On Flat Earth Studies, "Rapid-Onset Gender Dysphoria," and Bad Science

[Illustration by MidJourney]

In the past couple of years, almost half of the states in the US have banned the provision of gender-affirming care for minors. This explosion of transphobic legislation keeping trans youth from working with care providers who support them has been based on two central myths. 

One of these myths is about what sorts of care trans youths access. This panicky myth is that little kids are walking into clinics and being hustled into "mutilating surgeries" and dosed with "experimental and dangerous drugs." (The reality is that most of the care received by gender-dysphoric young people is supportive talk therapy, with a modest subset of patients accessing puberty-suppressing drugs that have been prescribed without controversy for many years to cisgender youths. Surgeries on trans youths are very rare, and most of these are chest reconstructions on 17-year-old trans boys. A vastly larger number of cisgender 17-year-olds get plastic surgeries on their chests every year to support their gender identities, as they are cis boys unhappy with the breast tissue they have grown, or cis girls unhappy with small or uneven breasts.)

But I want to talk to you about the second myth, which is that children are being rushed into medicalized gender transitions when in fact they have "rapid-onset gender dysphoria" caused by "social contagion." The claim is that teens go online and read that it is cool to be transgender, and decide to go along with the fad. Or a cool kid at their school transitions and gets social attention, so they say they're trans too. Then they are hurried into the "medical transition complex" with tragic results because this was just a passing immature delusion of theirs. The proof is that their parents report that their child was "normal" and gender-conforming, until one day they suddenly declared they were transgender and wanted to use a new name and pronoun and transition.

If you have ever tried to support a young trans person, it will be patently obvious to you that this is false. Coming out as trans is really scary for young people. Trans youths face a whole lot of stigma and harassment at school, and at home they may (rightly) fear that their parents will reject them. Only a third of trans minors report having parents who accept them in their identified genders. For this reason, trans youths often try to hide their identities from their families, and conform to their parents' desires for how they present themselves. So when they finally decide they can't hide anymore and must come out, or someone outs them, their unsupportive parents are shocked. As the senior mental health practitioner quoted in this Scientific American article states, “It is not [an issue of] rapid-onset gender dysphoria. It’s rapid-onset parental discovery.”

"Rapid-onset gender dysphoria" is not a real diagnosis. It has been rejected as such by the American Psychological Association. But again and again, when bills banning access to gender-affirming care have been debated and passed by state legislatures, "rapid-onset gender dysphoria" has been cited as proving the ban was necessary. This remains the case as we speak.

This brings us to the central point I want to make as a social scientist, and that is the problem of terribly bad "scientific reports" being generated and occasionally even published in academic journals, specifically in order to promote bigotry and conspiracy theories. The claim made by those who deploy these studies is, "You say science supports providing gender-affirming care to minors? Well, your science is wrong, and we have good science on our side! Your science is produced by corrupt gender ideologues and big pharma! Ours is produced by brave independent researchers!" And transphobic politicians are happy to dismiss the position of 98% of experts in the field, so long as they are handed some published study they can enter into the record.

And that is why it is important to note that one of the two "scientific studies" cited all the time now when transphobic bills are passed (because these two managed to get published) has now been retracted by the journal that published it, The Archives of Sexual Behavior. The reason the journal retracted the article is because the "researcher" who collected the data did not go through the required step of protecting the study subjects and getting their informed consent. But really, that is the tip of the iceberg.

Neither the retracted study nor the earlier study published in 2018, which coined the term "rapid-onset gender dysphoria," actually studied trans young people. Instead, they looked at posts in online groups made up of parents who opposed their children gender transitioning, and surveyed parents in these groups. This means the data they gathered was biased and invalid. 

The retracted study had two authors--one being a controversial psychologist who has been publishing long-critiqued homophobic and transphobic claims for years, Michael Bailey. (Bailey, for example, has framed being gay as a disorder that should be cured, prevented, or selectively aborted.) The second author was not actually a psychologist or academic at all. She used the pseudonym Suzanne Diaz, and is the mother of a gender dysphoric child who was a member of the group for parents who opposed allowing minors to gender transition from which she gathered surveys.

Now, let's be clear: it is ok for people to study subject pools with whom they sympathize! Doctors who are cis white men are "allowed" to study cis white men patients; jazz-aficionado sociologists are "allowed" to study jazz musicians. But researchers need to disclose their social position and potential conflicts of interest. They are supposed to lay out what potential biases they may have. And if 98% of researchers say XYZ, while the author's conclusion is that XYZ is wrong and in fact the opposite is true, they absolutely must acknowledge this and make a convincing argument for why the scientific consensus is incorrect. 

Most of all, surveying people from a group for flat-earth believers cannot tell you if the Earth is truly flat and not a globe. You have to study the actual Earth for the research to come to a valid conclusion. And academic journals should not be publishing invalid articles. This is especially true when those articles are being published in order to support a political campaign, and will impact the lives of thousands, unlike most scientific journal articles, which will only be read by a small pool of academics.

I am glad the Bailey and Diaz article was retracted. But it did great damage in the few years in which it was in print. We have to do a much better job of reviewing submissions that contradict scientific consensus. Sometimes a consensus can be wrong, and careful studies should prove that! But the burden of proof should be a high one, and publishing an article concluding that people may fall off the edge of the Earth based on interviewing people in Facebook groups for flat-earthers does not meet that burden.