Talk:Rapid-onset gender dysphoria controversy

Turban's claims about sex ratio

As I noted in an earlier discussion, we have a whole paragraph on Turban's work claiming no shift in sex ratio, on the grounds this "disproves" a central claim of ROGD.

This is a total outlier, the change in sex ratio is well-established in MEDRS.

Most recently, the York systematic reviews for the Cass Review:

There has been a twofold to threefold increase in the number of referrals and an increase in the ratio of birth-registered females to males referred to specialist paediatric gender services over time across countries.

The figure showing trends around the world shows a clear bias towards females across multiple countries, including the US, which flatly contradicts the Turban paper.

And indeed the Cass Review says on claims like Turban's:

A common explanation put forward is that the increase in presentation is because of greater acceptance. While it certainly seems to be the case that there is much greater acceptance of trans identities, particularly among younger generations, which may account for some of the increase in numbers, the exponential change in referrals over a particularly short five-year timeframe is very much faster than would be expected for normal evolution of acceptance of a minority group. This also does not adequately explain the switch from birth-registered males to birth-registered females, which is unlike trans presentations in any prior historical period.

See also this recent German paper on trends, which shows easily the largest and fastest growing group as 15-19 year old females.

Too much importance is being given to this outlier Turban paper, and relevant, higher quality work - including systematic reviews - continues to not be mentioned on this page. Void if removed (talk) 10:59, 10 June 2024 (UTC)

If other equal or higher-quality sources (such as reviews, and the Turban paper is only a single study) contradict the findings of Turban et al, then that needs to be added. To not mention them is misleading regarding the claims made in this article. If the argument ends up being that only the Turban paper mentions ROGD and the others do not (although they might, we should check), that fact isn't a loophole to cite only one paper on the topic of sex ratio when others say something else; the Turban paper would also need to go. WP:MEDRS applies to that medical fact. Crossroads ^-talk- 18:45, 11 June 2024 (UTC)

The Turban paragraph doesn’t say that there is no shift, only that there is a slight shift and other factors may be at play to explain it.

Actually the German paper further referenced and concurred - Die in unserer Studie gefundene Geschlechtsverteilung von F64-Diagnosen (Knabenwendigkeit präpubertär, Mädchenwendigkeit ab Pubertät, Angleichung im jungen Erwachsenenalter) gleicht weitgehend den Ergebnissen von Sun et al. (3). with Sun et. al. (2023) - which found that while some ratios have seen slight shifts (not two or threefold, but at a ratio of 10:13) and had some suggestions such as The time of physical and hormonal change during puberty might explain the different patterns of GD development by sex. Youth with GD tend to seek medical attention when puberty begins.

So it’s not like the paragraph of Turban is outlandish in supporting that the fringe theory of ROGD may not be the root cause, but simply other factors as the conclusion of Sun summarizes well: Our study demonstrated a climbing prevalence of GD, especially in AFABs. While further studies are warranted to determine the persistence of the diagnosis, we encourage youth to explore their gender identity with a non-biased stance, educate the public on gender diversity, and call upon clinicians to provide timely assessment for children and youth with GD concerns..

The German paper doesn’t reference ROGD, while Sun et al. does in passing, but they largely conclude that the overall mean age across the board is decreasing (as the title of their paper says) and discuss other factors as likely explanation for the shift, such as more information being available to youth now - The decreasing mean age of GD diagnosis suggests an increasing gender non-congruent youth population. The phenomenon might be related to increased accessibility of gender care as well as a gender-minority-friendly social context. Raladic (talk) 20:01, 11 June 2024 (UTC)

Not really following the point here - the York systematic review quite clearly shows a higher female:male sex ratio, including in the US, and this is just one of many. Two of the critical comments to the Turban paper explicitly point out this issue as well. The Turban paper is an outlier in that regard, which we devote a significant paragraph to, while mentioning none of the critical responses, and it is the only part of the page that directly references the shift in male/female sex ratio in GD presentation. The inclusion of the Turban claims in isolation introduces a problem by giving the reader the impression that the ratio does actually bias in favour of males, when stronger MEDRS are in agreement it does not.

I suggest the simplest route is to just drop this paragraph, per WP:NOTEVERYTHING. I don't think it adds anything in particular, I don't think the rest of the article depends on it in any way, and its inclusion introduces incomplete information that would mislead the reader and which is hard to balance. Void if removed (talk) 11:40, 18 June 2024 (UTC)

I think it's less that turban contradicts anything and more that the study is different in a couple of areas. One is that the only 2 years mentioned are 2017 and 2019. 2 is that the data is from the youth risk behaviour survery so mainly contains 14-17 year olds (as opposed to all under 18s like the York reviews) and doesn't require the children to be going to a clinic. I think the better way would be to rewrite the paragraph and be precise in the ways it was different and mention the results of finding a decrease in transgender youth and the higher bullying of transgender youth, both of these arguing against any social contagion theory. I might start writing out a draft and see how that's received LunaHasArrived (talk) 12:16, 18 June 2024 (UTC)

I'd also like to know about the critical responses, could you send them over. Also if any of the other studies mentioning sex ratio use transgender adolescents exclusively that could be helpful. LunaHasArrived (talk) 12:22, 18 June 2024 (UTC)

They are attached to the paper, scroll down to "comments":

(And slight correction - one of the comments is from Turban, responding to criticism, only four are critical)

Aside from the two that draw attention to the disparity over the sex ratio claim (including one from Littman) there is a lengthy comment critiquing the methodological flaws, ie that the results are largely dependent on the data from one state, that different states were used in both years making it not directly comparable, and so on.

Eg.

Regenstreif et al:

Their findings are in marked contrast to the internationally recognized phenomenon of a reversal in the sex ratio of adolescents presenting at gender clinics reported by multiple authors in settings where natal sex has been accurately documented;

Littman:

Finally, high-quality data from gender clinics worldwide demonstrate striking changes in the demographics of adolescent patient populations including a shift to sex ratios that favor natal females.4–7 The absence of a female predominant sex ratio in the unweighted YRBS sample of transgender-identified teens does not negate this fact. There is reason to doubt the reliability of the sex ratio reported by Turban et al., as a known limitation of the YRBS is that the “What is your sex?” question may be interpreted inconsistently by transgender-identified youth8. Further, the ROGD hypotheses have no requirement that all samples of gender dysphoric youth must favor natal females and thus, the sex ratio reported by Turban et al. can neither support nor refute the ROGD hypotheses.

Lett et al:

Turban et al. state that their estimates of the AMAB:AFAB-ratio are based on 16 states in the abstract, 15 for 2017 and 15 for 2019 (Delaware in 2017 only and New Jersey in 2019 only) as shown in the caption for Table 1. However, only 10 states fielded the SOGI module in 2017,6 and of them only 9 had publicly available data (Massachusetts does not provide permission for the CDC to share their data).7 Similarly, only 14 states with publicly available data fielded the SOGI module in 2019. Under these circumstances, the trend analysis is comparing subsets of trans youth from different states and any differences are likely due to sampling bias making the trend analysis invalid. Beyond issues with the trend analysis are issues with the individual point estimates for the AMAB:AFAB-ratio. For 2017 and 2019 less than one-fifth and one-fourth, respectively, of the 50 states and five territories in the United States are included in the analysis. Table 1 shows the high variability of the AMAB:AFAB-ratio between states and within states across time points. Much of this variability is driven by the sample size; for instance, in the Rhode Island sample between 2017 and 2019 the AMAB:AFAB-ratio inverted from 0.8 to 3.0, based on TGD youth samples of only 39 and 16 persons, respectively. In comparison to Rhode Island, Maryland dominates the sample for both years. Specifically, Maryland comprises 67% of the sample (1547/2302 persons) in 2017, and 40% (711/1790 person) in 2019. To show the sensitivity to state inclusion, we recalculated the AMAB:AFAB-ratio without that state for 2017 and 2019, and found 1.2 and 1.1, respectively compared to the 1.5 and 1.2 in the authors original analysis. Because the authors methodology did not account for oversampling, their analysis provided biased results and shifted the “national” estimate that is driven by a single state.

Turban, in response:

The primary question of this study was the sex assigned at birth ratio among TGD adolescents, which we found to favor TGD adolescents assigned male sex at birth in both 2017 and 2019.

If this is the primary question this study purports to answer, and higher quality MEDRS like the York systematic review say the exact opposite, then this needs to be placed in context or removed.

Frankly, I don't think its a very significant or robust contribution, and we should not bend over backwards to include it like this, and much simpler just to remove it.

Also if any of the other studies mentioning sex ratio

But why? This is the point of a systematic review, it has done this work. We should not have to go trawling for papers to put Turban in the proper context that it is an outlier. Void if removed (talk) 12:52, 18 June 2024 (UTC)

Thank you for showing me where they were (I usually go straight to the pdf for these kind of things). Having read everything the major point is just that turban uses a survery from schools rather than relying on clinical data, this point is crucial and shouldn't be left out of our mention of turban. It's all well and good to say that it's different but that's rather the point. Turban decided to use data from somewhere other than clinics and found something different. To refute this by saying, your data is different to that found at clinics is missing the point. I don't have time to do a full systematic review at the moment but looking at the titles of sources used to create the graphs in the York review they almost all seem to be from clinics. This doesn't mean turbans data is wrong or the York reviews data is wrong. They sampling from different populations. On turbans inclusion it seems to be one of the very few papers mentioning social contagion whatsoever so should be included on that basis. LunaHasArrived (talk) 13:49, 18 June 2024 (UTC)

I'm sorry I don't see where in our paragraph we say there isn't a change in sex ratio. In fact the paragraph in question (I'm presuming the one sourced to "sex assigned at birth ratio..." in the further research section) says there was a change, just this change was due to more a decrease in people AMAB. The systematic review does also notice a change but says distinctly there was limited data to explore any patterns. At the very least there doesn't seem to be any disagreement here? LunaHasArrived (talk) 01:26, 16 June 2024 (UTC)

The Turban study is cited because it claims to refute a central plank of what Littman sought to explain, ie a rapid unexplained increase in adolescent female presentation, coupled with a hypothesis of social contagion in this demographic.

By claiming there is no rapid rise in adolescent female presentation, it purports to show there is no underlying phenomenon for a social contagion hypothesis to explain:

An August 2022 study published in Pediatrics investigated claims of trans identities as "social contagion" for youth assigned female at birth (AFAB) by analyzing the ratio of assigned male at birth (AMAB) youth to AFAB trans youth in the US in 2017 and 2019. The study found that AMAB trans youth were more common than AFAB youth in both years

This is at odds with basically every other source which accepts that the rapid increase in adolescent female presentation is a real phenomenon, and that sex ratios have reversed, with no definitive explanation.

Turban's central claim here cannot be squared with eg. the York systematic review which shows the opposite. Void if removed (talk) 08:06, 16 June 2024 (UTC)

The York review showed a rapid increase in general, and that the sex ratio had changed (but no reason was given and it was left out of the actual conclusions) over a much much longer time frame. Turban et al was focused on a narrower time period and a much more precise area (mostly because it wasn't a systematic review). Interestingly in the current paragraph it says "this lack of increas of AFAB youth was interpreted as inconsistent with the social contagion hypothesis", in Turban et al they describe a lack of increase in transgender youth as incongruent with the rogd hypothesis of social contagion. The truth of the matter is, between those years in those 16 states a decrease in transgender youth was found, and that the ratio did changed but was still in favour of amab youth. Honestly the entire thing might just be because of the start date, but that shows that for some reason those US states aren't having the social contagion problem. It's probably worth noting that turban at el only studies the US (probably the best way to do this is saying it used data from the youth risk behaviour survey) but any comparisons made to the York review seems too far into OR for our own good. LunaHasArrived (talk) 13:39, 16 June 2024 (UTC)

The German letter to the editor is irrelevant and people need to stop citing it here. It is measuring the persistence of billing against the GD diagnosis. Not particularly meaningful, given those who are diagnosed GD and then hold off on transition or whose parents prohibit them from transitioning, are qualified as 'desisting'. Zenomonoz (talk) 02:21, 16 June 2024 (UTC)

Not sure what that has to do with my point, which is that this is yet more evidence of the sex ratio switch Turban claims to refute, despite basically every other source accepting it as real. Void if removed (talk) 07:56, 16 June 2024 (UTC)

You seem hyper-focused on debunking Turban, which is not what this talk page is for, and the discussion is becoming very WP:RGW. — The Hand That Feeds You:^Bite 16:36, 16 June 2024 (UTC)

This isn't about "debunking" Turban. We give excessive space to an outlier when a more recent systematic review finds the opposite. Per MEDRS I don't see why it's mentioned at all. And that's the topic of this section of talk so that's what the talk is focused on. Do you have a substantive comment? Void if removed (talk) 22:35, 16 June 2024 (UTC)

My substantive comment is to agree with other editors that your analysis of Turban and the other cites is incorrect and not going anywhere. — The Hand That Feeds You:^Bite 14:49, 17 June 2024 (UTC)

Another source

New paper out last week: Gender dysphoria in adolescence: examining the rapid-onset hypothesis. Some highlights:

Once again the sex ratio shift, contra Turban.

In recent years, specialized clinics have witnessed an unprecedented surge in adolescent patients seeking treatment for gender dysphoria [1,2,3,4]. Contrary to earlier trends where young natal boys displayed gender dysphoria from an early age, a marked shift has occurred, with significantly more natal female adolescents seeking treatment [3, 5,6,7,8]. Adolescents receiving clinical care for gender dysphoria are characterized by a considerable prevalence of co-occurring psychiatric disorders [9,10,11,12].

That criticising inflation of the significance of Littman's study is valid:

Despite the limitations and speculative nature of Littman’s findings, her theory of ROGD gained significant traction and sparked discussions that at times overlooked the scant evidence supporting it [22,23,24]. Even before the publication of Littman’s article, and thus before the results of the study were available, the phenomenon was discussed [25] and treated as established knowledge by prominent figures in the field such as Ray Blanchard and J. Michael Bailey [26]. This discrepancy between the significance of empirical findings from a single study and the far-reaching conclusions drawn from them is a valid point of criticism.

That Littman's use of parental surveys was valid:

While the limitations of the study are clear, the use of parental surveys about their children is a longstanding and valid method within various fields of research for gathering preliminary data, informing hypotheses, and tracking behavioral trends. Therefore, the use of such surveys for hypothesis-generating studies should not be discouraged in clinical research, provided that one acknowledges their inherent limitations and potential for bias, especially in areas that involve very personal issues of identity.

That peer contagion is a legitimate hypothesis:

The processes of peer contagion, particularly noted among adolescent natal females with psychiatric disorders, alongside the accumulating evidence of social media’s detrimental impacts on young people in general, give cause for consideration of the evidence emerging from Littman’s study. If it can be said that social contagion processes have been shown to play a role in certain disorders [67,68,69], and that social media can potentially exacerbate these processes [83], it is reasonable to assume that this may also be the case for some adolescents with gender dysphoria. This gives reason for closer study and, crucially, the direct involvement of adolescents themselves.

That this is a subject that requires more study:

In our view, it is imperative to investigate the phenomena described in Littman’s research regarding a subgroup with distinct phenomenology. From our clinical experience in the medical care of affected children and adolescents, we observe at least a subset of patients with significant co-occurring psychopathology. It is not uncommon for these adolescents to describe an increase in gender dysphoria with the onset of puberty, often coinciding with the Covid-19 lockdowns and accompanied by an increase in social media use. In order to validate the theory and document the core clinical phenomenology, attempts must be made to replicate her observations using multiple sources of information (youth, parents, clinicians) and diverse methodology [85]. If forthcoming research substantiates the existence of this clinical phenomenon, the development of explanatory models will become crucial to enhance our clinical insight into the distinct needs of these patients.

That neither lauding Littman's findings nor condemning them is appropriate, callis it an important contribution, and also cautioning that even though some people may seize upon this as an explanation that allows them to argue against medical transition, that should not be a reason not to research further:

This article aimed to examine the controversial theory of rapid-onset gender dysphoria (ROGD) in light of the existing evidence base. In summary, it becomes clear that neither prematurely adopting ROGD as a valid explanatory model nor its hasty condemnation as transphobic is an appropriate response. It is hard to deny that Littman’s research has made an important contribution to the discourse. It is now the task of the scientific community to take up this contribution and build on it with further research. We have to face the fact that ROGD may provide a convenient pathogenic explanatory model for those who are fundamentally opposed to medical transitioning of adolescents. In our opinion, however, the correct response to such possible tendencies is not to suppress research in this direction, but to strengthen it, so that evidence-based judgments of its validity are possible.

So, add this to Thompson et al. and Elkadi et al. as sources that should be cited in balancing out this article. Also further questions any claims this is WP:FRINGE or WP:PSEUDOSCIENCE. Void if removed (talk) 15:46, 8 July 2024 (UTC)

This is entering WP:RGW levels of disruptive behavior on this topic. Your crusade to personally smash Turban's cite here is depressingly repetitive. — The Hand That Feeds You:^Bite 19:44, 8 July 2024 (UTC)

What I said at the end was: sources that should be cited in balancing out this article

Any comment on how we might add this new source to balance out the content in the article, which is what this topic is about?

At the very least a paragraph in "further research", no? Void if removed (talk) 20:34, 8 July 2024 (UTC)

The TLDR of this paper was 1) There continues to be no evidence that ROGD exists 2) many people have claimed it exists despite the lack of evidence and 3) we should research it so we can more definitively say it's true or false. You said it should be cited in balancing out this article - I don't oppose citing it but you haven't laid out how the article is supposedly imbalanced. This paper is clear, claims that ROGD is definitely a real thing as opposed to a hypothesis based on shaky data continue to be WP:FRINGE. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:06, 8 July 2024 (UTC)

That's a rather slanted interpretation of the paper, which stated that "neither prematurely adopting ROGD as a valid explanatory model nor its hasty condemnation as transphobic is an appropriate response" and "It is hard to deny that Littman’s research has made an important contribution to the discourse". This is hardly declaring ROGD to be "fringe", but simply a hypothesis that as of yet has not gained sufficient data to prove or disprove, but has enough plausibility that further study is desirable. *Dan T.* (talk) 19:27, 9 July 2024 (UTC)

Proposed change to the lead section

In my view, the first sentence of the article should refer to ROGD as a "controversial hypothesis" because it is more suitable than alternative descriptors:

• The article currently calls it a "controversial, scientifically unsupported hypothesis", which is false. As demonstrated in the section above, there is at least some evidence in favor of the hypothesis.
• Another option which has been discussed previously is to call it a "controversial, scientifically unproven hypothesis", which is technically true but demonstrates a lack of understanding of scientific terminology because the term "proof" is reserved for math and formal logic and is not applicable in science.

Therefore the best option is just to omit both of those terms. Partofthemachine (talk) 03:02, 16 October 2024 (UTC)

We could move the initial sentence of the second paragraph detailing the original source up to the first paragraph. Alpha3031 (t • c) 04:45, 16 October 2024 (UTC)

Please see past discussions for WP:RS that I believe support your proposed wording. Void if removed (talk) 11:02, 16 October 2024 (UTC)

Those sources were dismissed in that discussion, and for good reason. ROGD has no support outside of WP:FRINGE believers. — The Hand That Feeds You:^Bite 12:14, 16 October 2024 (UTC)

From memory, the reviews (at their kindest) say that there is not evidence to dismiss or support rogd. As far as I can tell (from reading our article to find studies and reviews about this topic), there is no published study claiming to support this phenomenon actually existing. Given this it seems like scientifically unsupported is the fair way to describe this. LunaHasArrived (talk) 14:18, 16 October 2024 (UTC)

Because "controversial" is what WP:RS like the European Academy of Paediatrics say, but they don't say "scientifically unsupported", which appears to be over-egging things needlessly. Void if removed (talk) 15:15, 16 October 2024 (UTC)

There is plenty of sourced content in the article body about how this hypothesis isn't supported by research. We are supposed to summarize sources, especially in the lead, so saying it's unsupported seems completely fine given the article text. -- Maddy from Celeste (WAVEDASH) 15:34, 16 October 2024 (UTC)

Yeah, "scientifically unsupported" is probably too nice, even. We could easily say "pseudoscientific" and be fully justified in it. Loki (talk) 15:59, 16 October 2024 (UTC)

As with every other time we've discussed this, there continue to not be any scientific papers supporting this existing, *including the original paper* which was corrected to make it very clear that it doesn't prove or show anything—blindlynx 16:06, 16 October 2024 (UTC)

Again, the paper in the previous section says that ROGD has at least some evidence behind it. Partofthemachine (talk) 04:54, 20 October 2024 (UTC)

The paper directly calls littmans paper as "scant evidence" and that rogd is "a relatively unsupported theory". It only mentions 2 unretracted papers on rogd, littmans and buar et al. Given littmans says nothing about it existing (apart from in the mind of some parents) and Buar et al found no support for the hypothesis, scientifically unsupported seems like the only way to describe this. LunaHasArrived (talk) 08:27, 20 October 2024 (UTC)

"Relatively unsupported" seems both a fine compromise and an accurate reflection of the source. Void if removed (talk) 08:33, 20 October 2024 (UTC)

But that's not the only source though. Loki (talk) 13:36, 20 October 2024 (UTC)

This seems vague and far too generous to advocates of ROGD. Pseudoscientific is probably the best word. HenrikHolen (talk) 10:04, 21 October 2024 (UTC)

Another option would be: "critics contend it is scientifically unsupported". I think pseudoscientific could be mentioned if attributed e.g. "which critics contend it is pseudoscientific". Zenomonoz (talk) 10:39, 21 October 2024 (UTC)

I think "critics" becomes too vague and risks creating a false balance. A better choice could be to specify a medical organization or authority and write e.g. "the APA describes it as…" HenrikHolen (talk) 11:14, 21 October 2024 (UTC)

Ah, yeah you’re probably right about false balance. I think the other option makes more sense. Zenomonoz (talk) 13:50, 21 October 2024 (UTC)

far too generous to advocates of ROGD

Can you explain?

Pseudoscientific is probably the best word

Do you have a source? Void if removed (talk) 15:54, 21 October 2024 (UTC)

My main concern is that "relatively unsupported" is open to interpretation and might lead people to wrongly assume there is some basis for this theory in medical literature.

I see your point that, however we choose to describe it, the choice should reflect the wording used in the source. I propose we write "there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents", citing the 2021 letter from the APA et al.

https://www.caaps.co/rogd-statement HenrikHolen (talk) 17:03, 21 October 2024 (UTC)

We can paraphrase sources, there's no need to stick exactly to the wording of the source. Loki (talk) 17:47, 21 October 2024 (UTC)

The correction to the Littman paper makes it bends over backwards to clarify there is no scientific evidence provided in it!!!—blindlynx —blindlynx 13:53, 21 October 2024 (UTC)

This is one of the more contentious articles in a contentious topic area under WP:ArbCom constraints involving blocks, bans, and revert restrictions. I am opposed to changes to the lead without concomitant changes to the body which very clearly support such a change. Mathglot (talk) 17:36, 21 October 2024 (UTC)

I'd oppose this change -- MedRS places us into territory of increased scrutiny. Particularly for overall characterizations such as the ones proposed, we must exclude primary sources, and follow the consensus of major medical organizations. The three sources you reference ^{[1] , [2] , [3]}  don't seem to provide the evidence we would need to, contrary to the consensus of major professional organizations ^{[4] [5]}, imply that the theory is scientifically supported or validated. I agree that "unproven" is meaningless in this context -- it should not be used. Srey Sros^talk 19:31, 3 November 2024 (UTC)

Oppose. I think that the lead is already as kind to this hypothesised topic as is permissible. We are (rightly) avoiding terms like "discredited", "pseudoscientific" and "conspiracy theory" but we can't go further than that. It is not for us to sugarcoat the situation or introduce an illusion of doubt where there is none. --DanielRigal (talk) 20:59, 3 November 2024 (UTC)