Better, after

A group of detransitioners deliver a message of hope

Photo by Alexander Grey on Unsplash

On the up

A study of young people who on average spent almost five years identifying as transgender has found they experienced better wellbeing and less gender dysphoria after they detransitioned from medical treatment or desisted in their opposite-sex identity.

“Detransition and desistance [giving up a trans identity before any medical treatment] were associated with marked improvements in psychological functioning,” says a new article published by the journal Archives of Sexual Behavior and authored by public health researcher Dr Lisa Littman, psychotherapist Stella O’Malley, detransitioner Helena Kerschner and sexologist Professor J Michael Bailey.

“On several relevant measures—gender dysphoria, flourishing, and self-harm—participants indicated great improvement after they stopped identifying as transgender,” the paper says.

Chart: Flourishing, or general wellbeing, rated by detransitioners, with the vertical access showing the number of participants for a given flourishing score, 10 being the highest wellbeing

Source: Littman et al 2023

Settling back into birth sex

Among the study group of 71 American females and seven males, aged 18-33, the overwhelming majority said they felt most “authentic” after they detransitioned or desisted.

External pressures—such as anti-trans discrimination, family resistance or religion—were rated as the least important drivers of detransition and desistance.

“The factors most important to relinquishing a transgender identification were internal factors, such as participants’ own thought processes, changes in participants’ personal definitions of male and female, and becoming more comfortable identifying as their natal sex,” the paper says.

Another reported impetus was the feeling that the causes of their gender dysphoria were more complex than they had believed. Looking back, the young people said a key influence in becoming trans was mistaking mental health problems or trauma as gender dysphoria.

“Against official advice I met [in 2021] a young lady called Keira Bell. She was a lesbian who told me the horrific experience that she had at the Tavistock [gender] clinic. It was an eye-opening experience [for me]. I know that [another MP] talked about ‘transing away the gay’ in his speech… We are seeing, I would say, almost an epidemic of young gay children being told that they are trans and being put on the medical pathway for irreversible decisions and they are regretting it… I am making sure that [in future] young people do not find themselves sterilised because they are being exploited by people who do not understand what these issues are…”—speech in the UK parliament, Equalities Minister Kemi Badenoch, 7 December 2023

Suddenly syndrome

Analysis of survey responses suggested that at most, 17 per cent of the group would have met the diagnostic requirements for the classic form of gender dysphoria with onset in early childhood.

Just over half the group (41/78) said they recognised themselves in the new, much more common form known as rapid-onset gender dysphoria (ROGD) with its onset during or after puberty.

Although a hypothesis rather than a formal diagnosis, ROGD seems to describe the post-2010 international explosion in socially influenced clusters of teenagers, chiefly girls, suddenly embracing trans or non-binary identities.

The study by Littman et al found that young people in the group who reported less gender dysphoria in childhood were more likely to say that the term ROGD did apply to their experience.

“The purpose of this research is to learn about the experiences of desisters and detransitioners—specifically, to explore: 1) factors that may or may not be related to the development of and desistance from transgender identification; 2) whether or not individuals experienced changes in their sexual orientation during and after transgender identification; and 3) what kinds of counseling and informed consent were received by those who sought medical care to transition.”—flyer used to recruit participants for the Littman et al study

Inconvenient for gender experts

The authors say their findings are “necessarily tentative” and acknowledge several limitations in the research, which involved a convenience sample of young people being asked to recall their experience before, during and after gender transition.

The study cannot show how common detransition is, nor establish whether these particular young people happened to be bad risks for transition, nor elucidate whether better psychological health is a cause or an outcome of detransition.

Detransition and desistance are understudied and contentious topics. ROGD has awkward implications for the “gender-affirming” treatment approach with its dogma of young people as “experts in their gender identity”.

Activists highlight the paucity of research on ROGD—first described in 2018 by Dr Littman—while seeking to sabotage any more studies and pressuring journals to retract papers exploring this phenomenon.

The Littman et al study just published had to adopt videoconference screening to check that would-be participants were genuine; activists had boasted on social media about taking the online survey and giving fake responses.

“When little is known [about detransition and desistance], imperfect research is often better than no research,” Dr Littman and her colleagues say in their paper. “It can provide provisional answers, better-informed hypotheses, and ideas for future research.”

“Despite the absence of any questions about this topic in the survey, nearly a quarter (23 per cent) of the participants expressed the ‘internalized homophobia and difficulty accepting oneself as lesbian, gay, or bisexual’ narrative by spontaneously describing that these experiences were instrumental to their gender dysphoria, their desire to transition, and their detransition.”—A survey of 100 detransitioners, Dr Lisa Littman, September 2021. (Dr Littman believes there would be little if any overlap in participants between this 2021 group and those surveyed in the current 2023 study.)

Video: Corinna Cohn, who transitioned three decades ago when safeguards were stronger, testifies in support of a bill restricting paediatric transition in the American state of Ohio

Yes, they were trans

In the 2023 Littman et al study, all the males and most of the females had taken cross-sex hormones, almost a third of the females had undergone mastectomy and a small number had their uterus or ovaries removed. (Only two participants had taken puberty blockers, which Dr Littman attributes to the average age of trans identification being too old at 17 years.)

“Our participants invested a great deal of their lives in their gender transitions—in terms of time, disruption, and serious social and medical steps. Thus, we do not believe that a principled case can be made that participants detransitioned because they were never gender dysphoric,” the Littman et al paper says.

The researchers say that follow-up studies of gender dysphoric youth are “urgently needed”, and that gender clinics have “a particular obligation” to keep track of past patients—“Unfortunately, in North America at least, we see little evidence that this presently occurs.”

“Detransition has become much more visible in recent years. However, it was only recently that the rates of detransition began to be quantified. According to recent UK and US data, 10–30 per cent of recently transitioned individuals detransition a few years after they initiated transition.”—Current concerns about gender-affirming therapy in adolescents, Professor Stephen B Levine and E Abbruzzese, April 2023

Some other key points of the 2023 Littman et al paper—

Only 27 per cent of the young people had told their former gender clinicians they had detransitioned.

Most of those who took cross-sex hormones obtained them through the fast-track “informed consent” model.

Two-thirds of the group felt they had not been adequately informed about the risks of medical transition.

Fewer than one in ten had been told about the lack of long-term outcome studies for females with adolescent-onset dysphoria.

Important influences for females becoming trans men included wanting to avoid mistreatment and sexualisation as women.

Almost half the females indicated they were exclusively attracted to women.

ROGD may be chiefly a female condition, with the possibility that some males taken to be ROGD may actually be manifesting hitherto-suppressed autogynephilia (sexual arousal among males who cross-dress and/or imagine themselves as women).

More than a third of the group said most of their offline and online friends became trans-identified and it was common to mock people who were not trans.

Among counter-intuitive results, acknowledgment of the ROGD label by participants was not significantly related to the age at which they took on a trans identity.

Psychiatric diagnoses before transition were common, including depression (63 per cent); anxiety (60 per cent); attention deficit/hyperactivity disorder (24 per cent); eating disorder (23 per cent); obsessive compulsive disorder (18 per cent) post-traumatic stress disorder (15 per cent); bipolar disorder (12 per cent); hair pulling (10 per cent); and autism spectrum disorder (9 per cent).

Young people in the study showed relatively high scores on a trauma measure of “adverse childhood experiences” such as abuse inflicted within the family.

The participants had generally liberal politics and a clear majority supported gay marriage (67/78) and trans rights 71/78).