The academic journal PLOS One this week affirmed the findings of a study on rapid-onset gender dysphoria that sparked a national debate about transgenderism and teens.

The journal released a revised version of an August 2018 paper by Brown University professor Lisa Littman that suggests gender dysphoria in teens could be a social contagion and a maladaptive coping mechanism. The study has a new title, softened language, and a republication notice, but the primary findings remain unchanged.

Littman studied surveys of 256 parents of children who identified as transgender during adolescence after a gender dysphoria–free childhood. She found the vast majority were female and that most had at least one mental health disorder prior to the onset of their gender dysphoria. More than 86 percent of the parents reported that prior to declaring themselves transgender, their children had an increase in social media use or belonged to a friend group in which one or multiple friends came out as transgender in a similar timeframe.

Within days of the paper’s publication, transgender activists roared that the paper was “transphobic” and biased. Within a week, PLOS One posted a comment on the study saying it would seek further expert assessment of its methodology and conclusions, and that same day, Brown University pulled its press release on the paper and disavowed Littmann’s conclusions.

Senior members of the journal’s editorial team, two academic editors, a statistics reviewer, and an academic who treats gender incongruence in adolescents conducted a six-month review of the study. In the end, they made only cosmetic corrections. They determined Littman needed to reframe the paper in a way that clarified that it was a study of parental reports, that parental reports had limitations, and that rapid-onset gender dysphoria was not a clinical diagnosis. Other than the addition of a few missing values in one table, the results section was unchanged.

But the journal is still trying to smooth things over with transgender advocates who were critical of the study.

Editor-in-chief Joerg Heber issued a public statement on Tuesday supporting the study as a “valid contribution to the scientific literature” but also apologizing “for oversights that occurred during the original assessment of the study.” He also included a two-paragraph apology to transgender and “gender-variant” people for shortcomings in the original publication and affirmed the journal’s commitment to being “an inclusive, open, and non-discriminatory publisher that deeply cares for the concerns of the [transgender] community.”

Littman, who was vilified on social media and lost a consulting job over the controversy, continues to stand by her research and said she plans to keep studying the phenomenon of rapid-onset gender dysphoria.

“I realize now that other academics have received this type of pushback and more,” said Littman in a lengthy interview with Quillette published on Tuesday. “It’s part of a larger issue surrounding the study of gender dysphoria where, if the research findings or opinions are not consistent with a very specific gender narrative, there are efforts to shut down the discussion.”

Despite the controversy and contention, Littman said she believes a lot of good has come from her study, including a better understanding of the phenomenon by clinicians and parents. She also noted one “amazing outcome.” A group of women who identified as transgender males in their teens and have since desisted found each other and formed a group called the Pique Resilience Project to talk about rapid-onset gender dysphoria online.

“Dr. Littman and her very important work have been doubly vindicated—essentially having undergone the peer review process twice and coming to the same conclusion,” Michelle Cretella, the executive director of the American College of Pediatricians, told me. “However, it remains deeply disturbing that a scientific journal would kowtow to the bullying tactics of transgender activists. Dr. Littman’s work should not have been forced to undergo a second round of review.”