As access to gender-affirming care has expanded in recent years, public and clinical understandings of gender transition and detransition have remained limited and highly politicized. Anecdotal reports of detransition have become a flashpoint in culture war debates and international policy battles, while the actual experiences of people who have stopped, shifted, or reversed an initial gender transition remain under-researched.
A groundbreaking new study led by York University Professor Kinnon Ross MacKinnon, published today (Nov 5) in Archives of Sexual Behavior, emphasizes the need for a nuanced, evidence-informed understanding of detransition experiences among 2SLGBTQ+ individuals. Drawing on survey data from 957 participants in the U.S. and Canada, the research reveals that detransition is far from a homogenous experience.
"This particular topic is very contentious and debated along political lines. People with these experiences tend to feel marginalized and misrepresented by both sides," says MacKinnon, a social scientist at York's School of Social Work. "Our study aimed to build knowledge that was more empirically driven, to try to understand from people's own knowledge how they experienced gender transition, and their ongoing care needs."
Funded by the Social Sciences and Humanities Research Council and co-authored by Naail Khan and Katherine Newman, York PhD candidates in the Department of Psychology, the DARE (Detransition Analysis, Representation, and Exploration) study identifies four distinct pathways of detransition and offers a more nuanced framework for understanding why people decide to detransition. These findings may not be generalizable to the larger TGD population, especially those who do not detransition. Detransition is a minority experience within the TGD community, currently estimated at between one to 30 per cent.
"In Canada and the United States, there has been very little robust research into detransition in the last 30 years," says MacKinnon. "This is one of the first large-scale, community efforts to study detransition and gender fluidity since gender-affirming health care was widely scaled up about 10 to 15 years ago."
Understanding the study
Data collection for the SSHRC Insight Grant-backed study began in December 2023. Over the following year, 957 individuals were surveyed and 42 interviewed. Participants ranged from 16 to 74 years old. The average age was 26. The mean age at which most began to identify as TGD was around 15. A large majority (78.8 per cent) were assigned female at birth (AFAB), and nearly three-quarters were based in the U.S.
Participants had all detransitioned or retransitioned after a social and/or medical gender transition. The time between initially realizing a TGD identity and starting to detransition ranged from several months to over a decade. While reasons for detransition varied, the study found that gender identity and expression can be fluid over time, particularly for 2SLGBTQ+ youth. Some described their transitions and detransitions not as mistakes, but as part of a longer developmental journey. Others felt let down by gender-affirming health care or accessed care that may have deviated from recommended standards of care.
Four distinct detransition pathways
Survey results offer new insights into socio-demographic profiles and characteristics of individuals who have detransitioned or retransitioned (resumed transitioning after a temporary detransition). Using self-reported reasons, MacKinnon and co-authors identified four distinct pathways using Latent Class Analysis (LCA).
Class A (33 per cent of participants): Predominantly young, AFAB (89.87 per cent) individuals, who began transition early and later reported high decisional regret, mental health challenges and dissatisfaction with care. Most (85.4 per cent) no longer identified as TGD at the time of the survey. Participants in this group had the highest average number of lifetime gender identities, reported high adverse childhood experiences (ACEs) and strong decisional regret with transition. Over half of those who accessed gender-related surgery as minors were in this group; fewer than half reported receiving decision-making supports before they started to transition.
Class B (19.5 per cent): Participants whose gender identity evolved with little to no regret, and who expressed satisfaction with transition and care received. Most (62.3 per cent) still identified as TGD but had evolved in their gender identity/expression after their initial gender transition.
Class C (19 per cent): This group experienced a combination of internal struggles (neurodivergence, mental health, trauma and identity shifts) and external pressures (discrimination, romantic rejection, lack of support). Participants in this group reported high adverse childhood experiences (ACEs), moderate regret and mixed satisfaction with care. In this class, 29 per cent reported wanting to detransition but were feeling unable to take steps.
Class D (28.5 per cent): Detransition was involuntary, driven primarily by external pressures like discrimination, family rejection, difficulty with accessing gender-related treatments, and more. About 95 per cent reported a current TGD identity, and most (71 per cent) had retransitioned, suggesting this group had a temporary detransition. This group reported high treatment satisfaction and the lowest decisional regret, with a majority reporting access to decision-making supports prior to starting to transition. Best conceptualized as an "interrupted" transition. Trans women were more often in this group.
Beyond regret: gender fluidity, social context and complexity
Survey findings show that detransition can occur with or without decisional regret. While roughly half of those who accessed gender-related medical treatments reported decisional regret or ambivalence, many expressed ongoing satisfaction. For some, detransition reflected changing identity; for others, it was a forced interruption due to external or systemic barriers. A significant number retransitioned, illustrating that treatment needs can evolve across time and context.
Recent longitudinal research found that 20 to 79 per cent of gender-diverse young people experience shifts in gender identity over time. These changes are not necessarily signs of regret or pathology but may reflect typical child and adolescent identity developmental processes. This underscores the importance of care models that are responsive to evolving identities and the dynamic ways young people can experience gender.
More resources are required from health-care funders to improve high-quality research and ensure that gender care delivery follows recommended standards of care, particularly for gender-diverse children and youth. This would include training clinicians on the diversity of TGD experiences, including detransition and retransition, and updating guidelines like the World Professional Association for Transgender Health (WPATH) Standards of Care to reflect evolving research.
Gender-affirming care must be flexible, compassionate, trauma-informed and evidence-based. Providers must adopt non-stigmatizing, informed practices that reflect the reality that gender identity and treatment needs can evolve. By better understanding gender dysphoria, gender fluidity, and detransition, clinicians and health-care systems can offer safer, more comprehensive supports. Integrating a nuanced view of gender fluidity into care models will improve patient trust, reduce harm and ensure inclusivity across the full spectrum of 2SLGBTQIA+ experiences.
