Three Popular Myths About Transgender Youth

With JK Rowling’s newfound interest in the mental health of transgender youth, there’s been a resurgence of popular myths online about transgender kids. It’s understandable that the average Twitter user would get confused as they are flooded with this misinformation. I’m a physician-scientist whose research focuses on this topic. Here is some fact-checking of the most popular myths.

1. Most transgender youth “grow out of it,” so we shouldn’t offer them medical interventions.

I constantly hear people claim that most transgender youth will grow up to identify as cisgender. This claim is based on studies that followed young people who were referred to “gender clinics.” It turns out, the majority of kids in those studies never actually identified as transgender to begin with. Many parents referred their children because they were concerned about their cisgender tomboy children or their cisgender male children who liked feminine things like dolls. Because these kids didn't identify as transgender to begin with, it's not surprising that they did not identify as transgender later in life.

Some of those kids did meet criteria for the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV diagnosis of “gender identity disorder,” but children can meet criteria for this diagnosis without identifying as transgender. This problem with the diagnosis was fixed with the DSM-5’s diagnosis of “gender dysphoria.”

Furthermore, all of these studies examined very young transgender children: those who had not yet reached puberty. Medical interventions for transgender youth are not considered until adolescents reach puberty. Thus, these studies are irrelevant to the question of medical interventions. One of the reasons doctors wait until puberty to offer medical interventions is that there is broad clinical consensus that for the majority of transgender adolescents, gender identity is unlikely to change after puberty (the other main reason is that the first intervention is pubertal suppression, and before puberty, there is nothing to suppress).

Of note, even in the rare cases where gender identity does change after puberty, this can be a normal aspect of gender identity development, and kids who get medical interventions then change their minds don’t necessarily regret the intervention. Doctors always weigh the risk of regret (generally very low) with the risk of worsening mental health that is often seen with the progression of puberty and these adolescents’ bodies developing in ways that don’t match their identities.

2. “Rapid-onset gender dysphoria” is a mental health diagnosis where youth suddenly become transgender due to social media.

In 2018, a researcher named Lisa Littman published a paper in which she coined the phrase “rapid-onset gender dysphoria.” The term refers to a theory that some transgender adolescents become transgender all of a sudden, out of the blue, and that this happens because of "transgender contagion" through social media.

The study in question advertised an anonymous survey on four websites, all of which are known as places where parents gather to promote theories that their children became transgender all of a sudden, due to social media influences.

In the original paper, Littman overstated her findings. This led the journal to publish a correction on her paper in 2019. The correction highlights that the study did not interview any actual adolescents. It only interviewed parents who had gathered on these websites. This methodology is similar to if someone recruited on QAnon forums and asked people if they believed in the Pizzagate conspiracy theory. The only thing such a study establishes is that people on these specialty websites believe something to be true.

For this reason, the correction on the paper states:

Rapid-onset gender dysphoria is not a formal mental health diagnosis at this time. This report did not collect data from the adolescents and young adults (AYAs) or clinicians and therefore does not validate the phenomenon.

3. Gender-affirmation makes mental health worse.

Folks online frequently cite a study by Cecilia Dhenje and colleagues in which they examined the mental health of transgender people who received gender-affirming surgery. The first thing to know is that according to Endocrine Society guidelines, genital surgery is not offered to minors. The second thing to know is that this paper is commonly miscited to suggest that gender-affirming surgery worsens mental health.

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The paper used a large registry of data from Sweden to look at relationships between death from suicide and gender-affirming surgery. The abstract states that death from suicide was dramatically higher for those who underwent gender-affirming surgery. The problem here is that they compared transgender people who had surgery with cisgender people.

Though surgery can improve the mental health of transgender people, it does not solve other problems like widespread harassment and discrimination. Risk factors for suicidality among transgender people include lack of access to non-surgical medical affirmation, family rejection, and lack of government recognition of their identity. Though surgery can improve the mental health of transgender people, offering only one domain of gender affirmation is not expected to completely eliminate the mental health disparities faced by transgender people.

There is no data even suggesting that pubertal suppression (which pauses puberty for transgender youth experiencing distress around puberty) or gender-affirming hormones (estrogen or testosterone to help their bodies align with their gender identity) result in worse mental health outcomes for transgender youth. All existing studies show favorable mental health outcomes.

In the digital age, misinformation sadly flows as freely as truth. Transgender youth deserve the public to focus on accurate scientific information regarding their mental health.