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Teen social contagion: is transgender identity an exception?
Leading trans clinicians have undermined "gender affirming" dogma by conceding that peer influence may play a role in the explosion of gender clinic caseloads.
The well-known concept of social contagion is a threat to the “gender affirming” belief that children are experts in their transgender identity and cannot be swayed by social media or peer groups, says Australian psychologist Dianna Kenny.
“If gender is [supposedly] immutable, and you know it from a very young age, then you should not be susceptible to the influence of social forces,” Dr Kenny told GCN. She is a critic of the gender affirming model and its hormonal and surgical interventions.
Gender clinicians and trans activists have tended to reject out of hand any suggestion that social contagion may be a factor in the unprecedented surge of mostly female teenagers declaring a trans identity and seeking irreversible medical interventions.
However, a few leading American practitioners of the gender affirming treatment approach have broken with the dogma, and conceded that some of these sudden trans declarations probably do reflect the influence of social networks – and may be more likely to end in detransition, regret and harm.
On February 26, Dr Kenny will address a national forum on the role of social contagion in the international explosion of atypical gender dysphoria, a distressing sense of conflict with biological sex which, up until the 1990s, tended to be first diagnosed among a minuscule number of pre-schoolers, mostly boys. The majority of these boys grew out of the condition without medicalisation, and many of them emerging as gay or bisexual.
At the forum Dr Kenny, a former professor of psychology at the University of Sydney, will trace the psychological concept of social contagion from 1774, when Goethe’s novel The Sorrows of Young Werther led to a suicide cluster of young, disappointed romantics.
Social contagion has been documented more recently in eating disorders, and in South Korean girls’ emulation of celebrity suicide. Adolescent females as a group are considered especially vulnerable to this kind of network influence.
The rise of social media is seen as a key factor in the emergence of a mentally fragile generation of young people documented in the book The Coddling of the American Mind.
The forum to be held in Hobart under the title Gender Identity in Law: Impacts on Women, Children and People with Gender Dysphoria will bring together the Coalition for Biological Reality, the LGB Alliance Australia and Save Women’s Sport.
There was a prolonged but unsuccessful attempt within the Hobart City Council to stop the event going ahead in the town hall, and trans rights lobby Equality Tasmania plans to demonstrate outside the forum.
The possible role of social contagion in skyrocketing gender clinic caseloads is a central element in the international debate, with some commentators saying teenage girls are trying to opt out of puberty and sexually mature womanhood.
In 2018, American public health researcher Lisa Littman published a paper based on parents’ accounts of mostly female teens declaring trans identities with seemingly scripted threats of suicide if denied hormonal drugs. This followed immersion in social media, with clusters of friends coming out as trans.
Parents told Dr Littman these teens had no history of early childhood gender dysphoria.
The 1990s Dutch protocol that pioneered the use of puberty blockers would have excluded these teens as not good prospects for a successful medical transition.
The pioneering Amsterdam clinic also screened out patients with severe mental health problems, which are reportedly common in today’s gender clinics across the developed world.
Dr Littman’s survey was a preliminary study and simply concluded that her hypothesis, which she dubbed Rapid Onset Gender Dysphoria, warranted further research. She was upfront about the non-representative sample in her study, and did not claim that ROGD had the status of a formal diagnosis.
But there was activist outrage, her university issued an apology, and the journal PLOS ONE ordered an unusual post-publication review, publishing a “correction” with much massaging of language but leaving intact her findings.
The Littman hypothesis was central to Abigail Shrier’s best-selling book Irreversible Damage: The Transgender Craze Seducing Our Daughters. Activists demanded the book be banned and misrepresented the ROGD hypothesis.
In 2019, the Australian Psychological Society reflected the gender affirming worldview when it issued a statement “challenging the unfounded claim that social media influences the gender of young people specifically”.
The APS relied on the expertise of Damien Riggs, a fellow of the society and a Flinders University academic.
In the statement Dr Riggs said: “Empirical evidence consistently refutes claims that a child’s or adolescent’s gender can be ‘directed’ by peer group pressure or media influence, as a form of ‘social contagion’.”
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However, there were clinicians and parents who thought ROGD was a credible hypothesis warranting further research. Few psychologists were prepared to say this publicly because of the inevitable activist complaints and denunciations.
But dissenting voices have emerged at the highest levels of the gender affirming clinical community.
In March 2021 clinical psychologist Erica Anderson, a former president of the US Professional Association for Transgender Health, told journalist Jesse Singal it was “undeniable” that “chatter” among young people had an effect.
“Where’s the line between affirmation and persuasion? – I don’t think a lot of people ask that question,” she said.
Dr Anderson, who was working with San Francisco’s gender clinic, said she knew a trans girl who “literally calls out people in her peer group – she describes them as transtrenders”.
In October 2021 Marci Bowers, president-elect of the World Professional Association for Transgender Health and famous as surgeon to reality TV star Jazz Jennings, conceded the possibility of some social contagion.
“As for this ROGD thing,” Dr Bowers told Ms Shrier, “I think there probably are people who are influenced. There is a little bit of ‘Yeah, that’s so cool. Yeah, I kind of want to do that too’.”
Both Drs Bowers and Anderson are trans women.
Also in October last year, clinical psychologist Laura Edwards-Leeper, a team member from America’s pioneering Boston Children’s Hospital gender clinic, attributed the spike in trans teen declarations partly to the increased visibility, social acceptance of this gender identity, and wider availability of Dutch protocol medical treatments.
But Dr Edwards-Leeper told podcaster Meghan Daum it was “kind of crazy” to assert that peer influence can’t be at work in trans identity claims when it is well documented as a reality “in pretty much every other area of adolescent development”.
Dr Edwards-Leeper sketched the profile that should worry clinicians: a teenage female who admits she had no childhood history of gender dysphoria; had never thought about being trans until social media exposure; who fixates on this identity as the solution to all her troubles; and wants to join friends who have already started on hormonal drugs.
“Where it gets more complicated and concerning is where they’re wanting to move forward quickly with irreversible medical interventions,” she said.
“I do get frustrated when people dismiss the [ROGD] phenomenon so quickly, as if it’s something that could never possibly happen (with trans).
“I think it does happen … I think that's what's going on for some young people.”
“Every kid deserves to be thoroughly assessed on an individual level to figure out what’s really going on with this particular case … what’s going to be the best treatment plan for this individual.”
(Dr Edwards-Leeper chairs the Child and Adolescent Committee for the WPATH and has been involved in the revision of the standards of care issued by that gender clinician body.)
Another significant intervention in the social contagion debate comes from Finland, an early leader in medical treatment for gender dysphoria which in 2020 shifted away from the Dutch protocol to psychotherapy as its first-line treatment, following an independent expert review of the evidence base.
A leading Finnish clinician and researcher Riittakerttu Kaltiala told therapist-podcasters Stella O’Malley and Sasha Ayad that she and her colleagues were surprised that Finland’s patient profile proved to be mostly teenage girls, many with severe mental health disorders – a profile starkly different to the Dutch protocol literature.
"The evidence base for medical gender reassignment starting during [the developmental years of adolescence] is minimal, actually non-existent," Professor Kaltiala said, explaining the conclusion of the independent review.
And she said Finnish clinicians did notice peer group effects among their gender patients.
Asked her reaction when she first heard of Dr Littman's concept of ROGD, Professor Kaltiala says: "Oh, I thought, this is exactly what we are seeing in our clinic".