Lots more debunking of the Turban et al. study on gender dysphoria

August 6, 2022 • 11:30 am

On Thursday I wrote a post about a new paper in the journal Pediatrics by Jack Turban et al., a paper arguing against “rapid onset gender dysphoria” in adolescents and the attendant view that transgender identity is often spread by “social contagion”.  Turban et al. argued that the ROGD hypothesis—and social-contagion views of all gender dysphoria—were disproven because he found that, in a sample of adolescents from two years (2017 and 2019):

a. More males than females claimed to identify as transgender, whereas ROGD supposedly predicts the opposite.

b. There was no increase in the number or proportion of adolescents from 2017 to 2019 identifying as transgender, again supposedly contradicting the social contagion view

c. A higher proportion of transgender adolescents than cisgender adolescents reported having been bullied, which Turban et al. says is evidence against a “social contagion” hypothesis, for why would you assume a gender identity that would get you bullied?

d. A higher proportion of transgender adolescents than cisgender adolescents report attempting suicide. Turban et al. claims this is also evidence against a social contagion hypothesis, though I don’t see how.

I pointed out problems with all four of these claims, and now, it turns out, people with more knowledge than I have raised these same issues with the paper of Turban et al. (Turban seems to be a tendentious researcher who, says Singal below, has a tendency to misquote even his own data, and is on a single-minded drive to support “gender affirmative” treatment.)

There are three pieces to read, and I’ve read the first two below. You can access all three by clicking on the links. The first was published on Singal’s Substack site, the second at the City Journal, and the third is on SocArXiv Papers

The pdf of the note below can be downloaded here.

I was heartened that the authors found the same issues I singled out as problematic, but also found other issues as well. That’s not surprising, for, as a group, these authors have far more knowledge than I about the rise in transgender identification among adolescents and children—particularly Singal, who has spent much of his recent career minutely and critically examining papers about gender dysphoria.

All three of these papers take strong issue with the paper of Turban et al. (Pediatrics is published by the American Academy of Pediatrics, which, Sapir maintains, has a history of pushing gender-affirmative care, to the point of rejecting outright any papers that question it. One is mentioned below) The main issues raised by Singal and Sapir are similar to those I mentioned, and I’ll summarize them briefly.

1.) Asking children “what is your sex?” conflates biological sex, which is what we want to know, with what sex the interviewee sees themselves to be. If there is a difference, and Singal says there almost surely is, then this could underrepresent either the two groups AMAB (“assigned male at birth”) and AFAB (“assigned female at birth”). Indeed, there is some evidence that AFABs identify themselves as males, counter to Turban’s claim that it’s mostly biological males afflicted with gender dysphoria.

That information comes from Michael Biggs, who, says Singal, submitted what’s below as part of a critical comment on the Turban et al. paper, but the comment was rejected by Pediatrics within an hour of submission.  How could it have been properly reviewed.

Biggs:

Predicting height separately for each sex, OLS regression (adjusting for age and race) reveals that transgender respondents who identified as male were on average 2.5 cm shorter than non-transgender male respondents (95% CI: 1.3 … 3.8 cm, total n = 87,568). (There was no discernible height difference between transgender respondents who identified as female and non-transgender female respondents.) This height difference is evidence that some of the transgender respondents who identified themselves as male were natal females.

Singal’s gloss:

This means that if biological sex had been reported accurately, a number of members of the “male” category would instead be in the “female” category, which would nudge everything in exactly the direction that is unfriendly to Turban’s and his colleagues’ theory (that’s if you accept their logic).

For my part, I don’t see why the claim that observing more biological females than males afflicted by gender dysphoria needs to be part of a ROGD “hypothesis”. It could be the other way around, though clinical data (see below) suggests that it isn’t.  But a sex imbalance says nothing about social contagion. A hypothesis should not include in its assumptions what has already been observed.

2.) Turban’s claim that there are data showing that asking “what is your sex?” gives reliable information about biological sex is not supported by other studies. (I didn’t mention this issue, as I didn’t know about it, but Singal did. He looked up the three studies cited by Turban et al. as showing his method of asking about sex is reliable in pinpointing sex assigned at birth, and none of the three studies cited addressed that claim.  If this is the case, then Turban et al. are guilty of severe distortion of the literature.

3.) Turban et al.’s claim that gender dysphoria is on the wane is contradicted by multiple sets of data from multiple countries. These data are from clinical studies in which young people present themselves for treatment, so there are two explanations. First, more females than males suffer from gender dysphoria of a severe fashion—severe enough to go to a clinic. That would explain why the female bias seen everywhere in clinics conflicts with what Turban found, which is a survey on self-identification of high school students. Second, Turban could simply be using unrepresentative data.

We don’t know the answer to this, but it’s a flaw in the Turban et al. paper that they don’t really discuss this disparity (they give two citations to clinical data but then criticize them). But it’s the clinical data that are important, as I said, because people fighting for empathic rather than affirmative care are concerned not so much with what gender adolescents feel themselves to be as with whether they’re driven to take medical steps that may be harmful and irreversible. And those are the young people who go to clinics.

4.) Singal notes that Turban et al.’s study has sampling problems, and this issue is discussed in the last paper above, which I haven’t yet read.

5.) That children who identify as transgender report a higher rate of bullying does not refute the “social contagion” hypothesis. As several authors have pointed out (Singal at length), children with gender dysphoria tend to suffer from mental issues, and could be bullied because of that—or simply because their gender confusion makes them ripe for bullying. If these children then tend to seek like-minded people as a way of escaping from the bullying, then you get the correlation that is observed by Turban et al. Singal uses the example of bullied “goth adolescents, as “gothism” doesn’t have anything to do with biology or gender, but the point is clear. A correlation between identifying as transgender and being bullied says nothing about the absence of social contagion, and may well support it.

As for increased rates of suicide among youth identifying as transgender, that could have the same explanation as above: dysphoria is connected with mental distress and mental illness. Rates of attempted suicide say nothing to me about social contagion.

Singal in particular has followed Jack Turban’s papers and statements (including on Twitter) for a long time, and his paper is a litany of a scientist who seems tendentious and, well, dishonest about the data in the interests of ideology.

I’ll end with Sapir’s conclusion:

In a field known for its weak methodologies and even weaker scientific conclusions, Turban’s study sets a new low. Even trans activists in the academy who detest the ROGD hypothesis wrote a letter in which they take Turban to task [JAC: that’s the third screenshot above]. While the Turban study’s intentions are “admirable,” these authors write, its “results were overinterpreted and . . . the theoretical and methodological shortcomings of the article run the risk of being more harmful than supportive.”

That a study like this can pass the peer-review process unscathed, especially at a time when European countries are shutting down or putting severe restrictions on pediatric transition, is a sorry statement about the quality of knowledge gatekeeping in the medical research community. American journalists tout its findings without giving readers relevant information about its flaws, while left-of-center journalists in Britain have been busy blowing the whistle on the pediatric gender-medicine scandal. The U.S. has a long way to go to bring medical practice in line with scientific knowledge and common sense.

Note that the NBC News story I originally cited was completely uncritical, and I gather that other media outlets have parroted Turban et al. without the slightest notice of its flaws. That could reflect ideological bias, or simply arrant ignorance of how to vet a scientific finding.

_________________

h/t: A lot of readers who directed me to these sources. Thanks!

41 thoughts on “Lots more debunking of the Turban et al. study on gender dysphoria

  1. Wait … asking a child “What is your sex?” could be erroneous and confusing?

    1) That question has only two answers, and they are simple, objectively true, and never changing. “I am a girl,” or “I am a boy.”

    2) “What is your sex?” is not even the correct question for a three year old. Or a five. Or a seven. They don’t really know what “sex” is. The question should simply be: “Are you a boy or a girl.” If a child cannot answer that, it is cause for alarm.

    3) Gender? If a three year old cannot fully grasp the word “sex,” as I claim, how can they be expected to grasp “Gender.”

    Actually, the child should not have to answer ‘are you a boy or a girl.’ The parents should be the ones answering this simple factual question. And only if truly necessary. And if there is confusion, the truth test becomes a medical examination.

    I would normally say the subject ought not be put to a child, or discussed. If there is anxiety about it, let it arise. However, social contagion is a real thing, a poison on the land. Children are not protected from Identarian saturation of the schools and cultures with their mission to disrupt.

    Children might easily be disturbed about adults and other children bandying over “Are you really a girl?” A six-year-old coming home after a session of Woke Identarianism at school could easily test things out by an outrageous claim.

    This is an atrocity against any human of any age who is actually afflicted with identity dysphoria. Given the deliberate mass project to project “all children are queer,” a person raising their hand and spontaneously saying “I am a girl, but I feel like a boy” (or obverse) must be distrusted on the face of it. Not automatically affirmed. See how sly the identarian project is?

    1. Asking young children if they are a boy or a girl, assuming there is any sign of confusion, is a question that is indeed fraught with risks of further confusion. A boy who experiments with traditional girl dress and toys probably knows they are different, but they probably don’t know how to give a detailed answer. They could answer that they are a boy bc they believe their peers and their concerned parents want them to say that, even if it isn’t really true to them. They could say “I am a girl”, even if that isn’t how they really feel, because they just don’t grasp the juggernaut of “therapy” they can get which can continue to pressure them to say that.

      1. When I was little (1950s), a lot of people assumed that I wanted to be a boy, because I was a “tomboy”. I was interested in nature and animals, I was already horse-mad, and I was physically active.

        But I didn’t want to be a boy; I wanted to have the privileges boys had, just because they were boys. Chief among those privileges is that they got to wear comfortable clothes to school. Girls had to wear dresses or skirts, to “show respect”. Did they make the boys wear jackets and ties? No, they did not. (Of course not.) So girls were constrained by our clothing during recess.

        I had another experience, when I was about six, that I was acutely affected by. As I said, I was horse-crazy. We went to the rodeo at Madison Square Garden, and the featured star was Roy Rogers. We had terrific seats, right on the railing. He rode around the arena, shaking hands with the kids in the front row. No, not with the kids, with the BOYS. ALL THE BOYS. Girls were invisible.

        Although sexism is reduced (I hope) somewhat now, I can’t help but wonder how many girls still experience what I did, and whether that body of experience contributes to what some adults might interpret as gender dysphoria.

        L

        1. Fortunately, I never got to see Roy Rogers in person, only on TV, where often Dale and her horse Buttermilk were sometimes featured. And yes, also considered a “tomboy.”

          Clothing for women’s PE was certainly restricted in high school up until the late 60s, at least at my public high school in a suburb in Chicago. Girls has to wear culottes, a bulky shorts/skirt hybrid. Which was discontinued when the mother of a girl who hated them simply sued the school district, and won, the year after I graduated.

      1. The point of the word “assigned” is to give the impression of capriciousness and randomness. And I believe that the observation of sex lines up with development and gender about 99% of the time.

        1. Absolutely.

          Here’s what the American Academy of Pediatrics says :

          ” “Sex,” or “natal gender,” is a label, generally “male” or “female,” that is typically assigned at birth on the basis of genetic and anatomic characteristics, such as genital anatomy, chromosomes, and sex hormone levels. Meanwhile, “gender identity” is one’s internal sense of who one is, which results from a multifaceted interaction of biological traits, developmental influences, and environmental conditions. It may be male, female, somewhere in between, a combination of both, or neither (ie, not conforming to a binary conceptualization of gender).”

          Source : https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for?autologincheck=redirected

          [ end quote ]

          … I would point out the absence of the words “binary” or “nonbinary” in that quote. The reference _does_ contain those words but refers to this source :

          https://pubmed.ncbi.nlm.nih.gov/26753630/

          … why am I taking up space on a nit pick?

          Because, in my view, a set of male or female gametes is precisely that – a set. Thus, the language to use when referring to sets is that developed in Boolean logic. Not, “binary”.

          [ steps down from soapbox ]

          1. Oh – I erred. The quote certainly does use “binary” and also suggests one can be, e.g., 20% male and 70% female … or do they mean a sex which is previously not known to science? Among who know how many?

    1. The survey respondents were not all high school students. Some were middle school students. See table 1 in Turban et al., which gives an age breakdown of the respondents (there were even a few respondents younger than 12 years).
      Why did they not ask “What sex were you assigned at birth?” They were just using the same sex identification question that had been used in many earlier versions of this survey. Of course, they should not have done this because some transgender-identifying students will incorrectly answer the question (substituting their gender identity for their sex).

  2. Studies like these suffer from the same basic procedural problem as religion, namely, drawing the conclusion first and looking for the evidence afterward.

    Unwillingness to go where real evidence leads is getting worse, everywhere. Unwillingness to understand that all conclusions are provisional, ditto.

    The solution? Beats me.

    L

    1. How might schizophrenia be the product of evolution? Your question implies that all maladies, psychological are physical, must be explained as an adaptive result of natural selection.

    2. Gender dysphoria simply signifies being unhappy over one’s sexed body and its existence really isn’t extraordinary or disputed. I think the more puzzling claim is for an innate “Gender Identity” which forms in the womb and allows the individual to know whether they’re a boy or girl without any environmental learning or biological clues. This usually aligns with their reproductive system — but doesn’t always. Thus, transgenderism.

      At what point, and for what purpose, would this evolve? Gender Identity isn’t supposed to involve instincts and drives surrounding reproduction. Would mammals which lacked it be less likely to spread their genes? Or does it form before mammals? If everyone is actually born with this inner awareness of their “gender,” why hasn’t it been studied before now & incorporated into evolutionary theory? It seems to me that’s a weak spot. An innate Gender Identity is only used to explain trans people.

    3. Sorry this is a very late comment.

      This is one kind of evidence that could help explain the evolution and maintenance of gender dysphoria.

      https://doi.org/10.1038/s41562-021-01168-8

      In this case, the evidence by Zietsch et al. is about the evolution and maintenance of same-sex sexual attraction, but similar principles can help explain why other kinds of traits persist that are not obviously adaptive (or that seem to obviously reduce reproductive success). IDK of course if this is why gender dysphoria persists, but it seems at least possible.

      Edit after reading Max’s comment @11. I agree with Max that the vast majority of “transgender” kids are simply being misled by others. But there does seem to be a real sort of trans person who has persistent unhappiness about their sex from an early age. I guess a genetic or evolutionary account of gender dysphoria (if such an account exists) would be limited to that much smaller group.

  3. Contemporary transgender doctrine is in major ways a bowdlerized form of the writings of Foucault and of the anti-psychiatry movement of the 1960s. Similarly, the language of BLM and associated activities resembles the “black power” slogans of the 60s-70s; and the “decolonialize” clichés in contemporary academia are warmed over from Frantz Fanon, Edward Said, etc. etc.

    Conspiracy-minded writers (e.g., Christopher Rufo) ascribe this lineage to a deliberate “march through the institutions” plot. Instead, I suggest that we are rather witnessing a second generation echo effect, something like the story by Hanif Kureishi and film “My Son the Fanatic”, in which a relaxed, sensible Pakistani immigrant in Britain is baffled by the Muslim fundamentalism adopted by his British-born son. Another analogy is this. Once upon a time, there was the “red diaper baby” phenomenon, found among some children of Communist-lining parents. Today, in the guise of the ubiquitous wokeism, we may be seeing a “60s radical diaper baby” phenomenon.

    1. Really? It’s just a random issue with the echo-suppression acoustics? A humorous wayward bounce? A trifle? Nostalgia?

      For a moment, consider the other extreme, the deeply researched analysis of James Lindsay that we are seeing a specific, planned, full-court-press project by neo-Marxists to destroy the fabric of USA/Enlightenment/Capitalism. WokeMarxists: “Well, economic critique did not work, we are switching to racism-guilt, sexuality, and gender identity.”

      I’d love to go toe to toe in support of that worldview against your randomness. [not here] Over a beer in a capitalist tavern.

  4. Not sure if this has been noted in one of Dr. Coyne’s entry, but I understand that Turban derived his thesis about Rapid Onset Gender Dysphoria receding by comparing just 2 data points one from 2017 other from 2019.

    Yes, two data points from what i have read to deduce a trend.

    Turban will join the University of California San Francisco. Isn’t that the same school where that professor who went after the normal distribution, and in the process showed her cluelesness, teaches? The essay was published in Scientific American.

    1. That Sci Am essay also referred in passing to the “racism” of Gregor Mendel. Its misconstrual of what the normal distribution means is perfectly diagnostic of contemporary woke pop-Leftists. They are hostile, not only to the normal distribution, but to the very concept of distributions, i.e., arrays in which members differ in some quantitative characteristic. The existence of distributions contradicts two woke aspirations: (1) that all quantitative values be the same; and (2) that all phenomena in the universe be subject to administrative regulation by the DEI Committee.

  5. For the purpose of this question, I’m stipulating that the study itself has been shown faulty. That’s all, just the study. What about the phenomenon itself?

    General question: if Turban-style ROGD (social contagion) is not a thing, what IS the cause of a giant spike in claims of teen girls with no previous dysphoria whatsoever, suddenly contracting (developing? discovering? admitting?) full-blown gender dysphoria?

    1. I don’t know.

      When I read extensive pieces on this topic though, I find myself puzzled that the exposure of pregnant mothers, infants, and children to chemicals in their environment goes pretty much without mention.

      Chemicals such as Bisphenol-A, or lead, to name two that we know about, and sound like they should not be anywhere near that population. I thought BPA was just a panic back when it made news, and scoffed at lead. But I can recall anecdotally consumer goods containing lead (when reported), and possibly BPA. I do not know what is being used in place of BPA in “BPA-free” plastics.

      The FDA says “BPA remains safe in food contact materials.” :

      https://www.fda.gov/food/food-additives-petitions/bisphenol-bpa

      The Nat. Institute of Environmental Health Sciences gives non-specific “… concern, especially for parents, may be because some animal studies report effects in fetuses and newborns exposed to BPA.”, and gives guidance :

      https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm

      I do not know what to conclude about that, or the literature on BPA, which can be found to show it to bind estrogen targets, and so on, in lab conditions – so there is not simply a panic over ingredient lists (e.g. a “dihydrogen monoxide” scare – it’s just water.).

      Apologies for length/tangent.

    2. If may be incorrect and confusing to say “Turban-style ROGD” because Turban is trying to claim that trans is not a social-contagion phenomenon but instead is neurologically, biologically real. I would leave it to him and his acolytes to prove that hypothesis and elucidate a mechanism. Since his study in Pediatrics fails to disprove the social-contagion hypothesis, it is still in play in my opinion and we need not do his epistemological work for him.

      The sudden spike of what is called gender dysphoria in adolescent girls (some not yet teenagers) does have features of social contagion or mass hysteria. The excellent articles by Singhal and Sapir (referenced in the body of Jerry’s post) look closely at this and are well worth a read. In essence, misfit kids who are excluded from A-list in-groups often find meaning, solace, and support among other misfits. They adopt styles and fashion to be accepted by their new tribe, even if visibly doing so attracts more shunning from the in-group. But that doesn’t matter because they were already excluded from the in-group anyway. Anyone who remembers middle or high school who wasn’t one of the cool kids — athlete or cheerleader or mean girl — can surely relate to this.

      The dysphoria is real — high school is a cruel, Lord-of-the-Flies kind of place and woe betide the weak and the different. But how dysphoria is acted out is determined by cultural permission prevailing at that time and place, and the presence or absence of adults with agendas. I cited the link below in a response to an earlier discussion of this topic. I’m reposting it to give credit to my wife who found it and showed it to me:

      https://bprice.substack.com/p/trans-is-something-we-made-up

      1. I wonder if a discrepancy in that scenario might be found when comparing public school to private. That comparison might be expected to show a distinct difference the student bodies and associated personalities.

        1. This could be looked at. The CDC’s Youth Behaviour Risk Survey System, the primary database that Turban drew his inference from, does include private schools. Participation by Depts of Education at the state level is voluntary, as is participation by individual schools selected by the survey organizers for invitation. You could, in principle, look at whether there were differences between private and public schools in the prevalence of any risk the survey asked about, smoking, drug use, seat-belt use as passenger, etc., not just gender dysphoria, bullying and suicidal actions. The caveat would be that if private schools and public schools differed in their participation rate, the differences would be generalizable only to the types of schools that participated. The validity is already questioned by the inclusion of only 14-16 states (depending on year) in the middle-school version of the YBRS.

          And of course these are large surveys completed anonymously by students sitting at their desks. There is no attempt, through face-to-face interviews for example, to verify the truthfulness of any respondent.

      2. I acknowledge my take on Turban was wrong. I should have left off the “Turban-style”. Thanks for the gentle nudge.

        In noting past faddish syndromes … remember when ROWAAGP swept around the country briefly? I made that up…it stands for Rapid Onset We Are All Getting Pregnant. Groups of teen girls would swirl into a clique and get infected with the idea of getting pregnant — regardless. I mean, with absolutely no regard to the outcome, not even to the extent of visualizing gestation and birth. There might be a vague enrapture with ‘then I would have a sweet baby,’ but no real consideration for the word “parent.” And then … they went out and found boys and sure enough, We All Got Pregnant Together.

    3. I don’t know either, but I think social contagion (a fad), and related, seeking ‘victimhood status’ (also a fad) is a good starting hypothesis. After all, the great majority of ROGD cases are white girls from middle class families, ‘privileged’ in other words.

    4. General question: if Turban-style ROGD (social contagion) is not a thing, what IS the cause of a giant spike in claims of teen girls with no previous dysphoria whatsoever, suddenly contracting (developing? discovering? admitting?) full-blown gender dysphoria?

      As a culturally-bound syndrome, the diagnosis of not just gender dysphoria (discomfort with your sex…) but transgender identities (…means you were born with a brain that tells you you’re not your sex) has to be available. But why the rise in teen girls who desperately want to opt out of being female?

      One factor I’ve repeatedly seen mentioned is pornography and how it’s changed over the last several decades. The internet, social media, and cell phones have lead to it becoming mainstreamed among teens and even preteens. They’ve not only viewed it (sometimes regularly) but practices like oral and anal sex have become givens. Teens can even think bdsm kinks are normal among teen relationships. Peers might sext and send pics. Adolescents aren’t necessarily having more sex; they know more — or think they do. It’s what’s expected.

      How do the porn-driven images of what’s involved in sexual relations effect girls starting to undergo puberty? Nervous, embarrassed, worried, and frightened, they’re no longer navigating a landscape where they’re faced with the upcoming prospect of kissing a boy. It’s gotten much more explicit— and darker. Expectations of what they “ought” to be doing is creeping down to younger and younger demographics. And a lot of girls want out… of womanhood.

      They can do it through claiming the LGBTQ+ status of Demisexuality: sexual orientation in which a person feels sexually attracted to someone only after they’ve developed a close emotional bond with them. You’re not a prude: you’re Born That Way. They can assert they’re “non-binary.” Or, the iron-clad escape from what seems the inevitable fate of being a woman: not being a woman. They’re a transman.

      1. “But why the rise in teen girls who desperately want to opt out of being female?”

        -Fear of pregnancy – the Roe v. Wade news lately could stoke that – stigma of demanding/obtaining contraception

        – can’t get dates otherwise / comfort in socializing among their own gamete-based sex

        … though I am continually confused whom a transsexual would want to “go out” with, romantically.

      2. I think you are on to it. Especially the last sentence, “Or, the iron-clad escape from what seems the inevitable fate of being a woman: not being a woman. They’re a transman.”

        Instead of the anticipation of a thrilling kiss with a cute normal (but a little scary ’cause he’s a boy) guy she’s been on two library dates with, she grasps expectation of supplying oral sex and crude rude banter on a first date with a heartless body-count-oriented slob, and a ruined reputation if “she doesn’t put out.”

        Crude sexualization has ruined exquisite eros.

        {Add: in your example, her solution is not to “become” lesbian, since 1) that scene might be no less ugly; 2) you can’t control the spark.}

      3. I always thought long before I saw it confirmed elsewhere that the rise of internet-available porn was behind a lot of this trans stuff. I think it applies to young men as well, they can’t identify with the image of men seen in such media. (For the latter, I’m going on the anti-male identiy of a former student of mine who didn’t in anyway try to be female, just didn’t want to be male.)

      4. Profound insight, Sastra. This might even come out in counselling and therapy sessions with these kids, the ones who have distress and seek help. Except that the counsellors and therapists are expected to have an ideological bent to not go in any direction or come to any resolution except the one that results in a pre-emptive prescription for puberty blockers (for an imaginary disorder. But even if it was a real disorder, it is the failure to consider a differential diagnosis that offends.). So we’ll never know what opportunities were foreclosed too soon.

  6. I was not going to comment on this one, but I will do so anyway, trying not to repeat myself from earlier comments. A few comments I can try to address-

    “what IS the cause of a giant spike in claims of teen girls with no previous dysphoria whatsoever, suddenly contracting (developing? discovering? admitting?) full-blown gender dysphoria?”

    It is important for me to stress my observation that kids are mostly not diagnosing themselves with GD. Normal kids experience normal body awkwardness during puberty. In past eras, they were shown a film strip or just informed that they are having a universal human experience, and it will pass with time.
    The difference is that now they are likely to be told that their discomfort with changes in their body is a sure sign of GD, and that the best action is to begin “affirmation”, and most of all, to not tell their parents about it. Kids go into the counselors office on a routine visit, without the least expectation that the counselor is going to use the session for an uncomfortable talk about some of the more graphic aspects of human sexuality, and sell trans identity the way an out of work actor in Florida tries to get a retired couple to sign up for a time share.

    BPA and the possibility of synthetic hormones as a factor.
    We have much less exposure to that stuff out here than most people. Beyond that, the results from that exposure would be observable in the long term in these children, in forms such as early or late onset puberty. The kids in my group, before they decided to transition, were healthy and normal children

    “How might gender dysphoria be the product of evolution?” It is not. except on very rare cases, it develops when an adult successfully convinces a child that they suffer from it. It is not a medical issue, really. Medical interventions only make it worse. Mental health professionals see it as not being a mental disorder of any sort.
    The very existence of GD as anything but imaginary cannot be proven. There are no tests to confirm or deny it. The child say “I want to be a boy”, and that is all the proof needed

    1. “sell trans identity the way an out of work actor in Florida tries to get a retired couple to sign up for a time share.” Ouch

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