Statement from Brown University School of Public Health Faculty Members Committed to LGBTQI Affirmative Health Research

We at the Gender Dysphoria Affirmative Working Group wish to thank these distinguished faculty from Brown University School of Public Health for openly and directly speaking out to the Rapid Onset Gender Dysphoria ‘controversy’. We respect and appreciate their commitments to scientific honesty and rigor, to creating an environment of compassion and openness, to the necessity to include members of the trans and gender nonbinary community in all work done about the trans and nonbinary community, and to the health and wellbeing of trans and gender nonbinary people worldwide.

A few notable quotes:

“… [W]e write this letter as individual scientists and educators—who benefit from academic freedom—to publicly acknowledge the health-related harms and consequences of a lobby that seeks to undermine the legitimacy of transgender experiences. We also write this letter to state and underscore our commitment to uplift transgender and gender diverse communities through our research, scholarship, teaching, and service.”

“…The ROGD lobby has worked to undermine the experiences and identities of transgender and gender diverse individuals, with the potential for dire health consequences.”

“The ROGD lobby is also threatening transgender individuals’ rights via healthcare practice and public policy.”

“It is well-documented that being affirmed in one’s gender identity yields mental health benefits. Thus, we are committed to creating a safe and gender-affirming educational space for our students, staff, and fellow faculty of all genders, gender expressions, and sexual orientations.” 

“We also recognize that research is best conducted withnot onmembers of the population of interest. Thus, we are committed to carrying out our research in accordance with best practices for community-engaged research.”

“We also recognize the importance of having research agendas developed and implemented bytransgender and gender diverse communities. Thus, we are committed to building a pipeline of transgender students, fostering an environment where transgender and gender diverse students can thrive, and mentoring and training future generations of transgender and gender diverse researchers.

“Finally, an essential responsibility of learned communities is to contribute to social good by amplifying the voices of vulnerable populations. Thus, we affirm our unwavering commitment to transgender and gender diverse communities and the highest standards of ethical, rigorous, and affirming research and practice.”

We encourage the Brown University School of Public Health and Brown University as a whole to issue similar statements in the near future. 

Scientific American: Stop Using Phony Science to Justify Transphobia

An important overview and piece advocating for inclusivity from the prominent scientific journal Scientific American.

Published: June 13, 2019. Author Simón(e) D Sun.

“While this is a small overview, the science is clear and conclusive: sex is not binary, transgender people are real. It is time that we acknowledge this. Defining a person’s sex identity using decontextualized “facts” is unscientific and dehumanizing. The trans experience provides essential insights into the science of sex and scientifically demonstrates that uncommon and atypical phenomena are vital for a successful living system. Even the scientific endeavor itself is quantifiably better when it is more inclusive and diverse. So, no matter what a pundit, politician or internet troll may say, trans people are an indispensable part of our living reality.”

Counterpoint: Pediatric gender care is safe and necessary

While not research, this is a well written piece, concisely outlining the issues and why evidence-based, affirmative care for trans and gender nonbinary youth is safe and effective, and the current standard of care.

Published in: Star Tribune. June 25, 2019. Authors: KATHLEEN MILLER , MARLA EISENBERG , AMY GOWER AND G. NIC RIDER.

"Transgender and nonbinary youths experience persistent and significant distress when forced to conform to the gender they were assigned at birth. They face substantial health disparities, with higher rates of depression, suicide attempts, substance use, bullying and unprotected sexual encounters than their cisgender (i.e., not transgender) peers. However, research shows that these health outcomes are related to stigma, rather than the simple fact of being transgender or nonbinary. This is a subtle, but critical, distinction: Negative health outcomes are not intrinsic to being trans and nonbinary. Rather, daily experiences of discrimination and harassment lead to poor health outcomes..."

"The medical and research community supports gender affirming medical care as a powerful tool to improve the lives of children and adolescents who are transgender or nonbinary. There is ample and growing evidence that children and adolescents have better health outcomes when they are supported in their gender, which includes access to medical interventions when appropriate. As clinicians and pediatric researchers, we firmly support expanding access to gender affirming care for youth."

Getting Your Health Care Covered: a Guide for Transgender People

Not research, but a resource that could be quite useful in helping people access care… and we know that the ability to access care has a dramatic and positive effect on outcomes.

"Getting your insurance to cover the health care you need can be difficult. The good news is that it should be getting easier. Many insurance plans have gotten rid of exclusions that single out transgender people, and trans people are protected from public and private insurance discrimination under federal law and state laws, including in Medicaid and Medicare."

"But some insurance plans still make it hard to get coverage for transition-related health care, especially surgical care. "

"The most important thing to remember is that your insurance should cover transition-related care. However, you may need to show your insurance company why the treatment you need is medically necessary for you, with letters from your health care providers."

"If you are denied coverage or if your plan has an exclusion, you may also need to explain to your insurance company or employer why it is illegal discrimination to exclude medically necessary transition-related care."

"Use this guide to help you navigate the coverage process."

Trans teens face higher sexual assault risk when schools restrict bathrooms

Unfortunately the full study itself is behind a paywall, but summaries are available from many news sources online.

Original Study Publisher: Pediatrics. May 2019. Authors: Gabriel R. Murchison, Madina Agénor, Sari L. Reisner, Ryan J. Watson.

“Transgender adolescents may be less likely to be sexually assaulted when they can use school bathrooms and locker rooms that match their gender identity rather than their sex assigned at birth, a U.S. survey suggests.” 

“The survey of 3,673 trans and nonbinary teens in American middle schools and high schools found that more than one in four reported being sexually assaulted in the previous 12 months.'“

“When schools required students to use bathrooms and locker rooms based on their sex assigned at birth, transgender boys - who identify as male but are labeled female on their birth certificates - were 26 percent more likely to experience sexual assault.”

“And transgender girls - who identify as female but were assigned male at birth - had more than twice the assault risk when they had to use restrooms and locker rooms for boys.”

“… the results add to the evidence suggesting that failure to support trans and nonbinary youth can endanger both their physical and mental health, Rosenthal and Ehrensaft write.”

“' ‘Transgender youth who express their gender identity but are required to use facilities matching their genitalia are not only at risk for verbal and physical harassment, including sexual abuse, but, not surprisingly, some will avoid using restrooms altogether, resulting in increased risk for inadequate fluid intake, urinary retention, urinary tract infections, impacted bowels, and school avoidance,’ they write.”

Summary from Reuters:

Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of “Rapid-Onset Gender Dysphoria”

Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of “Rapid-Onset Gender Dysphoria”

Another critique outlining the central flaws in the only study allegedly documenting “Rapid-Onset Gender Dysphoria”.

Published in: Archives of Sexual Behavior. April 22, 2019. Author: Arjee Javellana Restar

“Conclusion: A common error in reports of descriptive studies is overstepping the study design and data (Grimes & Schulz, 2002) and Littman’s (2018) paper, for reasons described in this critique, is an example of this fundamental error. Littman’s methodological flaws in the conceptualization and design of the study illustrate the importance of and need for more rigorous survey design and data analysis in descriptive studies. In the context of research with transgender people, who have historically been subjected to pathologizing research, flawed methodologies that lead to tenuous conclusions can have serious implications. While most science has limitations, researchers studying in the field of transgender health should strive to design their studies with appropriate, non-stigmatizing, and non-pathologizing research aims and methods that are grounded in the lived perspectives and experiences of transgender populations.”

Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth

Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth

Published in: Clinical Child Psychology and Psychiatry. April 10, 2019. Author: Florence Ashley.

Youth explore their genders – both theirs and those of others. Exploration is not only a vessel of discovery and understanding but also of creation. Centring the notion of gender exploration, this article inquires into the ethical issues surrounding care for transgender youth. Arguing that exploration is best seen not as a precondition to transition-related care but as a process that can operate through transitioning, the article concludes that the gender-affirmative approach to trans youth care best fosters youth’s capacity for healthy exploration. Unbounded social transition and ready access to puberty blockers ought to be treated as the default option, and support should be offered to parents who may have difficulty accepting their youth.

What Gender Affirmative Therapy is and is not

While not a research study, this piece is a thoughtful and straightforward overview of affirmative therapy for trans youth.

Author: Meg-John Barker. Published March 18, 2019.

Two years on from 2017 when it began, we’re still in the midst of a moral panic about trans. Daily news stories across all sections of the media continue to spread myths and misinformation about trans people. It’s hard to even imagine the extent of the damage caused to trans people living our lives in this culture of hatred and denial of our basic existence and human rights, particularly young people who are growing up in this climate.

One topic which comes round frequently in this moral panic is the help and support given to people – particularly young people – who are gender diverse, or exploring their gender. Claims are often made that people are pressured to go down particular roots, for example that anybody who questions their gender is pressured to come out at trans, or that everyone is quickly pushed down a particular pathway of medical treatment and surgeries.

I was recently asked to put together a factsheet about what Gender Affirmative Therapy – or Gender Affirmative Practice in general – actually looks like: to put the record straight about what therapists, activists, and other practitioners in this area are actually doing – and inviting others to do. Here it is. You can download the pdf, or read the whole thing below that.

Don Cheadle Makes Powerful Fashion Statements On ‘SNL’

The Gender Dysphoria Affirmative Working Group would like to thank Saturday Night Live and actor Don Cheadle for their clear and visible statement in support of trans and gender nonbinary youth... some of the most vulnerable in our world today.

Don Cheadle Makes Powerful Fashion Statements On ‘SNL’

The award-winning actor offers support for transgender kids and takes a slap at Donald Trump.


By Carla Baranauckas

“Award-winning actor Don Cheadle had more than laughs on his mind when he hosted “Saturday Night Live” this weekend. And he made that clear with some of his wardrobe choices.”

“When he introduced Gary Clark Jr., the show’s musical guest, Cheadle wore a T-shirt that said, “Protect Trans Kids.” “

Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents 

The 2018 Australian SOC for Trans and Gender Diverse Children and Adults... a very strongly affirming document based on the latest research making clear that affirmative treatment approaches - in which the youth's identity is respected and supported, where the youth are provided the freedom and safety to explore their gender without judgment - yield much happier and better adjusted youth and young adults. It also makes clear that disaffirming approaches are unethical and may cause harm.

Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents 

Authors: M.M. Telfer, M.A. Tollit, C.C. Pace, & K.C. Pang.   2018.  

“Being trans or gender diverse is now largely viewed as part of the natural spectrum of human diversity. It is, however, frequently accompanied by significant gender dysphoria (GD), which is characterised by the distress that arises from incongruence between a person’s gender identity and their sex assigned at birth. It is well recognised that trans and gender diverse individuals are at increased risk of harm because of discrimination, social exclusion, bullying, physical assault and even homicide. Serious psychiatric morbidity is seen in children and adolescents. A study of the mental health of trans young people living in Australia found very high rates of ever being diagnosed with depression (74.6%), anxiety (72.2%), post-traumatic stress disorder (25.1%), a personality disorder (20.1%), psychosis (16.2%) or an eating disorder (22.7%). Furthermore 79.7% reported ever self-harming and 48.1% ever attempting suicide.”


“Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.”


“Understanding and using a person’s preferred name and pronouns is vital to the provision of affirming and respectful care of trans children and adolescents.  Providing an environment that demonstrates inclusiveness and respect for diversity is essential... Some children or adolescents may request use of a preferred name or pronoun only in certain circumstances, such as when their parents are, or are not, present in the room. This is important to respect and enact to enable optimal patient-clinician engagement, and ensure confidentiality and patient safety.”


“Avoiding harm is an important ethical consideration for health professionals when considering different options for medical and surgical intervention. Withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including increasing depression, anxiety and suicidality, social withdrawal, as well as possibly increasing chances of young people illegally accessing medications.” 


“In the past, psychological practices attempting to change a person’s gender identity to be more aligned with their sex assigned at birth were used.  Such practices, typically known as conversion or reparative therapies, lack efficacy, are considered unethical and may cause lasting damage to a child or adolescent’s social and emotional health and wellbeing.”


Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada

We know from other studies that approximately 40% of trans and gender nonbinary identified people attempt suicide at some point in the lifespan, a number shockingly high. While the study below is not specifically about youth, the same factors apply.

Published in: BMC Public Health. 2015. Authors: Greta R. Bauer, Ayden I. Scheim, Jake Pyne, Robb Travers, Rebecca Hammond.

“Large effect sizes were observed… suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.”

Young Trans Children Know Who They Are

Young Trans Children Know Who They Are: A new study shows that gender-nonconforming kids who go on to transition already have a strong sense of their true identity—one that differs from their assigned gender.

Published in: The Atlantic. January 15, 2019. Author: Ed Yong

“This study provides further credence to guidance that practitioners and other professionals should affirm—rather than question—a child’s assertion of their gender, particularly for those who more strongly identify with their gender,” says Russell Toomey from the University of Arizona, who studies LGBTQ youth and is himself transgender…”

““When the 85 gender-nonconforming children first enrolled in Olson’s study, her team administered a series of five tests that asked what toys and clothes they preferred; whether they preferred hanging out with girls or boys; how similar they felt to girls or boys; and which genders they felt they currently were or would be. Together, these markers of identity gave the team a way to quantify each kid’s sense of gender.”

“The team, including James Rae, now at the University of Massachusetts Amherst, found that children who showed stronger gender nonconformity at this point were more likely to socially transition. So, for example, assigned boys who had the most extreme feminine identities were most likely to be living as girls two years later. This link couldn’t be explained by other factors, such as how liberal the children’s parents were. Instead, the children’s gender identity predicted their social transitions. “I think this wouldn’t surprise parents of trans kids, and my findings are often ‘duh’ findings for them,” says Olson. “It seems pretty intuitive.””

“…“The findings of this compelling study provide further evidence that decisions to socially transition are driven by a child’s understanding of their own gender,” says Toomey. “This is critically important information given that recent public debates and flawed empirical studies erroneously implicate ‘pushy’ parents, peers, or other sources, like social media, in the rising prevalence of children and adolescents who identify as transgender.””

Coming Out as Trans Isn’t a Teenage Fad

Coming Out as Trans Isn’t a Teenage Fad: Conservatives are inventing a “syndrome” to undermine young people’s transitions.

Published in: The New York Times. January 8, 2019. Author: Jenny Boylan.

“At the end of the long weekend when my daughter came out as transgender, she headed back to her car with her girlfriend. I watched them from my apartment window as they packed up. My child looked up, and waved.”

“Then she drove off.”

“I closed the window. Tears rushed to my eyes. She’s saying goodbye, I thought. I’ll never see her again.”

“This, of course, turned out to be malarkey.”

“In the months to come I’d see her lots of times, and each time she seemed happier, and more herself.”

“… The term [Rapid Onset Gender Dysphoria] originated a few years ago on three blogs with a history of promoting anti-trans propaganda. There has been only one study on it, in the journal PLOS One. But the study isn’t about the children in question; it’s about their parents, who were recruited for the study by ads placed in the conservative blogs that had invented the concept of R.O.G.D. in the first place.”

“A child’s transition can indeed seem heartbreaking for parents at first. I understand that because I am a parent who, in experiencing it, felt as if my heart was breaking. And we, trans people, need to understand that too. It was heartbreaking for my own mother, even though she told me love would prevail, and it was heartbreaking for me, in spite of — or because of — the fact that I am trans myself.”

“What was my problem, you ask? Above all, I did not want my child’s life to be hard, in the way that my own life has been hard.”

“But if you want your children’s life to be hard, the quickest way to that end is to tell them that their deepest sense of self is nothing but a fad, and that you know them better than they know themselves.”

A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

Published in: International Journal of Transgenderism.  2018.  Authors: Julia Temple Newhook, Jake Pyne, Kelley Winters, Stephen Feder, Cindy Holmes, Jemma Tosh, Mari-Lynne Sinnott, Ally Jamieson & Sarah Pickett


“In the media, among the lay public, and in medical and scientific journals, it has been widely suggested that over 80% of transgender children will come to identify as cisgender once they reach adolescence or early adulthood. This statement largely draws on estimates from four follow-up studies conducted with samples of gender-nonconforming children in one of two clinics in Canada or the Netherlands… This article outlines methodological, theoretical, ethical, and interpretive concerns regarding these studies. We clarify the cultural, historical, and clinical contexts within which these studies were conducted to understand and to deconstruct the embedded foundational assumptions of the research as well as the widespread interpretations of the results.”

“While this commentary offers critiques of desistance research and its clinical and popular interpretations, these studies have also made contributions to the literature worthy of recognition:

“1. qualitative data on trans and gender diverse adolescents in clinical care, and

“2. factors in anticipating medical transition for gender-nonconforming children accessing clinical care…”


“We have identified the following methodological concerns in these four studies:

“1.the potential misclassification of child research participants

“2. the lack of acknowledgement of social context for research participants

“3.the age of participants at follow-up, and

“4.the potential misclassification of adolescent andyoung adult participants lost to follow-up…”


“We have identified the following theoretical concerns in the four studies:

“1.assumptions inherent in “desistance” terminology

“2.binary gender framework, and

“3. presumption of gender stability as a positive outcome…”


“We have also identified ethical concerns in these four studies:

“1. intensive treatment and testing of child participants,

“2.questionable goals of treatment, and

“3.lack of consideration of children’s autonomy…”


“We also have concerns with the authors’ interpretation in these four studies, including:

“1.the assumption that unknown future adult needs should supersede known childhood needs, and

“2.the underestimation of harm when attempting to delay or defer transition…”


“In this critical review of four primary follow-up studies with gender-nonconforming children in Toronto, Canada and the Netherlands (Table 1), we identify a total of 12 methodological, theoretical, ethical, and interpretive concerns as well as two often-overlooked contributions of this literature. We conclude that, while our understanding of gender diversity in adults has progressed, the tethering of childhood gender identity to the idea of “desistance” has stifled similar advancements in our understanding of children’s gender diversity. As we progress towards a fuller understanding of children’s gender in all its complexity, it will be important to move beyond longitudinal studies of identity that seek to predict children’s futures, and instead prioritize respect for children’s autonomy in the present. For all the resources devoted to studying these children, we have much more to learn by listening to them.”



Teach your parents and providers well: Call for refocus on the health of trans and gender-diverse children

Published in: Canadian Family Physician.  May, 2018. Authors Julia Temple Newhook, Kelley Winters, Jake Pyne, Ally Jamieson, Cindy Holmes, Stephen Feder, Sarah Pickett and Mari-Lynne Sinnott

“Today, however, we are witnessing a substantial progression of the field—what some have termed a paradigm shift. Globally, health care providers acknowledge that gender is “a matter of diversity, not pathology,” and gender identity is being formally recognized as a deeply personal and fundamental human right... We argue that this narrow focus on prediction is misplaced. An understanding of the developmental trajectory of gender identity is important. However, our main priority is not predicting children’s adult identities; it is supporting children’s present and future health and well-being.”

“Directives regarding the care of gender-diverse children have derived primarily from a small body of research… interpreted to suggest that about 80% of children who we might think of as transgender will not identify as transgender as adults. It has become common to see these studies cited as a reason to discourage children’s assertion of a non–birth-assigned gender, framing transgender children as “confused.” Yet recent reviews suggest the utility of the concept of desistance is limited, and have raised the following 7 critiques:

  • “Many children never asserted a transgender identity…”

  • “Consistency often leads to continuance…”

  • “Assumptions were made about loss to follow-up…”

  • “Some assert a transgender identity later in life…”

  • “Some assert a nonbinary identity…”

  • “There is no evidence of being ‘trapped’...”

  • “Studies do not examine harm of suppression…”

“In moving past the desistance myth, researchers and clinicians are then able to focus instead on the more crucial question: How do we foster optimal health outcomes for gender-diverse children? Emerging research indicates that children who are not permitted to express their gender freely within their key developmental contexts, including family and school, might be at risk of negative psychosocial outcomes, both in the short-term and into adolescence and adulthood. These include low self-esteem, low life satisfaction, poor mental health, lack of adequate housing, posttraumatic stress, and suicidal thoughts and attempts.”


“Every child is unique. To thrive, every child needs to be seen, valued, and loved for who they are—not for who we expect them to be. Rather than attempting to “fix” gender-diverse children, medical providers have a key leadership role to play in the acceptance of the gender spectrum as a fundamental element of our human diversity. Through affirmation in the present, and celebration of whatever the future might hold, our goal is for all children to reach their full potential in all aspects of their lives.”

Letter to the US Department of Health and Human Services

A letter signed by the California State Superintendent of Public Instruction, the Direcor of the Oregon Department of Education, and the Washington State Superintendent of Public Instruction challenging the US federal government's possible 'redefinition' of gender, also outlining the severe and predictable harm such a policy would cause on vulnerable trans and gender nonbinary youth and adults.

Find more on affirmative care for trans ad nonbinary youth and adolescents at our site:

And like/follow us on Facebook for regular updates:


Oregon DOE.jpeg

There Is No Evidence That Rapid-Onset Gender Dysphoria Exists

There Is No Evidence That Rapid-Onset Gender Dysphoria Exists

An article highlighting some of the major concerns with "Rapid Onset Gender Dysphoria." Find more on affirmative care for trans and gender nonbinary youth, as well as on the myths of "rapid onset" and "high rates of desistance" at our website:

Like and follow us on Facebook for regular updates: @gdaffirmative

Published in: PsychCentral. December 11, 2018.  Author: Florence Ashley.

“In March, 21 experts in trans health endorsed an essay concluding that the hypothesis of ROGD is bad science. The group included multiple past presidents of the Canadian Professional Association for Transgender Health, its current president, the heads of the specialized Meraki Health Centre, and the lead investigator of the Montreal arm of the Trans Youth CAN! studies.” 

“Despite significant sampling and interpretive concerns with the study, it is not uncommon for it to be uncritically cited as evidence of a social contagion of trans identities.” 

“The first and most commonly noted problem with the study is its choice of sample. It relies on parental report without independent confirmation and posted recruitment advertising exclusively on anti-trans websites…”

“The second and… biggest problem with the study is that Littman fails to consider alternative, more plausible explanations for her observations.  One of the main findings of the study is that children’s mental health and parent-child relationships deteriorate after coming out… However, parental acceptance of gender identity is a well-known predictor of mental wellbeing for transgender people and children who are not supported in their identities are unlikely to want to maintain a good relationship with their parents.”

“A similar interpretive issue arises with regards to social influence. Parents report that their children increased their internet and social media consumption prior to coming out, found themselves in friend groups with many trans people... None of this is surprising… [p]eople who are questioning their gender tend to find themselves consuming content by trans people, both for informational purposes and because of shared experiences… There’s nothing noteworthy about questioning young people consuming social media content representative of their contemporaneous concerns.”

“There is no evidence that ROGD exists. So far, all evidence proposed in favor of the hypothesis is best compatible with adolescent-onset gender dysphoria against a background of parental hostility to gender identity.”

“It is crucial for practitioners to have an adequate understanding of the facts surrounding ROGD, as a mistaken belief that its existence is established could lead to negative consequences in their practice…  It is essential for parents to move past this disruption to their life story and reconstitute a new one which makes room for their child by accommodating change and giving it meaning within the broader family narrative.”



“You Have to Give Them a Place Where They Feel Protected and Safe and Loved”: The Views of Parents Who Have Gender-Variant Children and Adolescents

A study on parent's experiences and feelings around their trans/'gender variant' youth. Sound familiar as a study topic? This study found that affirming these youth was initially difficult for some parents but ultimately led to better adjusted youth, and more close family relationships.

Find more on affirmative care for trans and gender nonbinary youth on our website, and follow us on Facebook for regular updates:
Gender Dysphoria Affirmative Working Group

Journal of LGBT Youth. 2008. Darryl E. Hill & Edgardo Menvielle

“This study focused on the experiences of parents of gender-variant children and teens. The goal was to document issues faced by parents of kids with childhood gender-variant behaviors and/or gender-variant identity… Parents were asked for a history of their child’s gender, focusing on their experiences and their thoughts about how to parent gender-variant youth. Parents spoke about their gender beliefs, how they came to accept their child, and the main challenges they faced.”

“... Another mother of a five-year-old boy shared: ‘You have to love your kid unconditionally. And you have to love them even a little bit more I think when they’re like this, because they know they’re different… you have to give them a place where they feel protected, and safe, and loved, and free to be who they are or what they’re going to be.’ ”

“Such unconditional acceptance had a strong positive impact on her boy, according to a different mother: ‘if you’re there for them and they’re happy and they’re confident, they’re going to be much more successful at dealing with [kids who tease them] than if they’re not and if you’re not there.’ ”

“One mother of a five-year-old boy, at the urging of a psychologist discouraged her boy’s stereotypical feminine interests while rewarding masculine ones: ‘it was probably the most horrible thing we’ve ever put [him] through… I mean you can just imagine what a blow to self-esteem that is for anyone? A four-year-old… You just can’t do that.’ As a result, ‘He became so introverted that he wouldn’t even discuss the issue with us at all…. He would spent countless hours alone in this room... it’s like what you imagine of an adult depressive person. I would never, ever do that to him again.’ ”

“A mother of a five-year-old boy who had censored her son’s behavior found that ‘All I saw was that it created more tension in him, more bad behaviors… Because I think a lot of his bad behaviors were [due to] the fact that he felt so… different and he felt so bad about himself… And since we’ve really started giving him this freedom to be himself within our family unit, he’s been a much, much, happier litte guy and a much more easier going kid.’ ”

“This study sought to portray a nuanced view of the experiences and issues faced by parents of children and adolescents who display variant behaviors… [While parents] initially questioned their role in their child’s gender, some felt unconditional acceptance was important and most discussed strategies they used to ensure their child would be safe.”

“Upon reflecting on their earlier attitudes, some parents came to see their earlier gender-normalizing efforts as either harmful or futile…”

“… Hopefully this study will encourage further development of affirmative interventions for youth with gender-variant behaviors and more rigorous scientific studies…"

Psychology Today Response

Some of you may have seen an article by Samuel Veissière Ph.D. in Psychology Today last week. Below is a response on behalf of the Gender Dysphoria Affirmative Working Group.

Find information on evidence-based, affirmative approaches to the treatment of trans and gender nobinary youth on our site:

And like/follow us on Facebook for regular updates:


December 5, 2018

An open letter to the owners, editors, members, advertisers, and others at Psychology Today:

We are a broad, international coalition of prominent medical and mental health professionals, academics, researchers, activists, and allies, some who are transgender-identified and others cisgender allies, all with vast expertise in gender and sexuality and troubled by the notion of “Rapid Onset Gender Dysphoria.”  Together we have published hundreds of peer-reviewed journal articles, written dozens of books, given countless lectures at universities, professional organizations, in the media, and elsewhere, and have counseled thousands of transgender and gender nonbinary youth.  We established the Gender Dysphoria Affirmative Working Group to highlight the overwhelming data demonstrating that evidence-based affirmative approaches yield happier and better adjusted children and that disaffirming approaches produce significant harm.  Our website can be found here:

We wish to refute in the strongest possible terms the article by Samuel Veissière Ph.D. and the study he cited by Dr. Lisa Littman.

 The Littman (2018) study has been widely contested as methodologically flawed and unethical, proceeding from an overt ideological bias.  The notion of “Rapid Onset Gender Dysphoria” is based solely on that one publication and runs counter to the evidence-based affirmative standard of care - in which the youth’s self-reported gender is respected and where the youth is provided the safety and freedom to explore the gender and identity without judgment or predetermined outcome. 

The World professional Association for Transgender Health(WPATH) and the American Academy of Pediatrics(AAP) both address the need to provide empathetic, nurturing environments, and reject attempts, “to instill fear about the possibility that an adolescent may or may not be transgender with the a priori goal of limiting consideration of all appropriate treatment options.” Furthermore, the AAP, “supports policies that are gender-affirming for children – an approach that is supported by other key professional organizations.” 

The Pediatric Endocrine Society arrives at the same conclusion, stating, "…the purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals..."and that “transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. For this reason, the Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender-nonconforming/transgender youth, as well as adequate mental health and medical care."  (Lopez et al., 2016)

A more comprehensive list of the dozens of organizations with public statements supporting the healthcare needs of transgender youth and adults can be found here:

The positions of these organizations, along with our own, are based on the best available research. Affirmative approaches demonstrate far-reaching improvements in quality of life, relationship satisfaction, self-esteem and self-confidence, and clearly show reductions in depression. anxiety, substance use, school dropout, incarceration, homelessness, self-harm, and suicide (Pyne 2016; Riley et al 2011; Russel et al 2018; Snapp et al 2015; Travers et al 2012).  Given space and time, these youth discover what gender is authentic and what level of transition is appropriate for them, if any.  

A 2018 Cornell University metastudy concluded that “[93% of peer reviewed studies] found that gender transition improves the overall well-being of transgender people… None of the reviewed studies showed that gender transition harms well-being.”  Others have documented that rates of regret are miniscule (Olson et al, 2018; Wiepjes et al, 2018).

Conversely, critiques of Littman’s article have cited numerous issues (Ashley, 2018; Ashley & Baril, 2018; Barasch, 2018; Borg, 2018; Serano, 2018; Tannehill, 2018):

·      The sample group of parents was drawn exclusively from websites openly hostile to transgender youth and their issues, thus deliberately skewing the results. 

·      Littman failed to acknowledge or account for the skew she introduced. 

·     Survey questions seem directed toward predetermined conclusions.  The study essentially surveyed the people who invented or were predetermined to support ROGD on whether they believe ROGD is real, then made its conclusions based on these beliefs.

·      She spoke with no trans youth, despite drawing conclusions on how such youth arrived at their trans identities, instead basing her conclusions solely on parents’ suppositions and skeptical beliefs. 

·      The ‘rapid onset’ often reported by parents is not a new phenomenon. Youth very commonly will delay coming out in hostile environments, being afraid to disclose due to minority stress factors including social stigma, internal stress, fears of rejection by family and friends, and legitimate concerns about violence. Given that these parents sought out hostile websites, the fears of these youth would seem to have been justified.

·      The disaffirming approaches suggested by the Littman study and also by Veissière’s post are likely to yield worsening mental health outcomes and a deterioration of the parent-child relationship.

·     Littman herself has no personal experience working with transgender youth.

There are many reports that when Littman presented her preliminary results, she was given extensive critique on the poor scientific quality of her research. She made no attempts to address these issues in her final paper, again suggesting she placed ideology over scientific rigor.  Some members of Gender Dysphoria Affirmative Working Group personally attended those sessions, and we have spoken to others with the same experience.

Studies also demonstrate that disaffirming approaches, such as those advocated by the proponents of “Rapid Onset”, cause harm.  There are a great deal of peer reviewed papers documenting that the high rates of depression, anxiety, substance abuse, poor school performance often identified in this population manifest primarily in youth from unsupportive environments (Bariola et al 2015; Bokting et al 2105; Hidalgo et al 2013; Roberts et al 2012). 

Klein and Golub (2016) report that a staggering 41% of transgender people have attempted suicide, and that 26.3% report misusing drugs or alcohol to cope with stigma related to their transgender identity.  The negative consequences of substance misuse and suicidal ideation and gestures “increased significantly with increasing levels of family rejection.”

Simultaneously, youth from environments where they are provided the freedom and validation to explore and determine their gender for themselves show no higher rates of these issues than their cisgender (non-trans) peers (Durwood, et al 2017; Olson, et al 2016).

More of these studies are excerpted below.

We also refute the charge that those opposing the Littman study are ‘radical transgender activists attempting to silence research we dislike’. We oppose any attempt to manipulate research in a way that would cause harm to our patients, community members, and children.  The Littman study has been widely criticized as being methodologically flawed, ideologically biased, and as such is bigotry masquerading as science. Poor science remains poor science.

Psychology Today represents a trusted source for information and referrals on mental health. Publishing an article based on poor, biased research that encourages practices found to be harmful is both irresponsible and a disservice to your readers and their clients.

We urge you to publish our letter and also to reconsider and withdraw the publication of such a flawed article.    


The Gender Dysphoria Affirmative Working Group

Noah Adams, MSW

Elsa Almås, PhD

Erica E. Anderson, Ph.D.

Esben Esther Pirelli Benestad, MD

Ady Ben-Israel, PhD

Peter Chirinos, MA 

Damon Constantinides, PhD, LCSW

Diane Ehrensaft, Ph.D.

Tony Ferraiolo, CPC

Dr. Robert Garofalo

Shawn V. Giammattei, Ph.D.

Melanie A. Gold, DO, DMQ, FAAP, FACOP

Linda A Hawkins, PhD, MSEd, LPC 

Marco A. Hidalgo, PhD

Laura A. Jacobs, LCSW-R

Aron Janssen, MD

Randi Kaufman, PsyD

Colt Keo-Meier, PhD

S.J. Langer, LSCW-R

Sean Lare, LCSW-C

Arlene Istar Lev LCSW-R, CASAC, CST

M. Dru Levasseur, Esq.

Jean Malpas, LMHC, LMFT

Zack Marshall, MSW PhD

Denise Medico, Ph.D

Christine Milrod, Ph.D

Margaret Nichols, Ph.D.

Johanna Olson-Kennedy, MD

Simon Pickstone-Taylor,  MBChB

Marjorie Rabiau, Ph.D. 

Stephen M. Rosenthal, MD

Cianán Russell, Ph.D.

Hershel Russell M.Ed

Dr. Annie Pullen Sansfaçon, PhD

Herb Schreier M.D. 

Judy Sennesh

Julia Serano, Ph.D.

Caroline Shahbaz, BBSc(Hons), MPsych

John B. Steever, MD

Françoise Susset, Psy.D.

Brynn Tannehill, M.S.

Barbara E. Warren Psy.D., LMHC

Erika P. Volkmar, DDS

Linda Wesp, MSN, FNP-C, AAHIVS


1. The Gender Affirmative Model: What We Know and What We Aim to Learn

Published in: Human Development.  October, 2013.  Authors: Marco A. Hidalgo, Diane Ehrensaft, Amy C. Tishelman, Leslie F. Clark, Robert Garofalo, Stephen M. Rosenthal, Norman P. Spack, Johanna Olson

"Children not allowed these freedoms by agents within their developmental systems (e.g., family, peers, school) are at later risk for developing a downward cascade of psychosocial adversities including depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, posttraumatic stress, and suicide ideation and attempts…”


2. Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults

Published in: LGBT Health.  May 25, 2016.  Authors: Augustus Klein & Sarit A. Golub

"42.3% of [transgender adults] reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination… family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection."


3. Statement on Gender Affirmative Approach to Care from the Pediatric Endocrine Society Special Interest Group on Transgender Health

Published by: Pediatric Endocrine Society Transgender Health Special Interest Group.  October 20, 2016.  Authors: Lopz, X, Marinkovic, M, Eimicke, T, Rosenthal, SM, Olshan, JS.

"The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth..."

"In conclusion, transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. For this reason, the Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender-nonconforming/transgender youth, as well as adequate mental health and medical care."


4. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

Published By: The American Academy of Pediatrics. September, 2018. Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence, Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness

“Supportive involvement of parents and family is associated with better mental and physical health outcomes. Gender affirmation among adolescents with gender dysphoria often reduces the emphasis on gender in their lives, allowing them to attend to other developmental tasks, such as academic success, relationship building, and future-oriented planning.


5. Gender nonconforming youth: current perspectives

Published in: Adolescent Health, Medicine and Therapeutics. 2017. Author: Diane Ehrensaft.

"The gender affirmative model is defined as a method of therapeutic care that includes allowing children to speak for themselves about their self-experienced gender identity and expressions and providing support for them to evolve into their authentic gender selves, no matter at what age.”


6. Mental Health of Transgender Children Who Are Supported in Their Identities

Published in: Pediatrics, February, 2016.  Authors: Kristina R. Olson, Lily Durwood, Madeleine DeMeules, Katie A. McLaughlin.  

"Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group… socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex."

7. Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals

Published in: The American Journal of Public Health. October, 2015. Authors: Emily Bariola, BA, Anthony Lyons, PhD, William Leonard, BSc, BA, Marian Pitts, PhD, Paul Badcock, PhD, and Murray Couch, BA.

“The findings indicated that, relative to other sources, family of origin may have the most influence in protecting against psychological distress… our findings support a need to encourage family members to be open and receptive sources of support.”

“…frequent contact with LGBT peers was revealed as a significant [protective] factor… for transgender individuals, frequent peer contact may be particularly important for developing individual resilience, as gender transitioning can be a complex and challenging process and having peers who share similar experiences may provide not only a sense of support and understanding, but also a sense of belonging.”


8. Social Support Networks for LGBT Young Adults: Low Cost Strategies for Positive Adjustment 

Published in: Family Relations.  July, 2015.  Authors: Shannon D. Snapp, Ryan J. Watson, Stephen T. Russell, Rafael M. Diaz, Caitlin Ryan.

“Our study adds to the growing body of evidence that family support, both general and sexuality specific, is a crucial factor in LGBT youth’s health and well-being…”

“Two variables were most relevant in predicting adjustment: (a) the percentage of friends who knew about participants’ sexual or gender identity and (b) support related to being LGBT from friends. The presence of a network of friends to whom youth can be out has been linked to measures of health and well-being…”

“Although friendship support is clearly associated with positive well-being in young adulthood, it appears that family acceptance has a stronger overall influence when other forms of support are considered jointly.”


9. Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population

Published in: American Journal of Public Health.  May, 2013. Authors: Walter O. Bockting, PhD, Michael H. Miner, PhD, Rebecca E. Swinburne Romine, PhD, Autumn Hamilton, HSD, and Eli Coleman, PhD.

 “… family support, peer support, and identity pride all were negatively associated with psychological distress, confirming that these assets are protective factors. Moreover, peer support significantly moderated the relationship between enacted stigma and psychological distress, thus emerging as a demonstrated factor of resilience in the face of actual experiences of discrimination. Only at high (but not low or medium) levels of peer support was enacted stigma not associated with psychological distress, which suggests that the negative impact of enacted stigma on mental health is pervasive and that regular contact with peers is necessary to ameliorate it.”

“Together, these results offer support for the value of transgender individuals connecting with similar others, possibly providing the opportunity to question stigma from the majority culture and reappraise their experiences in a self-affirmative way, which is consistent with what has been postulated and observed among gay and lesbian individuals. This finding is particularly pertinent because previous research found that transgender people have higher levels of depression and lower levels of peer and family support than their gay, lesbian, and bisexual counterparts. These results support a need to promote resilience by facilitating ample peer support.”

10. The Needs of Gender-Variant Children and Their Parents: A Parent Survey

Published in: International Journal of Sexual Health. 2011. Authors: Elizabeth Anne Riley, Gomathi Sitharthan, Lindy Clemson, Milton Diamond.

“The results of this study support the development of affirmative approaches in supporting gender-variant children and their parents. This is particularly evidenced by the parents’ own approaches to supporting their children where parents experimented with different ways of responding to various scenarios and realized that acceptance of their child was the only option as they learned that their child’s need for expression was not changed by their attitude or management of the behavior.”


Ashley, F.  (2018). Rapid-Onset Gender Dysphoria: A Parental Epidemic? Impact 

Ashley, F. & Baril, A. (2018).  Why ‘Rapid-Onset Gender Dysphoria’ is bad science. 

Barasch, A. (2018).  Criticism Is Not Censorship: A poorly designed study of “rapid onset gender dysphoria” deserves serious scrutiny, not protection from “activist interference.”

Bariola, BA., et al. (2015).  Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals.  The American Journal of Public Health. 

Bokting, W., Miner, MH., Swinburne Romine, RE., Hamilton, A., Coleman, E.  (2013).  Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population. American Journal of Public Health.

Borg, L.  (2018).  Transgender Article Removed at Brown Brings Controversy.  Providence Journal.

Cornell Chronicle. (2018).  Analysis Finds Strong Consensus on Effectiveness of Gender Transition Treatment.

Durwood, L., McLaughlin, KA, Olson, KR.  (2017). Mental Health and Self-Worth in Socially Transitioned Transgender Youth  Journal of the American Academy of Child and Adolescent Psychiatry.

Hidalgo, MA., Ehrensaft, D., Tishelman, AC, Clark, LF, Garofalo, R., Rosenthal, SR., Spack, NP, Olson,J. (2013).  The Gender Affirmative Model: What We Know and What We Aim to Learn. Human Development.  

Klein, A, & Golub, SA. (2016).  Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults. LGBT Health. 

Littman, L. (2018).  Rapid-Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports.  PLOS One.  

Lopez, X., et al. (2016).  Statement on Gender Affirmative Approach to Care from the Pediatric Endocrine Society Special Interest Group on Transgender Health.  Pediatric Endocrine Society Transgender Health Special Interest Group. 

Olson-Kennedy, J., Warus, J., Okonta, V.  (2018). Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults - Comparisons of Nonsurgical and Postsurgical Cohorts. Journal of the American Medical Association.  

Olson, KR, Durwood, L, DeMeules, M, McLaughlin, KA.  (2016). Mental Health of Transgender Children Who Are Supported in Their Identities.  Pediatrics.

Pyne, J.  (2016).  “Parenting Is Not a Job ... It’s a Relationship”: Recognition and Relational Knowledge Among Parents of Gender Non-conforming Children.  Journal of Progressive Human Services. 

Riley , E.A., Sitharthan, G, Clemson, L, & Diamond, M.  (2011).  The Needs of Gender-Variant Children and Their Parents: A Parent Survey.  International Journal of Sexual Health. 

Roberts, AL., Rosario, M., Corliss, HL., Coenen, KC., Austin, SB.  (2012).  

Childhood Gender Nonconformity: A Risk Indicator for Childhood Abuse and Posttraumatic Stress in Youth. Pediatrics.  

Russell, TR., Pollitt, AM., Li, G., Grossman, AH.  (2018). Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth.  Family Relations.

Serano, J. (2018).  Everything You Need to Know About Rapid Onset Gender Dysphoria.

Snapp, SD., Watson, RJ., Russell, ST., Diaz, RM., & Ryan, C. (2015). Social Support Networks for LGBT Young Adults: Low Cost Strategies for Positive Adjustment. Family Relations. 

Stein, F. (2017).  AAP Statement in Support of Transgender Children, Adolescents, and Young Adults.  The American Academy of Pediatrics.

Tannehill, B. (2018).  'Rapid Onset Gender Dysphoria' Is Biased Junk Science. 

Travers, R, Bauer, G., Pyne, J., Bradley, K., Gale, L., Papadimitriou, M.  (2012).  Impacts of Strong Parental Support for Trans Youth. Trans Pulse Project.   

Wiepjes CM, et al. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. The Journal of Sexual Medicine.

World Professional Association for Transgender Health.  (2018). WPATH Position on Rapid-Onset Gender Dysphoria.  Retrieved from:

HRC 2018 LGBTQ Youth Report

The survey results from HRC’s most recent survey on LGBTQ youth, including some disturbing information about the real need trans youth have for support. Below are a few brief excerpts.

“Parents and families play an essential role in promoting adolescent health and well-being. Studies have shown the positive health outcomes for LGBTQ youth whose families are supportive and accepting, including greater self-esteem and resilience, and a lower risk of negative health outcomes such as depression, distress, hopelessness and substance use.”

“Most LGBTQ youth are aware of their sexual orientation or gender identity by the start of adolescence. While “coming out” to their parents and close family members is an important and self- affirming developmental milestone, it is often fraught with worry. Many LGBTQ youth report coming out, being outed or being found out by their family as extremely stressful. Moreover, more than three- quarters of youth in our sample rate coming out as LGBTQ to their parents as extremely stressful…”

“…The mental health disparities between LGBTQ youth and non-LGBTQ youth continue to be an alarming trend. Today’s LGBTQ youth face a variety of stressors — harassment, family and peer rejection, bullying from their peers, isolation and a lack of a sense of belonging — that have a major impact on their overall well-being. Studies have shown that, compared to their non-LGBTQ peers, LGBTQ youth report much higher rates of depression, anxiety, alcohol and drug use, and lower self-esteem…”

“…Seventy-seven percent of LGBTQ youth surveyed report that on average they had felt down or depressed in the past week.17 Alarmingly, only 41 percent had received psychological or emotional counseling to address these issues in the past 12 months. LGBTQ youth of color face even greater challenges in accessing counseling services, with large disparities and an average of 37 percent of respondents having received psychological or emotional counseling in the past 12 months. Importantly, youth who had received counseling reported better mental health outcomes.”

“…LGBTQ youth of color often experience additional stress and adverse effects to their health and well- being as a result of bias around their intersecting identities. In addition to homophobia or transphobia, LGBTQ youth of color may encounter racism and discrimination on a daily basis and in various forms that can further complicate their ability to express, explore and/or manage their LGBTQ identities.”

“…Transgender and gender-expansive youth face many serious challenges in the school system. In addition to more overt forms of discrimination such as verbal and physical harassment, they also commonly report being barred from using locker rooms or bathroom facilities that match their gender identity and not being addressed by the appropriate pronouns or their chosen names. These negative school experiences have damaging implications for transgender and gender-expansive youth, and further contribute to hostile learning environments where they feel unsafe and unprotected.”