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PLOS ONE has republished the study of parental reports of adolescents experiencing Rapid Onset Gender Dysphoria by Dr Lisa Littman. This follows a rigorous re-review after the initial publication attracted a large amount of hostility from transgender groups and activists online. PLOS ONE confirmed that: “Other than the addition of a few missing values in Table 13, the Results section is unchanged in the updated version of the article.” The republished study can be viewed here.

Dr Littman issued a statement here which concluded:

Although this work is considered controversial in some circles, since publication I have received many appreciative emails from clinicians who have been seeing this type of presentation in their own patients, young adults who had de-transitioned and feel that the paper describes their own experiences with gender dysphoria, and many parents who are relieved to see research about something they were seeing in their own homes. I look forward to future research on this important topic. Gaining a better understanding of the development of gender dysphoria will allow us to better help the current population of teens and young adults experiencing it.

https://gdworkinggroup.org/2019/03/19/littman-statement-about-republication/

PLOS ONE also issued a statement explaining the review process and what has been modified in the re-published version of the study.

Parents who are concerned about medical transition, uneasy about the unquestioning affirmation approach, or simply don’t agree with the unevidenced hypothesis of innate gender identity, are characterised by transgender activists as “unsupportive parents.” One of the most distressing aspects for parents is the way their children too are encouraged online to view them with suspicion as “transphobic bigots” if they do not immediately “affirm” them and support their medical transition. In this context the following statement from PLOS ONE is very welcome:

Parental approaches are complex and cover many variables. For example, one parental approach might be to affirm the child as a person, support gender nonconformity, support gender exploration, support mental health evaluation and treatment as needed, support the exploration of potential underlying causes for the dysphoria while expressing caution about medical interventions. Another approach might be to affirm the child’s newly declared gender identity, support gender nonconformity, support a liberal approach to medical intervention while expressing caution about mental health evaluation and caution about the exploration of potential underlying causes for the dysphoria. To categorize the former as “rejecting” and the latter as “accepting” would be inaccurate.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214157

We hope that this will put an end to the vilification of parents who take parental responsibility in researching for themselves rather than accepting without question the claims of activists.

In the PLOS ONE statement there is also important acknowledgment that activists cannot claim to know what is best for teenage girls who experience Rapid Onset Gender Dysphoria because nobody knows; this presentation is a new phenomenon:

Although recent observations of adolescents and young adults who are predominantly natal female having a sudden onset of gender dysphoria symptoms beginning during or after puberty might technically fall under the existing definitions and criteria for adolescent and adult gender dysphoria […], the substantial change in the demographics of patients presenting for care, the inversion of the sex ratio with disproportionate increase in adolescent natal females […], and the new phenomenon of natal females exhibiting adolescent-onset and late-onset gender dysphoria […] signal that something new may be happening as well.

This is an extremely important statement and a validation of the cautious approach parents seek to encourage their teenage daughters to take. There is no evidence to show that “affirmation” is the only legitimate response or that this cohort is best served by medical transition. In this excellent interview, Lisa Littman points out:

Late-onset had only been observed in natal males until quite recently. About seven years ago, the phenomenon of natal females exhibiting late-onset gender dysphoria first started to become visible. This new type of presentation, largely absent from the research literature prior to 2012, seems to be on the rise. Also during the last decade, there has been a dramatic change in the patients presenting to clinics for gender dysphoria—including a striking increase in teens, with a predominance of natal female teens.

Lisa Littman goes on to say:

I believe that when a population seeking care for a condition drastically changes, it is the responsibility of the clinicians and researchers to start asking questions. Why is this change happening? Is the condition in the new population different from the condition in past populations? Without research to explore these questions, we don’t know if the treatments used for previous populations will be helpful or harmful to this new population.

This is why Littman’s study is so important. The attempts to suppress the study by those who claim the supportive and compassionate high ground, suggest that their efforts are in support of an ideology, not of young people themselves. Littman’s study is dangerous because it threatens the narrative of transgender activists. It suggests other possible reasons for the sudden onset of gender dysphoria in adolescence and if further research confirms Littman’s hypotheses, this would call into question the approach which assumes only that an innate gender identity is emerging late and that this identity must be immediately affirmed and validated.

We are accustomed to seeing claims in support of affirmation, social transition and medical intervention which are supported only by low or very low quality evidence and based on the non-scientific claim that all human beings have an innate inner sense of their gender. On the basis of this, transgender activists have been allowed to control the narrative, silence those who question it, put pressure on clinicians in their treatment of young people and intimidate professional bodies to ensure that anything other than “affirmation” is denounced as “conversion therapy.” This is not the behaviour of those who care about scientific rigour and the need for an evidence-based approach and treatment.

Now that Lisa Littman’s study has gone through a rigorous re-review, it must be considered by clinicians at Tavistock GIDS and we would hope that it will generate further research into the unknowns about this cohort of teenagers, both girls and boys; for example the high rate of autism spectrum children, along with young people with pre-existing mental health problems, previous trauma or troubled backgrounds.

Researchers must be enabled to do this important work without fear of retribution. The shocking fact is that Lisa Littman lost her consulting job over the hostility generated by her study and that this is the risk for any professional wishing to research in this area:

I realize now that other academics have received this type of pushback and more. It’s part of a larger issue surrounding the study of gender dysphoria where, if the research findings or opinions are not consistent with a very specific gender narrative, there are efforts to shut down the discussion.

We are extremely grateful to Lisa Littman for her ethical dedication to researching this area, for taking the risk and for her willingness to continue doing so:

Will you be doing more research in this area?

Yes. I feel very strongly that this this type of research is urgently needed and that continuing to explore this area is the right thing to do.