To better understand the factors that lead young people to identify as transgender, and then to detransition, data analyst M. Lal and psychiatrist Stephen B. Levine analyzed the stories told by 37 detransitioners—25 biological females and 12 biological males—on publicly available video testimony.4 Their scholarly goal was to identify the main factors (they call “pathways”) into transition and those that eventually led them to change course. Of course this group is not representative of all detransitioners, as if such a sample could ever be created, but their stories corroborate much of what is already known about the young people who find themselves caught in the gender-affirming world and later struggle to get out. Most of the group had originally transitioned in their mid-teens, and detransitioned in their 20s and some even their late 30s.
To know how and why these women and men abandoned their trans identities, we need to know how they adopted them to begin with. Consistent with almost all other studies, Lal and Levine found a high prevalence of concurrent conditions long known to accompany gender dysphoria in young people: psychological disorders (notably autism spectrum disorder, ADHD, eating disorders); sexual abuse; childhood neglect and a history of abusive relationships; and, sadly, homophobia. When young people take a deep dive into the internet to find explanations of their symptoms and suffering, they encounter communities that actively persuade adolescents who are uncomfortable with their bodies, or who have emotional disorders, that they are “really” trans and their problems would vanish with puberty blockers and cross-sex hormones. Many of Lal and Levine’s participants explicitly described the message they heard over and over: “if you are uncomfortable in your body, you are transgender.”
Well, no, you probably aren’t. There are many reasons adolescents (or anyone else) might feel uncomfortable with their bodies. Shall I count the ways? But the normal discomforts, pleasures, and surprises of puberty are magnified for young people on the autism spectrum, who, Lal and Levine found, misattributed the concrete thinking styles, sensory processing difficulties, and social deficits typical of autism to having gender dysphoria. One explained how having a transgender identity provided “a structured, rule-based community” that alleviated his social isolation. Another said that the dysphoria label “perfectly fit” his “severe OCD, undiagnosed autism, and a general sense of alienation.” Participants with ADHD spoke of how transitioning provided a focused goal for their hyperfixations, soothing their unflagging restlessness.
A second route to transitioning, for nearly half of this cohort, was the motive not to become the opposite sex but rather to escape the sex they were. Many had been sexually abused: One young woman’s distress over her developing breasts “was just from sexual abuse,” she said, yet when she told that to her physician, she was given puberty blockers immediately. Another described his transition as “surgical self-harm” to destroy the “boy whose presence was only worthy of contempt” from his father.
In a gloomy reflection of the state of male-female relations today, a significant number of the participants wanted to transition as a way of opting out of the heterosexual dating market. “[My] eating disorder and dysphoria came from the same place,” said one young woman. “If I had less fat, I would look less female.” Several of these women wanted to create a nonsexual, androgynous body rather than a masculine one, to escape the feeling that their body “was on display—like it was somehow ‘there for boys’ or ‘there for men.’”
For their part, several biological males described transition as a “flight from manhood” and a way to suppress what they felt was an overactive libido. (Note to boys: That’s normal, guys—you’re teenagers.) One said he wanted a “sexual lobotomy” to destroy the “brainwashing” that male sexuality was inherently evil. Some wanted to distance themselves from cultural claims of “toxic” masculinity and the “predatory” male; one associated a “caricature of maleness” with being “brutish” and concluded that “I can’t possibly be that.” Another said he had absorbed “a lot of rhetoric about how much men suck.”
Finally, a third route to transitioning was homophobia, another factor that turns up repeatedly in studies of adolescents in gender clinics. Eleven biological males transitioned primarily to escape the stigma associated with being gay; one said that he “100%” wanted to avoid the shame of homosexuality. Several biological females felt that living as a trans man was preferable to living as a masculine lesbian; one transitioned in an effort to bypass the complexities and stigma she associated with being lesbian.
