Rapid-Onset Gender Dysphoria: Parent Reports on 1,655 Possible Cases

Abstract

During the past decade, there has been a dramatic increase in adolescents and young adults (AYAs) complaining of gender dysphoria. One influential if controversial explanation is that the increase reflects a socially contagious syndrome among emotionally vulnerable youth: rapid-onset gender dysphoria (ROGD). We report results from a survey of parents who contacted the website ParentsofROGDKids.com because they believed their AYA children had ROGD. Results focused on parent reports on 1,655 AYA children whose gender dysphoria began between ages 11 and 21 years, inclusive. These youths were disproportionately (75%) natal female. Natal males had later onset (by 1.9 years) than females, and they were much less likely to have taken steps towards social gender transition (65.7% for females versus 28.6% for males). Pre-existing mental health issues were common, and youths with these issues were more likely than those without them to have socially and medically transitioned. Parents reported that they had often felt pressured by clinicians to affirm their AYA child’s new gender and support their transition. According to the parents, AYA children’s mental health deteriorated considerably after social transition. We discuss potential biases of survey responses from this sample and conclude that there is presently no reason to believe that reports of parents who support gender transition are more accurate than those who oppose transition. To resolve controversies regarding ROGD, it is desirable that future research include data provided by both pro-transition and anti-transition parents, as well as their gender dysphoric AYA children.

Full text

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
1
JOIBS: October 2023. ISSN 2992-9253
JOIBS © 2023 Diaz & Bailey
This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
Rapid-Onset Gender Dysphoria: Parent Reports on 1,655 Possible Cases
Suzanna Diaz, B.Sc., B.Ed., Parents of ROGD Kids
J. Michael Bailey, Ph.D., Northwestern University. E-mail: jm-bailey@northwestern.edu
Author’s Notes: “Suzanna Diaz” is a pseudonym.
Funding: Open Access of this paper was funded by the Society for Evidence-Based Gender
Medicine (SEGM). SEGM did not play any role in the study itself, including the method of
participant recruitment, the analysis of the data, and our interpretation/discussion of the
results.
Competing interests: The authors have declared that they have no competing interests.
Citation: Diaz, S. & Bailey, J. M. (2023). Rapid-onset gender dysphoria: Parent reports on 1,655
possible cases. Journal of Open Inquiry in the Behavioral Sciences.
https:/doi.org/10.58408/issn.2992-9253.2023.01.01.00000012
Supplemental Materials: https:\\osf.io/fd5hq
Abstract
During the past decade there has been a dramatic increase in adolescents and young adults
(AYAs) complaining of gender dysphoria. One influential if controversial explanation is that the
increase reflects a socially contagious syndrome among emotionally vulnerable youth: rapid-
onset gender dysphoria (ROGD). We report results from a survey of parents who contacted the
website ParentsofROGDKids.com because they believed their AYA children had ROGD. Results
focused on parent reports on 1,655 AYA children whose gender dysphoria began between ages
11 and 21 years, inclusive. These youths were disproportionately (75%) natal female. Natal
males had later onset (by 1.9 years) than females, and they were much less likely to have taken
steps towards social gender transition (65.7% for females versus 28.6% for males). Pre-existing
mental health issues were common, and youths with these issues were more likely than those
without them to have socially and medically transitioned. Parents reported that they had often
felt pressured by clinicians to affirm their AYA child’s new gender and support their transition.
According to the parents, AYA children’s mental health deteriorated considerably after social
transition. We discuss potential biases of survey responses from this sample and conclude that
there is presently no reason to believe that reports of parents who support gender transition
are more accurate than those who oppose transition. To resolve controversies regarding ROGD,
it is desirable that future research include data provided by both pro-transition and anti-
transition parents, as well as their gender dysphoric AYA children.
Keywords: Rapid-onset gender dysphoria, Adolescent gender dysphoria, Gender dysphoria,
Transgender

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
2
Introduction
The demographics of gender dysphoria have changed dramatically during the past two decades.
Specifically, the proportion of cases among adolescent natal females has sharply increased, both
absolutely and relatively (Aitken et al., 2015; Steensma et al., 2018; Zucker, 2019). This change
has been noted in clinic-referred samples across North America and Western Europe (Zucker,
2019; Zucker & Aitken, 2019). The causes of these changes are difficult to know. Two main
hypotheses have been proposed:
Hypothesis 1: There has not been an increase in the actual number of gender dysphoric
adolescents, but more of them are being recognized and referred to gender clinics.
Those who believe this hypothesis view the increase in referrals to gender clinics favorably,
because gender dysphoric youth are getting needed treatment rather than suffering in silence
(e.g., Turban & Ehrensaft, 2018). People who hold this view also tend to support gender transition
for gender dysphoric youth.
Hypothesis 2: There has been an increase in gender dysphoria among adolescents, especially
among females.
This hypothesis is associated with rapid-onset gender dysphoria (ROGD) (Littman, 2018;
Marchiano, 2017; Shrier, 2020), a recent and controversial theory. ROGD theory proposes that
common cultural beliefs, values, and preoccupations cause some adolescents and young adults
(AYAs), especially female AYAs, to attribute their social problems, feelings, and mental health
issues to gender dysphoria. That is, youth with ROGD falsely believe that they are transgender,
and that they must undergo social and medical gender transition to resolve their issues. A sharp
increase in such false beliefs among adolescents and young adults has led to the recent
“epidemic” in ROGD.
ROGD is believed to be a culture-bound syndrome, which did not exist until recently, when
transgender issues began to attract considerable cultural attention (Allen, 2015). Furthermore,
ROGD has been hypothesized to be socially contagious (Littman, 2018). Adolescents who know
others with ROGD are more likely to acquire ROGD themselves.
Advocates of the ROGD theory view the dramatic increase in referrals to gender clinics with alarm.
They are concerned that adolescents with ROGD are at risk of unnecessary, harmful, and
irreversible psychological and medical interventions (e.g., Marchiano, 2017; Shrier, 2020).
The surge in referrals for adolescent-onset gender dysphoria is so recent that neither hypothesis
has much support in the mainstream academic literature. This is understandable in the early
stages of research on any clinical phenomenon, especially one as controversial as gender
dysphoria.
Parents of Gender Dysphoric Youth as Influential Stakeholders
A new development in the history of gender dysphoria has been the formation of Internet
communities of concerned parents. These communities appear to be centered around the two

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
3
opposing viewpoints we have described. Some of these communities comprise parents
concerned that their AYA children have ROGD and are pursuing gender transition unnecessarily.
Examples include the Gender Critical Support Board, ParentsofROGDKids.com, and
Genspect.org. Other communities are more supportive of gender transition for gender
dysphoric youth. These include the Facebook group, Parents of Transgender Children, among
others. Some of these groups are quite large, with Gender Critical Support Board exceeding
3,500 registered members, and Parents of Transgender Children exceeding 8,000 members.
(Both numbers taken from their respective websites on April 12, 2022.)
Parents of gender dysphoric youth have had an especially important role in the controversies
regarding adolescent-onset gender dysphoria. For example, the blogger who writes as
4thwavenow became interested in the issue when her daughter “suddenly announced she was
a trans man after a few weeks of total immersion in YouTube transition vlogs and other trans-
oriented social media.” (4thwavenow.com, n.d.) (Her daughter’s gender dysphoria has
subsequently subsided.) Lisa Littman, who originated the theory of ROGD (Littman, 2018) was
strongly influenced by accounts of parents like this (Kay, 2019). ROGD is a controversial idea,
and has been challenged by both activists (e.g., Ashley, 2020) and scientific studies (Bauer et al.,
2022; but see Littman, 2022). Careful empirical study is sorely needed.
Parents who disagree with the concept of ROGD and who believe that their children are gender
dysphoric in the conventional sense (i.e., having a strong feeling of incongruence between their
physical body and the gender they identify with) have also played an important role in the
controversy. Until recently it was rare for parents to acquiesce to their children’s wish to
transition, but this has been changing. Parents have become much more likely to allow their
gender dysphoric children to socially and/or medically transition (see, e.g., de Graaf &
Carmichael, 2019; Olson et al., 2016). For example, minor children may be given puberty-
delaying hormones with parents’ permission. In some cases, youth years away from legal
adulthood may even receive “gender-confirming” surgery, such as mastectomy in natal females
(Olson-Kennedy et al., 2018). Thus, parents supporting gender transition have dramatically
altered acceptable social, psychological, and medical practice.
One relevant issue concerns the potentially differing motivations of parents who believe, and
those who disbelieve, the idea that their gender dysphoric adolescent children have ROGD. The
former have been accused of being prejudiced against transgender persons and other sexual
minorities (Restar, 2020; “Why are so,” 2018). However, Littman’s (2018) study found that most
such parents held tolerant views regarding the rights of sexual minorities. An alternative
explanation of these parents’ endorsement of ROGD is that it describes the trajectory of their
children’s gender dysphoria better than conventional explanations of gender dysphoria do.
ROGD has been studied primarily in adolescents and young adults (Littman, 2018). By
hypothesis, ROGD youth were not gender dysphoric prior to puberty. In contrast, early-onset
gender dysphoria begins prior to puberty, often during early childhood (Bailey & Blanchard,
2018; Zucker & Bradley, 1995). It is possible that parents of children with early-onset gender
dysphoria and parents of youth with ROGD have different preferences for their children. The
current study focuses on AYA children believed by their parents to have ROGD. Parents are the

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
4
sole source of information about these youths.
Parents of Gender Dysphoric Children as Sources of Information
Research on children’s development in many domains has long depended on parent reports.
Google Scholar reports 78,800 citations for the search term “parent reports,” as of April 12, 2022.
Research on gender dysphoria has also often included parent reports (e.g., Arnoldussen et al.,
2020; Olson, 2016; Wallien & Cohen-Kettenis, 2008; Zucker & Bradley, 1995). Researchers have
also long acknowledged the imperfections--including both incomplete information and biases--
associated with parent reports (Achenbach et al., 1987). Parent reports are especially
controversial when parent and child reports differ dramatically, as they often do in cases
considered to be ROGD (Littman, 2018).
We expect that parents’ and children’s reports are more similar for families in which parents
support their children’s transition, although this has not been studied directly. However, this does
not mean that parents who support transition are correct. These parents and their gender
dysphoric children could both be mistaken, especially if there is social pressure to accept
children’s claims of transgender status. The increasing number of people who have reidentified
with their natal gender (detransitioners) raises questions about the desirability of transition
(Littman, 2021; Marchiano, 2020).
Given the recent surge of cases of gender dysphoria in adolescents and young adults whose
demographic profile is unlike those from previous generations, it is important to seek data from
all sources and premature to reject any of them. As we learn more, we may come to prefer some
sources of information over others, but there is not yet any guide to this preference. In the
meantime, it is desirable–even urgent–to collect data from all available sources.
The Current Study
We analyzed data from a survey of parents who contacted a website for parents concerned that
their AYA children have ROGD. Parents provided data regarding their AYA children’s adjustment
before gender dysphoria onset, children’s gender dysphoria, and children’s social and medical
transition steps. We discuss potential biases in the data due to subject self-selection and survey
framing.
Method
Participants. Participants were parents or other caretakers of gender dysphoric children who
contacted the website ParentsofROGDKids.com. This website provides information and support
to parents who believe their children may have ROGD, and who are skeptical about “affirmative”
therapeutic approaches (i.e., those encouraging gender transition). ParentsofROGDKids.com did
not actively recruit parents. Rather, parents discovered the website via Internet searches or
mentions on Internet forums. After contacting the website, parents were asked to provide more
information about their gender dysphoric children, via email. This was done to ensure that those
engaging with the website were not attempting mischievous deception. Those whose information
was sufficiently detailed and credible received the following survey solicitation:

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
5
Rapid-Onset Gender Dysphoria (ROGD) is a new phenomenon that is only now beginning
to be recognized.
The so-called "gender clinics" are not forthcoming with information about demographics
or mental health issues of clients who seek out their services. Nor do they publish
information on patient outcomes.
The task is left up to us, the parents, to seek out this information on our own.
Please help us gain a better understanding of this emotionally devastating and physically
traumatizing, yet increasingly-common phenomenon.
Who Should Complete this Survey
If your child:
• Had a relatively normal childhood without showing any signs of discomfort with
their gender, and
• Suddenly, seemingly out of the blue, decided they identified as the opposite gender,
or some other "gender"
Please take the time to fill out this survey. It takes about 10-15 minutes to complete, a bit
longer if you write comments (which are very helpful!)
*Don't worry if the survey skips over some questions. It is designed to skip over questions
that do not apply to you.
All responses will be kept strictly confidential.
The authors acknowledge that the framing of the survey is biased towards belief in, and concern
about, ROGD. This may have influenced responses, although it is likely that a more important bias
was self-selection due to the website’s name and purpose. The initial purpose of the survey was
not for scientific publication, but information gathering for a community of parents with shared
concerns. In the Discussion, we consider which results are more or less likely to be biased.
Ethical Review
The first author and creator of the survey is not affiliated with any university or hospital. Thus,
she did not seek approval from an IRB. After seeing a presentation of preliminary survey results
by the first author, the second author suggested the data be analyzed and submitted as an
academic article. (He was not involved in collecting the data.) The second author consulted with
his university’s IRB. He was informed that IRBs do not certify studies in which data have already
been collected. However, the IRB explained that the first author (who collected the data) was not
required to have IRB approval to conduct the survey, because she was not a member of an
organization governed by relevant regulations. Furthermore, they advised that the second author
could ethically collaborate on the study if data were deidentified.
The Survey
Parent informants provided information about their gender dysphoric children. The data analyzed
herein include parents’ reports on the following variables: timing and early signs of children’s
gender dysphoria; children’s mental health (including formal diagnoses) and social adjustment
prior to the onset of gender dysphoria; and children’s steps taken towards both social and medical
transition. The survey and data are provided at https:\\osf.io/fd5hq.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
6
Results
Survey Respondents. Participants of the current study completed surveys from December 1, 2017
(the beginning of the survey) through October 22, 2021, a total of 46 months. In total 1,774
responses were received. (The number of potential participants who contacted the website was
not recorded.)
Most survey respondents (N = 1,496; 84.3%) were mothers reporting on their own children.
Fathers (N = 223) comprised 12.6% of the respondents, and persons with some other relationship
to the gender dysphoric youth, such as stepparent, grandparent, or adoptive parent (N = 55; 3.1%)
were the remaining respondents. For ease of presentation, we refer to respondents as “parents.”
To illuminate the general political/ideological orientation among the parents who responded, the
first author examined a subset of email correspondence in which some parents provided details
about their gender dysphoric children and family situation. Emails were chosen systematically, by
taking the first ten of every consecutive fifty. (Parents were not queried to provide this
information until after the project had commenced, and so not all parents provided emails.) A
total of 280 emails were examined for statements indicating either supportive/progressive
attitudes or unsupportive/conservative attitudes. Statements were coded as
supportive/progressive if they indicated that parents were politically progressive, including
supportive of LGBT rights and people. This included evidence that they were at least partially
supportive of their child’s gender-related choices. Emails were coded as
unsupportive/conservative if they indicated that parents were conservative or religious in ways
that may not be supportive of LGBT rights or people. (Statements indicating either conservative
or religious beliefs were not, by themselves, coded as the latter.) The number of coded statements
indicating supportive/progressive sentiments was 70, and the number indicating
unsupportive/conservative sentiments was 5. Table 1 contains 7 examples of the
supportive/progressive statements (every tenth statement starting at the first), and all 5
unsupportive/conservative statements. All deidentified coded statements are included as a
supplement.
Characteristics of Gender Dysphoric Youth
Current Age, Age of Onset, and Duration of Gender Dysphoria. The survey included the following
description of gender dysphoria: “feeling unhappy or uncomfortable with your gender. It can
include wishing to be the opposite gender, or to be a different ‘gender’ altogether. It can also
include simply rejection of your own gender.” It then listed several “signs of gender dysphoria,”
focusing on displaying cross-sex behavior (e.g., “changing your posture or way of moving”).
Respondents were asked to estimate when their child “began to exhibit signs of gender
dysphoria.” On average, the youths were reported to be 14.8 years (SD = 3.1) when they became
gender dysphoric. Onset ages ranged from 3 to “greater than 25 years,” with a median of 14 years.
Because ROGD is hypothesized to begin during puberty through early adulthood (Littman, 2018),
we limited subsequent analyses to parent reports on youths whose gender dysphoria was
reported to begin between ages 11 and 21, inclusive. This left 93.3% (N = 1,655) of the original
sample, of whom 75% (N = 1,249) were natal females and 25% (N = 406) natal males. They had a
mean age of gender dysphoria onset of 14.6 years (SD = 2.2). Current age of gender dysphoric
youths averaged 15.7 (SD = 2.7) years for females and 17.2 (SD = 2.7) for males, t(1653)=9.9, p <

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
7
0.001, d = 0.56.
Fig. 1 shows the distribution of age of gender dysphoria onset, separately for natal females and
males. Reported onset was significantly later for natal males (M = 16.0, SD = 2.2) than for natal
females (M = 14.1, SD = 2.2), t(1653) = 15.5, p < .001, d = 0.84. Duration of gender dysphoria,
from onset to the present, was briefer for the natal males (M = 1.2 years, SD = 1.6) than for the
natal females (M = 1.6 years, SD = 1.6), t(1772) = 5.3, p < .001, d = 0.25.
Demographics. Ethnic backgrounds of the youths were European (N = 1,276; 78.9% of those who
answered this question), ethnically mixed (N = 262; 16.2%), Asian (N = 45; 2.8%), Indigenous (N =
13; 0.8%), African-American (N = 10; 0.6%), Middle Eastern (N = 6; 0.4%), and East Indian (N = 6,
0.4%). Although the survey did not ask where respondents lived, it did include one question
regarding where the gender clinic the youth attended (if any) was located. The most common
location was in the United States (N = 357; 74.2% of those who provided any location), followed
by Canada (N = 49; 10.2%), Europe (N = 46; 9.6%), and Australia (N = 25; 5.2%). Thus, it is likely
that most respondents were from North America.
Prior Social Adjustment. Table 2 provides several ratings of gender dysphoric youths’ social
adjustment prior to the onset of gender dysphoria. Ratings were similar for natal females and
males, with only two showing statistically significant sex differences. Parents reported that natal
males were more likely to have been bullied and less likely to have had many good friends.
Informants rated the relationships between the youths and their mothers and fathers both prior
to gender dysphoria onset, and after social transition (if any), on a 6-point scale from 1
(estranged) to 6 (extremely close). Pre-dysphoria relationships with mothers had a mean rating
of 5.2 (with 5 representing “fairly close” and 6 representing “very close”), and relationships with
fathers a mean of 4.6 (with 4 representing “neutral”). For a subsequent analysis of change after
social transition, we computed a composite score of parental relationship quality by averaging
mothers’ and fathers’ ratings at each time period.
Mental Health History. Asked whether the gender dysphoric youth have a history of “mental
health issues,” 57% (N = 944) of informants responded affirmatively, 42.5% (N = 703) negatively,
and 0.4% (N = 8) did not respond. The percentage of affirmative responses was slightly higher for
natal females (59.4%) than for natal males (51%), c2(1, N = 1647) = 8.7, p = 0.003. Fig. 2 presents
the distribution of the onset of children’s mental health issues relative to the onset of their gender
dysphoria. On average, mental health problems began at 10.5 years (SD = 3.6; Mdn = 11), and
preceded gender dysphoria by 3.8 years, paired t(940) = 32.0, p < 0.0001, d = 1.31.
Informants were asked about several possible “first symptoms” of mental health issues. Table 3
provides the frequency of each initial symptom, separately by natal sex. More frequent
responses, averaged across natal sex, are higher in the table. The most common problem
mentioned was “anxiety,” and this was significantly more common among natal females than
among natal males. Other problems producing relatively large and significant sex differences
included self-injury (more common in natal females), and addiction to video games (more
common in natal males). In contrast, addiction to the Internet did not produce a significant sex
difference.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
8
Asked whether the youth had ever received “a formal psychological diagnosis,” 42.5% (N = 703)
of informants said “yes.” Responses to this question were highly correlated with responses to the
previously mentioned question whether the gender dysphoric youth had a history of mental
illness, r(1653) = 0.74. (For some later analyses, a variable was constructed by summing the
dichotomous responses to both items. The summed composite should have greater reliability
than either of its component items. We refer to the composite as “Mental Health Issues,” and
higher scores indicated more problems with mental health.) The percentage of youths with formal
diagnoses was similar for natal females, 43.4% (N = 542) and natal males, 39.7% (N = 161), c2(1,
N = 1665) = 1.75, p = 0.19. Furthermore, older youths were slightly more likely to have diagnoses,
with the correlation between current age and diagnostic status, r(1653) = 0.07, p = 0.006.
Diagnoses had been provided mainly by psychiatrists (41.6%; N = 294) and psychologists (30.0%;
N = 212). Table 4 provides the frequencies of specific diagnoses that were queried, separately by
natal sex. Youths with formal diagnoses averaged 2.2 diagnoses (SD = 1.1). This variable did not
differ significantly by sex.
Asked whether any stressful events in their AYA child’s life may have contributed to the onset of
gender dysphoria, 72.6% (N = 1,161) of parents said “yes.” Inspection of specific responses
suggested that these stressful events varied considerably in both their nature and severity. For
example, a number of parents noted that the family had moved recently. Others mentioned the
youth’s romantic difficulties. But a few said that the youth had suffered severe physical or sexual
abuse, and several mentioned that a friend or relative had committed suicide. Respondents rated
youths with these experiences higher on the composite variable Mental Health Issues, compared
with other youths, t(1597) = 3.9, p < 0.001, d = 0.22.
Intelligence. Informants rated the youths’ intelligence using a 5-point scale from 1 (exceptionally
low–mentally handicapped) to 5 (exceptionally high intelligence). In general, ratings were high,
with only 15.5% (N = 255) of youths rated as average or below average, and 35.6% (N = 587) rated
as having exceptionally high intelligence. Natal males (M = 4.38) were rated slightly higher than
natal females (M = 4.13), t(1645) = 6.1, p < 0.0001, d = 0.36.
Social and Medical Transition
Asked whether their gender dysphoric AYA child had “come out” as the “opposite gender or some
other gender,” 89.3% (N = 1,458) of those who answered responded affirmatively. Of these cases,
81.6% of the youths came out as the opposite gender, but in 18.4% another gender was specified,
such as “gender fluid,” “non-binary,” and “trans” or “transgender.” Coming out as a different,
rather than opposite, gender was more common among natal females (N = 235; 20.9%) than
among natal males (N = 31; 9.8%), c2(1, N = 1442) = 20.3, p < 0.0001. Of youths who had “come
out,” 22% (N = 321) were out “everywhere.” Being out everywhere was more common for natal
females (N = 273, 21.9%) than for natal males (N = 48, 11.8%), c2(1, N = 1655) = 19.7, p < 0.0001.
The survey included questions about social transition, which was explained as follows:
Social transition means taking formal steps to live as the opposite gender (or some other
gender) officially. This can include:
legally changing their name, gender and pronouns on government ID

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
9
expecting everyone to refer to them with their new name and pronouns
constantly trying to "pass" as the opposite gender in manner of dress, posture,
tone of voice, mannerisms and interests
Social transition formalizes "coming out" as transgender, and the two often occur
together.
Of 1,436 youths for whom informants provided relevant information, 65.3% (N = 937) had socially
transitioned, 33.8% (N = 485) had not socially transitioned, and 1% (N = 14) no longer wished to
transition (i.e., had desisted). Mean age at social transition was reported as 15.4 years (SD = 2.6).
Current social transition was much more common among natal females, 65.7% (N = 821) of whom
were rated as socially transitioned, compared with 28.6% (N = 116) of the natal males, c2(1, N =
1655) = 172.3, p < 0.0001. Furthermore, natal females tended to socially transition earlier (15.1
years) than natal males (17.4 years), t(932) = 9.1, p < 0.0001. Of those who had desisted, 13 of 14
were natal females, out of 1,120 females and 316 males for whom parents provided this
information.
Table 5 presents rates of several aspects of social transition, separately for natal males and
females. Natal females were substantially more likely than natal males to have taken most of the
social transition steps. Table 6 presents rates of several aspects of medical transition, separately
by natal sex. In general, steps toward medical transition were unusual. For example, hormone
blockers were reported for only 0.8% of natal females and 2.0% of natal males (test of the sex
difference, c2(1, N = 1655) = 3.9, p = 0.048). The most frequently reported medical intervention
was cross-sex hormones, received by 6.5% of females and 8.4% of males (the test of the sex
difference was not significant, p = 0.193). Surgical intervention was assessed using the question
“Has your child surgically transitioned?” Surgical transition was especially rare, reported for 1%
of males and 0.7% of females (the test of the sex difference was not significant, p = 0.604).
Parents were also asked to rate the separate effects of social transition on their AYA child’s gender
dysphoria, anxiety, and depression. These ratings were substantially correlated and were
averaged to provide an overall rating from 1=much worse to 5=much better, with 3 indicating no
change. Coefficient alpha for this 3-item scale was 0.73. Fig. 3 shows the distribution of this
variable for the 556 parents who answered all three questions. Parents were much more likely to
say that the youth had worsened than improved. The one-sample t-test comparing the sample
mean 2.1 with 3, the score signifying no change, was highly significant, t(566) = -24.6, p < 0.0001,
d = -1.0.
The change in the quality of parental relationships (from prior to gender dysphoria to after social
transition) was also strongly negative, declining from an average of 4.8 (indicating “fairly close”)
to 3.6 (between “neutral” and “don’t get along very well”), paired t(891) = -32.0, p < 0.0001, d =
-1.2. This decline was especially severe for mothers, a 1.5 point decrease compared with fathers’
0.9 point decrease, paired t(891) = 10.4, p < 0.0001, d = 0.4.
Parents were asked whether they had felt pressure from a “gender clinic or specialist” to
transition their child socially or medically. Of the 390 parents who answered this question, 51.8%
(N = 202) answered “yes,” 23.6% (N = 92) were unsure, and 24.6% (N = 96) said “no.” Treating this

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
10
item as a 3-point scale (from 1=“no” to 2=“unsure” to 3=“yes”), parents who felt pressured were
more likely to believe their children had deteriorated after transition, r(197) = 0.22, p = 0.002.
Correlates of Social and Medical Transition. We examined correlates of current social transition
(i.e., contrasting youths who are currently socially transitioned with those who have not socially
transitioned; these analyses ignored those who have desisted). Table 7 contains the results of
univariate and multivariate tests for the correlates we explored. Univariate tests are for the
associations between each single correlate and current social transition. (These were tested
either via logistic regression, for numeric correlates or via contingency analyses for dichotomous
correlates.) Socially transitioned youths were significantly more likely to be natal female (see
above). They tended to be older: 72.7% of females 16 or older had transitioned, compared with
60.1% of those younger than 16; for males the respective figures were 31.2% and 21.3%. They
tended to have had gender dysphoria longer: females who had been gender dysphoric for longer
than one year had a 75.5% rate of social transition, compared with 58.6% for those gender
dysphoric for one year or less; for males the respective figures were 45.7% and 22.6%. They
tended to have a history of mental health issues: 74.1% of females with both a history of mental
health issues and a formal diagnosis had social transitioned, compared with 57.2% of those with
neither; for males the respective figures were 31.5% and 24.2%. Finally, we examined associations
between social transition and contact with gender specialists. Of the 1,396 parents who answered
the relevant question, 37.8% (527) had received a referral to a gender specialist and 52.3% (737)
had not. (The remaining 9.5% [132] did not know.) These referrals were associated with a greater
chance of social transition: 82.3% of females with a referral had socially transitioned compared
with 58% of other females; the respective figures for males were 44.3% and 21.1%. The table also
contains multivariate tests for the association between each correlate and current social
transition, controlling for the other correlates. (These were tested via multiple logistic regression.)
In every case, the direction of associations was identical for univariate and multivariate analyses,
and the predictors remained statistically significant.
Table 8 contains analogous results for having received any hormonal treatment. The pattern of
results was similar to that for social transition, with the aforementioned exception of natal sex:
males were more likely than females to have received hormonal treatment. Males 16 and older
had a 11.4% rate of hormonal treatment, compared with 0% for those 16 or younger; respective
figures for females were 14.3% and 0.3%. Males whose gender dysphoria had persisted longer
than one year had a 23.8% rate of hormonal treatment, compared with a 3.0% rate for those with
a shorter duration; for females these figures were 13.6% and 1.3%, respectively. Males with both
indicators of mental health issues (see above) had a hormonal treatment rate of 8.8%, compared
with 7.6% for those with neither indicator; for females these figures were 8.7% and 3.7%. Finally,
males who had contact with gender specialists had a hormonal treatment rate of 12.2%,
compared with 6.6% for those without such contact; for females these rates were 10.1% and
4.8%.
Possible Social Influences on Gender Dysphoria and Transition. Asked whether the youths were
friends with others who “came out as transgender around the same time,” 55.4% of parents (N =
917) said “yes.” That response was significantly higher regarding natal females (60.9%, N = 760)
than natal males (38.7%, N = 157), c2(1, N = 1655) = 61.0, p < 0.0001. Among those who answered

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
11
“yes,” the mean number of transgender friends was 2.4 (Mdn = 2). Having friends come out as
transgender contemporaneously was significantly related to the likelihood of social transition,
statistically adjusting for natal sex, c2(1, N = 1655) = 63.5, p < 0.0001. Among females, 73.3% with
contemporaneous transgender friends had taken steps toward social transition, compared with
54% without such friends; for males, respective figures were 39.5% and 21.7%.
Informants estimated that before developing gender dysphoria, their children spent an average
of 4.5 hours per day “on the Internet and social media” (Mdn = 5). The estimate for natal males
(M = 5.6) was significantly higher than for natal females (M = 4.1), t(1455) = 8.6, p < .0001, d =
0.6. This variable (hours per day using the Internet and social media) was not significantly related
to the likelihood of social transition, statistically adjusting for natal sex, c2(1, N = 1457) = 1.0, p =
0.30.
Changes in Characteristics of Gender Dysphoric Youths
We examined whether any of the following variables have changed in a consistent manner across
the 3 years and 10 months of data collection for this article: natal sex, age of gender dysphoric
youths, years with gender dysphoria, mental health issues, and social or medical transition status.
This was done by regressing each variable on the continuous measure of survey completion date.
Table 9 shows that most of these variables have shown statistically significant changes. To clarify
these changes, we provide separate numbers for youths reported on prior to 2020 (first cohort)
with those reported on in 2020 and 2021 (second cohort). The former was 20.2% male, and the
latter 28.3% male. Ages of gender dysphoric youths at the time of the survey decreased from 16.3
to 15.9 years. Estimated age of gender dysphoria onset decreased from 14.7 to 14.5 years. Years
with gender dysphoria at the time of survey decreased from 1.6 to 1.4 years. The likelihood of
referral to a gender specialist decreased from 35.3% to 28.9%.
Discussion
Results of our study are generally consistent with other recent research about the current surge
of gender dysphoria among youth with onset during adolescence or young adulthood. Natal
females were affected more often than natal males. Preexisting mental health issues were
common, but so was high intelligence. Most youths had changed their pronouns, and most of
these changes were cross-sex rather than gender-neutral. Social transition was far more prevalent
than medical transition. There was evidence of immersion both in social media and in peer groups
with other transgender-identifying youths.
How does the rate of mental health issues compare with that from the general AYA population?
The 2020-2021 National Survey of Children's Health (NSCH) queried parents in the United States
about their children’s mental health statuses (Child and Adolescent Health Measurement
Initiative, 2021). The rate of adolescents aged 12–17 with at least one of ten queried conditions
was 29% (95 C.I.: 27.9%–30.1%). The mental health conditions queried included several surveyed
in our survey, including the most common conditions (Anxiety, Depression, ADHD, and Autism).
However, that study’s ten conditions also included learning disabilities, which our study did not
assess. In our sample, 41% of adolescent and young adult children had at least one mental health
diagnosis, a rate that was somewhat higher but not overwhelmingly so. Because the rates

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
12
estimated by NSCH and by us were derived differently, this comparison must be tentative. Future
research on mental health diagnoses among adolescents with gender dysphoria should ideally
include comparison groups of non-dysphoric adolescents assessed with the same instrument.
One causally informative, statistically powerful, and convenient method would be to compare
gender dysphoric adolescents with their non-gender dysphoric siblings.
Two sex differences are potentially important. These included the findings that natal males’
gender dysphoria was reported to be 1.9 years later than females’ and that natal males were
much less likely than females to have taken steps toward social transition. This difference
contrasts with findings from a study of clinic-referred gender dysphoric adolescents in Toronto
and Amsterdam, which did not show a sex difference in referral age (Aitken et al., 2015). That
study included adolescents regardless of when their gender dysphoria began, whereas youths
reported on in the present study were believed to have adolescent or young adult onset. The
current study’s results are consistent with the existence of different causes for gender dysphoria
in natal females and males, at least in some cases. Specifically, one kind of gender dysphoria,
stemming from autogynephilia–a natal male’s sexual arousal at the idea of being female–occurs
only in adolescent and post-adolescent natal males and does not appear to have an analogue
among natal females (Bailey & Blanchard, 2017). Unfortunately, the survey did not assess youths’
sexuality. An alternative potential explanation is that females begin puberty earlier than males.
To the extent that pubertal changes contribute to the onset of gender dysphoria, earlier onset
would be predicted for females (Aitken et al., 2015).
One statistically robust finding was both disturbing and seemingly important. Youths with a
history of mental health issues were especially likely to have taken steps to socially and medically
transition. This relationship held even after statistically adjusting for likely confounders (e.g., age).
The finding is concerning because youth with mental health issues may be especially likely to lack
judgment necessary to make these important, and in the case of medical transition permanent,
decisions. The finding supports the worries of parents whose preferences differ from their gender
dysphoric children. It is consistent with another finding of this study, that parents believed gender
clinicians and clinics pressured the families toward transition. The finding is particularly
concerning given that parents tended to rate their children as worse off after transition.
Limitations
At least two related issues potentially limit this research. First, parents were recruited via a
website for parents who believe their children have ROGD, rather than a more conventional and
less problematic form of gender dysphoria. Such parents are unlikely to be representative of all
parents with gender dysphoric adolescents. However, it is unclear how one might recruit a
representative sample of parents reporting on their gender dysphoric adolescents. National
gender clinics such as those found in Canada, the Netherlands, the United Kingdom, Sweden, and
Finland may have especially large caseloads. But without large community epidemiological
studies, we cannot know whether the patients seen at the clinics are representative of the
population of gender dysphoric youth. More than twice as many parents in our sample reported
that they had not received a referral for a gender specialist for their children as parents who had
received a referral. Thus, it is uncertain what proportion of gender dysphoric adolescents like

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
13
those reported on in our study are seen at national clinics. The ROGD phenomenon (or more
cautiously, the ROGD concept) is so new that nothing is confidently known.
Second, because parents in our sample were self-selected for concern that their children have
ROGD, parent reports could be biased and inaccurate. Why would parents be biased to believe in
ROGD, and to oppose their children’s gender transition? One hypothesis is that parents with these
attitudes are socially conservative and thus “transphobic.” However, the limited research on such
parents has shown the opposite, that such parents tend to be politically progressive and to hold
tolerant attitudes towards sexual and gender minorities (Littman, 2018; Shrier, 2020). Our results
also support the view that parents concerned that their AYA children have ROGD are not
motivated by intolerance or conservative ideology (Table 1). The possibility remains that it is
parents who reject the ROGD explanation who are incorrect and thus, biased. At present, it is
uncertain why some parents believe their children have ROGD and oppose their gender
transition, while other parents reject the ROGD concept and facilitate their children’s gender
transition. It is possible, of course, that the ROGD hypothesis and the alternative hypothesis are
both correct in certain cases, leading their parents to form different beliefs and attitudes.
Assuming for now that parents in our study were apt to provide responses biased in favor of
ROGD explanations and opposed to transition, which findings are most suspect, and which are
least so? Simple ratings averaged over all parents are especially likely to be due to bias. For
example, the finding that parents tended to view their children’s mental health and parental
relationships as worsening after transition could reflect a biased tendency to associate negative
outcomes with transition. In contrast, findings that depend on comparisons between parents in
this study are less likely to be due to bias. For example, it is unclear how bias could cause parents
of natal males to report a later age of onset for their children’s gender dysphoria compared with
parents of natal females. Nor is it clear how bias could cause parents to report a higher rate of
transition steps among youth with mental health issues compared with other youth.
Revisiting Two Hypotheses About the Recent Surge in Adolescent Gender Dysphoria
What explains the sharp increase in referrals in treatment for adolescent gender dysphoria,
especially among natal females? Is the increase attributable to increased awareness and
tolerance of transgender youth who have been gender dysphoric since early in life? Or does it
reflect emotional susceptibility to socially contagious ROGD? Our results cannot resolve this
question, but they were generally consistent with the latter hypothesis. On average, parents in
our study reported that their children first became gender dysphoric during adolescence. To be
sure, adolescent onset was an inclusion criterion. However, that criterion applied to 93.3% of
parents who responded to the survey, and the survey explanation did not mention adolescent
onset. Thus, adolescent or young adult onset appears to be a feature shared by most youths
whose parents believe they have ROGD.
Regarding social contagion, most parents reported that their gender dysphoric children had
acquaintances who “came out as transgender around the same time.” This was especially likely
for girls, who are hypothesized to be especially vulnerable to ROGD.
Parents who reported that their children had emotional issues dated these issues several years

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
14
before their children’s gender issues. According to parents, youths’ mental health substantially
worsened after social transition. That is more consistent with the hypothesis that these youths’
emotional issues caused their gender dysphoria than vice versa. Gender transition did not appear
to be a natural and beneficial remedy for gender dysphoria.
We have noted that parents in our study may be unrepresentative because they oppose gender
transition. This raises the question why these parents are responding differently than parents
who support their children’s gender transition. We provided evidence against the hypothesis that
parents in our study are prejudiced against the transgender. Instead, perhaps parents’ decisions
to support or oppose gender transition reflect characteristics of their gender dysphoric children.
Children whose parents support their gender transition may differ fundamentally from the youths
reported on in our study. For example, in a highly publicized cohort of youths who socially
transitioned with parents’ cooperation, the mean age was 7.7 years, and all were 12 or younger
(Olson et al., 2016). Thus, their gender dysphoria began during childhood rather than
adolescence. In contrast, the mean age of gender dysphoria onset in our study was 14.6 years.
Childhood-onset gender dysphoria is a well-known and well-studied syndrome (e.g., Zucker, 2019;
Zucker & Bradley, 1995) and is distinct from ROGD. Childhood-onset gender dysphoria is
associated with both marked gender nonconformity and unhappiness living as one’s natal sex that
manifest well before adolescence, typically by preschool age (Zucker & Bradley, 1995). In contrast,
ROGD is hypothesized to begin during adolescence or young adulthood. How likely is it that
parents in our sample failed to observe obvious early signs of gender dysphoria and gender
nonconformity until their children became adolescents? We think it is more likely that these
youths have a different syndrome: ROGD. Child-onset gender dysphoria is more likely than ROGD
to motivate parental support for gender transition because it is more clearly a syndrome of
gender dysphoria, rather than an expression of preexisting problems and social influences. A
recent finding from cohort being followed by Olson and colleagues provides further support for
the difference between the youths we (indirectly) studied and children whose gender dysphoria
began during childhood (Durwood et al., in press). In that study parents of child-onset cases
reported an improvement in their children’s psychological functioning after social transition. In
contrast, parents in our study reported marked worsening of their children’s functioning after
social transition.
Future Directions.
Our study relies on information provided by parents who believe their children have ROGD and
are thus unlikely to be supportive about their children’s transgender status and intentions to
transition. Obviously, it would be highly desirable for future studies also to include parents with
differing beliefs and attitudes. Furthermore, responses from gender dysphoric adolescents and
young adults, themselves, would be extremely important. None of these informants is
guaranteed to provide accurate information. But examining the extent and domains of their
agreement versus disagreement will be crucial to addressing the ongoing controversies
concerning ROGD and the “epidemic” of adolescent gender dysphoria. Longitudinal data will be
especially valuable, because all stakeholders in this controversy ultimately have the same goal:
the long-term happiness of gender dysphoric youth.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
15
References
4thwavenow. (n.d.). https://4thwavenow.com/about/ Retrieved September 9, 2021.
Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional
problems: Implications of cross-informant correlations for situational specificity. Psychological
Bulletin, 101(2), 213-232.
Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A., ... Zucker, K. J.
(2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria.
Journal of Sexual Medicine, 12(3), 756-763.
Allen, C. (2015, March 2). The transgender triumph. Weekly Standard. Retrieved from
https://www.weeklystandard.com/charlotte-allen/the-transgender-triumph/
Arnoldussen, M., Steensma, T. D., Popma, A., van der Miesen, A. I., Twisk, J. W., & de Vries, A. L. (2020).
Re-evaluation of the Dutch approach: are recently referred transgender youth different
compared to earlier referrals? European Child and Adolescent Psychiatry, 29, 803-811.
Ashley, F. (2020). A critical commentary on ‘rapid-onset gender dysphoria’. The Sociological Review,
68(4), 779-799.
Bailey, J. M., & Blanchard, R. (December 7, 2017). Gender dysphoria is not one thing. 4thWaveNow.
https://4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/ Retrieved September
9, 2021.
Bauer, G. R., Lawson, M. L., Metzger, D. L., & Trans Youth CAN! Research Team. (2022). Do Clinical data
from transgender adolescents support the phenomenon of “rapid onset gender dysphoria?”
Journal of Pediatrics, 243, 224-227.
Child and Adolescent Health Measurement Initiative (2021). Data Resource Center for Child and
Adolescent Health website. Child and Family Health Measures. 2020-2021 National Survey of
Children’s Health (two years combined). Retrieved 09/18/23 from www.childhealthdata.org.
de Graaf, N. M., & Carmichael, P. (2019). Reflections on emerging trends in clinical work with gender
diverse children and adolescents. Clinical Child Psychology and Psychiatry, 24(2), 353-364.
Durwood, L., Gallagher, N. M., Sifre, R., & Olson, K. R. (in press). A study of parent-reported internalizing
symptoms in transgender youth before and after childhood social transitions. Clinical
Psychological Science.
Kay, J. (March 19, 2019). An interview with Lisa Littman, who coined the term ‘Rapid Onset Gender
Dysphoria.’ Quillette. https://quillette.com/2019/03/19/an-interview-with-lisa-littman-who-
coined-the-term-rapid-onset-gender-dysphoria/ Retrieved September 9, 2021.
Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental
reports. PLoS ONE, 13(8), e0202330. https://doi.org/10.1371/journal.pone.0202330.
Littman, L. (2021). Individuals treated for gender dysphoria with medical and/or surgical transition who
subsequently detransitioned: A survey of 100 detransitioners. Archives of Sexual Behavior, 50(8),
3353-3369.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
16
Littman, L. (2022). Saying that Bauer et al. studied rapid onset gender dysphoria is inaccurate and
misleading. Journal of Pediatrics, 245, 250.
Marchiano, L. (2017). Outbreak: On transgender teens and psychic epidemics. Psychological
Perspectives: A Quarterly Journal of Jungian Thought, 60(3), 345-366.
Marchiano, L. (January 2, 2020). The ranks of detransitioners are growing. We need to understand why.
Quillette. https://quillette.com/2020/01/02/the-ranks-of-gender-detransitioners-are-growing-
we-need-to-understand-why/
Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender
children who are supported in their identities. Pediatrics, 137(3), e20153223.
Olson-Kennedy, J., Warus, J., Okonta, V., Belzer, M., & Clark, L. F. (2018). Chest reconstruction and chest
dysphoria in transmasculine minors and young adults: Comparisons of nonsurgical and
postsurgical cohorts. JAMA Pediatrics, 172(5), 431-436.
Pless, C. E., & Pless, I. B. (1995). How well they remember: The accuracy of parent reports. Archives of
Pediatrics and Adolescent Medicine, 149(5), 553-558.
Restar, A. J. (2020). Methodological critique of Littman’s (2018) parental-respondents accounts of “rapid-
onset gender dysphoria”. Archives of Sexual Behavior, 49, 61-66.
Shrier, A. (2020). Irreversible damage: The transgender craze seducing our daughters. Regnery
Publishing.
Steensma, T. D., Cohen-Kettenis, P. T., & Zucker, K. J. (2018). Evidence for a change in the sex ratio of
children referred for gender dysphoria: Data from the Center of Expertise on Gender Dysphoria
in Amsterdam (1988–2016). Journal of Sex & Marital Therapy, 44(7), 713-715.
Tur ban, J . L., & Ehre nsaf t, D. (2 018). Gender ident ity i n you th: Tre atm ent para digms and co ntro ver sie s.
Journal of Child Psychology and Psychiatry, 59(12), 1228-1243.
Wallien, M. S., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children.
Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413-1423.
Why are so many teenage girls appearing in gender clinics. (2018). Economist.
https://www.economist.com/united-states/2018/09/01/why-are-so-many-teenage-girls-
appearing-in-gender-clinics
Xu, G., Strathearn, L., Liu, B., & Bao, W. (2018). Prevalence of autism spectrum disorder among US
children and adolescents, 2014-2016. JAMA, 319(1), 81-82.
Zucker, K. J. (2019). Adolescents with gender dysphoria: Reflections on some contemporary clinical and
research issues. Archives of Sexual Behavior, 48(7), 1983-1992.
Zucker, K. J., & Aitken, M. (2019, April). Sex ratio of transgender adolescents: A meta-analysis. In 3rd
biennal EPATH Conference Inside Matters. On Law, Ethics and Religion (p. 48).
Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and
adolescents. Guilford Press.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
17
Table 1
Example statements by participants indicating either supportive/progressive attitudes or
unsupportive/conservative attitudes.
Supportive/progressive statements
1. Mother & partner are a same-sex couple
2. We knew nothing about this (ROGD) up until my son told us he was transgender. We
were initially of course entirely loving and supportive of him.
3. Any discussion of her sex, sexuality or any ‘gender issues’ resulted in verbal and physical
abuse. She has accused us all of homophobia, transphobia and assorted other bigotry.
To be honest I would love her to declare she is a lesbian and move on.
4. The LBGQT community's influence is very strong and their support seems to have no
end. I myself am a supporter and have friends in the community, but this has nothing to
do with them and is none of their business. It’s about me doing what is best for my child
5. At [age deleted] she told us she was gay. I didn't freak out, I really don't care if she's gay.
Then last year she asked me to take her to the Pride festival. I wanted to be supportive
so I took her,
6. One of my husband’s good friends is transgender...My husband having a personal
experience with a transgender friend, helped her to realize that we weren't bigots when
we said we were not going to affirm her friend’s choice of pronouns
7. My brother came out as gay…. My mom, who worked in [deleted occupation], knows a
lot about sexuality. She thinks it is a harmless sexual kink for many men to be treated
like a woman, but it does not really mean he is uncomfortable being a man; he just
wants to be desired and loved for a specific time like he thinks a woman is desired and
loved.
Unsupportive/conservative statements
1. Children who "think" that they can just turn themselves into something that is
impossible and wrong. God created male and female and no matter what a so-called
medical person thinks they can modify they cannot change the DNA it is still male and
female not the opposite. We need someone who is conservative, maybe faith-based,
someone who can help my son figure out why he is depressed and what is going on
inside his head someone who can help us.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
18
2. I am not against the LGBTQ but don't believe it's God's best for people. My husband is
more adamantly opposed. So far I haven't done much other than tell her I love her no
matter what & absolutely nothing will change that.
3. Are there professionals who can work with our daughter to guide her back to an
authentic biblical faith instead of her brand of "christianity" which includes [details
deleted], trans support, and a love of alternative lifestyles...She sees a weekly Christian
therapist that uses standard therapy CBT techniques but never challenges her
disordered gender/sexuality thinking.
4. We raised our kids in the faith to have love and respect for the dignity of all people, not
just those whose decisions and ideas we agree with.… We are being called
homophobic, transphobic, violent, abusive and bigoted by our daughter, her friends, our
former friends, and …family. We were given no chance to defend ourselves from any of
these accusations
5. I struggle constantly with how to show love to someone who shows complete disdain
for everything that has been dear to my heart from my faith to my country and my
traditions.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
19
Table 2
Parent reports of children’s social adjustment prior to gender dysphoria
Natal
Female
(%)
Natal
Male
(%)
Youth had a few good friends
56.7
57.6
Youth got along with other kids
33.9
33.7
Youth was bullied*
26.3
33.3
Youth was well liked
27.3
22.7
Youth had one good friend
17.4
15.8
Youth was not well liked by peers
14.3
16.8
Youth had many good friends*
9.9
3.9
Others instigated fights/arguments with youth
4.7
5.4
Youth instigated fights
2.3
3.2
Youth bullied others
2.2
0.7
Descriptors were not mutually exclusive. Numbers represent the percentages of parents
endorsing each descriptor.
*Significant sex difference, p < 0.01.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
20
Table 3
Parent reports of gender dysphoric children’s earliest mental health symptoms
Symptom
Natal
Female
(%)
Natal
Male
(%)
Te st o f S ex
Difference
(
c
2)
Probability
for Test of
Sex
Difference
Depression
33.2
25.1
9.4
0.002
Anxiety
47.3
35.2
18.2
<0.0001
Self-harm
19.9
6.9
37.4
<0.0001
Defiant behavior (acting out)
10.3
8.1
1.7
0.20
Suicidal ideation
13.1
9.9
3.0
0.08
Attempted suicide
4.1
3.2
0.6
0.42
Difficulty socializing with peers
26.5
28.1
0.4
0.53
Difficulty concentrating and completing tasks
17.1
18.7
0.53
0.47
Obsessive behavior
11.8
14.3
1.8
0.18
Socially withdrawn
18.7
18.0
0.1
0.76
Difficulty dealing with a specific stressful event (e.g. divorce, sexual assault)
10.3
5.2
9.9
0.002
Difficulty coping with stressful situations in general
23.2
19.2
2.8
0.09
Addiction to video Games
4.2
15.8
63.3
<0.0001
Addiction to the Internet
17.1
13.8
2.5
0.11
Substance abuse
0.4
1.7
7.5
0.006
In an abusive relationship
1.2
0.5
1.5
0.22
Difficulty with dealing with homosexual feelings
4.8
1.5
8.9
0.003

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
21
Table 4
Parent reports of gender dysphoric children’s formal diagnoses
Diagnosis
Natal
Females
(%)
Natal
Males
(%)
Te st o f S ex
Difference
(
c
2
)
Probability
for Test of
Sex
Difference
Anxiety
32.5
27.3
3.8
0.051
Depression
29.1
22.7
6.3
0.012
ADHD
13.0
19.5
10.4
0.001
Autism
6.5
13.3
19.0
<0.0001
Obsessive Compulsive Disorder
3.0
4.9
3.2
0.073
Borderline Personality Disorder
3.0
0.7
6.4
0.011
Bipolar Disorder
1.9
0.5
4.0
0.044
PTSD
2.8
0.5
7.5
0.006
Body Dysmorphia, Anorexia, Bulimia
2.1
1.0
2.1
0.150
Antisocial Personality Disorder
0.2
0.3
0.0
0.983
Schizophrenia
0.2
0.3
0.1
0.722

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
22
Table 5
Parent reports of their children’s social transition steps
Social transition steps
Natal
Females (%)
Natal
Males (%)
Te st o f S ex
Difference
(
c
2)
Probability for
Te st o f S ex
Difference
Began wearing clothing of
opposite sex
60.6
16.8
235.8
<0.0001
Changed hairstyle
58.5
20.2
180.1
<0.0001
Changed pronouns, opposite
sex
49.2
22.7
88.5
<0.0001
Changed posture
30.7
12.8
50.4
<0.0001
Changed voice tone
25.7
13.6
25.8
<0.0001
Transgender friends of same
natal sex
22.4
4.7
65.1
<0.0001
Changed pronouns, nonbinary
18.0
5.9
35.1
<0.0001
Changed sex-typed activities
7.9
5.7
2.3
0.143
Opposite sex friends
6.7
5.4
0.9
0.350
Legal name change
3.2
4.9
2.6
0.107
Use of makeup
0.9
12.6
115.9
<0.0001
Breast binding
76.8
N/A
N/A
N/A
Penis tucking
N/A
17.1
N/A
N/A
Bra stuffing
N/A
8.9
N/A
N/A

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
23
Table 6
Parent reports of their children’s medical transition steps
Medical transition steps
Natal Females
(%)
Natal Males
(%)
Hormone blockers
0.8
2.0
Any testosterone treatment
6.5
N/A
Current testosterone treatment
5.0
N/A
Αny female hormone treatment
N/A
8.4
Current female hormone treatment
N/A
7.6
Any Surgical transition
0.7
1.0

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
24
Table 7
Several potential correlates of social transition
Correlates of social transition
Univariate
Te st (
c
2)
Probability,
Univariate
Test
Multivariate
Te st (
c
2)
Probability,
Multivariate
Test
Direction
(more likely to transition)
Natal sex
172.8
<0.0001
179.2
<0.0001
Natal females
Current age
17.0
<0.0001
16.3
<0.0001
Older youths
Years with gender dysphoria
81.2
<0.0001
10.6
<0.0001
Longer duration of gender
dysphoria
Mental health issues
38.8
<0.0001
22.9
<0.0001
History of mental health
issues
Referral to gender specialist
85.8
<0.0001
83.7
<0.0001
Referral to gender specialist
Each row presents the c2 and associated probability values for two tests: the univariate test in which social transition (yes or no) is
predicted by the correlate in the leftmost column, and the multivariate test in which social transition is predicted by the same correlate,
statistically adjusting for the other correlates in the Table. Reported c2 values are for Likelihood Ratio tests (Ν=1655).

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
25
Table 8
Several potential correlates of hormonal treatment
Correlates of hormonal
treatment
Univariate
Te st (
c
2
)
Probability,
Univariate
Test
Multivariate
Te st (
c
2)
Probability,
Multivariate
Te st
Direction
(more likely to receive
treatment)
Natal sex
1.6
0.202
1.3
0.250
Natal males
Current age
252.4
<.0001
139.2
<0.0001
Older youths
Years with gender dysphoria
120.3
<.0001
2.9
0.090
Longer duration of gender
dysphoria
Mental health issues
8.4
0.004
6.0
0.014
History of mental health issues
Referral to gender specialist
15.2
<.0001
13.5
0.0002
Referral to gender specialist
Each row presents the c2 and associated probability values for two tests: the univariate test in which social transition (yes or no) is
predicted by the correlate in the leftmost column, and the multivariate test in which social transition is predicted by the same correlate,
statistically adjusting for the other correlates in the Table.

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
26
Table 9
Changes in reported characteristics of gender dysphoric youth: December 2017–October 2021
Characteristic
Univariate
Probability
Direction
(more characteristic of recent
youth)
Natal sex
<0.0001
Increased likelihood of being male
Current age
<0.0001
Younger
Age of onset of gender dysphoria
0.0015
Younger onset
Years with gender dysphoria
0.0001
Fewer years
Mental health issues
0.818
No significant change
Referral to gender professional
0.0005
Decreased likelihood of referral

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
27
Fig. 1. Distribution of parent reports of children’s age of onset of gender dysphoria (in years),
separately for natal females and males.
Age of onset: gender dysphoria
Percentage by sex
11 12 13 14 15 16 17 18 19 20 21
0%
5%
10%
15%
20%
Natal Sex
Female
Male
1 2 3 4 5
0
20
40
60
80
N
Change in functioning

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
28
Fig. 2. Parent reports of relative timing of gender dysphoria and mental health issues, in units of
years. Negative numbers indicate that mental health issues preceded gender dysphoria, and
positive numbers indicate that gender dysphoria preceded mental health issues.
-20 -15 -10 -5 0 5
0
50
100
150
N
Relative Timing

JOURNAL OF OPEN INQUIRY
IN THE BEHAVIORAL SCIENCES Rapid-Onset Gender Dysphoria
29
Fig. 3. Parent reports of change in functioning after social transition. 1=much worse; 2=somewhat
worse; 3=no change; 4=somewhat better; 5=much better.
1 2 3 4 5
0
20
40
60
80
N
Change in functioning