Rapid Onset Gender Dysphoria, scientific debate, and suppressing speech

Julia Serano
8 min readAug 28, 2018


Last week, I published an essay entitled Everything You Need to Know About Rapid Onset Gender Dysphoria — please check it out if you haven’t already. [note: in 2019, I added a series of relevant links to the end of that essay, including statements from major trans health professional organizations such as WPATH rejecting “ROGD,” and Littman’s paper undergoing revision due to its scientific shortcomings.]

In this post, I will address a few questions and points that others have raised in response to it. So from here on forward, I will presume that, if you are reading this, you are already familiar with that original essay.

Thus far, the response to my essay that has garnered the most attention among ROGD advocates was penned by Roberto D’Angelo and Lisa Marchiano. Since it’s entitled “Response to Julia Serano’s critique of Lisa Littman’s paper,” I should begin with a clarification: My essay was intended to be an accessible critique of the more general concept of ROGD — and especially, the unnecessary and unwarranted invention of a “second type” of gender dysphoria. Much of it was written prior to the publication of Littman’s paper (although I was familiar with some of her preliminary findings as presented in an earlier poster). In other words, my essay should not be viewed as a critical review of the Littman paper per se — if it were, I would have delved more thoroughly into the data and specific details, which include other shortcomings that I did not address in my essay.

Having said that, I stand by all of the criticisms that I did raise in my piece. And most of the counter-rebuttals that I would make have already been articulated in Florence Ashley’s essay A little less conversation, a little closer reading please: on D’Angelo and Marchiano’s response to Julia Serano on rapid-onset gender dysphoria, so I highly encourage you to consult that. I should add that many of D’Angelo and Marchiano’s arguments sound reasonable when taken individually (e.g., it is standard practice to interview parents on behalf of their children, solicit websites for survey respondents, publish preliminary studies that require further investigation, publish articles in PLOS One). But when you factor in all of the problems I cited together, they represent an extraordinary set of circumstances. Essentially, Littman used a highly biased sample of parents, with no input from the kids themselves, to propose that these kids are experiencing an entirely new and distinct “type” of a long-established medical condition, which if true, would not only have implications for treatment, but far-reaching social ramifications (I will revisit this momentarily).

The final section of D’Angelo and Marchiano’s response is entitled “Serano’s important omission,” where they highlight the fact that I did not mention that (according to Littman’s parental reports) “ROGD kids” experience other mental health issues at levels higher than most children. They imply that I must have omitted this because it would help bolster the ROGD case, when in actuality, I simply didn’t have the time to address every single claim made in defense of ROGD (and ROGD advocates have made many claims!). If I had addressed it, it would have fit neatly into my “correlation does not imply causation” section, as there is no evidence that these mental health issues are somehow causing gender dysphoria in these kids (as some ROGD advocates claim or insinuate). Florence Ashley (in the aforementioned piece) points out that such levels of comorbidity are not at all unusual for teenagers dealing with “social stigma, untreated gender dysphoria, and lack of perceived parental support for gender.” Brynn Tannehill has similarly made a connection between the “large body of evidence showing that transgender youth in unsupportive homes have worse mental health outcomes than those in supportive ones” (such research is reviewed here), and the fact that Littman recruited parents from three blogs known to champion gender-disaffirming approaches to children. As Tannehill suggests, such mental health issues, as well as some of other negative outcomes Littman reports (e.g., declining parent-child relationships, “distrust and isolating behaviors”) could very well be the result of these parents not supporting their children’s gender identities and experiences.

Also in their “Serano’s important omission” section, D’Angelo and Marchiano go on to state: “We fundamentally disagree with Serano’s implicit critique that Littman’s paper is transphobic.” Seriously? What the fuck?! I never once claimed nor implied transphobic intentions in my essay. I critiqued Littman’s research study and interpretations (and ROGD theory more generally). The word “transphobic” (and its variants) doesn’t appear once in my essay. This seems to be a cheap way of depicting me as an “angry irrational activist” rather than taking me seriously as a scientist, and someone who has researched and written about this field extensively in the past. Frankly, I was insulted that they would stoop to such a level.

I have to say that I was taken aback by multiple accusations from proponents of ROGD that I somehow claimed that PLOS One is “not a respectable journal” (those are D’Angelo and Marchiano’s words, not mine). Similarly, Ken Zucker tweeted “many serious researchers” are published in PLOS One (including him). In response to the Zucker tweet, I wrote this thread and immediately included a link to it in my essay, so from here on forward, I will assume that anyone making such claims is purposefully trying to misrepresent me. What I actually said was that the many flaws in the Littman paper that I described “would explain why Littman published her article in PLOS One, rather than a more respectable journal.” To elaborate for readers outside of the sciences and academia: The more prestigious the journal, the more rigorous the peer-review process. In my essay, I was simply expressing my doubts that Littman’s paper would have been accepted if it had been subjected to more thorough scrutiny. While PLOS One is not by any means an “unrespectable” journal (some research they publish is quite sound), their review process is not nearly as rigorous as most other journals. Everybody in the sciences knows this to be true — PLOS One even says it themselves — so I cannot help but believe that my aforementioned critics are being willfully obtuse here.

I alluded to this in my original essay, but it’s worth elaborating on here: PLOS One’s bucking-the-impact-factor publishing strategy works fine for most fields, where scientists can debate and decide amongst themselves whether a specific article or research study is valid (and worth citing and building upon) or unreasonable (and should be discounted). Back when I was studying crustacean Hox genes, if I published a sloppy study that squeaked through peer review, the worst-case scenario would be that I had wasted other researchers’ time reading my article and possibly attempting to verify my results. But in the case of Littman’s paper — which argues that some members of a stigmatized minority group (i.e., trans people) are not really what they say they are (i.e., experiencing bona fide gender dysphoria)— the ramifications can be horrifying. Like I said, I did not write my essay solely in response to the Littman paper. I did so because large swaths of people who espouse anti-transgender agendas are already citing the concept of ROGD (pre-Littman paper) as an excuse to disaffirm children’s gender identities and to isolate trans children from their peers, information, and resources. Frankly, it is irresponsible to consider the Littman paper without any acknowledgement of the potential social implications of its publication, and how it might be used to further stigmatize or dismiss trans youth. So while I respect some aspects of the PLOS One publishing model, I do think that it fails in cases such as these.

Along similar lines, I had a couple people suggest to me that, instead of me “stifling debate,” we should entertain the possibility that ROGD is really a new form of gender dysphoria. I mean, who knows, it could be true after all? This completely ignores the potential social ramifications of the Littman paper, as I just detailed. But it also completely ignores how science works! If I were to publish a paper claiming that, while evolution is true for some organisms, I have discovered a second class of organisms that arose in an evolution-independent manner, the onus would not be on other researchers in the field to “entertain” my hypothesis. Rather, the onus would be completely on me to demonstrate that my new theory explains all the available observations, data, and evidence better than the currently accepted theory of evolution. This is how science works.

Allow me to forward an analogy to help bring this point home: Imagine any other well established medical condition that affects children — perhaps it’s asthma, or autism, or diabetes, or insert-your-pet-condition-here. And imagine that I were to claim to have discovered a brand-new-type of that condition, one that has an entirely distinct cause (in fact, it is contagious!) and which likely requires an entirely different form of treatment. Furthermore, imagine that there is no easy way to distinguish between the old-type and this “new-type” of said condition, yet lots of parents are insisting that their kids have the “new-type,” thereby eschewing all the previously established treatment regimens. Would you simply “entertain” this new theory? I highly doubt it. If this were to occur, you would likely be extremely concerned. And so would lots of other people!

If that scenario would concern you, yet you nevertheless believe that we should simply “entertain” ROGD, it is either because 1) you are suspicious of gender dysphoria being a real condition to begin with, or 2) having little knowledge about the condition, it seems abstract to you, and therefore worth “entertaining” — you know, like a thought experiment. However, for many of us, gender dysphoria not an abstraction. It is a very real thing. And it is experiential — meaning that you either experience a dissonance or incongruence with the gender you were assigned at birth, or you don’t — and as such, it doesn’t come in different “types.” And the current understanding in the field (which is accepted by a majority of trans health professionals today) is that gender-affirming (rather than disaffirming) approaches are the most efficacious and produce the best mental health outcomes in the long run. (And no, gender-affirming doesn’t mean “rushing kids into hormones and surgeries” — it simply means taking what these children say seriously, and allowing them to explore who they are for themselves.)

ROGD isn’t merely some abstract hypothesis. Rather, it’s a purposeful end-around for many parents and practitioners who wish to avoid the standard and accepted practices for treating gender dysphoria. This is why anti-transgender forces are heavily promoting it. And why transgender activists and advocates are debunking and denouncing it.

Finally, as I write this, we have already seemed to move into phase two of these debates, where people are now claiming that trans activists are “attacking science” and “academic speech” and the like. I’ve lived through cycles like this many times before — I’ve come to refer to it as the Dregerian narrative. I am not “attacking” or “stifling” anything — I simply wrote an essay about a bad unsubstantiated theory that is likely doing real harm to trans children even as we speak. Every time that I write a cogent essay critiquing some poorly conducted study or theory regarding trans people (as I have done in the past), people are always quick to accuse me (and other trans people) of “attacking” or “stifling” scientific/academic debate. I (and we) are simply attempting to participate in such debates, sharing our knowledge and perspectives, and pointing out sloppy science and flawed logic that occurs on the other side. To those now pushing this Dregerian narrative, I would say: You are the ones who are working to suppress our speech and participation in these debates, not the other way around.

This essay is free & accessible thanks to the support of my Patreon supporters — if you liked it and want to see more like it, please consider supporting me there. You can learn more about my writings and activism at juliaserano.com.



Julia Serano

writes about gender, sexuality, social justice, & science. author of Whipping Girl, Excluded, 99 Erics, & her latest: SEXED UP! more at juliaserano.com