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Rapid-onset gender dysphoria controversy

Rapid-onset gender dysphoria (ROGD) is a controversial, scientifically unsupported hypothesis which claims that some adolescents identify as transgender and experience gender dysphoria due to peer influence and social contagion, particularly those assigned female at birth. ROGD is not recognized as a valid mental health diagnosis by any major professional association. The APA, WPATH and 60 other medical professional organizations have called for its elimination from clinical settings due to a lack of reputable scientific evidence for the concept, major methodological issues in existing research, and its stigmatization of gender-affirming care for transgender youth.

History
According to bioethicist Florence Ashley, "rapid-onset gender dysphoria" (or ROGD) is "a hypothesized new clinical subgroup of transgender youth, which would be characterized by coming out as transgender out of the blue in adolescence or early adulthood." Ashley states that ROGD is often associated with the work of Dr. Lisa Littman, who attempted to validate the ROGD hypothesis by publishing a study based on the reports of parents recruited from well-known anti-trans websites. Initial surveys (2016–2018) Lisa Littman, who had not previously studied transgender health care or gender dysphoria, noticed a few teenagers in the same friend group who started identifying as trans, and decided to survey parents. The term first appeared in 2016 notices posted to three anti-transgender blogs asking readers to respond to a research survey if they had a child who showed "a sudden or rapid development of gender dysphoria". An article published in Science described the first two websites (4thWaveNow and Transgender Trend) as "gathering places for parents concerned by their children's exploration of a transgender identity", with the third, Youth TransCritical Professionals (YTCP), being closed to non-members. The study was based on 256 responses to an online survey of parents recruited from these three websites, An email leak in 2023 revealed Lisa Marchiano, a Pennsylvania-based psychotherapist, was the author of YTCP; Marchiano also contributes to both of the other sites. Littman's manuscript thanked Marchiano for her "feedback on earlier versions of the manuscript" but did not disclose that she was the publisher of YTCP. In October 2016, Lisa Marchiano published a blog post discussing ROGD. In 2017, Marchiano argued in a paper in Psychological Perspectives that "social contagion" was a component of ROGD. The same year, American-Canadian sexologist Ray Blanchard and American psychologist J. Michael Bailey, whose work has been criticized for suggesting non-heterosexual transgender women transition due to sexual arousal, wrote for 4thWaveNow to promote the concept of ROGD. Kenneth Zucker, whose clinic was closed due to allegations of practicing conversion therapy on its patients, also referred to Littman's poster presentation on ROGD in publications in 2017 and 2018. Littman presented preliminary results at a 2017 conference. Littman's study reported on information the parents reported about their children's peer group dynamics, social media use, and prior mental health issues. Littman speculated that rapid onset of gender dysphoria could be a social coping mechanism for other disorders, such as depression and anxiety caused by trauma. The publication immediately sparked a debate. On the same day that PLOS One announced its review, Brown University took down a press release it had earlier posted about the paper. Responding to critics, Brown University president Christina Paxson and Provost Richard M. Locke said they had not infringed on academic freedom, noted that the paper was still accessible online, and stated that Brown's commitment to only "publicize research that unassailably meets the highest standards of excellence" required Brown to remove the press release after PLOS One opened an investigation on the paper in question. They said that "given the concerns raised about research design and methods, the most responsible course of action was to stop publicizing the work published in this particular instance. We would have done this regardless of the topic of the article." Common criticism The paper was immediately met with criticism from health researchers and transgender activists. The main criticisms of the study were: only parents were interviewed, the websites used to recruit those parents were biased, it suggested that gender dysphoria or a transgender identity could be "socially contagious", it relied on a pathologizing framework, and it made premature diagnostic suggestions. Another common concern was that the study had been politicized to give ammunition to those who opposed gender affirming care. In the journal's blog, PLOS One editor Joerg Heber apologized "to the trans and gender variant community" for the previous review and publication, saying "the study, including its goals, methodology, and conclusions, were not adequately framed in the published version, and that these needed to be corrected." Heber noted that the hypothesized condition of ROGD had "not yet been clinically validated". == Reactions ==
Reactions
Professional commentary Following publication of the original report in PLOS One, the World Professional Association for Transgender Health (WPATH) released an official statement on the proposed clinical phenomenon "rapid-onset gender dysphoria", stating that the term is not recognized by any professional association, nor listed in the DSM or ICD lists of disorders and diseases. WPATH concluded by warning against the use of any term intended to cause fear about an adolescent's possible transgender status with the goal of avoiding or deterring them from accessing the appropriate treatment, in line with the standards of care appropriate for the situation. The Gender Dysphoria Affirmative Working Group (GDA) of 44 professionals in transgender health wrote an open letter to Psychology Today citing previously published criticism of the study, stating it had multiple biases and flaws in methodology, as it drew its subjects from "websites openly hostile to transgender youth" and based its conclusions on the beliefs of parents who presupposed the existence of ROGD. Noting Littman had not interviewed the teens, the GDA stated onset may only have been "rapid" from parents' point of view because teens often delay coming out. In 2022, the eighth edition of WPATH's Standards of Care (SOC-8)—a publication providing clinical guidance for healthcare professionals working with transgender and gender diverse individuals—criticized the study due to its methodological flaws. The study's focus on parents of transgender youth recruited from communities with skepticism towards gender affirming care presents difficulty in establishing social influence as a possible factor in development of gender dysphoria. According to the SOC-8, the study's results also have not been replicated by other researchers. In 2024, the European Academy of Paediatrics published a position statement on clinical management of gender dysphoria in children that briefly noted ROGD as a "controversial suggestion" that had produced a debate "familiar to all, with many experts and scientific bodies critical of the research and concept." The statement also noted that more research into the role of social media in gender dysphoria and mental health was "overdue." Academic Several critiques of the study have been published in peer-reviewed journals. In a 2020 paper published in The Sociological Review, bioethicist Florence Ashley described the study as an attempt to circumvent existing research supporting gender-affirming care. Shortly after PLOS One published the corrected study, a critique of the original study's methodology appeared in Archives of Sexual Behavior. The author, Arjee Restar, said that Littman's study was fatally methodologically flawed, beginning with the choice to sample exclusively from users of three websites "known for telling parents not to believe their child is transgender", with the result that three-quarters of those surveyed had rejected their child's gender identity; 91 percent of respondents were white, 82 percent were women, and 66 percent were between the ages of 46 and 60. She wrote that the study was mostly composed of "white mothers who have strong oppositional beliefs about their children's trans identification" and that there was very little evidence that Littman's survey responses were representative of trans youth and young adults as a whole. She additionally said "the majority of methodological and design issues stem from the use of a pathologizing framework and language of pathology to conceive, describe, and theorize the phenomenon [of ROGD] as tantamount to both an infectious disease…and a disorder". In a letter to the editor, Littman responded that her methodologies were consistent with those that had been used, without controversy, in widely cited studies supporting gender identity affirmation health care. The SAGE Encyclopedia of Trans Studies describes ROGD as "an anti-trans theory" that "violates principles of research methods by using a pathologizing framework and language", using terminology that compares gender dysphoria and transgender identification to a contagious disease, in opposition to organizations such as WPATH, the American Psychiatric Association, and the World Health Organization who state that being trans is not a mental disorder. The encyclopedia further states that bias appears to be present at every stage of the study, including its basic premise, the absence of random sampling, self-selection bias in the recruitment process, and the data collection procedure, which was described as "fundamentally flawed in a number of critical ways". Additionally, the encyclopedia entry notes that, although the parents may have believed the development of their child's gender identity to have been abrupt, the data were not collected from the youths themselves, and so Littman's study cannot ascertain whether these individuals had simply chosen not to reveal their gender identity at an earlier time. According to MIT Technology Review, "while theories and rumors about something like ROGD had quietly percolated online before the paper was published, Littman's descriptive study gave legitimacy to the concept.... The ROGD paper was not funded by anti-trans zealots. But it arrived at exactly the time people with bad intentions were looking for science to buoy their opinions." ROGD is often cited by gender-critical groups as a reason not to allow children to socially transition at school. Littman serves as the president of the Institute for Comprehensive Gender Dysphoria Research (ICGDR), formed in January 2021, and serves on the board of the Gender Dysphoria Alliance with Ray Blanchard. The ICGDR funds open-access articles that question gender-affirming care and promote ROGD. It receives programmatic support and shares personnel with the overlapping groups Genspect, the Society for Evidence-Based Gender Medicine, and the Gender Exploratory Therapy Association. They had previously stated "The rise of anti-trans sentiment among anti-LGBTQ groups has fueled a cottage industry of anti-trans research that in turn is promoted by anti-LGBTQ groups, including ACPeds, which has become a go-to for expertise in anti-trans pseudoscience", listing the original study as an example, further stating "anti-LGBTQ media circulated the study widely, and ACPeds' Cretella touted the study at the 2018 Values Voter gathering (sponsored by anti-LGBTQ hate group Family Research Council)." The Human Rights Campaign stated "anti-LGBTQ+ activists often use concerns about internet safety in order to spread harmful rumors about the LGBTQ+ community. You may see opponents of trans people specifically use junk science by Lisa Littman at Brown University to falsely claim that access to social media and the internet has created a 'contagion' that causes many youth to mistakenly identify as transgender." Gillian Branstetter, a communications strategist at the American Civil Liberties Union said the paper "laundered what had previously been the rantings of online conspiracy theorists and gave it the resemblance of serious scientific study" and "It is astonishing that such a blatantly bad-faith effort has been taken so seriously". Popular press Scholars writing in The Conversation and journalists in Slate columns have condemned what they saw as politicization of science by social conservatives. Madeleine Kearns, a contributing writer at National Review, called for further study into the proposed phenomenon. Writer and transgender advocate Liz Duck-Chong described the hypothesized condition as "a poisonous lie used to discredit trans people" in an op-ed published in The Guardian, while Abigail Shrier, who later published the controversial book Irreversible Damage about the concept, called it an explanation for the experiences of parents in an op-ed published in The Wall Street Journal. In a Psychology Today opinion piece, Rutgers University psychology professor Lee Jussim described the PLOS-requested rewrite of the paper as an "Orwellian correction" involving additions and minor changes where no errors had existed. Jeffrey Flier, a former dean of Harvard Medical School, called Brown University's failure to defend Littman "an indictment of the integrity of their academic and administrative leadership", and described Brown's explanation of the retraction as "anti-intellectual" and "completely antithetical to academic freedom". == Further research ==
Further research
Some clinicians state that an increasing prevalence of trans youth first presenting in early adolescence, as described in Littman's research, is consistent with their patient population, though they are uncertain as to causes or implications for clinical treatment. In a 2020 commentary in Pediatrics, citing Littman's paper among others, Annelou de Vries wrote that gender identity development was diverse and called for more research into this demographic cohort. A November 2021 study by Bauer et al. published in the Journal of Pediatrics examined data on a cohort of 173 trans adolescents from Canada to assess whether there was evidence for a rapid-onset pathway for gender dysphoria. The authors noted that while it was common to see adolescents presenting with gender dysphoria around puberty, in many cases patients had been aware of gender dysphoria from a younger age. The authors sought to establish whether there was any link between later awareness of gender ("rapid onset") and other factors including mental health problems, lack of parental support, and high level of support from online and/or transgender friends. No evidence was found for any link between "rapid onset" and mental health problems, lack of parental support, or high level of support from online or transgender friends. Where relationships were found, they were in the opposite direction to that suggested by Littman's work. For instance, trans adolescents who had been dissatisfied with their gender for longer were more likely to suffer anxiety and more likely to misuse marijuana. The authors considered that they found no evidence of "rapid onset gender dysphoria" being a distinct clinical phenomenon. Ferrara et al. noted the controversy that rose around the possibility of a rapid-onset of gender dysphoria condition and the position of major medical associations not to recognize ROGD and to discourage its use, due to a lack of consistent scientific evidence for the concept. They also cited the Bauer finding of no support for ROGD being a distinct phenomenon, and the Littman response to Bauer. In 2023, Springer retracted a paper by Diaz and Bailey on the rapid onset gender dysphoria (ROGD) hypothesis "due to concerns about lack of informed consent", which had been published in the Archives of Sexual Behavior. This followed an open letter signed by a number of researchers and LGBTQ organizations criticizing the journal's publication of the paper, stating that Bailey's paper did not have institutional review board (IRB) approval, and requested the journal's editor Kenneth Zucker be replaced. Critics also said that the paper disregarded countervailing evidence and used a biased method of gathering study participants. == See also ==
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