Study Challenges Rapid-Onset Gender Dysphoria Claims With Longitudinal Data

New findings indicate that gender identity among sexual and gender minority (SGM) youths can change over time. Researchers have found that these changes are not associated with significant alterations in depressive symptoms.¹

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The longitudinal study published in JAMA Network Open sheds light on the mental health of youths undergoing gender identity transitions. The research aimed to understand the frequency and nature of changes in self-reported gender identity among SGM youths and their association with depressive symptoms. Results suggest that gender identity can evolve over time.

The mental health of youths navigating gender identity transitions has garnered increased attention as of late, prompting a need for empirical evidence to clarify these dynamics, according to the study. Expanding on evidence is especially meaningful for this population of patients because of its tumultuous history.²

“It has been only 10 years since transgender identities were declassified as ‘disordered,’ and it may be difficult to believe in the care they are receiving when they still find themselves teaching clinicians about their bodies and their needs and encounter hostility or are turned away by providers they rely on,” Kyle Munz, The American Journal of Managed Care^®, wrote.

In the current study, researchers examined the prevalence of changes in self-reported gender identities over time in a longitudinal sample of SGM youths and explored the relationship between these changes and depressive symptoms.¹

The cohort study analyzed data from four waves, each spaced nine months apart, of a longitudinal community-based study conducted between November 2011 and June 2015 in two large US cities—one in the Northeast and one in the Southwest. Eligible participants were youths who identified as SGM and were recruited from community-based agencies or college groups for SGM youths. Data analysis was performed from September 2022 to June 2023.

The primary exposures assessed were gender identity trajectories and gender identity variability, measured by the number of times participants reported changes in their gender identity.

Depressive symptoms were measured using the Beck Depression Inventory for Youth. The study also applied Bonferroni adjustments to adjust for multiple group comparisons (significance for these analyses was set at P < .008). Hierarchical linear models were employed to analyze gender identity trajectories and the association between gender identity variability and depressive symptoms over time.

The study included 366 SGM youths (mean age, 18.61 years, 49.4% assigned male at birth, 50.6% assigned female at birth). Four gender identity trajectory groups were identified:

1. Cisgender across all waves: 274 participants
2. Transgender or gender diverse (TGD) across all waves: 32 participants
3. Initially cisgender but TGD by wave 4: 28 participants
4. Initially TGD but cisgender by wave 4: 32 participants

Results demonstrated approximately 18.3% of youths reported a different gender identity over the study period of about 3.5 years, with 28 participants changing their gender identity more than twice. The group that transitioned from cisgender to TGD exhibited higher levels of depression at baseline compared with the consistently cisgender group (B = 4.66; SE = 2.10; P = .03). However, this difference was not statistically significant after adjusting for exposure to violence (Β = 3.31; SE = 2.36; P = .16).

The researchers also reported that gender identity variability did not correlate with within-person changes in depressive symptoms (Β = 0.23; SE = 0.74; P = .75) or the overall level of depressive symptoms (Β = 2.43; SE = 2.51; P = .33).

“Implications for current controversies” on this subject were acknowledged in the discussion. Concerns have emerged over the past decade regarding the increasing number of youths identifying as TGD, particularly those assigned female at birth, seeking treatment. Findings from this study challenge the claims of the rapid onset gender dysphoria (ROGD) proponents, who argue that rising TGD identification is due to compromised mental health and social contagion. Contrary to these claims, previous studies have shown consistent psychological well-being and demographic characteristics among TGD youths over the past decade, except for changes in sex ratios. Additionally, the study stated that a later transgender identity was not linked to poorer mental health.

The data also refute the ROGD hypothesis by showing that the initially higher depressive symptoms reported by youths transitioning from cisgender to TGD were not significant after accounting for exposure to LGBT violence, the authors wrote. These youths experienced more LGBT violence, likely due to higher gender nonconformity. Furthermore, the study found that depressive symptoms remained stable over time for those who transitioned to TGD, opposing the notion that TGD identification leads to worsening mental health.

“Yet, despite being stable, youths from the cisgender-to-TGD group reported sustained high levels of depressive symptoms over time,” the study noted. “In addition to the accumulation of exposure to LGBT violence among this group, transitioning to a more stigmatized identity may be mentally taxing because of exposure to new types of violence (eg, gender-based violence), expectation of rejection from family and others, and loss of support.”

Gender identity variability was not associated with more depressive symptoms, either between participants or for individuals over time.

“Youths who reported more changes in their gender identities were no different in terms of their mental health compared with those with fewer changes, and longitudinally, youths were not more depressed after a shift in their gender identities,” the researchers wrote. “These findings are more consistent with an explanation of adolescent gender identity exploration and development, rather than arguments that gender identity changes would be associated with compromised or worsening in mental health.”

References

1. Gonzales Real A, Lobato MIR, Russell ST. Trajectories of gender identity and depressive symptoms in youths. JAMA Netw Open. 2024;7(5):e2411322. doi:10.1001/jamanetworkopen.2024.11322

2. Munz K. The evolution of transgender health care. AJMC. March 31, 2024. https://www.ajmc.com/view/the-evolution-of-transgender-health-care