Fresh trans myths of 2017: “rapid onset gender dysphoria”

If, like me, you make a habit of trawling through the darker side of opinion pieces on trans issues, you might have come across a peculiar new term: “rapid onset gender dysphoria”. This supposedly recent occurrence is described by the National Review, the right-wing Alliance Defending Freedom, Robert Stacy McCain, and others as a phenomenon of teenagers “suddenly” coming out, sometimes “in groups”, after “total immersion” in social media related to transitioning. Even a recent article in The Stranger made reference to this alleged trend:

Increased visibility and societal acceptance are also logical explanations for the perceived growth in the trans population: More people are aware it’s an option now. But, as a study published this year in the Journal of Adolescent Health notes, parents have begun reporting “a rapid onset of gender dysphoria” in adolescents and teens who are “part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same time frame.”

If researchers have potentially discovered a previously unknown type of gender dysphoria, this would certainly be a fascinating development. There’s just one problem: there is no evidence to suggest that this is any kind of distinct clinical entity. The various features of this purported phenomenon can already be explained within existing models and currently available evidence. And more than that, it appears that the very concept could have originated with a specific group of transphobic activists.

Let’s take a closer look at the “study published this year in the Journal of Adolescent Health”. As the full study does not appear to have been released yet, only a poster abstract is available in the February 2017 issue (Littman, 2017). The study is introduced as follows:

Parents online are observed reporting their children experiencing a rapid onset of gender dysphoria appearing for the first time during or after puberty. They describe this development occurring in the context of being part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same timeframe and/or an increase in social media/internet use.

Obviously, “parents online” encompasses a rather large portion of the population, and further details on what distinguishes this particular group of parents and their online activity would certainly help to clarify this phenomenon. However, the occurrence of “gender dysphoria appearing for the first time during or after puberty”, as well as the surprise of parents, is already widely recognized in literature, to the extent that it is explicitly mentioned in the DSM-5’s description of gender dysphoria (American Psychiatric Association, 2013):

Late-onset gender dysphoria occurs around puberty or much later in life. Some of these individuals report having had a desire to be of the other gender in childhood that was not expressed verbally to others. Others do not recall any signs of childhood gender dysphoria. For adolescent males with late-onset gender dysphoria, parents often report surprise because they did not see signs of gender dysphoria during childhood.

The study’s abstract also does not provide definitions that would delineate a “rapid” appearance of gender dysphoria from a “non-rapid” appearance: how fast is rapid? Its methods have an additional weakness – only parents were surveyed, and not the children allegedly experiencing this “rapid onset”.

Methods: Recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions, was placed on three websites where parents had reported rapid onsets of gender dysphoria. Data was collected anonymously via SurveyMonkey.

Results: There were 164 parent-completed surveys that met study criteria.

Published studies on transgender-identified and gender-dysphoric youth and their parents are typically conducted via detailed in-person interviews of the youth, their parent(s), or both, sourced from those who are already known to gender specialists and clinics. An anonymous web survey of previously uncontacted parents, inquiring about their children’s experiences of gender dysphoria without any information reported by the dysphoric children themselves, comprises a far lower quality of evidence – particularly when this is used as a basis to declare the discovery of an entirely new form of gender dysphoria.

Given that many people with gender dysphoria are known to conceal their true gender for a lengthy period of time due to fear of stigma, discrimination, or disapproval from family members, this further calls into question the unexamined parental reports that these children are “experiencing a rapid onset of gender dysphoria appearing for the first time”. The onset of learning the words to declare one’s identity, the onset of confidence to come out and reach out, is not the onset of gender dysphoria itself. On this weak basis, it could just as easily be claimed that a trans person who comes out at age 35, 55, or 75 has experienced “rapid onset gender dysphoria” if this came as a surprise to the cis people around them. A cis person’s awareness of a trans person’s identity is not a reliable proxy for a trans person’s awareness of their own identity.

Littman also states that this online survey recruited respondents via “three websites where parents had reported rapid onsets of gender dysphoria”. When searching for the phrase “rapid onset gender dysphoria”, the earliest publicly available result is a blog post on 4thwavenow.com from July 2, 2016, titled “Rapid-onset gender dysphoria: New study recruiting parents”:

The survey study is being conducted by Lisa Littman, MD, MPH, Adjunct Assistant Professor, Icahn School of Medicine at Mount Sinai, New York. Dr. Littman’s survey description is below. The SurveyMonkey link at the bottom of this post contains more detailed information.

A similar post on YouthTransCriticalProfessionals.org from July 5, 2016 states:

Please note: YTCP has collaborated with 4thwavenow.com and transgendertrend.com to disseminate this survey. This same material will be posted on all three sites.

These three sites – 4thwavenow.com, Transgendertrend.com, and YouthTransCriticalProfessionals.org – contain a variety of claims regarding transgender identities and gender dysphoria that are not supported by contemporary medical consensus. Whereas major organizations such as the American Psychological Association, American Psychiatric Association, and American Academy of Pediatrics support transition (including transition among transgender youth) as effective and necessary, YouthTransCriticalProfessionals.org is a WordPress blog largely consisting of anonymous contributions; most of the “critical professionals” are unnamed. Highlights of this blog include:

• Advocating for “legislation making it very difficult for young people to access these treatments until they are in their late 20’s”
• Describing medical transition as “clinical injury” and “a cult based on sexual fetishism and pseudoscience”
• Condemning transgender youth on the basis of “the harm it will cause their non-gender-discordant peers, many of whom will subsequently question their own gender identity, and face violations of their right to bodily privacy and safety”
• The claim that transgender people are collectively “indoctrinating” “confused fetishists”
• The suggestion of treating dysphoric symptoms with alternatives to transitioning such as “hot yoga” and “getting enough sleep”

Transgendertrend.com further cites “professionals questioning medical transition of children“, which include the largely debunked claims of Paul McHugh as well as Michelle Cretella from the hoax organization American College of Pediatricians. These sites contain multiple references to transness as a supposed “social contagion” or “pathogenic meme”.

The selection bias inherent to seeking participants from these pervasively anti-trans websites makes it unlikely that their responses would even allow for the possibility that transgender children could benefit from transitioning. Predictably, the study’s findings reflect these conspiratorial themes of transgender “indoctrination” and “contagion”:

Although the expected prevalence rate for transgender young adults is 0.7%, 38.8% of the friend groups described, had more than 50% of the pre-existing friend group becoming transgender. On average, 3.5 friends per group became gender dysphoric. Where friend group activities were known, 63.7% of friend groups mocked people who were not transgender or LGBTQ. Where popularity status was known, 64.2% of adolescents had an increase in popularity within the friend group after announcing they were transgender. AYAs received online advice that if they didn’t transition immediately they’d never be happy (31.7%) and that parents who didn’t agree to take them for hormones are abusive and transphobic (37.3%). AYAs expressed distrust of people who are not transgender (24.7%); stopped spending time with non-transgender friends (25.3%); withdrew from their families (46.5%), and expressed that they only trust information about gender dysphoria that comes from transgender sources (53.1%).

A study such as this, which alleges a variety of previously unseen negative outcomes of transition, must be seen in the context of its thematic origins and the beliefs of its respondents regarding transgender identities. As this study and the supposed entity of “rapid onset gender dysphoria” continue to receive media attention, we should be equally vocal about its ideological roots in the pseudoscientific rejection of extensive medical evidence and expert consensus. ■

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Littman, L. L. (2017). Rapid onset of gender dysphoria in adolescents and young adults: a descriptive study. Journal of Adolescent Health, 60(2), S95-S96.