Previously: J. K. Rowling and the Trans Exterminationists, Book 1
The same phenomenon has been seen in the US. In 2018, American physician and researcher Lisa Littman set out to explore it. In an interview, she said:
‘Parents online were describing a very unusual pattern of transgender-identification where multiple friends and even entire friend groups became transgender-identified at the same time. I would have been remiss had I not considered social contagion and peer influences as potential factors.’
Littman mentioned Tumblr, Reddit, Instagram and YouTube as contributing factors to Rapid Onset Gender Dysphoria, where she believes that in the realm of transgender identification ‘youth have created particularly insular echo chambers.’
Littman’s study (Littman, 2018) is a legendary example of pervasively bad anti-trans science, as if transphobia itself tore off a piece of its corrupted soul and embedded it in a paper. This is a publication containing so many egregious errors, with such thorough disregard for the entire body of literature that already exists pertaining to the topics it touches on, it is difficult to know where to begin; in the years since this study came out, I’ve published several Rowlings worth of dissections and criticism of its numerous shortcomings. What Littman created is a paper so deeply flawed from start to finish that it is practically useless and provides no credible results of any value whatsoever.
The fundamental problem with this study is its choice of methodology: it proposes the existence of a new syndrome called “rapid onset gender dysphoria” without once interacting with a single person who has this alleged condition; instead, its entire dataset is based on an anonymous online survey of individuals claiming to be parents of trans or gender-variant youth (although the ages of these “youth” ranged from 11 to 27). This is why the 2018 paper, originally titled “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports”, was corrected and republished in 2019 as “Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria” – it is only a study of parental perceptions, not a study of transgender youth themselves. (Littman, an OB/GYN, later admitted at a conference that she had never worked with a single trans patient.) Dr. Joshua Safer of the Mount Sinai Center for Transgender Medicine and Surgery stated:
Littman has actually written a paper about the anxiety of parents who question an open approach to transgender care and frequent sites that cast doubt on the current management approaches. No children were involved.
This is a critical error that completely upends any conclusions the study attempts to draw. The original paper summarizes its claims of a “rapid onset” of gender dysphoria as follows:
For the purpose of this study, rapid-onset gender dysphoria (ROGD) is defined as a type of adolescent-onset or late-onset gender dysphoria where the development of gender dysphoria is observed to begin suddenly during or after puberty in an adolescent or young adult who would not have met criteria for gender dysphoria in childhood. … Most of the parents (80.9%) answered affirmatively that their child’s announcement of being transgender came “out of the blue without significant prior evidence of gender dysphoria.” Respondents were asked to pinpoint a time when their child seemed not at all gender dysphoric and to estimate the length of time between that point and their child’s announcement of a transgender-identity. Almost a third of respondents (32.4%) noted that their child did not seem gender dysphoric when they made their announcement and 26.0% said the length of time from not seeming gender dysphoric to announcing a transgender identity was between less than a week to three months.
Its defining features, separating this alleged condition from gender dysphoria proper, are that a parent did not believe their child appeared to be gender-dysphoric before coming out as trans, and that their child coming out as trans therefore came as a surprise. Based on this, Littman declares that this constitutes a new type of gender dysphoria “where the development of gender dysphoria is observed to begin suddenly during or after puberty”.
But these are multiple distinct events which Littman improperly collapses into one. A parent’s awareness of their child’s transgender identity, obtained at the moment of the child’s coming out to them, is not something that occurs contemporaneously with the emergence and development of the child’s gender dysphoria itself. By relying solely on parent-reported perceptions, Littman has wrongly treated the former as a reliable proxy for the latter, creating the appearance that gender dysphoria itself has manifested “rapidly” on the basis that parents found their child’s disclosure unexpected.
Many studies on the course of transgender self-awareness, identity development, and disclosure show why it is a mistake to make this assumption. This process has distinct milestones occurring years apart; one does not suddenly become gender-dysphoric the moment one voices the thought aloud to a parent. Grossman (2005), actually surveying trans people themselves, found that trans girls reported a feeling of being “different from others” at an average age of 7.6 years, privately considered themselves transgender at 13.4 years, and first came out as trans to someone else at 14.2 years; among trans boys, these respective milestones took place at an average age of 7.5 years, 15.2 years, and 17 years. Grossman & D’Augelli (2006) studied another group of trans youth, who reported that they “first became aware that their gender identity or gender expression did not correspond to their biological sex” at an average age of 10.4 years, labeled themselves as transgender at 14.3 years, and first disclosed their transness to someone else at 14.5 years. Restar et al. (2019), surveying young trans women, found that they had an “initial self-awareness of transfeminine identity” at an average age of 9.9 years, first engaged in “transfeminine expression in private” at 12.9 years, and disclosed their transness to others for the first time at 15.8 years. Kuper, Lindley, & Lopez (2019) specifically studied trans youth aged 6 through 17, finding that trans girls first identified as their gender at an average age of 9.9 years and first disclosed this to others at age 12.2; trans boys first adopted their identity at 10.7 and first disclosed this at age 13.1. This reflects a similar progression of identity milestones in the LGB population: awareness of difference, explicit self-identification in private, and coming out to others, all typically taking place years apart.
Littman’s approach, disregarding this extensive body of literature in order to construct a timeline of gender identity development in perhaps the most deficient and unsuitable way possible, is akin to skipping to the end of Deathly Hallows and exclaiming “Wow, that came out of nowhere!” The DSM-5’s description of gender dysphoria specifically addresses this phenomenon (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. . . . Parents of natal adolescent females with the late-onset form also report surprise, as no signs of childhood gender dysphoria were evident.
By treating coming out to one’s parents as marking the onset of gender dysphoria itself, Littman has simply ignored years of gender identity development, and, on this basis, concluded that none of this ever happened at all – instead, transness simply struck these youth like a bolt from the blue. The entire condition of “rapid onset gender dysphoria” thus only appears to exist because of the unjustifiable choice to equivocate between two very different things. Her results are nothing new, surprising, or inconsistent with previous findings; if she were to survey the trans children of her cis parent respondents, there is every reason to expect they would report the same lengthy trajectory of private identity development with discrete milestones occurring over many years.
This fatal flaw also undermines Littman’s claim that “multiple friends and even entire friend groups became transgender-identified at the same time” as a result of “social contagion and peer influences”. We know that a parent’s perception of when their child’s gender dysphoria first appeared – which we’re asked to believe takes place at the moment they come out – is not reliable. But Littman goes even further, treating her respondents’ perceptions as evidence for the onset of gender dysphoria in other people’s children:
Along with the sudden or rapid onset of gender dysphoria, the AYAs belonged to a friend group where one or multiple friends became gender dysphoric and came out as transgender during a similar time as they did (21.5%), exhibited an increase in their social media/internet use (19.9%), both (45.3%), neither (5.1%), and don’t know (8.2%). . . . The adolescent and young adult children were, on average, 14.4 years old when their first friend became transgender-identified (Table 6). Within friendship groups, the average number of individuals who became transgender-identified was 3.5 per group. In 36.8% of the friend groups described, the majority of individuals in the group became transgender-identified.
This passage explicitly illustrates how Littman has deliberately chosen to treat “became gender dysphoric”, “became transgender-identified”, and “came out as transgender” as though these are all the same event occurring all at once. But if her deeply flawed interpretation of parental reports is not fit to provide useful information on their child’s actual history of gender identity development, it is certainly not adequate as a source of data on when other people’s children “became gender dysphoric”. And without reliable data, there is no basis for declaring that gender dysphoria itself is acquired via “social contagion” at all.
While this is sufficient to cast significant doubt on Littman’s findings, it is by no means the only problem with her study. She chose to recruit respondents in 2017 from three blogs whose userbases are hostile to trans people generally and their own trans children’s gender identities specifically; these blogs had already declared the existence of this supposed “rapid onset gender dysphoria” condition long before her study was published. The content of these blogs also includes calls for “legislation making it very difficult for young people to access these treatments until they are in their late 20’s”; descriptions of transitioning as a “clinical injury” and transness as “a cult based on sexual fetishism and pseudoscience”; accusing trans youth of being responsible for “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”; and recommendations that gender dysphoria should be treated with “hot yoga” and “getting enough sleep”.
One of these websites, 4thWaveNow, shared on Twitter claims that transitioning consists of “varying degrees of chemical & surgical damage” and autistic people who transition are part of “a modern eugenics scandal”; another website from which respondents were recruited has approvingly retweeted the assertion that transitioning is “deliberately confusing young females, convincing them to be overdosed with drugs, and then hacking off healthy breasts and organs”; one parent who serves as the spokesperson for 4thWaveNow and confirms she responded to Littman’s survey has described transition as “becoming a life-long medical patient”, “physician-assisted self-harm”, and “enslaving”.
When Littman went looking for a sample, she decided to recruit users of these websites, which already had an interest in asserting that “rapid onset gender dysphoria” exists and a motivation to doubt and deny the authenticity of their trans children’s genders. She asked people who already believed that cisgender children were suddenly “catching” transness, and they offered responses consistent with that belief. This is indeed simply a study of the attitudes of certain parents. The result is this: If you’re a trans person in your late 20s who’s been diagnosed with and treated for gender dysphoria by qualified clinicians – perhaps you no longer live with your parents, perhaps you even have children of your own – and your parent doesn’t like that you’re trans, and your parent hangs out on websites full of other parents who don’t like that their children are trans, and you’ve never heard of Lisa Littman let alone spoken to her… that is sufficient under Littman’s standards for you to be labeled as having “rapid onset gender dysphoria”. Such an outcome is absurd, but not too absurd for Rowling to consider it credible science.
And what of “Tumblr, Reddit, Instagram and YouTube”, alleged to be “contributing factors to Rapid Onset Gender Dysphoria”? On the day Littman’s study was first published, I read it with great interest, and was surprised to find that her sole example of such material from Tumblr was actually a selectively-quoted excerpt from my own writing on this very website:
Littman has labeled this as an instance of “vague and nonspecific symptoms called signs of GD [gender dysphoria]” and claims “it is plausible that online content may encourage vulnerable individuals to believe that nonspecific symptoms and vague feelings should be interpreted as gender dysphoria stemming from a transgender condition.”
The problem: These aren’t “vague and nonspecific” symptoms, and they really are related to gender dysphoria. The article she cited (and only properly attributed following her study’s correction and republication) describes the symptoms of a chronic dissociative condition known as depersonalization/derealization disorder. This is a syndrome characterized by a sense of detachment or distancing from your own thoughts and feelings as if you’re split into two people, one experiencing things and one observing this at the same time, leading to a kind of constant running commentary or rumination, and the sensation that one’s feelings or self are less than real or even absent entirely. It presents as extreme emotional numbness to the point that truly feeling one’s own emotions becomes impossible, and sufferers have a general sense of disconnection from the world around them and find themselves lacking the agency to do things or even want things. The world itself seems flat or colorless or unreal to them, almost like it’s only a dream or a photograph, and they feel separated from it as if by some kind of skin, veil, fog, or pane of glass. This constant and unremitting condition leads sufferers to experience life as though they are a robot, a zombie, or even “dead”. And they do suffer greatly: chronic depersonalization is associated with a significantly elevated prevalence of depression, anxiety, and suicidality, as well as severe impairments in functioning at work, school, and in personal relationships.
Depersonalization/derealization disorder often first appears in adolescence (Medford, 2012). It is significantly more frequent among trans people with gender dysphoria than it is in the general population. And medical transition, particularly with cross-sex hormone therapy, is associated with the remission of chronic depersonalization in those trans people who do suffer from it. I suffered from depersonalization for as long as I can remember, with a severe worsening at the onset of puberty – and it stopped almost immediately when I started HRT at the age of 23. That is why I wrote about it: this is a real and specific condition that occurs among trans people with untreated gender dysphoria, and the remission of this suffocating and all-encompassing state of nightmarish half-existence felt like truly coming to life for the first time. It was one of the most profound, unexpected, and valuable things I’ve ever experienced – it gave me the life I was meant to have without this condition draining all color and feeling and meaning from my every waking moment. At the time, I didn’t even know HRT could do that, and neither did many other trans people who hadn’t yet experienced this surprising and life-affirming change. That post has since become my most popular article of all time, with hundreds of thousands of views; it is regularly circulated as a resource in online trans communities, and gender therapist Dara Hoffman-Fox LPC has included it in their book, You and Your Gender Identity: A Guide to Discovery.
Apparently unaware of the syndrome of depersonalization or the clinical evidence linking it to gender dysphoria, Littman instead baselessly claimed that my blog post functions as a vector by which some kind of “contagious” gender dysphoria has turned cis people trans. This is ultimately what Rowling supports when she endorses Littman’s study as credible. It was surreal enough to see a researcher publish a study that implies I, Zinnia Jones, have somehow crafted a series of words with the power to induce gender dysphoria among cis people; the creator of Harry Potter accusing me of using gender identity transfiguration spells is a rather indescribable experience. I hope she’ll go on to explain whether I belong in Ravenclaw or Slytherin.
Alas, trans support communities are neither magical nor even new. Littman asserts that “online advice promotes the idea that nonspecific symptoms should be considered to be gender dysphoria, conveys an urgency to transition, and instructs individuals how to deceive parents, doctors, and therapists to obtain hormones quickly” – yet trans people have been engaged in such conversations with one another since at least the 1960s. People don’t become trans because they were exposed to such information, they seek out this information because they are trans. From the inception of medical transition treatment, trans people have participated in their own communities parallel to the medical system, sharing important knowledge with one another at a time when clinicians expected them to adhere to the most narrow gender stereotypes of masculinity or femininity as a condition of access to treatment. This was made necessary by the inadequacies of a medical system that neither fully understood nor bothered listening to trans people, a shortcoming that Littman conveniently illustrates with her own ignorance of transgender depersonalization. Of course we would decide to act on our own to help one another. This is not characteristic of a recent phenomenon of “rapid onset gender dysphoria”, it is characteristic of a historical phenomenon of “trans people talking to each other”. It should come as no surprise that when wizards and witches are poorly served by an Umbridge, a Dumbledore’s Army soon follows.
Yet it is these very communities that Littman explicitly marks as pathogenic, directly comparing them to “pro-ana” groups encouraging disordered eating behaviors:
Peer contagion has been shown to be a factor in several aspects of eating disorders. There are examples in the eating disorder and anorexia nervosa literature of how both internalizing symptoms and behaviors have been shared and spread via peer influences which may have relevance to considerations of rapid-onset gender dysphoria. . . . Online environments provide ample opportunity for excessive reassurance seeking, co-rumination, positive and negative feedback, and deviancy training from peers who subscribe to unhealthy, self-harming behaviors. The pro-eating disorder sites provide motivation for extreme weight loss (sometimes calling the motivational content “thinspiration”). Such sites promote validation of eating disorder as an identity, and offer “tips and tricks” for weight loss and for deceiving parents and doctors so that individuals may continue their weight-loss activities. If similar mechanisms are at work in the context of gender dysphoria, this greatly complicates the evaluation and treatment of impacted AYAs.
To state the obvious, transitioning does not entail deliberate starvation to the point of serious injury or death; instead, it is associated with improvements in depression, anxiety, suicidality, quality of life, relationship satisfaction, and self-esteem (and, as it happens, eating disorders). But I suspect this comparison is made with a particular goal in mind. After all, what happens to pro-ana content on social media and other platforms? It’s targeted for blocking and removal as a matter of policy by Tumblr, Instagram, Facebook, and Pinterest, with politicians and professional organizations calling for legal sanctions against this material. Treating trans communities as though they’re of a kind with pro-ana content means treating our words, our voices, our very bonds with one another as a danger to public health that demands swift action – even when we simply pursue the same treatments endorsed as beneficial by numerous medical organizations (whose content ought to be sanctioned? The American Psychological Association? The American Psychiatric Association? The American Academy of Pediatrics?) Even when we talk about our own life experiences. Even when we write about a real condition that Lisa Littman didn’t know existed. And my own work is Undesirable No. 1.
Rowling, of course, bemoans the impact of Littman’s study on Littman:
Her paper caused a furore. She was accused of bias and of spreading misinformation about transgender people, subjected to a tsunami of abuse and a concerted campaign to discredit both her and her work. The journal took the paper offline and re-reviewed it before republishing it. However, her career took a similar hit to that suffered by Maya Forstater.
How terrible! Was she accused of causing a disease via the act of writing? Was she told she’s spreading a contagion that must be contained? No – her paper is still online, still citing my blog as a cause of dangerous transmissible gender dysphoria infecting children, still treating trans people’s own communities and our very existence as literally pathological, and still being promoted by the most well-known author in the world. Rowling claims to be “standing up for freedom of speech and thought”; what she’s endorsing is a blueprint for censorship.
Let’s pause for a moment and take stock: J. K. Rowling claims that “increasing numbers” of people are detransitioning, on the basis of apparently nothing. She says some people have chosen to transition in order to escape homophobia, even though this is highly implausible given the tight correlation between homophobia and transphobia and the relative rarity of heterosexuality among trans people. She appears to believe too many of the people now transitioning are assigned female but never specifies how many assigned-female trans people there “should” be. She implies there are now too many youth altogether who are transitioning, even as the number of trans youth accessing medical transition care is still a small fraction of all trans youth and the increase in utilization of these services is part of a trend that has been observed for decades among trans people of all ages. She suggests it is concerning that autistic spectrum conditions are more common among trans people seeking treatment, even though transness and autism are known to be co-occurring rather than mutually exclusive, and autistic trans people have repeatedly spoken out against the ableist insinuation that they lack the competence to know their own gender. She cites a study which attempted to establish that an inauthentic form of “rapid onset gender dysphoria” is occurring among children who falsely believe that they’re trans, and did so by surveying only their anonymous parents, selected from communities which were already predisposed to believe that transness in children is inauthentic or undesirable; the study ignored all available literature on the protracted course of trans people’s private gender identity development and public disclosure. The study she endorses inappropriately used my own work as an example of some vector of “socially contagious” gender dysphoria in youth because the author was apparently unaware of the existence of depersonalization disorder and its comorbidity with gender dysphoria. That same study makes the absurd claim that online information on transness can be regarded as similar to harmful “pro-ana” content promoting disordered eating behaviors.
Now consider Rowling’s assertions of her own diligence:
My interest in trans issues pre-dated Maya’s case by almost two years, during which I followed the debate around the concept of gender identity closely. I’ve met trans people, and read sundry books, blogs and articles by trans people, gender specialists, intersex people, psychologists, safeguarding experts, social workers and doctors, and followed the discourse online and in traditional media.
How is it that after spending years reading up on these topics, she has only a handful of the same bombastic and long-debunked claims to show for it, and no familiarity with the vast body of data which shows exactly why these talking points are wrong? What was she reading – the Daily Prophet? If Rowling is willing to promote such glaring misrepresentations and falsehoods, what else in her essay might turn out to be false as well?
I want to be very clear here: I know transition will be a solution for some gender dysphoric people, although I’m also aware through extensive research that studies have consistently shown that between 60-90% of gender dysphoric teens will grow out of their dysphoria.
Studies have not consistently shown any such thing. “Desistance” research examines the differing courses that childhood gender dysphoria can take, with the onset of puberty being accompanied by either the persistence of gender dysphoria into adolescence and adulthood, or its seemingly permanent remission and the development of a cisgender identity. The studies she is referring to are not about whether gender dysphoria that is already present in adolescence will persist into adulthood – there is no similar forking path of persistence and desistance at the threshold of adulthood. This is a particularly dangerous misrepresentation, because it suggests that necessary gender-affirming treatment should be withheld from trans adolescents in the hopes that their transness will vanish upon reaching adulthood, when it is overwhelmingly likely that this will not happen – and by the time adolescence is over, they will have missed that window to use puberty blockers to prevent the development of dysphoria-inducing undesired secondary sexual characteristics, many of which cannot be fully corrected by medical or surgical means.
Even certain studies tracking childhood gender dysphoria and whether it persists into adolescence have at times found that, rather than “60-90%”, possibly only 45% of these children will cease to have gender dysphoria after the onset of puberty (Temple Newhook et al., 2018). Moreover, the strength and intensity of a child’s cross-gender identity and behavior are usefully predictive of the likelihood of persistence of gender dysphoria into adolescence. But Rowling’s assurances that she believes transition is appropriate for “some” people with gender dysphoria rings rather hollow when she seems most comfortable with the presence of perhaps only a few dozen trans youth in the entire UK.
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