Summary

This 2025 Austrian review weighs the evidence for and against 'rapid-onset gender dysphoria'. This is the idea that some teens, mostly girls, with no childhood signs suddenly identify as trans at or after puberty, partly to cope with other mental health problems and under the influence of friends and social media. The authors find Littman's original parent survey limited but a fair starting point for an idea to test. They note that a 2022 clinic study that found no support (Bauer and others) may not have measured the right thing. They find indirect support in research on peer influence, social media and detransitioners' accounts, and report seeing such a group in their own clinic. Their verdict: unproven but worth serious study. As they did not search the research systematically, it is a map of the debate, not strong evidence either way.

Key findings

• Forfatterne argumenterer for, at nuværende evidens hverken berettiger til at acceptere ‘rapid-onset gender dysphoria’ som en bevist forklaring eller til at fordømme den som transfobisk.
• I Littmans undersøgelse fra 2018 af 256 forældre var 83 % af de beskrevne unge født som kvinder, og 63 % havde en psykisk eller udviklingsmæssig diagnose, før deres kønslidelse begyndte.
• Et klinikstudie fra 2022 (Bauer m.fl.) fandt ingen støtte til idéen. Men gennemgangen fremhæver Littmans kritik af, at det behandlede ‘nylig viden om sit køn’ som hurtig begyndelse uden henvisning til puberteten.
• Citerede undersøgelser af detransitionister omfatter én (Vandenbussche), hvor 70 % af 237 detransitionister sagde, at deres lidelse havde andre årsager, og én (Littman m.fl.), hvor 53 % af 78 følte, at deres oplevelse passede til idéen om hurtig begyndelse.
• Forskning i, hvordan spiseforstyrrelser og selvskade breder sig blandt venner, og i skader fra sociale medier, gør social påvirkning troværdig for nogle teenagere. Dog fandt en citeret samlet analyse lignende effekter på kropsbilledet hos drenge og piger.
• Fra deres egen klinik beskriver forfatterne en gruppe teenagere med alvorlige psykiske problemer, hvis kønslidelse voksede med puberteten, COVID-19-nedlukninger og øget brug af sociale medier.
• De opfordrer til langsigtede studier, der kombinerer teenageres, forældres og klinikeres synspunkter, og understreger samtaleterapiens centrale rolle for teenagere, der også har andre psykiske tilstande.

Abstract

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

Conclusion

The authors conclude that neither prematurely adopting ROGD as a valid explanatory model nor hastily condemning it as transphobic is an appropriate response, and that Littman's research has made an important contribution that the scientific community should build on. They acknowledge ROGD may offer a convenient explanatory model for those opposed to medical transition of adolescents, but argue the right response is to strengthen rather than suppress research so that its validity can be judged on evidence. They call for longitudinal, well-designed studies capturing co-occurring psychopathology, social influences and identity development, warn that neither generalized suspicion nor an uncritically permissive approach meets adolescents' needs, and stress that clinicians must be wary of their own ideological predispositions. If substantiated, the ROGD framework could refine clinical treatment.