Leor Sapir and Lisa Littman dunk on Tony and Evan Erquhart's criticism of their recent ROGD letter to the editor. They also dunk on Tony's troon bio in section 5.
4: What counts as “rapid”?
Here we get to what appears to be the main criticism of our Letter, which is that 3 years—the median time from realization to disclosure using Q3.1—is not “rapid” at all. Others said we were moving the goal posts for what counts as rapid in order to keep the ROGD theory alive.
What “rapid” means is a good question. We do not address it in our Letter, and to our knowledge it has never really been discussed in the academic literature. Before we offer some thoughts, we wanted to emphasize, again, that even if we use Turban’s method but restrict it to the relevant age group (18-24), the USTS-15 shows evidence of 2,127 respondents who have onset of gender dysphoria or trans identity within one year or less.
Critics of ROGD will naturally want to define “rapid” as narrowly as possible so as to minimize the incidence of ROGD. Thus, for instance,
Assigned Media’s Evan Urquhart writes: “In 2018, Lisa Littman estimated that youth with ROGD declared their trans identity between one week and three months after displaying signs of gender dysphoria. When the data failed to back this up, she and other proponents did away with the rapidity.”
Actually, only 26 percent of Littman’s 2018 sample went from non-dysphoric to dysphoric in three months or less. The times from non-dysphoria to dysphoria in the remainder of the sample were:
- 4-6 months: 12.4%
- 7-9 months: 4%
- 10-12 months: 11.6%
- More than 12 months: 8%
- Don’t know: 5.6%
- Did not seem at all gender dysphoric when they announced a trans identity: 32.4%
Littman did not define what counts as “rapid.” She merely presented the findings from her survey. What Urquhart is doing here is setting up a straw man. By misrepresenting Littman’s findings, and then mischaracterizing those findings as a definition, Urquhart is leading readers to believe that Littman (along with Sapir and Biggs) are now redefining “rapid” due to inconvenient findings in USTS-15. Littman no doubt considers three months or less to be “rapid,” but it hardly follows that her original hypothesis considers anything beyond three months to be non-rapid.
Let us, once again, try to be as charitable as we can to critics of ROGD. Let’s suppose that Q3.1 is the correct proxy for “realization.” Let’s assume that the median is 3 years from realization to disclosure. And let’s forget, for a moment, that even under these assumptions, 2,127 respondents still said that they went from no issues with their sex to trans-identified within a year or less.
Is 3 years “rapid”? Rapid is a relative term. Turban et al. report that the median time from realization to disclosure (in the “early realization”) cohort is 14 years. Three years is rapid compared to 14.
More importantly, until recently the two recognized subtypes of gender dysphoria were adult-onset (almost all middle-aged males) and childhood-onset. The latter was observed to manifest from very early in life through gender nonconformity and confusion. The Dutch protocol, which started the pediatric transition experiment, recommended only adolescents who had childhood-onset of symptoms. By the time they emerged into puberty and were eligible for puberty blockers, candidates would have had to be dysphoric for quite a few years.
Thus, a possible definition of “rapid” is: dysphoria that arises in the context of puberty as opposed dysphoria that begins much earlier in life and persists into adolescence. The first sentence of Littman’s 2018 article abstract reads: “In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria,
appearing for the first time during puberty or even after its completion” (our emphasis).
Littman might have spared us the headache of quibbling over the exact meaning of “rapid” by choosing another term—say, “adolescent-onset gender dysphoria with novel and unknown etiology.” As we’ll discuss in a moment, the hypothesis about rapidity, though important, is not more important than the hypothesis about trans identity being a maladaptive coping mechanism or arising due to social/peer influence or internalized homophobia. If trans identity is secondary to these other issues, that has massive implications for clinical care. The precise speed at which a teenager comes to use a trans identity as a way to cope with, say, internalized homophobia and a history of sexual trauma, is less important than recognizing the trans identity as a coping mechanism and not letting it get in the way of a more productive therapeutic approach.
Some critics might argue that 3 years cannot be rapid, period. But this claim depends on context. Is a 1-month period from spraining one’s ankle to full recovery rapid? That depends on whether we’re talking about an 80-year-old with multiple health problems or a 15-year-old athlete.
There is a tendency among gender clinicians and researchers to treat “gender” as an exceptional aspect of human identity. Thus, when considering what counts as “rapid,” it’s worth thinking about the pace at which other aspects of human identity develop—for instance, patriotic attachment, religious identity, relationships with family members, realizing our vocation in life, and so on. These aspects typically take far longer than 3 years. Sometimes they never end.
Take the example of finding your vocation. It’s common these days for people to finally figure out what they want to do in life in their mid- or late-thirties, after more than a decade of trying things out, experiencing disappointment, going through periods of feeling everything is pointless and nothing is fulfilling, and so on. Some people go through life never figuring out what their calling is. Now, imagine we were to come across a teenager who, in the space of 3 years between age 12 and 15, figured out, definitively, that her calling in life is to be a biochemical engineer. Could we not reasonably say that this teenager had a rapid-onset of vocational identity?
Going from not even thinking about one’s sex as a problem to “feeling uncomfortable being a girl” to “knowing I’m a boy who was assigned the wrong sex at birth” is, to put it mildly, a dramatic change. To go through such a change in the space of even 3 years can reasonably be described as “rapid.”
Rapid Onset Gender Dysphoria and the U.S. Transgender Survey of 2015: A Response to Critics
