I’d worked with trans clients for years — starting with my first, who was 16 at the time and living as female — when I began seeing more pre-teens and teens who were questioning whether they were trans, nonbinary, pan-sexual, or bisexual. Some of them weren’t sure of the difference in gender identity and sexuality.
Their parents sent them to me to help “straighten them out” — pun intended. Not all parents, of course. Some were supportive, others not so much. Some teens requested therapy, and came out to me during sessions.
I’ve worked with pre-teens and teens for almost 30 years. Even at my current age, I have rapport with them. They seem to sense my inner rebel, who remembers what it’s like to be their age. In a real way, not a lecturing, story-telling kind of way.
Parents have brought their children to me, saying,
Those are the kids who talk and talk. They tell me everything.
Until the mid-2000s, that didn’t often include questioning their gender unless that’s why they came to see me specifically. Before then, there were, naturally, questions of sexuality. Some were confused about the difference in gender and sexuality, as were their parents. That confusion continues today among many older people.
Starting in the mid-2000s, more kids who were coming to see me for depression, anxiety, and/or difficulties at school began expressing thoughts, questions, and decisions about gender to me — often before expressing them to their parents (which is its own issue I’ll also address).
Because the number of young people questioning either their sexuality or gender increased at schools and in therapists’ offices, conservative groups began accusing exposure to social media as the “cause.” The term is called social contagion.
A survey study in 2018 popularized this notion of rapid onset gender dysphoria, but the study was deeply flawed. The sample size was small, and it was made up of only parents. The survey did not poll transgender youth. The parents who responded were recruited from three websites that were pointedly anti-trans.
“Methods for this descriptive, exploratory study, recruitment information with a link to a 90-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. The study’s eligibility criteria included parental response that their child had a sudden or rapid onset of gender dysphoria and parental indication that their child’s gender dysphoria began during or after puberty. To maximize the chances of finding cases meeting eligibility criteria, the three websites (4thwavenow, transgender trend, and youth trans critical professionals) were selected for targeted recruitment.”
Bias in research produces inaccurate results.
A longitudinal — long term — study published by Pediatrics, and distributed by The National Library of Medicine, states the following,
The progression of gender-expansive behavior to gender dysphoria and to gender-affirming hormonal treatment in children and adolescents is poorly understood. We do not yet know rates of conversion, diagnosis, or speed of progression to diagnosis.
What the study found is that those who receive both a diagnosis and access to hormone therapy are typically older than 15 years, were assigned female at birth, and are most often non-Hispanic white. A larger study including more ethnicities is needed. Around a third of those with gender dysphoria get the diagnosis, and only about a fourth receive hormone therapy.
The study is intended to help doctors and therapists working with adolescents with gender dysphoria. The conclusion also calls for more research about the attitudes of parents of children and adolescents who express gender dysphoria.
With respect to their clinical interpretation, our findings are more likely to inform primary health care providers who first encounter GD children rather than practitioners specializing in gender-affirming care. In future studies, researchers should explore the possible reasons for the observed differences by recruiting a cohort with a wider range of sociodemographic characteristics, especially with regards to race and ethnicity, and include data on parental perceptions of transgender care and pubertal staging.
Longitudinal studies are more accurate than short-term studies. Studies done with children and adolescents are complicated by also needing to study the attitudes of parents.
Parents who believe social contagion is causing their child to believe they are gender dysphoric will naturally tilt the outcomes in that direction. They will usually also stand in the way of diagnosis and treatment for their adolescents.
Since not enough well-designed and executed studies have been done on child and adolescent gender dysphoria, it’s easy for a parent or even a doctor or therapist to wonder about the concept of social contagion.
My own thought is that social media has simply made it more acceptable for young people to bring their questions and feelings out into the open. When they already have concerns or convictions about their own sexuality and/or gender, social media and friends experiencing similar feelings give them the courage to express themselves and ask the questions.
This is a new generation, with more access to information than preceding ones. Those of us who are their parents, caretakers, or professional helpers did not grow up with this same openness in our communities. We didn’t have the internet at our fingertips while growing up.
If we experienced gender dysphoria, or an attraction to anyone but the opposite gender, it was difficult to find either information or support. We kept it hidden and often felt shame.
That is no longer the case for Gen Z and younger. What looks like social contagion to others is simply access to information and support for them.
What’s the best way for parents, caretakers, and therapists to support children and adolescents when they come out with gender dysphoria, or ask questions about it? Listen and respond calmly. Stay open to them. Ask non-threatening questions.
For yourselves, look at all the research. Be aware that correlation and causality are not the same. There’s a correlation of gender fluidity and dysphoria with social media because the internet can provide more information, and adolescents are posting their experiences. Social media doesn’t cause gender dysphoria, it sheds light on it.
