Contra “ROGD”: A recent cohort of youth evaluated at Amsterdam’s gender clinic does not have less intense gender dysphoria or greater psychological issues

Zinnia JonesAttempts to legitimize the lay anti-trans narrative-slash-conspiracy theory of “rapid onset gender dysphoria” as a genuine health condition are risky business, as specifying particular features of an alleged new clinical phenomenon places it in the dangerous realm of that which can be disproven. Littman (2018), in her extensively criticized paper on this supposed condition, claimed that “clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic”, and cites parental reports that “clinicians failed to explore their child’s mental health, trauma, or any alternative causes for the child’s gender dysphoria.” Zucker (2019), commenting on “ROGD”, asserted:

Over the past dozen or so years, it is my view (and that of others) that a new subgroup of adolescents with gender dysphoria has appeared on the clinical scene. This subgroup appears to be comprised—at least so far—of a disproportionate percentage of birth-assigned females who do not have a history of gender dysphoria in childhood or even evidence of marked gender-variant or gender nonconforming behavior.

Littman, Zucker, and others have further implied that a shift in the sex ratio of adolescents presenting for evaluation for gender dysphoria toward those assigned female is itself indicative of the emergence of an entirely new kind of dysphoria. These assertions – that a clinically distinct new phenomenon has emerged over the past decade, and that this is embodied largely by apparently gender-dysphoric AFAB adolescents assigned female who experience serious psychiatric comorbidities that may be presenting only the appearance of gender dysphoria – are testable. And a recent study from Amsterdam’s VUmc gender clinic puts them to the test.

Arnoldussen et al. (2019) examined data on 1,072 adolescents aged 10.1 to 18.1 years referred to the clinic between 2000 and 2016, a timespan that overlaps substantially with “the past dozen or so years”, and analyzed various characteristics of these adolescents over time to see whether potentially gender-dysphoric adolescents are now significantly different from those who sought treatment in years past. The authors explicitly sought to answer some of the questions raised by Littman, Zucker, and others, including “whether the positive outcomes of early medical intervention also apply to adolescents who are referred in more recent years”, and whether “present referrals may have less extreme and non-binary forms of GD”.

What they found is this: There was no change over time in adolescents’ average age at first presentation to the clinic, average IQ score, likelihood of living with both of their biological parents, or their parents’ education levels. Their psychological functioning, as determined by measures of behavioral and emotional problems and suicidality, actually improved slightly. The percentage of youth evaluated who were ultimately diagnosed with gender dysphoria did not change significantly over time, nor did the proportion who went on to receive medical treatment. There was no change over time in the average intensity of their gender dysphoria, among either those assigned male or assigned female.

The sex ratio of adolescents presenting for evaluation has continued to skew toward those assigned female – but that’s just about the only notable change.

The authors did not see a reason to consider adolescents presenting for evaluation in recent years as presenting a different clinical picture such as the one suggested by Littman and Zucker:

The described fndings have clinical implications for providing early medical interventions. Since the assessed adolescents are so similar on most relevant characteristics over the years, this provides confdence that early medical treatment may also be helpful for recent referrals. It is likely that previously found results regarding the efectiveness of the Dutch protocol that includes puberty suppression as part of a multidisciplinary approach, can be generalized to the transgender adolescents who currently apply.

And they do not find the growing number of adolescents seeking treatment to be itself indicative of the emergence of new clinical phenomena such as “ROGD”:

Our study also provides a new insight into factors that have possibly contributed to the recent increase in the number of adolescent referrals in gender identity services. Since most characteristics remained similar, we suggest that GD might be more common than previously thought and the exponential increase in referrals is just a refection thereof. The increased publicity and visibility may have helped more young people and their parents to recognize and come out for their transgender feelings, and they seem more likely to dare to seek assessment and treatment.

This is a study that certainly could have detected the changes that ROGD proponents have claimed are occurring – it could have found that youth more recently presenting for evaluation have less actual gender dysphoria, more severe psychological problems, and that AFABs are significantly different from AMABs on these measures.

It just didn’t.

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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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