Rapid-onset gender dysphoria controversy
Rapid-onset gender dysphoria is a controversial, scientifically unsupported hypothesis which claims that some adolescents identify as transgender and experience gender dysphoria due to peer influence and social contagion, particularly those assigned female at birth. ROGD is not recognized as a valid mental health diagnosis by any major professional association. The APA, WPATH and 60 other medical professional organizations have called for its elimination from clinical settings due to a lack of reputable scientific evidence for the concept, major methodological issues in existing research, and its stigmatization of gender-affirming care for transgender youth.
The paper initially proposing the concept was based on surveys of parents of transgender youth recruited from three anti-trans websites; following its publication, it was re-reviewed and a correction was issued highlighting that ROGD is not a clinically validated phenomenon. Since the paper's publication, the concept has frequently been cited in legislative attempts to restrict the rights of transgender youth.
History
According to bioethicist Florence Ashley, "rapid-onset gender dysphoria" is "a hypothesized new clinical subgroup of transgender youth, which would be characterized by coming out as transgender out of the blue in adolescence or early adulthood." Ashley states that ROGD is often associated with the work of Dr. Lisa Littman, who attempted to validate the ROGD hypothesis by publishing a study based on the reports of parents recruited from well-known anti-trans websites.Initial surveys (2016–2018)
Lisa Littman, who had not previously studied transgender health care or gender dysphoria, noticed a few teenagers in the same friend group who started identifying as trans, and decided to survey parents. The term first appeared in 2016 notices posted to three anti-transgender blogs asking readers to respond to a research survey if they had a child who showed "a sudden or rapid development of gender dysphoria". An article published in Science described the first two websites as "gathering places for parents concerned by their children's exploration of a transgender identity", with the third, Youth TransCritical Professionals, being closed to non-members. Bioethicist Florence Ashley described the first as "dedicated to opposing gender-affirmative care for trans youth" and the latter two as dedicated to opposing what they call "trans ideology".The study was based on 256 responses to an online survey of parents recruited from these three websites, though Littman said she encouraged wider distribution of the survey beyond them. The study states that participants were encouraged to distribute the study only to "individuals or communities that they thought might include eligible participants", which the study defined as parents who believed "their child had a sudden or rapid onset of gender dysphoria".
An email leak in 2023 revealed Lisa Marchiano, a Pennsylvania-based psychotherapist, was the author of YTCP; Marchiano also contributes to both of the other sites. Littman's manuscript thanked Marchiano for her "feedback on earlier versions of the manuscript" but did not disclose that she was the publisher of YTCP. In August 2016, the conservative Christian advocacy group Alliance Defending Freedom sent an email to members warning of the "danger" of ROGD, linking to a column in the National Review. In October 2016, Lisa Marchiano published a blog post discussing ROGD. In 2017, Marchiano argued in a paper in Psychological Perspectives that "social contagion" was a component of ROGD. The same year, American-Canadian sexologist Ray Blanchard and American psychologist J. Michael Bailey, whose work has been criticized for suggesting non-heterosexual transgender women transition due to sexual arousal, wrote for 4thWaveNow to promote the concept of ROGD. Kenneth Zucker, whose clinic was closed due to allegations of practicing conversion therapy on its patients, also referred to Littman's poster presentation on ROGD in publications in 2017 and 2018.
Publication sparks debate
The study, originally titled "Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports" was initially published in PLOS One in August 2018. Littman's poster abstract for the study was published in February 2017, using the phrase "Rapid Onset of Gender Dysphoria" in the title. Littman presented preliminary results at a 2017 conference. Littman's study reported on information the parents reported about their children's peer group dynamics, social media use, and prior mental health issues. Littman speculated that rapid onset of gender dysphoria could be a social coping mechanism for other disorders, such as depression and anxiety caused by trauma. Of the parents surveyed, 76.5% "believed their child was incorrect in their belief of being transgender" and over 85% said their child had increased their internet use and/or had trans friends before identifying as trans; Littman acknowledged "parent-child conflict may also explain some of the findings."The publication immediately sparked a debate. The publisher of the study, PLOS One, announced two weeks after publication that it would open a post-publication review of the study's methodologies and analyses. On the same day that PLOS One announced its review, Brown University took down a press release it had earlier posted about the paper. Responding to critics, Brown University president Christina Paxson and Provost Richard M. Locke said they had not infringed on academic freedom, noted that the paper was still accessible online, and stated that Brown's commitment to only "publicize research that unassailably meets the highest standards of excellence" required Brown to remove the press release after PLOS One opened an investigation on the paper in question. They said that "given the concerns raised about research design and methods, the most responsible course of action was to stop publicizing the work published in this particular instance. We would have done this regardless of the topic of the article."
Common criticism
The paper was immediately met with criticism from health researchers and transgender activists. The main criticisms of the study were: only parents were interviewed, the websites used to recruit those parents were biased, it suggested that gender dysphoria or a transgender identity could be "socially contagious", it relied on a pathologizing framework, and it made premature diagnostic suggestions. Another common concern was that the study had been politicized to give ammunition to those who opposed gender affirming care.Post-publication review and correction (2019)
In March 2019, PLOS One completed its post-publication review, and Littman's corrected version of the paper was published on March 19, 2019. In the journal's blog, PLOS One editor Joerg Heber apologized "to the trans and gender variant community" for the previous review and publication, saying "the study, including its goals, methodology, and conclusions, were not adequately framed in the published version, and that these needed to be corrected." Heber noted that the hypothesized condition of ROGD had "not yet been clinically validated".In a notice of correction prefacing her updated version of the study, Littman stated:
Littman also noted that "Rapid-onset gender dysphoria is not a formal mental health diagnosis at this time." She wrote:
PLOS Ones editor wrote that "the corrected article now provides a better context of the work, as a report of parental observations, but not a clinically validated phenomenon or a diagnostic guideline". On behalf of the journal, Heber wrote: "Correcting the scientific record in this manner and in such circumstances is a sign of responsible publishing", where further scrutiny was called for to "clarify whether the conclusions presented are indeed backed up by the analysis and data of that original study". Heber later stated, "At its core, the survey of the parents stands as it is... We let the original results stand."
In a formal comment published by PLOS One at the conclusion of its review, academic editor and professor of social psychology Angelo Brandelli Costa wrote, "the level of evidence produced by the Dr. Littman's study cannot generate a new diagnostic criterion relative to the time of presentation of the demands of medical and social gender affirmation." Costa suggested, "Several procedures still need to be adopted to generate a potential new subcategory of gender dysphoria that has not yet been clinically validated. One of these procedures is the assessment of mental health professionals trained according to the World Professional Association for Transgender Health and the American Psychological Association guidelines, interviewing not just the family, but the youth."
Reactions
Professional commentary
Following publication of the original report in PLOS One, the World Professional Association for Transgender Health released an official statement on the proposed clinical phenomenon "rapid-onset gender dysphoria", stating that the term is not recognized by any professional association, nor listed in the DSM or ICD lists of disorders and diseases. They said in summary that "it is nothing more than an acronym created to describe a proposed clinical phenomenon that may or may not warrant further peer-reviewed scientific investigation." They affirmed the need for academic freedom and scientific exploration without censorship, and that much is still unknown about the factors contributing to the development of gender identity in adolescence, and said it was "premature and inappropriate" to use "official-sounding labels" that might influence professionals or the public to reach conclusions about how or when adolescents decide to come out as transgender. WPATH concluded by warning against the use of any term intended to cause fear about an adolescent's possible transgender status with the goal of avoiding or deterring them from accessing the appropriate treatment, in line with the standards of care appropriate for the situation.The Gender Dysphoria Affirmative Working Group of 44 professionals in transgender health wrote an open letter to Psychology Today citing previously published criticism of the study, stating it had multiple biases and flaws in methodology, as it drew its subjects from "websites openly hostile to transgender youth" and based its conclusions on the beliefs of parents who presupposed the existence of ROGD. Noting Littman had not interviewed the teens, the GDA stated onset may only have been "rapid" from parents' point of view because teens often delay coming out.
In 2021, the Coalition for the Advancement and Application of Psychological Science released a statement calling for the elimination of the concept of ROGD from clinical and diagnostic use, as "there are no sound empirical studies of ROGD and it has not been subjected to rigorous peer-review processes that are standard for clinical science." The statement also states that the term "ROGD" is likely to stigmatize and cause harm to transgender people, and that misinformation surrounding ROGD is used to justify laws suppressing the rights of transgender youth. The statement was cosigned by the American Psychological Association, the American Psychiatric Association, the Society of Behavioral Medicine, and dozens of other professional and academic organizations.
In 2022, the eighth edition of WPATH's Standards of Care —a publication providing clinical guidance for healthcare professionals working with transgender and gender diverse individuals—criticized the study due to its methodological flaws. The study's focus on parents of transgender youth recruited from communities with skepticism towards gender affirming care presents difficulty in establishing social influence as a possible factor in development of gender dysphoria. According to the SOC-8, the study's results also have not been replicated by other researchers.
In 2024, the European Academy of Paediatrics described ROGD as a controversial and polarized concept, criticized by many experts and scientific bodies, while stating that the role of social media in ROGD, gender dysphoria and mental health more broadly was "overdue serious academic exploration". It also stated "others recognise the need to thoroughly investigate one of the few offered explanations for the recent demographic changes", citing a 2019 article by Kenneth Zucker.