Rapid-onset gender dysphoria (ROGD) is the name given to 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. Under this hypothesis, which is unsupported by evidence, children with ROGD falsely believe they are transgender due to social influence, trauma, and experiences of sexual objectification.
ROGD is mostly strongly associated with the work of Dr. Lisa Littman, who published a study purporting to substantiate the hypothesis of ROGD. The study was based on the reports of parents recruited from well-known, anti-trans websites.
As the World Professional Association for Transgender Health wrote, “it is both premature and inappropriate to employ official-sounding labels that lead clinicians, community members, and scientists to form absolute conclusions about adolescent gender identity development,” pointing out that ROGD “is not a medical entity recognized by any major professional association.”1
In March, 21 experts in trans health endorsed an essay concluding that the hypothesis of ROGD is bad science.2 The group included multiple past presidents of the Canadian Professional Association for Transgender Health, its current president, the heads of the specialized Meraki Health Centre3, and the lead investigator of the Montreal arm of the Trans Youth CAN! studies.
Despite significantsamplingandinterpretiveconcerns with the study 4,5, it is not uncommon for it to be uncritically cited as evidence of a social contagion of trans identities.6 I write this article in the hopes of aiding practitioners develop a better understanding of the scientific concerns raised by ROGD and Littman’s study.
The first and most commonly noted problem with the study is its choice of sample. It relies on parental report without independent confirmation and posted recruitment advertising exclusively on anti-trans websites. The websites where participants were recruited discourage parents and the public alike from accepting or affirming the gender identities of trans people and routinely depict all transgender people as deluded and subject to false belief. This introduces a significant bias, as parents are already encouraged to view their children’s identities as false beliefs, and may intentionally or unintentionally misreport certain facts, notably due to recall bias. As I previously noted, it is legitimate for studies to include parental reports.7 However, sole reliance on parental report majorly undermines scientific validity. In the study, parental reports of ROGD were uncritically accepted even when contradicted by the child’s counsellor, therapist, or doctor.
The second and, in my opinion, biggest problem with the study is that Littman fails to consider alternative, more plausible explanations for her observations. One of the main findings of the study is that children’s mental health and parent-child relationships deteriorate after coming out. Littman interprets this as evidence of a new subgroup of trans adolescents for whom social and medical transition may not be indicated. However, parental acceptance of gender identity is a well-known predictor of mental wellbeing for transgender people and children who are not supported in their identities are unlikely to want to maintain a good relationship with their parents.8
Brynn Tannehill cogently explained this chronology of events: “After coming to grips with their gender identity, transgender youth then delay telling hostile parents until they cannot bear not to, which makes it appear to the parents that this came out of nowhere. After they come out, and their parents do not support them, the parent-child relationship deteriorates, and the mental health of the youth declines. An interview I conducted with the (now adult) child of one of the parents who participated in this survey confirms this narrative as true for him.”