According to a study published in the Journal of Adolescent Health, a significant proportion of transgender and gender diverse (TGD) adults realize during adolescence or later that their gender identity is different from their sex assigned at birth.
As many states have or are now drafting legislation to prohibit or limit access to gender-affirming medical care for TGD adolescents, there has been considerable discussion of what has been called “rapid-onset gender dysphoria” or ROGD. This is the theory that many adolescents who realize and disclose their TGD identities in adolescence are experiencing a transient dysphoria triggered by peer influence and social contagion.
Given the lack of reputable scientific evidence to support this hypothesis, medical organizations have not recognized ROGD as a valid mental health diagnosis. Use of this term has been discouraged by the American Psychological Association, the American Psychiatric Association, the World Professional Association for Transgender Health. Nonetheless the ROGD hypothesis has been used to support legislative efforts to limit access to gender-affirming care.
The 27,715 TGD adults participating in this survey were asked about the age at which they first realized that their gender identity was different from societal expectations based on their sex assigned at birth. They were also asked about the age at which they first shared their gender identity with another person.
Later Age at Realization of TGD Identity is Common
In this cohort, 40.8% of the participants reported later realization of TGD identities (at the age of 11 or older); the remainder reported that their realization of TGD identity occurred during childhood (at the age of 10 or younger). The age of 10 was used as the cutoff to approximate the onset of puberty. (This age was chosen as it is the age at which the emergence of secondary sexual characteristics has been observed among large, national samples of youth.)
Among the participants with childhood realization of TGD identities, the median age of sharing their gender identity with another person was 20. In this group, the median time between realization of TGD gender identity and sharing this with another person was 14 years.
It is vital that clinicians, health policy analysts, and journalists familiarize themselves with the facts about gender identity development. — Alex S. Keuroghlian, MD, MPH
The study also noted important differences between those who came to realize their TGD identities in adolescence or later compared to those experienced this realization at a younger age:
- Participants in the later realization group were more likely to be assigned female sex at birth compared to those in the childhood realization group (63.2% vs. 53.1%)
- More participants in the later realization group identified as nonbinary or genderqueer (49.1% vs. 25.2%).
- Fewer participants in the later realization group experienced K-12 harassment based on gender identity (13.1% vs. 26.9%), had a history of exposure to gender identity change efforts (13.1% vs. 26.9%), and received pubertal suppression (0.2% vs. 0.4%) or gender-affirming hormones (34.8% vs. 56.6%).
Challenging the ROGD Hypothesis
The current study adds important information to our understanding of gender identity development. While the ROGD theory suggests that individuals who initially realize their transgender and/or gender diverse identities during adolescence will not continue to maintain their TGD identities into adulthood, this study challenges this view. The current study indicates that among TGD adults, later realization of TGD identity is common.
This study also observed that while many TGD adults first began to recognize their TGD identity before the age of 10, the median age of sharing their TGD identity with another person was 20. The authors thus note that what might be viewed by parents and others as the first realization of TGD identity in adolescence, or what some might label as rapid-onset gender dysphoria, is more likely the first disclosure of an identity first realized in childhood. Therefore, it is likely that the data derived from parental reports — and used to support the ROGD hypothesis– is largely inaccurate.
Misinformation and disinformation, including the ROGD hypothesis, have been used by numerous governmental agencies, lawmakers, and policy analysts to justify legislative and regulatory measures prohibiting adolescents from accessing gender-affirming medical care, despite opposition from all major medical organizations. “The damage that has been done to transgender and gender diverse youth and their families by new laws prohibiting them from accessing gender-affirming medical care as well as the toxic rhetoric promulgated by these legislative campaigns is incalculable,” said study senior author Dr. Keuroghlian.
Read More
Turban JL, Dolotina B, Freitag TM, King D, Keuroghlian AS. Age of Realization and Disclosure of Gender Identity Among Transgender Adults. J Adolesc Health. 2023 Mar 13: S1054-139X(23)00070-8.
In the News
New Study Undercuts The Rapid Onset Gender Dysphoria Hypothesis (Fenway Health)
Alex Keuroghlian, MD MPH is the Michele and Howard J Kessler Chair and Director of the MGH Division of Public and Community Psychiatry and Associate Professor of Psychiatry at Harvard Medical School. In addition, he is the Director of the MGH Gender Identity Program, Director of Education and Training Programs at the Fenway Institute, and Director of the National LGBTQIA+ Health Education Center.
