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Gender dysphoria study faces criticism

Recent study uses parental surveys to examine ‘rapid-onset gender dysphoria’ in transgender youth

On Aug. 22, the University published a press release on the first-ever research study to investigate “rapid-onset gender dysphoria,” which was authored by Lisa Littman, assistant professor of the practice of behavioral and social sciences in the School of Public Health. Littman’s study proposed that online forums and social media have allowed transgender identities to spread among adolescents in a manner dubbed “social contagion.” Five days later, PloS ONE, the peer-reviewed journal which published the study, posted a comment on the online paper indicating that the journal would “seek further expert assessment on the study’s methodology and analyses.” The same day, Aug. 27, Brown removed the press release highlighting Littman’s findings from its website and news distribution.

The following day, Dean of the School of Public Health Bess Marcus issued a letter affirming the School’s commitment to both academic freedom and the well-being of sexual and gender minority populations. A recent petition supporting Littman’s research and calling on both Brown and PloS ONE to “resist ideologically-based attempts to squelch controversial research evidence” has garnered 3,926 signatures, as of press time.

Methodology and data collection

Gender dysphoria is defined by the American Psychiatric Association as a conflict between a person’s physical or assigned gender and the gender with which they identify. Littman’s study defined a new form of this phenomenon, “rapid-onset gender dysphoria,” which takes place when “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.” In the study, Littman gathered data by posting a survey that asked parents about their transgender teens on three parenting websites focused on transgender adolescents.

Littman declined a request for comment.

“The three websites (that Littman posted to) all have ties (to) organizations and people that promote conversion therapy and reject gender identity,” wrote Brynn Tannehill, who has written widely about transgender experiences, including her own, in a follow-up email to The Herald. “The fact that she did not acknowledge the bias of these websites, and the effects that this would have on the data, clearly distorts whatever conclusions you may find. That’s flat-out bad research,” she said.

Multiple other experts interviewed for this article agreed with Tannehill, adding that it was unfair to draw conclusions about transgender adolescents and their experiences based on parent experiences.

“The data is not presented as parents’ thoughts, feelings and perceptions of youth experience, but is extrapolated to ‘this is what happened to these youth, this is their experience,’” said Michelle Forcier, professor of pediatrics and clinician educator. “Anyone who has kids or takes care of kids knows that parent perception doesn’t accurately tell you what that adolescent’s experience is.”

Anne Fausto-Sterling, professor emeritus of biology, claimed that this research was a beginning point rather than an endpoint.

“Frankly, it’s disingenuous to attack the method when (Littman) is the first person to even try to figure out what’s going on,” she said. “I don’t think the study does any more than say this is something we need to look at.”

Accounting for transgender experiences

Some experts do not believe Littman is exploring a new circumstance at all. Adolescents commonly show little to no sign of gender dysphoria prior to puberty, Forcier said. “The physical changes of puberty mean you can’t just live in this androgynous place where everyone looks the same, but that doesn’t discount their early experience or their timing for seeking gender-affirming treatment.” Forcier has seen patients coming out in their forties, fifties and sixties, she said.

Many adolescents hide their gender identities from unsupportive parents until they no longer feel that they can, multiple experts noted. The stigmas surrounding transgender people can be incredibly isolating in many sociocultural situations, Forcier said.

“That’s what rapid onset is actually describing — the parents finding out rapidly,” said Katie Chung MD’20, who studies LGBTQ health care and advocacy.

“Are we witnessing a new phenomenon, or are we witnessing the same old phenomenon that we would see in any transgender kid in an unsupportive home?” Tannehill asked. “Littman is describing something already very well understood, but she’s trying to put a ‘scientific’ veneer on rejecting the identity of trans youth.”

It should come as no surprise that transgender teens use online forums to discuss their identities, Tannehill said. “We know that there are not a lot of trans people, especially trans youth. It was a 50-minute drive for me to find another trans person that was out,” she said. “Where else are you going to find a trans community but online?”

Suggesting that transgender identities spread through social contagion is not only invalid, but harmful to an already vulnerable population, said Julia Serano, an author who has written extensively on transgender experiences, including her own.

“This idea has been used by many parents and by some practitioners to isolate trans children from trans peers, from resources related to trans people and from treatment,” Serano said. “If you say that (being) transgender is contagious, what effect will that have on trans children?”

Such framing and wording used throughout the study is incredibly dangerous, making gender dysphoria sound like “some weird pandemic,” Chung said. “It can only serve to further marginalize this population.”

“If one doesn’t do a semi-rigorous analysis of the methodology, the headline of this study will be used to question people’s experience of their body and their identity and adolescents’ ability to assert their identity,” said Georgia Lipkin MD’21, who studies LGBTQ health care and advocacy. “This is gatekeeping by another name, and I think it’s going to do a lot of damage,” they added.

Many of the experts interviewed agreed that the study’s conclusions have harsh implications for the safety of transgender youth. Transgender adolescents who are not listened to or supported are more prone to a host of mental health issues that have historically been brought on by the stress of holding a marginalized identity, Forcier said.

Academic freedom and scientific responsibility

Fausto-Sterling, however, worries that shutting down Littman’s research has its own consequences. She believes the University and PLoS ONE journal have been treating Littman unfairly.

The University claims to support free speech, Fausto-Sterling said. “I’m not convinced they’re doing it.”

The research study, the University’s promotion of it and the subsequent removal of the associated press release were covered by a wide variety of news sources. While some of these, such as Slate Magazine, argued Littman’s methods and conclusions were flawed, others such as Fox News critiqued the University’s decision to remove the press release.

The choice to take down the press release was not a result of the Univerity taking a side, but rather from PLoS ONE’s own comment raising questions about the research design and methodology, said Cass Cliatt, vice president for communications. At this point, the University believes it is the “responsible thing to halt the distribution of our news of that research as those questions are assessed,” she wrote in a follow-up email to The Herald.

The approval of research for this project was provided by the Icahn School of Medicine at Mount Sinai. Thus, the study went through a human studies board and office of research integrity independent of the University, Marcus said.

“We very much support our students and we very much support the transgender community, and we also very much support academic freedom and rigorous debate in our faculty. We don’t see those as at odds,” Marcus said.

Members of the Brown community have expressed feeling personally affected by the study. “I feel really worked up in a way that I don’t often feel about science. It’s dangerous when science pretends to be neutral and it isn’t, and I think that’s when it does a lot of harm,” Lipkin said. “This study repeats a lot of dangerous narratives around trans identity that I thought we had moved past.”

Clarification: A line in this story has been updated to clarify that Georgia Lipkin MD'21 is a member of the Brown community and not a member of the School of Public Health.


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