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Why Some Transpersons Decide to Detransition

Best practices are still evolving.

Gender dysphoria has been studied by sex researchers since the late nineteenth century. As scientists gain greater insights into this phenomenon, social attitudes about gender non-conformity have changed from viewing it as a sexual perversion to accepting and affirming an individual’s gender identity. The development of gender-affirming medical procedures has also helped many of those who struggled with gender dysphoria to lead happy and productive lives.

Traditionally, researchers have recognized two types of gender dysphoria. Early-onset gender dysphoria manifests itself in early childhood, and it occurs in equal numbers of boys and girls. Typically, the child shows a strong interest in opposite-sex clothing, toys, and behaviors. The child may even express an other-sex identity and prefer playing with opposite-sex peers at a time when most children engage in only same-sex friendships.

Late-onset gender dysphoria occurs at puberty or later. In many cases, the individual reports having a tendency toward gender nonconformity since childhood but resisting these urges until adolescence, when these feelings developed into gender dysphoria. In other cases, the individual reports a gender-conforming childhood and that their gender dysphoria only emerged with puberty. Interestingly, almost all cases of late-onset gender dysphoria have involved persons who were born male—at least until recently.

Rapid-Onset Gender Dysphoria

As medical researcher Lisa Littman points out in a series of articles, the demographics of late-onset gender dysphoria have changed significantly since the turn of the twenty-first century. Specifically, the number of gender dysphoria cases has increased dramatically. Furthermore, the vast majority of those now reporting late-onset gender dysphoria these days are adolescent or young adult women.

There are two explanations for the shifting landscape of gender dysphoria, both of which involve the internet. One explanation is that these young women now have access to information that can help them make sense of their psychological struggles surrounding sex and gender. In other words, more young women are now coming out as trans because they have a better understanding of their condition and a supportive online peer group. This is the position taken by trans activists as well as by much of the healthcare community.

The other explanation, which Littman has proposed, is that this recent rise in female late-onset gender dysphoria may be due to social contagion. Many adolescents and young adults experience depression and anxiety, among other psychological disorders. This is especially true for young women, who are constantly bombarded with conflicting social messages, some encouraging them to conform to traditional standards of femininity while others urge them to challenge old sexist values and see themselves as the equals of men.

In many of these cases, the young person had no feelings of gender nonconformity until they read about it online. Seeking an understanding of their ongoing anxiety and depression, they find articles and even support groups that encourage them to attribute their psychological problems to gender dysphoria. They then come out to their family, who had never noticed any signs of gender nonconformity before that time. Littman refers to this as rapid-onset gender dysphoria.

Littman's 2018 article describing rapid-onset gender dysphoria generated considerable controversy, especially among trans activists who interpreted it as an attempt to deny the reality of transgender identity. In response, Littman revised this article, clarifying that she was using the term as a label for a social phenomenon and not as a clinical diagnosis. (For more about the controversy, see this post.)

An Upsurge in Detransitioning Cases

Generally speaking, people who transitioned after experiencing early- or late-onset gender dysphoria are happy with their new gender and lead productive lives. In recent years, however, there’s been an upsurge in detransitioning cases. These are instances where a transperson decides they want to return to their birth gender, and they seek counseling and medical assistance to achieve this.

Since the majority of these detransitioning cases involve women who transitioned to men and are now seeking to return to their female birth gender, Littman asks whether there might be a link between detransitioning and rapid-onset gender dysphoria. To explore this question, Littman recruited one hundred transpersons who had subsequently transitioned back to their birth sex to respond to an anonymous survey. Two-thirds of the respondents had been born female, reflecting the gender distribution of detransitioners found in other studies.

The respondents often reported multiple reasons for detransitioning, but the most common were as follows:

  • 60 percent reported that they had become more comfortable identifying as their birth sex.
  • 49 percent marked concerns about medical complications, particularly regarding hormone replacement therapy.
  • 38 percent noted that transitioning hadn’t resolved their psychological issues, so they’d concluded that gender dysphoria wasn’t the cause.
  • 23 percent reported that experiences of discrimination had made living as a transperson untenable.
  • Another 23 percent understood that they had in fact been struggling with sexual orientation issues rather than gender dysphoria.

Although a quarter of the respondents had reluctantly detransitioned because of family pressure, difficulty finding a job, or other forms of discrimination, the remaining three-quarters had found that gender dysphoria was a misdiagnosis of their psychological disorder. In fact, the majority felt they hadn’t been given an adequate evaluation from a medical or mental health professional before starting the transition process.

Exploring the Roots of Gender Dysphoria

Littman notes that there’s been a substantial change in the clinical approach to treating gender dysphoria in recent years. Previously, clinicians took a “watchful waiting” approach that involved extensive counseling, during which time the client and counselor carefully explored the implications of transitioning. There was also a thorough check for other psychological disorders that could be misinterpreted as gender dysphoria.

Recently, however, most clinicians have adopted an “affirmative approach” that accepts the patient’s claims of gender dysphoria at face value and encourages a rapid transition to the desired sex. Also known as the “informed consent model,” this is the approach that has been championed by trans activists and has been adopted by the American Academy of Pediatrics and Planned Parenthood. Littman’s data suggest that the increase in detransitioning cases may be due to not having thoroughly explored the roots of the reported gender dysphoria or the implications of transitioning.

In the end, it’s clear that transitioning isn’t a process that should be undertaken lightly. More clinicians are now recommending an “exploratory approach” in which the client and counselor carefully consider the source of the gender dysphoria as well as the implications of transitioning. The goal isn’t to convince patients not to transition but rather to help them gain the personal insight they need to make informed decisions.

References

Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLoS ONE, 13, e0202330. https://doi.org/10.1371/journal.pone.0202330

Littman, L. (2021). Individuals treated for gender dysphoria with medical and/or surgical transition who subsequently detransitioned: A survey of 100 detransitioners. Archives of Sexual Behavior. Advance online publication. https://doi.org/10.1007/s10508-021-02163-w

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