Diversity Debate, Free Speech, Identity, Women

Discovering the Link Between Gender Identity and Peer Contagion

The following is excerpted, with permission, from Abigail Shrier’s newly published book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, Regnery Publishing (June 30, 2020) 276 pages.

In 2016, Lisa Littman, ob-gyn turned public health researcher, and mother of two, was scrolling through social media when she noticed a statistical peculiarity: Several adolescents, most of them girls, from her small town in Rhode Island had come out as transgender—all from within the same friend group. “With the first two announcements, I thought, ‘Wow, that’s great,’” Dr. Littman said, a light New Jersey accent tweaking her vowels. Then came announcements three, four, five, and six.

Dr. Littman knew almost nothing about gender dysphoria—her research interests had been confined to reproductive health: abortion stigma and contraception. But she knew enough to recognize that the numbers were much higher than prevalence data would have predicted. “I studied epidemiology… and when you see numbers that greatly exceed your expectations, it’s worth it to look at what might be causing it. Maybe it’s a difference of how you’re counting. It could be a lot of things. But you know, those were high numbers.”

In fact, they turned out to be unprecedented. In America and across the Western world, adolescents were reporting a sudden spike in gender dysphoria—the medical condition associated with the social designation “transgender.” Between 2016 and 2017, the number of gender surgeries for natal females in the United States quadrupled, with biological women suddenly accounting for—as we have seen—70 percent of all gender surgeries. In 2018, the UK reported a 4,400 percent rise over the previous decade in teenage girls seeking gender treatments. In Canada, Sweden, Finland, and the UK, clinicians and gender therapists began reporting a sudden and dramatic shift in the demographics of those presenting with gender dysphoria—from predominately preschool-aged boys to predominately adolescent girls.

Dr. Littman’s curiosity snagged on the social-media posts she’d seen. Why would a psychological ailment that had been almost exclusively the province of boys suddenly befall teenage girls? And why would the incidence of gender dysphoria be so much higher in friend clusters? Maybe she had missed something. She immersed herself in the scientific literature on gender dysphoria. She needed to understand the nature, presentation, and common treatment of this disorder.

Dr. Lisa Littman

Dr. Littman began preparing a study of her own, gathering data from parents of trans-identifying adolescents who’d had no childhood history of gender dysphoria. The lack of childhood history was critical, since traditional gender dysphoria typically begins in early childhood. That was true especially for the small number of natal girls who’d presented with it. Dr. Littman wanted to know whether what she was seeing was a new variant on an old affliction, or something else entirely. She assembled 256 detailed parent reports and analyzed the data. Her results astonished her.

Two patterns stood out: First, the clear majority (65 percent) of the adolescent girls who had discovered transgender identity in adolescence—“out of the blue”—had done so after a period of prolonged social-media immersion. Second, the prevalence of transgender identification within some of the girls’ friend groups was, on average, more than 70 times the expected rate. Why?

Dr. Littman knew that a spike in transgender identification among adolescent girls might be explained by one of several causes. Increased societal acceptance of LGBTQ members might have allowed teenagers who would have been reluctant to “come out” in earlier eras to do so today, for example. But this did not explain why transgender identification was sharply clustered in friend groups. Perhaps people with gender dysphoria naturally gravitated toward one another?

The rates were high; the age of onset had increased from preschool-aged to adolescence; and the sex ratio had flipped. The atypical nature of this dysphoria—occurring in adolescents with no childhood history of it—nudged Dr. Littman toward a hypothesis everyone else had overlooked: peer contagion. Dr. Littman gave this atypical expression of gender dysphoria a name: “rapid-onset gender dysphoria” (“ROGD”).

* * *

Many of the adolescent girls suddenly identifying as transgender seemed to be caught in a “craze”—a cultural enthusiasm that spreads like a virus. “Craze” is a technical term in sociology, not a pejorative, and that is how I use it here. (Dr. Littman never does.) It applies to Hula-Hoops and Pokémon and all sorts of cultural fads.

If this sudden spike in transgender identification among adolescent girls is a peer contagion, as Dr. Littman hypothesized, then the girls rushing toward “transition” are not getting the treatment they most need. Instead of immediately accommodating every adolescent’s demands for hormones and surgeries, doctors ought to be working to understand what else might be wrong. At best, doctors’ treatments are ineffective; at worst, doctors are administering needless hormonal treatments and irreversible surgeries on patients likely to regret them. Dr. Littman’s theory was more than enough to touch a nerve.

Activists stormed the Twitter page of PLoS One, the peer-reviewed scientific journal of the Public Library of Science that had published Dr. Littman’s paper, accusing her of anti-trans bigotry. They claimed that Dr. Littman had deliberately solicited parent reports from conservative, anti-trans parent groups. (In fact, over 85 percent of the parents self-identified as supporting LGBT rights.)

Journalists saw smoke and rushed over, flagons of gasoline in hand. A graduate student and self-described “transgender advocate” in Dr. Littman’s own Brown University department disparaged Dr. Littman in the press, calling her work shoddy—“below scientific standards”—and published an article accusing Dr. Littman of having been motivated by bias. Other transgender activists accused Dr. Littman of having hurt people with the paper. They called her work “dangerous,” and insisted it could lead to “worse mental health outcomes” for trans-identifying adolescents.

Brown University stripped its own press release on her paper from its website and replaced it with an apology from the dean of public health, who lamented that “the conclusions of the study could be used to discredit efforts to support transgender youth.” PLoS One’s editor in chief took the rare step of issuing an apology for not having provided better “context” for the research and promised additional review into possible “methodological errors” the paper might have contained.

Dr. Littman’s paper had already been peer-reviewed by two independent academics and one academic editor. But Brown and PLoS One knew a woke mob when they saw one. They decided it was best not to make any fast moves, to slowly hand over their wallets.

Diane Ehrensaft, a prominent child gender psychologist, told the Economist that Dr. Littman’s use of parent reports was akin to “recruiting from Klan or alt-right sites to demonstrate that blacks really were an inferior race.” (The “Klan,” in this case, was the parents, who had simply been asked questions about their own children.) Few cared that the surveyed parents had not expressed anti-transgender attitudes generally, but rather had expressed disbelief and upset that their daughters had adopted this identity “out of the blue” without any childhood history of gender dysphoria—and that following this identification, their adolescents’ mental health seemed to get worse.

None of the attacks acknowledged that parent report is a standard method for assessing child and adolescent mental health. (How else would you obtain the psychological history of a child?) Nor did any of these critics mention that the primary academic research used to promote “social transition” (changing an adolescent’s name and pronouns with school and friends) for gender dysphoric children similarly relies on parent surveys. PLoS One issued a correction that suggested Dr. Littman’s methods had not been made sufficiently clear, despite the fact that the words “parent reports” had appeared in the paper’s title.

Dr. Littman’s paper became one of the most widely discussed academic articles of 2018. Her analysis and conclusions drew praise from some of the most distinguished world experts on gender dysphoria. Dozens of parents wrote to her to thank her for giving name to the phenomenon they were observing in their adolescents.

But she was also widely tarred as a bigot and a bully. This, despite the fact that she had neither the security of tenure nor a faculty coauthor for cover. She wasn’t right-wing or anti-trans. She had spent several years working part-time for Planned Parenthood and, with her husband, contributed several pieces to HuffPost on such topics as the rotten GOP approach to healthcare, but the truth no longer seemed to matter much.

Psychology Today published an open letter from “transgender identified [and] cisgender allies… with vast expertise in gender and sexuality” purporting to refute Dr. Littman’s paper. The letter called her work “methodologically flawed” (for having relied on parental report) and “unethical” (for having reached its conclusions) and accused Dr. Littman of harboring “overt ideological bias” (for having dared examine the causes of trans identification at all).

Activist clinicians hunted Dr. Littman to the Rhode Island Department of Health (DOH), where she worked part-time as a physician consultant on projects related to the health of pregnant women and preterm infants. Her work there had nothing to do with transgender youth; it had nothing to do with young children or adolescents per se at all. Her interest in preemies stemmed from her years of training in obstetrics. Caring for preemies had been a passion of hers ever since she had given birth to a preemie of her own, just over one pound at birth.

The activists denounced Littman to her employer, the DOH, claiming that she had written a paper “harmful” to transgender youth. They demanded that the DOH “terminate its relationship with Dr. Littman immediately.” Adding a dash of threat, the authors airily suggested that the DOH might add “a gender-neutral restroom” to its facilities to send a message to the community “that trans and gender diverse lives are valued by DOH.”

The activists wanted a head on a pike. The DOH gave them Dr. Littman’s. Her paid consultancy was over.

* * *

I met Lisa Littman in a family-style Italian chain restaurant along Route 1 just outside of Boston. Her shoulder-length dark brown hair was lightly mussed from a busy workday and the stress of the traffic that had delayed her. Clutching her purse strap as she rushed toward our table, she looked every bit the suburban mom: eager to fill the unforgiving minute, hoping I hadn’t been waiting there too long.

She has large brown eyes, tortoiseshell glasses, a broad reassuring smile, and a nervous laugh. As she told me several times, she hates being interviewed. Based on her many follow-up questions about how I would ensure the accuracy of everything I wrote, it was clear she was telling the truth.

Abigail Shrier is a Los Angeles based writer, and contributor to the Wall Street Journal. Follow her on Twitter @AbigailShrier.

Excerpted, with permission, from Irreversible Damage: The Transgender Craze Seducing Our Daughters, by Abigail Shrier, published by Regnery. © 2020 Abigail Shrier.



  1. Interesting article to have juxtaposed with an article on arguing. Here an educated woman notices a statistical anomaly, conducts research and publishes her results, only to face character assassination. I don’t know who is worse the woke mob or the cowards who enable them.

    Childhoods are being sacrificed so that adults can strut, preen and virtue signal. This is child abuse. Why can’t physiological alterations wait until a child reaches the age of majority?

  2. Great article. Might of mentioned the slew of cases awaiting litigation in the UK, where detransitioning young women are claiming that they were given inadequate counselling and therapy, before undergoing life-changing hormones and surgery.

  3. I realize that Lisa Littman did not write this article, but after reading I don’t know how many versions of this story recently - an apparently respected physician destroyed by the left - I have a few questions that I’d like to put to her. Among them:

    “Dr. Littman, were you a registered Democrat before this predominantly white liberal mob turned on you?”

    “If your answer is ‘yes’, are you still a registered Democrat?”

    “If your answer is ‘yes’, I have no further questions for you.”

  4. :slight_smile: Yep. I’m now that way. I have no time for, ‘Look at me, I’m a milquetoast lefty, I’m so reasonable and moderate.’ They will keep their head below the parapet, regardless of who is fighting whom. It’s not a bad life strategy----for most people it makes sense to stay out of the fray. (I only wish to kill the taxpayer subsidy, that’s all.)

    The majority of Americans sat out of the American revolution. :slight_smile:

  5. I’m fine with people making their own choices about their bodies and lifestyles, as long as they are safe and healthy. But today’s transgenderism insists that we accept an ideology, indeed a metaphysical doctrine, to go along with gender transition. We are supposed to believe in some kind of “essential gender” that lives in the mind/brain and can be immediately and unmistakably recognized by the subject. We are supposed to believe that this gender identity is innate and not culturally constructed. Questioning the scientific or philosophical basis for this doctrine is deemed politically incorrect. There is no explanation given for what a gender identity is or how we can know about it, but it is packaged into animistic language that can be swallowed by any uneducated human.

  6. We now inhabit a world where the ‘liberal’ consensus tries to force us into believing that Gender, Sexuality and Race are not immutable characteristics but merely fluid ‘Social Constructs’, and that we can opt in or out of them as we choose.

    Yet at the same time - (and conveniently for many of these activists) Obesity is deemed to be genetic.

  7. That was me being scatterbrained. So apologies and thanks for pointing that out. Still, I guess just find it bizarre. Female to male surgery is even less convincing and considerably more expensive. I see it is a growth industry. https://www.gminsights.com/industry-analysis/sex-reassignment-surgery-market
    I kind of find it grim. I do wonder if plastic surgeons think they’re genuinely helping someone or if they just like play Mr Potato Head with live models for fun and profit

  8. Like I’ve said before, what’s most troubling to me is that there’s been clear evidence for many decades that many (most?) progressive ideas are bad, but their popularity has continued to grow during that time. That’s a very bad sign.


  9. I think you have this backwards- but given that the extreme left has taken an ideological position on this issue that is a complete self-contradiction, your confusion is understandable.

    The core concept of modern feminist thought is that gender is a social construct, and therefore amenable to change. The differences between men and women are therefore potentially erasable, human beings completely interchangeable. The logical implication that diversity is therefore also a social construct must be ignored.

    But when transgender people began claiming that men could become women, the implication that the category “female” was also merely a social construct, and that therefore “women’s rights” was a kind of ontological non sequitur, was seen as a threat. This was the beginning of the TERF movement.

    Whether gender is a social construct or a biological reality is at the core of this debate. The science would suggest that the term “gender” refers to psychological differences between the sexes formed through several million years of evolutionary pressure, in particular, through sexual selection by both sexes, choosing members of the other sex for attributes useful for procreation and survival.

    Such psychological differences would be the result of structural effects on the developing brain as a consequence of prenatal hormones, probably in the limbic system. Those differences show up in children at birth, and are driven to completion by puberty.

    On the other hand, just as gay people may be the result of hormones not being sufficiently effective enough in some stages of fetal development, leading males to have a female sexual orientation, for example, it is logically possible for some people to have the body of one sex but the psychology of the other.

    So yes, gender is innate, although the performative aspects are certainly affected by social mores. Only by defining gender in this narrow way can feminist orthodoxy be sustained. Transgenderism has some basis in science, but is unlikely to be found in more than a diminishing small percentage of the population.

    As the research by Shrier indicates, the rush to transition by young females is more likely the result of a desire to conform combined with a narcisistic need for attention, ironically both attributes more often found in females.

  10. I had a Twitter exchange with the awesome Heather Heying on this subject and she believes that the theory of social contagion among her students was a real thing.

    Children will always have bone-headed ideas and share them with their friends. What baffles me is the total absence of adults exercising their authority. It is now known that our frontal cortices keep developing well into our twenties, yet we’re to believe that a 14-year-old has the wisdom to discover, within the span of a long weekend sleep-over, that she really is a boy.

    This is absolute madness, and I am convinced our descendants will look back at this the way we look back at children chimney sweeps.

    I keep playing with the idea that the fanaticism of the modern trans activists is fueled by the pathology of being a true trans person.
    By that I mean that these people, whose lot I sympathize with, are trying to attain the impossible, which must be maddening, looking in the mirror, wanting to see a woman, but always seeing a man.
    I think this state of mind, of always falling short, of always failing to achieve your goal, will in itself be highly destabilizing to the point where anyone pointing out the bleeding obvious, that sex-reassignment for children is absurd, will cause them to lose their minds.


  11. I want her to recognize and acknowledge who it was who turned on her and savaged her career, and then, very importantly, recognize and acknowledge the political party that is giving those people organizational strength and support. And that would be the Democratic Party.

    First, we need rational Democrats.

    Where were they when she needed them?

  12. They were not there. But frankly, neither were the Republicans. Now Republicans are starting to attack cancel culture, and they should press this advantage as far and as long as possible. Democrats are caught in a bind, because to oppose the woke view is political suicide for Democrats right now.

  13. The problem here is in the title of the book itself: Irreversible Damage: The Transgender Craze Seducing Our Daughters

    I think a more fitting and accurate title might be: Irredeemably Stupid: Leftists discover that teenage girls want to be liked by their friends so desperately that they’ll even pretend to be transgender as long as it makes them popular… (and that girl Caitlyn is the absolute worst! We hate her because she said she liked Brad but we know she was lying. Brad was with Melissa anyways and like, you know, she’s a vegan now and like totally into social justice and stuff… she even sometimes helps with those poor people in the city if her mom promises to drop her off at Forever 21 after she does some volunteer work…)

  14. I think that by labeling gender a “social construct” people think that this weakens its importance. Gender seems to be a biological reality that all human societies recognized in their cultural infancy. Language is a “social construct” too but it is also one that we are natively inclined towards. The issue here is not whether gender is “socially constructed” (as it may be… albeit informed by genetics) but whether or not it is “politically constructed.” These arguments about gender are not happening in “social space” they are happening as part of a political debate and they are being championed by one side much more vociferously than the other.

    And if we are to consider this issue from a “social construct” standpoint, why aren’t other grand and ancient societies such as India, China and the Middle Eastern states going through a similar social reorganization? These societies seemed to have independently developed very similar “gender identities” over the many centuries…

    Simply put: the gender issue is a political matter being hijacked by crass opportunists among the extreme left. They have neither shame nor conscience.

  15. Factually inaccurate. Sure, there are differences in terms of gender expression, there will always be a tiny percentage of individuals who don’t fit categories comfortably and a larger percentage of the population who are gender atypical, or in modern parlance gender nonconforming. But every culture in human history has made a distinction in definition between genders, and assigned arbitrary roles on the basis of gender- individual customs may vary, but the distinction made on the basis of assigning gender roles on the basis of innate biological strengths and weaknesses, by sex, is universal.

    I’m not fond of the extremists on either end of the spectrum. The biological and the social both play a role in society, and individuals should be free to be true to themselves- but any objective analysis of gender would have to rate gender around 80% biological and 20% social expression. The most harmful thing about this idea that people can be nonconforming is that it actually amplifies the categorical imperative at either end of the spectrum. Women shouldn’t fell the need to dress a certain way and men should neither be encouraged towards traditional masculinity nor away from it- our current cultural direction encourages both.

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