A Letter on Rapid Onset Gender Dysphoria

from Brown University School of Public Health Faculty Members Committed to LGBTQI Affirmative Health Research

In 2018, a lobby supporting the concept of “rapid onset gender dysphoria” (ROGD) gained traction. ROGD is defined as the seemingly quick development of gender dysphoria (i.e., the distress arising from having a discordant gender identity and assigned birth sex) during or following puberty and in the absence of documented gender dysphoria in childhood. Proponents of ROGD were emboldened by research publications and online articles utilizing the self-reported data of the parents and families of transgender individuals claiming that gender dysphoria can develop rapidly via “social contagion,” or exposure to other adolescents with gender dysphoria. Claims of ROGD have bolstered the voices of those who doubt the very existence of transgender and gender diverse people and their need for gender-affirming medical care. As we approach nearly one year since this lobby gained momentum, one voice that has been largely unheard by the community is ours – Brown University School of Public Health faculty dedicated to supporting LGBTQI affirmative health research. Over the past year, we have reflected on the various events that have transpired, listened to transgender and gender diverse community members and allies, and determined that it is necessary for us to publicly comment on the efforts of this lobby and related harms.

The goal of this letter is not to critique the methods of research that support the ROGD lobby. Thoughtful essays critical of this research have already been published, including those by Brown’s own Arjee Restar, PhD-C; professional organizations, such as the World Professional Association of Transgender Health (WPATH) and the Gender Dysphoria Affirmative Working Group (GDA); and transgender leaders and allies from across the globe. Further, this letter is not intended to discuss the principle of academic freedom that has been invoked in debates about this research.

Rather, we write this letter as individual scientists and educators—who benefit from academic freedom—to publicly acknowledge the health-related harms and consequences of a lobby that seeks to undermine the legitimacy of transgender experiences. We also write this letter to state and underscore our commitment to uplift transgender and gender diverse communities through our research, scholarship, teaching, and service.

The Consequences of the ROGD Agenda

Transgender and gender diverse individuals have existed across time and cultures. In the past two decades, there has been a notable rise in societal recognition about the experiences of transgender and gender diverse people, with corresponding gains in access to health resources for these communities. However, in an increasingly polarized time, the rights and the livelihood of transgender and gender diverse people are being threatened. Thus, it is critical for transgender and gender diverse people to be seen and affirmed for who they are. While we wholeheartedly support studying the diversity of transgender experiences, such research must be conducted, interpreted, and disseminated in ways that minimize the risk to transgender and gender diverse communities.

In contrast, the ROGD lobby has worked to undermine the experiences and identities of transgender and gender diverse individuals, with the potential for dire health consequences. At the very basic level, claims that gender dysphoria is simply the product of peer influence during adolescence delegitimizes the experiences of transgender and gender diverse youth. Given the well-documented challenges of coming out as transgender, particularly to one’s family, and the high rates of suicide among transgender and gender diverse youth, parental and family reports that discredit transgender and gender diverse youth have the potential to contribute to the already high burden of serious psychological distress and suicidality faced by this population.

Moreover, claims of ROGD have been cited by parents and medical providers in reports aimed at restricting access to social and medical forms of gender affirmation. A recent report released by Transgender Trend, a group of parents who question the “transgender narrative,” cites ROGD as a justification for enacting school policies and practices to silence the voices of transgender youth and challenge their right to educational spaces free from discrimination. The report also points to the potential value of “conversion therapy,” which aims to “assist” LGBT youth in becoming cisgender and/or straight. Notably, leading medical organizations, such as the American Psychiatric Association, oppose “conversion therapy” and 18 U.S. states have legally banned licensed mental health practitioners from subjecting LGBT minors to these techniques due to the questionable validity and documented psychological harms of these practices.

The ROGD lobby is also threatening transgender individuals’ rights via healthcare practice and public policy. For example, in October 2018, more than 1,000 parents of transgender and gender diverse children wrote a letter to the American Academy of Pediatrics citing ROGD and calling for the medical organization to overturn its transgender-affirming healthcare policy recommendations, including the use of medications to delay puberty.

In another example, a March 2018 lawsuit filed against the Alberta, Canada school district used parental reports of socially-derived ROGD as a rationale to oppose legislation that protects the safety of gender diverse children and supports the creation of Gay-Straight Alliances (GSA). GSAs are student-led initiatives that create spaces in which youth can safely seek peer support for their gender identity and sexuality. Research has tied higher levels of structural-level stigma such as this to elevated suicide attempts for transgender people. Thus, the very existence of structural stigma aimed at restricting the rights of transgender and gender diverse youth has the potential to contribute to poor mental health and potentially loss of life for this population.

In sum, reports of ROGD are being used as a justification to restrict transgender and gender diverse individuals from garnering health-promoting forms of social support and medical care, highlighting the danger of published reports that rely upon the perspectives of parents and families rather than the lived experiences of transgender and gender diverse people.

Our Personal Commitment to Transgender and Gender Diverse Communities

To transgender and gender diverse communities in Rhode Island, the U.S., and across the globe, we regret and apologize for the delay in writing this letter. We want you to know that we see you, we value you, and we recognize your incredible resilience that has allowed you to thrive, even in the face of widespread stigma.

It is well-documented that being affirmed in one’s gender identity yields mental health benefits. Thus, we are committed to creating a safe and gender-affirming educational space for our students, staff, and fellow faculty of all genders, gender expressions, and sexual orientations.

We also recognize that research is best conducted with not on members of the population of interest. Thus, we are committed to carrying out our research in accordance with best practices for community-engaged research. As such, we will continue to engage transgender and gender diverse communities in identifying the urgent and understudied issues that shape their health and wellbeing; and leverage our combined knowledge and skills to work toward the shared goal of ensuring health equity for transgender and gender diverse people.

We also recognize the importance of having research agendas developed and implemented by transgender and gender diverse communities. Thus, we are committed to building a pipeline of transgender students, fostering an environment where transgender and gender diverse students can thrive, and mentoring and training future generations of transgender and gender diverse researchers.

Finally, an essential responsibility of learned communities is to contribute to social good by amplifying the voices of vulnerable populations. Thus, we affirm our unwavering commitment to transgender and gender diverse communities and the highest standards of ethical, rigorous, and affirming research and practice.

Sincerely,

Don Operario

Theresa Shireman

Matthew Mimiaga

Katie Biello

Jaclyn White Hughto

Jacob van den Berg

Brad Brockmann