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‘Rapid Onset Gender Dysphoria’ Should Be Investigated, Not Smeared

Flag at a protest against Trump administration transgender policies in New York City, 2018 (Brendan McDermid/Reuters)
Medical specialists contradict the assertions in a trans activist’s New York Times article.

Jennifer Finney Boylan, an English professor and transgender activist, wrote a piece for the New York Times earlier this month attacking a Wall Street Journal op-ed by Abigail Shrier. Shrier had referred to the new phenomenon of “social contagion” among trans-identifying youth — a phenomenon now widely referred to as “rapid onset gender dysphoria” — after a research paper by Lisa Littman, M.D., in the science journal PLOS One attracted international scrutiny. Boylan sought to smear “R.O.G.D.,” and the subhead of her Times piece read, “Conservatives are inventing a ‘syndrome’ to undermine young people’s transitions.”

Kenneth Zucker disagrees with Boylan. Zucker, a psychologist and sexologist and the editor in chief of the journal Archives of Sexual Behavior, has over 40 years’ clinical and research experience in the area of childhood gender dysphoria. He helped shape the term for the Diagnostic and Statistical Manual of Mental Disorders. Zucker sent the following letter to the editor of the New York Times, which did not publish it:

Boylan’s OP-ED piece (It’s Not a Teenage Fad. It’s Life, January 9, 2019) takes aim at what she calls “a bogus new diagnosis — Rapid Onset Gender Dysphoria” (ROGD). She argues that the “inventors” of this “spurious term” claim that ROGD is not a “real trans identity,” but something else and that ROGD is not a “clinical term” but a “political one.”

As a clinician and researcher in the field of gender dysphoria, I disagree with Boylan’s perspective. ROGD is a provisional label that has been used to characterize a new subgroup of adolescents, mainly biological females, who appear to have a developmental history leading to gender dysphoria that has not been previously described. They are as likely to meet the DSM-5 criteria for Gender Dysphoria as adolescents who have a more traditional gender developmental pathway leading to this mental health diagnosis.

I see these youth all the time now in my clinical practice. Rather than trying to shut down continued exploration of the subjective experience of these youth, ROGD needs to be studied further by gender dysphoria specialists in order to develop best-practice guidelines. [Emphasis added]

In her Times op-ed, Boylan seems to take disagreement personally: “Even the headline on that essay [Shrier’s Journal piece] is an insult: ‘When Your Daughter Defies Biology.’ An abundance of scientific research makes clear that gender variance is a fundamental truth of human biology, not some wacky dance craze.” The link is to Science in the News, a blog at the Harvard University website — specifically, to a post by Katherine J. Wu, who has a Ph.D. in biomedical sciences. Her specialization is in bacteria and, unlike Zucker and Littman, she has not published any research papers in the area of gender dysphoria, according to the PubMed database.

Wu sets about explaining the “ABC’s (and LGBTQQIAAP+2S’s) of Gender and Sexuality” — the initialism, she “humbly accepts,” is “not all-inclusive” — and suggests that there is “indeed a genetic influence” on gender identity. Developing that point into an altogether different argument, Wu then refers to an accompanying diagram of a “cisgender” brain versus that of a “transgender” brain and cites studies that show “that transgender people appear to be born with brains more similar to gender [sic] with which they identify, rather than the one to which they were assigned.”

For his part, Zucker has warned of the dangers of “liberal biological essentialism,” the argument that transgenderism “is a brain thing.” In October, he told National Review:

I have no quarrel with the idea that there are biological factors that predispose people to having gender dysphoria, and I’ve done biological research myself, but it does not explain 100 percent of the variance because if it did, then you would find that if you had a set of young people that meet the diagnostic requirement for gender dysphoria, they all should persist when they grow. If it’s a complete brain thing. So this is an example of binary, either-or, simplistic thinking.

Like other trans activists, Boylan conflates gender-affirmative care with parental support (and even “love”). But this, too, is erroneous.

In a recent issue of The Journal of Clinical Endocrinology and Metabolism (JCEM), the Endocrine Society’s leading journal, a group of endocrinologists who specialize in gland and hormone disorders give a starkly different view of gender-affirmative treatment. “There are no laboratory, imaging, or other objective tests to diagnose a ‘true transgender’ child,” the endocrinologists write in their letter to the editor, adding that “there is currently no way to predict who will desist and who will remain dysphoric.” They explain that “the consequences of this gender affirmative therapy (GAT) are not trivial and include potential sterility, sexual dysfunction, thromboembolic and cardiovascular disease, and malignancy.” Like Zucker, the endocrinologists find “the recent phenomenon of teenage girls suddenly developing GD — Rapid Onset GD — without prior history through social contagion” to be “particularly concerning.”

Last year, Littman justified her research of “R.O.G.D.” in an email to National Review:

The decision to make a medical transition is a difficult one and people need accurate information about risks, benefits and alternatives to assess whether, in their individual case, it will be beneficial — that is the essence of informed consent. When activists shut down gender dysphoria research about potential risks and contraindications of transition, they are depriving the transgender community of their right to receive accurate information.

With their half-truths, overstatements, omissions, and smears, Boylan and the New York Times are doing exactly that.

Editor’s note: An earlier version of this article quoted Kenneth Zucker saying, “it does not explain 100 percent of the variants.” This has been corrected to “100 percent of the variance.” 


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