Gender Dysphoria Isn’t A “Social Contagion,” According To A New Study

A Brown researcher slams the 2018 study — from a different researcher at Brown — which found teenagers were identifying as trans due to “rapid-onset gender dysphoria.”

A controversial study claiming that some teens abruptly decide to change genders due to peer pressure was deeply flawed, according to a scathing new scientific critique.

The original 2018 study used a new term — “rapid-onset gender dysphoria,” or ROGD — to describe certain young adults, typically those assigned female at birth, who develop gender dysphoria due to “social and peer contagion.” The paper has been widely cited, particularly in conservative media, to cast doubt on many gender-nonconforming people’s experiences by framing trans identification as a trend, phase, or disease.

But scientific critics and trans advocates have long criticized the methods chosen by the paper’s author, Lisa Littman of Brown University. Within a week of its publication in August 2018, PLOS One, the journal in which the study appeared, announced that it would seek “further expert assessment on the study’s methodology and analyses,” citing reader concerns. This, in turn, prompted Brown to remove a press release touting its findings. Just last month, PLOS One published a correction and an apology, while also noting that the study’s results were largely unchanged.

Arjee Restar, a trans researcher in the same department as Littman at Brown, told BuzzFeed News that even in the corrected version of the study, “the methods remain unchanged, flawed, and below scientific standards.”

Frustrated by how the work was handled by the journal and her own institution, Restar, a trans graduate student at Brown’s School of Public Health, wrote the new critique, the most thorough and damning description of the research to date.

Restar’s study, published today in the Archives of Sexual Behavior, points to several methodological problems, such as relying on survey responses from parents who had visited sites promoting anti-trans views, and biasing their responses with the wording of the study’s consent forms. Littman’s approach, Restar contends, pathologizes trans people. “It’s important to use methods and terminologies that don’t further stigmatize an already disenfranchised community,” she said.

Littman declined to discuss the new critique with BuzzFeed News. But in an interview with the website Quillette last month, she stood by her research, saying, “Overall, I am very pleased with the final product and [with the fact] that my work has withstood this extensive peer-review process.”

Since its publication last year, Littman’s study has reverberated widely throughout many distinct communities, from parenting websites to lawmakers to health care professionals.

Last October, for example, more than 1,000 parents of gender-nonconforming children wrote a letter to the American Academy of Pediatrics begging them to reconsider their trans-affirming health care policy recommendations. The letter cites Littman’s work as “a recent groundbreaking study” about trans-identified youth that “finds significant parallels with the phenomenon of eating disorders, and includes social contagion as a key factor.”

The American College of Pediatricians, classified as an anti-LGBT hate group by the Southern Poverty Law Center, cites Littman’s study to advocate against trans-affirming health care; its representatives recently met with lawmakers on Capitol Hill fight the passage of the Equality Act. And Transgender Trend, one of the sites Littman used to gather responses for her study, has published a lengthy school resource pack that warns a child’s gender dysphoria can be a result of “simple social contagion.”

Julia Serano, a writer, activist, and biologist who has extensively charted the rise of ROGD and trans social contagion theory, said that promoting trans identity as contagious has huge ramifications.

“If you’re a trans kid, will parents not let their kids interact with you?” Serano told BuzzFeed News. “People will say ‘Let’s just see what the science says’ ... and will be given justification to say ‘I’m not going to allow my children to absorb any information or media that involves trans people.’”

What’s more, Serano worries that defining an entirely new “rapid onset” category of gender dysphoria might inspire different treatments than those currently recommended by the likes of the American Academy of Pediatrics. That could lead some parents to turn away from the “gender affirming” treatments — such as social or medical transition — for persistently trans-identifying youth, and instead try “reparative” gender treatments, which encourage children to feel better in their assigned sexes. For critics like Serano, the latter category is akin to gay conversion therapy.

When PLOS One republished Littman’s study with a correction last month, the editors said the new version emphasized that it was a study of parental observation alone, and that ROGD is not a clinical diagnosis. PLOS One’s editor-in-chief also apologized to the trans community “for oversights that occurred during the original assessment of the study.” The results section, however, remained unchanged.

Littman released a statement at the time saying she is “delighted to report that, after a rigorous post-publication review, a revised version of [her] paper has been published by PLOS ONE.”

While some activists had campaigned against the study as soon as it was published last year, more than 5,000 people signed a petition in support of her study and the defense of “academic freedom and scientific inquiry.” In the interview with Quillette — a “platform for free thought” which has published many trans-critical articles — Littman elaborated that “because this paper was of interest to scientists and non-scientists alike, extra care was taken to make sure that certain terms and concepts were not misconstrued by individuals outside of the scientific community.” She also told the reporter, Jonathan Kay — who has tweeted (and deleted) graphic descriptions of autistic teens being forced to chop off their breasts because of trans orthodoxy — that backlash to the study led to her losing her consulting job.

Restar, along with the few other openly trans graduate students in the School of Public Health, attempted to meet with Brown administrators soon after Littman’s article was published to convey what they thought was the institutional promotion of shoddy — and harmful — anti-trans science. Those meetings “did not go well,” Wesley King, one of the students, told BuzzFeed News.

Although Brown did remove its press release, King’s group felt that the school could have done more on behalf of the trans and gender-nonconforming students who were rankled by Littman's study.

“We asked for them to request Dr. Littman remove the Brown University affiliation on the article because she conducted the research before being hired at Brown and it didn’t go through brown’s [ethics review],” King said. The administrators declined. (Regarding Littman’s study and the new critique, a spokesperson for the university said, “We are fully committed to academic freedom for all researchers at Brown, a fundamentally important tenet of the mission of any research university, and Brown faculty have the freedom to conduct and publish research on the topics they choose.”)

Restar took her critiques to the Archives of Sexual Behavior. Her new paper contends that Littman designed the study in order to frame gender dysphoria as “tantamount to both an infectious disease (‘cluster outbreaks of gender dysphoria’) and a disorder (e.g., ‘eating disorders and anorexia nervosa’).”

Restar rejects this because, as she writes, “identifying as transgender is not a disease nor is it considered a mental disorder.”

The biggest scientific problem with the study, according to Restar, is how it obtained its data. Littman placed a 90-question survey on three websites — 4thWaveNow, Transgender Trend, and Youth Trans Critical Professionals — and received responses from 256 parents.

Before filling out the survey, the parents had to sign consent forms for participation. And in those forms, Littman describes “social and peer contagion” extensively. This, according to Restar, could have easily biased the respondents to give answers confirming the idea of social contagion. What’s more, those three websites are known for their trans-critical views.

“From a methods standpoint, one could say she was looking for individuals who have specific beliefs that could confirm her hypothesis — which is a symptom of biased sampling,” Restar said.

What’s more, ROGD is not a clinical diagnosis, and has not been validated by medical professionals. Littman made no attempts in her survey to precisely define what “rapid onset” meant, or when exactly parents should note their child’s “puberty” began.

The editor of the Archives of Sexual Behavior journal is Kenneth Zucker, a prominent and controversial figure in the field of trans health care. A clinical psychologist who helped write the definition of gender dysphoria in the most recent edition of Diagnostic and Statistical Manual of Mental Disorders, Zucker was ousted in December 2015 from his long-held position as head of the Family Gender Identity Clinic at Toronto’s Centre of Addiction and Mental Health (CAMH), following activist complaints and an internal investigation over his methods for treating gender-nonconforming children. Late last year, he reached a settlement with CAMH for what he claimed was unfair dismissal and libel, and was awarded over half a million dollars. He now runs his own practice in Toronto.

Zucker told BuzzFeed News he greenlit Restar’s article because “it’s an important issue, and this is what academic discourse is about.” But he also believes that Littman’s study is valid — for spotlighting a previously underappreciated subgroup of adolescents.

“I think people who work in the field need to do more research on who are these kids,” he said. “What’s the best way to work with them therapeutically, and can we apply the same standards of care we use with adolescents who have been struggling with gender dysphoria for a long time?”

Zucker has previously written and spoken favorably about Littman’s research, tweeting that it is “important” and that Littman losing her consulting work as a result of her study “is nothing less than bald intellectual McCarthyism circa 2019.”

He acknowledged that studies relying on parents’ perspectives of their kids are limited, but that this approach “is a longstanding tradition in developmental clinical psychology and psychiatry.”

Over the past few months, he added, he’s been wondering why the backlash to Littman’s study has been so loud. He believes it’s because, if social factors indeed influence a person’s gender identity, then “that would sort of go against — let’s call it, the essentialist or 'born that way' model,” he said.

But many trans, queer, and gender-nonconforming people don’t subscribe to the “born this way” model of gender identity in the first place. Julia Serano and Arjee Restar, for example, say they are worried about what it might mean to liken trans identity to a contagious disease — much the same way that gay people have been thought to be contagious and thus prevented from being Boy Scout leaders, teachers, or otherwise fully integrated members of society. “The same argument is now being used in context of transgender people,” Serano said.

Zucker acknowledged these concerns, but also believes that the kids described in Littman’s work are worthy of study. He’s currently researching why an increasing number of assigned-female young people have been seeking treatment at gender identity clinics in North America and Europe over the past 15 years, when previously, the ratio was reversed: Mostly assigned-male adolescents were seeking care.

Some women who have transitioned and then gone back to identifying with their assigned gender — “desisting” and “detransitioning” — do think that rapid-onset gender dysphoria via social contagion describes their experiences. But activists and researchers like Serano think that, for the vast majority of gender-nonconforming youth, ROGD doesn’t explain this increase.

“I think it’s important for us to recognize that the prevalence of trans people in the past was artificially reduced by the lack of visibility, and by gatekeepers who weren’t allowing people access to trans health,” she said.

Zucker agrees that increased visibility, and decreased stigma, could explain the rise. Yet another theory, he says, is that young girls are aware that they are perceived as sex objects, making them more self-conscious about their bodies and gender identity than boys are. “A lot of what Littman would call ROGD females will talk about how when, in grades 7, 8, 9, all of a sudden other kids talking about sex made them feel uncomfortable, and they started to feel more alienated from the category of being a girl.”

Whatever explains the increase, treating children and young adults with gender dysphoria remains hotly contested. Zucker mentioned the three general approaches to treating trans youth: the intermediate, cautionary approach known as “watchful waiting”; gender affirmation, which can involve either social or medical transition, or both; or therapeutic treatment “to see if one can help a child feel more comfortable in the gender that matches their birth sex.” Zucker’s use of the third approach in young children is what, in part, led critics to call for his ouster in 2015.

But today, he said, he doesn’t favor any particular approach over another. “You need data to decide what’s best, but all these approaches are designed to reduce dysphoria.” But who, in the end, gets to decide what’s best for a gender-nonconforming child? “I think the choice of therapy is going to depend a lot on what parents want,” Zucker said. “It’s their kid.”


Jonathan Kay's name was misspelled in an earlier version of this post.

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