Hey, Jack Turban! “Nah-UH!” Is Not Research

Yesterday an article from NBC News made some surprising claims:

“ ‘Social contagion’ is not driving an increasing number of adolescents to come out as transgender, according to a new study published Wednesday in the journal Pediatrics. 

“The study also found that the proportion of adolescents who were assigned female at birth and have come out as transgender also has not increased, which contradicts claims that adolescents whose birth sex is female are more susceptible to this so-called external influence.”

Both of those claims seemed rather definitive, so I had to look up the full article to see what this amazing new research showed.

And what do you know?

Jack Turban is at it again.

Fun side note: I see that UCSF – a formerly great university that has slowly come to value ideology over evidence – has made him a new assistant professor.  

He’s an unaccountably lucky guy – but maybe luck has less to do with it than the fact that he’s famous for embracing ideas that are politically very popular.

Whatever the reason, both UCSF and Pediatrics provide polish to his literary turds. And they, in return, get to look “progressive.” It’s an odd and unfortunate symbiosis.

On the surface, it all looks very impressive: a UCSF professor publishing in Pediatrics. Except the article doesn’t come close to supporting its own claims. This is one of the most content-free articles I’ve ever seen published in a medical journal.

But how many people who see the NBC News article (or any of a zillion others) will read the actual article in Pediatrics?

Look. I tried to read this as fairly and generously as possible, especially because I know my own inclination is to assume the worst about Turban’s ability to think critically or to do research of any kind.

But… even reading generously, there’s nothing here. I encourage you to read it yourself, from start to finish, and not just the summary available to the public. Find someone with a university library account and ask her or him to send it to you.

The TL;DR version if you won’t read it yourself

Turban and colleagues used publicly available survey data (self-reported from anonymous high school students in 16 states) which was gathered as part of a CDC biennial survey on risk behavior among high schoolers.

So, Turban didn’t conduct his own “research” or “design a study” per se. He took some publicly available data, which asked a few questions that were of interest to him. He told readers what the answers to those questions were, and then…he made some huge leaps.

Basically, even being as generous as possible, a reader cannot say that his claims are in any way supported by the data he presents.

Turban and colleagues looked at the self-reported numbers of high school students identifying as transgender in 2017 and 2019, and they broke those down by sex. Here’s their Table:

In this survey, there were more male (“AMAB”) than female (“AFAB”) adolescents who claimed they were trans.*

Quoting from the conclusion of the article, this is what Turban makes of these numbers:

"The [male to female] ratio of [transgender] adolescents in the United States does not appear to favor [transgender female] adolescents, and the notion of [Rapid Onset Gender Dysphoria (ROGD)] should not be used to restrict the provision of gender-affirming medical care for [transgender] adolescents."**

Do you follow that logic? I do not. (Honestly, I don't. I’m not trying to be a jerk.)

What has he shown by counting the numbers of high school student respondents in each sex category?

He has shown that there is a small, and possibly decreasing, number of high school kids who self-identify as trans, and in this survey, there were more boys than girls who self-identified as trans.

That’s it. Really.

So far, so good. But what does he do with those facts?

It’s really mind-boggling (and it made me ask in all earnestness, “Who served as his peer reviewers at Pediatrics? Who the hell is minding the store?”).

The second part of his sentence is “and the notion of [Rapid Onset Gender Dysphoria] should not be used to restrict the provision of gender-affirming medical care for [transgender] adolescents."

A reader has to assume that he thinks the second part of the sentence follows from the first in a logical way. Does Turban think he’s debunked the phenomenon described provisionally as “Rapid Onset Gender Dysphoria” (ROGD)?

How does that follow? And what is ROGD?

Lisa Littman, then at Brown University, published a set of parent observations in 2018. That’s all her article was: a description of parent observations.

In earlier generations, the typical kid who later identified as trans was someone who everyone – family, friends, neighbors – noticed was very gender nonconforming from a very early age (for example, preschool boy who played princess dress-up with the girls and preferred girls as friends; or a preschool girl who shunned “pretty” clothes and preferred rough play).

There was also a second category of trans person in earlier decades: men, often married and with children, who decided to transition in middle age; think Renee Richards or Caitlyn Jenner.

In more recent times, Littman thought she was hearing about an increasingly common third category: These were not kids who were gender non-conforming from a very young age. These were not middle-aged men. She was hearing from parents about a lot of adolescents whose gender dysphoria seemed to come upon them suddenly (as far as their parents could tell – a stark contrast from earlier generations of parents).

Here’s how Littman described what she was doing in her 2018 paper and why:

“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 [thus leading later to speculations about “social contagion”]. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. 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. The purpose of this study was to collect data about parents’ observations, experiences, and perspectives about their adolescent and young adult (AYA) children showing signs of an apparent sudden or rapid onset of gender dysphoria that began during or after puberty, and develop hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among this demographic group.”

As much as this article caused a stir among trans activists, notice what Littman wasn’t saying: Littman wasn’t saying what caused it. She wasn’t saying the kids’ gender distress wasn’t real. She wasn’t claiming to have “discovered” some new “diagnosis.”

She was simply observing that a lot of parents seemed to be saying something different from previous generations of parents, and she gathered a little preliminary data for the purpose of generating hypotheses about what might be happening.

That’s how science is done – you notice something that seems to be new, and then you start to look at it so that then you can generate testable hypotheses. So that’s where the ROGD label came from – parent observations – with the goal of looking at it more closely and trying to figure it out.

So to go back to Turban’s conclusion:

"The [male to female] ratio of [transgender] adolescents in the United States does not appear to favor [transgender female] adolescents, and the notion of [Rapid Onset Gender Dysphoria (ROGD)] should not be used to restrict the provision of gender-affirming medical care for [transgender] adolescents."

Even with the context of understanding what ROGD is, this statement still doesn’t make sense. If I want to read between the lines and really try to help him out, I will say that he’s probably responding to the fact some people have made this factual observation:

During the last couple decades, when trans identifications among kids and adolescents presenting at gender clinics have exploded, there has been a marked increase in the number of girls and young women identifying as trans.

Here's my best attempt to make Turban’s logic here (such as it is) explicit:

·       Some people think ROGD is a new category of gender dysphoria.

·       Some of those people have also observed that an increasing number of adolescent girls, in particular, appear to fall in this ROGD category and present to gender clinics with dysphoria.

·       If I can find a set of numbers that appears to show more boys than girls as trans-identified (even if it’s not limited to kids with gender dysphoria presenting at a gender clinic), that means ROGD is not a real thing, and we can dismiss it.

But yeah, you didn’t have to get an A on your syllogisms quiz in 10th grade to see that this is faulty logic. It just doesn’t follow.

There really are more girls appearing at gender clinics in recent years.

The number of girls with gender dysphoria has exploded. That fact is not really a matter for debate.

See for example this news story from the BBC in 2021, referring to their national gender clinic in the UK, which sees all kids in the nation referred for gender dysphoria:

“The number of children and young people referred to the [national gender clinic] grew from 97 in 2009-10 to 697 in 2014-15….But accompanying the increase in numbers was a shift in the type of patients being referred.

“Since it opened its doors in 1989, around 75% of GIDS' patients had been boys….

“In 2011, girls equaled boys in number for the first time. And by 2015 there had been a reversal in the sex ratio, with girls now outnumbering boys two to one.

“What's more, the nature of the cases appeared to have changed too. Young people often appeared to have complex mental health problems alongside their gender dysphoria….”

Here’s the table that accompanied the article, showing the explosion both in overall numbers and the proportion of girls with gender dysphoria:

And the trend only continued. Here is a chart from another BBC news article, covering later years:

Girls are presenting at the gender clinic much more often than boys. But it’s not just in the UK. This article from 2018 describes the same phenomenon in New Zealand:

“There has been a progressive increase in number of people identifying as transgender presenting to the clinic, particularly since 2010. In addition to increasing overall numbers, there has been in particular increase in referrals for people under age 30, as well as an increasing proportion of people requesting female-to-male (FtM) therapy so that it is now approaching the number of people requesting male-to-female therapy (MtF).”

In this article, Ken Zucker (who was working with gender-questioning kids several decades before it was cool) says,

“In childhood, the sex ratio continues to favor birth-assigned males, but in adolescents, there has been a recent inversion in the sex ratio from one favoring birth-assigned males to one favoring birth-assigned females.”

This is the demographic which the people who want to explore “ROGD” are talking about: adolescents, and especially adolescent girls.

Zucker’s article (and reference section) notes the same trend found in Dutch, Canadian, and Finnish clinics.

This is something that doesn’t seem to be in dispute:

All over the Western world, there seems to be a large increase in girls and young women presenting at gender clinics with gender dysphoria, and in many cases, their numbers have exceeded the number of boys (and the numbers of boys have also gone way up).

But then Jack Turban in his Pediatrics article comes along and says “Nah-UH!” – using a sample of kids who aren’t presenting to clinics with gender dysphoria, but rather a general sample of high schoolers – and somehow leaping from that to the conclusion that this debunks the observations that many teens, especially teen girls, seem to be experiencing “rapid onset gender dysphoria” – when in fact his article does no such thing, no matter how hard you squint and try to see it Jack’s way.

To be fair, the increasing number of girls presenting at gender clinics doesn’t “prove” anything about the phenomenon called “ROGD.” I’m just saying, Turban seems to be stretching the limits of reality pretty hard in order to make a point that doesn’t logically follow from his data. At all.

But Wait, There’s More.

The second part of Turban’s conclusion in the Pediatrics article is this:

“Results from this study also argue against the notions that [transgender] youth come to identify as [transgender] because of social contagion or to flee stigma related to sexual minority status.”

How does he get there? It’s very hard to tell, even with a generous reading, but I’ll give it my best good-faith shot. (Please read it yourselves, so you can see how ridiculous the article is, really – I dearly want people to see that I’m not exaggerating even a little.)

First, let’s note that the “social contagion” hypothesis of ROGD is simply a hypothesis to be tested. No one is out there claiming “it’s true.” It’s something that needs to be looked at. Littman observed, based on parent reports, that some kids in recent years – in contrast to say the ’80s or ’90s – seem to make their trans identifications in little clusters. From the Littman paper:

“Most (86.7%) of the parents reported that, along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media/internet use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar timeframe, or both.”

This is not the same thing as saying, “Trans identification is caused by social contagion!” But if 86.7% of parents claim something that parents didn’t claim in earlier decades, it’s worth taking a look at. It’s by no means a crazy stretch to say, “Hm, I wonder if there’s an element of social contagion involved?” and then to ask yourself how you’d go about testing this, and whether there are any implications for treating this group of kids.

And it’s not just parents, but teachers and detransitioners too who believe they have made these observations. Most of you probably know an experienced middle-school teacher. If he or she has been working for 20 years or longer, ask what s/he’s observed about trans identifications among students in that time.

I can almost guarantee that your middle-school teacher friend will say (1) the numbers have exploded; (2) the phenomenon is most common among quirky girls, as well as kids who are not neurotypical, and often includes kids who have other mental health challenges and are socially on the fringes; (3) kids often seem to identify within a short period of time in little clusters.

You’re less likely to know a detransitioner than a middle-school teacher, but several detransitioners have spoken about what they perceive as the social contagion aspect of trans identification, too. You can search this yourself online to read some first-hand accounts.

In other words, it’s not a few wacky parents in denial who are making this claim — it’s people like middle-school teachers, who don’t have a horse in that race.

I’ve written before about social contagion – the most familiar current example is TikTok tics, and I mentioned,

“in a brief personal conversation with one of the German researchers, I learned that she as well as some of her other colleagues who study Tourette syndrome noticed that many of the [social contagion, TikTok] tic sufferers also identified themselves under the trans umbrella. (She made no statement or claims about what, if anything, that might signify. It was simply an observation she made in passing. To me, though, it was an interesting observation.)”

All’s I’m saying is that social contagion deserves to be looked at, based on everything I’ve seen and heard. We’re not ready to dismiss it yet.

But back to Jack – how does he get to his conclusion?

So how does Jack Turban get to this second part of the conclusion in his article?

“Results from this study also argue against the notions that [transgender] youth come to identify as [transgender] because of social contagion or to flee stigma related to sexual minority status.”

He found in the CDC’s survey that kids with a trans ID are more likely than other kids to be bullied.

That’s it.

That doesn’t disagree with anything I’ve ever heard: many teens identifying as trans are already on the social fringes. These are not typically “the popular kids.”

I suppose, several years ago, when “trans” was still a novelty is many schools, some parents informally speculated that being “trans” (and therefore “special”?) meant that this set of kids had friends, sometimes for the first time.

But that’s not the same thing as, you know, scientists saying that “Kids become trans because it makes them popular.” No one is saying that. No one is saying that trans kids aren’t bullied. In fact, everyone agrees the opposite is true. Jack Turban is setting up a straw man.

Nor is anyone saying that “social contagion” is the same thing as “peer pressure” or “pressure to conform or be cool.” The kids with TikTok tics, or the nuns meowing like cats in 14th century France, were not exactly “popular.” No one, as far as I know, really thinks that.

Here’s how Jack Turban explains his reasoning, though:

“we found that TGD youth were more likely to be victims of bullying and to have attempted suicide when compared with cisgender youth. …These exceptionally high rates of bullying among TGD youth are inconsistent with the notion that young people come out as TGD either to avoid sexual minority stigma or because being TGD will make them more popular among their peers.”

Everyone agrees these kids are at risk for bullying, both before and after their trans identification. Everyone agrees these are not the “popular kids.” I don’t think anyone disputes that.

There’s No “There” There***

Even with the most generous reading, nothing in Jack Turban’s Pediatrics article supports his conclusions.

And yet you could see headlines all over media yesterday and today (I’m not including links because I don’t want to give them the clicks – so google if you must):

A New Study Debunks the Myth that Kids Become Trans Through “Social Contagion” (MSN.com)

“Social Contagion” Isn’t Causing Adolescents to Become Trans, Study Finds  (US News & World Report)

New Research Challenges Claim That Youth Identify as Transgender Due to “Social Contagion” (Yahoo)

No, “Social Contagion” Isn’t Driving Transgender Teens, Study Finds (CTV News – a Canadian site)

New Study Examines the “Social contagion” Hypothesis of Transgender and Gender Diverse Identities (FenwayHealth.org)

“Social Contagion” Isn’t Causing More Youths to Be Transgender, Study Finds (Today.com)

“Social contagion” Isn’t Causing Adolescents to Become Trans, Study Finds (Drugs.com)

New Research Challenges Claim that Youth Identify as Transgender Due to “Social Contagion” (TheHill.com) (This one actually says, “The paper disproves the ‘social contagion’ hypothesis”)

And on and on and on.

If you’re a person who casually reads the news, you’re going to believe that both “social contagion” and ROGD as an observed phenomenon have been debunked – and that’s simply not true.

This new article shows…nothing. Really. Read it. Tell me what you think.

---

*It’s also interesting to note that fewer kids across all categories claimed a trans identity in 2019 than in 2017. (I make no claim as to what that means – it’s interesting nevertheless.)

**The brackets are here because I spelled out the acronyms to make this an easier read.

***Gertrude Stein was a lesbian, not a trans man.