Straight to the point

Since my academic paper on Rapid Onset Gender Dysphoria was published last month, it has been downloaded more than 38,000 times and is ranked in the top percentile of similar articles in terms of online attention. One might think that the academic society associated with the journal — the International Academy of Sex Research — would be delighted. Instead, its officers are trying to cancel the article.

Imagine that your daughter, aged 14, tells you that she is transgender. You are confused, not to mention worried. For several years she has had emotional and social issues serious enough that you took her to a therapist. But there was no hint that she struggled with her gender identity. You would have never called her a tomboy — she liked wearing dresses and playing with dolls, and she never played with boys. Yet you learn that one of her few friends has also told her parents that she is “trans” and intends to become a boy. What are the chances? Is your daughter going to do this too?

Across the industrialised West, there has been an explosion of gender dysphoria among adolescent girls in recent years. In England, for example, annual referrals for child and adolescent gender dysphoria treatment grew in the 10 years between 2011-12 to 2021-22 from 250 (mostly boys) to 5,000 (mostly girls). In the United States, no one is keeping track, but the signs are the same. Two explanations have been given for this trend, and they have provoked a bitter controversy. The first holds that increased tolerance of transgender people has allowed transgender youth to come out earlier and in greater numbers. People who believe this also tend to assume we should not question children and adolescents who declare that they are transgender but should help them if they want to start their transition.

The second explanation, called “rapid onset gender dysphoria” (ROGD), suggests that, for poorly understood reasons, adolescent and young adult females are susceptible to a socially contagious false belief that they are transgender. Especially susceptible are girls with pre-existing emotional problems who have been exposed to the ideas that transgender people are common, and that an underlying and unrecognised transgender identity can cause emotional problems only curable by gender transition.

The idea of ROGD, like the phenomenon that inspired the hypothesis, is quite recent. The first peer-reviewed empirical article was published in 2018 and attempted to determine whether gender dysphoric youth with an ROGD profile existed, according to parent informants. They certainly did. The article provoked a firestorm of criticism and an unprecedented (and shameful) demand by the journal, Plos One, that the author, Lisa Littman, revise the paper to mollify its critics. Shortly after Littman’s paper was published, polemical critiques of ROGD began appearing in academic journals. There have also been a few unsuccessful attempts to refute ROGD with data. Yet none of these pieces provoked attempts to get them cancelled or retracted; those who find ROGD a legitimate explanation want more information and discussion, not less.

In 2018, I attended a small invitation-only conference about ROGD. The conference co-organiser, Suzanna Diaz, presented results of an online survey conducted by the organisation Parents of ROGD Kids. I was impressed by the findings and, given that ROGD was little-known in 2018, I told her she should publish her study. Eventually, we explored co-authoring an article, and the result is the one now threatened with cancellation.

We focused on parents’ reports on gender-dysphoric adolescents and young adults whom the parents believed had ROGD. You can read the full article here, but the key observations that motivated the cancellation attempt are as follows. First, we identified 1,655 cases of ROGD — a significant number for activists to ignore. Second, parents said that these youth had a high proportion of pre-existing mental health problems, predating gender dysphoria by four years on average. Third, youth with higher preponderance of emotional problems were especially likely to have socially or medically transitioned. Fourth, the best predictor of transition was consulting a gender specialist, and parents who did so tended to feel they were pressured to transition their children. Finally, parents said their children’s general functioning deteriorated after they socially transitioned.

On April 19, the following message was circulated on the Listserv of the International Academy of Sex Research (IASR), the organisation closely associated with (but not the owner of) Archives of Sexual Behavior, the journal that published our paper after its careful peer review:

“Dear IASR members,

In the interest of transparency, we want to communicate to the Membership about recent concerns regarding a publication in our official journal, the Archives of Sexual Behavior. On March 29th, the journal published an article authored by Suzanna Diaz & J. Michael Bailey entitled, “Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases.” Since its publication, significant concerns about the ethical conduct and integrity of the editorial process have been raised about this study, by both members and nonmembers of the Academy, including Editorial Board members. The IASR recognizes the sensitivity and controversy of the study topic, and we deeply value ethical and scientific integrity. While the Archives of Sexual Behavior has editorial independence and IASR is not involved in determining what is published in the journal, Archives is our flagship journal. The IASR Executive is currently learning more about this matter, consulting with both the Archives of Sexual Behavior’s Editor and our publisher Springer Nature, and will update the membership appropriately.

Kind regards,

The IASR Executive Committee”

What was the IASR leadership’s problem with our article? One must distinguish between what they say their problem is — the ruse — from what their actual problem is. Here’s the ruse: the study was unethical because it was not examined by an Institutional Review Board, and its reliance on reports from a sample of parents recruited for believing their children have ROGD renders it incapable of providing useful data.

These are both easily refuted. It is true that the study providing our article’s data was not approved by an Institutional Review Board (IRB). IRB approval is required for those of us who work in institutions that require IRB approval (redundancy intended). These include universities and hospitals. But ordinary citizens outside such institutions are not required to get IRB approval before conducting surveys or any other kind of research. Some academics have become so used to the necessity of IRB approval that they have wrongly come to equate it with ethical acceptability. Not me. I seek IRB approval because I must, or else I am likely to get in trouble.

But Suzanna Diaz, who launched the survey and collected the data, did not have to get IRB approval. (Suzanna Diaz is the mother of a gender dysphoric child she believes has ROGD. “Suzanna Diaz” is a pseudonym — I don’t even know her real name, although I have met her in person and have spoken to her and emailed with her numerous times. She wants to stay anonymous, for the sake of her family. Think about why someone might feel this is necessary.) I consulted my own IRB to seek retrospective approval so that I wouldn’t get into trouble. My IRB representative explained that currently IRBs do not provide retrospective approval of already-collected data. But in this case, my IRB’s policy permitted me to co-author publications using Suzanna Diaz’s data. Publication of our article without IRB approval was also consistent with the policy of the journal’s publisher, Springer. From their website: “If a study has not been granted ethics committee approval prior to commencing, retrospective ethics approval usually cannot be obtained and it may not be possible to consider the manuscript for peer review. The decision on whether to proceed to peer review in such cases is at the Editor’s discretion. [emphasis mine]”

Regarding the methodological limitations of the study, these were addressed forthrightly and thoroughly in our article. While acknowledging the obvious fact that parents in our study “are unlikely to be representative of all parents with gender dysphoric adolescents”, and that in principle their “reports could be biased and inaccurate”, we argued that no one knows at this time how representative the families we studied are, and that there is no reason to assume that parents in our study are any more biased observers than are adolescents reporting on themselves. The idea that parents often understand their children better than their children understand themselves used to be uncontroversial.

I have reviewed hundreds of papers for Archives of Sexual Behavior, including multiple articles submitted by the current IASR leadership. Yet in my 32-year membership in IASR, nothing like this has ever happened. Never had the IASR officers raised official concern about an article published in Archives of Sexual Behavior. Did we publish the most unethical, most methodologically deficient article ever? Or is something else going on?

Let’s start with a counterfactual. Suppose that Suzanna Diaz had been a transgender person unaffiliated with a university who had conducted research, without IRB approval, suggesting that ROGD didn’t exist. Imagine it had been published in Archives. Would the IASR leadership have behaved similarly? As we academics sometimes like to say: no way in hell.

I suspect there are two real reasons for the attempt to cancel our article. First, the IASR is increasingly dedicated to identity politics and activism. Second, the IASR’s unfortunate decay has led to activists, outside and inside, challenging the editorial process of the Archives of Sexual Behavior when it publishes articles they dislike. The second issue is more important — Archives of Sexual Behavior remains an excellent, interesting, and prestigious journal — and it deserves an extended discussion.

In 2019, I wrote an essay for Archives of Sexual Behavior about the disintegration of another sex research organisation (Society for the Scientific Study of Sexuality) due to ideological reasons, and worried the IASR was heading the same way. This article was entitled “How to Ruin Sex Research” and offered suggestions that included:

1. Advocate for marginalised groups.
2. Don’t question people’s identities and narratives.
3. Focus on linguistic sensitivity rather than efficient communication.
4. Follow the example of gender studies.
5. Focus on moral and political implications and “sensitivity” of scientific presentations and publications rather than on the accuracy of their scientific content.
6. Discourage discussion of controversial ideas.

The current controversy exemplifies most of these. The marginalised group is adolescents and young adults who believe they have genuine gender dysphoria rather than ROGD. This may not be questioned. The only communication I have received from the IASR officers included an unspecified concern about “inflammatory language”. And discouragement of a controversial idea — ROGD — is the real motivation of the IASR leadership in this episode.

The Editor of Archives of Sexual Behavior, Kenneth J. Zucker, is one of the world’s most distinguished and influential researchers on child and adolescent gender dysphoria. For example, in the fifth revision of the important psychiatric diagnostic manual (DSM-5), Zucker was the only non-psychiatrist selected to lead a section. (Full disclosure: Ken Zucker is my friend and occasional collaborator. I would not falsely praise him. Ask around about my bluntness.) Zucker is a superb editor. He has deep knowledge of the areas he oversees (submissions in others he passes to Associate Editors), he has sound and objective judgment, and he errs in the best way: for intellectual inclusion and scientific debate.

He has also published at least 10 different pieces responding critically to mine. When I initially read these critiques, my reaction was never happiness. More often it was annoyance, both at the ideas they expressed and the time I would have to devote, if I chose to respond. I recall Anne Lawrence, a brilliant scholar of gender dysphoria and a transwoman herself, bemoaning Zucker’s decision to publish articles she (correctly) judged seriously flawed for the sake of discussion, because they would cost her time and effort to correct in the published record.

Yet I have come to believe that Zucker’s approach is exactly what we need for healthy, vigorous science. Put ideas and data on the table. Not everyone can benefit from this — some don’t understand data and others can’t get past their biases. But some of us can. Regardless of their likely numbers of citations, exchanges occurring in Archives’ Letters and Commentaries are lively, interesting, and highly informative. I recommend them more often than I recommend my empirical publications. I do not relish the prospect of responding to letters criticising our ROGD article in Archives. But I will do so, and Zucker will undoubtedly accept all intelligible, non-libellous submissions. (This assumes, of course, that this will be possible.) Can anyone doubt that such an exchange would be the best way to illuminate both the flaws and virtues of our article?

The IASR Executive Committee and the complainants (and complainers) around our article have put Zucker in an unwelcome spotlight. Not because he did anything wrong — he didn’t. These days one doesn’t need to do anything wrong to suffer consequences. His boss at Springer has asked him to clarify his decision process for publishing our article. Perhaps this is just reasonable oversight. But the last time this kind of thing happened to Zucker, he was unfairly fired. I don’t think Ken Zucker is worried about his livelihood. He is worried about IASR and Archives of Sexual Behavior and his relationship with both. He loves both institutions. He has unarguably been the second-most important person in their history (after Richard Green, who founded both and is rolling in his grave about the IASR’s current directions). He has been Editor of Archives since 2002 and has attended every IASR meeting since 1983. I suspect he is not only worried but also a little heartbroken about the recent shenanigans.

The most important remaining uncertain outcome is what the publisher of Archives of Sexual Behavior will do. My advice is that they do nothing. It is straightforward to ascertain whether the publication of our article is consistent with Springer’s policies (yes) and whether the article was thoroughly and critically peer-reviewed by scholars who know much more than the complainants/complainers (yes; the reviews are available to Springer staff). Springer should be satisfied that the Editor did nothing wrong, even if some staff there might wish he had made different decisions. Any action on the part of Springer will be correctly interpreted as a decision to enter the culture wars on a particular side. That would be a blow for both business and for scholarship.

Whatever happens, all the signs suggest that IASR will continue to deteriorate as a scholarly society and will become increasingly activist. Not all current IASR members will embrace this. Some will leave IASR, as I did. Others will either endure or become more activist. For my part, I plan to help form an alternative organisation of sex researchers who value ideological impartiality, meritocracy, and, above all, pursuit of truth and knowledge, wherever they lead us.

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