The Perfect Storm

What drives rapid onset gender dysphoria in adolescent boys?

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When Lisa Littman posited the existence of rapid onset gender dysphoria (ROGD) back in 2018, she told a simple and compelling story: (a) we know from historical examples involving anorexia, self-harm, and recovered memory syndrome that adolescent girls are especially vulnerable to social contagions; and (b) because the current data show that cases of gender dysphoria and trans-identification among teenage girls appear to cluster in specific geographical locations and within friend groups, it therefore appears that (c) we’re in the midst of yet another social contagion afflicting the same cohort.

Simple to explain, easy to understand.

The increasing number of gender distressed boys is more challenging to explain and involves a perfect storm of psychological vulnerability colliding with cultural zeitgeist and new technologies. In brief, I believe that a generation of sensitive, awkward, and often highly intelligent boys is coming of age at a time when gender identity ideology suffuses the education system, social media, and online discussion forums, and when the cultural conversation around toxic masculinity and the patriarchy has made growing up to be an “oppressor” seem repellent.

This essay will flesh out the details of my hypothesis.

Most people don’t pay much attention to the fact that Lisa Littman’s landmark paper relied on survey responses from parents of adolescent boys (17.2 percent) as well as girls, largely because the “children described were predominantly natal female.” Examples used to illustrate that study’s themes nearly always depict adolescent girls, and the prior social contagions referred to by Littman have afflicted that cohort almost exclusively.

Littman’s paper also lays heavy emphasis on the “substantial change in demographics of patients presenting for care [at gender clinics] with most notably an increase in adolescent females and an inversion of the sex ratio from one favoring natal males to one favoring natal females.” Despite the presence of those teenage boys in Littman’s study, one comes away with the impression that ROGD is a novel phenomenon mostly occurring among teenage girls. Media coverage since has consistently described the condition as one “primarily” or “predominantly” afflicting that demographic.

The subtitle of Abigail Shrier’s 2020 book (“The Transgender Craze Seducing our Daughters”) likewise seems to exclude adolescent boys from the phenomenon. And in the United States today, the most prominent detransitioners speaking out against gender medicine or testifying in support of legislative bans on hormones and surgery for minor children are nearly all female: Chloe Cole, Laura Becker, Luka Haim, and Prisha Mosley. One might naturally make the assumption that the boys showing up at gender clinics today don’t differ much from the ones who for decades have wanted estrogen and sex reassignment surgery (SRS), and that this novel phenomenon of ROGD is all about the girls.

In truth, the number of adolescent boys claiming a trans identity has also risen dramatically, but that increase is overshadowed by the ahistorical explosion of girls showing up at gender clinics. Take, for example, commonly cited data from the Tavistock’s Gender Identity Development Service (GIDS):

(Source: Transgender Trend, July 19, 2019)

Due to the striking increase in girls depicted by the rising red line, one can easily miss the comparatively less dramatic increase in boys. But it’s nonetheless a very large increase (1490 percent since 2009 according to Transgender Trend); recent studies have shown that boys make up between 29 and 36 percent of gender distressed youth today.

Who are they, and does their psychological profile differ in any significant ways from gender distressed boys and men in the past?

To answer that question, we first need to understand their predecessors, those dysphoric males who showed up at gender clinics before the sudden rise in numbers that began after 2009.

The Blanchard Typology and Beyond

In the 1980s and 1990s, the Canadian sexologist Ray Blanchard proposed a psychological typology of gender dysphoria and transsexualism, categorizing the vast majority of trans-identified males requesting SRS into two groups: (a) homosexual transsexuals (HSTS)—that is, men exclusively attracted to other men and who had exhibited feminine behavior/appearance from an early age; and (b) autogynephilic transsexuals (AGPs)–heterosexual men who experience sexual arousal at the thought or image of themselves as female.[1] According to data from before 2009, HSTS represented roughly 40 percent and AGPs 60 percent of the men requesting SRS at gender clinics.[2]

Since he first articulated it, Blanchard’s typology has come under intense and persistent attack by trans rights activists (TRAs), though other researchers such as Michael Bailey (2003) and Anne Lawrence (2013) have written extensively in support of it. Based upon a January 30, 2024 comment Bailey made on 𝕏 (formerly Twitter), he apparently believes this typology still holds true for the dramatically increased number of boys and men seeking to transition: “Male adolescents are youth. And they are seeking gender transition. And most are probably AGP.”

As a psychotherapist working primarily with gender-distressed males, I’ve of course encountered both HSTS and AGPs as clients in my practice; I know they continue to show up at gender clinics for hormones and SRS, probably in the same relative proportions as before. But there’s a new cohort that doesn’t conform to the Blanchard typology, and in the pages ahead, I’ll attempt to describe and account for this new phenomenon, this Third Way into trans-identification. My views have evolved in part from my private psychotherapy practice working with trans-identified teenage boys, detransitioned males who realized too late (post-surgery) that they were gay, and men who struggle with autogynephilia.

My insights have been deepened by working with a coalition of professionals and parents of trans-identified male children and young adults who recently launched a website called ROGD Boys devoted to promoting awareness of this cohort. Much of what follows is informed by their research, my interviews with a dozen or so of these parents about their trans-identified boys, and visiting the many online websites and subreddits they brought to my attention. In doing so, I’ve followed in the tracks of my good friend Alasdair Gunn, whose series of articles When Sons Become Daughters, written for Quillette under the pseudonym Angus Fox, first blazed the trail and drew attention to the phenomenon of ROGD in boys back in 2021.

“The typical hyper-ruminative gender-questioning boy,” Gunn writes, “is smart, with communication and intellect out of proportion to his social skills. He’s excellent at mathematics in particular, and often in academic pursuits more generally, although this isn’t always reflected in grades. … [H]e’s likely to have a diagnosis of autism, Asperger’s syndrome or ADHD.” Often described as “quirky,” he hasn’t ever really fit in with his peer group and was likely bullied for his difference. Like virtually all teenagers, he wants desperately to belong, and for this reason seeks “an explanation for why he doesn’t fit in, especially one that comes in a form that his friends and classmates will readily understand.”

Survey research conducted by the coalition behind ROGD Boys supports Gunn’s description. With 124 parents providing survey answers, 81 percent identified their sons as either moderately, highly, or profoundly gifted. 20 percent of the boys had received an official diagnosis of autism and another 35 percent displayed “[p]oor social skills, sensitivity issues, poor eye contact, repetitive behaviors, etc. – but [were] not formally diagnosed” with autism spectrum disorder. About 32 percent of the boys struggled with symptoms of ADHD both before and after “coming out.” More than half of the parents described their sons as socially isolated, a condition which was exacerbated by the COVID lockdowns.

When given a choice of options to describe their son’s pre-adolescent gender behavior, almost 90 percent selected “Masculine (male – but avoided contact sports, somewhat introverted).” The remainder were identified as “Extremely Masculine,” and none were described as either “Feminine” or “Extremely Feminine.” These boys absolutely do not fit the profile of HSTS as described by Blanchard. Whether they qualify instead as AGP has been hotly contested. While certain critics on 𝕏 regularly denounce all trans-identified males, regardless of their age, as fetishistic perverts (that is, autogynephiles) and therefore unworthy of compassion or understanding, parents of trans-identified males are naturally unwilling to accept this description.

I don’t believe these boys are all autogynephilic, though a small unknown number may go on to develop that condition. Instead, I see these lonely boys as full of self-loathing and desperate to “identify out” of their hated self. The story of how and why that might occur involves a condition I’ve called “outsider shame”–the sense that you’re weird, defective, or damaged in a way that means that you don’t belong, not anywhere, and never will.

I believe the source of that shame can sometimes be found in a set of psychological traits that get lumped together as neurodivergence, encompassing autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Sometimes the shame arises from being overly sensitive, awkward or especially gifted in ways that make a child stand out in an unfavorable way. Understanding those traits will also shed light on why these boys are so vulnerable to gender ideology and the siren song of transition.

As did Lisa Littman, I’d like to emphasize that this is a hypothesis requiring extensive research and follow up. We have so little data, and what we do have is of middling quality: the parent survey I cited above, for example, is only a small convenience sample. But we do know from Hannah Barnes’ book Time to Think (2023) that around 35 percent of the children referred to the Tavistock’s Gender Identity Development Service presented with “moderate to severe autistic traits”–a rate much higher than the under-2 percent rate of autism spectrum disorder to be found within the UK’s general child population.

And that 35 percent rate likely understates the true number of neurodivergent kids treated at GIDS. The British psychoanalyst Az Hakeem has said that, excluding the transvestic cross-dressers in his practice, 100 percent of the males he treated while working for the Tavistock “were on the autistic spectrum.” 

Why do so many neurodivergent or otherwise unusual children self-identify as trans?

How It Feels to be Neurodivergent

To the extent they know anything about autism spectrum disorder, most people think it means having poor social skills and limited empathy for others. The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) groups these and other features under the heading “Persistent Deficits in Social Communication and Social Interaction.” A second set of diagnostic criteria involve “Restricted, Repetitive Patterns of Behavior, Interests, or Activities.” These criteria describe people who find change unsettling and who insist upon consistency and sameness. They may have “[h]ighly restricted, fixated interests that are abnormal in intensity or focus.”[3]

Those diagnosed with ASD often have a hard time identifying and understanding what’s going on inside their bodies (interoception) and may also find it difficult to know which emotions they’re feeling (alexithymia). As a result, they can’t easily self-regulate their feeling states, are prone to explosive outbursts, and may react in ways that seem bizarre and incomprehensible to other people. For an analysis of “How Autistic Traits Can be Mistaken for Gender Dyphoria,” see the excellent essay by that title written by autism researcher Christina Buttons.

Adolescent boys who struggle with ASD come across to other people as “quirky”–the word used by Gunn in the passage quoted above and by virtually every parent interviewed for this essay in describing their sons. These boys strike their peers as weird or eccentric, as “geeks” or “freaks,” and they’re often bullied for their difference. The diagnostic criteria in the DSM-5 diagnosis may give a “scientific” description of someone who struggles with ASD but miss the agony of how it’s experienced within–the feeling that you’re damaged goods, different in a bad way from everyone else, and some kind of ugly alien.

As explained by Buttons,

[A]utistic people typically intuit that they differ from their peers, but are unable to pinpoint or describe the reason, which can be distressing. As they struggle to assimilate, they may become preoccupied with understanding themselves and how they fit in with those around them. In a desperate attempt to resolve their distress, they may “try on” different identities or diagnoses to see what “fits.”

Thus, identifying as “trans” may offer, as Gunn suggests above, “an explanation for why he doesn’t fit in, especially one that comes in a form that his friends and classmates will readily understand.”

I didn’t realize before that I was trans and that’s why I never fit in! I used to be a despised outsider but now I’m celebrated as a part of the queer community.

It’s not hard to understand why someone might want to “identify out” of a tormented self that feels defective and has been bullied by his peers. As adolescence approaches and the desire to belong intensifies, along comes gender identity ideology just in time to save these kids from outsider shame, to “explain” why they’ve never fit in. I believe this holds true for both adolescent boys and girls; it also applies to other kids who struggle with ADHD, and even to those who are so highly intelligent or sensitive that they stand out as “weird” in a social milieu that values conformity. Just recently, one of my teenage clients said it quite succinctly: “You do know I’ve always been a nerd, right? Like really, really strange. I just never understood that it was because I’m trans.”

It’s a simple and alluring explanation, one that also appeals to the autistic tendency to view the world in simplified terms of black-and-white. As Buttons explains, when autistic people “come across overly simplistic views about gender, it can provide them with a quick explanation for their troubles (they are transgender) and a ready-made solution (transition) to achieve what they hope will be a sense of normalcy and comfort in their bodies.” Their tendency toward rigid thinking and a dislike of change will make it difficult for them to relinquish this newfound identity.

A psychological approach to trans-identification gains little traction in public debates about the issue. Instead, a simplified explanation is endlessly advanced by critics such as Kellie Jay Keen: trans-identified males are “porn addled fetishists” and the entire phenomenon of men identifying as women can be accounted for by their addiction to pornography. I reject this theory but believe we must nonetheless understand the influence that pornography does have upon a subset of these boys.

Anime and Pornography

As first noted by Gunn in his series of Quillette articles, quirky trans-identified boys usually display an obsessive interest in anime, a form of hand-drawn or computer-generated animation that originated in Japan. Given how the algorithms work, it seems inevitable that, at some point, they will be exposed to the adjacent category of anime pornography and may become fascinated by it. Based on my clinical experiences with these boys, I see their interest in anime porn as a way station between childhood and fully adult sexuality, with child-like cartoon figures engaged in acts that come across as strangely innocent and sexually graphic at the same time.

At this point, some readers who have so far been empathizing with these boys might suddenly recoil. As I’ve noted before, few subjects elicit as much disgust as the idea of males masturbating in front of their computer screens, and you may be inclined to dismiss these boys as creeps. Bear in mind that boys included in the survey cited above were as young as 10 years old and clustered in their mid-teens. These young boys are struggling with and confused by their testosterone-fueled sexuality; it seems both unkind and simple-minded to write them off as sexual perverts.

Nor do we know how many of these boys have been seduced by more hardcore pornography online. Some boys I’ve seen in my practice seem detached from their bodies and find sexual arousal to be disturbing. Others are exploring their sexuality via anime pornography in a way that seems almost childlike, not compulsive in the way of boys who struggle with a true porn addiction. We need to keep an open mind and not resort to across-the-board categorization or harsh moral judgments.

In addition to anime, another type of pornography bears mentioning here: sissy hypno porn and forced feminization videos. In this genre, male viewers of (or performers in) the video are devalued, debased, and emasculated, usually by a dominant female who mocks them. They may be forced to wear women’s clothes against their will and scorned for being beta males–that is, “losers” who will never be “real men.” For a chilling example of how sissy hypno porn can persuade a vulnerable young man to believe he is trans, watch this recent episode on Benjamin Boyce’s YouTube channel.[4]

The boys I’ve described in this essay often feel that they are losers. Socially awkward misfits, they may feel hopeless about ever attracting females or having a girlfriend. Afflicted by outsider shame and sexually frustrated, they may then find ways to sexualize their shame through forced feminization videos, a topic I discussed in my presentation at Genspect’s 2023 Killarney conference; sometimes these young men take the transmax route and transform themselves into facsimiles of women, inspiring this humorous but disturbing meme: if you can’t get a girlfriend, become someone else’s girlfriend.

Boys that discover forced feminization porn online may in turn be “discovered” by older men, usually autogynephiles, who then groom the boys through conversations held in discord servers and private chats. The older men will encourage this dawning belief that they are girls trapped inside of male bodies and the boys must of course undertake medicalized transition. The groomers may offer compliments and praise for how “pretty” the boys look when cross-dressing and invite them to engage in sexting or the sharing of intimate images of their body parts.

One contentious topic is the relationship between pornography and trans-identification–that is, whether exposure to the former can cause the latter due to habituation and novelty-seeking. In his 2007 book The Brain that Changes Itself, Norman Doidge states: “When pornographers boast that they are pushing the envelope by introducing new, harder themes, what they don’t say is that they must, because their customers are building up a tolerance to the content.” The trans-activist Andrea Chu famously stated that it was exposure to sissy porn that did “make me trans.”

As I told Stephanie Winn in this podcast episode, I remain skeptical. I don’t believe that exposure to forced feminization videos can gradually transform a boy with a strong sense of self into a trans-identified female who finds degradation to be arousing. There must be a pre-condition, a prior sense of shame or inferiority which sissy hypno porn can then exploit.

A main contributor to that sense of shame is the way these quirky teens feel about themselves as boys and men.

Problematic Masculinity and the Male Sex Drive

In the article cited above, Christina Buttons notes that autistic kids tend to fixate on “social justice” issues in addition to transgender identities. In my experience, those social justice issues include the ongoing cultural critique of “toxic masculinity” and the patriarchy; nearly all the trans-identified boys I’ve encountered (either as clients in my practice or through interviewing their parents) subscribe to the oppressor-oppressed world view and consider white heterosexual males to be at the despicable top of that power structure.

These boys have a deeply problematic relationship with masculinity (whatever that means to them) and to their own bodies. Given their struggles to accurately identify bodily sensations and feeling states, they may find the emergence of sexual arousal during puberty to be profoundly unsettling; having learned to look down upon men, they may find  their new masculine sexual urges to be disturbing. As I discussed in my presentation at Genspect’s Denver conference (November 2023), some of these boys never masturbate and find both spontaneous erections and nocturnal emissions to be profoundly unsettling. One of my trans-identified clients, a young man on the spectrum, told me he wanted to take estrogen and become a woman because female sexuality “aligned more with my value system.”

At the same time, these boys have often been the targets of toxic masculinity during adolescence, ridiculed and bullied for being strange. As the survey data discussed above demonstrate, they don’t necessarily display feminine traits and behaviors from an early age, but many boys on the spectrum do come across as “gender non-conforming” in that they don’t behave like typical boys. The link between symptoms of ASD and gender non-conformity/gender dysphoria has been established by a number of studies[5], although the reasons for it are yet to be explained. The study cited in the footnote below links it to a mediating factor–a poor ability to “mentalize” or to infer the interior state of mind of other people. Why a poor ability to mentalize should be linked to a higher incidence of gender dysphoria is but one of many questions needing further research.

I believe these boys come to “explain” the ways they differ from typical biological males (their odd behaviors that might have provoked bullying) by believing something simplistic like: If I don’t fit in with the boys, then I must be a girl. Black and white, either/or. In addition, their inability to identify their own emotions and to grasp the interior states of other people makes them vulnerable to overly cognitive or ideological explanations detached from internal feeling states. I’ll have more to say about the relationship between this kind of detachment (or dissociation) and trans-identification in a later essay.

While these boys may display or cultivate certain gender non-conforming traits and denounce traditional masculinity, they also come across as typical boys obsessed with video gaming, technology, science, and strategies of war–like my client mentioned above who described himself as a “nerd.” It’s not unusual for such a boy to discover another trans-identified male who shares his science nerd interests and to become romantically involved with him. As “transwomen,” they may consider themselves to be lesbians.

I’ve heard these boys express overpowering joy in finding someone like themselves, and relief from a profound sense of loneliness and being different. When you’ve always had a hard time mentalizing the interior states of other people, it comes as an immense relief to meet someone who appears to think and feel the same ways that you do. These romantic relationships seem more like puppy love, not terribly sexual, and steeped in the sense of sameness.

Comprehending the mysterious mental states of these boys may be difficult for those unfamiliar with neurodivergent or highly gifted and sensitive boys, but a combination of profound loneliness and shame holds the key. Most of us can understand how it feels to be an outsider, excluded or rejected; we can imagine what it’s like to sense that you’re weird or different from other people in a bad way. And after years of listening to relentless public discourse about toxic masculinity, it’s not hard to understand how boys coming of age might feel ambivalent, at the very least, to confront testosterone-fueled sexual urges that trouble them.

Gender identity ideology, spread across emergent technological platforms in recent years, has offered these boys an escape. As destructive as we know that ideology to be, we can also understand why a strange and lonely boy coming of age today, desperate to belong and feel good about himself, might embrace it.

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If you are concerned with the medicalization of young men and boys suffering from gender identity confusion—and how that population’s reasons for identifying as transgender are often misunderstood and overgeneralized—visit the ROGD Boys website for information, resources, and support.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Bailey, J. M. (2003). The man who would be queen: The science of gender-bending and transsexualism. Joseph Henry Press.

Barnes, H. (2023). Time to think: The inside story of the collapse of the Tavistock's Gender Service for Children. Swift Press.

Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Penguin Books.

Lawrence, A. A. (2013). Men trapped in men's bodies: Narratives of autogynephilic transsexualism. Springer Science & Business Media.

Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13(8), e0202330. https://doi.org/10.1371/journal.pone.0202330

Shrier, A. (2020). Irreversible damage: the transgender craze seducing our daughters. Regnery Publishing.

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[1] For those unfamiliar with this phenomenon, I’ve written two detailed accounts of autogynephilia for this Substack which can be found here and here.

[2] Blanchard R, Clemmensen LH, Steiner BW. Heterosexual and homosexual gender dysphoria. Arch Sex Behav. 1987 Apr;16(2):139-52. doi: 10.1007/BF01542067. PMID: 3592961.

[3] Canadian psychologist Ken Zucker believes that becoming fixated on gender identity might explain why kids on the spectrum are over-represented among trans-identified teens.

[4] Note how Shane, the subject of this episode, had absorbed and been influenced by the cultural conversation around toxic masculinity before he encountered sissy porn.

[5] See, e.g., Kallitsounaki A, Williams DM, Lind SE. Links Between Autistic Traits, Feelings of Gender Dysphoria, and Mentalising Ability: Replication and Extension of Previous Findings from the General Population. J Autism Dev Disord. 2021 May;51(5):1458-1465. doi: 10.1007/s10803-020-04626-w. PMID: 32740851; PMCID: PMC8084764.