"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."