Within trans and detrans community networks, there is a shared awareness that experiences of neurodivergence, trauma, disability, and madness can intersect with gender dysphoria.
The academic field of Trans Studies has offered important insights into this dynamic. Cameron Awkward-Rich, among several other transmasculine scholars, has developed the concept of “trans maladjustment” to describe forms of on-going psychic distress sometimes associated with transness. This can include madness, post-traumatic identity formations, suicidality, and pervasive bad feelings.
Although detransition research is a much newer academic field, it engages with closely related questions. Why do so many detrans folks report high rates of neurodivergence, post-transition psychological distress, or a sense that medical interventions failed to alleviate—or even worsened—gender dysphoria? Why do profound shifts in self-understanding and identity emerge as central reasons for discontinuing or reversing transition?
Attending to these questions invites dialogue between the disciplines of Trans Studies, Mad Studies, and detransition research, particularly around how distress, embodiment, and identity are theorized across different transition pathways.
To date, research has examined the mental health of transgender/gender-diverse and detrans people in isolation from one another. Although both groups consistently report high rates of mental health difficulties, the absence of comparative research makes it hard to determine if their psychological profiles, trajectories of distress, and care needs are meaningfully similar or different.
Without this data, it’s difficult to move forward in creating community understandings and clinical approaches to care that are responsive to everyone’s needs.
As I explained in a previous post, my PhD project, NORTASUN (Basque word for “identity”) was specifically designed to address this gap using empirical data.
The project was a comparative, mixed-methods study that recruited two distinct groups of participants—transgender/gender diverse (TGD) and detrans adults—and used both in-depth qualitative interviews and quantitative validated questionnaires to understand their experiences.
Today, I’m sharing the results of one of the studies from this project, which was just published in The Spanish Journal of Psychology: “Differences in Personality and Psychopathological Symptoms Among Adults with Distinct Gender Trajectories.”
The article is open access, so you can read it for free here.
This study focused on a portion of the quantitative data of the project, using standardized clinical assessment tools to compare psychological profiles across groups.
A total of 29 TGD participants and 21 detransitioned participants completed a battery of validated measures, including:
The Personality Assessment Inventory (PAI): A 344-item clinical instrument widely used by psychologists to assess personality traits, emotional functioning, and psychopathological symptoms.
The Sick-Control-One stone-Fat-Food (SCOFF): A brief screening tool for possible eating disorders.
The 10-item Autism Quotient (AQ-10): A short screening instrument for possible autism.
Despite their different gender trajectories, both groups showed substantial overlap in their mental health burden.
Suicidal ideation
Suicidality was the most critical shared finding. Over 60% of participants in both groups scored in the elevated range on suicidal ideation, and nearly 50% scored in the highest range of acute clinical concern.
This finding highlights that, regardless of of whether individuals continue or discontinue gender transition, these are populations carrying a heavy burden of psychological distress.
High psychosocial stress and low perceived support
Both TGD and detrans participants reported high levels of psychosocial stress and elevated scores on the nonsupport scale, reflecting a strong perception of lack of social support.
Risk for eating disorders
The screening risk for eating disorders was high and nearly identical across the groups. Overall, 28% of the sample screened positive for a possible eating disorder (27.6% in the TGD group vs. 28.6% in the detransition group).
This is consistent with growing evidence of elevated disordered eating in gender minority populations.
Despite these shared vulnerabilities, the PAI revealed meaningfully different average psychological profiles between the groups, suggesting different patterns of distress and potentially different needs for support.
The TGD group: Externalizing symptoms and emotional dysregulation
On average, the TGD group showed a profile characterized by what clinicians describe as “externalizing” symptoms—distress that tends to be expressed outwardly.
Compared to the detransitioned group, TGD participants scored higher on:
alcohol-related problems,
self-harm indicators,
borderline features, and
manic symptoms.
This pattern suggests a constellation of mental distress characterized by emotional dysregulation, impulsivity, and instability.
However, it is important to contextualize these findings:
The TGD group scored higher on the negative impression validity scale, which assesses whether respondents may be emphasizing or overstating distress. This does not mean participants were “faking” symptoms; rather, it may reflect a heightened need to communicate suffering, possibly as a response to stigma or barriers to being taken seriously in clinical settings.
Elevated borderline features may indicate difficulties with identity stability and self-concept. Importantly, these symptoms can overlap with trauma-related responses. Supporting this interpretation, the TGD group scored above the clinical concern range on the traumatic stress subscale, and nearly two-thirds endorsed at least one critical traumatic stress item (e.g., intrusive memories).
Elevated externalizing patterns and substance-related problems may reflect maladaptive coping strategies developed in response to chronic minority stressors such as discrimination or interpersonal rejection.
The detransitioned group: Internalizing symptoms and social inhibition
In contrast to the TGD group, the detrans group showed an average profile characterized by “internalizing” symptoms—distress that is more often directed inward.
This group scored higher on:
phobic anxiety,
social detachment, and
anxiety-related disorders.
They also showed:
low levels of alcohol and drug problems,
markedly low scores on interpersonal dominance, indicating reduced confidence and assertiveness in social contexts.
Overall, this pattern suggests a psychological profile characterized by anxiety, avoidance, and social inhibition.
How do we interpret these findings? The prominence of anxiety and social withdrawal may be related to:
detransition-related stigma and shame,
distress related to irreversible bodily changes, and
disruptions to social relationships following detransition, which is consistent with other findings in the literature.
The detransition group also showed elevated somatic concerns, which may reflect distress over bodily changes or general health concerns related to their medical gender transition.
Differences in screening for autism
Another important difference emerged on the screener for autism: While 28% of the total sample screened positive, the rate was notably higher in the detransition group (42.9%) compared to the TGD group (17.2%).
A few critical caveats about this finding:
The AQ-10 is a screening tool, not a diagnostic instrument.
Elevated scores may partly reflect high levels of social anxiety and social detachment, which are known to inflate AQ-10 scores.
Nonetheless, the higher rate of positive screens among detransitioned participants highlights an important area for future research. It raises questions about whether neurodivergence may shape experiences of gender dysphoria or identity development in some individuals with a history of transition/detransition.
This study provides the first direct, comparative data on TGD and detrans people using validated clinical tools.
The primary implication is that, while both groups are suffering, their distress can manifest differently. Thus, different transition and detransition pathways may call for tailored care.
For TGD individuals: Interventions might benefit from focusing on emotion regulation, impulsivity, and maladaptive coping (including substance use). Given the high rates of trauma exposure, a trauma-informed approach that builds resilience against chronic social stressors and discrimination is also likely beneficial.
For detrans individuals: Interventions might benefit from prioritizing anxiety reduction, managing detransition-related minority stressors, and developing social connections to buffer against the observed pattern of social inhibition and perceived stigma. Some detrans people may have experienced transition itself as traumatic and may also benefit from trauma-informed care.
For both groups: There is an urgent need to address suicidality and the perceived lack of support. Furthermore, routine screening for eating disorders and autism should be standard practice, as these diagnoses are common in both trajectories. Clinicians should be prepared to explore how underlying neurodivergence or body dissatisfaction may intersect with gender dysphoria, gender identity development, and manifestations of distress.
This was an exploratory, cross-sectional study, which means we cannot draw conclusions about causality (i.e., we cannot say why these profiles are different, only that they are different in this study). It also used a small convenience sample, which limits the generalizability and statistical power of the comparative analyses.
Despite these limitations, this study provides some preliminary evidence that TGD and detrans individuals share critical vulnerabilities—especially suicidality—but exhibit different psychological profiles. Understanding these nuances is essential for offering compassionate and data-driven gender-related care.
This work is also integral to putting the fields of Trans, Mad, and Detransition Studies in conversation with each other, especially to think together around the concepts of trans maladjustment and post-transition distress.
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