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How the idea of a “transgender contagion” went viral—and caused untold harm

A single paper on the notion that gender dysphoria can spread among young people helped galvanize an anti-trans movement.

August 18, 2022
rapid onset gender concept illustration
Franziska Barczyk

When Jay told his mom he was bisexual at 14, she was supportive. But when he came out as transgender a few years later, she pushed back. She felt blindsided by the news. YouTube videos and online forums soon convinced her that she was right to feel that way. To her, it was clear that Jay was simply mistaken. A trans “contagion” called “rapid-onset gender dysphoria,” spread through social media, had caught hold of him and convinced him he was not female, she said. The Internet had “turned” him trans. 

Widely introduced four years ago in a PLOS One paper by Lisa Littman, a physician and researcher, the concept of ROGD hypothesizes a “potential new subcategory” of gender dysphoria—the feeling of distress that one’s gender and assigned sex do not match. Young people with ROGD, the theory claims, feel symptoms of gender dysphoria and identify as trans as a result of peer influence, especially online. They hide behind a false diagnosis of gender dysphoria, the thinking goes, instead of confronting whatever issues are truly challenging them.

Littman polled parents and reported that they “describe a process of immersion in social media … immediately preceding their child becoming gender dysphoric.” Once a teen identifies as trans, Littman argued, they can unduly—and perhaps unwittingly—influence peers to do the same. This can partially explain the rising numbers of trans youth, she said, adding that the dynamic particularly affects those assigned female at birth.

The paper, which was based on parent surveys recruited from explicitly anti-trans or trans-skeptical websites and forums, almost immediately drew criticism. Shortly after its publication in August 2018, PLOS One, a peer-reviewed open-­access journal covering science and medicine, issued a comment that questioned Littman’s methodology. Brown University, her then-employer, retracted its press release about the study. In early September, the World Professional Association for Transgender Health put out a statement saying ROGD “constitutes nothing more than an acronym” and urged restraint in using the term. Six months after that, PLOS One reissued the study with a large correction emphasizing that Littman’s paper was simply a “descriptive, exploratory” one and had not been clinically validated. In 2021, the Journal of Pediatrics published a comprehensive study that found no evidence for ROGD’s existence. More than 60 psychology organizations, including the American Psychological Association, called for elimination of the term

The scientific community, in short, agreed there was no such thing as ROGD. But did it matter?

The paper was a turning point. While theories and rumors about something like ROGD had quietly percolated online before the paper was published, Littman’s descriptive study gave legitimacy to the concept. Soon after, it took on a life of its own. People describing themselves as “parents of ROGD kids” formed online support groups. Abigail Shrier’s anti-trans tome Irreversible Damage: The Transgender Craze Seducing Our Daughters sold more than 100,000 copies and has been promoted on extremely popular conservative podcasts. YouTube videos peddling the theory have scored hundreds of thousands of views. Justifications for anti-trans bills, like a memo on Florida’s attempt to stop Medicaid funding for adult transition-related health care, routinely cite the study in their footnotes. 

Five years later, Jay’s mom still doesn’t believe that he’s trans. 

Littman believes her study has been misinterpreted, but the concept of ROGD continues to provide scientific fuel to anti-trans rhetoric and legislation, including a current wave of state laws targeting trans youth. Understanding the theory’s ascent from fringe forums to scientific journals to the halls of Congress helps clarify some of the moral panic and pernicious logic employed to restrict the autonomy and rights of trans people today. It also serves as a vivid example of how questionable science can be weaponized to achieve political goals.

A number of studies on trans youth have taken on “misinformational afterlives,” says TJ Billard, an assistant professor of communications at Northwestern University and executive director of the Center for Applied Transgender Studies. Among them are four papers published between 2008 and 2013 that have together been used to claim that most children “grow out” of gender dysphoria and opt not to transition. All have been shown to have numerous shortcomings. In some, nearly 40% of young people surveyed did not meet the criteria for the official gender dysphoria diagnosis in the Diagnostic and Statistical Manual of Mental Disorders edition used at the time. In two, researchers classified some subjects as having detransitioned—or reversed their transition—purely on the basis of whether a parent or third party said it happened. A 2018 study found that three of the papers labeled those who had stopped responding to researchers as detransitioners; and in one, a subject who identified as nonbinary was classified as detransitioning.

“There’s a wealth of bad science that is out there, and this science doesn’t stay in journals,” Billard says. Parents unfamiliar with trans issues, who don’t understand gender-affirming health care and don’t have the expertise to read the studies themselves, often fall under its sway.

Think of it this way: Your teen, who you think you know better than anyone else does, “suddenly” identifies in a way you never expected. You’re confused. You might ask some friends for advice, but you mostly feel alone in dealing with this revelation. Late one night, you take to Google. Maybe you read the Wikipedia page for “gender dysphoria in children,” some news articles, a report from the CDC. 

You’re inundated with words you’ve never heard, concepts that challenge a gender binary you’ve never questioned. You panic. 

What often happens next, Billard says, is “you stumble upon a blog post or a news article or a YouTube video that says: ‘This is only bullshit, and somebody is just trying to corrupt your child.’” 

You learn about ROGD and read about a “social contagion” infecting lonely children online. You discover that there are thousands of parents whose kids have it too, and there’s even a whole book about it. So you go back to your child, who you know better than they know themself, right? Because they’re only a kid. And you say, Actually, no, you’re not trans. Honey, you’ve been duped.

The problem: Overwhelming evidence shows that your child almost certainly hasn’t been duped. Although some people do reconsider or reverse their transition, once a person starts identifying as trans, it’s quite unlikely they’ll change their mind. No matter how strongly you believe that the internet, social contagion, and positive representations of transgender people turned your child trans, chances are your child disagrees. 

Littman began her research after noticing that in her small town in Rhode Island, a few teens in the same friend group started identifying as trans. She had not previously studied gender dysphoria or trans health care, but she thought it was peculiar and merited some exploration. She did not approach the work with “a chip on my shoulder,” she says.

At that time, one thing most researchers studying trans youth agreed on is that there was a dearth of unbiased studies on the subject. Scientists had been researching trans youth for decades, but studies often had small sample sizes, unreliable methodology, or little longitudinal follow-up. By 2016, researchers had begun to take note of a rise in youth identifying as trans, but there was (and still is) no easy explanation for why, although there were many theories—some based on existing research and some just on hunches.

When Littman took up the question, she decided to survey parents, who she felt would be easier to reach than trans youths themselves. In her Methods section, she writes that “to maximize the chances of finding cases meeting eligibility criteria”—meaning youths who suddenly became gender dysphoric, according to their parents—she turned to three websites: 4thwavenow.com, a “community of people who question the medicalization of gender-­atypical youth”; transgendertrend.com, which says it’s concerned about “the unprecedented number of teenage girls suddenly self-identifying as ‘trans’”; and youthtranscriticalprofessionals.org, a now-private website that was “concerned about the current trend to quickly diagnose and affirm young people as transgender.”

The ROGD paper was not funded by anti-trans zealots. But it arrived at exactly the time people with bad intentions were looking for science to buoy their opinions.

The results were in line with what one might expect given those sources: 76.5% of parents surveyed “believed their child was incorrect in their belief of being transgender.” More than 85% said their child had increased their internet use and/or had trans friends before identifying as trans. The youths themselves had no say in the study, and there’s no telling if they had simply kept their parents in the dark for months or years before coming out. (Littman acknowledges that “parent-child conflict may also explain some of the findings.”) 

Arjee Restar, now an assistant professor of epidemiology at the University of Washington, didn’t mince words in her 2020 methodological critique of the paper. Restar noted that Littman chose to describe the “social and peer contagion” hypothesis in the consent document she shared with parents, opening the door for biases in who chose to respond to the survey and how they did so. She also highlighted that Littman asked parents to offer “diagnoses” of their child’s gender dysphoria, which they were unqualified to do without professional training. It’s even possible that Littman’s data could contain multiple responses from the same parent, Restar wrote. Littman told MIT Technology Review that “targeted recruitment [to studies] is a really common practice.” She also called attention to the corrected ROGD paper, which notes that a pro-gender-­affirming parents’ Facebook group with 8,000 members posted the study’s recruitment information on its page—although Littman’s study was not designed to be able to discern whether any of them responded.

But politics is blind to nuances in methodology. And the paper was quickly seized by those who were already pushing back against increasing acceptance of trans people. In 2014, a few years before Littman published her ROGD paper, Time magazine had put Laverne Cox, the trans actress from Orange Is the New Black, on its cover and declared a “transgender tipping point.” By 2016, bills across the country that aimed to bar trans people from bathrooms that fit their gender identity failed, and one that succeeded, in North Carolina, cost its Republican governor, Pat McCrory, his job.  

Yet by 2018 a renewed backlash was well underway—one that zeroed in on trans youth. The debate about trans youth competing in sports went national, as did a heavily publicized Texas custody battle between a mother who supported her trans child and a father who didn’t. Groups working to further marginalize trans people, like the Alliance Defending Freedom and the Family Research Council, began “printing off bills and introducing them to state legislators,” says Gillian Branstetter, a communications strategist at the American Civil Liberties Union.

The ROGD paper was not funded by anti-trans zealots. But it arrived at exactly the time people with bad intentions were looking for science to buoy their opinions. The paper “laundered what had previously been the rantings of online conspiracy theorists and gave it the resemblance of serious scientific study,” Branstetter says. She believes that if Littman’s paper had not been published, a similar argument would have been made by someone else. Despite its limitations, it has become a crucial weapon in the fight against trans people, largely through online dissemination. “It is astonishing that such a blatantly bad-faith effort has been taken so seriously,” Branstetter says.

Littman plainly rejects that characterization, saying her goal was simply to “find out what’s going on.” “This was a very good-faith attempt,” she says. “As a person I am liberal; I’m pro-LGBT. I saw a phenomenon with my own eyes and I investigated, found that it was different than what was in the scientific literature.” 

One reason for the success of Littman’s paper is that it validates the idea that trans kids are new. But Jules Gill-Peterson, an associate professor of history at Johns Hopkins and author of Histories of the Transgender Child, says that is “empirically untrue.” Trans children have only recently started to be discussed in mainstream media, so people assume they weren’t around before, she says, but “there have been children transitioning for as long as there has been transition-related medical technology,” and children were socially transitioning—living as a different gender without any medical or legal interventions—long before that.

Many trans people are young children when they first observe a dissonance between how they are identified and how they identify. The process of transitioning is never simple, but the explanation of their identity might be.

Others have slower and more complicated journeys, where identity is murky and gender is anything but straightforward. This compounds confusion among cisgender people who have only been exposed to the simple trans narratives of “being stuck in the wrong body.” Perhaps they can comprehend being “born a man” and wanting to “be a woman” but not the limitless options in between.

When we first talked in 2019, Jay was using different pronouns. He knew he wasn’t cis; he knew he was trans. But he was working through the specifics and asking himself questions. Growing up, Jay—like a lot of queer and trans kids—had trouble making friends. Online, he had room to explore his identity while living in a home where he wasn’t embraced.

His mom thinks of that online space differently. She “thinks because the trans community is accepting of me, which other communities haven’t always been, that I’m gonna stick with them,” Jay says. 

If Jay goes on testosterone, as he hopes to, he’ll be kicked out of the house. After countless arguments during the five years he’s identified as trans, he says, his mom “still believes I’ve been brainwashed by trans activists on the Internet.” When he presented evidence that debunked ROGD, he says, she claimed it was engineered by trans activists. “She doesn’t listen or care, because she doesn’t trust anything I say about this,” he says. (To protect Jay’s safety, MIT Technology Review did not reach out to his mother and used only his first name for this story.)

Many people who are citing Littman’s work probably haven’t even read the study or seen the correction, Billard says: “People are citing a Reddit post in which somebody invoked the idea of Littman and her research.” Littman agrees with this characterization. “It boggles my mind how people are comfortable holding forth on topics that they haven’t actually read papers [about],” she says. 

Littman thinks her ROGD paper is often misappropriated to speak to the trans experience at large. “It does not apply to all cases of gender dysphoria,” she says. “This doesn’t imply that nobody benefits from transition. People will take it to assume that.”

But Littman stands by the core claims made by her paper and thinks more research needs to be done (which she herself continued with a 2021 survey on young people who reversed their transition).

When Littman’s paper appeared in 2018, there was science that supported youth transition, but little longitudinal research and few studies with large cohorts. Researchers are still filling in the gaps. There are researchers and clinicians treating patients who agree with Littman and say ROGD is a real and growing phenomenon that they’ve witnessed firsthand.

But a July 2022 study found that five years after socially transitioning, 94% of youth surveyed still identified as transgender and 3.5% identified as nonbinary. 

And research has shown that family acceptance and appropriate medical intervention can have lasting benefits. In February 2022, for example, researchers reported that trans and nonbinary youths who went on puberty blockers or hormones had 60% lower odds of depression and 73% lower odds of suicidality, compared with those who did not. 

Lawmakers in more than 25 states have introduced anti-trans bills during 2022 legislative sessions. Politicians writing such legislation have plenty of questionable studies, partisan doctors, and associations that lobby against transgender rights to draw on. Littman’s ROGD study is often a go-to. The Coalition for the Advancement & Application of Psychological Science wrote in 2021 that many of the “over 100 bills under consideration in legislative bodies across the country that seek to limit the rights of transgender adolescents” are “predicated on the unsupported claims advanced by ROGD.”

Littman says she is “personally opposed to legislative bans on medical interventions for gender-dysphoric youth.” She does believe, however, that “the majority of young people with gender dysphoria will often grow up to be lesbian, gay, or bisexual adults who are not transgender.” Overall, she says, the conclusions of her research “are not justifications for banning, or for not covering” trans health care altogether. Rather, they show the need for caution. 

Still, a June 2022 report commissioned by Florida’s Republican governor, Ron DeSantis, as part of his effort to stop Medicaid funding for transition-related adult health care cites her work multiple times. In 2019, US Representative Doug Collins of Georgia read part of her study into the Congressional Record when voicing his opposition to the Equality Act, which would broadly prohibit discrimination on the basis of sex, sexual orientation, and gender identity. 

Even as the voices saying he’s been brainwashed get louder, Jay, who is now 21, has only become more confident in his identity. 

He can’t wait until he can get out of the house, live on his own, and finally start hormones. He’s on a waitlist for an assessment to get the process started. Not being able to be himself, he says, can feel miserable and isolating. Thinking of the future is what keeps him hopeful.

But Jay speaks of a dark alternative timeline where he is never able to medically transition and live the life he wants. In that scenario, which he makes clear is only hypothetical, he dies by suicide. 

He thinks he knows what his mom would say after he died:

“The trans activists on the internet killed my daughter.” 

Ben Kesslen is a journalist based in New York City.

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