). that the information provided was not adequate: 66.7% felt
Only 27.1% of participants informed the clinician or clinic they were inadequately informed about risks and 31.3% felt
that facilitated their transition that they had detransitioned. this about benefits. Only one participant (2.1%) reported
that a clinician provided information about treatment alter-
natives to cross-sex hormones (including the possibility of
Table 6 Correlations with Variable Correlation with child- Correlation with

recalled negative experiences hood adverse experi- later negative expe-
ences riences
r p r p
Gender Dysphoria before trans-identification 0.08 0.50 0.07 0.58

Age at start of trans-identification – 0.09 0.41 0.10 0.39
Duration of trans-identification 0.41 < 0.001 0.25 0.03
Agreement that ROGD applies to self – 0.23 0.04 0.04 0.72
Number of mental disorders before trans-identification 0.23 0.047 0.35 0.002
Number of mental disorders, lifetime 0.14 0.21 0.39 < 0.001
13
Table 7 Steps taken for social and medical transition causes for [their] gender dysphoria were more complicated
N (%) than [they] previously understood them to be” (M = 4.25,
SD = 1.22); and the participant’s “personal definition of
Social transition ‘female’ and ‘male’ changed and [they] now felt comfort-
Different name 68 (87.18%) able identifying as natal sex” (M = 4.03, SD = 1.42). Factors
Pronouns 71 (91.03%) that might be described as external pressures to desist or
Clothes/Hair/Makeup 73 (93.59%) detransition obtained the lowest ratings of importance scores,
Natal female including “transphobia or discrimination while transgen-
Binder 63 (88.73%) der identified” (M = 1.46, SD = 0.84); “pressure from fam-
Prosthetic penis 30 (42.25%) ily” (M = 1.37, SD = 0.75); “religion or religious beliefs”
Natal male (M = 1.15, SD = 0.61); and “peer pressure” (M = 1.11,
Breast form 1 (16.67%) SD = 0.48).
Gaff 1 (16.67%) Anecdotally, it is common for transgender individuals
Medical transition to report feeling most “authentic” following gender transi-
Puberty blockers 2 (2.56%) tion. We asked participants if they felt most authentic before
Hormones 49 (62.82%) identifying as transgender, while identifying as transgender,
Surgery 22 (28.21%) or after they no longer identified as transgender. (Partici-
Natal female pants could select more than one option). The overwhelming
Testosterone 42 (59.15%) majority of participants (95%) reported feeling most authen-
Breast removal 21 (29.58%) tic after detransition/desistance. Only 9% felt most authentic
Uterus removal 3 (4.23%) while identifying as transgender.
Ovaries removal 2 (2.82%) We asked participants to rate the likelihood that they might
Natal male re-identify transgender in the future. Only three participants
Estrogen 7 (100.00%) viewed this outcome as likely (one as “very likely” and two
Anti-androgen 6 (85.71%) as “moderately likely”). The remaining participants indicated
Breast augmentation 0 (0.00%) that this was somewhat unlikely (20.5%) or not at all likely
Testes removal 0 (0.00%) (75.6%).
Penis removal 0 (0.00%)
Vaginoplasty 0 (0.00%)
Discussion
Results of our exploratory and wide-ranging study of

not taking cross-sex hormones), and 75.0% of participants detransition and desistance among previously transgender-
reported that they received inadequate information about identified young adults are necessarily tentative. Our results
these alternatives. suggest that the following applies to many of our partici-
Participants were asked whether they were informed about pants: Adolescents and young adults struggling with mental
scientific evidence regarding late-onset gender dysphoria. health issues began to experience gender dysphoria—often
Fewer than one-tenth (8.3%) of participants indicated that suddenly and without prior history of gender issues. Subse-
they were informed by their clinician about the lack of long- quently these individuals identified as transgender. Transgen-
term studies about natal females with late-onset gender dys- der identification was not fleeting, but typically lasted for
phoria. Similarly, only 12.5% were informed that the risks, several years, and was associated with serious social and
benefits, and outcomes for medical transition of late-onset medical steps. All our informants took steps to socially tran-
gender dysphoric youth have not been well studied. sition, and most also obtained and used cross-sex hormones.
An appreciable minority also had “gender-affirming” surgery.
Desistance and Detransition During transgender identification, gender dysphoria and gen-
eral unhappiness increased considerably.
Participants were asked to rate the importance of 20 factors In our study, the factors most important to relinquish-
on the cessation of their transgender identification using a ing a transgender identification were internal factors, such
scale from “not at all important” (coded for analyses as 1) as participants own thought processes, changes in partici-
to “extremely important” (5). Mean ratings are reported in pants’ personal definitions of male and female, and becom-
Table 8 in descending order of magnitude. The factors with ing more comfortable identifying as their natal sex. External
the highest rating of importance were the participant’s “own factors such as discrimination and pressure from family were
thought processes” (M = 4.74, SD = 0.65); “feeling that the rated as least important. The greater importance of internal
13
Table 8 Ratings of importance of various factors to the cessation of transgender identification

N Mean (SD)
Participant’s own thought processes 78 4.74 (0.65)

Feeling that the causes of gender dysphoria were more complicated than participant previously understood 75 4.25 (1.22)
Understanding of “female” and “male” changed so that participant now felt comfortable identifying as natal sex 75 4.03 (1.42)
Feeling that “transgender” no longer fit participant 73 3.86 (1.37)
Discovering a specific cause of gender dysphoria, such as trauma or a mental health condition 71 3.68 (1.45)
Feeling uncomfortable with the transgender community 74 3.45 (1.50)
Lack of improvement in mental health while identifying as transgender 76 3.41 (1.46)
Change in participant’s political or philosophical views 71 3.25 (1.52)
Unmet expectations about life improvement 73 3.04 (1.52)
Worsened mental health while identifying as transgender 76 3.03 (1.62)
Resolution of strong emotions that led to transgender identification 65 2.72 (1.43)
Transgender identification no longer served a purpose 76 2.67 (1.33)
Dissatisfaction with physical changes from transition 59 2.59 (1.49)
Wishing to return to cisgender 69 2.46 (1.47)
Missing life from before coming out or transition 70 2.19 (1.38)
Difficulty finding someone for a dating, romantic, or sexual relationship 62 1.79 (1.38)
Transphobia or discrimination while transgender identified 72 1.46 (0.84)
Pressure from family 63 1.37 (0.75)
Religion or religious beliefs 52 1.15 (0.61)
Peer pressure 63 1.11 (0.48)
Mean importance score derived from a scale where 1 = “not at all important”; 2 = ”somewhat important”; 3 = ”moderately important”; 4 = ”very
important”; 5 = ”extremely important.” “Not applicable” responses were excluded from counts, and so N represents the number of responses
with numeric ratings
factors than external factors is consistent with the findings Our study deviated from the near-ideal design in several
from other studies of detransitioners (Littman, 2021; Van- respects. Our sample of detransitioners and desisters was
denbussche, 2022) and differs from results of studies of recruited by distributing announcements through social
currently transgender-identifying individuals (James et al., media and relevant Internet sites. Hence, we cannot know
2016; Turban et al., 2021). After detransition and desistance, whether our informants were representative of detransition-
informants became much happier and much less gender dys- ers and desisters. Nor can we know how they differed from
phoric. They reported little inclination to regret detransition transgender-identifying individuals who have not detransi-
and desistance. Before elaborating these and other findings, tioned or desisted. Our study relied exclusively on detransi-
we consider our study’s scientific limitations. tioners’ and desisters’ self-reports. Furthermore, informants
were surveyed only once, but they reported on their own
Limitations feelings and behavior across a wide range of time, from child-
hood through early adulthood.
A methodologically near-ideal study of detransition and Although our study’s limitations seriously constrain our
desistance would follow a randomly selected group of ability to answer some questions with certainty, they con-
transgender-identified youth over time, assessing relevant strain us less in some other important domains. Obviously,
factors (e.g., gender dysphoria, transition steps, current our design does not allow us to estimate how common detran-
adjustment, and sexuality) repeatedly. Furthermore, to reduce sition and desistance are. Nor can we know which if any
distortions due to self-report bias, additional informants (e.g., variables predict detransition and desistance. Some variables
parents and therapists) would be enlisted. This design would that we studied, including childhood gender dysphoria, nega-
allow the estimation of the likelihood that transgender-identi- tive life events, and current sexual orientation, may some-
fied individuals would take various transition steps, that their times be inaccurately reported. Conclusions depending on
well-being would improve, and that they would detransition these data are especially tentative. However, participants’
or desist—among other important potential findings. Further- experiences of gender dysphoria and of flourishing before,
more, this design would allow exploration of which factors during, and after transgender identification are more likely
predict important later outcomes. to be accurately remembered. Other information provided
13
by respondents that we see little reason to question includes in our study were already much higher than this, even though
psychiatric diagnoses, Internet usage, social and medical our participants were much younger than 75 years.
transition steps, experiences obtaining cross-sex hormones, The sample also reported a high lifetime rate of self-harm:
and experiences with informed consent. 83%. Unfortunately, again, we are unaware of a close com-
A final reason why our study makes a valuable contribu- parison sample. A US cohort of adults younger than 30 years
tion is that little is currently known about detransitioners and produced a rate of 19%. A more recent study of British adults
desisters, especially during the recent past. Indeed, little is found a lifetime rate of self-harm of 5% (Liu, 2023). A recent
known about any aspect of gender dysphoria that begins after study of Norwegian university students found a lifetime rate
childhood, especially among natal females. This is true even of self-harm of 19.6%, much higher than the British sample
though the incidence of adolescent-onset gender dyspho- but much lower than the present one.
ria among natal females has been briskly growing (Zucker, One variable that did not allow generalization but instead
2019). When little is known, imperfect research is often better suggested considerable divergence, is self-reported child-
than no research. It can provide provisional answers, better- hood gender dysphoria. Scores on the relevant measure were
informed hypotheses, and ideas for future research. In the widely dispersed. The most common score was zero (i.e., no
remaining Discussion, we attempt to provide these. childhood gender dysphoria), but a considerable minority
(30.8%, 24/78) of scores on that variable exceeded the middle
Who Are the Detransitioned? of the scale. Validity of this variable is especially problem-
atic because it relies on childhood memory, Furthermore,
Only a history of adopting and then relinquishing a exaggerated memories of childhood gender nonconformity
transgender identity—the primary inclusion criteria for and dysphoria may be encouraged in both clinical and peer
our study—was true of all participants. Some other, less contexts (Littman, 2018). Thus, our results concerning child-
uniform, trends were also evident. For example, partici- hood gender nonconformity are especially tentative. Future
pants were far more likely to be natal females than natal research would benefit by including reports of childhood
males. Some other kinds of gender dysphoria occur more behavior using additional informants (e.g., parents).
often among natal males than among natal females (Bailey
& Blanchard, 2017; Zucker et al., 2012). Despite the small Causes of Gender Dysphoria
number of natal male participants in our study, results
suggested some important sex differences. Nearly all the Keeping in mind these caveats, what do our results suggest
natal male participants reported a history of sexual arousal about causes of gender dysphoria in our sample? Approxi-
while cross-dressing, a primary sign of autogynephilia. mately one-half of the sample endorsed the applicability
Autogynephilic gender dysphoria is one of two well- of “rapid-onset gender dysphoria” (ROGD) to themselves,
established types of gender dysphoria in natal males. The one-quarter was uncertain, and one-quarter disagreed with
other type, homosexual gender dysphoria, occurs among this application. This is consistent with the finding that most
natal males whose gender nonconformity (and usually participants did not recall high levels of childhood gender
gender dysphoria) is obvious during childhood and whose dysphoria. Furthermore, those reporting lower degrees of
sexual attraction is exclusively toward other males. None childhood gender dysphoria were more likely to endorse an
of our male participants reported exclusive attraction to explanation of ROGD for themselves.
other males. Our results are consistent with the possibility Two other aspects hypothesized to contribute to ROGD
that all the natal male participants were autogynephilic. were surveyed: emotional turmoil unrelated to gender dys-
Neither autogynephilia nor its gender-reversed version, phoria, and social influence (Littman, 2018). Participants
autoandrophilia, has been established as an important rated adjustment to mental health challenges and to trauma
cause of gender dysphoria among natal females. as more important causes than the feeling of “being born in
Our participants reported seemingly high levels of previ- the wrong body” as reasons for transgender identification
ous mental problems. These usually predated transgender (Table 4), although those who did not believe that ROGD
identification, with more than 90% of participants reporting applied to them rated them similarly. Regarding social influ-
a prior clinical diagnosis. Mean (and median) number of life- ences, a substantial minority of participants reported previ-
time diagnoses exceeded 2. Unfortunately, we are not aware ous immersion in peer groups with high levels of transgender
of good comparison estimates for representative samples identification. Furthermore, participants reported a high level
of youth for the number of lifetime diagnoses. A large and of problematic Internet usage during the first six months of
epidemiologically representative 2005 study estimated that transgender identification.
by age 75 about half of US adults will be diagnosed with a We have noted that participants reported high levels of
mental disorder (Kessler et al., 2005). The rates self-reported stress and trauma, and some believed these experiences were
important in the development of their gender dysphoria.
13
However, drawing causal conclusions about the role of have transitioned at similar ages—in our sample the mean
trauma in causing psychological problems has been difficult was approximately 17 years—adjust well to their gender
in general. This is because there are often multiple possible change. Our participants invested a great deal of their lives
explanations for associations between trauma and psycho- in their gender transitions—in terms of time, disruption, and
logical problems (Bailey & Shriver, 1999). This difficult serious social and medical steps. Thus, we do not believe that
scientific issue cannot be resolved in this study. a principled case can be made that participants detransitioned
Finally, the concept of rapid-onset gender dysphoria may because they were never gender dysphoric.
be more valid for natal females than for natal males. Auto-
gynephilic natal males may appear to have a rapid onset, Future Directions
but they are typically aware of autogynephilic arousal since
puberty, when strong sexual feelings begin. To be sure, both Follow-up studies of gender dysphoric youth are urgently
autogynephilic males and ROGD females may, in principle, needed. Ideally, gender dysphoric youth should be recruited
be socially influenced toward adopting a transgender identity. using a variety of sources, including social media, treatment
However, their underlying motivations differ. facilities, gender clinicians, and parent groups. When possible,
information should be obtained from multiple sources, espe-
cially youth and their parents. Results of both the present study
Transition Experiences
and prior research support the desirability of collecting data on
several important variables: childhood gender nonconformity
Our participants had undergone substantial gender transition.
and dysphoria, sexuality, psychiatric diagnoses, parental atti-
On average, participants identified as transgender for nearly
tudes toward transition, transgender prevalence in peer groups,
five years (Md = 4 years). During this time, all participants
current gender dysphoria, and current psychological adjust-
took at least one step toward socially transition, such as name
ment. Organizations providing clinical services to gender dys-
and pronoun changes, as well as changing their physical pres-
phoric youth have a particular obligation to follow these youth
entation; most participants took several steps. Most obtained
and assess their outcomes. Unfortunately, in North America at
cross-sex hormones, and a substantial minority also under-
least, we see little evidence that this presently occurs.
went serious surgeries: 30% of female participants had had
their breasts removed. Although most participants recalled
Conclusions
receiving information about the risks and benefits of cross-
sex hormones, a majority did not feel the information they
We surveyed a sample of young adults who previously identi-
were provided about risks was adequate.
fied as transgender but had detransitioned or desisted. Most
participants were born female. Mental health issues, includ-
Detransition and Desistance ing prior diagnoses and a history of self-harm, were espe-
cially common. A history of gender dysphoria during child-
Detransition and desistance were associated with marked hood was reported by a nontrivial minority of participants. A
improvements in psychological functioning. On several slight majority believed their histories were consistent with
relevant measures—gender dysphoria, flourishing, and self- rapid-onset gender dysphoria. Factors most associated with
harm—participants indicated great improvement after they detransition were internal factors, reflecting psychological
stopped identifying as transgender. These findings depend on change, rather than external factors, such as family or social
retrospective self-report, but this seems appropriate. pressure. Detransitioned participants reported that they had
Our study cannot resolve whether detransition and desist- become much less gender dysphoric, and much happier, than
ance caused these changes in our participants. It is possible, they were during their period of trans-identification.
for example, that improvement in psychological functioning
Supplementary Information The online version contains supplemen-
preceded detransition, or that detransition and improvement tary material available at https://doi.org/10.1007/s10508-023-02716-1.
were both caused by a third factor. Participants believed that
their detransition reflected realizations that they had mis- Acknowledgements At the time of the study’s ethical approval, Dr. Litt-
taken ideas about gender dysphoria, lack of improvement man was affiliated with the Brown University School of Public Health.
Open access fees were provided by the Institute for Comprehensive
during trans-identification, and changes in their self-concep- Gender Dysphoria Research. The authors thank the Pique Resilience
tualizations (Table 8). They rejected family and peer pres- Project for their collaboration with the survey instrument creation and
sure, transphobia, and religious beliefs as explanations of recruitment efforts and six colleagues for their valuable contributions
detransition. to the survey instrument development.
One issue that we cannot resolve in this study is whether Funding The authors did not receive support from any organization
our participants are unique in respects that made them poor for the submitted work.
candidates for transition. Perhaps many or most youth who
13
Conflict of Interest The authors declare that the research was con- Bailey, J. M., & Blanchard R. (2017). Gender dysphoria is not one thing.
ducted in the absence of any commercial or financial relationships that 4thWaveNow. https://4thwavenow.com/2017/12/07/gender-dysph
could be construed as a potential conflict of interest. oria-is-not-one-thing/
Blanchard, R. (1989). The concept of autogynephilia and the typology
Ethical Approval This research was approved as exempt by the Brown of male gender dysphoria. Journal of Nervous and Mental Disease,
University Human Research Protection Program (HRPP). The HRPP 177(10), 616–623.
determined the original research protocol to be exempt from 45 CFR 46 Boyce, B. (2021). https://w ww.y outub e.c om/c/B
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regarding the inclusion of human participants in research. Two modifi- Boyd, I., Hackett, T., & Bewley, S. (2022). Care of transgender patients:
cations were accepted with limited IRB review to determine that there A general practice quality improvement approach. Healthcare (p.
were adequate provisions to protect the privacy of subjects and to main- 121). Multidisciplinary Digital Publishing Institute.
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Evans & M. Moore (Eds.), Transgender children and young peo-
Informed Consent Electronic consent was obtained from all partici- ple: Born in your own body (pp. 166–180). Cambridge Scholars
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ticipants were informed of the research purpose and potential risks and D’Angelo, R., Syrulnik, E., Ayad, S., Marchiano, L., Kenny, D. T., &
benefits of participating, that their participation was voluntary, and were Clarke, P. (2021). One size does not fit all: In support of psycho-
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Open Access This article is licensed under a Creative Commons Attri-
N., & Landén, M. (2011). Long-term follow-up of transsexual
bution 4.0 International License, which permits use, sharing, adapta-
persons undergoing sex reassignment surgery: Cohort study in
tion, distribution and reproduction in any medium or format, as long
Sweden. PLoS ONE, 6(2), e16885.
as you give appropriate credit to the original author(s) and the source,
Diaz, S., & Bailey, J. M. (2023a). Rapid onset gender dysphoria: Par-
provide a link to the Creative Commons licence, and indicate if changes
ent reports on 1655 possible cases. Archives of Sexual Behavior,
were made. The images or other third party material in this article are
52, 1031–1043. [Retracted Article: Rapid Onset Gender Dyspho-
included in the article's Creative Commons licence, unless indicated
ria: Parent Reports on 1655 Possible Cases. Arch Sex Behav 52,
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permitted by statutory regulation or exceeds the permitted use, you will
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months. Dailymail.com. https://www.dailymail.co.uk/news/artic Publisher's Note Springer Nature remains neutral with regard to
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Detransition

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Archives of Sexual Behavior

Detransition and Desistance Among Previously Trans‑Identified Young

Received: 17 February 2022 / Revised: 24 September 2023 / Accepted: 25 September 2023

Introduction articles (Callahan, 2018; Entwistle, 2021; twitter.com/ftm-

the sabotage attempts, the study was modified to increase Sexuality

Several kinds of psychosocial experiences have been identi- Transition Experiences

reinterpreting past feelings and behaviors to be consistent

Table 2 Time course of trans- Mean (SD) Range

Anxiety 47 (60.26%) 62 (79.49%)

Table 6 Correlations with Variable Correlation with child- Correlation with

Gender Dysphoria before trans-identification 0.08 0.50 0.07 0.58

Results of our exploratory and wide-ranging study of

Table 8 Ratings of importance of various factors to the cessation of transgender identification

Participant’s own thought processes 78 4.74 (0.65)

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