Investigating the effect of stress on gender dysphoria

Some people report that they feel stress contributes to their gender dysphoria, being more gender dysphoric when they are more stressed. I’ve been skeptical of this, but Pasha did a survey where he found that a lot felt it applied to them:

Pasha’s takeaway from this seemed to be to take it at face value; some felt more gender dysphoric due to stress, while others did not. However, even with this survey, I was still pretty skeptical. Causal inference is hard, and it doesn’t seem super logical that stress would make you dysphoric. Couldn’t it just be that there was some sort of confounding, perhaps with the being a specific kind of stressful context where one is more dysphoric?

But then I got an idea. Stress levels vary a lot over time due to knowable exogenous factors. For instance, social tension is pretty stressful. Thus, if we investigated the gender dysphoria associated with those exogenous factors, we could perhaps untangle it from this.

If this was to be done properly, then it would probably involve some sort of experience sampling method. But that’s very invasive and a lot of work, so I hacked it by describing 7 stressful and 7 non-stressful situations1, and asking people to say how gender dysphoric they would feel during those situations. I posted this survey to /r/Blanchardianism, /r/TGandSissyRecovery, and /r/detrans and got 54 responses.


Before we go into the results regarding reactions to situations, it is worth first looking into whether I replicated Pasha’s result of respondents feeling that stress contributes to gender dysphoria. I had three questions asking about this, which I analyzed with a latent class model in order to summarize the responses. 40% of my respondents felt that they were more gender dysphoric when stressed. Of these 40%, half felt less gender dysphoric when relaxing, while the other half felt that it was complicated. 20% of the respondents reported that they generally felt no gender dysphoria, while 30% of respondents reported that they felt equally gender dysphoric regardless of stress, and 10% reported that they felt more gender dysphoric when relaxing. I will get back to the results by different subgroups later in the post, but first let’s consider the overall average results in the survey.

Here is a scatterplot with the different situations, as well as how stressful and gender dysphoria inducing they were perceived to be:

All of the stressful situations were on average perceived to be more stressful than all of the relaxing situations. Further, overall the ranking in terms of stressfulness seems to make a lot of sense; situations that are intuitively more stressful are also quantitatively placed in more stressful spots in this plot. However, there was no correlation between stressfulness and gender dysphoria. Case closed, there’s no contribution of stress to gender dysphoria, end of investigation?

Method flaw: focus

Definitely not. I had multiple spots for comments in the survey, and some respondents pointed out some things that may be problematic for the previous investigation:

If being distracted alleviates someone’s dysphoria, it follows that being stressed could do the opposite.

When I have a urgent problem that needs focus to be resolved, I tend to not think about my body and dysphoria related things in that moment, but I still feel that I want to be male. I just have less focus on dysphoric feelings.

Time to think when lying in bed can open up opportunities for thoughts to wonder to stressful topics

If I’m walking on my own I’ll be left with my thoughts so it comes up.

That is, a topic that came up several times was a feeling that situations that require more focus can help distract from the dysphoria, and therefore temporarily reduce distress. This… actually seems like a really compelling point? Just eyeing the scatterplot, it vaguely seems like focus could account for it.

In order to investigate this, I asked Pasha to collect ratings from /r/SampleSize on how much focus each of the situations require, so that this information could be added to the model. The ranking of focus requirements, from most to least, was as follows:

  • High-stakes situations
  • Struggling with duties
  • Hanging out with friends
  • Social tension, loud/noisy places, and doing something creative
  • Spiders and other creep
  • An obstacle blocking your task
  • Reading news about problems in the world
  • Eating food
  • Listening to music
  • Taking a walk
  • Going to bed on a Saturday evening
  • Knowing that all of your chores are completed

This seems like a pretty reasonable ranking to me. So what happened when I used both focus requirement and stress to predict dysphoria? Nothing; an R^2 of 0.0026. To get an overview of what is going on, let’s take a look at a scatterplot, with the amount of gender dysphoria interpolated2 between the different situations:

Scatterplot showing situations placed according to their stressfulness and focus reguirements. In order to emphasize the overall structure, I colored regions according to the amount of gender dysphoria associated with situations in that region, using machine learning to interpolate. Red = more gender dysphoric than average, blue = less gender dysphoric than average.

This looks like… pure noise probably. Given that the different scenarios vary quite a lot in how dysphoria-inducing they are, it seems like there must be something that can explain it. But stress + focus requirement does not seem to be it.

Effect of situation on dysphoria is consistent across groups?

Here’s something to consider: some participants felt that stress contributed to gender dysphoria, while others didn’t. This raises the question that perhaps the ambiguous results are just due to individual differences in how different situations relate to gender dysphoria.

To investigate this, I investigated things by subgroup. It turns out, the different subgroups have very high agreement about what situations are gender dysphoria inducing:

The main disagreement seems to be high-stakes situation and struggling with duties, where those who feel that stress contribute to dysphoria feel more dysphoric, and news about problems, where those who feel that stress doesn’t contribute to dysphoria feel more dysphoric. Speculatively, I’d guess that it is perhaps more a question of whether not living up to responsibilities causes dysphoria? Or maybe related to self-esteem rather than stress? Not sure.

But to me, a much more noteworthy observation is that there appear to be large situational differences in how gender dysphoric people feel, and that these situational differences are basically agreed on by people who otherwise seem to interpret the factors in their dysphoria very differently. To me, this suggests that it may be fruitful to scale up these investigations, by collecting data on the relationship between dysphoria and a broader range of situations, as well as taking a much larger number of ways that the dimensions differ into account.

If any readers want to suggest situations or situational factors that should be taken into account in further research on this, I would encourage you to do so in comments or through any other method.

If you want the dataset, send me a message or join the discord. There’s more that can be done with this dataset, and I hope to eventually get around to some further investigations to blog about later, but the post must end at some point, and this is that point.

1. The descriptions given in the blog post above are brief titles rather than full descriptions. The full descriptions in the survey can be seen below:

  • Obstacle blocking your task: When there is an obstacle blocking your task (e.g. you need to use the sink but someone has left dishes in the sink; or similar), to what degree do you feel distressed about being male, wishing instead to be female?
  • Going to bed on a Saturday evening: When you go to bed on a Saturday evening, to what degree do you feel distressed about being male, wishing instead to be female?
  • Social tension: When two or more other people around you have a conflict or otherwise social tension, to what degree do you feel distressed about being male, wishing instead to be female?
  • Eating food: When you are eating food, to what degree do you feel distressed about being male, wishing instead to be female?
  • Loud/noisy places: When you are in loud/noisy places, to what degree do you feel distressed about being male, wishing instead to be female?
  • Hanging out with friends: When you are hanging out with friends, to what degree do you feel distressed about being male, wishing instead to be female?
  • Struggling with duties: When you have some task that someone is expecting you to handle (such as a task at work that your boss expects you to deal with), but you are struggling with it and are about to meet with the person who has given you the task, to what degree do you feel distressed about being male, wishing instead to be female?
  • Taking a walk: When you go for a walk (not to get to some specific place, just for leisure/exercise), to what degree do you feel distressed about being male, wishing instead to be female?
  • Spiders and other creep: When there’s a spider, a moth, or some other creep in your room, to what degree do you feel distressed about being male, wishing instead to be female?
  • Knowing that all of your chores are completed: When you have completed all of your chores and are free for the immediate future, to what degree do you feel distressed about being male, wishing instead to be female?
  • High-stakes situations: When you have to deal with high-stakes situations, such as a test or needing to make a good impression to someone you only meet briefly but who has a big effect on your future, to what degree do you feel distressed about being male, wishing instead to be female?
  • Listening to music: When you listen to music, to what degree do you feel distressed about being male, wishing instead to be female?
  • Reading news about problems in the world: When you get news about problems or potential problems in the world (e.g. war, pandemics, economic trouble, political scandals, etc.) to what degree do you feel distressed about being male, wishing instead to be female?
  • Doing something creative: When you do something creative, to what degree do you feel distressed about being male, wishing instead to be female?

2. More specifically, I used a support vector machine for regression with a radial basis function. I wouldn’t make too much of the interpolation, it’s just to get a big picture overview of what’s going on.

Contra James Cantor on desistance

In 2016, James Cantor wrote a blog post about desistance of gender dysphoria, arguing:

Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks.

However, while this is an accurate summary of the results in males, it is not an accurate summary of the results in females. Out of the 11 studies he cited, 7 studies dealt with males only, 1 study had only a single female participant, and only 3 studies had multiple female participants. Among the desisters, the studies with females got the following results:

Thus, looking over the studies that Cantor cited, there were 41 female desisters, of which 28-31 appear to be heterosexual, 3-5 appear to be bisexual, and 2 appear to be lesbian. This does not seem to match the idea that they generally turn out to be regular lesbian folks; rather they seem to generally turn out to be heterosexual.

Across these studies, there were no persisters in the first study, 9 persisters in the second study, 3 persisters in the third study, and 24 persisters in the fourth study, for a total of 36. In the latter three studies, the numbers of persisters who were exclusively gynephilic appear to be 7, 2, 13-14 respectively, for a total of perhaps 23. (It is worth noting that while 23 is much smaller than 36, most of this gap is due to participants with unknown sexual orientation.)

Overall, persistence among natal females appears to be near-perfectly correlated with sexual orientation. What to make of this correlation is unclear2, but certainly it seems to make Cantor’s characterization inaccurate.

1. It’s a bit unclear to me from the study text, but it seems like possibly this study may have sample overlap with the other dutch study. The “psychosexual outcome” paper got its sample from the clinic between 1989 and 2005, while this study got its sample from the same clinic between 2000 and 2008. This doesn’t seem to change the substantive conclusion of this post, but it may be worth keeping in mind.

2. There seem to be two general approaches; either sexual orientation gets assumed to affect desistance, or desistance gets assumed to affect sexual orientation. For instance, I’d be inclined to think that for someone to desist, some sort of factor must change that makes it more advantageous to live like one’s assigned sex, compared to transitioning. A heterosexual orientation surfacing might be such a factor. But that’s speculative. Another thing that one could claim is that transitioning somehow influences orientation. Alternatively, one might believe that there is misreporting in sexual orientation. Point is, there’s a lot of possibilities here.