BOSTON, March 20, 2023—A study published in the Journal of Adolescent Health found that a substantial proportion of transgender and gender diverse (TGD) adults realized that their gender identity is different from their sex assigned at birth during adolescence or later. It also found that TGD people typically waited many years before sharing this realization with another person. The study adds important new knowledge to clinical and popular understanding of the timing of TGD people’s awareness, understanding, and sharing of their gender identity. It also undercuts a core component of the “rapid onset gender dysphoria” (ROGD) hypothesis, which posits that TGD identities realized in adolescence are transient and will not continue into adulthood.
“The ROGD hypothesis suggests that transgender and gender diverse identities that become clear after puberty don’t last beyond one’s adolescent years,” said lead study author Dr. Jack Turban, Director, Gender Psychiatry Program and Assistant Professor, Division of Child & Adolescent Psychiatry at the University of California, San Francisco. “With over 40 percent of transgender and gender diverse adults reporting that they first realized that their gender identity differed from their sex assigned at birth during adolescence, that theory clearly does not hold.”
The study, titled “Age of Realization and Disclosure of Gender Identity Among Transgender Adults” divided 27,715 TGD adults in the United States into two groups based on how old they were when they realized that their gender identity was different from their sex assigned at birth. The first group (16,279 participants, or 59.2%, known as the “childhood realization” group) came to understand that they were TGD at age 10 or younger; the second group (11,218 or 40.8%, known as the “later realization” group) reported realization of their TGD identity at age 11 or above. Participants were also asked how old they were when they first shared their gender identity with another person. Overall, several years typically elapsed between realization of one’s gender identity and sharing this with another person.
Other important findings from the study include the following:
- A larger proportion of participants in the later realization group were assigned female sex at birth (63.2% vs. 53.1%)
- A larger percentage of participants in the later realization group identified as nonbinary or genderqueer (49.1%) compared to those in the childhood realization group (25.2%)
- A smaller proportion of participants in the later realization group experienced K-12 harassment based on gender identity (13.1% vs. 26.9%), had a history of exposure to gender identity change efforts (13.1% vs. 26.9%), and received pubertal suppression (0.2% vs. 0.4%) or gender-affirming hormones (34.8% vs. 56.6%).
- Among the childhood realization group, the median time between realization of one’s gender identity and sharing it with another person was 14 years.
“It is notable that study participants in the later realization group were also more likely to have been assigned a female sex at birth. This further undercuts the ROGD hypothesis, which asserts that people assigned female sex at birth who come to understand their trans identities after puberty will not continue to hold these identities in adulthood,” Turban added. “Additionally, the fact that participants in the childhood realization group took approximately 14 years to disclose their gender identity to another person refutes the notion inherent in the ROGD hypothesis that disclosure of a trans identity to parents coincides with when trans youth first come to understand their gender identities.”
The ROGD hypothesis, first published in 2018, immediately gained influence in public policy debates with coverage by publications ranging from The Economist to Science. A correction was issued shortly after publication of the initial ROGD manuscript stating that “ROGD is not a formal mental health diagnosis at this time. This report did not collect data from the adolescents and young adults or clinicians and therefore does not validate the phenomenon.” Despite this, elements of the ROGD hypothesis continue to be prominently featured in influential mainstream media discourse, including the New York Times. The hypothesis is also used by numerous governmental agencies, lawmakers, and policy analysts to justify legislative and regulatory measures prohibiting adolescents from accessing gender-affirming medical care, despite opposition from all major medical organizations.
“The damage that has been done to transgender and gender diverse youth and their families by new laws prohibiting them from accessing gender-affirming medical care as well as the toxic rhetoric promulgated by these legislative campaigns is incalculable,” said study senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “It is vital that clinicians, health policy analysts, and journalists familiarize themselves with the facts about gender identity development.”
“Age of Realization and Disclosure of Gender Identity Among Transgender Adults” is based on data from the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, which surveyed over 27,000 transgender people in all 50 states, Washington D.C., Puerto Rico, U.S. territories abroad, and U.S. military bases on a multitude of questions about their lives. The paper is the latest in a series of secondary analyses of the groundbreaking 2015 survey. Prior papers include “Factors Leading to ‘Detransition’ Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis,” published in 2021 in LGBT Health, “Association Between Gender-Affirming Surgeries and Mental Health Outcomes,” published in 2021 in JAMA Surgery, “Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation,” published in 2020 in Pediatrics, and “Association Between Recalled Exposure to Gender Identity Conversion Efforts and Suicide Attempts,” published in 2020 in JAMA Psychiatry.
“Age of Realization and Disclosure of Gender Identity Among Transgender Adults” was authored by the same researchers who wrote the 2022 study, “Sex Assigned At Birth Ratio Among Transgender and Gender Diverse Adolescents in the United States.” Published in Pediatrics, that study provided evidence undercutting the “social contagion” component of the ROGD hypothesis.
“Age of Realization and Disclosure of Gender Identity Among Transgender Adults” is available here.