New paper ignites storm over whether teens experience ‘rapid onset’ of transgender identity

Controversy is exploding around a paper published earlier this month in PLOS ONE by a public health expert at Brown University describing reports by parents that their children suddenly experienced unease with the gender they were assigned at birth; the paper calls the condition “rapid onset gender dysphoria” (ROGD). The paper, by physician-scientist Lisa Littman, is drawing fierce criticism from transgender advocates, who call it antitransgender because it suggests that some cases of gender dysphoria may be “socially contagious.” They say the paper has serious methodological flaws, noting that Littman interviewed only parents, not the young people themselves, and recruited from websites frequented by parents who were concerned about their children’s apparently sudden gender transitions. Meanwhile, the reactions of Brown and the journal are being assailed by critics who accuse them of caving to political pressure.

On Monday, PLOS ONE announced it is conducting a postpublication investigation of the study’s methodology and analysis. “This is not about suppressing academic freedom or scientific research. This is about the scientific content itself—whether there is anything that needs to be looked into or corrected,” PLOS ONE Editor-in-Chief Joerg Heber in San Francisco, California, told Science Insider in an interview yesterday.

Also on Monday, Brown officials removed the university’s press release highlighting the paper from its website. On Tuesday, Bess Marcus, dean of Brown’s School of Public Health, wrote in an open statement that the university acted “in light of questions raised about research design and data collection related to the study.” She added that people in the Brown community have raised concerns that the study’s conclusions “could be used to discredit efforts to support transgender youth and invalidate the perspectives of members of the transgender community.”

The actions by the journal and the university have infuriated some researchers who say the moves trample academic freedom, although the paper remains freely available. “This is a sad day for @BrownUniversity, and an indictment of the integrity of their academic and administrative leadership,” Jeffrey Flier, a former dean of Harvard Medical School in Boston and a professor of medicine there, tweeted on Monday. In an interview with Science Insider, he called elements of Marcus’s statement “anti-intellectual” and “completely antithetical to academic freedom,” and said he found it “horrifying” that Brown failed to defend Littman. A petition urging Brown and PLOS ONE “to resist ideologically-based attempts to squelch controversial research evidence” was gathering 80 signatures per hour on Wednesday.

The paper is the first in the literature to name ROGD, which it describes as a sudden onset of gender dysphoria during or after puberty in an adolescent or young adult. Littman based the paper on findings from a 90-question survey completed by 256 parents of transgender youths with an average age of 16. She recruited the parents from three websites where she had seen parents describe sudden transgender transitions in their adolescents—4thWaveNow, Transgender Trend, and Youth TransCritical Professionals. The first two are gathering places for parents concerned by their children’s exploration of a transgender identity. (The third website is closed to nonmembers.) According to the parents surveyed, none of their children had symptoms that matched the professionally defined diagnosis of gender dysphoria during childhood. The finding suggests “that not all [young people] presenting at these vulnerable ages are correct in their self-assessment of the cause of their symptoms,” Littman wrote in the paper. She suggested some young people may be seeking gender transition to escape other emotional difficulties.

But ROGD’s existence is furiously disputed by transgender activists. They argue that what may seem “rapid onset” to parents is likely the result of a lengthy internal process in children. “What’s ‘rapid’ about ROGD is parents’ sudden awareness and assessment of their child’s gender dysphoria,” the Oakland, California–based transgender writer and former developmental biologist Julia Serano wrote in a critical essay last week. She argues that Littman’s paper provides no evidence for the existence of ROGD.

The most explosive of Littman’s findings may be that among the young people reported on—83% of whom were designated female at birth—more than one-third had friendship groups in which 50% or more of the youths began to identify as transgender in a similar time frame. This, she writes, was more than 70 times the expected prevalence of transgender identity in young adults, which she reports is 0.7%. Littman hypothesizes that “social contagion” may be a key driver of the purportedly rapid onset dysphoria. To trans activists, such a suggestion risks both stigmatizing and further isolating transgender young people from their peers and from the resources that could support them.

Critics also assailed Littman for failing to recruit participants from other websites supportive of transgender youth and for failing to interview such youths themselves. Littman defends her choice of sites, writing in an email to Science Insider that in order to find cases of ROGD, if it exists, she targeted the only three sites where she had seen parents discussing something like it. She encouraged wide distribution of the survey beyond the websites where she launched it, she told Science Insider in an email, and wrote that she plans to interview youth in follow-up work.

“I would have rejected this manuscript outright for its methodological flaws and also its bias,” says Diane Ehrensaft, director of mental health at the Child and Adolescent Gender Center Clinic at the University of California, San Francisco’s Benioff Children’s Hospital, who treats transgender young people as a clinical psychologist and has reviewed scientific papers for journals. Its implication that gender exploration “is simply a fad whipped up by peer influence” should not be taken as authentic, she argues. “It negates the experience of many transgender youth.”

Serano adds that even before the paper was published, there was a movement advocating for the existence of ROGD “in order to do an end run around existing trans health practices that advocate for supporting and affirming trans kids.”

But Ray Blanchard, a professor of psychiatry at the University of Toronto in Canada who worked for 15 years in a gender identity clinic that screened candidates for sex reassignment surgery, says the paper points to a clear phenomenon: a new subgroup of adolescents, mainly women, with gender dysphoria and no behavioral signs of such dysphoria during childhood.

“Many clinicians in North America and elsewhere have been seeing such patients,” Blanchard, who worked with adults, wrote in an email, “and it has been speculated that this subgroup is one reason for the predominance of adolescent females now being seen in North America and elsewhere (Aitken et al., 2015). No one can deny the clinical reality,” he wrote, that the documented increase in adolescent girls being referred to clinics for gender dysphoria is being augmented by those with no history of the condition in childhood.