Everything You Need to Know About Rapid Onset Gender Dysphoria

photo by FreeImages.com/Joanne Kim

As a biologist, I’ve always been fascinated by Hollywood’s tendency to portray science laboratories as being filled with test tubes and flasks full of various colored liquids. I’ve worked in research laboratories for most of my adult life, and I’ve used all sorts of liquids and solutions in my experiments, but they were almost always clear. Seriously, most liquids and solutions are clear! So what’s up with all those gratuitous shots of beakers with boiling blue liquid in them? Well, most people don’t know much about science, so it seems exotic to them. And colored liquids also seem exotic, and therefore “science-ish” in many laypeople’s minds. Even though such depictions are not rooted in actual science.

“Rapid Onset Gender Dysphoria” (ROGD) also seems science-ish on the surface. After all, it’s a four-word technical-sounding term — seriously, who but scientists would have come up with such an esoteric-sounding name?! And I can easily imagine how laypeople who may have come across this term in The Globe and Mail, National Post, or National Review (all of which have recently published ROGD op-eds) might mistake this for an authentic medical condition or diagnosis, even though it is not rooted in actual science.

So for those unfamiliar with this term and curious as to what it’s all about, I have put together this handy primer.

Who invented the term Rapid Onset Gender Dysphoria?

Zinnia Jones from Gender Analysis has written two excellent articles chronicling the origins of the phrase “Rapid Onset Gender Dysphoria.” Basically, it originated in July 2016 on three blogs (4thwavenow.com, Transgendertrend.com, and YouthTransCriticalProfessionals.org) that have a history of promoting anti-transgender propaganda. The term was intended to explain some parents’ observations that 1) their children came out as transgender seemingly suddenly, often during puberty, and 2) their children also had trans-identified peers and interacted with trans-themed social media. Unfortunately, it’s not uncommon for reluctant parents to presume that their child has adopted a trans (or LGBTQ+ more generally) identity as a result of undue influence from other children and/or outside sources — hence the recurring accusations about transgender agendas, peer pressure, and trans identities supposedly being “trendy.” ROGD takes this presumption one step further: It asserts that any gender dysphoria these adolescents experience represents an entirely new phenomenon that is wholly distinct from the gender dysphoria that transgender people have historically experienced (e.g., as described in the DSM-5, the WPATH Standards of Care, and many decades of past research).

While ROGD is scientifically specious, the concept serves a very clear practical purpose. It provides reluctant parents with an excuse to disbelieve and disaffirm their child’s gender identity, under the presumption that it is merely a by-product of ROGD. It also provides a rationale for restricting their child’s interactions with transgender peers and access to trans-related information, as such things are the imagined cause of the condition.

In addition to these parental motivations, ROGD provides political cover for those who wish to rollback trans rights and healthcare. For instance, anti-trans groups can cite ROGD as a rationale for excluding trans kids and censoring trans-related media and resources (under the presumption that these things are causing ROGD in other children), and limiting or eliminating the ability to transition (under the presumption that some kids who seek this out are merely ROGD, and/or because ROGD is a brand new medical condition that will require years of further study). And if anyone objects to such measures, these ROGD proponents can conveniently claim that they are not anti-trans — after all, they acknowledge the existence of transgender people and gender dysphoria! (in some cases, at least) — it’s just that they are acting primarily out of concern for “ROGD kids.”

Is this really a new phenomenon?

No, it is not. Within trans health circles, it’s been well established that trans people may become gender dysphoric and/or come out about being transgender at any age. For instance, in the current WPATH Standards of Care (published in 2011), the section entitled “Phenomenology in Adolescents” explicitly states:

Yet many adolescents and adults presenting with gender dysphoria do not report a history of childhood gender-nonconforming behaviors (Docter, 1988; Landén, Wålinder, & Lundström, 1998). Therefore, it may come as a surprise to others (parents, other family members, friends, and community members) when a youth’s gender dysphoria first becomes evident in adolescence.

And as Zinnia Jones points out, the DSM-5 diagnosis for Gender Dysphoria (published in 2013) contains similar language:

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.

There is nothing inherently erroneous or illegitimate about a “rapid” onset of gender dysphoria — some trans people experience an epiphany during which all the clues and puzzle pieces suddenly come together, and they finally realize that they are transgender. (This is what happened to me when I was eleven, as I describe in Chapter 5 of Whipping Girl and Chapter 13 of Outspoken.) But the above passages — both of which describe parents experiencing “surprise” — illustrate that the word “rapid” in ROGD doesn’t necessarily refer to the speed of gender dysphoria onset, especially in the many cases where the child keeps their experiences to themselves for a time before sharing them with parents. Rather, what’s “rapid” about ROGD is parents’ sudden awareness and assessment of their child’s gender dysphoria (which, from the child’s standpoint, may be longstanding and thoughtfully considered).

As ROGD has garnered increasing mainstream attention, many adult trans folks have taken to sharing their “ROGD stories” on social media — for instance, pointing out how they came out as trans during adolescence, much to their parent’s surprise, and how their parents insisted that they weren’t “really trans” and/or attempted to suppress their gender explorations. In other words, this is not a new type of gender dysphoria, but rather a new name for a recurring parental dynamic.

But isn’t there a research study on ROGD?

To date, only one research study on ROGD has been published — it is authored by Lisa Littman and appeared in PLOS One a few days ago. There are numerous problems with this study, as Zinnia Jones and Brynn Tannehill detailed in their critiques of an earlier rendition of this same study back when it appeared as a non-peer-reviewed poster in the Journal of Adolescent Health. For starters, this was not a study of the children themselves, but rather their parents, who were instructed to fill out a “90-question survey . . . about their adolescent and young adult children.” What’s even more troubling is how this sample set of parents was selected: “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).”

In other words, this supposed study of ROGD is entirely based on the opinions of parents who frequent the very same three blogs that invented and vociferously promote the concept of ROGD. Frankly, this is the most blatant example of begging the question that I have ever seen in a research paper. The fact that Littman didn’t even bother to post a link to the survey on any of the many other online groups for parents of trans kids (i.e., ones that do not push an ROGD agenda, and who thus might have very different assessments of their adolescent trans children) strongly suggests that she purposefully structured her study to confirm the former parents’ assumptions, rather than objectively assess the state of their children.

All of this would explain why Littman published her article in PLOS One, rather than a more respectable journal. PLOS One’s publishing philosophy is quite different from other research journals in that, as an online open-access journal, they focus on quantity over quality. While they review the more technical aspects of each paper they publish (a fairly low bar to clear for an article analyzing an online survey), they are generally hands off with regards to “subjective concerns” — such as which experiments the authors choose to carry out, and their interpretation of the results. Another journal would likely press Littman to use a more representative sample, provide concrete evidence that ROGD is distinct from regular old gender dysphoria, and more thoroughly explore other possible explanations for the results, as any spurious or unreasonable claims made by Littman would reflect poorly on the journal itself. PLOS One, on the other hand, is not concerned with such matters, as they believe that the importance and relevance of an article should be determined by the scientific community post-publication (via debates and citations). Within scientific circles, researchers are well aware of this, and will take any claims made in a PLOS One article with a grain of salt, if not multiple grains (note: I have subsequently elaborated on this point here). Unfortunately, the lay public (not being aware of this) will likely take this study as “proof” that ROGD is a scientifically validated concept. Even though it isn’t.

So how would a researcher prove that a novel form of gender dysphoria exists?

I am so glad that you asked this question! Because this is the gargantuan elephant in the room, isn’t it? I mean, it’s not like you can just urinate into a cup, send it off to some lab, and await the results to find out what kind of gender dysphoria you have. There are no tests for gender dysphoria! It is entirely experiential — meaning that the only way to know whether someone is experiencing gender dysphoria is if they tell you they are experiencing it. (I discuss this, and its ramifications, at considerable length in this essay.)

Over the course of the twentieth century, there were countless attempts to classify transgender people based upon a variety of factors (e.g., gender non-conformity during childhood, adult gender expression, sexual orientation, age of onset and severity of gender dysphoria) in the hopes of finding indicators of a “true” trans identity and garnering insight into what causes gender diversity. However, every categorization scheme researchers invented was confounded by overlap between groups and countless exceptions to the rule. One of the last such taxonomies to be taken seriously was Ray Blanchard’s autogynephilia theory (circa 1989). Blanchard claimed that there were two distinct causes of gender dysphoria in trans women: an early onset version (which he seemed to conflate with effeminate male homosexuality) and a late onset version experienced by lesbian, bisexual, and asexual trans women (which he claimed was driven by paraphilia). While Blanchard made many bold claims about the supposed causations and distinctions between these groups, numerous follow up studies (summarized here) failed to support the notion that trans women fall into two fundamentally distinct classes, each with a unique cause.

While there remain a few outliers and holdovers who still embrace these outdated categories and theories of etiology, the field as a whole has moved on. It is now widely accepted that trans people are simply a part of natural variation, that there are many different transgender trajectories and potential identities, and that trans people may vary from one another in almost every possible way (including in their gender expression and age of onset, as explicitly acknowledged in the DSM-5 and WPATH Standards of Care passages that I cited earlier). ROGD proponents act as though they’ve discovered something new — whoa, there seems to be a brand new second type of gender dysphoria! — when in reality, they are merely retreading over old abandoned theories. Indeed, the very phrase “rapid onset” seems to intentionally harken back to a time when “early onset” and “late onset” trans people were viewed by some researchers as unrelated species. And rather fittingly, Blanchard and his fellow die-hard-autogynephilia-supporter J. Michael Bailey have subsequently embraced ROGD as a logical extension of their antiquated pet theory.

Anyway, to return to the initial question: What would it take to prove that ROGD is a novel condition that is entirely distinct from regular old gender dysphoria? A preponderance of evidence — that’s what. Rather than offering mere speculation and hypotheses, show me that there is some specific reproducible cause of gender dysphoria in “ROGD kids” that is largely or completely absent from kids who experience regular old gender dysphoria. Or show me that kids who are deemed ROGD exhibit an entirely different spectrum of outcomes than other transgender children. And while you’re at it, why don’t you begin by explaining how you can even distinguish between “ROGD kids” and the children described in the aforementioned DSM-5 and WPATH Standards of Care passages — you know, the ones who did not exhibit early childhood gender non-conformity, yet experienced gender dysphoria as adolescents, even though this was years before ROGD was supposedly even a thing. Because seriously, all of the ROGD anecdotes that I’ve come across do not seem unique or unusual in any way. They basically sound like regular old gender dysphoria stories, with the same old surprised and disbelieving parents.

Until convincing evidence materializes to the contrary, we should adhere to the principal of Occam’s razor and presume that these children are experiencing regular old gender dysphoria. This is not to say that all trans-identified children are exactly the same. Individuals will no doubt experience their genders somewhat differently, have different needs and desires, face different obstacles, and so forth. We should meet each individual child where they are in the present, give them space to explore their genders, and refrain from coercing them into relinquishing their identities and isolating them from their peers (which is what some ROGD proponents are currently advocating).

But what about the shifting demographics, YouTube videos, and “cluster outbreaks”?

If you have ever taken a logic, statistics, or science class, then you are likely familiar with the axiom “correlation does not imply causation.” That is to say, just because A and B often occur together, it does not necessarily follow that A causes B. It could be that B causes A. Or that some independent factor C causes both A and B. Or maybe C causes A, but not B (or vice versa). Or perhaps A and B co-occur due to mere coincidence. And so on. Because ROGD proponents cannot (and will likely never be able to) prove that ROGD is a novel form of gender dysphoria, they often rely on such “false causation” arguments to help bolster their case. In this final section, I will address the three most commonly cited arguments to this effect.

I have already alluded to two of these: ROGD proponents frequently harp on the fact that “ROGD kids” tend to have other trans-identified peers, and spend lots of time immersed in transgender-themed social media. The clear implication is that said peers and social media are somehow causing or contributing to the gender dysphoria and trans-identification they experience. But here’s the thing: I’d bet that children who have regular old gender dysphoria also tend to have transgender friends and spend lots of time on trans-themed social media. Hell, I’m an adult, and if I had to make a guesstimate, I’d probably say that somewhere in the ballpark of 25% of my close friends are trans-identified. (That figure probably goes up to 60–70% if you broaden it to LGBTQ+-identified.) When I was first coming to terms with being trans, there was no social media, but I eagerly read everything and anything that I could find on the subject. And when I transitioned in the early 2000s, I spent tons of time on trans-focused email groups (the social-media-equivalent of the time).

I can understand how straight cisgender people might jump to the conclusion that A (trans friends and social media) causes B (gender dysphoria and trans-identification). But from a trans/LGBTQ+ perspective, it seems clear that these people are ignoring the crucial element C — the fact that trans/LGBTQ+ people are highly stigmatized, face harassment, and our perspectives are largely discounted and not readily accessible in society at large. This (aka, C) is what leads trans/LGBTQ+ folks to seek one another out (regardless of age) for mutual support, shared understanding, and the exchange of relevant information and ideas.

In Littman’s PLOS One article, she makes a really big deal out of “ROGD kids” having other trans friends — she actually refers to them as “cluster outbreaks of transgender-identification,” as if they had all come down with the pox at the same time. She even does math to it:

The expected prevalence of transgender young adult individuals is 0.7% [4]. Yet, more than a third of the friendship groups described in this study had 50% or more of the AYAs [adolescents and young adults] in the group becoming transgender-identified in a similar time frame, a localized increase to more than 70 times the expected prevalence rate.

Wow, that does sound highly unlikely! But what if we do math to my hypothesis — i.e., that the marginalization of trans/LGBTQ+people leads such kids to seek one another out? When I was in junior high and high school (way back when), the average class size was about 500 students (your mileage may vary). If the prevalence of adult trans people is around 0.7% (the same statistic Littman uses), then we would expect approximately 3.5 potential trans kids per grade in that case. And if we’re talking about a four-year middle or high school, that could be as many as 14 potential trans students per school! Not to mention additional trans friends these kids may have met through other activities or online (remember, we’ve been told that they spend lots and lots of time on social media, seeking out trans stuff!). Given all this, doesn’t it seem quite plausible (if not outright likely) that these kids might find and befriend one another?

Littman also makes a big deal out of “cluster outbreaks” among pre-existing friends (i.e., who knew one another before any of them were out as trans), or friends who all came out as trans within a relatively short period of time. She presumes that all of these kids started out as “not trans,” then suddenly “became trans” en masse (because transgender is a “social contagion,” according to her argument). But how could Littman possibly know this to be true? It is well established that trans/LGBTQ+ youth often share their experiences and identities with one another before opening up to their parents (e.g., see here, plus my and many other trans/LGBTQ+ people’s personal experiences). So they very well could have been out to one another as trans (or gender-questioning) early on, without others being aware of it. Furthermore, Littman’s only source for all this are the parents who frequent pro-ROGD blogs and (as such) are likely skeptical of their children’s trans identities. Don’t you think these kids would pick up on this skepticism fairly quickly? And wouldn’t it likely lead them to be less forthcoming about their transgender friends and experiences with gender? And even if they are completely open with their parents, who’s to know whether these parents are even reporting their child’s experiences accurately? Maybe they’re playing down the longevity and severity of their child’s gender dysphoria? Or maybe they’re playing up certain aspects of their child’s story so that it conforms better to the canonical ROGD narrative? Seriously, getting at the truth here is like trying to discern adolescent sexualities and sexual histories when all you have to go on is a survey of parents who frequently visit abstinence-only blogs.

The third and final “false causation” argument that I will address here goes something like this: 1) There has been sharp increase in the number of adolescents who were assigned female at birth (AFAB) who are now coming out as transgender and expressing a desire to transition to male, 2) ROGD primarily afflicts AFAB adolescents, 3) therefore, ROGD must be responsible for driving this new artificial pandemic of AFAB trans-identification.

There’s a lot to unpack here. Let’s start with point #1: While this may be true, I cannot confirm it, as there are no reliable statistics to this effect. And I must say that I’m experiencing a bit of déjà vu here, because I vividly remember people making similar alarmist claims — that there was a sharp rise in AFAB people transitioning to male, and how they couldn’t possibly *all* be trans — back in the early ’00s, and yet now it’s fifteen years later and there’s no evidence that this was an aberration, or that there was widespread regret amongst this population. Maybe the numbers did rise back then, and perhaps they are rising again now? But these claims might also be related to the fact that we, as a society (and especially in the media and trans-related discourses) have historically been obsessed with trans female/feminine people, whereas trans male/masculine individuals have received considerably less attention (for reasons I explain in my book Whipping Girl and in this essay). Even today, some people are surprised upon hearing that trans male/masculine people even exist! So I can’t help but wonder whether these “sharp increases” in AFAB people transitioning to male (whether today or back in the early ’00s) simply reflect the fact that people have a tendency to overlook this demographic in the first place.

Come to think of it, given that people are often surprised by the existence of AFAB trans people, and that the only distinguishing characteristic of ROGD (insofar as I can tell) is that parents are “surprised” by their child coming out as trans, couldn’t point #2 (i.e., that “ROGD primarily afflicts AFAB children”) also be a by-product of this trans male/masculine invisibility? Something to consider . . .

Anyway, even if point #1 is true, there is not necessarily anything anomalous about it. Rather than insisting that ROGD is artificially causing this increase, couldn’t it simply be that historically AFAB adolescents who were predisposed to being trans didn’t come out as such due to a lack of information and the invisibility of trans male/masculine people in the media? But now that social media exists (including all the YouTube videos and Tumblr posts ROGD parents are constantly complaining about), these same AFAB adolescents are now aware of trans male/masculine lives and perspectives, and perhaps this has opened up possibilities for them that they would not have had in the past?

Proponents of ROGD keep pushing the idea that “social contagion” is turning kids transgender. But there is a far simpler explanation for the rise in trans-identification (whether among AFAB individuals, adolescents, or people more generally). As I explained in a previous essay, what we are seeing today is akin to the rise in left-handedness during the twentieth century:

from BBC News: “Do left-handed people really die young?”

Both left-handedness and transgender identities are pan-cultural and trans-historical phenomena that have been historically stigmatized in Western societies. During the 1900s, as left-handedness gradually became less stigmatized, there was a sharp rise in left-handedness, as individuals no longer had to hide or suppress that natural predisposition. Similarly, while transgender people remain quite stigmatized, this stigma is gradually abating, allowing more and more individuals (including adolescents) to express their gender-diverse tendencies and gravitate toward transgender identities.

If there was suddenly a new movement — let’s call it Rapid Onset Left-Handedness — that involved parents refusing to let their children interact with left-handed peers, or consume media created by or involving left-handed people, for fear that their children might be “turned left-handed,” we would probably consider that to be, not only irrational, but mean-spirited and unfair to left-handed children and people everywhere. Including these parents’ own potentially left-handed children, who would be forced to suppress their natural tendencies.

Transgender kids exist. They don’t have magical powers of persuasion to “turn” your child transgender. (If trans people did possess such powers, I can assure you that way more than 0.7% of the population would be transgender by now!) And if your child tells you that they are experiencing gender dysphoria, it isn’t because they’ve been “turned trans” by other children, or because it’s “trendy” (because seriously, it’s not — if it was, way more than 0.7% of the population would be transgender). Far and away, the most likely explanation is that they are simply experiencing regular old gender dysphoria. I encourage you to take them at their word, and give them the space to explore their gender and figure out who they are for themselves.

Note added 8–28–18: in response to questions & criticisms of this essay, I have written a follow up piece: Rapid Onset Gender Dysphoria, scientific debate, and suppressing speech.

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