Rapid Onset Gender Dysphoria

Remember that old thing? No? OK, quick summary:

Parental reports (on social media) of friend clusters exhibiting signs of gender dysphoria and increased exposure to social media/internet preceding a child’s announcement of a transgender identity raise the possibility of social and peer influences.

Littman L (2018) Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE 13(8): e0202330.

In short, maybe social media is making the kids transgender? This seems like something someone should study, and someone did!


For instance, you might think that a good starting point would be asking the kids about their feelings of gender. Emphasis mine:

A 90-question survey instrument with multiple choice, Likert-type, and open-ended questions was created by the researcher. The survey was designed for parents (respondents) to complete about their adolescent and young adult children.

Littman L (2018)

So right off the bat, we’re starting with second-hand information. But it gets worse!

Recruitment information with a link to the survey was placed on three websites where parents and professionals had been observed to describe what seemed to be a sudden or rapid onset of gender dysphoria (4thwavenow, transgender trend, and youthtranscriticalprofessionals), although the specific terminology “rapid onset gender dysphoria” did not appear on these websites until the recruitment information using that term was first posted on the sites. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques.

Littman L (2018)

If those websites don’t set off alarm bells, maybe this will help:

4thWaveNow was started by the mother of a teenage girl who suddenly announced she was a “trans man” after a few weeks of total immersion in YouTube transition vlogs and other trans-oriented social media. (The daughter has since desisted from identifying as transgender.) After much research and fruitless searching for an alternative online viewpoint, this mom began writing about her deepening skepticism of the ever-accelerating medical and media fascination with the phenomenon of “transgender children.”


We are a group of parents based in the UK, who are concerned about the current trend to diagnose ‘gender non-conforming’ children as transgender. We reject current conservative, reactionary, religious-fundamentalist views about sexuality and we have no political affiliation. We are also concerned about legislation which places transgender rights above the right to safety for girls and young women in public bathrooms and changing rooms.


This website is a community of professionals thinking critically about the youth transgender movement. We are psychologists, social workers, doctors, medical ethicists, and academics.

There are two principal authors of this site. One is a clinical social worker, the other is a university professor. We are left-leaning, open-minded, and pro-gay rights. However, we are concerned about the current trend to quickly diagnose and affirm young people as transgender, often setting them down a path toward medical transition.

Let’s sketch out an alternative hypothesis. A bunch of bigoted parents were shocked that their kids hid their feelings about gender from them, until the kids had gained enough confidence to discuss the subject through peer support. This caused the parents to launch or join a tonne of websites and discussion groups where they groused about this. A researcher spotted these websites, and crafted a study asking people if they thought social media played a role in their kids’ ideas about gender…. which they only shared with parents who already thought social media played a role in their kids’ ideas about gender!

Places where said bigoted parents swap social media stories about gender identity with their peers, and may have been influenced by said stories. As the original study helpfully points out,

In developmental psychology research, impacts of peers and other social influences on an individual’s development are sometimes described using the terms peer contagion and social contagion, respectively. The use of “contagion” in this context is distinct from the term’s use in the study of infectious disease, and furthermore its use as an established academic concept throughout this article is not meant in any way to characterize the developmental process, outcome, or behavior as a disease or disease-like state, or to convey any value judgement. Social contagion is the spread of affect or behaviors through a population. Peer contagion, in particular, is the process where an individual and peer mutually influence each other in a way that promotes emotions and behaviors that can potentially have negative effects on their development.

Littman L (2018)

The study design is so poor, it’s comical. If you’re suspicious that was deliberate, because the author was fishing for data that confirmed their prior beliefs, give yourself a cookie. None of that is news, though, others have long since poked major holes in this study. So why do I bring it up now?

After publication of this article, questions were raised that prompted the journal to conduct a post-publication reassessment of the article, involving senior members of the journal’s editorial team, two Academic Editors, a statistics reviewer, and an external expert reviewer. The post-publication review identified issues that needed to be addressed to ensure the article meets PLOS ONE’s publication criteria. Given the nature of the issues in this case, the PLOS ONE Editors decided to republish the article, replacing the original version of record with a revised version in which the author has updated the Title, Abstract, Introduction, Discussion, and Conclusion sections, to address the concerns raised in the editorial reassessment. The Materials and methods section was updated to include new information and more detailed descriptions about recruitment sites and to remove two figures due to copyright restrictions.

The journal which published it has issued a correction. Not a retraction, alas, but nonetheless the editorial board endorses the points made by those critiques and adds several more:

This report did not collect data from the adolescents and young adults (AYAs) or clinicians and therefore does not validate the phenomenon. Additional research that includes AYAs, along with consensus among experts in the field, will be needed to determine if what is described here as rapid-onset gender dysphoria (ROGD) will become a formal diagnosis. Furthermore, the use of the term, rapid-onset gender dysphoria should be used cautiously by clinicians and parents to describe youth who appear to fall into this category. The term should not be used in a way to imply that it explains the experiences of all gender dysphoric youth nor should it be used to stigmatize vulnerable individuals. […]

There is some controversy over whether what is described as rapid onset of gender dysphoria, particularly in natal females, falls under the existing definition of late-onset or adolescent-onset gender dysphoria or whether it represents a new kind of development or presentation. This controversy might be a false dichotomy because both might be true. […]

As mentioned in the article, the study design of this research falls under descriptive research: as such, it did not assign an exposure, there were no comparison groups, and the study’s output was hypothesis-generating rather than hypothesis-testing. Descriptive studies often represent a first inquiry into an area of research and the findings of descriptive studies are used to generate new hypotheses that can be tested in subsequent research. Because of the known limitations of descriptive studies, claims about causal associations cannot be made, and there were none made in the article. […]

The use of targeted recruitment and convenience samples, used elsewhere and in this study, offers the benefit of connecting with hard-to-reach populations but introduces limitations associated with selection bias that can subsequently be addressed by further studies. For the current study, selection bias may have resulted in findings that are more positive or more negative than would be found in a larger and less self-selected population. […]

For a clinician to make a diagnosis of gender dysphoria in childhood, a child would need to exhibit at least six of the eight indicators. Given that 97.6% of the participants reported 2 or fewer readily observable indicators, even if hypothetically all participants incorrectly under-reported all three of the subtler indicators, 97.6% would still have fewer than six indicators. So, although no clinical evaluation was performed and a clear presence or absence of a diagnosis cannot be verified, given the reports of the easily observed behaviors and preferences, it can be said that it would be very unlikely for these AYAs to have met criteria for childhood gender dysphoria if they had seen a clinician for an evaluation.

PLoS ONE also published a formal comment, which continues to poke holes in the original study.

Evidence also points to a low correlation between parents’ and children’ self-evaluation in several domains of mental health. For example, regarding quality of life, a systematic review verified that parent and children do not agree in the evaluation for children non-observable states (such as emotions). The authors point to the need for collecting information from both parts. The same seems to be true in the assessment of children’s anxiety. This discrepancy may be due to parental attribution bias in the recollection of children’s medical history. Furthermore, parents’ biases may be enhanced in the presence of stress and psychological symptoms. Studies have shown that this could be the case for a good proportion of parents of gender-variant children and adolescents, who tend to present negative attitudes toward their offspring gender variation. […]

Parental anxiety seems to increase with the level of gender nonconformity of their children and this anxiety is associated with negative impacts on the well-being of their children. It is therefore not surprising that growing up without proper healthcare and in families that do not support gender and sexual diversity may negatively impact the mental health outcomes of gender variant young people (growing-up to be trans-adults or not).

Brandelli Costa A (2019) Formal comment on: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE 14(3): e0212578.

At best, the study author found a new type of gender dysphoria. At worst, they laundered bigoted and ill-informed opinions through the scientific record to make them appear more credible. Either way, the author has given TERFs and transphobes (compare and contrast) a new talking point and made the life of transgender children worse.

That’s not how science should work.