Bad Science: Rapid Onset Gender Dysphoria

Picture this. You’re a 90s cartoon character, walking around your cheerful suburb, whistling cisgenderedly. And then, suddenly, you find yourself in a dark alley, or the wrong side of the playground, or maybe an evil fantasy world of some kind. The music becomes menacing as your friend from school surround you. One of them holds out a hypodermic needle filled with hormones. Another wields a scalpel. “Come on,” they say. “All the cool kids are doing it!”

Welcome to the world of Rapid Onset Gender Dysphoria.

If you’re just tuning in: Two weeks ago, my article about how gender affirming care for minors is good actually dropped in Lux Magazine, along with a companion substack about how bad it is that a scientific question has become a political one. These actions summoned Gender Critical Commenters, leading to my first ever Substack ratio (comments > likes). I declared academic jihad against the gender criticals, put out a call for peer reviewed, scientific papers that support their arguments, and swore to return with FACTS and LOGIC to destroy the very concept of gender and make every bathroom gender neutral.

This is going to take a few substacks, which sucks, because I hate writing about science, but I also hate having this conversation, and I want something to link back to whenever someone is like “hast thou considered” online. I have considered, actually, far more than I ever wanted to, and I will write about those considerations now:

Rapid Onset Gender Disorder (ROGD)

Dr. Lisa Littman, an OB/GYN and former professor at Brown Univerity, introduced the concept of ROGD to academia in a 2018 paper published by PLOS ONE, an open-source Internet-only publication that, along with other PLOS publications, has published over 300,000 articles since 2011. The journal publishes papers based purely on technical merit: unlike most academic journals, it does not care whether the work is significant. But it is a legitimate journal with peer review and a good reputation.

ROGD postulates that many children who begin to experience dysphoria in their adolescence are not actually trans, but have instead fallen victim to a fad and to peer pressure. This dysphoria, the ROGDs say, develops after the children became involved in a peer group with one or more dysphoric or trans-identified kids, and/or after “an increase in social media/internet use.”

Right off the bat I would like to point out two things:

1. In our culture, when children become adolescents, they tend to spend a lot more time on the internet then when they were children. Like, all of them. Unless you lock them in a broom closet or something. If excessive Internet use made people trans, everyone would be trans.

2. Maybe there’s a reason trans-identified kids hang out together.

Almost all of my friends—maybe literally all of them—are neurodivegent. Did we peer-pressure each other into being crazy? Or do people tend to make friends with people who have similar life experiences and worldviews? Maybe the correlation/causation thing is backwards here, is what I’m saying.

Anyway, back to the science: to find out whether children were transitioning because they were persuaded or convinced or pressured by other teenagers and adults, Littman asked the people best able to describe the experience of ROGD: the parents. Littman asked them to complete a 90-question survey. 256 parents completed the survey, which is a decent sample size.

Littman recruited these parents from:

• 4th Wave Now: a small website that describes itself as “a community of people who question the medicalization of gender-atypical youth” created by a mother who became concerned about her child transitioning after spending too much time on the Internet.

• Transgender Trend, an organization with the tagline “no child is born in the wrong body.” Transgender Trend has come under fire for distributing an information packet to UK schools that warned schools against “giving a transgender child rights that are not afforded to other children,” including allowing for gender-nonconforming hairstyles and dress (because at its core, the gender critical movement is about enforcing gender norms, no matter how often they insist it isn’t)

• Youth Trans Critical Professionals. This website is now private, but back in 2018 it was exactly what it sounds like: a website explicitly for psychologists, medical professionals, and academics who are “concerned about the current trend to quickly diagnose and affirm young people as transgender.”

What I am trying to tell you is that Littman primarily recruited those 256 parents from a population of parents who sought out and then spend time reading websites that preached Littman’s exact hypothesis.

Littman argues that this is fine actually because she used a “snowball sample” which is apparently neither a sex act nor a key bump but a thing where you encourage people to share the link to your survey in the name of getting a wider sample. Thanks to snowballing, the survey eventually ended up posted on Parents of Transgender Children, a private Facebook group with over 8,000 members in 2018. Unlike the other three survey locations, Parents of Transgender Children is, by all reports, in favor of gender-affirming care. The study did not track where their respondents found the survey link, so it’s unclear what percentage of parents in this survey came from Parents of Transgender Children and which came from the three websites created explicitly to convince parents that their children are suffering from ROGD.

Littman didn’t track where the parents found the survey, of course—why would she? But If an equal number of participants came from all four websites, you’d expect that about 75% of parents surveyed would not believe their child is transgender. Which is almost exactly what we find, by the way: the actual number is 76.5%.

As it turns out, when you survey a bunch of parents pre-selected to believe in ROGD, you find really robust evidence that ROGD exists. “Most of the parents (80.9%) answered affirmatively that their child’s announcement of being transgender came “out of the blue without significant prior evidence of gender dysphoria.”” Then again, it seems like maybe some of these parents aren’t very observant generally: about a third of respondents said, and you really cannot make this up, that “their child did not seem gender dysphoric when they made their announcement.”

69.2% of respondents believed their kids came out “using language that they found online,” which—where else would you expect them to find it? 100% of people who use the term ROGD are “using language that they found online,” since that’s where the paper got published. It’s meaningless. It’s a nothing statement. One of the big tropes you’ll see if you dive into the ROGD section of the gender-critical pool is parents claiming that their child’s coming-out statement sounded “wooden” or “like they were reading from a script,” and here’s the thing: a lot of those kids probably were reciting a script they’d practiced many times before. Whomst amongst us has not rehearsed a difficult conversation? A break-up, maybe, or a proposal, or a pick-up line, or a resignation? What would be the correct way to perform gender dysphoria, in Lisa’s eyes? Unclear.

Littman also discovered that 62.5% of parents said their children were diagnosed with some other mental illness before the dysphoria became apparent, and that 45% of them engaged in self-harming behaviors. Again, I have correlation/causation questions. Did these kids feel dysphoria as a result of mental illness, or were they mentally ill because they felt dysphoric? Was transition another form of self-harm, or were they self-harming because they felt trapped in their own body? Further research needed, surely.

Some people found this research very compelling when it came out, and one of the reasons it may have seemed compelling to them is that, in the original version of the paper, Lisa Littman did not disclose her recruiting methods. Didn’t mention how she found the parents. Just threw them out as a morass of random people, just regular folks not at all handpicked to deliver the result Littman was likely hoping for.

When Littman’s ROGD paper began making headlines, scientists looked at the paper, noticed this pretty stunning ommission, and demanded she reveal her methods. PLOS ONE gave the paper a second review and issued a correction that a) exposed her fucked-up recruitment scheme and b) stated explicitly that the paper generated a hypotheis but did not prove one. Where is the control group? Where are the parents of teenagers who are not transgender? Where are the stats on their internet usage? How many of cis kids hang out in peer groups with one or more trans person?

I guess we’ll never know.

Anyway, the journal said further research was needed, the PLOS ONE Wikipedia article got a paragraph describing the controversy, and gender critical scientists spent the next five years doing follow-up research, by which I mean

Further Research

Littman herself has performed no further research on ROGD. In 2021, she authored a paper on transition regret (we’ll get to that in a different substack), but doesn’t seem terribly interested in proving her theory right or wrong. Why should she? Her audience doesn’t need more information to be convinced.

I was able to find two studies that directly test the ROGD hypothesis. The first, conducted by Bauer, Lawson, and Metzger in 2021, studied 173 adolescents with gender dysphoria: all first-time patients at one of ten Canadian medical clinics. Unlike Littman, Bauer & co have heard of a control group: they compared kids whose gender dysphoria began less than two years ago with kids of the same age who had experienced dysphoria for more than 2 years. If ROGD was a thing, one would expect the average 15-year-old whose dysphoria was relatively recent to be measurably different from the average 15-year-old who developed dysphoria at a younger age. We would expect the ROGD contingent to have higher rates of mental illness and more supportive friends/online community than “regular” adolescent-onset gender dysphoria havers.

The team found none of this:

Not only did the study fail to find higher rates of mental illness in the ROGD component, that group actually had lower levels of anxiety than their long-timer peers.

More recently, in March of 2023, Littman’s fellow gender-critical J. Michael Bailey and co-author Suzanna Diaz published a peer-reviewed study that claims to support the existence of ROGD based on a review of 1655 possible cases. The study came out in Archives of Sexual Behavior, the official publication of the International Academy of Sex Research. Its editor, Ken Zucker, is also involved in the gender-critical movement. Zucker was the head of the Gender Identity clinic at Toronto’s Centre for Addiction and Mental Health until 2015, when it closed amidst controversy over methods many described as conversion therapy. Here’s a quote from an NPR article that describes Zucker’s methods with “Bradley,” a child assigned male who identified as female (CW: IF YOU DO NOT FEEL LIKE READING ABOUT CONVERSION THERAPY TODAY, PLEASE SKIP DOWN TO THE NEXT PARENTHETICAL):

In this article, Bradley’s parents get rid of her “girlish toys,” but she refuses to play with the “boy” toys. Instead, she draws and colors, but she refuses to draw boys, only girls with long hair. Her parents bothered her about this for months until he finally gave in and obediently drew boys with short hair.

(OK IT’S OVER)

I print all that because—as I mentioned earlier and will continue to mention throughout this series—gender criticals writ large do not actually want society to accept boys who like girl things and girls who like boy things, as they will often insist they do. Their conception of gender is just as “shallow” as the trans conception of gender, because gender is a shallow concept. It’s a performance. What does it mean? Everything and nothing.

Anyway, back to J Michael Bailey’s article, which appeared in a journal edited by Kenneth “Don’t play with dolls” Zucker and which was retracted shortly thereafter because he forgot to get consent from the 1655 participants in his study.

Bailey is pretty mad about this, and I actually kind of get it: they got him on a technicality. If you’ve ever done or participated in an academic or medical study, chances are you had to write or sign some insane waiver where they were like “these questions might make you feel unpleasant emotions” or “this data will be triple-anonymized and then fed into a shredder afterwards.” The idea is to make absolutely double-sure the academic or medical professional isn’t exploiting anyone against their will. Well, Bailiey didn’t do that. When he solicited survey respondents, he told them, “We will publish our data on our website when we have a large enough sample.” That’s not the same thing as “We will use your response in academic research.”

Look, whatever. I think this rookie mistake is indicitave of the kind of slipshod work these gender-critical scientists tend to perform, this willingness to skirt scientific convention in the name of making their point, but I agree with Bailey that the issue doesn’t negate the findings. Let’s look at those findings now:

Like Littman, Bailey went straight to the most authoritative source on the feelings of trans adolescents: their parents, and like Littman, Bailey recruited them from a totally unbiased source: ParentsofROGDKids.com:

I’m losing my fucking mind.

“The authors acknowledge that the framing of the survey is biased toward belief in, and concern about, ROGD,” Bailey wrote in his paper, “although it is likely that a more important bias was self-selection due to the website’s name and purpose.” But Bailey thinks we should take his results seriously, because:

1. The parents largely identify as progressive and not conservative

2. “It is unclear how one might recruit a representative sample of parents reporting on their gender dysphoric adolescents.”

Regarding #1: for people who don’t like it when other people self-identify, these gender-criticals put so much weight into the way people politically self-identify. This came up in Littman’s study too. But I don’t care if the parents voted for Obama or whatever, I care what they think about trans people. More specifically, I want to know what form this supposed support for trans people takes. Is it a “trans women are women, trans men are men” kind of support? Or is it a “I support everyone’s rights to do whatever they want behind closed doors but I don’t see why they have to do it out in the open around my children” kind of support?

Regarding the difficulties of finding a representative sample of parents: imagine working a job where “waah! It’s hard!” is an excuse to do slipshod work. Oh I’m sorry, Dr Bailey. Is your job difficult? Does it involve more effort than throwing 180 questions onto Survey Monkey and spamming it on one message board? Might your inflated salary as a tenured professor require you to go outside, talk to some gender clinics, wade through larger samples of parents not actively affiliated with anti-trans acivism? Perish the thought.

By the way: as long as we’re talking about hard things, this might be a good time to bring up the fucksaw incident. I mean, is there ever not a good time? J Michael Bailey is famous for two things: support for the Blanchard Typology theory of trans people (Contrapoints has a great video on this) and, back in 2011, inviting his students to stick around after his sexology class to watch him bring a woman to orgasm with a sex toy he created by strapping a dildo onto a reciprocating saw.

He has enough free time to do a proper survey, is what I’m saying. He just chooses to spend his time differently.

Back to the article.

Half of the parents in this survey reported that their children had a trans friend before transitioning. 42.5% had a diagnosed mental illness. Assigned female children spent an average 4.5 hours per day on the Internet; assigned males spent an average of 5.6 hours. Is this an unusual amount of time for young adults to spend on the Internet? Who knows! Like Littman, Bailey has apparently never heard of a control group—or perhaps he has, but fears that finding one might require him to break a sweat. Either way, the statistics hang in space, signifying nothing.

72.6% of parents said their children had experienced a “stressful event” that may have led to gender dysphoria. However, when asked for specifics, these stressful events were incredibly normal: things like moving or having romantic difficulties (imagine what the world would look like if teenage heartbreak led to transiton!). “A few said that the youth had suffered severe physical or sexual abuse, and several mentioned that a friend or relative had committed suicide,” the paper said, declining to specify what “a few” or “several” meant in terms of actual numbers.

Other shocking insights from this survey:

• Most parents considered their children to be of above average intelligence

• After the child came out as trans to the non-supportive parent, parent/child relations degraded

Shocking.

Something that has almost nothing to do with ROGD, but features heavily in the article, is how profoundly rare medical transition was within this populace. A lot of this is probably because of the unsupported parents. Part of it might be that it’s actually fine and good to play with gender socially before deciding whether it’s a forever thing. Either way, 65.3% of the kids in the study had socially transitioned, between 6.5 and 8.4% of kids had experienced hormone therapy, and just 1% of participants had undergone medical transition.

Anyway, that’s everything I think is important about this article, but let’s look at the two points Bailey thought important enough to highlight in his discussion:

1. Trans women develop gender dysphoria 1.9 years later, on average, than trans men. Bailey points out that this may be because puberty begins earlier in assigned female people than assigned male people: seems plausible, cool, not sure what it has to do with ROGD.

2. “Youths with a history of mental health issues were especially likely to have taken steps to socially and medically transition.” We’ve talked about this already. It makes sense that someone who is very unhappy with their body, their social role, or both, might suffer other mental health complications as well. Further research is needed to figure out the direction of causation. And I am once again asking for a goddamn control group. I’m never going to get one. But I’m asking

In conclusion, this paper provides no actual support for the ROGD hypothesis and plenty of support for Bailey being a slipshod embarrassment to the social sciences.

Odds are someone is in the comment section right now saying that we just need more research and if The Trans Agenda wasn’t suppressing research into ROGD there would be plenty of proof. But Bailey isn’t the other gender critical person with access to academic backing. Zucker is clearly willing to publish heterodoxy. Littman herself apparently can’t be assed. So what’s the hold-up? Could it be that this entire movement is in fact deeply unscientific and they’d rather take this debate to social media than actually put in the work to make their case in the scientific arena?

Rhetorical. I won’t be here to read your replies anyway, unfortunately: at time of scheduled publication, I am in the wilds of Maine hopefully far away from anything that even resembles cell reception on a 5-day canoe trip with family. I am probably not thinking about gender at all. I am probably thinking about how out of shape I am. Sitting on the shore, perhaps, explaining to our tour guide that “It is unclear how one might gain the kind of upper body strength necessary to paddle a canoe” and demanding to be carried.

When I get back, we’ll continue our gender critical journey with a look at detransition and trans regret, which actually seems like a super interesting topic with a lot of nuance utterly flattened by the just-asking-questions fucksaw crowd. Until then: if you’re still sitting on some shit-hot gender-critical study you think will change my mind about gender-affirming care, it’s not too late to send it: [email protected].