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In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion. Parents describe that 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.

Recently, clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic. Academics have raised questions about the role of social media in the development of gender dysphoria.

For this descriptive, exploratory study, recruitment information with a link to a question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children.

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To maximize the chances of finding cases meeting eligibility criteria, the three websites 4thwavenow, transgender trend, and youthtranscriticalprofessionals were selected for targeted recruitment. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques.

Data were collected anonymously via SurveyMonkey. Open-ended responses from two questions were targeted for qualitative analysis of themes. There were parent-completed surveys that met study criteria.

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The AYren described were predominantly natal female Many In Most Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria referred to as rapid-onset gender dysphoria that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms. Parent-child conflict may also explain some of the findings. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.

Citation: Littman L Parent reports of adolescents and young adults perceived to show s of a rapid onset of gender dysphoria. This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data cannot be made available due to ethical and regulatory restrictions. The study participants did not provide consent to have their responses shared publicly, shared in public databases, or shared with outside researchers. Parents have described clusters of gender dysphoria in pre-existing friend groups with multiple or even all members of a friend group becoming gender dysphoric and transgender-identified in a pattern that seems statistically unlikely based on research [ 1 — 8 ].

These types of presentations have not been described in the research literature for gender dysphoria [ 1 — 10 ] and raise the question of whether social influences may be contributing to or even driving these occurrences of gender dysphoria in some populations of adolescents and young adults. Gender dysphoria GD is defined as an individual's persistent discomfort with their biological sex or ased gender [ 11 ]. Two types of gender dysphoria studied include early-onset gender dysphoria, Seeking erotic private show the symptoms of gender dysphoria begin in early childhood, and late-onset gender dysphoria, where the symptoms begin after puberty [ 11 ].

Late-onset gender dysphoria that occurs during adolescence is now called adolescent-onset gender dysphoria. The majority of adolescents who present for Seeking erotic private show for gender dysphoria are individuals who experienced early-onset gender dysphoria that persisted or worsened with puberty although an atypical presentation has been described where adolescents who did not experience childhood symptoms present with new symptoms in adolescence [ 712 ].

Adolescent-onset of gender dysphoria has only recently been reported in the literature for natal females [ 51013 — 14 ]. In fact, prior tothere were little to no research studies about adolescent females with gender dysphoria first beginning in adolescence [ 10 ]. Thus, far more is known about adolescents with early-onset gender dysphoria than adolescents with adolescent-onset gender dysphoria [ 615 ]. Although not all research studies on gender dysphoric adolescents exclude those with adolescent-onset gender dysphoria [ 10 ], it is important to note that most of the studies on adolescents, particularly those about gender dysphoria persistence and desistance rates and outcomes for the use of puberty suppression, cross-sex hormones, and surgery only included subjects whose gender dysphoria began in childhood and subjects with adolescent-onset gender dysphoria would not have met inclusion criteria for these studies [ 16 — 24 ].

Therefore, most of the research on adolescents with gender dysphoria to date is not generalizable to adolescents experiencing adolescent-onset gender dysphoria [ 16 — 24 ] and the outcomes for individuals with adolescent-onset gender dysphoria, including persistence and desistence rates and outcomes for treatments, are currently unknown.

As recently asthere were only two clinics one in Canada and one in the Netherlands that had gathered enough data to provide empirical information about the main issues for gender dysphoric adolescents [ 25 ]. Both institutions concluded that the management of adolescent-onset gender dysphoria is more complicated than the management of early-onset gender dysphoria and that individuals with adolescent-onset are more likely to have ificant psychopathology [ 25 ]. The presentation of gender dysphoria can occur in the context of severe psychiatric disorders, developmental difficulties, or as part of large-scale identity issues and, for these patients, medical transition might not be advisable [ 13 ].

Although, bythere was research documenting that a ificant of natal males experienced gender dysphoria that began during or after puberty, there was little information about this type of presentation for natal females [ 5 ]. Starting in the mids there Seeking erotic private show been a substantial change in demographics of patients presenting for care 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 [ 26 — 28 ]. And now, some clinicians have noted that they are seeing increasingly in their clinic, the phenomenon of natal females expressing a post-puberty rapid onset of gender dysphoria [ 14 ].

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Some researchers have suggested that increased visibility of transgender people in the media, availability of information online, with a partial reduction of stigma may explain some of the increases in s of patients seeking care [ 27 ], but these factors would not explain the reversal of the sex ratio, disproportionate increase in adolescent natal females, and the new phenomenon of natal females experiencing gender dysphoria that begins during or after puberty.

If there were cultural changes that made it more acceptable for natal females to seek transition [ 27 ], that would not explain why the reversal of the sex ratio reported for adolescents has not been reported for older adult populations [ 26 ]. There are many unanswered questions about potential causes for the recent demographic and clinical changes for gender dysphoric individuals. Social contagion [ 29 ] is the spread of affect or behaviors through a population.

Peer contagion, in particular, is the process where an individual and peer mutually influence each other in a way that promotes emotions and behaviors that can potentially have negative effects on their development [ 30 ]. Peer contagion has been associated with depressive symptoms, disordered eating, aggression, bullying, and drug use [ 30 — 31 ]. Internalizing symptoms such as depression can be spread via the mechanisms of co-rumination, which entails the repetitive discussion of problems, excessive reassurance seeking ERSand negative feedback [ 3032 — 34 ].

Deviancy training, which was first described for rule breaking, delinquency, and aggression, is the process whereby attitudes Seeking erotic private show behaviors associated with problem behaviors are promoted with positive reinforcement by peers [ 3536 ]. Peer contagion has been shown to be a factor in several aspects of eating disorders. There are examples in the eating disorder and anorexia nervosa literature of how both internalizing symptoms and behaviors have been shared and spread via peer influences [ 37 — 41 ] which may have relevance to considerations of a rapid onset of gender dysphoria occurring in AYAs.

Peer influence is intensified in inpatient and outpatient treatment settings for patients with anorexia and counter-therapeutic subcultures that actively promote the beliefs and behaviors of anorexia nervosa have been observed [ 39 — 41 ].

Online Seeking erotic private show provide ample opportunity for excessive reassurance seeking, co-rumination, positive and negative feedback, and deviancy training from peers who subscribe to unhealthy, self-harming behaviors. If similar mechanisms are at work in the context of gender dysphoria, this greatly complicates the evaluation and treatment of impacted AYAs.

In the past decade, there has been an increase in visibility, social media, and user-generated online content about transgender issues and transition [ 45 ], which may act as a double-edged sword. On the one hand, an increase in visibility has given a voice to individuals who would have been under-diagnosed and undertreated in the past [ 45 ]. On the other hand, it is plausible that online content may encourage vulnerable individuals to believe that nonspecific symptoms and vague feelings should be interpreted as gender dysphoria stemming from a transgender condition.

Recently, leading international academic and clinical commentators have raised the question about the role of social media and online content in the development of gender dysphoria [ 46 ]. Concern has been raised that adolescents may come to believe that transition is the only solution to their individual situations, that exposure to internet content that is uncritically positive about transition may intensify these beliefs, and that those teens may pressure doctors for immediate medical treatment [ 25 ].

There are many examples on popular sites such as Reddit www. Fig 1 includes examples of online advice from Reddit and Tumblr. Rapid presentations of adolescent-onset gender dysphoria occurring in clusters of pre-existing friend groups are not consistent with current knowledge about gender dysphoria and have not been described in the scientific literature to date [ 1 — 8 ]. During the recruitment period, parents completed online surveys that met the study criteria. The sample of parents included more women Most respondents were White The adolescents and young adults AYAs described by their parents were predominantly female sex at birth See Table 2.

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A question survey instrument with multiple choice, Likert-type, and open-ended questions was created by the researcher. The survey was deed for parents respondents to complete about their adolescent and young adult children. The survey was active from June 29, to October 12, 3. Participants completed the survey at a time and place of their own choosing.

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Data were collected anonymously and stored securely with Survey Monkey. Participation in this study was voluntary and its purpose was clearly described in the recruitment information. Electronic consent was obtained.

Participants had the option to withdraw consent at any time prior to submitting responses. After cleaning the data for the completed surveys, 8 surveys were excluded for not having a sudden or rapid onset of gender dysphoria and 10 surveys were excluded for not having gender dysphoria that began during or after puberty, which left completed surveys for inclusion.

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As the survey was voluntary there was no refusal or dropout rate. There were four sites known to post recruitment information about the research study. The first three were posted due to direct communication with the moderators of the sites.

The fourth site posted recruitment information secondary to the snowball sampling technique. The following descriptions provide details about these sites. The perspective of this site might be described as cautious about medical and surgical transition overall—specifically with a cautious or negative view of medical and surgical interventions for children, adolescents, and young adults and an accepting view that mature adults can make their own decisions about transition [ 29 ].

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Transgendertrend was founded in November We reject current conservative, reactionary, religious-fundamentalist views about sexuality. In July ofthere was additional text added, expressing concern about legislation regarding public bathrooms and changing rooms [ 50 ]. Youth Trans Critical Professionals was created in March We are psychologists, social workers, doctors, medical ethicists, and academics. We tend to be left-leaning, open-minded, and pro-gay rights.

However, we are concerned about the current trend to quickly diagnose and affirm young people as transgender, often setting them down a path toward medical transition. Our concern is with medical transition for children and youth. Parents of Transgender Children is a private Facebook group with more than 8, members [ 52 ]. Although the parent discussions and comments are not viewable to non-members [ 52 ], this group is perceived to be pro -gender-affirming. Basic demographic and baseline characteristic questions, including parental attitudes about LGBT rights, were included.

Questions about trauma and non-suicidal self-injury were also included as were questions about social difficulties described in a research study about gender dysphoric adolescents [ 13 ]. The DSM 5 criteria for gender dysphoria in children consist of eight indicators of gender dysphoria [ 57 ].

Five of the indicators A2-A6 are readily observable behaviors and preferences such as a strong preference or strong resistance to wearing certain kinds of clothing; a strong preference Seeking erotic private show strong rejection of specific toys, games and activities; and a strong preference for playmates of the other gender [ 57 ].

The eight indicators were simplified for language and parents were asked to note which, if any, their child had exhibited prior to puberty. The requirement of six-month duration of symptoms was not included. The DSM-5 criteria for gender dysphoria in adolescents and adults consist of six indicators of gender dysphoria [ 57 ]. To meet criteria for diagnosis, an adolescent or adult must manifest at least two of the six indicators.

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