Understanding ‘social contagion theory’ and what it means for trans kids

A couple hundred parents told a researcher that their child had “suddenly” come out as trans. 

These parents—many of whom were already hanging out on anti-trans forums—thought their kid was wrong about being trans, and had only come out because of their trans-affirming friend group (especially their online friends).

The central ideas from that study—“social contagion theory,” and “rapid-onset gender dysphoria”—took off, and still show up everywhere from news-reporting to legislative bodies.

But when a lot more researchers went back to these questions, and actually asked trans people about their own experiences, they were told a very different story. 

For the overwhelmingly vast majority of trans people, coming out isn’t because of their friends, and it isn’t at all sudden.

So why are these ideas so persistently sticking around? Why did this theory emerge? And what does the research actually say about whether young people’s social groups are influencing their gender identities?

There’s no question that kids and teens learn a lot from their friends—from introductions to favourite bands, opinions on whether to take shop class or drama, feedback on styles and outfits.

But around 2018, another idea about the way child and youth friend groups influence each other came into the mainstream: that young people coming out as trans was a “social contagion,” causing more and more people to suddenly start identifying and coming out as trans as well. 

The social contagion theory, as it came to be known, spread quickly—first online, and soon into legislative hearings. 

Where did social contagion theory originate? 

To understand, we have to go back to a 2018 paper published in the multidisciplinary journal PLOS One by physician-researcher Lisa Littman—claiming that many kids, teens and young adults who were coming out as trans were actually cis, and were just being misled or misinformed, or wanted to fit in with their friends.

This wasn’t the first time that someone had floated the idea that young people coming out and/or coming to understand themselves as trans was directly influenced by their friends coming out. The concept of social contagion was certainly being discussed on online forums for parents of trans youth prior to the release of Littman’s paper. It was particularly easy to find on some of the most vocally anti-trans forums. But the idea hadn’t yet made it into scientific literature, let alone more mainstream reporting and public conversations.

Littman began working on her paper after she noticed a few young people in her hometown who were in the same friend group, and who had recently come out as trans. It seemed like more and more kids were coming out.

So she decided to see if she could find out more about kids like these, who seemed to be coming out “all of a sudden.” But rather than ask the youth themselves about why they wished to transition, Littman decided to exclusively survey parents. And not just any parents—but primarily parents who frequented online anti-trans forums.

Looking to “maximize the chances of finding cases meeting eligibility criteria,” as she wrote in her Methods section, she focused her sampling on three websites that she knew hosted communities of parents who frequently complained that their children had suddenly started identifying as trans.

The websites—4thWaveNow, Transgender Trend and Youth Trans Critical Professionals—described themselves respectively as a “community of people who question the medicalization of gender-atypical youth,” concerned about the “unprecedented number of teenage girls suddenly identifying as ‘trans,’” and “concerned about the current trend to quickly diagnose and affirm young people as transgender” (this latter website has since been made private).

In the information that was sent to parents before they completed the survey, Littman described her hypothesis that young people were coming out as trans due to “social and peer contagion.” In this type of study, researchers have to be careful about sharing specific details about their hypothesis and expected results in advance, because of the risk of biasing the data (both in terms of who participates in the survey, and how they answer the questions).

No trans youth were surveyed, nor was the survey intentionally sent out to groups or forums for gender-affirming parents and guardians.

More than two-thirds of people who filled out the survey said they thought their child was “incorrect in their belief of being transgender,” and most said that their child had increased their internet use or had trans friends before they started identifying as trans themself.

Of course—especially without the youth perspective—it’s impossible to compare the timeline of a person’s “sudden” coming out to when they actually started to question their gender or understand themself as trans. 

Information that feels sudden to a parent whose child has just come out for the first time might have been something that child has been figuring out over months, years or a lifetime.

Still, in 2018, Littman decided she had enough data to publish, and to coin a new term: Rapid Onset Gender Dysphoria (ROGD).

The term—which Littman suggested was a “potential new category” of gender dysphoria — referred to young people who come out as trans because of their peers’ influence, particularly online.

Littman argued that a young person who comes out as trans and says they feel distress because their gender and assigned sex don’t match (a classic definition of gender dysphoria)—but only because that’s something their friend group is talking about, exploring or encouraging—isn’t actually trans at all, and therefore shouldn’t be getting gender-affirming care.

Most scientific papers don’t get a lot of public or media attention outside of their specific academic field. But Littman’s 2018 paper landed in the middle of a series of mainstream news cycles related to the lives of trans people—in particular, escalating controversies over trans youth in sports, and over the perception that the general social and political climates had somehow become “‘too accepting’ of trans people.”

Ripple effects from the article 

As American Civil Liberties Union (ACLU) communications strategist Gillian Branstetter told the MIT Technology Review in 2020, the paper “laundered what had previously been the rantings of online conspiracy theorists and gave it the resemblance of serious scientific study.” Nearly instantly, Littman’s theories became a cudgel to wield against trans people, particularly trans youth. 

Since then, ideas first introduced or popularized in Littman’s study have kept showing up in anti-trans laws. In 2021, the Coalition for the Advancement & Application of Psychological Science found “over 100 bills under consideration in legislative bodies across the United States that seek to limit the rights of transgender adolescents … predicated on the unsupported claims advanced by ROGD.”

And in 2022, Florida specifically referred to the ROGD hypothesis as a justification for prohibiting Medicaid funds for gender-affirming healthcare. 

Whether researchers and institutions should be studying questions like why some people are trans, and others are not, is a matter of scientific ethics. There are good arguments to be made that the purpose of science is simply to understand. But there’s also an awareness of the danger of looking for the “root cause(s)” of specific identities, particularly those that remain marginalized in many societal contexts; throughout history, that type of science (or pseudo-science) has been at the root of eugenics projects.

As the ideas of “social contagion” and “rapid-onset gender dysphoria” were filtering into the broader conversation, other researchers were picking the 2018 paper apart, noting that the survey, sampling and data had serious problems from the start.

Eventually, PLOS One added a major correction to the paper. After a review, the journal decided that the article’s title, abstract, introduction, discussion and conclusion all needed to be revised, because the original version didn’t meet PLOS One’s publication criteria. The correction also clarified that no trans or gender-diverse youth were actually included in the study, and specifically noted that “rapid-onset gender dysphoria (ROGD) is not a formal mental health diagnosis,” which is still the case today.

 What today’s research on social contagion theory says

Since 2018, quite a lot of new research exploring the social contagion theory—with bigger samples, including youth themselves—has failed to produce the same results. 

The central idea of so-called “rapid onset” gender dysphoria is that it describes a distinct type of gender dysphoria that teenagers allegedly start to experience out of the blue—according to their parents.

But does coming out really happen out of the blue? A 2023 paper in the Journal of Adolescent Health did the math, using the 2015 U.S. Transgender Survey, which included over 25,000 trans and gender-diverse adults in the United States. 

Whether people started to understand themselves as trans as children, teens or adults, most waited a very long time to tell anybody else: the median time between their personal realization and their first coming out was over 10 years. 

In other words, not “rapid.”

Another study, published in The Journal of Pediatrics in 2022, looked at Canadian youth seeking gender-affirming care for the first time to see if there was a difference between the teens who had recently come out as trans and the teens who had known they were trans for a long time.

But when researchers compared the recently out trans kids to their peers who had come out years before, they didn’t see a difference—the answers to questions like how many trans friends they had, how big their online friend group was, whether they had supportive parents or whether they had mental health diagnoses were statistically the same. 

Yet another study found that, five years after socially transitioning, 97.5 percent of youth still identified as trans or non-binary; reflecting a lasting identity, not a passing fad.

In 2022, researchers used data from the CDC’s Youth Risk Behavior Survey—which surveys tens of thousands of children in the U.S. every two years—to show that the number of youth identifying as trans or gender-diverse was not rising, and had actually fallen slightly (from 2.4 percent in 2017 to 1.6 percent in 2019). 

It is the case that there are more trans youth than trans seniors (at least, more trans youth who have had the chance to embrace this part of their identity, and who are comfortable telling a survey-taker about it)—in 2019, about 0.001 percent of baby boomers in the United States said that they were trans. But there isn’t some pattern showing more and more young people coming out as trans every year (like you would expect, if being trans were actually “contagious”). In practice, this is a slowly changing, fluctuating percentage of people.

And rather than getting some sort of social benefit from coming out as trans, as the social contagion hypothesis suggests, the trans and gender-diverse youth in this survey reported that they were much more likely to be bullied than their cis peers at school. 

“The idea that attempts to flee sexual minority stigma drive teenagers to come out as transgender is absurd (and) the damaging effects of these unfounded hypotheses in further stigmatizing transgender and gender-diverse youth cannot be understated,” lead study author Dr. Jack Turban said in a statement at the time. 

As the old saying goes, the nature of science is to be self-correcting—but when bad science like social contagion and rapid-onset gender dysphoria get picked up and shared far outside their original field, it’s irresponsible (at best) not to amplify the follow-up research just as loudly too. People who, in good faith, want to understand why they’re meeting more out trans people in their life, or how to support a young person who has come out as trans, or even might be questioning or exploring their own gender deserve to know that being trans doesn’t seem to be contagious, and young people aren’t coming out to fit in.

As trans people themselves know—and as more and more research confirms with every passing year—the best explanation for why a person is coming out as trans is simply because they’re trans.