A recent study claiming to describe more than 1,600 possible cases of a “socially contagious syndrome” was retracted in June for failing to obtain ethics approval from an institutional review board. The survey examined “rapid-onset gender dysphoria,” a proposed condition that attributes adolescent gender distress to exposure to transgender people through friends or social media. The existence of such a syndrome has been the subject of intense debate for the past several years and has fueled arguments against transgender rights reforms, despite being widely criticized by medical experts.

The American Psychological Association and 61 other health care providers’ organizations signed a letter in 2021 denouncing the validity of rapid-onset gender dysphoria (ROGD) as a clinical diagnosis. And a steadily growing body of scientific evidence demonstrates that it does not reflect transgender adolescents’ experiences and that “social contagion” is not causing more young people to seek gender-affirming care. Still, the concept continues to be used to justify anti-trans legislation across the U.S.

“To even say it’s a hypothesis at this point, based on the paucity of research on this, I think is a real stretch,” says Eli Coleman, former president of the World Professional Association for Transgender Health. Coleman helped create the organization’s most recent standards of care for trans people, which endorse and explain the evidence for forms of gender-affirming care.

Many transgender people experience gender dysphoria, meaning that the gender that was assigned to them at birth and their gender identity don’t align, causing distress. ROGD was proposed as a gender dysphoria subtype in a 2018 paper by physician and researcher Lisa Littman, then at Brown University.* Littman’s survey asked parents of transgender adolescents—recruited predominantly from anti-transgender websites and forums—to describe their child’s “sudden or rapid onset of gender dysphoria” and to state if it coincided with increased social media usage or the child’s friends coming out as transgender.

Littman later issued a correction that updated the methodology, including a brief description of the websites and forums, and noted that ROGD is not a formal diagnosis. But the concept had already been taken upin books and podcasts—and by politicians—to promulgate the idea that peer pressure and social media are making kids transgender or that being transgender is a form of mental illness. As legislation targeting trans people has reached an all-time high in the U.S., ROGD’s alleged social contagion has been invoked by lawmakers in states such as Missouri, Utah and Arkansas to justify banning or restricting gender-affirming care for young people.

“This is just a fear-based concept that is not supported by studies,” says Marci Bowers, president of the World Professional Association for Transgender Health. The term ROGD is being used to “scare people or to scare legislators into voting for some of these restrictive policies that take away options for young people. It’s cruel, cruel legislation.”

Like the 2018 study that coined the term rapid-onset gender dysphoria, the recently retracted paper, which was published this March in Archives of Sexual Behavior, surveyed parents of transgender children about their children’s experiences. The study was co-authored by Michael Bailey, a psychologist at Northwestern University, and Suzanna Diaz, a pseudonym used by a mother of a child with gender dysphoria. Diaz is not affiliated with an institution and had already collected the survey data before collaborating with Bailey on the paper. The study was retracted because Diaz and Bailey did not get consent from the survey’s respondents to have their responses published, although Bailey disputes this. (Bailey declined to answer questions about the retraction from Scientific American.)

The participants in both the 2018 and the retracted 2023 studies were recruited from online communities that were explicitly critical about many aspects of gender-affirming care for transgender kids. Littman’s research was inspired in part by parents’ posts on these skeptical websites.

In response to criticisms that recruiting parents from anti-transgender websites may have biased the results, Littman says, “I reject the premise that parents who believe transition will harm their children are more likely to discredit their kids’ experiences than parents who believe that transition will help their children.”

Most experts cite the survey of parents rather than transgender children themselves as another major flaw in the methodology of both studies.

Diane Ehrensaft, director of mental health at the University of California, San Francisco, Child and Adolescent Gender Center, concurs. “To talk about what children are thinking, feeling and doing, particularly as they get old enough to have their own minds and narratives, you need to interview them,” she says.

Parents can often be the last to know about their child’s gender identity, Ehrensaft says. Coming out can be terrifying for many transgender kids. Family members often respond with violence or distrust or may even kick the child out of the house. Almost 40 percent of transgender youth experience homelessness or housing instability, according to a 2022 report from the Trevor Project, a nonprofit that provides crisis support for young LGBTQ+ people. Many kids who wait to discuss their gender identity with their parents before appearing to “suddenly” come out are simply keeping themselves safe, Ehrensaft says.

“It is not rapid-onset gender dysphoria,” she says. “It’s rapid-onset parental discovery.”

Many experts have also questioned what length of time qualifies as a “sudden” experience of gender dysphoria. Both the 2018 and 2023 studies left the definition up for parental interpretation. Complicating this, there isn’t one pathway or time line for being transgender, says Tey Meadow, a Columbia University sociologist who studies sexuality and gender. “For some people, it can evolve slowly. For others, it can evolve quickly,” she says.

For most transgender youth seeking gender-affirming care, considerable time elapses between when they realize they may be transgender and when they receive such care. A recent analysis of 10 Canadian medical centers in the Journal of Pediatrics found that 98.3 percent of young people seeking gender-affirming care had realized more than a year prior that they may have been transgender. “If ROGD were a real thing, we would expect to see two discernible streams of patients coming in [to receive care],” says Greta Bauer, a co-author of the study and director of the Eli Coleman Institute for Sexual and Gender Health at the University of Minnesota Medical School. There would be a distinct group of adolescents with more recent knowledge about their gender identity going to clinics and another group that had had such knowledge for years. “But we didn’t see that,” she says.

Thomas Steensma, a psychologist at Amsterdam University Medical Centers who provides gender-affirming therapy, says he has not seen evidence of the “social contagion” component of ROGD, and he cautions against even using these terms. “Rapid means out of control, and contagion signals a warning, and that warning induces fear,” he says. “There’s no evidence that certain developmental pathways are more problematic or less beneficial or helpful than others” for a child’s gender identity.

Steensma reports that he sees two “peaks” of referrals in his clinic: young adolescents and 15-year-olds. In a 2020 study Steensma and his colleagues looked at adolescent referrals from 2000 to 2016 and found no measurable difference in the psychological functioning or the intensity of the gender dysphoria between more recent referrals and those who came to the clinic starting in 2000. If adolescents are presenting with a different form of gender dysphoria, Steensma has not seen it.

The researchers did observe a change in their referral population in recent years, however. More kids assigned female at birth have been transitioning in recent years than those assigned male at birth. Many studies have captured this difference—including the 2018 survey proposing ROGD—but experts are unsure of its cause. Littman suggests that female-assigned kids are more susceptible to the “social contagion” of gender dysphoria because they feel social pressure more acutely than male-assigned kids. But Ehrensaft says nothing in the clinical literature corroborates this assertion. Instead she attributes this discrepancy to shifting cultural factors that influence how children express themselves and explore their identity. In our culture, Ehrensaft says, “there’s a lot more gender stress for the boy in the tutu than the girl in the football uniform.”

Other forms of gender incongruence, such as identifying as nonbinary or gender nonconforming, further challenge the idea that children should be forced to abide by traditional gender categories. And the best way to understand what kids are experiencing is to ask them questions and listen to their answers, Ehrensaft says.

“In some ways, [kids] are far more advanced than I am, as somebody in my 70s, about how they live and understand gender,” Ehrensaft adds. “So if we want to really understand gender, turn to the experts—and that would be the youth themselves.”

*Editor’s Note (8/24/23): This sentence was edited after posting to correct Lisa Littman’s occupation and her affiliation at the time of her 2018 paper.