A new study in the journal Pediatrics sets out to refute a central claim made by critics of pediatric gender transition: that social pressure rather than organic processes is the major cause of transgender self-identification among youth. Among the study’s authors is Jack Turban, an oft-quoted proponent of “gender affirming care” (GAC) and propagator of the affirm-or-suicide myth.
Pediatrics, recall, is the journal that published Jason Rafferty’s thoroughly debunked 2018 article purporting to find conclusive evidence that alternatives to GAC are futile and harmful. That article has become Exhibit A in efforts by policymakers to promote GAC and is widely cited by activist groups working with schools to make (iatrogenic) “social transition” easier for students. The American Academy of Pediatrics (AAP), which publishes Pediatrics, has spent the past few years suppressing petitions from members to conduct a thorough review of the evidence on this issue. According to the Society for Evidence-Based Gender Medicine, Michael Biggs, a U.K. researcher who has published on this topic, submitted a rebuttal to the AAP, which the organization refused to publish (offering no explanation). It is becoming increasingly clear that AAP’s policy on this issue is “no debate.”
Turban takes aim at the two key claims driving the social-genesis approach. The first, known as the social contagion hypothesis, is that adolescents adopt a transgender identity in response to social cues and pressures. This phenomenon was first documented in a 2018 study by Lisa Littman and inspired Abigail Shrier’s book Irreversible Damage. Its plausibility has since been strengthened by clinicians working in the field. According to some proponents of the contagion hypothesis, the effect exists mostly or even exclusively among teenage girls. Relying on a supplemental questionnaire adopted by 16 states on the CDC’s biennial Youth Risk Behavior Survey, however, Turban finds that more boys than girls identified as trans in 2017 (1.5 boys for every girl) and 2019 (1.2 boys for every girl). Thus, he concludes, the contagion hypothesis is false.
This is an astonishing leap of logic. First, the supplemental questionnaire asks respondents whether they self-identify as transgender. It gives them four options: yes, no, I don’t know, and I don’t understand the question. Turban includes only those who said yes (2.4 percent in 2017, 1.6 percent in 2019). He leaves out those who answered, “I don’t know,” a far more numerous category (4 percent). This is a problem, because that category might include adolescents who identify as something other than girl or boy—for instance, the increasingly common “nonbinary”—or who may still be in the process of figuring out whether they identify as trans. Not only is it conceivable that members of this group are more likely to be female, but kids who aren’t sure about their “gender identity” also seem more likely to be affected by social contagion than those whose trans self-identification is tenacious and has been ongoing. (The Dutch experts who developed pediatric transition argued that early-onset symptoms are a strong indication that the problem will persist over time.)
Second, the supplemental questionnaire also asks respondents what their “sex” is. Turban assumes that respondents understand this second question to mean “sex assigned at birth” rather than “gender identity,” and cites three studies to confirm that that is how teenagers “are likely to understand” the word “sex.” Yet the first two citations say nothing of the sort, and the third only weakly hints in that direction. No less damning, the researcher who developed the questionnaire for the CDC has herself emphasized the “uncertainty as to whether transgender students responded to the sex question with their sex or gender identity.”
Unless there is something Turban isn’t telling us, he seems to have simply made up this crucial assumption, without which his argument cannot work. If a non-insignificant portion of respondents interprets “sex” to mean gender self-identification—a plausible assumption, given how male and female have been popularly reinterpreted in recent years—then we simply cannot know how many of the respondents who ticked “male” as their “sex” are (biological) boys who identify as girls and vice versa.
Third, Turban’s claim about the sex ratio is inconsistent with existing data, which clearly show a strong predominance of girls over boys. These trends have been documented in peer-reviewed research, are internationally observed, and have remained fairly steady over the past decade or so. By contrast, Turban’s data are solely from the U.S., sample only one-third of states (Turban mentions 16 states, but it appears that the actual number of states collecting data is even lower), and focus only on two specific years. Not only that, but the YRBS asks respondents whether they identify as trans; it does not track how many of these adolescents have sought medical transition. And in any case, even if Turban is right about the ratios, a decline of girls relative to boys at gender clinics would not refute social contagion, just as a reduction in the infection numbers of Covid wouldn’t prove that Covid is not a contagious virus.
In short, much more needs to be known to infer from a flip in the sex ratio (assuming that Turban’s very limited data do represent a trend—and that is a huge assumption) that girls are not declaring themselves trans out of social pressure or to boost their social status. Considering the amount of evidence for social contagion, Turban falls well short of refuting or even weakening this hypothesis.
As Turban understands it, the social genesis explanation assumes that trans identity is “desirable.” Hence, that explanation would be refuted if it turned out that trans-identified youth were at higher risk of bullying than non-transgender as well as gay or lesbian teenagers. If true, this would dispel the belief among researchers and gay rights advocates that many, if not most, teenagers with “rapid onset gender dysphoria” (ROGD) are gays and lesbians who adopt a trans identity in part due to internalized homophobia or as a way to make sense of their nascent same-sex attraction. And indeed, relying on YRBS 2017 and 2019, Turban finds that trans-identified youth report being bullied more often than gay, lesbian, and non-transgender-heterosexual youth.
But this, too, is a huge logical leap. For one thing, it is certainly possible that teenagers believe “coming out” as trans will help them evade bullying but miscalculate. Second, even if they are subject to more bullying, that hardly means that social genesis is not at play, given how trans-identified youth of the new rapid-onset cohort tend to exhibit much higher rates of social maladjustment to begin with. Indeed, trans identification is sometimes thought to be a strategy of coping with social maladjustment, especially in autistic and neurodivergent youth (a group that represents one-third of female referrals, according to the Cass Review of the U.K.’s now-closed Tavistock Clinic). In other words, the bullying may be a response to social maladjustment, independent of any gender issues.
Finally, as mentioned above, Turban’s bullying hypothesis overlooks the possibility—strongly indicated in research and first-hand accounts of de-transitioners—that same-sex-attracted youth often do in fact use trans identity to make sense of their emerging sexual desires.
Because efforts to push back against GAC are largely fueled by concerns over ROGD, and because ROGD is thought to have a social genesis, Turban and his coauthors conclude that “ROGD should not be used to restrict the provision of gender-affirming medical care for TGD adolescents.” It is no surprise that the study was received uncritically by an eager left-of-center media. Turban’s study “disproves popular theories used mostly by conservative politicians and those in the medical field seeking to restrict access to gender-affirming health care for transgender youth,” wrote The Hill’s Brooke Migdon. “‘Social contagion’ isn’t causing more youth to be transgender, study finds,” wrote NBC News’s Jo Yurcaba (who uses “they/them” pronouns).
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. 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.
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