“Rapid Onset Gender Dysphoria” and transphobic science: the case of fraught objectivity

With the recent and tumultuous controversy concerning “Rapid Onset Gender Dysphoria” (ROGD), the science, and what counts as science, has been muddied by researchers who are explicitly hostile to the rights of transgender folks. A few weeks ago, behavioural scientist Lisa Littman published an article claiming to have empirical evidence for the existence of a new form of gender dysphoria that explicitly impacts youth, through so-called “social contagion,” with the consequences of confused cisgender children inauthentically at odds with the gender they were assigned at birth.

Littman concludes, “Rapid-onset gender dysphoria (ROGD) describes a phenomenon where the development of gender dysphoria is observed to begin suddenly during or after puberty in an adolescent or young adult who would not have met criteria for gender dysphoria in childhood”. This “distinct” form of gender dysphoria is allegedly linked to “social or peer contagion” which allegedly allows the “ROGD’s” transmission to youth who are exposed to transgender cultural or technical knowledge. Brown University, Littman’s scholarly nook, has recently pulled down mentions of the article from it’s website in response to criticisms of methodological rigging and the studies hostilities towards trans folks.

And as reported by Science Magazine, the article’s publisher PLOS ONE began a “post publication investigation” into Littman’s methods, methodologies, and analysis. As editor-in-chief said to Science Magazine, “This is not about suppressing academic freedom or scientific research. This is about the scientific content itself — whether there is anything that needs to be looked into or corrected”.

The publication of this research paper and its subsequent uptake by anti-trans groups has immense societal impacts on trans folks and the communities we belong in. It’s a clear effort of widely anti-queer groups to re-medicalize trans identity (which was declared not a mental illness via scientific consensus in 2013), the consequences of this would strongly imply that children with ROGD are mentally ill and in need of medical intervention. This is uncomfortably close to a renewed push for the use of conversion therapy, a dangerous form of medical intervention which has been widely condemned as abusive and unscientific.

Recently, the World Professional Association for Transgender Health (WPATH), the international body that essentially sets the standards of care for trans related medical and psychological clinical treatments, has published a statement declaring,

The term “Rapid Onset Gender Dysphoria (ROGD)” is not a medical entity recognized by any professional association, nor is it listed as a subtype or classification in the Diagnostic and Statistical Manuel (DSM) or International Classification of Diseases. Therefore, it constitutes nothing more than an acronym created to describe a proposed clinical phenomenon that may or may not warrant further peer-reviewed scientific investigation

WPATH reinforces the lengthily processes of scientific inquiry, debate, and rigorous scrutiny that an observation must go through before being officially considered a clinical phenomenon.

Another consequence of this debate is that our collective public presence as trans folks, whether it be through activism, journalism, or scholarly work, is being rendered an existential threat to allegedly cisgender children.

Oh, those darn trans-activists and their SJW agenda!

I will leave the science-y critique to folks who are closer to the subject area than I am, check out Julia Serano’s critique of Littman’s poor scientific praxis, and Florence Ashley’s critique of Serano’s critics.

What I want to address in this essay is the rapidly expanding viral moral panic that trans folks and our allies are attempting to impose trans-ness on cisgender youth through the widely practiced gender affirmative and informed consent models of therapy. Littman, and her now broad platform of supporters, have muddied what counts as rigorous quantitative and qualitative scientific methods to make vastly unsubstantiated claims about the existence of “ROGD”.

What is concerning to me is that Littman’s poor scientific praxis is being un-critically taken as objective knowledge production and her methodological problems are being neatly tucked away in lieu of critiques.

This is further aggravated by claims that queer activists, writers, and scholars are anti-science, biased because they are trans, and against free speech (Serano responds to these claims here). Of course, this is a regular rhetorical strategy utilized by transphobic public figures to render trans activists, writers, and scholars as fanatics interested in shutting down conversations (aka, anti-trans bigotry) and putting forward “feelings” ahead of science and reason.

The fundamental issue at play is the prominence of vernacular or folk understandings of scientific objectivity. In other words, how non-scientists and folks outside of the academy think scientists do the labor of knowledge production. Through the vernacular, non-scientists often impose a romanticised image of objective scientific methods that tidy up the messiness of research and obfuscate the scientific process.

Fraught objectivity

Scientists (usually a term relegated solely to those who use quantitative, as opposed to qualitative, methods within the popular imagination) are already and always “objective” (unless they are trans folks, people of color, or women) and thus are arbitrators of “facts”. The problem here isn’t science, but how scientific knowledge production is understood by non-experts navigating everyday life.

I’ve encountered the hypocrisy of this mentality many times over Twitter conversations, where the expert knowledge of progressive scholars and journalists are rendered ideologically biased or elitist, while far-right public figures like Jordan Peterson are uplifted as the very pinnacle of the scientific method (whether they use scientific methods or not).

As many scholars in the discipline of science and technology studies (STS) have noted, objectivity and the operability of the scientific method is entirely contingent on a scientist’s ability to put together a sound methodology that is reflexive of their biases. STS sociologist John Law has pointed out in a review of the ethnographic work conducted on scientific labor within laboratories that methodologies are always exposed to researcher bias, which impacts scientific results, and oftentimes are made opaque by the mere illusion of being objective. This is especially relevant for the messy disciplines of human behavior — a field of study that is wrapped up in the seemingly infinite complexities of historically contingent and culturally shaped subjectivities.

Littman’s research is emblematic of this issue. Her methods consisted of recruiting participants from a series of blogs that are known to contain transphobic parents, in order conduct empirical research on transgender children. Littman’s cisgender bias is present in how she constructs her research tools, before an analysis is even conducted.

As Serano notes,

The fact that Littman didn’t even bother to post a link to the survey on any of the many other online groups for parents of trans kids (i.e., ones that do not push an ROGD agenda, and who thus might have very different assessments of their adolescent trans children) strongly suggests that she purposefully structured her study to confirm the former parents’ assumptions, rather than objectively assess the state of their children.

This contamination of Littman’s objectivity is further aggravated by a key analytical issue — Littman didn’t speak to any of the children she claimed to have data on. She only surveyed transphobic parents who presumably have zero understanding of how their children feel. In a response to Serano’s critique, Robert D’Angelo with the newly formed Pediatric and Adolescent Gender Dysphoria Working Group (made up of the same anti-trans scientists), published a statement declaring that research through the proxy of a parent is standard practice.

This might be true, but it also has consequences for the project’s analysis. Littman’s research is not a study of trans children, it is a study of the perceptions of transphobic parents whose children are navigating the complex world of gender dysphoria and cissexism.

Getting access to children for academic research is difficult, but not impossible. And if a research isn’t willing to do the leg work to produce a workable methodology, then I hardly see how it is appropriate for her to “discover” a new form of gender dysphoria. There is a chance that Littman’s research, if proposed to be conducted on children, would not have passed an Institutional Review Board (IRB) which typically governs how academics conduct themselves in human research.

The point is, this research had never been objective, and it is surprising to me that these issues weren’t picked up by the peer reviewer at PLOS ONE.

In the scholarly world, knowledge is meant to be vetted by experts. A scholar typically can’t publish just anything in a scholarly journal — their knowledge needs to be rigorously assessed. A peer review process includes a panel of scholars who blindly review research to draw out methodological errors, poor or unsubstantiated analysis, and potential ethical ramifications of the publication. In the case of Littman, this process failed her.

Free speech ideologies do not count the same in academic publishing, scholars are restrained from making willy-nilly expert decisions for good reason.

The ability for a scholar to set aside their bias in order to achieve objectivity is fraught. Our own capacity to be reflexive of the biases and hostilities that inform our thinking are often made invisible. It is very difficult to point out the things that influence our ability to be objective, because, well, we’re human beings with complex emotional states informing our perceptions of the world around us. This is among the many reasons that scientists review each other’s work, because oftentimes we are unable to point out our own methodological errors and mistakes.

Scientists are, in fact, human like everyone else.

I do not have answers for the failure of PLOS ONE to conduct a proper peer review but considering the hostile history of cissexism in research on transgender folks throughout history, I have some speculations.

An historical primer of cisgender and heterosexual bias and gatekeeping

Cisgender and heterosexual (cishet) researchers have a long history of conducting bias research where prejudice against LGBTQ+ folks had become embedded in research design, methodologies, and analysis. Since the late nineteenth century, psychologists and sexologists have been pumping out research that sought to either hide or eradicate queerness. It was seen as a pathology, and like other mental illnesses or disabilities at the time, queerness was exposed to intense degrees of policing, incarceration, and extreme social stigmatization.

The history of science is far from objective, it reflected the ideological underpinnings of white cishet men and served to subjugate LGBTQ+ folks, women, people of color, and disabled folks.

The science at the time seemed to be clear, if you weren’t a white, male, cishet, you were sick and in need of remedy. As historical sociologist Johnathon Ned Katz illustrates in his book The Invention of Heterosexuality, the very historical development of the psychological categories of heterosexuality and homosexuality was infused with notions of what was considered normal at the time (fun fact, the first usage of the term “heterosexuality” in 1892 was in reference to people who were attracted to men AND women, not straight folks).

Katz observes,

In the twentieth century, creatures called heterosexuals emerged from the dark shadows of the nineteenth-century medical world to become common types acknowledged in the bright light of the modern day.

According to Katz, the production of the terms heterosexuality and homosexuality are laced with the bias of its late eighteen to early nineteen century Christian moral puritanism which eschewed sexual desire in favor of the “reproductive imperative” (or, in other words, having loads of babies). These emerging categories were put to work in the psychological discourse of the time and eventually came to be used to refer to straight people and everyone else. Those terms carried with it a baggage that constructed moral and biological hierarchies — straight folks were considered superior to queer folks.

The science of this period (and I would argue the same for contemporary science) was first framed through a cishet lens that privileged their culturally-shaped position in the world and actively othered queer folk. Not only was objectivity not achieved, the analysis emerging from this research was taken-for-granted and rarely critically interrogated. As historian Susan Stryker notes in her book Transgender History, in the eighteenth-century, science had come to supplant religion as the “highest social authority” and had massive influence over the moral codes that shaped everyday life. So not only were people pathologized for being different, they were actively stigmatized.

At the same time, the history of medical science in the Western world had been plagued with eugenics and an unhealthy obsession with creating natural hierarchies. This was an era of scientific exploitation that categorized everything that wasn’t a white cishet man to be degenerate and morally corrupt. For an interesting and colorful exploration of the history of degeneracy, check out this Contrapoints video.

Stryker observes that the words “transgender” and “transsexual” came into usage during the 1950s; it’s not that trans folks didn’t exist before this time, but they didn’t have a language to describe being trans. These categories emerged initially as a way of describing “gender identity disorder,” however, they were eventually reclaimed as categories used within the trans cultural lexicon. Despite these changes in usage, the terms and the identities they describe carry the historical baggage of discrimination.

The parents that Littman surveyed are among many transphobes that tap into the historical notion that queerness is a mental illness to justify forcing their children back in the closet. This is a form of violence that push queer youth into isolation, mental illness, and potentially, death by suicide. The hostility of abusive and anti-queer family members can also lead to spikes in youth homelessness as trans youth are either kicked out of their home or forced to flee abusive behavior.

Though informed consent models and gender affirmative therapy have been growing in popularity, there is still an overwhelming attachment to the gateway model of trans health care. As Serano writes in her book Whipping Girl, “Until 1998, the HBIGDA Standards of Care stated that ‘[a]ny and all recommendations for sex reassignment surgery and hormone therapy should be made only by clinical behavioral scientists’”. The gateway model proposes that a trans person must prove that they really are the gender they claim to (largely) cishet doctors, psychiatrists, and social workers in order to gain access to medically necessary treatments.

The history of gatekeeping is dark AF. For one, cishet experts were put into the position of judging what types of gender performances counted as authentic. So non-binary and gender non-conforming trans folks were often deemed ineligible for HRT or any form of gender affirming surgeries. In the case of trans women, because of prevailing norms of femininity, trans women had to perform 150% femme in order to get access to services. Otherwise, they would be deemed not woman enough, and would be denied access. In many cases, doctors could refuse medical access to queer trans folks for not conforming to the prevalent sexual norms. In order to get needed medical assistance as a trans person, you had to be straight.

These medical and legislative strategies were aimed at curing trans folks of their “ailment”, and if that wasn’t possible, to make sure the only people able to transition would be those who could pretend to be cishet and fade into relative invisibility. These practices were policed by a system of surveillance called the “real-life test” where a trans person would have to prove that they lived full-time in the gender they aligned with.

The historical legacy of cissexist and transphobic medical science are echoed in the vernacular understandings of trans science put forward by anti-queer activists today. To these folks, it doesn’t matter whether or not there is a general scientific consensus that being trans is a natural and normal human experience. All it takes is a problematic and morally dubious publication in an academic journal in order for these controversial discussions to be revitalized in the public eye.

Efforts to bring forward a critique of Littman’s research are obfuscated by accusations of censorship, anti-science mentalities, and the public harassment of trans writers, activists, and scholars. Legitimate academic criticism becomes immediately suspicious due to its connection to the notorious “trans activist agenda”.

Littman’s research, which she positioned in opposition to gender affirmative therapy, taps into the long history of biased, cissexist research that has served to disadvantage queer folks in our society. Her conclusions showcase a renewed effort to re-pathologize trans identity, and even if these assertions are rejected by WPATH, they provide the foundation for intensified transphobia, prejudice, and discrimination in the public discourse.

Gender affirmation and trusting the experiences of trans folks

When faced by biased and unobjective research, there is a need for grassroots mobilizing to highlight already existing platforms for medical and therapeutic intervention. The Sherbourne Health Centre in Toronto is a medical grassroots and community initiative that provides LGBTQ+ specific treatment to marginalized populations.

Their scientifically supported Guidelines and Protocols for Hormone Therapy and Primary Health Care for Trans Clients document has become a cornerstone in Canadian transgender healthcare. The document reads, “The trans population has suffered a great deal of prejudice, misunderstanding and harm from the medical community, and systemic oppression experienced by trans clients has often resulted in the denial of service”. This sort of scientific reflexivity is a sight for sore eyes in the realm of trans health care. Recognizing the historical and current abuses by medical professionals, the guidelines suggest a move towards the informed consent model which advocates that the threshold for prescribing hormone replacement therapy is given to the client after an information session of the positive and negative impacts of transition related medical procedures.

As pointed out by Florence Ashley and Alexandre Baril, the use of gender affirmative therapy attempts to affirm and encourage parents to take their children’s issues with gender identity and expression seriously. It is not, as many transphobic critics fearmonger, forcing children to undergo invasive medical procedures to undergo gender transition.

Ashley and Baril write,

Instead of encouraging the child not to be transgender and risking pushing them back into the closet, therapists seek to support the child and their parents throughout the process of exploring gender. They remain neutral with regards to whether the child should be trans or not.

Being transgender is confusing, but the confusion involved in transitioning has nothing to do with being mentally ill, it has everything to do with the misinformation, lack of education, and wider societal anti-trans prejudices. The lack of information about gender identity and expression in primary and secondary education curriculum means that children aren’t getting the proper education to help them navigate gender dysphoria.

Littman and her crowd view queer education and gender affirmative therapy as ideological nonsense pushed by the “trans agenda”. She renders knowledge about queerness as a catalyst for “social contagion” which threatens to contaminate cisgender children. Their solution to this issue is to literally silence and police gender non-conformity in children. This is enormously problematic.

Scientific objectivity is a fraught process that is mired with the messiness of research and the biases and prejudices of researchers. This is why WPATH asserts that “ROGD” can hardly be considered clinical, as it is one study with relatively little scientific scrutiny. The construction of facts in the medical world is a very slow process that unfolds through a multitude of studies that contest each others knowledge production in order to sift out lazy methods and potential biases.

In the face of these scientific hostilities, we need to listen to the experiences of trans folks. No one knows our struggles better than ourselves. This is why there is an emerging emphasis on gender affirmative therapy and the informed consent model. Instead of working from a position of suspicion and practices of surveillance and scrutiny, we need to give folks some well needed agency to explore their gender identity and expression.

We also need to listen to the experiences of trans writers, activists, and scholars who are working in the interest of safekeeping our access to basic human rights and dignity. We still live in a world that is hostile to queerness and difference and social conservatives consistently bemoan having to accept trans folks as human. Trans critics are painted as anti-free speech and anti-scientific, even while we raise legitimate scientific concerns with bias research that is being used against our communities.

So please, stop putting forward your romanticized assertions about what counts as objective research — you’re muddying good scientific practice and making life increasingly difficult for trans folks.