Lisa M. Marchiano, LCSW

“Those with an internal locus of control experience themselves as able to influence outcomes that affect them. Those with an external locus of control feel that most of what happens to them is beyond their ability to affect.” —Lisa Marchiano


  • Name: Lisa Mullins Marchiano
  • Aliases:
    • Lisa Bell, founder of Youth Trans Critical Professionals
    • skepticaltherapist on 4thWaveNow
  • Description: Licensed counselor and social worker in Philadelphia, Pennsylvania; Jungian psychoanalyst; prolific anti-trans activist; key architect of the “rapid onset gender dysphoria” diagnosis; significant roles in several major anti-trans websites and organizations from 2016-present; Quillette contributor; former sexual trauma specialist and readjustment counselor at VA
  • Affiliations:
    • Cofounder of Wider Lens Consulting (with cofounders Sasha Ayad and Stella O’Malley)
    • Cofounder of Gender Exploratory Therapy Association (GETA)
    • Member of Society for Evidence-Based Gender Medicine (SEGM)
    • Advisor to Genspect
    • Director of Institute for Comprehensive Gender Dysphoria Research (with president Lisa Littman, vice president Stella O’Malley, director Sasha Ayad, director J. Michael Bailey, treasurer Roberto D’Angelo)
    • Director of Rethink Identity Medicine Ethics (ReIME) (with directors Jane Wheeler and Jenny Cyphers)
    • Member of and Adolescent Gender Dysphoria Working Group (with Roberto D’Angelo, Dianna Kenny, Ray Blanchard, James Cantor, Ken Zucker, Sasha Ayad, J. Michael Bailey, Michael Laidlaw, Michelle Peixinho, and Robert Withers)
    • Member of International Association of Therapists for Desisters and Detransitioners

Summary of findings and themes

  • Lisa Marchiano was previously recognized as providing feedback on the 2018 study proposing the “rapid onset gender dysphoria” hoax pseudo-diagnosis. This hypothesis asserts that many trans youth and young adults (age 11-27) are instead actually cis people experiencing a false belief that they are transgender, caused by “social contagion” through the internet and friend groups. Marchiano has contributed extensively to online publications and other efforts to promote the ROGD concept in the public discourse from 2016 to the present.
  • A trove of thousands of emails was released online in March 2023, including dozens of messages from Marchiano to other anti-trans activists spanning 2016-2021. These emails reveal previously undisclosed information showing that Marchiano was using the pseudonym “Lisa Bell” to run the blog Youth Trans Critical Professionals, one of three anti-trans websites (with 4thWaveNow and Transgender Trend) used to recruit parent respondents to the ROGD study’s survey in 2016.
  • Marchiano’s role in providing feedback was included in the final ROGD study; her founding role in Youth Trans Critical Professionals was not. In multiple emails, Marchiano indicates that she did not want her real name to be connected to the Lisa Bell alias. Additionally, recent information indicates Marchiano was also going by the alias skepticaltherapist on 4thWaveNow. On separate occasions, she has claimed to be either the mother of a trans child, or the friend of a mother of a trans child, or the therapist of a mother of a trans child. Under the name Lisa Bell, Marchiano privately offered the ability to crosspost “on YTCP, and simultaneously for maximum effect”.
  • Under the pseudonym Lisa Bell, Marchiano cosigned a right-wing anti-trans letter in 2016 with major anti-gay groups and conversion therapy advocates, including leaders of the American Family Association, Traditional Values Coalition, MassResistance, Eagle Forum, and the American College of Pediatricians. Marchiano also indicated that some posts on Youth Trans Critical Professionals and 4thWaveNow are later edited to be suitable for republication in the far-right outlet The Federalist. As Bell, Marchiano defended the potential benefits of Ken Zucker’s approach of “‘taking all the girl toys away'” and “enforcing gendered play” to “help the child feel comfortable identifying with his or her natal sex” (Marchiano: “I would much rather pack away the Barbies”).
  • Marchiano was aware of Gender Analysis’ 1 July 2017 coverage revealing the three sites surveyed in the ROGD study, and expressed concern that the author (Zinnia Jones) might associate her blog The Jung Soul, under her real name, with the three sites. On 6 July, Marchiano requested links to doxxing threads on the author (Marchiano: “Links are being passed to Fox News”).
  • Marchiano privately proposed a theory that transitioning and social gender affirmation are causative of suicidality, and sought supporting evidence in the form of anecdotal news reports. After receiving stories of trans youth who had committed suicide, Marchiano replied: “This is good stuff.”

Files and resources





It’s worth lifting up that we will all, like Coraline’s real mother, sometimes hurt, disappoint, thwart, and frustrate our children, sometimes in ways that are truly damaging. We can’t possibly only embody the bright pole of the archetype. And when we do hurt them, we will likely create the conditions for our child to experience the archetypal Negative Mother. I remember when my daughter was three, and I firmly asked her to clean up after herself. She yelled at me stridently that I was like Cinderella’s evil stepmother. Well, yes dear. I suppose I am. In time, Coraline again finds her “real, wonderful, maddening, infuriating, glorious mother.” As real, human mothers, we will at times be both wonderful, and maddening.

  • Feb 20: Comment by skepticaltherapist on 4thWaveNow “About” page. The commenter states that she is the mother of a trans or gender-questioning child.

The alien mind control device made its way into my home about two years ago when my then eleven year old daughter begged me for a tumblr account since her friends all had one. … But last month the degree of my alarm grew. She started dropping provocative hints, such as asking us if she could get a buzz cut. I found some writing she had left around the house where she wondered to herself whether she were “really a girl.” …

I have decided that the cult indoctrinators have had free access to her beautiful thirteen year old brain for two years now, and that it is time that I intervene and fight for my daughter. I am so grateful for the clarity I have found on this site. Because of this blog and the stories shared here, I am feeling cautiously optimistic that we may have been able to pull her back from this brink. We have closed her tumblr account. My husband and I have been confronting her about thinking she is trans. …

I believe that open-ended non-judgmental exploration is the very essence of the therapeutic process. The current prohibition on exploring a patient’s feelings of gender dysphoria seems a perversion of this process. I would feel that I had done someone a terrible disservice by imposing an external yardstick on someone’s private decision as to whether to divorce. The potential for harm is so great! How much greater is the potential for harm when we are talking about impressionable young people electing to undergo permanent sterilization?


“But that doesn’t mean that every teen who asks for medication should be recommended for medical intervention. The vital task here is to honor the adolescent’s affirmed gender while helping that young person explore what that means for them.” I applaud PN for taking on this timely issue, but I feel that something important is being lost in the way it has been addressed. Something is going on, and it is very concerning. I large number of young people — especially teen age girls — are coming out as trans after intense internet binges on sites such as reddit, tumblr, or YouTube. These young women often suffer from social anxiety, depression, aspergers, or in some cases, bipolar disorder. The coming out is happening in peer groups. In some cases, whole friend groups “come out” together. While I am supportive of transgendered people receiving the medical care and human rights that are their due, I am very concerned about a social contagion phenomenon. The current transgender trend among young people — which is many cases is getting uncritical support among therapists — puts distressed young people on a path that may lead to serious surgeries and life-long medical treatment. Puberty blockers and cross-sex hormones are being prescribed off-label to children and teens at increasingly young ages without adequate knowledge about potential long-term consequences. Once a young person has gone through their teen years presenting as their affirmed gender, whether on hormones or not, surgery may seem like a natural next step. Transition will always remain on option once a young person reaches adulthood. One cannot undo a surgery that removed healthy organs, or get back one’s ability to have biological offspring. I am disappointed in my fellow therapists who have embraced a well-meaning social justice agenda that precludes their using their critical and diagnostic expertise. Our role should be to do as we always would when someone comes in with important questions that lead to major consequences — to help them explore without judgment — not to blindly affirm.

I wanted to mention that this month’s Psychotherapy Networker is focusing on trans youth issues, and the tone of each article is uncritically celebratory — lots of mentions of “courage,” and “bravery.” You may need a subscription or at least an account to comment, but I have so far.

  • Mar 15: Youth Trans Critical Professionals posts “What’s at Stake?”, replying to the Psychotherapy Networker article with language similar to the commenter “Lisa”/skepticaltherapist.

This month’s Psychotherapy Networker focuses on trans youth. I was disappointed to see how uncritically the trans narrative was embraced. In this piece in particular, trans kids are applauded and celebrated as if there isn’t another side to this issue, as if something very, very serious isn’t at stake. The article is also full of bad science. I don’t know that I will have the energy today to cover all of this, but let’s get started. …

In an upbeat, breezy tone, the author treats “body modification,” “surgery,” and “hormones” casually. Like, it’s no big deal to take a “low dose of testosterone” for decade upon decade. In fact, cross-sex hormones given to gender dysphoric young people are being used off label. Very little is known about the long-term effects of these drugs, and we are unlikely to know more for quite awhile. …

How is it ethical that we as professionals support and encourage young people in undergoing such treatments as a treatment for gender dysphoria? I would personally favor legislation making it very difficult for young people to access these treatments until they are in their late 20’s. I understand this would mean asking some people to live in a way that felt inauthentic or painful, but it would spare the pain that many might feel in the future when they wake up to realize they have permanently mutilated themselves. …

Let’s think first about doing no harm. Transition will remain an option in adulthood, after the prefrontal cortex has had time to develop. As clinicians and professionals, we do young people a disservice when we uncritically sing the praises of the “courageous” path of medical intervention.


  • Apr 5: Interviewed as “the founder of Youth Trans Critical Professionals” in 4thWaveNow post “Do No Harm: An interview with the founder of Youth Trans Critical Professionals”. Marchiano finds points of substantial agreement with Ken Zucker’s approaches to “enforcing gendered play”, including “‘taking all the girl toys away'”, in order to “help the child feel comfortable identifying with his or her natal sex”.

There is an Atlantic article about this from 2008 that I found very interesting. It profiled several of these kids who are “persistent, insistent, and consistent” starting at an early age. Some of the Canadian kids were treated by Dr. Kenneth Zucker. The article describes some of the things involved in the treatment such as “taking all the girl toys away.” I admit that made me cringe. Really?! Who would want to do that to their child? However, at the time the article was written, Chris, the child in question, had grown up to be a gay, effeminate man who had a healthy, intervention-free body.

My understanding is that when Zucker’s team assessed a gender dysphoric child, they closely examined the family system, considering carefully different dynamics that were in play, and then crafting an individualized treatment plan that might involve several different kinds of interventions. I believe that enforcing gendered toys was something that was done in some cases, but was accompanied by other therapeutic interventions that took into account the whole family dynamic. The ultimate aim was to help the child feel comfortable identifying with his or her natal sex.

So I think, if I had a little boy who insisted he were a girl, and I could do this terrible thing of enforcing gendered play, or I could do this terrible thing of altering his body and destroying his ability to have his own children, which would I pick? If I knew I would have a healthy, happy, whole gay man at the end of it, if I had a reasonably good guarantee that would be the outcome, I would much rather pack away the Barbies. The personal and social difficulties of back-tracking on a childhood or adolescence spent transitioning will inevitably be immense. If a child has been transitioned from a young age how will they know, or be able to begin to articulate, that a mistake has been made? …

The other major difference – and this is the heart of the artichoke – is intervention. Gays and lesbians are not seeking intervention. They just want to love whom they love. My hypothetical gay boy client and I would be free to discuss and explore his experience of being gay and his coming out process without any high stakes medical decisions hanging over our heads. If I knew that my hypothetical trans patient would not have access to medical intervention until she was, say, 25 years old, she and I could spend our therapeutic hours exploring her experience as a trans woman, and I could offer support for the difficulties involved in being different in this way.


  • Jun 6: Under the name “Lisa Bell”, Marchiano cosigns an anti-trans letter by the National Association of Scholars (“The Office for Civil Rights Overreaches on Transgender Mandate”) with leaders of major right-wing and anti-LGBT groups. Partial list of cosignatories:
    • Cathie Adams (Texas Eagle Forum)
    • Brian Camenker (MassResistance)
    • Anne Schlafly Cori (Eagle Forum)
    • Dr. Michelle Cretella (American College of Pediatricians president, National Association for the Research and Therapy of Homosexuality board member, Catholic Medical Association)
    • Elaine Donnelly (Center for Military Readiness)
    • Frank J. Gaffney Jr.
    • Rep. Louie Gohmert (R-TX)
    • Robert Knight
    • Andrea Lafferty (president of Traditional Values Coalition)
    • David H. Pickup (anti-gay conversion therapist, cofounder of National Task Force for Therapy Equality)
    • Sandy Rios (American Family Association)
    • Eunie Smith (Eagle Forum of Alabama)
    • Tim Wildmon (president of American Family Association)



Mandates by public institutions to force the acceptance of GD as a normal variant of child development and require social accommodation, toxic hormone therapy and surgical removal of healthy body parts, are misguided and dangerous. The Association of American Physicians and Surgeons, the Christian Medical Association, and the Catholic Medical Association share the College’s concern over this approach. Together our groups represent over 20,000 physicians and health professionals. Opposition also exists among liberal-leaning healthcare professionals who have created an online community known as Youth Trans Critical Professionals.

This is the realm of the psyche governed by the fearsome Mesopotamian goddess Ereshkigal who was known as Queen of the Great Earth. Ereshkigal is not a nice goddess. When her beautiful, upper world sister comes down for a visit, Ereshkigal has her stripped naked and killed, then hangs her corpse on a peg to rot. Ereshkigal’s energy is the archetypal, universal dark aspect of the feminine associated with death and decay. It is this aspect of the feminine that we come to know in part “through the lower brain acitivities that regulate peristalsis, menstruation, pregnancy, and other forms of bodily life to which we must submit.” (Sylvia Perrera, Descent to the Goddess, p. 24). This dark aspect of the feminine is especially reviled and feared in Western culture.

Imagining that we can, with surgeries and injected synthetic hormones, subvert the deep wisdom of the instinctual, Ereshkigal part of our psyches is evidence of just how divorced we are from those instincts. It is the arrogant assertion of supremacy of science and technology over the silent perfection of our animal bodies. When we align with this goal, we are indeed cutting off ourselves from our own inner source of nourishment and wisdom. It is an act of violence against our very natures. “It felt like I was burying a piece of myself,” confessed one young transman who had been on testosterone and had had a mastectomy.

  • Aug 24: The Alliance Defending Freedom’s James Arnold warns of “rapid onset gender dysphoria” in the ADF weekly digest.


However, an identity model of working with transgender people goes further. An identity model stipulates that it is wrong to explore or question a client’s self-determined identity. Gender dysphoria is seen as evidence that someone is transgender, and merely wondering about underlying psychological reasons for dysphoria or alternative explanations for symptoms is seen as synonymous with denying a person’s identity. …

In opposition to an identity model, then, the main task in mental health therapy with a client experiencing gender dysphoria would be to deeply explore the symptoms without making assumptions about what the symptoms mean. In fact, while identity therapy knows what gender dysphoria means – i.e. that the client is trans – mental health therapy will start with the assumption that we have no idea what the symptom means. We must be open to the meaning that emerges for patients as we explore their experience with them. …

Because of this, an increasing number of minors are going on hormones and even undergoing surgery that will permanently alter their bodies. Even 18 is probably too young to make such major medical decisions. In cases where the 18-year-old is making medical decisions based on a social transition that she or he began years earlier, it is possibly even more likely that that young person has not carefully considered the consequence of transition.


Coming out as transgender is without question a provocative thing to do. Sometimes people do provocative things because they authentically need to do them. And sometimes they do provocative things for secondary gain, such as to signal distress about something else, or to avoid another problem. A parent’s job is to try to sense whether there is a genuine emergency, or whether the child is engaging in emotional flame throwing. In the latter case, a more neutral, matter-of-fact approach may help to de-escalate the situation. This might mean choosing to focus on gender and related topics as little as possible. …

If your child is under 18 and lives under your roof, you can use your parental authority to limit when, where, and how much time your child uses screens. There is a wealth of evidence that too much screen time negatively effects both academic performance as well as mental health among young people. If possible, get your child off the internet by engaging her in other activities. Take weekend trips as a family and leave the phones at home. Sign your child up for any activity that she enjoys. Don’t allow cell phones or computers in bedrooms. During summer break, make sure your child is occupied with employment or camp, preferably one that restricts technology.

Trans identifying teens have often come to inhabit a small echo chamber of peers obsessed with gender. Like most teens, they lack the sense of where they fit in the larger world. The self-preoccupation of adolescence breeds myopia. Connecting kids with the wider world – through travel, employment, time in nature, time spent with relatives, extracurricular activities, etc. is a powerful corrective to the natural self-absorption of adolescence. A month or so in nature or on an overseas trip that dramatically widens their worldview can serve as a “hard reset,” reminding them of different facets of their personality they may have lost touch with.


  • Dec 15: Marchiano posts on her personal blog The Jung Soul: “What’s My Agenda?” (content warning: child sexual abuse). Here, Marchiano states she is the friend of a mother (named “B”) with a trans or gender-questioning child, and that “this is happening in my house, so to speak.”

Until about a year ago, I hadn’t thought much about the issue of transgender teens and kids. I certainly would have agreed that trans teens deserve support and protection.

Then an old friend contacted me about her teen daughter. This woman has been a close friend of mine for decades, and I have known her daughter from birth. My friend — I will call her B — told me that her daughter had decided she was really a boy, and was imploring her mother for hormone blockers. She had even done research on getting a mastectomy.

B was shaken and upset when she called, and I immediately understood why. Amelia had always been a quiet, thoughtful, delightfully quirky child, but had never shown any discomfort with her gender or body until then. Her sudden announcement that she was transgender accompanied by a fervent interest in arresting puberty and even amputating her breasts came just a month after she was molested by an older teen boy. …

I am concerned that there will be many “false positives,” — young people who could have managed these symptoms with less invasive methods who may come to regret the permanent changes to their bodies. I feel a duty to say something because this is happening in my house, so to speak.

To wrap up this post, I just want to report that my friend B (who kindly gave me permission to share her story here) and Amelia are doing well. With patient support, Amelia came to accept her own body. She recently told her mom she was glad she held the line and didn’t immediately give in to giving her blockers.



  • The poster abstract of the eventual ROGD study, “Rapid Onset of Gender Dysphoria in Adolescents and Young Adults: a Descriptive Study”, is published in the Journal of Adolescent Health (Littman, 2017). The information in the abstract allowed Gender Analysis to identify the three sites as 4thWaveNow, Transgender Trend, and Youth Trans Critical Professionals on 1 July 2017.

Parents online are observed reporting their children experiencing a rapid onset of gender dysphoria appearing for the first time during or after puberty. They describe this development occurring in the context of being part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same timeframe and/or an increase in social media/internet use. …

Recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions, was placed on three websites where parents had reported rapid onsets of gender dysphoria. Data was collected anonymously via SurveyMonkey.



How would you feel if this was posted on YTCP, and simultaneously for maximum effect?

Lisa Bell

It looks great. Are you okay if 4thwave makes some edits? She is a great editor. She can shoot back final draft for your approval.


The second significant risk in facilitating a social transition among pre-pubertal children is that transition almost certainly increases persistence. If a five-year-old boy is “affirmed” that he is the opposite sex, and is addressed by a typically female name and pronouns by the adults around him, it is very likely that the child will be reinforced in his belief that his body is “wrong.”

Moreover, the surge of endogenous hormones at puberty rewires a young person’s brain in complex ways. It is likely these hormones and the changes they bring that in part account for desistance in the roughly 80% of children who grow out of dysphoria and come to feel at home in their natal sex. By blocking these pubertal hormones with Lupron, it is probable that clinicians and parents are setting the child’s cross-sex identification in stone. …

In contrast, if the story we tell our child is that he has gender dysphoria, suddenly a range of possible options becomes available to us. We can support him in managing his distress. We can work to challenge rigid gender expectations. We can try to find him like-minded peers, and adult role models of feminine men. We can teach him self-soothing skills. We can work with the school to reduce bullying. And of course, the option to transition will still be there. 

Psychotherapists know that often, the answer to dealing with discomfort is to learn to sit with it. It must be excruciating as a parent to watch a child suffer with dysphoria. The temptation to end the suffering with a quick pharmaceutical fix must be immense. But I can’t help but think that at least some of time, it might be better to sit with this discomfort rather than reaching for a drug.

I’ve had it on my list to write you an email. Will do later today — from my real address (this is a pseudonym).

So now you know I am the blogger for YTCP. I am not “out” so I appreciate your keeping my secret.

I have copied 4thwave on this email to keep her in the loop. We have discussed some of this generally, but I am not intending to speak for her. …

Personally, my views on gender are informed in part by the writings of Carl Jung. He believed that every man has an inner feminine part of himself, and every woman has an inner masculine. He felt that these were distinct “splinter personalities,” and saw them as so important that he named them “anima” and “animus” — the Latin word for soul.

I think it is exactly these contrasexual energies that Jung intuited that inform many of the third gender designations we see in other cultures, and I agree it is healthy to have a culture that is accepting of these.

My concern about nb in the current climate is that WPATH is pushing a medical pathway for nonbinary people. It is clear to me that the DSM V gender dysphoria diagnostic criteria were written in such a way as to leave open the possibility of medical transition for nb folks (Magdalen Burns did video on this). In addition, I was at USPATH in February. (I would appreciate it if you didn’t broadcast this.) I attended a presentation on treatment of nonbinary people that was all about hormones and surgery.

Finally, my last concern is that it seems to me that most of the young people identifying as nb are teen girls — I suspect they are trying to be anything other than female. :(

The sick thing is, you created the legal designation as an alternative to help people avoid medical intervention. I’m afraid WPATH is using it to broaden the number of people eligible for medical intervention.

Was JOK [Johanna Olson-Kennedy] involved in this case? I feel like we are creating suicidally [sic] in these kids.

This is great stuff Jamie. I’ll say more soon but just know I am making good use of it.


Gifted children may suffer from anxiety and perfectionism. Anxiety disorders were also well-represented among the comorbid issues reported in the detransitioners survey mentioned previously. It has been suggested by some that adopting a transgender identity may in some cases be an anxiety management strategy. I am familiar with one young man with dysphoria who is both gifted and learning disabled. His preoccupation with gender waxes and wanes, but is predictably worse during exam periods, when he tends to fall behind and become overwhelmed. The feelings of dysphoria seem to allow him to distract himself from his feelings of intense anxiety and insecurity, while alleviating some of the academic pressure. When he is suffering from increased distress over gender dysphoria, his teachers and parents are more focused on his mental well-being, and they place fewer demands on him.


He tweeted something from my personal blog yesterday and it did make me nervous. It has my real name, etc. But I haven’t been swarmed with hate yet! Not even any negative comments. This is the piece he took issue with:

He has a porn acct on twitter. I usually use people’s pronouns but not for the likes of him.

Can you get me links to those Kiwifarms pages? I think someone mentioned he mods some porn Reddit subs. Do you know anything about that? Anything you’ve got on him, please send.

Is there an archive of Jones’s Tumblr? Links are being passed to Fox News.

As background, I have spoken with dozens of parents looking to help their child deal with gender dysphoria without resorting to transition. In virtually every case, these parents were motivated by a desire to help their child avoid unnecessary medical intervention that could compromise fertility and expose their child to potentially serious side effects. These parents were not motivated by transphobia, bigotry, or right wing ideological beliefs. Many consider themselves politically liberal. In quite a few cases, the young person came out as gay or lesbian to full parental support and acceptance before going on to later come out as trans. …

It is worth noting that there may be many families who noticed an improvement in their teen’s symptoms after supporting a social transition, but these families are unlikely to seek me out, so of course my experience is limited in this regard and may not be representative. However, my observations are supported by recent research published in the February, 2017 Journal of Adolescent Health that noted that mental well-being and parent child relationship tended to get worse in the majority of cases after an adolescent came out as trans. This is one of the many areas where further research would be helpful. …

It’s important to remember that adolescence is nearly always a time of increased conflict between parents and children. It is normal for teenagers to experience some degree of distress. The majority of teen girls feel some degree of displeasure or even hatred of their bodies. Limit testing is also a typical feature of the teen years. When we see our dysphoric teenager become angry or upset when we impose a limit around transition, it might help us to place her reaction within the context of normal teen behavior. Just because they express unhappiness does not mean that we ought to give in to their every demand.

I hope you don’t mind any of my edits.

Also, I have a request for you. I am looking for an up to date list of informed consent clinics. Do you know if such a list exists?

Your piece has been shared with the Federalist. They may be interested in republishing. Would you be open to that?

The Federalist will want to condense and edit significantly (this is what they did to 4thwavenow posts). You should write and let them know that’s okay. Or perhaps offer an interview

4thwavenow is also in touch with Joy.

So I feel like this military ban is complex and my liberal friends are all freaking out and hand-wringing. What would your talking point be in a few sentences?


  • Oct 6: Psychological Perspectives publishes Marchiano’s article “Outbreak: On Transgender Teens and Psychic Epidemics” (Marchiano, 2017). In this article, Marchiano identifies herself as first becoming involved in “rapid onset gender dysphoria” as the therapist of a mother with a trans or gender-questioning child. Marchiano has now at various times claimed to be the mother of a trans child, the friend of a mother (named “B”) of a trans child, or the therapist of a mother of a trans child.

“Rapid-onset gender dysphoria” is a new presentation of a condition that has not been well studied. Reports online indicate that a young person’s coming out as transgender is often preceded by increased social media use and/or having one or more peers also come out as transgender. These factors suggest that social contagion may be contributing to the significant rise in the number of young people seeking treatment for gender dysphoria. …

This topic first came to my attention in my practice. A patient reported that her daughter was identifying as transgender. I admired the way this mother attempted to support her child, and I marveled at the creativity of youth culture in challenging traditional conceptualizations of gender. My view of this cultural trend as benign collapsed in an instant, however, when I learned that young women were having mastectomies as young as 14 (Rowe, Citation2016). Realizing that the identity exploration of teenagers was being treated in a concretized way that would have drastic, permanent consequences for the young people involved immediately filled me with concern. Further research online and through speaking with people only increased my alarm. It quickly became clear to me that teens were coming out as trans in peer clusters, as we have seen happen before with suicide and eating disorder contagion.

So do you think it is possible that someone who passes 100% of the time would have less suicidality? Is it possible that those who are blocked and then transition will have good long-term outcomes?

I think it might be possible, but then we’ll never have a good control group to know whether they could have been fine without losing their fertility. I also suspect we will see major health problems w Lupron and long-term HRT.

That’s an important point — blocker generation not integrating in cis society. Always and [sic] outsider.


As for your suit, yes! I know people who would testify. I believe that Ken Zucker would. Mike Bailey perhaps also. And if they can’t, they will know people who can. Keep me posted. I won’t say anything to anyone yet, but I know several smart people who would likely have some helpful thoughts. So just let me know what you need. My lips are sealed, though, until you ask me to share.

Tell me what kind of help you might need when you get a chance, and I will start emailing around. I know someone who specializes in informed consent who would be very happy to help, I think. He is a psychiatrist with a lot of legal experience as well.


  • Dec 17: Marchiano emails Shupe “Re: Catching Up” at 7:32 PM, responding to Shupe’s question of “On the legal front, I don’t know if ADF can be trusted or not?”

I don’t know why the ADF wouldn’t be trustworthy. Do you want me to see if I can poke around back channel?

Thinking of ourselves as oppressed or infirm may inadvertently cultivate what psychologists call an external locus of control. Locus of control is a psychological concept articulated in the 1950s by Julian Rotter. Those with an internal locus of control experience themselves as able to influence outcomes that affect them. Those with an external locus of control feel that most of what happens to them is beyond their ability to affect.

A diagnosis carries with it a sense of absolution. It isn’t our fault that we have anxiety or depression. Forces beyond our control have conspired against us. Psychiatric diagnosis has myriad practical benefits. It can contextualize and normalize distress, reduce stigma, and point the way toward intervention and treatment. However, when our diagnosis becomes an important part of who we are, we are encouraged to abdicate responsibility for our plight. We are adrift on life’s turbulent currents, without blame, but also without agency. This fosters a sense of helplessness, which in turn can lead to increased anxiety.

We have had an interesting development. We have a very capable lawyer looking for a litigant. Are you still interested?

Can I connect you directly with 4thwavenow? She is the one with the contact. I’ll connect you via email if that is okay. This lawyer’s specialty is malpractice, specifically mental health “quackery.”


I’ll check w 4thwavenow. I think they are hoping for a pediatric transition case, but let me ask again.

I did that. Just rethinking the blog a bit. I may change some things. It’s not gone. Stay tuned.

In this chapter, I will explore transgender identities among adolescents as a symbolic communication of psychic conflicts that are a normal part of the painful and often frightening passage to adulthood. In doing so, I will draw upon my clinical work with parents of transgender teens. …

Harry Potter author J. K. Rowling captures the essence of what it means for something to be psychologically true in dialogue between the young wizard and the elder Dumbledore. When the pair meet in liminal space after Dumbledore’s death, Harry asks whether the experience is real, or just happening in his head. “Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?” replies Dumbledore (Rowling, 2007, 723).

  • Apr 29: Marchiano appears as a member of on the group’s “Who We Are” page with fellow members Roberto D’Angelo, Dianna Kenny, Ray Blanchard, James Cantor, Ken Zucker, Sasha Ayad, J. Michael Bailey, Robert Withers, Michelle Peixinho, and Michael Laidlaw.
  • Aug 7: Marchiano writes “No, You Don’t Have a Disorder. You Have Feelings” at Areo Magazine.

Pollan’s observations may provide a clue as to why traditional conceptualizations of mental illness tend to be self-reinforcing and create more illness. Much mental suffering results from being stuck in a story about ourselves. When we take the story at face value, we risk reifying and reinforcing it, when what heals and transforms is anything that allows us to shift our perspective and transcend the narrow, ego-bound experience of ourselves.

Psilocybin and other psychedelics appear to offer such experiences, but there are other ways to access this perspectival shift, and I suspect that taking psychedelics is not in and of itself a guaranteed way to attain this. The ego cannot manufacture such an experience. It cannot be forced by another, and it is not available in pill form—at least not yet. What is required is a degree of receptivity to that which is other-than-ego.

  • Aug 16: Lisa Littman’s original uncorrected study “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports” is published in PLoS One (Littman, 2018), crediting Lisa Marchiano for her feedback while omitting mention of Marchiano’s role in the surveyed Youth Trans Critical Professionals site.

Recruitment information with a link to the survey was placed on three websites where parents and professionals had been observed to describe rapid onset of gender dysphoria (4thwavenow, transgender trend, and youthtranscriticalprofessionals). Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. The survey was active from June 29, 2016 to October 12, 2016 (3.5 months) and took 30–60 minutes to complete. …

I would like to acknowledge Michael L. Littman, PhD, for his assistance in the statistical analysis of quantitative data, Michele Moore, PhD, for her assistance in qualitative data analysis and feedback on an earlier version of the manuscript, Lisa Marchiano, LCSW, for feedback on earlier versions of the manuscript, and two anonymous peer-reviewers for their valuable input.

The study additionally misrepresented an inaccurately truncated quote from a Gender Analysis article, citing an intermediary source (fig. 1, “Example quotes of online advice from reddit and tumblr”).

I am hoping you can help us with a research project. Comparing notes, we are noticing that the only suicides of trans teens that we hear about are among those kids who are being supported and affirmed, and are transitioning or have transitioned. Leelah Alcorn being the only exception.

Since there are no national statistics that would allow us to test the hypothesis that transition may increase suicidality, we want to try to mine news reports to see what they show. Are you able to put your hands on as many reports of trans teen suicide stories as possible? We can possibly have someone analyze them to see if there are any conclusions that can be drawn.

Can you help?

This is good stuff.

Many critics of pubertal suppression hold a modernist teleological worldview. They find it self-evident that there is a purposeful design to human nature, and that cooperation with this design leads to human flourishing. Others, however, identify as post-modernists who reject teleology. What unites the two groups is a traditional interpretation of “First do no harm.” For example, there is a growing online community of gay-affirming physicians, mental health professionals, and academics with a webpage entitled “First, do no harm: youth trans critical professionals.” They write:

We are concerned about the current trend to quickly diagnose and affirm young people as transgender, often setting them down a path toward medical transition…. We feel that unnecessary surgeries and/or hormonal treatments which have not been proven safe in the long-term represent significant risks for young people. Policies that encourage—either directly or indirectly—such medical treatment for young people who may not be able to evaluate the risks and benefits are highly suspect, in our opinion.

  • Nov 24: Unnamed anti-trans parents meet with Paul Jenkins and Dr. Sally Hodges at the Tavistock and Portman, and suggest continuing professional development courses for therapists led by Lisa Marchiano.

[redacted] and [redacted] suggested involving others in CPD sessions by Skype e.g., Tania Marshall and Lisa Marchiano; work more on trauma and sexual orientation. Paul and Sally wrote these ideas down. [redacted] outlined her credentials for relevant CPD input, facilitation ad [sic] research.

  • Dec 23: Marchiano signs an open letter in the UK’s Sunday Times supporting a review of grants to the pro-trans organization Mermaids (with Michael Biggs, Heather Brunskell-Evans, Stephanie Davies-Arai of Transgender Trend, Michele Moore, Stella O’Malley, and Robert Withers).


Recruitment information with a link to the survey was placed on three websites where parents and professionals had been observed to describe what seemed to be a sudden or rapid onset of gender dysphoria (4thwavenow, transgender trend, and youthtranscriticalprofessionals), although the specific terminology “rapid onset gender dysphoria” did not appear on these websites until the recruitment information using that term was first posted on the sites. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. The survey was active from June 29, 2016 to October 12, 2016 (3.5 months) and took 30–60 minutes to complete. …

Youth trans critical professionals

Youth Trans Critical Professionals was created in March 2016. The digitally archived screenshot from the April 2016 “About” section stated the following: “This website is a community of professionals “thinking critically about the youth transgender movement. We are psychologists, social workers, doctors, medical ethicists, and academics. We tend to be left-leaning, open-minded, and pro-gay rights. However, we are concerned about the current trend to quickly diagnose and affirm young people as transgender, often setting them down a path toward medical transition. Our concern is with medical transition for children and youth. We feel that unnecessary surgeries and/or hormonal treatments which have not been proven safe in the long-term represent significant risks for young people” [51]. …

I would like to acknowledge Michael L. Littman, PhD, for his assistance in the statistical analysis of quantitative data, Michele Moore, PhD, for her assistance in qualitative data analysis and feedback on an earlier version of the manuscript, Lisa Marchiano, LCSW, for feedback on earlier versions of the manuscript, and four external peer-reviewers, three PLOS ONE staff editors and two Academic Editors for their attention to this research.

The correction does acknowledge Gender Analysis’ authorship of a quote previously attributed to “Tumblr” in fig. 1.

The purpose of Fig 1 was to provide the reader with a quick sense of what kinds of advice can be found and shared on Reddit and Tumblr. One example includes an excerpt from a publicly available Tumblr blog that posted a list of purported indirect signs of gender dysphoria. This excerpt is indeed an example of advice that can be found on Tumblr. Note, however, that the excerpted Tumblr post itself does not reflect the full content of the original blog it refers to, nor does the excerpt in Fig 1. The original blog is titled, “‘That was dysphoria?’ 8 signs and symptoms of indirect gender dysphoria” [15].

Yes, this is very helpful information. It definitely makes sense for what parents and detransitioned people say regarding how their child’s or their own dysphoria became worse when they started to identify as trans.

  • Jun 1: Marchiano signs open letter “Trans ideology is damaging children” in The Times (UK) (with Heather Brunskell-Evans, Michele Moore, Richard Byng, Graham Linehan, Michael Biggs, Stephanie Davies-Arai of Transgender Trend, Emma Hilton, Helen Joyce, Lord Lewis Moonie, Stella O’Malley, Sonia Poulton, Sophie Scott, and Robert Withers).

Previous guidance, developed in partnership with the transgender lobbying group Mermaids, undermined safeguarding by promising “complete confidentiality”; promoted the idea that children as young as two can be identified as having a “true gender” that does not match their sex; and normalised the practice of teenage girls binding their breasts.

We urge Girlguiding to review its own policies to ensure that Brownies and Guides are also protected.

We are concerned about the role of groups such as Mermaids in the development of policy by schools and groups working with young people. The ideology it pushes causes gender-non-conforming children to believe they need unnecessary medical treatments, which risks their health. An inquiry is needed before a scandal breaks.

I hope you are doing well. I’m wondering if you can help me with something. I would like to write something about how the trans narrative is actually making kids feel suicidal — how the suicidality is because of transition or perhaps being told that if they are trans, they will feel suicidal. I would be interested to know if you have collected and archived news reports about trans teens who were fully supported by their families who nevertheless attempted or completed suicide. I would like to collect these anecdotes.

Thank you!

I could not make sense of this case because I did not know then what I know now—that virtually all psychiatric disorders are to some extent artifacts of the time and place in which they occur. The instinctual energies that arise from the unconscious are protean in form. They make their way into consciousness via vague sensations, mysterious moods, strange impulses, or fleeting images. When we suffer from underlying psychosocial vulnerabilities, disruption, trauma, or interpersonal anguish, our unconscious looks for culturally sanctioned garb in which to clothe our distress. Symptoms gain cultural currency through a complex and largely unconscious negotiation between the medical establishment, activists and advocates, media, and the patients themselves. Once these symptom templates have been codified and validated, they can be found by those unconsciously seeking to express wordless distress, and a feedback loop begins, further reifying the condition. …

By choosing to use the word ‘hysteria’ to describe the recent trend of transgender children and teens, I am locating this phenomenon within a tradition of clinicians and thinkers who have carefully documented the role of culture in shaping and spreading psychological symptoms. These writers have noted the psyche’s tendency to express itself through the language made available to it by current cultural conceptualizations of distress. All of them speak to the dangers of well-intentioned attention to these kinds of contagions. Privileging the symptoms only makes them more entrenched and likely to spread, claiming more victims (Watters, 2011). …

The notion of being transgender could not exist without doctors. Transgender was not a category one could imagine for oneself until medical and surgical advances created transition.


  • Sep 27: Marchiano signs letter to the editor in The Sunday Times (UK) in support of J.K. Rowling (with Graham Linehan, Stella O’Malley, Abigail Shrier, and Malcolm Clark).
  • Oct 21: Marchiano coauthors “One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria” in Archives of Sexual Behavior with Roberto D’Angelo, Ema Syrulnik, Sasha Ayad, Dianna Kenny, and Patrick Clarke (D’Angelo et al., 2021).


Would you want to talk to 60 Minutes? They are doing a piece on detransition and are interested in talking to as many detransitioners as possible. If you give me the go ahead, I will introduce you via email.


As the Jungian analyst Lisa Marchiano says, each parent is the world expert on their own child. This is the time to own your authority, to honor your feelings, and to take your time to evaluate each decision you choose to make.

  • Apr 25: Marchiano attended a meeting of SEGM with the United States Department of Health and Human Services Office for Civil Rights regarding proposed rulemaking on Nondiscrimination in Health Programs and Activities (RIN 0945-AA17). The meeting lists Marchiano as a member of SEGM, and she presented her remarks following Dr. William J. Malone, Dr. Richard Byng, Richard Stephens, Dr. Riittakerttu Kaltiala, Dr. Hildur Hjaltadottir, and Sasha Ayad.

Previously, regret was considered to be low. However, in recent years, since gender affirmation became popularized in medicine, we are seeing more and more young people who regret their transition. Newer research from the UK shows rates of detransition and regret are nearing 10% after just 16 months.

With as many 2-10% of young people now claiming a trans identity, I and many of my colleagues are concerned that we are creating an epidemic of wrongly – treated young people by providing them with permanent body-altering interventions. If clinicians are afraid to exercise their judgement because non-provision of hormones and surgeries is equated with discrimination, tens of thousands of young people will be permanently harmed.

The order does not impose an outright ban on therapy for gender-dysphoric youth. But it will have a “chilling effect”, says Lisa Marchiano, a Jungian therapist and a co-founder of the Gender Exploratory Therapy Association. Most decent therapists should be able to help people with gender dysphoria, she says. Yet America’s focus on affirmation means many are wary of doing so. Instead, they refer children to gender therapists, who are likely to affirm a trans identity and suggest drugs.

I agree that we do not have conclusive proof that peer and social media influence are part of the equation, but we also don’t have evidence that they are not. Given the high stakes nature of the medical interventions that are often sought by young people identifying as trans, this area of medicine needs more good quality research.

We will be able to produce publishable academic results that show the drivers of the social contagion I have called “The Gender Bubble;”

We will be able to produce trend-data by identify large statistically valid population samples and track influence over time to correlate with media events—like the launch of the reality show, “I am Jazz;” to determine to what extent these various influences had an impact on the stunning rise of trans-identification in teens since 2015.

We will be able to see into the black box of the digital influence on kids who are self-diagnosing as transgender and see what patterns may exist around their decisions to change pronouns, to socially transition and to medicalize.

We will be able to map the extent to which this online cult(ure) influences parental alienation for questioning a child’s trans identity;

  • Sep 11: Marchiano is lead signatory of a letter by the Gender Exploratory Therapy Association to the United States Department of Education (RIN 1870-AA16), objecting to gender identity nondiscrimination in schools and social transition for trans youth generally (with Stella O’Malley, Sasha Ayad, Roberto D’Angelo, Joseph Burgo, Joanne Sinai, Stephanie Winn, Robert Withers, Michelle Peixinho, Susan Evans, Marcus Evans, and Aaron Kimberly).

As therapists, we believe that psychological approaches should be the first-line treatment for all cases of gender dysphoria, and that immediate social transition by school personnel is contrary to an effective therapeutic approach intended to explore the various possible causes of a young person’s psychological distress. …

Social Affirmation in School Settings Harms Children by Interfering with Exploratory Psychotherapy and Putting them on a Pathway to Experimental Medical Interventions

Mulvaney’s TikTok following grew to 8.4 million after her White House appearance, and while she is entitled to share her experiences online, experts told that online influencers like her in part drive an alarming uptick in teen transitioning.

‘They’re called social media influencers because they influence people,’ said Lisa Marchiano, a clinician with the Gender Exploratory Therapy Association, a group of therapists.

‘It’s very concerning to see social media influencers get this kind of attention, being asked to visit the White House, celebrated and valorized without any critical appraisal or explanation or alternative viewpoints – and that could affect people.’

Transgender children fall prey to the bizarre belief that they are the opposite sex or neither sex. Taken away from the clamor and din of politics, the assertion that one is biologically one sex but of a different “gender” in some mysterious way makes no sense and is every bit as strange as asserting that daycare workers sacrificed babies and fed them to children. …

And as with the false beliefs present in many cases of false memory therapy, the belief of gender nonconforming youth that they are actually the opposite sex disrupts other adaptive behavior, severs important relationships, and can become obsessional. …

They become obsessed with their appearance and with “passing.” They might suffer outsized distress over the indignity of being “misgendered.” Their ambit of concern can shrink to encompass only the paranoid echo chamber of illusory oppression.


  • Feb 3: “Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report with lessons about unanticipated harm”, reviewed by Sarah Earle and Lisa Marchiano, is published in Frontiers in Global Women’s Health (Gribble, Bewley & Dahlen, 2023).

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Last updated on 2 Apr 2023 by Zinnia Jones