For over a decade, the Gender Affirmative Model has been the standard of care for gender dysphoric youth across the West. Yet, despite its widespread and long-standing use, good evidence to support it remains elusive. Maybe that’s because there isn’t any.
A new paper reports on results from a survey of 1,655 parents of children who developed gender dysphoria during adolescence or soon after. American Academy of Pediatrics guidelines recommend affirming these kids in their new gender, and supporting them along the path to social, medical (hormonal), and surgical transition.
The results of this survey provide strong support for Dr. Littman’s Rapid-Onset Gender Dysphoria (ROGD) hypothesis, which suggests that gender dysphoria in this group may resolve with time and good psychological and social support, if needed.
Key Findings
Key findings of particular concern are that these children tend to have emotional problems that predate their gender-related issues by nearly four years. Furthermore, children with mental health issues were more likely than those without to have taken steps to transition. Children who were referred to a gender specialist were also more likely to have taken steps to transition. Parents reported feeling pressured by these specialists to transition their child. And parents reported a decline in their child’s mental health and social functioning after transition.
History of Gender Dysphoria and Standards of Care
About 15 years ago, Western countries began experiencing an exponential rise in adolescents and young adults suddenly developing gender dysphoria and being referred to gender clinics for treatment. Around the same time, a new philosophy on transgenderism began to take root: Just as there is nothing wrong with being attracted to the same sex, there was nothing wrong with identifying with a gender that did not match your biological sex. In other words, being transgender is perfectly normal. It is not a mental illness. If a trans person does have any mental health issues, it can be attributed to the extreme distress of having to live in a body that does not feel right (gender dysphoria), and the stress of living in a judgmental, transphobic world.
Out of this philosophy grew the Affirmative Care Model. This model focused on reassuring (affirming) people that their gender identity was real, normal and natural, and helping them take steps to relieve their gender dysphoria through social, medical (hormonal) and surgical transition. In order to address their social distress from lack of acceptance, much effort is devoted to creating a supportive environment among friends, family, schools and society in general.
Although there was almost no evidence to support it at the time, the Affirmative Care Model quickly became the standard of care in most Western countries.
In 2016, Dr. Littman noticed an anomalous spike in teenage girls suddenly declaring themselves transgender and became concerned. She conducted a survey of their parents to learn more about this new phenomenon. Based on what she found, she proposed that a new sub-category of gender dysphoria had emerged, this one sharing more similarities with anorexia and other eating disorders than with the previously recognized types of gender dysphoria. Dr. Littman described Rapid Onset Gender Dysphoria (ROGD) in her seminal paper published in 2018.
ROGD develops suddenly, during or after puberty in a person who would not have met the criteria for childhood gender dysphoria. Most often, these kids are white, highly intelligent and come from well-educated families. ROGD affects mainly girls, and groups of friends often come out as trans together. The influence of social media is believed to play a role. They often have a prior history of mental health issues, developmental difficulties or have experienced a traumatic or stressful event before developing gender dysphoria. A prior history of self-harm and difficulty fitting in with their peers are also common. Sadly, transitioning is not likely to help these kids with their issues as it does not address the root cause. In fact, it has a good chance of making things much worse.
The ROGD hypothesis suggests that for these unhappy kids, “gender dysphoria” is a catch-all phrase for any kind of distress, and transition is the cure-all solution
Since the publication of Littman’s paper, the ROGD hypothesis has come under fire from proponents of the affirmative care model. It’s easy to see why: The affirmative care model is based on the premise that being transgender is perfectly normal. The ROGD model suggests that this particular kind of gender dysphoria – and the desire to transition – is most definitely not normal. It’s a maladaptive coping mechanism.
Unfortunately, there is little evidence to support either hypothesis.
The World Professional Association for Transgender Health’s newest Standards of Care, published in Oct. 2022 admits, “A key challenge in adolescent transgender care is the quality of evidence evaluating the effectiveness of… gender-affirming medical and surgical treatments.” “The number of studies is still low and there are few outcome studies that follow youth into adulthood.”
Testing the ROGD hypothesis presents its own challenges. In North America, gender clinics are still using the affirmative model as a standard of care, which views taking steps to transition as medically necessary and thus, would be unwilling to test the ROGD model. Further, ROGD has become such a contentious topic at universities that any academic who broaches the subject risks career suicide. Just ask Dr. Littman and Dr. James Caspian.
survey results
Concurring with Dr. Littman’s findings, our survey indicates children who are most likely to develop ROGD are of European descent (78.9%), with above-average intelligence. They are also more likely to be female (75%). Their gender dysphoria develops around the age of 14 for girls, and 16 for boys. This may be partly due to the fact that boys go through puberty later than girls.
Their parents are more likely to be progressive and hold positive views towards LGBTQ+ rights. Frequently, parents went out of their way to make sure the reader understood this when they told their stories. Many had family and friends in the LGBTQ+ community, and some were members themselves. They just didn’t feel it made sense in their child’s case.
A majority of these kids were dealing with mental health issues (57%) that began around the age of 10, well before they developed gender dysphoria, and 42% of them had received a formal psychological diagnosis. The most frequently-reported issues were anxiety and depression. Self-harm was also prevalent in girls. Attention deficit disorder, autism, and obsessive-compulsive disorder were reported in numbers higher than the general population.
Very often, these kids had experienced a stressful event before they developed gender dysphoria (72.6%). Some described issues that would be overwhelming even for an adult to deal with, such as the suicide of a close relative, receiving a serious medical diagnosis such as cancer, being sexually assaulted, or being present at a mass shooting. Sometimes, the stress was more mundane, like moving, breaking up with a girl- or boyfriend, or having a good friend turn on them, but the child was having a hard time dealing with it. During the lock downs due to COVID, the strain of isolation was especially hard on these kids.
Parents also reported that their kids were having a lot of trouble fitting in with their peers at an age when being accepted feels like the most important thing in the world. Only about a quarter of parents reported that their child was well liked, and only one third said their kids got along well with other kids.
Parents reported their kids spent an average of 4.5 hours per day on the internet and social media.
When asked whether their child had friends who came out at the same time, 60.9% said their daughters did, compared with only 38.7% of their sons. The average number of friends who came out were 2.4.
“My daughter used to be so lonely her only friend was her guinea pig. At 11, a girl at school befriended her as did her group of friends. All of a sudden, my daughter said she was bi, then gay, then pan, then poly, then fluid, now trans. Her mental health is deteriorating and the psychiatrists (this is her 6th) seem to push their own agenda and label me transphobic. I KNOW my daughter. When no social group will welcome you and one finally does, you’ll conform to fit in, to not lose the only ‘friends’ you have.”
~Parent of an ROGD Kid
transition
The majority of the children had socially transitioned at the time parents completed the survey (65.3%), and girls tended to socially transition earlier (age 15) than boys (age 17). In general, parents reported that their children had not started taking puberty blockers or hormones, and surgery was especially rare.
Girls who had friends who socially transitioned were more likely to do so themselves (73.3%), compared with only 39.5% of boys who were more likely to transition if they had a friend who did so.
One very concerning finding was that children with preexisting mental health issues were also more likely to socially transition than those without. This is worrisome, because children with emotional issues may lack the judgment needed to make serious, and sometimes irreversible, decisions about their bodies.
Another troubling finding was that children who received a referral to a gender specialist were more likely to have transitioned. This is especially concerning because 51% of parents who took their kids to a gender specialist also reported that they felt pressured to transition their child.
Effects of transition on mental health and social functioning
When asked about the state of their child’s mental health after social transition, they were much more likely to say it had worsened than improved.
Sadly, the change in the quality of the parental relationships also declined, as shown in the table below:
Conclusion
The results of the largest survey to date on gender dysphoric adolescents support Dr. Littman’s ROGD hypothesis. These youth are most likely using “gender dysphoria” to describe general feelings of dysphoria that they have no other name for, and do not understand. Transitioning will not help them. It can only cause irreversible harm and make things much worse.
Sweden, Norway, Finland, the UK and some States are backing away from the gender affirmative model, citing the lack of evidence and amid the growing number of detransitioners, many of whom are launching lawsuits against the gender specialists who harmed them. (See Ritchie Herron and Keira Bell, Michelle Zacchigna and Chloe Cole.)
Yet here in North America, the United States and Canadian Governments, the American Academy of Pediatrics and most other medical associations, are doubling down on the gender affirmative model.
If they truly want to “do no harm”, then they must follow Sweden’s lead and stop transitioning minors.
Footnote: On March 23, 2023, the Washington Post reported on a survey that found the majority of trans adults were happy they had transitioned. While they may feel that way, on every question relating to mental health and social functioning, they rated themselves as worse off than the total population surveyed. Most alarming, 78% of trans respondents reported that they had serious mental health issues as a child or teenager. These results support our conclusion: Transitioning does not improve social and emotional functioning.
about us
Parents of ROGD Kids was created by two mothers with teenage daughters who suddenly decided they were transgender without any prior history of gender dysphoria, but with long histories of mental health issues. They were skeptical of the affirmative model. It just didn’t seem to fit in their child’s case, yet everywhere they went, they were told to affirm their children. These mothers felt isolated, intimidated and terrified for their daughters.
They met online in a group of like-minded mothers. Eventually, the group arranged a secret meeting somewhere in the US. It had to be secret to avoid angry trans-rights activists. It was such a relief to find others in the same situation, and so empowering to know they were not alone, that they decided to create Parents of ROGD Kids, so that no other parent would ever have to feel so isolated and alone.
Their website launched on Dec. 1st, 2017. Since that time, their organization has grown to over 2,300 parents. The majority of parents come from the US (74%), and they have affiliate groups in Canada, the UK, Australia/NZ, Scandinavia and Germany. Some parents come from as far away as Czechoslovakia, South Africa, Hong Kong and Japan.
They are nonpartisan, non-religious and welcome parents of any sexual orientation. Their only focus is to offer support for parents of ROGD kids, because they have nowhere else to turn.
They do not advertise and they have no budget. Parents seek them out on their own. Clearly, many parents do not believe in the affirmative model.
Parents of ROGD Kids can be contacted via their website: ParentsofROGDKids.com
Origin of the survey
The survey was created by Suzanna Diaz (a pseudonym) as a means of vetting parents for support groups and filtering out troublemakers. As she was creating it, she thought she might as well collect some useful data about ROGD kids at the same time. Suzanna presented her preliminary results at a conference for gender-critical professionals in Toronto in July of 2018. Dr. Bailey attended the conference and offered to compile the results for publication.
We are deeply grateful to Dr. Bailey for the hours of work that he has dedicated this paper. Without his help, it would not have been possible.
Please direct all questions about the survey to Dr. Bailey at: jm-bailey@northwestern.edu