In what’s being described as the largest study yet to tackle a damaging narrative surrounding transgender health, researchers looked at data on more than 90,000 trans or non-binary teenagers across the U.S. and found no evidence that “social contagion” is driving transition rates among adolescents.
Researchers found that teens assigned female at birth (AFAB) were no more likely than teens assigned male at birth (AMAB) to identify as trans or gender diverse, refuting a core tenet of an idea experts say is currently being leveraged politically to eliminate health care for trans youth.
In the study published Wednesday in Pediatrics, the official journal of the American Academy of Pediatrics, researchers looked at national data collected in the U.S. in 2017 and 2019 in order to challenge the controversial theory of “rapid onset gender dysphoria” (ROGD).
This theory, viewed by many experts and critics as transphobic, suggests that many teens suddenly decide to transition as teenagers purely to fit in with friends, likening transition to a dangerous fad.
A 2021 position statement co-signed by more than 60 international health-care and scientific organizations, including several Canadian ones, condemned the theory, stating that “there are no sound empirical studies of ROGD.”
But not many studies before this one have been able to directly address ROGD’s claims.
The main assertion of ROGD is that youth assigned female at birth are more susceptible to “social contagion”, with supporters pointing to some smaller studies as evidence of a disproportionate rise in AFAB trans teens.
However, this new, national U.S. study found that the percentage of AFAB youth identifying openly as transgender or gender diverse actually decreased slightly from 1.9 per cent in 2017 to 1.4 per cent in 2019, and that AFAB youth were not overrepresented among trans teens as a whole.
“The hypothesis that transgender and gender diverse youth assigned female at birth identify as transgender due to social contagion does not hold up to scrutiny and should not be used to argue against the provision of gender-affirming medical care for adolescents,” Dr. Alex S. Keuroghlian, director of the National LGBTQIA+ Health Education Center at The Fenway Institute and the study’s senior author, said in a press release.
The study also looked at data on the reported levels of bullying that students faced, in order to address another persistent component of ROGD: the suggestion that cisgender teens might be transitioning genders purely to escape being persecuted for being gay or lesbian, or because transitioning provides social benefits.
The study showed that cisgender adolescents of a sexual minority, such as gay, lesbian or bisexual, did experience more bullying than their straight peers.
But the transgender students were even more likely to be targeted by bullies. In 2019, around 29 per cent of cisgender students belonging to a sexual minority reported being bullied in school, compared to 45 per cent of transgender students.
Trans and gender diverse students were also more likely to have attempted suicide than cisgender sexual minorities.
“The idea that attempts to flee sexual minority stigma drive teenagers to come out as transgender is absurd, especially to those of us who provide treatment to [trans and gender diverse] youth,” Dr. Jack Turban, incoming Assistant Professor of Child & Adolescent Psychiatry at The University of California and the study’s lead author, said in the release.
“The damaging effects of these unfounded hypotheses in further stigmatizing transgender and gender diverse youth cannot be understated. We hope that clinicians, policymakers, journalists, and anyone else who contributes to health policy will review these findings.”
INSIDE THE DATA
To get a broad picture, the study used data collected in the 2017 and 2019 Youth Risk Behaviour Survey, a biennial survey of high school students conducted by the U.S. Centers for Disease Control and Prevention.
Not all U.S. states collect information regarding gender identity, so only 16 states were included in the study, with more than 91,000 respondents in 2017 and more than 105,000 respondents in 2019.
Researchers also looked at age, grade, race/ethnicity and sexual orientation, along with gender identity.
When looking at the student body as a whole, the study found that less youth were identifying as trans or gender diverse in 2019 compared to 2017.
In 2017, 2.4 per cent of the sample identified as transgender, while in 2019, that number had fallen to 1.6 per cent. Of the 2017 cohort, 2.8 per cent of AMAB adolescents were trans, while 1.9 per cent of AFAB adolescents were trans. In 2019, 1.7 per cent and 1.4 per cent of AMAB and AFAB adolescents, respectively, identified as trans or gender diverse.
Since a part of ROGD includes the perception that AFAB teens are transitioning at faster rates, researchers looked at how many trans or gender diverse students were AMAB vs. AFAB and found that both years showed fewer AFAB trans youth.
In 2017, 40.5 per cent of trans or gender diverse students were AFAB, while 59.5 per cent were AMAB.
In 2019, the AFAB percentage jumped to 47.2 per cent compared to 52.8 per cent AMAB students, but this was actually because of a larger drop in AMAB students openly identifying as trans. There were 876 AFAB trans students in 2017 compared to 774 in 2019, while AMAB numbers went from 1,285 in 2017 to 866 in 2019.
When it came to bullying, trans students reported higher levels of both in-school bullying and electronic bullying compared to their cisgender peers who identified as gay, lesbian, bisexual, or another sexual minority.
And teens who identified as trans reported much higher attempts at suicide.
Although 94 per cent of cisgender students said in 2017 that they had never attempted suicide, only 67 per cent of transgender students could say the same. Almost one in ten transgender teenagers reported in 2017 that they had attempted suicide six or more times, compared to 0.4 per cent of cisgender teens.
These results align with numerous previous studies showing that transgender adolescents face hostility from their peers and struggle with their mental health, often due to that lack of acceptance.
“These exceptionally high rates of bullying among [trans or gender diverse (TGD)] youth are inconsistent with the notion that young people come out as TGD either to avoid sexual minority stigma or because being TGD will make them more popular among their peers, both of which are explanations that have recently been propagated in the media,” the study noted.
ROGD has not been accepted as a clinical diagnosis by any major psychological or medical organization, but its influence needs to be challenged, authors say.
The concept tracks back to a widely discredited study from 2018, which resulted in an apology and a correction posted by the journal that published it.
Even though that study was based entirely on interviews of parents of trans teens, many of whom had been sourced through apparently anti-trans online forums, and sparked immediate scientific condemnation for its bias, the concept of ROGD took hold in political and social discourse.
As of March 2022, 15 U.S. states had restricted access to gender-affirming care for teens or were considering legislature to do so — with many lawmakers citing the so-called threat of social contagion among their reasoning.
“This study comes as there are many political attacks against trans youth in legislative arenas,” Turban said on Twitter Wednesday. “The social contagion and fleeing LGB stigma hypotheses have featured prominently in these debates.
“We hope [this] new data will be urgently brought to those legislative discussions.”