Criticism Is Not Censorship

A poorly designed study of “rapid onset gender dysphoria” deserves serious scrutiny, not protection from “activist interference.”

A study on teens and young adults ostensibly “turned trans” by the internet is really about the parents who doubt them.
A study on teens and young adults ostensibly “turned trans” by the internet is really about the parents who doubt them. Photo illustration by Slate. Photo by Thinkstock.

This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

Rapid-onset gender dysphoria” is a term that might be familiar from anti-trans op-eds and blog posts, but despite the clinical-sounding name, it doesn’t have much of a place in the scientific literature. Earlier this week, the journal PLOS One published a paper that sought to change that, formalizing the idea of ROGD as a distinct, observable phenomenon in which dysphoria appears, with seeming abruptness, during or after puberty, likely (so the hypothesis goes) as a result of peer-pressure and “social contagion.” In ascribing trans identities to the influence of friends or the internet, the phrase is almost universally used to cast suspicion on teens’ claims about who they are.

When the author’s dubious data collection practices and conjectural conclusions came under rightful criticism, PLOS announced that it would be reassessing the study’s methodology. Good practice, right? You wouldn’t know it, based on the furor that’s erupted. Some have taken the very mention of an editorial review in response to readers’ concerns as evidence of censorship, with PLOS ostensibly caving to activists (as one tweet put it, “This is literally an attempt to destroy a scientific study solely on the grounds that it conflicts with a political narrative, these are truly Orwellian times indeed”). But re-evaluating a study’s content and methodology doesn’t stymie the scientific process; it’s a natural and necessary extension of it.

The study, conducted by Brown University’s Lisa Littman, is purportedly about 256 trans-identified “adolescents and young adults” (ranging in age from 11 to 27). But it’s perhaps fairer to say that it’s about their parents, who participated in a 90-question survey about their relationships with and perceptions of their children—with no input from the kids themselves, and no controls to speak of.

Indeed, Littman’s study is marred by errors and omissions, starting with its very premise: Though the introduction treats the emergence of dysphoria around or after puberty as something new and unusual that should be treated with suspicion, the existence of late-onset gender dysphoria (defined as exactly that) is already recognized by both the World Professional Association for Transgender Health and the DSM-5. Littman doesn’t provide evidence to suggest that “rapid-onset gender dysphoria” is a discrete phenomenon—she just asks self-fulfilling questions of parents who already believe in and fear it, including those who have described the effects of medical transition as tantamount to “human rights violations.”

More worryingly, Littman does not account for the way this opposition to transition might skew her findings. The fact that the majority of parents said they believed “transgender people deserve the same rights and protections as others” is treated as proof that those surveyed aren’t disproportionately transphobic, but as Brynn Tannehill pointed out in the Advocate, even basic non-discrimination protections are regarded not as “the same rights” but as “special rights” by those who oppose them.

And you hardly need to know to look for such semantic distinctions; the sites that participants were culled from are full of damning evidence of bias. One, 4thwavenow, hosts long missives from parents who have strenuously denied their children’s identities for years, and its founder notes how she created the site “after much research and fruitless searching for an alternative online viewpoint,” as a platform for “her deepening skepticism of the ever-accelerating medical and media fascination with the phenomenon of ‘transgender children.’ ” Transgender Trend is similarly explicit in its mistrust of “recent theories of ‘transgenderism’” and anxieties about trans people seeking access to public bathrooms and changing rooms. Littman expresses concern over the possibility that trans youths are “isolat[ing themselves] from … mainstream sources of information” even as she deliberately seeks out parents who have done just that.

These convictions manifest clearly in the parents’ responses to her questions—the majority believed that their children were wrong about their identity, and 86.8 percent of those surveyed were “reasonable [sic] sure or positive that their child misrepresented or omitted parts of their history” to the doctor. Not that they seem to be authorities on the subject: 22 parents admitted that they didn’t even know if their child still identified as trans at the time of the survey, and though Littman makes much of the possibility that the internet is responsible for an uptick in trans-identified youths, more than 50 percent of parents weren’t sure if their child had received any online advice about transition-related topics.

In light of all this, one of the study’s most glaring flaws is that she makes no effort to substantiate the parents’ claims—or to fill in these sizable gaps in her data—by speaking to the kids (and er, 27-year-olds) themselves. To take such a spotty secondhand account of the population you seek to understand at face value is simply bad science: Why should we trust parents who are convinced their children are lying to them about the particulars of those children’s lives, mental health, and day-to-day interactions?

One of the elements of the study that garnered the most handwringing was “friction between parent and child” and “the worsening of parent-child relationships” after the kids came out, and their tendency to favor friendships with other members of the LGBTQ community. It’s not surprising that teens faced with such skepticism and hostility at home might suffer from depression, flock together online or in-person (as LGBTQ youths are known to do), or that their relationships with their parents might be frayed. But Littman assumes the worst, painting a dire and largely speculative picture of the “effects” of ROGD without establishing any such causality. Age- and gender-matched controls might also have helped to tease apart classically stormy parent-teen dynamics from something specific to dysphoric adolescents. And if she had included families from more supportive forums, her findings might have been more in line with the existing literature, which shows favorable mental health outcomes among those who are allowed to socially transition. But the study as it stands offers few substantive insights. In exclusively surveying parents from these “gender critical” spaces, Littman sharply limited both the relevance and the validity of her results.

This sloppiness extends to the way the survey itself is structured, which further undermines the conclusions drawn. Littman notes that “many (48.4%) [of the trans-identified children] had experienced a traumatic or stressful event prior to the onset of their gender dysphoria”—but it’s impossible to know how fair this claim is or how much this figure should alarm us when a middle school break-up would count as “sex or gender related trauma” under her criteria.

The rest of the paper is likewise peppered with alarmist turns of phrase and a cherry-picked selection of “the most striking examples” the parents provided. Littman herself repeatedly describes “cluster outbreaks” of dysphoria, mirroring the language of the community she surveyed, which has responded enthusiastically to her seeming validation of their narrative—the paper has already been widely shared in tweets decrying “this awful epidemic.”

These same supporters have taken measured responses from Littman’s university and the journal as a betrayal of her work, harbingers of the death of academic inquiry as we know it. In reality, both are heartening signs that research with potential real-world consequences is being held to a necessarily higher standard. All Brown and PLOS One have promised is a more rigorous review of the study design, which clearly warrants one; far from being censored, the paper remains fully accessible on the journal’s website. In other words, the scientific process is moving forward as usual.

This kind of post-publication critique is both standard and vital because, despite how it’s perceived outside of academia, peer review isn’t an automatic assurance of ironclad science.
PLOS itself has allowed questionable research to slip through the cracks before: A now-notorious 2016 paper was retracted when it was found that the authors had suggested “hand coordination should indicate the mystery of the Creator’s invention.” Another was renounced following the discovery of no less than 10 flaws—including plagiarism from Wikipedia, insufficient evidence to support its conclusions, and a typo in the title. As PLOS One editor Joerg Heber said in an interview at the time, “Peer review continues once an article is published and we are committed to follow up on all problematic cases emerging after publication, and will correct the scientific record where needed.” And they have: earlier this summer, an article was reviewed and ultimately withdrawn due to “concerns regarding the study design, methodology, and interpretation of the data, such that the results of the study were determined to be unreliable.”

The lesson now, as then, is simpler and far less sinister than the backlash would suggest: Studies are at their strongest when they’re comprehensive and conducted in good faith. That a process is in place to identify and correct for research that falls short is something we should all welcome.

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