What Is Rapid Onset Gender Dysphoria?

Although various names have referred to it, the phenomenon of gender dysphoria has been well-studied for over a century. Gender dysphoria occurs when a person's biological sex doesn’t match their perceived gender identity. The scientific consensus is that this likely occurs due to anomalies in fetal development that lead persons to experience preferences for social roles and personal identity that are more typical of the opposite sex.

Early- and Late-Onset Gender Dysphoria

Traditionally, two forms of gender dysphoria have been recognized. The first is early-onset gender dysphoria, which appears in early childhood. For instance, a boy may prefer the company of girls and the play activities typical of that gender. Likewise, a girl may prefer hanging out with the boys and doing boyish things.

Such children are often teased as “sissies” and “tomboys,” and they often maintain their transgender identity into adulthood. Many of them cross-dress or seek gender-affirming surgery and live their adult lives as members of the opposite sex.

The second form of gender dysphoria is known as late-onset gender dysphoria because it first appears in early to mid-adulthood. Persons who experience late-onset gender dysphoria are almost exclusively male. This may simply involve experiencing sexual arousal through dressing and acting as a woman, but it can also lead to surgery and living as a female.

Rapid-Onset Gender Dysphoria

As American sexuality researchers Suzanna Diaz and J. Michael Bailey pointed out in an article recently published in the Archives of Sexual Behavior, the last two decades have seen the rise of a third type of gender dysphoria. This type occurs in adolescents, and those who experience it are overwhelmingly female. These teens showed no signs of gender dysphoria before puberty but reported a fairly sudden shift in gender identity, so the condition has been dubbed rapid-onset gender dysphoria.

The fact that there has been a recent surge in gender dysphoria in adolescents, especially females, is uncontroversial since these cases are clearly documented. However, explaining what causes rapid-onset gender dysphoria is the subject of a heated debate.

Some researchers maintain that there has been no real increase in gender dysphoria in youth. Rather, it’s just that the condition is better diagnosed and documented now than it was in the past. Through analogy, they pointed to the supposed “autism epidemic.” While it’s true that the recorded cases of autism have increased considerably over the past few decades, we also understand that this has happened because doctors now have a better understanding of the nature of autism and how to detect it.

However, proponents of the “better detection” hypothesis have difficulty explaining why there hasn’t been a similar increase in reports of early- and late-onset gender dysphoria. They also can’t explain why we’ve been regularly diagnosing and documenting cases of gender dysphoria in childhood and adulthood for at least half a century, but not cases occurring in adolescence.

The Social Contagion Hypothesis

Other researchers argue that rapid-onset gender dysphoria is a form of social contagion. Such an assertion flies in the face of overwhelming evidence that gender dysphoria is biological. However, proponents of the “social contagion” hypothesis contend that this condition is really a misdiagnosis of gender dysphoria and that its real cause lies elsewhere.

Two lines of evidence support the “social contagion” hypothesis. The first comes from reports of parents whose children transitioned as teens. While many parents support their children’s desire to transition, others are hesitant to do so. It could be that these parents are transphobic, but research shows this may not be the case. Rapid-onset gender dysphoria often occurs in adolescents growing up in well-educated, reasonably affluent families with fairly liberal social values. These parents aren’t anti-trans. It’s just that they don’t think gender dysphoria is the right diagnosis for their child.

According to parental reports, these teens were already experiencing mental health issues, and it wasn’t until after they started interacting with trans groups on social media that they began to attribute their psychological problems to gender dysphoria. Furthermore, their online friends convinced them that the only way to overcome their feelings of depression and anxiety was to transition.

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It could be that gender dysphoria is the root of the mental health issues these teens are experiencing. It can take time to diagnose some psychological disorders properly; bipolar disorder, for example, can easily be misidentified as depression at first. However, in the case of rapid-onset gender dysphoria, patients may get diagnoses from untrained amateurs with a political agenda rather than trained professionals with expertise in the field.

The second line of evidence for the “social contagion” hypothesis is the observation that a proportion of teens who transition seek to de-transition a few years later. They decide for themselves that their psychological issues weren’t really due to gender dysphoria. Or, at least, they find that transitioning hasn’t resolved those issues.

Political Arguments vs. Scientific Evidence

As Diaz and Bailey pointed out in their article, research on rapid-onset gender dysphoria has been hampered by political activism. The lay public and healthcare professionals are split in their support for the “better detection” and “social contagion” hypotheses. Those who believe we’re just getting better at detecting gender dysphoria in adolescence generally advocate for rapid transition, while those who believe that rapid-onset gender dysphoria likely has a social origin urge a wait-and-see approach.

At this point, we just don’t know which hypothesis is correct. If transitioning will help these teens regain their mental health, we should pursue this course of action. However, if many of these adolescents will eventually de-transition, early transitioning may be a treatment that causes more harm than good.

We need a dispassionate approach that examines the full range of evidence without bias. This includes comparisons of trans adults who choose to de-transition with those who don’t and studies of those who transition early versus those who transition later. We also need to consider parents' reports, both those who supported their teen’s transition and those who didn’t. Only in this way can we understand the true nature of rapid-onset gender dysphoria and the best way to treat it.