Detransition Measure

Abstract

The Detransition Measure (Pullen Sansfaçon et al., 2023, 2025) is a multidimensional survey instrument formulated to evaluate the clinical experiences, perceptual frameworks, and professional practices of health and psychosocial care providers working directly with trans and nonbinary youth (TNBY), specifically focusing on those who have discontinued a gender transition. Emerging in response to the polarized and empirically sparse discourse surrounding gender transition discontinuation, this instrument operationalizes provider-level assessments across three distinct thematic modules: attitudes and beliefs regarding gender transition (18 items), descriptive observations concerning the situational contexts and precipitants of transition discontinuation (36 items), and theoretical or clinical beliefs regarding the nature, permanence, and psychological meaning of discontinuation (19 items), alongside comprehensive provider demographic and practice-related indicators. Developed for bilingual administration in English and French across international cohorts (including clinicians in Australia, Canada, France, Italy, Switzerland, the United Kingdom, and the United States), the measure captures complex nuances between non-linear gender exploration, external social pressures, physical health constraints, and authentic shifts in internal gender identity. Although formal classical test theory (CTT) indices and structural confirmatory factor models (CFA) have not yet been comprehensively established in peer-reviewed psychometric literature, the instrument demonstrates high content and ecological validity. It provides a structured framework for quantifying clinical consensus, elucidating systemic care barriers, and disentangling the multifaceted pathways that characterize gender identity evolution in pediatric and adolescent populations.

Keywords

Detransition Measure, Gender Transition Discontinuation, Trans and Nonbinary Youth (TNBY), Gender-Affirming Healthcare, Healthcare Provider Perspectives, Gender Identity Development, Clinical Attitudes, Psychometrics, Discontinuation Factors, Minority Stress, Epistemic Injustice, Transgender Health Services

Authors

The Detransition Measure was conceptualized, designed, and deployed by an interdisciplinary team of researchers and clinical experts specializing in social work, youth gender diversity, and queer sociology:

• Annie Pullen Sansfaçon, Ph.D. — School of Social Work, Université de Montréal, Montreal, Quebec, Canada. (ORCID: 0000-0003-2286-8997; Correspondence: [email protected])
• Tommly Planchat, M.Sc. — School of Social Work, Université de Montréal, Montreal, Quebec, Canada.
• Morgane A. Gelly, Ph.D. — School of Social Work, Université de Montréal, Montreal, Quebec, Canada.
• Alexandre Baril, Ph.D. — School of Social Work, University of Ottawa, Ottawa, Ontario, Canada.
• Françoise Susset, Psy.D. — Clinical Psychologist and Couple/Family Therapist, Centre de santé Méraki, Montreal, Quebec, Canada.
• Mélanie Millette, Ph.D. — Department of Communication, Université du Québec à Montréal (UQAM), Montreal, Quebec, Canada.

Purpose

The primary purpose of the Detransition Measure is to provide a rigorous, empirical, and clinically grounded assessment of how providers working directly with trans and nonbinary youth (TNBY) perceive, understand, and navigate the phenomenon of transition discontinuation. In recent years, transition discontinuation—often subsumed under the clinically contested and heterogeneous terminology of “detransition”—has become a flashpoint for intense biomedical, socio-political, and ethical debate. Despite heated public controversies, healthcare professionals frequently find themselves navigating this complex terrain with minimal standardized guidance and an absence of systematically collected provider-level data. The scale addresses this gap by measuring provider experiences, attitudes, clinical decision-making strategies, and conceptualizations regarding youth who pause, reverse, or re-evaluate medical, social, or legal aspects of their gender transition.

From an applied clinical perspective, the scale functions as both an evaluative survey tool and a reflexive instrument for healthcare personnel. By assessing provider-reported frequencies, identified etiologies of discontinuation (e.g., family rejection, societal transphobia, medical complications, fluid nonbinary identity evolutions, or misdiagnosis), and clinical belief systems, the measure elucidates whether clinical practitioners operate from binary, rigid assumptions or integrative, non-linear models of gender development. This evaluation is critical for identifying continuing education needs, uncovering latent clinical biases, and establishing benchmark competencies for multidisciplinary gender services encompassing pediatric endocrinology, adolescent medicine, clinical psychology, and social work.

From a research and public policy perspective, the instrument addresses a pronounced epistemic vacuum. Most historical accounts of transition discontinuation were derived either from small retrospective clinical case series or polarized online convenience samples, each susceptible to substantial ascertainment bias. The Detransition Measure systematically gathers data from front-line clinicians spanning multiple international jurisdictions, thereby documenting the multi-systemic realities of care delivery across differing healthcare frameworks. The theoretical rationale rests on the imperative to distinguish external structural stressors (such as financial barriers, discrimination, and lack of social support) from intrinsic developmental shifts (such as emerging nonbinary or cisgender identities), ensuring that healthcare policy reflects empirical reality rather than politicized rhetoric.

Psychological Construct

The Detransition Measure evaluates a constellation of interrelated psychological, attitudinal, and observational constructs centered on the care trajectories of trans and nonbinary youth. Rather than conceptualizing discontinuation as a monolithic or pathologized event, the instrument breaks down the phenomenon into three primary structural dimensions:

1. Attitudes and Beliefs About Gender Transition (18 Items)

This dimension operationalizes the provider’s foundational philosophical and clinical paradigms regarding gender identity formation, medical intervention, and adolescent autonomy. It measures the degree to which a provider endorses essentialist versus dynamic models of gender development. Key constructs embedded within this section include:

• Affirmative Practice Endorsement: Beliefs regarding the psychological necessity, timeliness, and life-saving efficacy of social and medical affirmation for youth experiencing gender dysphoria.
• Epistemic Trust in Youth Self-Knowledge: The extent to which clinicians attribute cognitive and emotional competence to adolescents in articulating their gender identity, contrasted with paternalistic frameworks that view gender diversity as secondary to neurodivergence, psychological trauma, or peer influence.
• Tolerance for Developmental Ambiguity: The clinician’s capacity to conceptualize transition trajectories as non-linear, open-ended processes where exploratory transitions are valid developmental milestones rather than therapeutic failures.

2. Clinical Observations of Discontinuation Precipitants (36 Items)

This observational dimension measures the descriptive characteristics and situational drivers observed by clinicians among youth who have discontinued a social, medical, or legal transition. The items delineate a wide range of external, systemic, and internal dynamics, measuring constructs such as:

• Extrinsic/Systemic Drivers: Experiences where discontinuation is precipitated by acute interpersonal rejection, parental or familial estrangement, workplace or academic discrimination, school bullying, or systemic structural hurdles (e.g., loss of insurance, prohibitive financial burdens, or restricted clinical access).
• Iatrogenic and Somatic Factors: Discontinuation driven by adverse physical reactions, chronic somatic symptoms, fertility concerns, or inadequate management of medical transition protocols.
• Intrinsic Identity Evolution: Scenarios where youth realize that their initial transition trajectory no longer aligns with their evolving sense of self, including movements from binary trans identities toward nonbinary, agender, or genderfluid identifications, as well as genuine returns to a cisgender identity.
• Psychosocial and Mental Health Dynamics: The interaction between transition navigation, isolation, unresolved trauma, internalized transphobia, and co-occurring mental health conditions.

3. Theoretical Beliefs About Discontinuation (19 Items)

The third dimension evaluates the clinician’s conceptual and ethical interpretation of what transition discontinuation signifies. It measures latent belief systems regarding clinical responsibility, regret, and the ontology of gender diversity, capturing:

• Regret versus Re-evaluation Formulations: Whether the provider conceptualizes discontinuation primarily through the lens of tragic mistake, medical regret, and therapeutic harm, or as an adaptive, natural, and benign phase of personal maturation and identity recalibration.
• Perceived Etiological Attribution: Beliefs regarding why youth discontinue, contrasting attributions of insufficient initial diagnostic gatekeeping with attributions of pervasive societal transphobia and lack of societal safety.
• Clinical Support Frameworks: Beliefs concerning the duty of care, ethical obligations, and clinical modalities required to support youth through discontinuation without ostracism, judgment, or pathologization.

Theoretical Framework

The Detransition Measure is rooted in several converging paradigms within developmental psychology, social work, trans studies, and social epidemiology:

1. The Gender-Affirmative Care Model

The foundational underpinning of the instrument aligns with the contemporary gender-affirmative care model (GACM) (Keo-Meier & Ehrensaft, 2018). In contrast to historical models that prioritized gatekeeping, conversion, or rigid diagnostic classification, the GACM posits that gender diversity is an inherent, healthy aspect of human variation. Gender development is conceptualized not as a fixed, unidirectional progression toward a permanent binary endpoint, but rather as an evolving, dynamic interplay between somatic embodiment, cognitive self-awareness, and relational contexts. Within this paradigm, transition discontinuation is not viewed as a diagnostic error, but rather as an individualized shift along a spectrum of gender exploration that merits full clinical support.

2. Minority Stress Theory

The design of the 36 situational driver items directly draws from Meyer’s (2003) Minority Stress Model, extended to trans and gender-nonconforming populations (Hendricks & Testa, 2012). This framework posits that sexual and gender minority individuals experience chronic, unique proximal and distal stressors—ranging from overt structural stigma, prejudice events, and physical violence, to expectations of rejection, concealment, and internalized transphobia. When applied to discontinuation, minority stress theory hypothesizes that many youth do not discontinue transition due to an internal misalignment with their affirmed gender, but rather as an adaptive survival mechanism to reduce extreme hostile minority stress, restore familial safety, or escape social persecution.

3. Epistemic Injustice and Hermeneutical Marginalization

Drawing on philosophical frameworks articulated by Miranda Fricker (2007) and adapted to trans studies by Alexandre Baril (2015, 2020), the Detransition Measure addresses epistemic injustice. Historically, both individuals who transition and those who discontinue transition have faced testimonial injustice (having their credibility degraded) and hermeneutical injustice (lacking the conceptual tools within mainstream medical discourse to make their lived experiences intelligible). The instrument counteracts this by assessing provider capacities to offer epistemic credibility to youth narratives, investigating whether providers possess the conceptual vocabulary to validate discontinuation without invalidating trans existence broadly.

4. Dynamic Systems and Non-Linear Trajectory Theories

The instrument incorporates developmental systems theories (e.g., Bronfenbrenner’s ecological systems theory) that view child and adolescent identity formation as an ongoing transaction between the microsystem (family, peers), mesosystem (schools, clinics), exosystem (healthcare access policies), and macrosystem (cultural ideologies). This framework rejects the binary classification of transition outcomes (“success” vs. “failure”), conceptualizing identity trajectories as dynamic, flexible, and responsive to ecological context over the life course.

Validity

The validation history of the Detransition Measure reflects its initial deployment as a specialized exploratory survey designed for an international, bilingual research study (Pullen Sansfaçon et al., 2023, 2025). When evaluating the validity profile of this instrument within classical and modern psychometric paradigms, several dimensions emerge:

Content and Face Validity

The content validity of the instrument was established through intensive expert development. The multidisciplinary authorship team comprised senior researchers in social work, developmental psychology, trans sociology, and child and adolescent healthcare, including front-line clinicians from specialized gender health centers (e.g., Centre de santé Méraki). Items were formulated based on an extensive synthesis of contemporary literature on transition discontinuation, emerging qualitative reports, and direct clinical interactions with TNBY. The items underwent qualitative vetting and iterative revisions to ensure that terminology was neutral, non-stigmatizing, and capable of capturing nuanced clinical observations in both English and French sociocultural contexts. This rigorous development process established exceptional face and content validity for identifying the multifaceted determinants of discontinuation.

Ecological and Cross-Cultural Validity

The measure possesses high ecological validity, as it was directly administered to an international sample of practicing health and social service providers across seven nations (Australia, Canada, France, Italy, Switzerland, the United Kingdom, and the United States). By gathering data across divergent healthcare systems—ranging from single-payer, publicly funded centralized systems (e.g., the UK National Health Service) to decentralized, private-payer models (e.g., the United States)—the instrument captured provider perspectives across varied clinical and socio-legal environments. This international implementation confirmed the scale’s relevance and linguistic resonance across diverse provider cohorts.

Construct, Convergent, and Discriminant Validity

Formal quantitative metrics of construct, convergent, and discriminant validity were not published in the initial descriptive study. Standard psychometric benchmarking—such as correlating subscale scores with validated measures of transphobia, provider burnout, or affirmative practice competence—remains an essential objective for ongoing research. Preliminary bivariate findings from the primary dataset demonstrate that provider beliefs about discontinuation correlate systematically with their broader endorsement of the gender-affirmative care model: providers holding non-binary, affirmative viewpoints were significantly more likely to attribute discontinuation to external minority stressors and social isolation rather than internal diagnostic regret. While these patterns provide initial evidence of construct validity, formal multitrait-multimethod (MTMM) evaluations are required before the tool can be classified as a fully validated psychometric scale.

Reliability

In the primary empirical publication (Pullen Sansfaçon et al., 2025), the Detransition Measure was utilized primarily as an exploratory survey instrument; consequently, formal classical reliability statistics, such as Cronbach’s alpha coefficients, McDonald’s omega (ω), or test-retest reliability intraclass correlation coefficients (ICC), were not reported. The absence of published internal consistency parameters represents a standard limitation of newly developed, comprehensive public health and clinical surveys that prioritize broad item coverage and descriptive mapping over unifactorial scale construction.

From a psychometric perspective, several reliability considerations apply to this instrument:

• Internal Consistency Potential: Given the high item density within each of the three modules (18 items for transition attitudes, 36 items for discontinuation precipitants, and 19 items for discontinuation beliefs), the instrument holds considerable structural capacity for creating highly reliable subscales. When grouped into coherent latent dimensions (e.g., systemic external stressors vs. intrinsic shifts), composite reliability coefficients (ω) are expected to be robust due to item redundancy and strong thematic cohesion.
• Measurement Error and Subjective Variance: Because the 36 situational driver items rely on provider proxy reporting of youth experiences rather than direct youth self-reports, responses inherently reflect an unknown degree of provider observational variance, recall bias, and clinic-specific patient demographics. Standardization of administration protocols is essential in future validation trials to minimize this error variance.
• Temporal Stability (Test-Retest): Longitudinal stability coefficients have not yet been documented. While core philosophical beliefs regarding gender diversity (Modules 1 and 3) are likely to exhibit moderate-to-high test-retest stability over short intervals (e.g., 2–4 weeks), provider reports on the situational drivers of discontinuation (Module 2) are expected to fluctuate based on dynamic patient caseloads and evolving clinical encounters.

Factor Analysis

To date, no formal Exploratory Factor Analysis (EFA) or Confirmatory Factor Analysis (CFA) has been published for the Detransition Measure. The initial study utilized item-level descriptive frequency reporting and non-parametric comparative statistics to analyze international provider responses. Consequently, the empirical latent structure of the instrument remains to be confirmed through factor analytic modeling.

Based on the conceptual architecture developed by Pullen Sansfaçon et al., psychometric researchers have proposed that the 73 core items could be structured into a hierarchical, multidimensional model:

Theoretical Latent Factor Structure for Future Validation

• Module 1: Attitudes Toward Transition (18 Items)
  • Factor 1A: Affirmative Epistemology — Items assessing validation of youth self-determination, early intervention benefits, and depathologization of nonbinary identities.
  • Factor 1B: Developmental Gatekeeping — Items emphasizing caution, concerns regarding adolescent cognitive maturation, and the necessity of exhaustive psychological differential diagnosis.
• Module 2: Precipitants and Drivers of Discontinuation (36 Items)
  • Factor 2A: Minority Stress and Interpersonal Hostility — Family rejection, peer bullying, threats of physical harm, and lack of social safety.
  • Factor 2B: Structural and Socioeconomic Barriers — Inability to afford medical care, lack of specialized local services, loss of insurance, and administrative impediments.
  • Factor 2C: Endogenous Identity Fluidity — Realization of a cisgender identity, evolution into a nonbinary or genderqueer paradigm, and shifts in physical dysphoria profiles.
  • Factor 2D: Somatic, Medical, and Health Complications — Severe side effects, endocrine complications, unmanaged surgical outcomes, and physical health contraindications.
• Module 3: Beliefs About Discontinuation (19 Items)
  • Factor 3A: Discontinuation as Identity Exploration — Conceptualizing detransition as a normative, adaptive phase of gender journeying.
  • Factor 3B: Discontinuation as Iatrogenic Regret — Conceptualizing detransition as an adverse medical outcome resulting from misdiagnosis and premature clinical intervention.
  • Factor 3C: Clinical Responsibility and Continuing Care — Beliefs regarding the obligation of gender services to retain and holistically support discontinuing youth.

Future structural equation modeling (SEM) studies should aim to conduct split-sample EFA and CFA on sufficiently powered clinician cohorts (minimum sample size: N ≥ 400), evaluating goodness-of-fit indices (e.g., CFI ≥ .95, TLI ≥ .95, RMSEA ≤ .06, SRMR ≤ .08) and establishing multigroup invariance across geographic regions (North America vs. Europe) and professional disciplines (medical vs. mental health).

Instrument / Measurement Tool

The Detransition Measure is a standardized, self-administered electronic survey instrument designed for healthcare and mental health professionals. Below is a structured summary of its technical specifications:

• Instrument Name: Detransition Measure
• Test Type: Original exploratory survey and clinical provider questionnaire
• Target Population: Adult healthcare providers, clinical psychologists, social workers, pediatricians, endocrinologists, and allied professionals working directly with trans and nonbinary youth (TNBY)
• Administration Format: Electronic questionnaire (online survey platforms such as Qualtrics or REDCap); self-report administration
• Time Required: Approximately 20 to 35 minutes for complete administration
• Linguistic Versions: English, French
• Overall Structure: Comprises 4 primary sections:
  • Provider Demographics and Practice Profile: Multiple-choice and open-ended questions assessing country of practice, professional discipline, years of clinical experience, clinical setting (hospital, private practice, community clinic), and estimated volume of TNBY and discontinuing patients.
  • Module A — Attitudes and Beliefs About Gender Transition: 18 items.
  • Module B — Circumstances and Precipitants of Discontinuation: 36 items.
  • Module C — Beliefs About Discontinuation: 19 items.
• Response Anchors and Scales:
  • Module A (Transition Attitudes – 18 items): 4-point Likert scale (1 = Strongly Agree, 2 = Agree, 3 = Uncertain, 4 = Disagree).
  • Module B (Discontinuation Drivers – 36 items): 4-category descriptive frequency scale (1 = Yes: describes the situation well; 2 = A bit: somewhat describes the situation; 3 = No: does not describe the situation; 4 = Not applicable / I don’t know).
  • Module C (Discontinuation Beliefs – 19 items): 4-point Likert scale (1 = Strongly Agree, 2 = Agree, 3 = Uncertain, 4 = Disagree).
• Scoring Conventions: In its original publication, items were analyzed individually using descriptive statistics, frequency distributions, and non-parametric tests (e.g., Mann-Whitney U, Kruskal-Wallis, Chi-square tests of independence). Composite subscale scoring can be achieved through mean scoring after appropriate reverse coding of negatively phrased items.

Permissions & Fee and Test Year

The Detransition Measure was developed in 2023, with comprehensive international findings published in 2025 in the peer-reviewed journal Psychology of Sexual Orientation and Gender Diversity. The instrument is a non-commercial academic instrument developed for clinical research and quality improvement purposes. No licensing fees or purchase charges are required for its non-commercial empirical use.

However, the specific survey questionnaire and all associated proprietary item matrices remain under the academic copyright of the lead author and research team. Researchers, institutional healthcare networks, and clinician-educators wishing to utilize, adapt, or translate the Detransition Measure for academic or clinical evaluation must obtain explicit permission from the corresponding author:

Dr. Annie Pullen Sansfaçon, Ph.D.
Full Professor, School of Social Work
Université de Montréal
Pavilion Lionel Groulx, CP 6128, Succursale Centre-Ville
Montreal, Quebec, H3C 3J7, Canada
Email: [email protected]
ORCID: 0000-0003-2286-8997

References

• Baril, A. (2015). Transness as debility: Rethinking intersections between trans and disabled embodiments. Feminist Review, 111(1), 59–74. https://doi.org/10.1057/fr.2015.21
• Baril, A. (2020). Suicidism: A new theoretical framework to conceptualize suicide from an anti-oppressive perspective. Disability Studies Quarterly, 40(3). https://doi.org/10.18061/dsq.v40i3.7053
• Fricker, M. (2007). Epistemic injustice: Power and the ethics of knowing. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780198237907.001.0001
• Hendricks, M. L., & Testa, R. J. (2012). A conceptual model of clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460–467. https://doi.org/10.1037/a0029597
• Keo-Meier, C., & Ehrensaft, D. (Eds.). (2018). The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children. American Psychological Association. https://doi.org/10.1037/0000095-000
• Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
• Pullen Sansfaçon, A., Planchat, T., Gelly, M. A., Baril, A., Susset, F., & Millette, M. (2025). Understanding the experiences of youth who have discontinued a gender transition: Provider perspectives. Psychology of Sexual Orientation and Gender Diversity, 12(1), 154–164. https://doi.org/10.1037/sgd0000644
• Turban, J. L., Loo, S. S., Almazan, A. N., & Keuroghlian, A. S. (2021). Factors leading to “detransition” among transgender and gender diverse people in the United States: A mixed-methods analysis. LGBT Health, 8(4), 273–280. https://doi.org/10.1089/lgbt.2020.0437

Items of the Scale