"There is a paucity of data regarding transgender and gender diverse (TGD) people who ‘‘detransition,’’ or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States."

"Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future."

"Of all respondents who reported a history of detransition, 82.5% cited at least one external factor. A total of 15.9% of respondents cited at least one internal factor. Of all participants who ever pursued gender affirmation, 10.8% reported lifetime history of detransition due to an external factor and 2.1% reported a lifetime history of detransition due to an internal factor."

"Older age cohorts were more likely to report a history of detransition due to caregiving responsibilities, or pressure from a spouse or partner. Younger age cohorts were more likely to report a history of detransition due to pressure from a parent, pressure from the community or societal stigma, and pressure from friends or roommates."

"In this national study, 13.1% of TGD respondents who had ever pursued gender affirmation reported a history of detransition. To our knowledge, this is the first study to systematically examine reasons for detransition in a large national sample of TGD adults. The vast majority of participants reported detransition due at least in part to external factors, such as pressure from family, nonaffirming school environments, and sexual assault. External pressures such as family rejection, school-based harassment, lack of government affirmation, and sexual violence have previously been associated with increased suicide attempts in TGD populations. Our findings thus extend prior studies, and suggest that external pressures should be understood not only as risk factors for poor mental health but also as obstacles to safely living in one’s gender identity and expression."

"A history of detransition was significantly associated with male sex assigned at birth, consistent with prior research, indicating that TGD people assigned male sex at birth experience less societal acceptance. Detransition was also significantly more common among participants with a nonbinary gender identity or bisexual sexual orientation. These findings are congruent with past studies, indicating that TGD people who identify beyond traditional binary and heteronormative societal expectations are less likely to access gender-affirming services."

"Lack of family support was also associated with a history of detransition, which is of particular concern, given the strong association between familial nonacceptance and suicidality."

"[G]ender affirmation is a highly personal and individualized process, and not all TGD people will desire all domains of gender affirmation at all times, as has been highlighted in case literature regarding people who desire medical but not social affirmation."

"It is important to highlight that detransition is not synonymous with regret. Although we found that a history of detransition was prevalent in our sample, this does not indicate that regret was prevalent. All existing data suggest that regret following gender affirmation is rare. For example, in a large cohort study of TGD people who underwent medical and surgical gender affirmation, rates of surgical regret among those who underwent gonadectomy were 0.6% for transgender women and 0.3% for transgender men. Many of those identified as having ‘‘surgical regret’’ noted that they did not regret the physical effects of the surgery itself but rather the stigma they faced from their families and communities as a result of their surgical affirmation. Such findings mirror the qualitative responses in this study of TGD people who detransitioned due to family and community rejection."

"Although there have been published guidelines for gender affirmation, case studies regarding detransition, and published data on the uncommon experience of regret following gender affirmation, there has been little rigorous study with large TGD community samples regarding detransition."