“Rapid onset gender dysphoria” study: On “recent” changes in sex ratios

Demographic changes in recent years toward a predominance of adolescent AFABs presenting for gender dysphoria evaluation and treatment have been frequently touted by proponents of the “rapid onset gender dysphoria” condition, who often infer that such an increase must be indicative of an entirely new syndrome afflicting this group specifically. In the full “rapid onset gender dysphoria” study, published this month, study author Lisa Littman offers this speculation:

This research sample of AYAs also differs from the general population in that it is predominantly natal female, white, and has an over-representation of individuals who are academically gifted, non-heterosexual, and are offspring of parents with high educational attainment [41–43]. The sex ratio favoring natal females is consistent with recent changes in the population of individuals seeking care for gender dysphoria. Gender clinics have reported substantial increases in referrals for adolescents with a change in the sex ratio of patients moving from predominantly natal males seeking care for gender dysphoria to predominantly natal females [19, 44–46]. Although a decrease in stigma for transgender individuals might explain some of the rise in the numbers of adolescents presenting for care, it would not directly explain the inversion of the sex ratio. It is plausible that rapid-onset of gender dysphoria may have some similarities to anorexia nervosa and the characteristics that make female adolescents more susceptible than male adolescents to anorexia nervosa may be the same characteristics that make natal females more susceptible than natal males to rapid-onset gender dysphoria.

Those presenting this shift in sex ratios as due to the emergence of a new condition such as “rapid onset gender dysphoria” often depict such a shift as being entirely unheard of and never before observed. But as evidence from several decades indicates, there is no universal baseline sex ratio that is being deviated from here – sex ratios of adolescent and adult gender dysphoria have often favored either trans men or trans women in different countries over different time periods, with those sex ratios frequently showing substantial shifts.

To get an idea of these known variations, consider the following findings:

  • Bakker et al. (1993) found a sex ratio in the Netherlands of 2.5:1 trans women to trans men.
  • Olsson & Möller (2003) reported a sex ratio in Sweden of about 1:1 in the late 1960s, shifting to about 2:1 trans women to trans men in the 1990s.
  • Garrels et al. (2001) observed a sex ratio in Germany of 2:1 trans women to trans men from 1970 to 1994. However, after 1994, this shifted to a ratio of 1.2:1 trans women to trans men.
  • Godlewski (1988) reported that over six years, the sex ratio in Poland remained constant at 5.5:1 trans men to trans women.
  • Wilson et al. (1999) found a sex ratio in Scotland of 4:1 trans women to trans men.
  • Tsoi (1998) found a sex ratio in Singapore of about 3:1 trans women to trans men.
  • De Cuypere et al. (2007) reported a sex ratio in Belgium of 2.43:1 trans women to trans men.
  • Vujovic et al. (2009) observed a sex ratio of 1:1 in Serbia, remaining constant over 20 years.
  • Cohen-Kettenis & Gooren (1999) reported a sex ratio in Poland and Czechslovakia of 5:1 trans men to trans women.
  • Okabe et al. (2008) reported a sex ratio in Japan of about 1.5:1 trans men to trans women.
  • Veale (2008) reported a sex ratio in New Zealand of 6:1 trans women to trans men.

The problem with a sex ratio argument for “rapid onset gender dysphoria” is that it proves too much. If shifts in sex ratio are indicative of the emergence of a new condition, then on that same basis, we could claim that any number of such new gender dysphoria syndromes have been afflicting various populations throughout history. Were AFABs in Poland and Czechslovakia succumbing to “rapid onset gender dysphoria” in the 1980s? Is Japan currently experiencing such an epidemic as well, resulting in a predominance of trans men? Did “rapid onset gender dysphoria” strike in Germany after 1994, leading to a nearly equal sex ratio where this ratio was 2:1 in favor of trans women before? What about Sweden – after the 1960s, did some new kind of gender dysphoria begin to afflict AMABs, resulting in a shift from a 1:1 ratio to a 2:1 ratio favoring trans women?

And if it was not necessary to propose new gender dysphoria syndromes to account for these known historical demographic changes, why is it necessary to propose “rapid onset gender dysphoria” to account for this now? 

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About Zinnia Jones

My work focuses on insights to be found across transgender healthcare, public health, psychiatry, and history of medicine, integrating these many perspectives and guided by the lived experiences of trans people. I live in Orlando with my family, and work mainly in technical writing.
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