What parents don’t know: Trans youth study reveals fatal flaw at the heart of “rapid-onset gender dysphoria” (ROGD) pseudo-diagnosis (2 of 3)

Part 1 — Part 2 — Part 3

A recent study fills in ROGD’s missing pieces, joining trans youth and parent reports of gender milestones

Zinnia JonesSorbara et al. (2021) surveyed trans youth receiving care at a youth gender clinic as well as their parents or caregivers, asking each of them to describe the child’s (perceived) age of self-recognition as trans and age of first disclosure of their gender to others. 121 trans youth and 121 of their caregivers responded:

  • Trans youth who first presented for evaluation at 14 years or younger reported self-recognizing as trans at a median age of 9.5 years and first coming out at 12.6, a span of over 3 years. Meanwhile, this group’s caregivers reported perceiving that their child first privately self-identified as trans at age 12 and came out at age 12.4, little over four months later.
  • Similarly, trans youth who presented for treatment at age 15 or over reported identifying themselves at a median age of 12.5 years old and first coming out at 14.3, but their caregivers believed they first identified as trans at 14.3 – the same median age as their first coming out – and first came out at 14.7 years old.

The distance between parent and youth perspectives can be measured: For trans youth, what took two to three years appeared to their parents to take place over perhaps a season. The overall pattern is dramatic. While the youth self-identified as trans at 11.3 years, their caregivers said this happened at 13.

Youth reported a median time of 2 years from self-recognition to first coming out. Their caregivers perceived a median time of 0 years (as in 0.0 years). The caregivers believed that gender self-recognition and coming out were happening at the same time – an apparent rapid onset.

The authors note the relevance of these findings for claims of ROGD:

Our data point to another interesting aspect regarding recognition of gender incongruence. Both younger- and older-presenting youth recognized their gender incongruence before their caregivers, and consistent with what we and others have reported, both groups waited a number of years to come out after recognizing their gender identity. Conversely, caregivers reported recognizing their child’s gender incongruence and their child coming out as nearly contemporaneous events. These findings contrast descriptions of apparently rapid development of gender dysphoria among older adolescents. Instead, our data suggest that perceived rapidity may reflect caregiver unawareness of both the existence and duration of their child’s transgender identity before an explicit disclosure.

It could indeed be the case that Littman succeeded in accurately capturing parents’ perceptions of their children’s gender identity development, but this would still say nothing about their children’s actual gender identity development. Sorbara et al. captured here the same pattern of perceived rapidity reported by parents in Littman (2018). At the same time, they also captured the actual pattern of trans youth’s experiences of gender development over time.

When trans youth speak up, ROGD claims fall short

This pattern of perceived rapidity reported by parents does not mean actual rapidity in the gender identity development of trans youth. For this reason, Littman’s evidence, consisting solely of parents’ secondhand observations with no engagement with any trans youth, is insufficient to demonstrate the key distinguishing feature of the ROGD condition itself: the rapidity of its onset in these youth. The perception of rapidity by parents has always been entirely compatible with a gradual, private period of considered exploration on the part of trans youth throughout childhood and beyond. Littman’s proposed ROGD condition fails to rule out or even diminish at all the possibility that the youth being discussed in her study are in fact taking their time in introspection and contemplation about what gender means to who they are.

These researchers have previously reported in Sorbara et al. (2020) that timing of disclosure and presentation for treatment is also associated with substantial differences in mental health outcomes. Further confirming the results reported in earlier literature, this sample of 300 trans youth reported typically waiting 4.3-4.5 years between first recognizing their gender incongruence and first coming out to others. Those who were at a later pubertal stage when presenting for treatment were more likely than those at earlier stages to have depressive and anxiety disorders, more likely to have been prescribed psychiatric medication, and more likely to have engaged in self-harm.

Obtaining gender-affirming treatment in adolescence at an earlier stage of development may help avert these common mental health comorbidities. The authors observe:

Although the prevalence of pediatric depression increases with age and peaks after the onset of puberty, particularly for AFAB youth, we found that late pubertal GI youth were 5.49 times more likely to report this diagnosis independent of age and assigned sex. Anxiety disorders in the general population are not shown to exhibit a relationship with pubertal development, yet GI youth with more advanced puberty were 4.18 times more likely to report these diagnoses. To our knowledge, these are the first quantitative data relating pubertal stage to mental health problems among GI youth presenting to care, supporting clinical observations that pubertal development, menses, and erections are distressing to these youth and consistent with the beneficial role of pubertal suppression, even when used as monotherapy without gender-affirming hormones.

Puckett et al. (2021) likewise found that living full-time as one’s gender and accessing gender-affirming medical treatment were associated with lower levels of depression and anxiety, greater self-acceptance as trans, and greater sense of congruence in one’s appearance.

If a parent’s observations are relied upon as the sole source of information about the “rapidity” and therefore the (in)authenticity of their child’s gender dysphoria, a parental perception of suddenness – masking the years-long trans identity of their child – could be used to deny that gender-dysphoric child access to affirming treatment. That affirming treatment may be needed by these trans youth, and effective treatment of gender dysphoria can promote overall health and well-being as well as prevent common mental health comorbidities such as depression, anxiety, and self-harming behaviors.

Trans youth in need of transition treatment are placed at risk of delayed care and worse health outcomes when their own gender is doubted on the basis of a parent’s secondhand impressions.

Next: What Parents Don’t Know – Part 3 of 3.

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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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