Controversial physician and public health researcher Dr Lisa Littman, known for coining the hotly contested term Rapid-Onset Gender Dysphoria (ROGD), published a qualitative study on detransitioners with a goal of identifying reasons for detransitioning and collecting narratives to better inform clinical care and future research. It was published in the peer-reviewed journal Archives of Sexual Behaviour in October 2021.
Littman’s study had many points in common with the more recent Re/Detrans Canada study and the earlier Vandenbussche study. All three studies found that discrimination or external factors were not the primary reason study participants reported detransitioning. Also of note was that many study participants underwent gender identity shifts over time, a finding replicated in the Re/Detrans Canada study. For some transitioners at least, gender identity seems malleable over time, indicating that irreversible medical interventions may not be an appropriate response.
In the past, Littman has been accused of sampling participants from anti-trans websites; however the demographic information of this study seems to indicate that most participants were politically progressive, with a majority supporting LGBTQ+ rights such as same-sex marriage.
Of particular interest to me as a clinician, was that a majority of detransitioners in the study had felt that transitioning was their only available treatment option at the time of transition, and a significant percentage (37%) felt pressured into transitioning by others (including clinicians and therapists). Also of note was that over half felt that transitioning delayed them from dealing with underlying issues that had contributed to their developing gender dysphoria (e.g. trauma, abuse, other mental health conditions). A significant number also felt that internalized homophobia and/or misogyny had contributed to their decision to transition.
I’ve summarized some of Littman’s findings below:
Study timeline and methods. Littman’s study consisted of a 115-question anonymous online survey. Participants were largely recruited through detransition blogs or social media (e.g. Facebook, Twitter, Tumblr, Reddit), as well as listservs for clinicians and researchers (e.g. WPATH, APA, Sexnet) for them to share with their networks. The survey was open between Dec 15th 2016 and April 30th 2017.
Demographics. Of the 100 participants, 69% were ‘natal females’ and 31% were ‘natal males’. Approximately 90% were White, and 66% were based in the USA. The ‘natal female’ participants were more likely to have identified as homosexual prior to transition, while the ‘natal male’ detransitioners were more likely to have identified as heterosexual prior to transition. Sixty-three percent (63%) reported no religious affiliation, while 91% supported legal marriage for gays and lesbian couples. Nine (9) of the 100 participants reported residing in Canada.
Transition-related interventions. All participants had undergone steps toward a medical gender transition, including puberty blockers, cross-sex hormones, breast surgery, and genital surgery, and all had taken steps toward halting their medical gender transition by, for example, stopping hormones or puberty blockers, or reversing transition-related surgeries. Natal female participants accessed medical care at younger ages than their natal male counterparts.
Reasons for transitioning. The study asked participants their reasons for transitioning. Seventy-seven percent (77%) stated that they wanted others to perceive them as their target gender, while 71% said that they thought transitioning was their only option to feel better. Seventy-one percent (71%) said that their body felt wrong to them the way it was. Sixty-seven percent (67%) said that it made them feel uncomfortable to be perceived romantically/sexually as a member of their natal sex/gender. About a third of the participants (37%) felt pressured in some way to transition, such as from gender therapists, doctors, partners, friends, and online forums.
Reasons for detransitioning. Littman found that most study participants detransitioned due to more than one factor. A minority of detransitioners reported detransitioning due to external pressures and discrimination (29%). A majority (58%) felt that their gender dysphoria was better explained by trauma or a mental health condition and over half (51%) felt that the process of transitioning delayed or prevented them from dealing with the underlying trauma or mental health condition. Just under a quarter (23%) expressed difficulty accepting themselves as lesbian, gay or bisexual as contributing both to their transition and detransition.
Mental health and trauma histories. Littman’s study assessed for mental health issues or traumatic experiences prior to the onset of gender dysphoria among participants. Researchers found especially high rates of depression (32%) and anxiety (27%), and nearly half of the ‘natal females’ (47%) reported a trauma less than one year prior to the onset of gender dysphoria. More than half (55%) of the ‘natal female’ participants reported that their gender dysphoria did not start until puberty or later.
Self-identity following detransition. The majority of participants (61%) returned to identifying as their natal sex after detransition, with an additional 10% identifying as their birth sex along with another identification (e.g. nonbinary). A quarter (25%) identified as nonbinary and 13% continued to identify as transgender.
Views on transition. Feelings on transition were mixed. A large majority (79%) reported some feelings of regret about having transitioned while 11% were glad they had transitioned. About half (49%) had strong feelings of regret. A majority (64%) felt that if they knew then what they knew now, they would not have transitioned.
Healthcare evaluations. Just over half of study participants (56%) stated feeling like they did not receive adequate evaluation from a healthcare professional prior to transitioning, and 65% felt that their clinicians did not evaluate whether their desire to transition was secondary to trauma or a mental health condition. Significantly, only 24% notified the clinicians that had supported their transition that they were detransitioning, meaning that 76% did not notify their original healthcare providers.
You can read Littman’s peer-reviewed journal article for free online.