Exploring the Psychological Mechanisms of Gender Transition and Detransition.

This qualitative study investigates the retrospective psychological mechanisms of initial gender transition and subsequent detransition. While recent quantitative studies have established high rates of psychiatric comorbidity among detransitioners, the explanation for these comorbidities remains unknown. A two-step qualitative clinical audit and qualitative content analysis were conducted on public video transcripts from 37 detransitioners (25 females, 12 males). Five overlapping retrospective pathways to transition emerged: (1) Neurocognitive conditions; (2) Prior sexual abuse and dissociation; (3) Social contagion and digital amplification; (4) Ego-dystonic sexuality; and (5) Fear of emerging sexuality and extreme sexual stereotyping. The new identity was frequently accompanied by initial validation euphoria and maintained by sunk-cost psychology. Upon detransitioning, despite navigating complex post-transition medical sequelae and grief, some participants reported profound relief. Within this cohort, transition appeared to be at least partially an attempt to decrease preexisting psychosocial distress. These findings support the critical necessity of comprehensive psychiatric evaluations to establish a thorough developmental timeline of adolescent distress and comorbid conditions-prior to medical interventions. The findings highlight the clinical risks of diagnostic overshadowing.