Rapid-onset gender dysphoria — a discussion that won’t go away

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Is “4th Wave” becoming a tidal wave?

Why are an increasing number of teenagers surprising their families by suddenly rejecting their own birth gender, even though they previously seemed quite comfortable with it? Are gender therapists and medical professionals missing something in the way they are dealing with these teenagers?

A couple of weeks ago the peer-reviewed journal PLOS ONE published a paper about these questions. The paper, by Lisa Littman of Brown University, Providence, RI, is based on a survey completed by 256 concerned parents.

Littman’s paper uses the term “rapid-onset gender dysphoria” — note absence of capital letters — to describe sudden appearance of gender dysphoria in an adolescent or young adult who didn’t show signs of gender dysphoria before puberty.

Lisa Littman questions the widespread current view that transgender identity is always present from birth. She suggests that

* adolescent-onset gender dysphoria has a strong cultural component — it is often influenced by peer groups and online media.

* gender dysphoria can be a way for adolescents to cope with other problems, such as traumas and depression. However, it is a flawed way of coping, since it can result in the other problems remaining unacknowledged and unresolved.

She takes issue with current practice of quick affirmation of identity of adolescent trans identity. Simply because they say they are transgender, should therapists agree that they are that, no matter how young, confused or upset they may be?

Currently affirmation of identity is often followed by prescription of puberty blockers, later male or female hormones, and eventually surgery.

Littman acknowledges that these procedures may be appropriate for some, but she does argue for greater caution in using them. She ends her paper with a call for further research.

Less than three weeks after publication, Lisa Littman’s paper has already had over 56 thousand page views.

The paper has been hotly criticised on the grounds that her questionnaire was completed by parents, and that the these parents were contacted through supposedly conservative and prejudiced websites such as 4th Wave Now.

But Littman’s paper sets out clearly how she received and analysed the information in it.

The fact that parents completed the survey is mentioned not only in the body text of the paper, but also in its very title “Rapid-onset gender dysphoria in adolescents and young adults: a study of parental reports”.

In her survey, Lisa Littman asked the 256 parents whether they supported same-sex marriage, and a big majority said that they did — hardly a typical conservative position.

She also sets out clearly that she contacted these parents through online forums catering to parents concerned about the sorts of questions she is looking at — websites including 4th Wave Now.

Whether these sites deserve to be dismissed as bastions of conservative prejudice is questionable, to say the least. Perhaps worth noting that 4th Wave Now provides detailed direct statements by teenagers about their experiences with dysphoria, for instance here, and here, as well as statements by parents.

A surprisingly slogan-like response to Littman’s work came from an academic publication, the Journal of Adolescent Health (JAH). The journal released a tweet on August 24 saying simply: “Folks, Rapid-Onset Gender Dysphoria (#ROGD) is not a thing.”

This was followed by a further tweet: “To clarify, we are aware of one study showing that certain parents have a shared and consistent view of their child’s gender identity. That is evidence of something, but it is not evidence that #ROGD is a thing that exists.”

Although these tweets did not mention Lisa Littman by name, the allusion to her work is unmistakable. JAH later retracted its “not a thing” tweet, but the tweet can still be found at archive.today.

Responding to complaints, PLOS ONE said it would carry out a further review of Littman’s research.

Brown University then removed a press release about the paper from its website and made a statement referring to “concerns about research methodology” as well as “concerns that the conclusions of the study could be used to discredit efforts to support transgender youth”.

The trouble with this statement is that it assumes that professionals trying to “support transgender youth” already understand the needs of all young people who say they are transgender.

Then came the counter protest — an online petition in support of Lisa Littman’s academic freedom has attracted over 3,500 signatures in less than a week, plus over one thousand comments, most of which are thoughtful and supportive.

The response to the online petition shows that Littman’s paper, whatever its limitations, addresses a growing public concern.

This is a discussion that won’t go away.

(Image: “Great Wave off Kanagawa”. Via Wikimedia Commons. Public domain.)

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