On August 16th, 2018, Brown University published a controversial study that claimed to establish clear causal connections between gender transition and mental health disorders such as depression and anxiety among teens.
Two days later, in response to significant negative response from respected members of the mental health community and experts on gender dysphoria and adolescent mental health, Brown University retracted the study, and removed any mention of the paper – “Rapid-Onset Gender Dysphoria In Adolescents And Young Adults: A Study Of Parental Reports” – from their official website and press releases.
They republished it a year later with the title “Parent Reports Of Adolescents And Young Adults Perceived To Show Signs Of A Rapid Onset Of Gender Dysphoria” alongside an announcement of the correction in this paper: “Correction: Parent Reports Of Adolescents And Young Adults Perceived To Show Signs Of A Rapid Onset Of Gender Dysphoria.”
Why?
We encourage you to read both papers, with a focus on the correction, to understand the entire story. However, we can give you a two-item, tl;dr answer:
- There’s no such thing as rapid-onset gender dysphoria.
- The methods reported in the paper didn’t meet common standards associated with scientific, peer-reviewed research.
There’s a lot to unpack around that article and the subsequent retraction. For our purposes, we can use that novel sequence of events to illustrate the misunderstanding and confusion about gender identity, gender transition, and depression among teens and young adults. Let’s start with critical commentary on the term rapid-onset gender dysphoria (which is not a real diagnosis):
“The term reflects a deliberate attempt to weaponize scientific-sounding language to dismiss mounting empirical evidence of the benefits of transition. ROGD theory is best understood as an attempt to circumvent existing research that demonstrates the importance of gender affirmation, relying on scientific-sounding language to achieve respectability.”
That sums it up succinctly, which brings us to the topic at hand: evidence-based research on the relationship between gender transition and depression among teens and young adults.
Gender Identity and Mental Health
When a person expresses a gender identity that does not match social expectations based on the sex assigned them at birth, we say they’re transgender. We may also use phrases like non-binary or gender-fluid. Studies show that in the U.S., 1.4 – 1.8 percent of youth identify as transgender or gender diverse (TGD).
In most cases, the individual experience of gender remains stable throughout life. In some cases, however, the individual experience of gender changes over time. Experts in gender identity label these changes as follows:
- Dynamic gender presentations
- Gender journeys
- Transition
- Retransition
- Detransition
To clarify, transitioning means changing the gender with which an individual identifies, while retransitioning or detransitioning means affirming a cisgender identity after a period in which they affirm a gender other than the one assigned at birth. Among adults, around one (1) percent of people report different gender identities within any given four-year period. A recent study showed that in a group over 17,000 people who transitioned, around 13 percent retransitioned, and reaffirmed a cisgender identity.
Understanding that 13 percent is critical to our discussion about gender transition, teens, and depression. A review of the data shows that among individuals who re- or de-transitioned, only 3.9 percent cited psychological reasons, and 2.4 percent cited uncertainty about gender.
What caused individuals to re- or de-transition, and reaffirm a cisgender identity? In almost all cases, individuals cite external factors.
Factors Affecting Re- or Detransitioning
- Pressure from parents
- Social stigma
- Pressure from friends
- Pressure from partners
- Problems getting a job
- Pressure from religion
With these facts in mind, we’ll examine the results of a new study called “Trajectories of Gender Identity and Depressive Symptoms in Youths,” published in May 2024 on the Journal of the American Medical Association (JAMA).
Gender Transition, Depression, and Teens
A group of researchers from the University of Texas and the Universidad Federal do Rio Grande do Sul in Brazil designed the study around a simple question:
Are gender identity trajectories and changes in youth-reported gender identity associated with depressive symptoms over time?
Researchers examined responses from 366 teens and young adults, age 15-21, who identified as members of the sexual and gender minority. Roughly half of participants were assigned male at birth, and roughly half were assigned female at birth: 49.4 percent and 50.6 percent, respectively. Participants lived in two large U.S. cities, one on the Northeast and one in the Southwest. The research team divided participants into four groups and gathered information and mental health and gender identity in four waves – every 9 months – between 2011 and 2015.
First, to determine gender identity, researchers determined sex identified at birth. Second, at each of the four waves, they asked participants their gender identity, with options of answering man, woman, genderqueer, trans-woman, trans-man. In addition, participants were allowed to write-in an identity. Third, researchers paired the responses at each wave and categorized participants as one of three gender identities:
- Binary transgender
- Genderqueer and nonbinary
- Cisgender
To measure depressive symptoms, researchers used the Beck Depression Inventory for Youth (BDI-Y). High scores on the BDI-Y indicated the presence of more depressive symptoms, while lower scores indicated the presence of fewer depressive symptoms. The Presence of more depressive symptoms generally correlate with the possible presence of a depressive disorder, while the presence of fewer depressive symptoms indicate the possible absence of a depressive disorder.
In addition to assessing gender identity and depressive symptoms across the four waves, researchers gathered information on possible explanatory variables between transition and depression. Because youths who identify as members of the SGM often report experiencing anti-LGBT violence, they included questions about instances of bullying, intimidation, or violence related to their LGBT identity.
Let’s take a look at the results.
Gender Transition and Symptoms of Depression Among Teens
First, we’ll share the general numbers on transitioning in this group of teens and young adults. Here’s what the research team observed.
Gender Identity: Changes Identified Between 2011 and 2015
- Cisgender across all waves: 274
- Transgender or gender diverse (TGD) across all waves: 32
- Initially cisgender but TGD by wave 4: 28
- Initially TGD but cisgender by wave 4: 32
In total, 18.3 percent – roughly 1 in every 5 – participants affirmed a different gender identity over the course of the study. Next, let’s look at exposure to anti-LGBT violence among these four groups.
Experience of Anti-LGBT Violence/Bullying
- Group 1, Cisgender all waves:
- Lowest/least experience of violence/bullying, low risk of experiencing violence /bullying.
- 4th of 4
- Group 2, TGD all waves:
- Second highest experience of violence/bullying, significant risk of experiencing violence/bullying
- 2nd of 4
- Group 3, cisgender to TGD:
- Highest/most experience of violence/bullying, high risk of experiencing violence/bullying
- 1st of 4
- Group 4, TGD to cisgender:
- Third highest experience of violence/bullying, moderate risk of experiencing violence/bullying
- 3rd of 4
Now let’s look at the presence of depressive symptoms, before and after controlling statistics for exposure to LGBTQ violence. Note: when researchers control for a variable in a set of statistics, it means they account for extraneous variables and use statistical equations to remove the effect of a specific variable on a specific outcome. Below, in order to level the playing field, statisticians eliminated the impact of anti-LGBT violence on levels of depression.
Depressive Symptoms Among Teens Who Did and Didn’t Affirm TGD Identity
- Group 1, Cisgender all waves:
- Before control: Moderate levels of depression
- After control: Moderate levels of depression
- Group 2, TGD all waves:
- Before control: Low levels of depression
- After control: Low levels of depression
- Group 3, cisgender to TGD:
- Before control: High levels of depression
- After control: Moderate levels of depression
- Group 4, TGD to cisgender:
- Before control: Moderate levels of depression
- After control: Moderate levels of depression
This data shows us that the most common expectation – that affirming a TGD identity is associated with higher levels of depression – is not supported by the available facts. Although group 3, the cisgender to TDG group, showed the highest levels of depression at baseline and over time, the data show that affirming a TGD identity – i.e. transitioning – did not have an impact on levels of depression. Controlling for experiencing violence eliminated the differences.
What Can We Learn From This Study?
It’s time to circle back to the topic we opened this article with: the controversy over an article about a nonexistent phenomenon called rapid-onset gender dysphoria. We understand parents and adults around the country have legitimate concerns about teen and young adult mental health. Rates of suicide and suicidal ideation have increased over the past fifteen years, as well as rates of depression, anxiety, and other mental health disorders among teens and young adults.
However, we need to ground our concern for the welfare of our teens and young adults in verifiable facts provided by peer-reviewed scientific research.
To read the latest facts and figures on teen mental health in general, please navigate to our blog and read this article:
The Youth Risk Behavior Survey: Mental Health Among High School Students (2023)
To learn the latest facts and figures on mental health among LGBTQIA+ teens and young adults, please read this article:
Pride Month at BACA: New Reports on Mental Health Among LGBTQ+ Teens and Young Adults
It’s true: in 2024, our youth and young adults face challenges and experience mental health issues at rates we haven’t seen before. What we can learn from this article is that transitioning gender is not a primary factor in what many people call an adolescent mental health crisis. Here’s how a member of the research team describes their findings, with regards to LGBTQ teens and young adults:
“Depression among transgender youth is a big public health concern, but it’s not gender identity or transitioning that is at the root. It’s the bullying, rejection and victimization we need to be worried about.”
The data we share above show that after controlling for bullying/anti-LGBTQ violence, the differences in levels of depression between groups disappeared. That’s an important finding, and can help us accurately calibrate our approach to teen and young adult mental health, especially among LGBTQ youth and young adults.
Helping Teens and Young Adults Who Affirm TGD Identities: How to Move Forward
This is the first study we know of that examined the impact of gender transition on depression among teens and young adults. What it teaches us is that for some teens, the exploration of gender and identity is part of growing up – and this exploration neither causes nor is caused by a mental health disorder such as depression.
That’s an important lesson for all of us: if we haven’t already, we need to open ourselves up to the concept that for some people, gender expression is not stable and consistent throughout their lives – and that’s okay. The data in the study we discuss above makes clear that it causes no harm.
Here’s how the lead author of the study sees this new research:
“We found that gender identity is not the primary driver of mental health. Mental health is related to the environment young people are living in. Being a transgender young person does not lead to depression on its own, but the social environment that many of these young people experience does.”
Therefore, as responsible adults, its our job to create a social environment that’s kind and loving, and affirms the validity of everyone’s personal gender identity. Our job is to help our youth and young adult be the best possible version of themselves – and they get to decide what that is for themselves.
