5 unanswered questions about the “rapid onset gender dysphoria” hoax diagnosis

Zinnia Jones“Rapid onset gender dysphoria” is a proposed diagnosis applied to teen trans boys, positing that their dysphoria appears suddenly in adolescence as the result of receiving it via “social contagion”, such as by having trans friends or reading about trans people online. It is claimed to have emerged only recently and to constitute a distinct condition from traditional gender dysphoria. This alleged condition was originally created by several anti-trans advocacy sites, and given a scientific gloss with an unpublished study of the site visitors’ responses to an anonymous survey about their children’s dysphoria and gender identity development.

Since that study, no further clinical information has been published about this supposed population of youth experiencing a new form of gender dysphoria. As a result, much remains unknown about this phenomenon, including whether it actually is a distinct phenomenon. There are numerous open questions about “rapid onset gender dysphoria” that have yet to be satisfactorily answered. Knowing more about trans youth is key to understanding how best to treat them, and at present, the notion of rapid onset gender dysphoria offers little in the way of clarity.

1. How has the course of onset been verified? This diagnosis proposes that these teens are formerly non-dysphoric, but that during puberty they suddenly acquire dysphoria. This is based entirely on the reports of parents, and given that many trans youth conceal their identities for fear of disapproval or punishment, parental reports do not rule out the possibility of a previously present gender dysphoria that was simply revealed recently.

2. How do internet usage and “social contagion” differ between rapid onset gender dysphoria and traditional gender dysphoria? Proponents of the rapid onset diagnosis have claimed that these youths “became” transgender after engaging with online communities of trans people on Tumblr, YouTube, Reddit, and elsewhere, indicating a “socially contagious” phenomenon. But seeking out information on transness from online sources is a crucial way for questioning people to understand themselves better. How does this look any different from a closeted teen reading about trans people online for the first time, and realizing that these descriptions apply to their own life? How do we know that their dysphoria didn’t predate and give rise to their online engagement with trans-related materials, something which is already known to occur? And why does a mechanism of “social contagion” need to be proposed to explain the rise in trans youth seeking treatment, when this can already be accounted for by the factors leading to the rise in trans adults seeking treatment? What observations exist to distinguish between these possibilities?

3. Why should teens with “rapid onset gender dysphoria” and comorbid psychiatric conditions be treated differently from those with traditional gender dysphoria and comorbid conditions? Advocates of the “rapid onset” diagnosis, like Debra Soh, Ray Blanchard and J. Michael Bailey, have claimed that these youth are autistic or experiencing borderline personality disorder or other conditions, and that such conditions “should be the focus of concern instead” – “Identify your child’s problems that existed before”. But existing literature recognizes that trans people with genuine gender dysphoria may also experience autism, personality disorders, or other mental health issues as comorbid conditions. The presence of these conditions doesn’t preclude gender dysphoria, nor is it considered to rule out gender-affirming treatment.

How do advocates of the diagnosis distinguish “rapid onset” trans youth, whose apparent dysphoria is caused by other mental health struggles, from trans youth with both traditional gender dysphoria and comorbid mental health conditions? The possible presence of such conditions has already been accounted for by what we currently know about transness, without needing to be explained by proposing an entirely new form of gender dysphoria.

4. How should treatment for “rapid onset” dysphoria differ from treatment for traditional dysphoria, and why? Blanchard and Bailey claim that gender-affirming treatments are “least justifiable” in cases of rapid onset dysphoria because it is a “false belief acquired through social means”, and that these youth should “delay any consideration of gender transition”. But practically nothing is known about the actual course of gender identity development in these “rapid onset” youth. The origin of their dysphoria as first appearing rapidly in adolescence has not even been confirmed, and there is no information on how long this “false belief” dysphoria might persist, or if rapid onset youth are more likely to desist than youth with traditional dysphoria. No evidence exists comparing the results of affirming treatment in rapid onset youth and traditionally dysphoric youth, and studies of trans youth accepted for treatment with puberty blockers show extremely high rates of satisfaction, suggesting that there is not a population with “false” dysphoria who have been mistakenly given affirming treatment.

5. Where is the evidence? Existing studies of trans youth include more evidence than anonymous online surveys answered by parents. They include case series, case reports, and clinical evaluations of trans youth themselves. In the case of “rapid onset gender dysphoria”, no such evidence has been published. Stronger and more consistent evidence is needed before the case for an entirely new form of gender dysphoria can be persuasively made, particularly when most phenomena proposed to be part of this condition can already be explained under existing models.

This proposed diagnosis does not only fail to clarify the most beneficial approach to treating these “rapid onset” youth. The lack of clear parameters for this phenomenon allows for plenty of trans youth with the already-established typical form of gender dysphoria to be inappropriately labeled as “rapid onset”, such as youth who concealed their identities from their parents, youth who learned the language for who they are via friends or online resources, and youth who also face mental health struggles. Given that proponents of the rapid onset diagnosis recommend that gender-affirming treatment be withheld from these youth, all trans youth are thus placed at risk of being denied necessary treatment. Whether “rapid onset” or not, these youth may be deprived of the known benefits of affirming care and face the well-recognized harms of non-treatment. A better model of this supposed dysphoria is necessary – as is, this superfluous diagnosis adds much confusion and little clarity. 

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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8 Responses to 5 unanswered questions about the “rapid onset gender dysphoria” hoax diagnosis

  1. tailcalled says:

    I think those are some good questions. However, Bailey and Littman raise some points that need to be answered. In particular, the most important point is how so many trans men seem to have multiple other people in their social circles also transition.

    I have some suspicions about what the answer to this is. For example, I strongly expect Littman’s estimate to be too high, due to sample bias. However, the phenomenon seems to be real to an extent, and it would be a good idea to examine its prevalence (e.g. by surveying transmascs about this topic).

    Secondly, I suspect that pre-trans people have various psychological characteristics (feminism, nerdyness, bisexuality, mental health issues, unusual sexual interests, …) that likely makes them cluster together socially. This could account for social groups transitioning. However, it needs to be documented better that this is the explanation.

    I think it could also be worthwhile to examine whether multiple people in the social groups of trans women transition, to have a base rate to compare to. I think some basic surveys on this topic could go a long way for convincing Bailey that ROGD is wrong (or at least make him look worse in his mailing list when he pushes it).

    • I. Rohl says:

      To the extent that this isn’t covered by “made friends over our shared transness before we were ready to come out to our parents”, is there any reason to think this effect is specific to transmasculine folks or to people who come out in adolescence? If not, it might still be an interesting phenomenon, but it stops being evidence for “rapid onset” dysphoria as a distinct phenomenon. (My subjective experience is that this very much isn’t limited to transmasculine folks or to people who come out in adolescence, but my own recollections of my life and my social circles are hardly a systematic study.)

      • tailcalled says:

        My impression is that the effect also exists for transfeminine people, but to a smaller degree. However, the really important thing would be to just document its extent, since doing so would be pretty easy (just do a better-designed survey than Littman and you have some usable data) and would answer a lot of questions.

    • Trans Man says:

      I’m a trans man (came out in 2008, am 8 years on HRT) and I’ve never knowingly met a fellow trans man randomly. I know plenty of trans men, but I met them all through trans/LGBT groups. Could it be that the trans men you’re referring to met each other *after* coming out as trans? After all, it really helps to have someone you can discuss the transition process with – preferably someone who is also going through it.

      Trans men seek friendships with each other because there are so many questions to ask (about coming out, name changes, hormones, surgeries, etc), and so few detailed sources of information. The idea that anyone is being ‘pressured’ or ‘recruited’ into being trans is not something that’s ever been proven, any more than “the gays are recruiting your children” was proven in the 80s. Transitioning is difficult, leaving little energy to ‘recruit’ anyone else, and most long-transitioned folk simply want to move on with their lives and often go ‘stealth’.

    • Kaathe says:

      Well, I’d like to see a comparison between different countries.. Like. I read that in the usa how, many 1/4 of lgbt youth arent accepted by their parents or even kicked out, while the number for germany is far smaller..

      soo a proposal: If you have no friend ane grow up in a transphobic environment, you will naturally gravitate to other trans people and they can feel your pright, can help with tips and support-and in case where the kids get kicked out by parents even more.
      If you live with supportive friend, families, peer, school then you still will search for some trans friend because-well those people know the emotional turmoil, you can vent without having to explain and the do the #notallcis stuff, but its not so bad because family and friend will be supportive and so you can depend on them more.

      so if one compared trans-kids in a generally supportive environment (as far as possible at the moment in the US) to some without-would we find more online connections and friend for the unsupported one?..
      because, I can guarantee you, that one will have the parents who deny the trans identity of their child, demonize it and will possibly search for a “reason” why their kid is how they are..

      I mean I have also more LGBT people in my circle of friends, because I dot have to risk stupid comments or shit with them, I don’t have to self control to come over queer or “weird” because those people are either similar to me in experience and behavior or know and love me as I am and aint arses.

      so.. I don’t see why that would be any different to other people.. you search for those who understand you and dont judge, and, most likely those are people with similar experiences..

  2. Trans Man says:

    I came out as trans in 2008, then aged 18. My family accused me of having something similar to ROGD because I’d only, very suddenly started presenting as masculine as soon as I started university. They said that I’d been influenced by the university LGBT society.

    What was not noted was:
    a) I’d been sent to a religious all-girl’s boarding school, where the slightest indication of being queer made any child a target of bullying. I thus had to grow my hair long and wear skirts to fit in. These things were done out of necessity, not personal preference, and I suffered horrible gender dysphoria and depersonalisation throughout.

    b) I had gender dysphoria years before being sent to boarding school, and still have friends who can testify that I told them aged 11 that I wanted to be a boy

    c) I joined the LGBT society in the first place because I was having these feelings, not vice versa! Talk about putting the cart before the horse!

    Tl;dr: parents have been accusing their children of having this for many years. It’s only recently that terfs have given it the name ‘ROGD’.

    • Trans Man says:

      I’d like to add that I’ve been professionally diagnosed with Asperger Syndrome. Thank goodness that I was diagnosed *after* hormones and surgery! I shudder to think of the extra resistance to me getting HRT that I’d have had to put up with if I’d been diagnosed with AS previously, as though comorbid conditions can’t possibly exist. This ‘ROGD’ and “they just have autism” stuff is, IMO, evidence that they’re just looking for any excuse not to take trans youth seriously.

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