“Everyone wonders about being the other gender.”
“How many hours a day?”
Lisa Littman’s study on a proposed new condition called “rapid onset gender dysphoria” occurring among adolescents and young adults (Littman, 2018) is largely an attempt to relabel known phenomena of gender dysphoria in adolescence as instead being some newly emergent and uniquely pathological entity. Through the distorted lens of unreliable parental reports and a severely biased sample recruited from communities of anti-trans parents who already believe this condition exists, the study presents adolescent gender dysphoria in the most sinister possible light: novel, unexpected, dangerous, even infectious.
To explain the supposed genesis of this condition and its “contagious” nature, Littman proposes that many kinds of individuals in many kinds of circumstances may be susceptible to experiencing feelings of gender dysphoria as a result of something other than having gender dysphoria itself. Her list of potential precipitating factors for gender-dysphoric symptoms is extensive: depression, anxiety, autism, ADHD, eating disorders, sexual trauma, gender-related trauma, rape, attempted rape, sexual harassment, abusive partners, breakups, death of a parent, parents divorcing, mental health conditions in family members, bullying, social isolation, moving, and changing schools are all considered as possible contributors to feelings that appear to be gender dysphoria.
Such an exhaustive list would end up including vast swaths of teenagers at baseline, including many transgender youth. And in those trans youth, the presence of any of these personal or environmental factors – which are, taken together, entirely common – could lead to misdiagnosis of these youth as having a false “rapid onset” appearance of gender dysphoria caused by one of these circumstances, rather than the recognition that they genuinely do have gender dysphoria while also experiencing a life circumstance that is unrelated to this.
It is hard to say whether such an outcome is by incompetence or design: it has the potential to invalidate, wrongly, the gender identity and gender-dysphoric symptoms of nearly any trans youth. And to that list of possible factors producing apparent symptoms of gender dysphoria, we can now add: nothing. Yes, according to Littman’s paper, these false feelings of gender dysphoria can occur for no reason at all other than simply existing as an adolescent.
Throughout the paper, she describes adolescence as “almost universally tumultuous”, refers to “symptoms that are part of normal puberty” being misinterpreted as gender dysphoria, and quotes a parent who believes their trans or gender-questioning child was merely experiencing an “uncomfortableness” and “very normal feelings” common in puberty:
The argument to surface from this study is not that the insider perspectives of AYAs presenting with rapid-onset gender dysphoria should be set aside by clinicians, but that the insights of parents are a pre-requisite for robust triangulation of evidence and fully informed diagnosis. All parents know their growing children are not always right, particularly in the almost universally tumultuous period of adolescence. . . .
Another respondent described the online influence as part of a different question, “I believe my child experienced what many kids experience on the cusp of puberty—uncomfortableness!—but there was an online world at the ready to tell her that those very normal feelings meant she’s in the wrong body.”. . .
It is unlikely that friends and the internet can make people transgender. However, it is plausible that the following can be initiated, magnified, spread, and maintained via the mechanisms of social and peer contagion: (1) the belief that non-specific symptoms (including the symptoms associated with trauma, symptoms of psychiatric problems, and symptoms that are part of normal puberty) should be perceived as gender dysphoria and their presence as proof of being transgender; 2) the belief that the only path to happiness is transition; and 3) the belief that anyone who disagrees with the self-assessment of being transgender or the plan for transition is transphobic, abusive, and should be cut out of one’s life.
These assertions make testable claims. Is gender dysphoria among the “very normal feelings” of adolescence? Are these symptoms really “part of normal puberty”, the mere chance outcome of a “universally tumultuous” stage of life?
This is not supported by available evidence. By all indications, symptoms of gender dysphoria remain uncommon in adolescents overall, occurring at a rate not much greater than the percentage of the general population who are transgender.
The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) is 27-item inventory of symptoms related to gender dysphoria. It has been repeatedly validated as highly accurate in distinguishing people with clinically significant gender dysphoria from cisgender controls, with a sensitivity of 90-91% (e.g. 91% of people with gender dysphoria will be correctly identified as such) and a specificity of 99+% (99% of people without gender dysphoria will be correctly identified as such) (Deogracias et al., 2007; Singh et al., 2010). The GIDYQ-AA, when used, can be just one of many components of clinical evaluation for gender dysphoria.
This test has been given to the wider population as well, including both cis and trans people. Sumia et al. (2017) administered the adolescent version of the GIDYQ-AA to a community sample of 719 boys and girls in Finland who were an average of 17 years old, as well as a sample of 47 adolescents who had been referred for transition treatment. Only 1.3% of the community sample – 2.2% of those assigned male, and 0.5% of those assigned female – reported clinical levels of gender dysphoria symptoms according to the GIDYQ-AA, answering similarly to the adolescents undergoing transition. The authors note that this figure “corresponds to earlier prevalence figures based on a single question about transgender identification among adolescents”.
Is gender dysphoria a “normal” part of adolescence? According to a test for gender dysphoria given to hundreds of cisgender and transgender adolescents, no.
This mistake is not harmless. Many trans people recall having been told dismissively that “everyone feels that way” when expressing their feelings of gender dysphoria during puberty. Their deep and abiding grief at irreversible changes that were utterly discordant with their sense of their body and gender was met only with vague platitudes and sweeping assertions about how it’s “normal” to feel “uncomfortable”, or that it’s “just a phase” common to adolescence. This casts unnecessary doubt onto what we know we’re experiencing, and can delay our access to affirming care: there are trans people coming out in their 20s, 30s and 40s who recall having these very symptoms during puberty, and this was certainly not some “phase” of nonspecific discomfort. In reality, nearly every adolescent does not “feel that way”, and those who do feel that way are quite likely experiencing gender dysphoria. ■
