ROGD: Looking Back, Looking Forward

Five years ago today, Lisa Littman put words to a phenomenon that many clinicians and researchers had been trying not to notice: the surge of adolescent girls suddenly coming out as trans. Littman coined the term “rapid-onset gender dysphoria”(ROGD) to describe what she was seeing.

What’s changed over the past five years? Five years in the life of a young person can bring immense changes.  When it comes to gender medicine, however, the pace of change is slow. 

Activist Resistance Continues

Five years on, the term ‘ROGD’ still prickles nerves. Activists still claim—falsely—that Littman’s paper was retracted or that rapid-onset gender dysphoria has been “debunked.” At this year’s European Professional Association for Transgender Health conference in Killarney, Ireland, ROGD was everywhere—and everyone was trying hard not to see it. The winner of the poster competition claimed to find no basis for ROGD—all because the researcher decided not to look. The incoming president of EPATH, the Dutch clinician and researcher Annelou De Vries, said the “ROGD hypothesis” was a “concept we need to get rid of.” Other presenters tiptoed around the topic—the huge demographic shift is hard to miss, after all—before declaring that there may well be a demographic shift but patients with adolescent-onset gender dysphoria are just as valid—just as ‘trans,’ just as worthy of access to life-altering interventions—as previous cohorts. 

In a “critical commentary” on rapid-onset gender dysphoria, Florence Ashley spent most of the article explaining why it wouldn’t matter even if Littman were right:  

“Let us assume, for a moment, that there is indeed a new subgroup of youth who, having experienced trauma and mental illness, come to believe themselves to be trans as a maladaptive coping mechanism. It would not follow that social and/or medical transition is unethical or harmful… Not all coping mechanisms are unhealthy. Even if it were the case that for some people believing oneself transgender is a coping mechanism brought on by trauma, transition may still be indicated. If the rise in transgender identities evidences social contagion – a claim I have shown to be unsubstantiated – it may yet be a healthy contagion.” 

In other words: nothing to see here! And—if it is a contagious maladaptive coping mechanism—so what?

Online, trans-identified young people trash the concept while serving up evidence for it: 

“I think its more that lgbtq+ people have a tendency to group together (seriously almost all my close friends have since come out as lgbtq+ or at least questioned it) before you even know it and its generally about teens who are probably going to realise their gender around the same time anyway. And one person coming out can make someone realise oh hey yeah this is a thing.”

A Cautious Prediction

Littman has always been clear about the limitations of her 2018 study: she surveyed parents—concerned parents, at that—and not kids, and shared these parents’ efforts to make sense of what was going on with their children from the outside-in. She did something else that was taboo, too. She drew parallels between gender dysphoria and other mental illnesses, like anorexia, where research clearly shows the way disordered eating behaviors tear through social networks:

“Peer contagion has been shown to be a factor in several aspects of eating disorders. There are examples in the eating disorder and anorexia nervosa literature of how both internalizing symptoms and behaviors have been shared and spread via peer influences which may have relevance to considerations of a rapid onset of gender dysphoria occurring in AYAs [adolescents and young adults]… Online environments provide ample opportunity for excessive reassurance seeking, co-rumination, positive and negative feedback, and deviancy training from peers who subscribe to unhealthy, self-harming behaviors… If similar mechanisms are at work in the context of gender dysphoria, this greatly complicates the evaluation and treatment of impacted AYAs.”

Littman also flagged online trans content and friend groups transitioning together as potential indicators of social influence over trans identity: 

“It is unlikely that friends and the internet can make people transgender. However, it is plausible that the following can be initiated, magnified, spread, and maintained via the mechanisms of social and peer contagion: (1) the belief that non-specific symptoms (including the symptoms associated with trauma, symptoms of psychiatric problems, and symptoms that are part of normal puberty) should be perceived as gender dysphoria and their presence as proof of being transgender; 2) the belief that the only path to happiness is transition; and 3) the belief that anyone who disagrees with the self-assessment of being transgender or the plan for transition is transphobic, abusive, and should be cut out of one’s life. The spread of these beliefs could allow vulnerable AYAs to misinterpret their emotions, incorrectly believe themselves to be transgender and in need of transition, and then inappropriately reject all information that is contrary to these beliefs. In other words, ‘gender dysphoria’ may be used as a catch-all explanation for any kind of distress, psychological pain, and discomfort that an AYA is feeling while transition is being promoted as a cure-all solution.”

The trends Littman picked up on have become increasingly clear over the last five years: young people disappearing online, only to reemerge with fragile new identities. Therapists speed-walking assessments, even when patients present with comorbidities and complicated biographies. Families fracturing under the pressure. The pandemic, with its dire effects on social isolation and mental health, seems to have made everything worse. 

In my own work, I see evidence for Littman’s hypothesis every day. Negative co-rumination is everywhere online, where young social-media users share their every up and down—and there are always more downs than ups. Girls and young women on TikTok and Reddit gush about the trans social-media influencers who helped them figure out their gender identities. Concerned parents still compare notes and search for help. One mother I spoke to observed that the therapist she took her teenage daughter to see “transitioned a whole group of six girls together, like a class project.” 

Even pro-transition TikTokkers see it. One clip shows a young woman with a mop of curly hair bouncing around and roaring at the camera, accompanied by the caption: “when you’re the only one who stayed trans after the gender questioning phase hit your friend group in 7th grade.” 

What Was Predicted Is Coming to Pass

Meanwhile, the very young people Littman described have started to emerge on the other side of transition. One young woman on Twitter wrote: “i showed no signs of dysphoria in childhood. i struggled with depression and body image issues. i spent too much time online. i had a lot of trans friends. i was obviously lost in life. i was a very feminine preteen and loved it. all these warning signs, yet they put me on HRT.” 

On the subreddit r/detrans, young people who have desisted or detransitioned trade stories: 

“Back when I was around 17, I watched a YT [YouTube] video (Ty Turner’s 1 year on Testosterone) which had a huge impact on my dysphoria. Just watching a ftm transition for the first time (the voice change, the body, the confidence, the girl to boy) was enough to get me hooked on the idea of transitioning. It just glorified it so much. I had little dysphoria before that, besides the usual being a tomboy, not wanting to be a girl and relating more with qguys [sic], then all of a sudden I made my mind up that I was a guy and that I was trans, and nothing could change my mind. I didn’t even know what trans was before that. I was wondering if there was a sort of social contagen [sic] for you, if you had a similar experience?”
“There literally is a social contagion,” another user wrote. “I was part of it, and I experienced ROGD related to my comorbid disorders and constant exposure to trans content.” She then described being unable to speak freely about her experiences—because “ROGD” and “social contagion” are dirty words for inconvenient truths.

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Header image by Tiago Bandeira on Unsplash