2.1 FACTORS LEADING TO “DETRANSITION” AMONG TRANSGENDER AND GENDER-DIVERSE PEOPLE IN THE UNITED STATES: A THEORETICAL FRAMEWORK AND MIXED-METHODS ANALYSIS

Abstract

This presentation aims to present a systematic framework for understanding the driving factors underlying gender “detransition” and to identify the estimated prevalence of and reasons underlying a history of detransition among currently identified transgender and gender diverse (TGD) people in the United States. This presentation will first present a systematic framework for understanding internal and external factors that may drive gender detransition. It will then present a secondary analysis of the 2015 US Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD people living in the United States. Participants were asked if they had ever detransitioned and to report driving factors, through multiple-choice options and free-text responses. A mixed-methods approach was used to analyze the data, creating qualitative codes for free-text responses and applying summative content analysis. A total of 17,151 (61.9%) participants reported that they had ever pursued gender affirmation, broadly defined (ie, “transitioned”). Of these, 2242 (13.1%) reported a history of detransition. Of those who had detransitioned, 82.5% reported at least one external driving factor. Frequently endorsed external factors included pressure from family and societal stigma. History of detransition was associated with male sex assigned at birth, nonbinary gender identity, bisexual sexual orientation, and having a family unsupportive of one’s gender identity. Among the respondents, 15.9% reported at least one internal factor as a reason, including fluctuations in or uncertainty regarding gender identity. A substantial proportion of TGD people have detransitioned at some point in their lives. The majority have done so due to external factors including societal stigma, harassment, or rejection from family. A smaller proportion have detransitioned due to external factors, including uncertainty about their gender identity or a change in their gender identity. Clinicians should utilize a systematic framework of internal and external factors when evaluating and supporting patients endorsing a desire to detransition.