Detransition: Highlights of Dr. Littman’s latest peer-reviewed study

Written by Genspect parent Lynn Chadwick. (All bolded and italicized sections are our emphasis.)

NOTE: Dr. Lisa Littman will be one of the keynote speakers at the ROGD: What we know and what we’re learning online conference happening this Saturday November 20. Please join her, Stella O’Malley, Dr. David Bell, and a Genspect parent to learn more about this phenomenon. Sign up here.

Detransition, the act of stopping or reversing a gender transition, is not well quantified or documented, but the numbers are clearly on the rise, as the growth in videos, blogs, and the subreddit r/detrans starting with 100 members to more than 23,000 in November 2021 demonstrates. In the largest academic study on detransition to date, Dr. Lisa Littman recruited 100 participants to complete a 115-question survey instrument composed of multiple choice, Likert-type, and open-ended questions created by Dr. Littman with two individuals who personally detransitioned. Her peer-reviewed findings were published in October 2021 in the Archives of Sexual Behavior: Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners.

Participants described gender dysphoria beginning at a mean age of 11.2 years, with more than 55% of natal females reporting their dysphoria began with puberty or later. Participants were on average 21.9 years old when they sought medical care to transition, and the average duration of transition was 3.9 years. “The most frequently endorsed reasons for wanting to transition were: wanting to be perceived as the target gender (77.0%); believing that transitioning was their only option to feel better (71.0%); the sensation that their body felt wrong the way it was (71.0%); and not wanting to be associated with their natal sex (70.0%) Most participants believed that transitioning would eliminate (65.0%) or decrease (63.0%) their gender dysphoria and that with transitioning they would become their true selves (64.0%).”

More than a third of the participants (37.4%) felt pressured to transition. Clinicians, partners, friends, and society were named as sources that applied pressure to transition, as seen in the following quotes:

“My gender therapist acted like [transition] was a panacea for everything.”

“[My] [d]octor pushed drugs and surgery at every visit.”

“I was dating a trans woman, and she framed our relationship in a way that was contingent on my being trans.”

“A couple of later trans friends kept insisting that I needed to stop delaying things.”

“[My] best friend told me repeatedly that it [transition] was best for me.”

“The forums and communities and internet friends.”

“By the whole of society telling me I was wrong as a lesbian.”

“Everyone says that if you feel like a different gender…then you just are that gender and you should transition.”

The majority (56.7%) of participants felt that the evaluation they received by a doctor or mental health professional prior to transition was not adequate, and 65.3% reported that their clinicians did not evaluate whether their desire to transition was secondary to trauma or a mental health condition. Although 27% believed that the counseling and information they received prior to transition was accurate about benefits and risks, nearly half reported that the counseling was overly positive about the benefits of transition (46%) and not negative enough about the risks (26%). In contrast, only a small minority found the counseling not positive enough about benefits (5%) or too negative about risks, (6%), suggesting a bias toward encouraging transition.”

“The most frequently endorsed reason for detransitioning was that the respondent’s personal definition of male and female changed and they became comfortable identifying with their natal sex (60%). Other commonly endorsed reasons were concerns about potential medical complications (49%), transition did not improve their mental health (42%) ; dissatisfaction with the physical results of transition (40%) and discovering that something specific like trauma or a mental health condition caused their gender dysphoria (38%). External pressures to detransition such as experiencing discrimination (23%) or worrying about paying for treatments (17%) were less common.”

“Most participants (58%) expressed the gender dysphoria was caused by trauma or a mental health condition narrative which included endorsing the response options indicating that their gender dysphoria was caused by something specific, such as a trauma or a mental health condition. More than half (51%) responded that they believe that the process of transitioning delayed or prevented them from dealing with or being treated for trauma or a mental health condition.

”The majority of respondents were dissatisfied with their decision to transition (69.7%) and satisfied with their decision to detransition (84.7%). At least some amount of transition regret was common. (79.8%) and nearly half (49.5%) reported strong or very strong regret. Most respondents (64.6%) indicated that if they knew then what they know now, they would not have chosen to transition.

Only a small percentage of detransitioners, (24%) informed the clinicians and clinics that facilitated their transitions that they had detransitioned. Therefore, clinic rates of detransition are likely to be underestimated and gender transition specialists may be unaware of how many of their own patients have detransitioned, particularly for patients who are no longer under their care.”

These findings highlight the complexity of gender dysphoria and suggest that, in some cases, failure to explore co-morbidities and the context in which the gender dysphoria emerged can lead to misdiagnosis, missed diagnoses, and inappropriate gender transition. Also, contrary to arguments against the potential role of homophobia in gender transitions, participants reported that their own gender dysphoria and desire to transition stemmed from the discomfort they felt about being same-sex attracted. For these individuals, exploring their distress and discomfort around sexual orientation issues may have been more helpful to them than medical and surgical transition or at least an important part of exploration before making the decision to transition. This research adds to the existing evidence that gender dysphoria can be temporary.

Because of the potential for some to experience trauma, mental health conditions, internalized homophobia, and misogyny as gender dypshoria, research needs to be conducted on the evaluation process before transition to find approaches that respectfully and collaboratively explore factors that might contribute to gender-related distress. There continues to be an absence of long-term outcomes evidence for youth treated with medical and surgical transition and a lack of information about the trajectories of youth experiencing late-onset gender dysphoria – research is needed to address these gaps.”

Read Dr. Lisa Littman’s entire peer-reviewed publication on detransition here.

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