Culture & Ethics
Examining Causes of Gender Dysphoria
Author’s note: This is Part Six of a seven-part series about transgenderism. Nothing in the series is intended to disparage any transgender person, any gender non-conforming person, or any person attracted to members of the same sex. I write as a developmental biologist (Berkeley PhD), and I focus on evidence pertaining to transgender treatments for children.
WARNING: Parts of this series contain explicit language. Reader discretion is advised.
I’ve spent most of my career as a biologist writing about embryos and evolution. Transgenderism was not on my radar until I read a news story in October 2019. The story reported that a Texas court had granted sole custody of a seven-year-old boy to his surrogate mother. She planned to transition him to a girl by starting him on a puberty blocker as early as age nine. But his father, who until October shared joint custody of the child, opposed the plan.
The couple had divorced when the boy was three. According to the surrogate mother, the boy had decided at that time that he was a girl. So she gave him a girl’s name and had him wear dresses. When he was old enough, she sent him to school as a girl. But the father and others reported that when the child was with him he behaved happily like a boy.
Until October 2019, I had no idea that the movement to transgender children had become so powerful. I also had no idea of the extent to which the government was condoning it. For example, the U.S. Food and Drug Administration has not approved puberty blockers for children with gender dysphoria. But it looks the other way when the drugs are prescribed “off-label.”
I continued to read about the Texas case. Then a cell phone video surfaced of the boy talking to his father soon after the parents divorced. “You’re a boy, right?” the father asks his three-year-old son. “No,” the child responds, “I’m a girl.”
“Who told you you’re a girl?” the father asks.
“Mommy,” the child answers.
What Are the Causes of Gender Dysphoria?
Not all cases are like the one described above. But some are. On November 12, 2020, HBO released “Transhood,” a documentary about four children. One of the children is a boy named Phoenix. The documentary shows his mother telling him at age four that he’s a girl.
Yet there are also children who start insisting as early as age three that they’re in a body of the wrong sex. No one knows the cause(s) of such cases of childhood gender dysphoria. Part One of this series pointed out that neuroscience has not settled whether brain differences might be responsible. Differences in child-rearing and parental attitudes have not been well studied. Nor has the possible effect of sexual abuse.
What about spiritual influences? Many people, even in the modern world, are convinced that spirits can influence our thoughts. This includes the thoughts of young children. But modern science, dominated as it is by materialistic philosophy, does not acknowledge such influences. So modern science has not developed methods to study them.
In recent years, there has been increased interest in a possible connection between gender dysphoria and autism. Autism is not a discrete phenomenon, but a range of behaviors called “autism spectrum disorder” (ASD). A 2019 survey of parental reports of children from 6 to 12 years old found “associations” between ASD and variant gender attitudes and behavior.
A 2020 review of the literature about adults suggested “a prevalence of 6-26% [of ASD] in transgender populations, higher than the general population, but no different from individuals attending psychiatry clinics.” Thus, “Low-level evidence exists to suggest a link” between ASD and gender dysphoria (GD).
But correlation does not imply causation. ASD and GD might be due to a third unidentified cause. So these studies bring us no closer to understanding the cause(s) of childhood gender dysphoria.
Rapid Onset Gender Dysphoria
In 2018 physician Lisa Littman reported a recent dramatic increase in what she called “rapid onset gender dysphoria” (ROGD). ROGD affects adolescents and young adults, about 83 percent of whom are female. According to Littman, “parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria.” This appears “for the first time during puberty or even after its completion.” Parents have also reported that ROGD “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” around the same time.
So according to Littman, ROGD tends to appear in “clusters” of individuals in close contact with each other. The contact can be direct or through the Internet. Littman called this “peer contagion,” though she emphasized that the term “is not meant in any way to characterize [ROGD] as a disease or disease-like state, or to convey any value judgment.”
Doctoral student Arjee Restar criticized Littman’s article for “methodological flaws in the conceptualization and design of the study.” According to Restar, research on transgender people should be “non-stigmatizing” and “non-pathologizing.” In response, Littman made some corrections to her original article. But her results and conclusions remained essentially unchanged.
In 2020, investigative journalist Abigail Shrier published Irreversible Damage: The Transgender Craze Seducing Our Daughters. Shrier interviewed numerous parents and their daughters. She also interviewed educators and medical professionals. Some affirmed what Shrier called the “dogged ideology” that promotes irreversible transgender treatments. Some opposed it. But Shrier emphasized that “the social contagion captivating teens has nothing to do with those who have suffered gender dysphoria since childhood.” So ROGD does not help us to understand the cause(s) of the latter.
A Momentous Step in the Dark
Understanding the cause(s) of a condition is relevant to deciding on the best treatment. Yet we remain profoundly ignorant of the cause(s) of childhood gender dysphoria. As we saw in Part Four of this series, gender dysphoria is officially a “mental disorder.” But it is routinely treated socially, hormonally, and surgically (the Dutch Protocol). Given our ignorance, it seems that such treatments are a “momentous step in the dark.”
Sadly, children with gender dysphoria suffer. They may even contemplate or commit suicide. Transgender advocates claim that transitioning reduces the risk of suicide. But does it? Part Seven in this series begins by examining the evidence for this.