They Keep Getting Younger and Younger

A new article confirmed what many of us already knew: “The mean age of gender dysphoria diagnosis is decreasing.” But why?

Photo by Mercedes Mehling on Unsplash

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About the Author

Lisa Selin Davis

is the author to TOMBOY: The Surprising History and Future of Girls Who Dare to Be Different and HOUSEWIFE, forthcoming in March. She’s currently researching a book on the youth gender culture war.

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For years, the patient demographics remained similar. The bulk of those with what was originally called gender identity disorder—marked discomfort with or distress at one’s sexed body—were middle-aged men. Of the small number of children suffering from this rare condition, the majority experienced it beginning in early childhood. Most were boys.

Then, sometime in the 2010s, things began to change. The sex ratio flipped, with many more girls than boys suffering from GID, which was renamed gender dysphoria in 2013[1]. Within a decade, the number of teens identifying as trans shot up, most of them girls with no history of gender issues—trends viewable in both published data and endless personal accounts.

This week, a new article confirmed what many of us already knew, and it says it all in the title: “The mean age of gender dysphoria diagnosis is decreasing.”

The data comes from anonymized medical records of 43 million patients, from ages four to 64, 80 percent of whom were from the U.S. “The estimated prevalence of GD diagnosis increased significantly from 2017 to 2021,” the authors noted. The mean age dropped from 31.49 to 26.27. Patients with GD were most likely to be young white women.

The increase “was significantly more rapid” among women under age 22. “We found that the estimated prevalence of GD in [females] sharply increased at the age of 11, peaked at 17–19, and then decreased below [males] at 22.” For males, the increase began at 13 and peaked at 23, then started declining again. “The estimated prevalence of GD in [males] started to increase at the age of 13, peaked at 23, and then gradually decreased.”

As for why this happened, they have some thoughts: girls tend to go through puberty earlier than boys, and “youth with GD tend to seek medical attention when puberty begins.” The steep drop-off after adulthood, then, perhaps occurs because the earlier girls go on hormones, the more likely they are to stay on them. If they haven’t medicated before then, perhaps they won’t.

Further, the authors suggest that social media has encouraged girls to “embrace diversity and independence,” and girls are “more likely to want to express their identities.” Moreover, they say that society appears more accepting of gender-diverse girls than boys. In old fashioned terms, people like tomboys, but sneer at sissies—so much so that there isn’t even a positive term for girlish boys.

These aren’t new arguments. For years, activist organizations and the medical associations they’ve likely influenced have suggested that increasing tolerance had led to this explosion in trans identities—a claim repeated by mainstream media. In other words, kids finally have the language to articulate what they’d always felt.

Perhaps there is some truth to these arguments. However, the paper in question, along with others, seems to willfully ignore a key aspect of the demographic transformation—the “social contagion theory.”

In 2018, the American Academy of Pediatrics published its statement supporting “gender-affirming care,” and warning of potential psychological harm of not affirming a child’s identity. That same year, Dr. Lisa Littman published a research paper on what she termed “Rapid Onset Gender Dysphoria.” “The onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe,” she wrote. Often the trans identity surfaced after prolonged exposure to social media, watching trans influencers extol the virtues of medical transition.

Social media wasn’t encouraging girls to embrace diversity, it turned out. It was encouraging them to hate themselves and their bodies, to disassociate, to cling to mental illness as an identity in itself, to self-diagnose with gender dysphoria, among a host of other ailments. The only difference between GD and those other illnesses was that ROGD girls were often clamoring for hormones and double-mastectomies, convinced that’s what their diagnosis required. And they were affirmed—which may be why more and more of them are emerging, years later, as detransitioners, regretting what doctors did to them.

We’ve seen an acknowledgement by social scientists and the media of all kinds of social media “contagions,” from tics to “dissociative identity disorder.” But ROGD has been hopelessly politicized by medical groups, activist organizations, and the media, which all insist there is no social media contagion when it comes to “trans kids.” They’ve worked to debunk it, rather than acknowledge the new demographic and research how best to treat its members. In fact, a recent paper on ROGD was retracted because of activist pressure, even though it was full of information researchers should be incorporating into their work—and paints a similar picture of gender dysphoria in girls manifesting around two years earlier compared with boys. Why is so much American scholarship and politicking dedicated to explaining away this phenomenon, instead of tending to it?

Now many are finally acknowledging the shift, but saying it’s because of social acceptance. However, if this is the case, why is dysphoria still present? This is happening despite the fact that the same trends have been found in several European countries, prompting stricter guidelines for treating these young people.

Here’s why acknowledgement of the new group is so important. The treatment protocol for kids, developed by Dutch psychiatrists in the late 90s, was created for children who’d suffered from GD since early childhood, and for whom it got worse at the onset of puberty. These kids largely didn’t have other serious mental health conditions (or they were under control), and they lived in supportive families. The research seemed to indicate that these kids—who went on puberty blockers and cross-sex hormones, followed by surgeries—found their gender dysphoria almost miraculously alleviated in the year-and-a-half afterward.

At the same time, it was common knowledge that the bulk of those kids, if not socially transitioned, would outgrow their gender dysphoria by the end of puberty, and that the majority would turn out to be gay or bisexual. Because of that, kids weren’t socially transitioned—that’s an intervention that seems to concretize what might otherwise be a transient identity or discomfort. That is, it’s thought to be iatrogenic: the treatment creates the condition.

The new demographic that this “Mean Age” paper refers to is so different from the original cohort that the protocol, the approach, doesn’t—or shouldn’t—apply to them. If one medication works for middle-aged men with a long-term issue, it doesn’t necessarily mean it works for teen girls for whom it’s suddenly arisen, especially when the condition is presenting in largely novel ways in the new group. If we aren’t admitting and investigating the etiology of these teen girls’ gender dysphoria, we’re not going to determine the proper treatment for it. I can figure this out with no medical training whatsoever.

And, at any rate, the Dutch protocol has recently been convincingly questioned. The methodology was so deeply flawed. The kids were mostly gay. They were transitioning children because transition hadn’t worked so well in adults—not because it had worked so well that they were extending it to younger patients.

While I recognize the danger of ignoring or dismissing the social contagion theory, I admit I feel it’s only one part of a much bigger story. So much has changed concurrently with this demographic shift. ROGD occurs primarily in upper middle class, white families. These are the parents who in this era became likely to engage in “snowplow parenting,” in which parents try to protect kids from pain, rather than teaching them to navigate it. Thus, these kids may assume that “distress at puberty” is a problem that needs solving with medical intervention, rather than a completely normal reaction that needs accommodating with self-soothing techniques.

Meanwhile, kids as young as three years old are learning to “break the binary,” listening to books about kids with “girl brains” and boy bodies, and being told that there’s such a thing as gender identity and that everyone has one. What some of us call “gender identity ideology” has been taught to them. They’ve learned that gender is a feeling of maleness or femaleness inside them, rather than a system of roles, stereotypes and expectations imposed onto them because of their physical sex. In fact, they’ve looked at teaching tools like the “gender unicorn,” which doesn’t mention stereotypes at all.

The medical narrative has changed drastically in that same time period. Doctors started announcing that gender dysphoria started early and wouldn’t subside, that trans kids “know who they are,” and must be affirmed—that is, socially and medically transitioned, often without much in the way of evaluation, according to many parental reports. If they weren’t affirmed, we were told, these kids were at great risk for suicide. Over and over, parents were told they had to choose between a living trans child or a dead cis one. Safeguarding—mislabeled “gatekeeping”—became a problem to overcome, rather than an important principle to uphold.

Contagion is accidental. This has been a concerted marketing effort from almost every liberal institution in America, coupled with a powerful censorship campaign. Together, these efforts prevent so many troubled kids from getting the help they need.

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Notes

[1] The gender dysphoria diagnosis allowed for treatments to still be covered by insurance, but removed some of the stigma associated with the word “disorder.”

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