Transgender series, part 1: What is rapid-onset gender dysphoria and why does it matter?

(The Daily Signal) – Studies have suggested that the number of young people who identify as transgender has exploded in recent years. While activists claim that these people are just discovering…

(The Daily Signal) – Studies have suggested that the number of young people who identify as transgender has exploded in recent years. While activists claim that these people are just discovering a latent truth suppressed by society, some scientists have set out to question what lies behind a phenomenon they term “rapid-onset gender dysphoria.”

Leor Sapir, a fellow at the Manhattan Institute, has worked with Lisa Littman, a doctor who first coined the term rapid-onset gender dysphoria and laid out her hypothesis in the medical journal PLOS One. Sapir joins “The Daily Signal Podcast” to break down what ROGD is, why some activist scientists have failed to disprove it, and what he and Littman have done to advance the theory.

“Gender dysphoria” refers to the condition of persistently and painfully identifying with the gender different from one’s biological sex, and “rapid-onset gender dysphoria” refers to a new, third form of gender dysphoria. Current literature recognizes adult and childhood gender dysphoria, but ROGD refers to a form of gender dysphoria that often emerges in adolescence and may be a social contagion.

Sapir explains that the phenomenon emerges among “adolescents who do not have a childhood history of gender nonconformity or gender distress or issues with their sex.” These people “don’t have issues with being boys or girls, and these problems seem to develop only in adolescence.”

“They have co-occurring mental health problems, anxiety, depression, autism, [obsessive compulsive disorder], eating disorders, history of trauma, you name it,” he adds. “They are predominantly, although not exclusively, but predominantly female, right, and they belong to peer groups where some of them are male or female. The kids come out as trans in clusters.”

Sapir describes these facets as “indicators of symptoms” that have emerged “in the medical literature in the last few years.”

He does not claim that ROGD is “settled science,” but he insists that it is a scientifically rigorous hypothesis to explain the jump in transgender-identifying youth in the past few years. The hypothesis suggests that therapy, rather than invasive medical interventions often referred to as “gender-affirming care,” might be the proper path forward for youth who struggle with gender-identity issues.

Sapir and Littman recently defended the ROGD hypothesis against an attack from Dr. Jack Turban, an assistant professor of child and adolescent psychiatry at the University of California at San Francisco. Turban and others published a January 2023 study in the Journal of Adolescent Health claiming to debunk ROGD by analyzing the U.S. Transgender Survey of 2015.

Sapir and Littman responded with a December letter to the editor in Archives of Sexual Behavior and in an article on Sapir’s substack, Reality’s Last Stand.

Sapir tells “The Daily Signal Podcast” that Turban didn’t come close to disproving the ROGD hypothesis, and he explains how Turban tried to manipulate the data to suggest that people cannot get rapid-onset gender dysphoria because transgender people do not reveal their identities right away, but keep them secret for years.

“They did a lot of gymnastics” to suggest that teens today do not have rapid-onset gender dysphoria, Sapir explains.

Sapir says the 2015 study asked people who identify as transgender three questions: (1) at what age did you start to feel that your gender was different from your sex?; (2) at what age did you begin to feel that you were trans, even if you didn’t have a word to articulate it?; and (3) at what age did you disclose a trans identity to a family member or somebody else in your life?

Rather than relying on question No. 2 as a proxy for when people realized they were transgender, Turban chose question No. 1. Sapir says that question is more subject to “recall bias,” when a person reinterprets a memory of feeling a certain way early on, in order to reaffirm their identity and choices in the present.

“So, why wouldn’t Turban use question No. 2?” Sapir asks. “Well, we dug down into the data. We did some analysis, and it turns out if he had used question No. 2, the median time from realization to disclosure would have been one year, and a one-year time from realization to disclosure supports the ROGD hypothesis.”

Yet the biggest problem with Turban’s analysis is timing, the Manhattan Institute fellow says.

The ROGD hypothesis is “that this phenomena really started to emerge in the late 2000s and picked up speed in the 2010s,” Sapir notes. “The sample, a survey of adults from 2015, cannot possibly pick up on ROGD phenomena if that’s what Turban and his colleagues are trying to investigate.”

Furthermore, the survey only includes adults who currently identified as transgender, not anyone who stopped identifying as transgender, he explains, and Turban and his co-authors have no control group to compare with the survey.

Sapir admits that it is unlikely researchers are “going to get a study that will definitively resolve the ROGD debate.” Yet, he predicts that “we are going to have piecemeal evidence that comes out as a trickle confirming aspects of the ROGD hypothesis.”

He emphasizes that the burden of proof rests with those who advocate for experimental transgender medical interventions, not with critics who study ROGD.

“Because what’s riding on this debate is the legitimacy of a medical intervention that can cause severe, irreversible lifelong harm and suffering, the burden of proof here is on those arguing that anybody who says, ‘I’m trans,’ is eligible for medical intervention. They face the burden of proof, not us,” Sapir adds.