What Parents Don’t Know: Trans Youth Study Reveals Fatal Flaw at the Heart of “Rapid-onset Gender Dysphoria”
By: Zinnia Jones
Tags: LGBTQ, Transgender, Gender Identity, Coming Out, Gender Dysphoria

(printeraction/Alex Crease)

Origin and scope of the “rapid-onset gender dysphoria” (ROGD) pseudo-diagnosis of trans youth

Rapid-onset gender dysphoria (ROGD) is an alleged new social phenomenon of inauthentic gender dysphoria suddenly appearing among cisgender adolescents in growing numbers and in social clusters, unlike other currently known forms of gender dysphoria already seen among trans people. This claimed syndrome was first named by Dr. Lisa Littman of Brown University in an abstract (Littman, 2017) and later study (Littman, 2018) based on sampling readers of three prominent anti-trans communities which featured claims throughout 2016 of a growing trend of “sudden onset” of this false gender dysphoria in cis adolescents.

The proposed condition of ROGD thus suggests that, as apparent trans adolescents may actually be misdiagnosed as cis youth, the effective gender-affirming treatment given as a standard of care for trans youth would be inappropriate or harmful for this group of youth, and so this gender-affirming treatment should be withheld from them.

Following Littman’s 2018 study, this claimed condition has been widely promoted in the public discourse by anti-trans advocacy groups, right-wing legal groups, conservative legislators, “intellectual dark web” commentators, and those of any stripe whose politics include the invalidation of trans youth. The spectre of this contagion of mistaken gender running rampant among youth has recently been the subject of alarm among Republican lawmakers, as always under the banner of “protecting children”, working to ban access to medical transition for trans adolescents — and in at least one state succeeding.

Littman’s study has a fundamental flaw in its methodology that broadly undermines its reported findings. According to Littman, a key feature distinguishing ROGD from classic gender dysphoria is that ROGD appears very quickly in a child who was heretofore apparently cisgender with no sign of gender incongruity. The observations of this rapidity consisted entirely of reports from anonymous parents on their own perception of their child’s gender identity and development, almost universally expressing surprise at the sudden nature of their child’s statement of a transgender identity. The youth themselves were not surveyed on their own experiences of gender incongruity throughout their childhood, how long they had experienced gender incongruity or considered themselves transgender, or how long they had waited to make their trans identity visible to these parents for the first time.

These secondhand parental observations are the only evidence offered by Littman for the distinct “rapid” nature of the progression of ROGD, unlike classic gender dysphoria, which we can infer that Littman considers to have a more complex or protracted course of development and consideration. There is a problem: In this area, parental reports of their child’s gender development are not sufficient to make the case that their child actually has experienced a “rapid onset”. Extensive existing literature over decades has already shown that many parents do experience surprise at a trans child coming out; at the same time, their child gave much thought to their gender and identity for many years before that. The converse of parents’ surprise is the consistent finding, when trans youth and adults are the ones asked, that several years can pass as we contemplate our gender in our childhood and take our time before deciding when we come out as trans.

These two sets of observations occur because trans people have access to our own internal experiences and perceptions of gender while our parents can only access what we voluntarily express externally. Littman’s mistake in formulating ROGD is treating the latter as though it defines the former, with a child’s actual gender development being collapsed into a parent’s own perception, one necessarily narrowed down to the first time we chose to be visible. Treating parental observations as synonymous with actual child gender development processes is unsupported and contradicted by nearly every other published study in this area.

One notable study recently acquired the information Littman’s study conspicuously lacked, surveying both trans youth and their parents or caregivers on their reports of their own gender self-recognition and disclosure milestones versus their caregivers’ perception of the timing and pace of their gender development milestones. The discrepancy between parent perceptions and trans youth’s identity development has been quantified and it is a significant difference.

ROGD’s methodological error: Using parent perceptions to equivocate between trans youth’s self-recognition and disclosure

In July 2017 I had already pointed out the insufficiency of Littman’s reliance on parental reports as a proxy for youth’s gender identity development, and in February 2018 I explained why this methodology ran the risk of producing highly biased results:

This is a crucial gap: these children have not been administered any validated survey instruments on gender dysphoria, mental health, social functioning, or anything that would serve to demarcate this “new” condition from the traditional form of gender dysphoria currently observed among youth. Parent reports of a “rapid” onset of dysphoria are especially questionable: many trans youth understandably conceal their identities for years, knowing the consequences of coming out to potentially unaccepting parents could be dire. What appears to a parent to be a “rapid” onset may not have been rapid for their child at all, and it is common in trans support forums to hear from youth (and adults) whose parents protest that they “never showed any signs”.

Dr. Joshua Safer of the Endocrine Society and Mount Sinai’s Center for Transgender Medicine likewise explained that Littman’s study of what she calls ROGD actually only consists of a survey of parents’ perceptions and attitudes:

I don’t know if there is such a thing as ROGD — a phrase that applies to the parent might be legitimate but the term ROGD is a complete overreach and it is unfair to the field. We need to limit this to what the data show us only. . . . 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.

Even the DSM-5 (American Psychiatric Association, 2013) notes in its description of gender dysphoria that parents’ surprise at trans adolescents is common:

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.

Meanwhile, Littman’s study plays fast and loose with the very meaning of “rapid”, describing anything from one day to one year and effectively using the label of “rapid” merely to function as an invalidation (Pitts-Taylor, 2020):

Is a half-year wait for an appointment with a specialist far too quick? Or is it far too slow? The answer may hinge on whether the parent welcomes any gender affirmative treatment at all, or believes it is warranted in the first place. . . . These different durations are all deemed pathological, although the normative or “healthy” timeframe against which they are measured is not explicitly delineated. The study does not provide a stable referent for what constitutes pathological untimeliness. Rather, it treats a set of variegated durations as homogenously “rapid,” while applying the term to multiple objects, from subjects’ gender identifications to clinicians’ responses. Understood in semiotic terms, “rapid” is a floating signifier — it has a “semantic function whose role is to allow symbolic thought to operate despite the contradiction inherent in it” (Levi-Strauss, cited in Mehlman, 1972). The logic of ROGD uses (varied) patterns in the timing of (multiple) events to propose a singular etiological difference, social contagion, and to hypothesize the anomalous development of gender nonconforming youth.

We see what parents’ reports can tell us about their perception of their children’s gender identity development — and it really is only about their secondhand perceptions.

We can also choose to look at what Littman did not: the body of literature on the developmental course of transgender identity, gender dysphoria, and other gender-variant experiences among trans youth. As it turns out, trans people’s self-reports consistently and significantly differ from their parents in the description of their life course and gender development milestones. In several studies across decades, trans youth describe lengthy developmental timelines including landmarks of the first self-awareness of one’s gender variance, first identifying as transgender privately, first disclosing to someone else, first living as one’s gender part-time or full-time, and first pursuing medical transition. These events span years, not weeks.

Littman largely failed to engage with this literature:

Grossman et al. (2005) found among 55 trans people aged 15–21, trans girls felt “different from others” at a mean of 7.6 years old, considered themselves transgender at 13.4 years, and first came out to anyone else at 14.2 years. Trans boys on average felt different at 7.5 years, identified as trans at 15.2, and first told someone at 17. For trans youth and young adults, this was a course of awareness and identity development lasting several years.

Restar et al. (2019) found in 298 trans women aged 16–29, their average age of “initial self-awareness of transfeminine identity” was 9.9 years old, followed by “transfeminine expression in private” at an average of 12.9 years. They also first disclosed their trans identity to someone else at 15.8, presented as feminine in public at 17.4, and began taking feminizing hormone therapy at an average of 20.4 years old. Again, this process of identity development was not brief or passing, but lasted for a majority of their childhood.

Kuper, Lindley, & Lopez (2019) found that in 224 trans youth aged 6–17, trans girls first self-identified as their gender at an average of 9.9 years old and first disclosed to their immediate family at 12.2 years. Trans boys similarly self-identified at 10.7 years old and disclosed to family at an age of 13.1 on average.

Puckett et al. (2021) studied 415 Millennial trans people (born 1981–1996) and 196 Generation Z trans people (born 1997–2012). Millennials reported their gender first felt “different” at a mean age of 11.6 years, recognized themselves as having a transgender identity at 19, started living part-time as their gender at 20.8, lived full-time at 22.2, and accessed their first medical transition treatment at an average of 23.1 years old. Gen Z likewise experienced years of developmental milestones: feeling different at 11.5, identifying as trans at 15.2, living part-time at 16.1, full-time at 17 and medically transitioning at 17.6 years old on average.

Littman’s report of parental perceptions does not actually make any predictions as a hypothesis about a new and distinct syndrome, and it does not succeed in usefully paring down the space of possible observations of reality. These parental reports are fully compatible with a state of the world where trans youth’s gender dysphoria is not “rapid” in its onset at all.

The claims of ROGD are in danger of being unfalsifiable: Because trans youth consistently show this pattern of development and yet Littman’s methodology would never detect that pattern in favor of only reporting their parents’ subjective surprise, the supposed condition of ROGD can always serve as a possible reason to cast doubt on the authenticity of any trans person’s identity or experience of gender dysphoria. The youth who are clearly trans-identified and have been for many years could still be incorrectly classified as “rapid onset” by looking only at parental perspectives.

Based only on parental reports, are their children experiencing an inauthentic “rapid onset” gender dysphoria, or are they genuinely experiencing classic gender dysphoria as a trans person? How could you possibly tell the difference when working only from this limited evidence and misleading methodology?

This is a recipe for false negatives — a person with a trait is incorrectly identified as not having that trait. Wrongly declaring gender-dysphoric trans youth to be mistaken, non-dysphoric cis youth can then mean depriving them of the necessary affirming treatment for them to thrive in their authentic gender.

Parent reports of youth gender milestones are clearly not sufficiently accurate. And when we include both the parents’ perspectives and the reports of their trans youth on their gender identity development, that complete picture shows why this partial picture is so inaccurate. In June 2020 I made the following prediction about Littman’s study and the likely results of more comprehensive parent-child surveys:

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.

Such a comprehensive survey has now been provided this year.

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

Sorbara 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.

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, 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 [gender incongruent] 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.

If ROGD is fundamentally unsound, what about its related claims?

Littman has not sufficiently demonstrated that a syndrome characterized by a “rapid onset” of false gender dysphoria exists as a new entity distinct from classic forms of gender dysphoria. She ignores nearly all existing research on the subject of trans youth’s gender development timelines, the feature that is supposedly key to ROGD’s difference from authentic gender dysphoria.

In light of decades of research in this area as well as more recent studies of both trans youth and their parents, what is proposed as “rapid onset gender dysphoria” based on only parental reports is most likely to be just an incomplete observation of the lengthy course of trans youth’s development that has already been studied in detail — the experience of gender dysphoria throughout childhood.

Littman (2018) goes on to make numerous speculations about the nature and manifestations of the “rapid onset gender dysphoria” condition. But if there is no reason to believe that there even is a “rapid onset gender dysphoria” condition, these notions are nonstarters. This undermines much of the rest of Littman’s paper. Consider how she describes the ROGD condition and its behavior among youth:

As a “social contagion”, this rapid-onset false gender dysphoria can be contracted from viewing transgender resources online, such as YouTube videos, Tumblr posts, or social media.

The ROGD contagion can also be caught from individuals in one’s friend group who already have this rapid-onset false gender dysphoria.

Online transgender communities and resources, as well as offline friendships with other trans people, are comparable to materials promoting eating disorders such as “pro-ana” communities.

These youth’s attempts to access gender-affirming medical care are always a misguided and potentially dangerous effort, as they must be mistaken in believing that they are trans.

By extension, any clinician’s acknowledgment of these youth’s transness, and any treatment for their gender dysphoria, is incorrect and inappropriate, an unnecessary treatment putting an actually cisgender child at risk.

But you can’t catch a condition that doesn’t exist from your friends or from reading things on the internet. Being trans and the benefits of transitioning aren’t at all like the serious and life-threatening harms of eating disorders; a condition that doesn’t exist isn’t like or unlike anything.

A person cannot be diagnostically precluded from being genuinely trans or experiencing gender dysphoria on the basis that they are instead suffering from this non-condition. These youth’s reported approaches to finding gender-affirming care, whether social or medical transition, therapy or prescriptions, are simply those that any trans person does indeed engage in when seeking out treatment for their gender dysphoria. And a mass epidemic of a nonexistent condition is a mass of nothing.

ROGD: Into the Shrierverse

A substantial gap exists between the strength of scientific support for “rapid onset gender dysphoria” and the vigor of its promotion by anti-trans advocates. Rather than being constrained by the limitations of fact and the distorted scope of their foundational study, proponents of the alleged condition increasingly seem to have freed themselves of any empirical ballast.

What was once a claim of a discrete syndrome is now a loose storyline to an alternate universe inviting personal flights of fancy, akin to a tabletop RPG for cis people whose hobby is treating trans kids like a problem. And it’s difficult to overstate how downright weird the ROGDverse has become:

Andrew Sullivan and Katie Herzog invoke a social trend of ROGD when claiming a (nonexistent) decline in cis lesbians is due to this population transitioning as men. Herzog notably asserts she could find little more than a half dozen cis lesbians on the North American continent.

Glenn Greenwald has brazenly lied about the lesbian population allegedly shrinking while the trans population is growing, shamelessly distorting the actual finding that the lesbian population is growing even faster than the trans population. This was something so obviously wrong, the act of asserting it almost seemed like a disturbing power move to see who among the audience will acquiesce to the most overt lies and stick around for more.

Debra Soh, a sexual neuroscientist writing for Quillette, misread the Littman study and incorrectly claimed that transition for youth serves as an anti-gay “conversion therapy” as apparent cis gay youth who transition would become straight and transgender. According to the distribution of youth’s sexual orientations as reported by their parents in the Littman study, a smaller proportion of them would acquire the label of being exclusively attracted to the other sex (straight) if all of them transitioned, while more of them would be termed straight if none of them transitioned.

“Angus Fox” of Quillette recently suggested that adolescent trans girls are not truly trans but are catching rapid-onset gender dysphoria from a surprising asymptomatic carrier: cis-identified cis girls, who are transmitting the dangerous contagion of calling a trans person by their name and going out shopping together.

Chad Felix Greene, writing for The Federalist, asserted that Elliot Page’s coming-out is the result of rapid-onset gender dysphoria. This would mean that Elliot Page, a 34-year-old award-winning actor and household name, who knew he was a boy when he was a toddler and consistently insisted on identifying and presenting as a boy and being addressed as a boy throughout his childhood, was suddenly in 2020 stricken by a rapid attack of Littman dysphoria.

Abigail Shrier, author of the pop-pseudosci ROGD book “Irreversible Damage”, is not particularly concerned with shoring up the scientific foundation of her pet theory; instead, she told Joe Rogan that this condition (a parent’s unawareness of their trans child’s gender) is just like other social contagions such as cutting, eating disorders, witchcraft, and demonic possession. Rogan helpfully added that this nonexistent condition is like joining “suicide pacts”.

As any real existence of ROGD becomes more and more tenuous, it’s increasingly treated like magic, taking on the role of an incantation to be applied liberally whenever you need help imagining that trans people are doing bad things. After all, if this were intended as a serious argument, it would mean arguing that a wholly unproven but contagious social epidemic of deceptive gender dysphoria symptoms infecting men in their 30s is more likely than the simple fact that parents often don’t know everything about their children who are in the closet. ■