4thwavenow: Gender Dysphoria Is Not One Thing

4thWaveNow
A community of people who question the medicalization of gender-atypical youth
Gender dysphoria is not one thing

Posted on December 7, 2017
by J. Michael Bailey, Ph.D and Ray Blanchard, Ph.D
This is the second in a series of articles authored by Drs. Bailey and Blanchard; see
here for their first piece.
Many parents who are part of the 4thWaveNow community have daughters who fit
the profile of a sudden onset of gender dysphoria in adolescence. This phenomenon
is discussed in detail by the authors after the first two types, in the section “Rapid-
onset Gender Dysphoria (Mostly Adolescent and Young Adult Females).” Some
4thWave parents will also find the section “Two Rarer Types of Gender Dysphoria” of
particular interest (near the end of the article).
We recognize that regular readers and members of 4thWaveNow will not agree with
all of what Bailey and Blanchard have to say, but as always, if you wish to challenge
the authors, your comments will be more likely to be published if they are delivered
respectfully.
As their time permits, Drs. Bailey and Blanchard will be available to interact in the
comments section of this post.
Michael Bailey is Professor of Psychology at Northwestern University. His book The

Man Who Would Be Queen provides a readable scientific account of two kinds of
gender dysphoria among natal males, and is available as a free download here.
Ray Blanchard received his A.B. in psychology from the University of Pennsylvania
in 1967 and his Ph.D. from the University of Illinois in 1973. He was the psychologist
in the Adult Gender Identity Clinic of Toronto’s Centre for Addiction and Mental Health
(CAMH) from 1980–1995 and the Head of CAMH’s Clinical Sexology Services from
1995–2010.
One problem with the current mainstream narrative regarding gender dysphoria is
that it makes no distinctions among apparently very different kinds of persons. For
example, Bruce Jenner appeared to be a very masculine man, an Olympic athlete
who was married to three different women and had six children with them, before
becoming Caitlyn Jenner. In contrast, Jazz Jennings, a natal male, was so feminine
that she earned a diagnosis of gender identity disorder at the age of four. She is
attracted to males. Jenner and Jennings are so different in their presentation and
history that it is surprising to us that anyone thinks they have the same condition.
Jenner and Jennings are examples of two very different kinds of gender dysphoria
that have been scientifically well studied, and have fundamentally different
motivations, clinical presentations, and likely causes.
The failure of so many therapists and activists to acknowledge this distinction is

disturbing for at least two reasons. First, it suggests they are either ignorant of
relevant scientific evidence or are purposefully ignoring it. Second, failure to make
scientifically valid and fundamental distinctions among different kinds of gender
dysphoric persons can only prevent progress toward finding the best approach to
helping each. Measles, influenza, and strep throat are all associated with fever. But if
we had merely lumped them together as “fever,” we would not have effective
treatments for them.
Types of Gender Dysphoria
Gender dysphoria isn’t common. But there are at least three distinct types of gender
dysphoria that, presently, regularly occur in children and adolescents. We summarize
these at length here. Two other kinds of gender dysphoria are much less common in
these age groups, and so we address them less fully near the end of this essay. The
main three types differ in their age of onset (childhood, adolescence, or adulthood),
their speed of onset (gradual or sudden), their associated sexual orientations
(members of the same sex or the fantasy of belonging to the opposite sex), and their
sex ratio (equally or unequally likely in males and females).
The first type—childhood-onset gender dysphoria—definitely occurs in both biological

boys and girls. It is highly correlated with homosexuality–the sexual preference for
one’s own biological sex–especially in natal males. (Sexual orientation is usually not
apparent until a child reaches adolescence or adulthood, however.) This is the type
that Jazz Jennings had before her gender transition. The second type—
autogynephilic gender dysphoria—occurs only in males. It is associated with a
tendency to be sexually aroused by the thought or image of oneself as a female. This
type of gender dysphoria sometimes starts during adolescence and sometimes
during adulthood, and its onset is typically gradual. (Onset may appear sudden to
family members, however.) Although Caitlyn Jenner has not discussed her feelings
openly, we strongly suspect she is autogynephilic. The third type—rapid-onset gender
dysphoria—mostly occurs in adolescent girls. This type is primarily characterized by
the age and speed of onset rather than the associated sexual orientation, and it may
not be limited to one sex, as the second type is. Our impression is that rapid-onset
gender dysphoria is especially common among daughters of parents who read
4thWaveNow as well as those who post on the support board at
gendercriticalresources.com.
The first two types (childhood-onset gender dysphoria and autogynephilic gender
dysphoria) have been well studied, although autogynephilic gender dysphoria has
primarily been studied in adults. The third (rapid-onset gender dysphoria) has only
recently been noticed, and it is possible that it didn’t occur much until recently.
How do you know which type of gender dysphoria your child has? If there were clear
signs well before puberty that your child was gender dysphoric, s/he has child-onset
gender dysphoria. (You would certainly have noticed signs at the time; at the very
least you would have coded your child as extremely gender nonconforming.) If your
child showed signs of gender dysphoria for the first time during adolescence, s/he
has one of the other types. Remember, autogynephilic gender dysphoria occurs only
in natal males, and it starts either during adolescence or adulthood. (And to a parent,
it usually seems sudden.) We describe the three types more thoroughly below.
Childhood-onset Gender Dysphoria (Boys and Girls)
The most obvious feature that distinguishes childhood-onset gender dysphoria from
the other types is early appearance of gender nonconformity. Gender nonconformity
is a persistent tendency to behave like the other sex in a variety of ways, including
preferences of dress and appearance, play style, playmate preferences, and interests
and goals. A very gender nonconforming boy may dress up as a girl, play with dolls,
dislike rough play, show indifference to team sports or contact sports, prefer girl
playmates, try to be around adult women rather than adult men, and be known by
other children as a “sissy” (a term generally used to ridicule and shame feminine
boys). A very gender nonconforming girl shows an opposite pattern, with the less
derogatory word “tomboy” replacing sissy.
Onset of gender nonconformity is childhood cases is very early, typically about as

early as gendered behavior can be noticed.
It is important to understand that not all gender nonconforming children (even very
gender nonconforming children) have gender dysphoria. Probably most don’t, in fact.
But we know of no cases of childhood-onset gender dysphoria without gender
nonconformity.
Gender dysphoria in the childhood cases requires that children are unhappy with their
birth sex. Furthermore, they typically yearn to be–or even assert that they are–the
other sex.
What do we know about childhood-onset gender dysphoria?
Childhood-onset gender dysphoria has been systematically studied by two high

quality international research centers (one in Toronto, which was led by Kenneth
Zucker, and one in the Netherlands, which was led by Peggy Cohen-Kettenis). Both
centers have assessed and followed representative samples of gender dysphoric
children seen at their clinics. Reassuringly, results are fairly similar across the two
sites. Furthermore, their results are similar to less representative samples studied
earlier in the United States.
The published literature shows that at least in the past, 60-90% of children whose
gender dysphoria began before puberty adjusted to their birth sex without requiring
gender transition. That may be changing, however, due to changes in clinical practice
that encourage gender transition. (See below.)
It is important to realize that childhood-onset gender dysphoria is the only kind of

gender dysphoria that has been well-studied in children and adolescents. This
means, for example, that the persistence and desistance figures we have provided
apply only to that type. We do not know comparable figures about autogynephilic or
rapid-onset gender dysphoria. Furthermore, most people, when they think of
“transgender children and adolescents” have childhood-onset gender dysphoria in
mind. (And they think of happy Jazz more than they think of Jazz’s serious medical
surgeries and hormonal treatment for life.) But this association is misleading for all
cases of gender dysphoria that are not childhood-onset. Autogynephilic and rapid-
onset gender dysphoria have very different causes and presentations than childhood-
onset gender dysphoria.
Sexuality
Children with childhood-onset gender dysphoria have a much higher likelihood of

non-heterosexual (i.e., homosexual or bisexual) adult outcomes compared with
typical children. Childhood-onset gender dysphoric boys who desist usually become
nonheterosexual men. A smaller percentage have reported that they are heterosexual
at follow up. Those who transition become transwomen attracted to men.
Although most childhood-onset gender dysphoric girls who have been followed
identify as heterosexual, those who desist have a much higher rate of
nonheterosexuality compared with the general population. Among those who
transition, most are attracted to women.
We repeat: there is no evidence that parents can change their children’s eventual
sexual orientation, and we don’t think they should try.
Risk Factors for Persistence of Childhood-onset Gender Dysphoria
Which childhood-onset gender dysphoric children will persist, and which will desist?
Evidence suggests that we can’t distinguish these two groups with high confidence,
although we can distinguish them better than chance.
There is some evidence that the severity of gender dysphoria distinguishes these two
groups, although it is far from a perfect predictor. Children who not only say they want
to be the other sex but who assert that they are the other sex may be especially likely
to persist. The reasons why a child’s expressed belief that s/he is the other sex
predicts persistence remain unclear, and this variable does not allow even near-
perfect prediction. The idea that it is the essential test of “true trans” is an
overstatement.
Other empirically supported risk factors include being of lower socioeconomic status
and having autistic traits, both of which predict persistence. Why should these factors
matter? Researchers have speculated that socioeconomically disadvantaged families
are more likely to have problems that prevent them from providing the consistent
supportive social environment that may be most likely to help the gender dysphoric
child desist. Autistic traits include perseverative and obsessional thinking, both of
which may make desistance more difficult. Furthermore, parents of children with
autistic traits may be so concerned about other problems that they are permissive
about things likely to foster gender transition.
One powerful predictor of persistence is social transition, or a child’s living as the

other sex. Until recently this was practically unheard of. Increasingly, however, it is
not only known but encouraged by many gender therapists. (Watch an episode of “I
am Jazz.”) In the Netherlands social transition has been common longer than in the
United States. A recent study found that social transition was the most powerful
predictor of persistence among natal males. That is, gender dysphoric boys allowed
to live as girls strongly tended to want to become adult women. (The same trend
occurred for natal females, but it was less robust.) This is not surprising. If a gender
dysphoric child is allowed to live as the other sex, what will change his/her mind? No
one disputes that gender dysphoric children really, really would like to change sex.
What should you do?
The necessary studies have not been conducted to be certain. But based on the
overall picture, we suggest:
If you want your childhood-onset gender dysphoric child to desist, and if your child is
still well below the age of puberty (which varies, but let’s say, younger than 11 years),
you should firmly (but kindly and patiently) insist that your child is a member of his/her
birth sex. You should consider finding a therapist if this is difficult for you and your
child. You should not allow your child to engage in behaviors such as cross dressing
and fantasy play as the other sex. Above all else, you should not let your child
socially transition to the other sex.
At the same time, you should recognize that despite your best efforts, your child may
ultimately need to transition to be happy. If your child’s gender dysphoria persists well
into adolescence (again, the ages vary by child, but let’s say age 14 or so), s/he is
much more likely to transition. At that point, in our opinion, parents should consider
supporting transition.
Autogynephilic Gender Dysphoria (Adolescent Boys and Men)
From a parent’s perspective, autogynephilic gender dysphoria (which occurs only in

natal males) often seems to come out of the blue. This is likely to be true whether the
onset is during adolescence or adulthood. A teenage boy may suddenly announce
that he is actually a woman trapped in a man’s body, or that he is transgender, or that
he wants gender transition. Typically, this revelation follows his intensive internet
research and participation in internet transgender forums. Importantly, the adolescent
showed no clear, consistent signs of either gender nonconformity or gender
dysphoria during childhood (that is, before puberty).
There is an important distinction between rapid-onset gender dysphoria and

autogynephilic gender dysphoria that happens to have an adolescent onset. Rapid-
onset gender dysphoria is suddenly acquired, whereas autogynephilic gender
dysphoria may be suddenly revealed, after having grown in secret for a number of
years. We will talk more about this later.
Where does autogynephilic gender dysphoria come from? We know a lot about the
motivation of this kind of gender dysphoria. Most of our knowledge comes from
studies of adults born male who transitioned during adulthood. Some of these adults
had gender dysphoria during adolescence, but all of them had the root cause of their
condition: autogynephilia.
(Warning: Autogynephilia is about sex. We understand that it is awkward and

uncomfortable for any parent to consider their children’s sexual fantasies. But you
can’t understand your son with this kind of gender dysphoria without doing so.)
Autogynephilia is a male’s sexual arousal by the fantasy of being a woman. That is,
autogynephilic males are turned on by thinking about themselves as women, or
behaving like women. The typical heterosexual adolescent boy has sexual fantasies
about attractive girls or women. The autogynephilic adolescent boy’s may also have
such fantasies, but in addition he fantasizes that he is an attractive, sexy woman. The
most common behavior associated with autogynephilia during adolescence is
fetishistic cross dressing. In this behavior, the adolescent male wears female clothing
(typically, lingerie) in private, looks at himself in the mirror, and masturbates. Some
autogynephilic males are not only sexually aroused by cross dressing, but also by the
idea of having female body parts. These body-related fantasies are especially likely to
be associated with gender dysphoria.
It is important to distinguish between autogynephilia and autogynephilic gender

dysphoria. Autogynephilia is basically a sexual orientation, and once present does not
go away, although its intensity may wax and wane. Autogynephilic gender dysphoria
sometimes follows autogynephilia, and is the strong wish to transition from male to
female. A male must have autogynephilia to have autogynephilic gender dysphoria,
but just because he is autogynephilic doesn’t mean he will be gender dysphoric.
Many autogynephilic males live their lives contented to remain male. Furthermore,
sometimes autogynephilic gender dysphoria remits so that a male who wanted to
change sex no longer does so.
In general, adolescent boys are unlikely to divulge their sexual fantasies to their
parents. This is likely especially true of boys with autogynephilia. Furthermore, many
boys who engage in cross dressing feel ashamed for doing so. The fact that
autogynephilic fantasies and behaviors are largely private is one reason why
autogynephilic gender dysphoria usually seems to emerge from nowhere. Another
reason is that autogynephilic males are not naturally very feminine. An adolescent
boy with autogynephilia does not give off obvious signals of gender nonconformity or
gender dysphoria.
It is likely that most autogynephilic males do not pursue gender reassignment, but
this is difficult to know. (We would need to conduct a representative survey of all
persons born male, asking about both autogynephilia and gender transition. This has
not been done and won’t be done anytime soon.) Many males with autogynephilia are
content to cross dress occasionally. Some get married to women and many also have
children. Family formation is no guarantee against later transition, although that may
slow it up somewhat. In past decades, when autogynephilic males have transitioned,
they have most often done so during the ages 30-50, after having married women
and fathered children. It is possible that autogynephilic males have recently been
attempting transition at younger ages, including adolescence.
The relationship between autogynephilia and (autogynephilic-type) gender dysphoria

is uncertain. One view is that gender dysphoria may arise as a complication of
autogynephilia, depending perhaps on chance events or environmental factors.
Another view is that autogynephiles who become progressively gender dysphoric
were somewhat different from simple autogynephiles from the beginning (for
example, more obsessional). Because we do not actually know the causes of
autogynephilia, it is quite difficult to sort out these various interpretations at present.
Autogynephilia—the central motivation of autogynephilic gender dysphoria—can be
considered an unusual sexual orientation. As with other kinds of male sexual
orientation, we do not know how to change it, and we shouldn’t try. The dilemma is
how to live with autogynephilia in a way that allows the most happiness. For some
with autogynephilia, this will mean staying male. For others, it will mean transitioning
to female.
What do we know about autogynephilic gender dysphoria?
Much of what we know about autogynephilic gender dysphoria comes from research
conducted on adults. Most of the early research was conducted by the scientist who
developed the theory of autogynephilia, Ray Blanchard. This work was subsequently
confirmed and extended by other researchers, especially Anne Lawrence, Michael
Bailey, and Bailey’s students.
Blanchard’s research identified two distinct subtypes of gender dysphoria among

adult male gender patients. One type, which he called “homosexual gender
dysphoria” is identical to childhood onset male gender dysphoria. Males with this
condition are homosexual, in the sense that they are attracted to other biological
males. Blanchard provided persuasive evidence that the other male gender patients
were autogynephilic. We currently favor the theory that there are only two well
established kinds of gender dysphoria among males, because no convincing
evidence for any other types has been offered. This could change–we are committed
to a scientific open-mindedness. In particular, it is possible that some cases of
adolescent-onset gender dysphoria among males are essentially the same as Rapid-
onset Gender Dysphoria that occurs among natal females. This will require more
research to establish, however.
Autogynephilia is a probably rare, although it is difficult to know for certain. Among

males who seek gender transition, however, it is common. In fact, in Western
countries in recent years, including the United States, autogynephilia has accounted
for at least 75% of cases of male-to-female transsexualism.
Given how important autogynephilia is for understanding gender dysphoria, it may

surprise you that you had never heard of it. Autogynephilia remains a largely hidden
idea because most people–including journalists, families, and many males with
autogynephilia–strongly prefer the standard, though false, narrative: “Transsexualism
is about having the mind of one sex in the body of the other sex.” Many people find
this narrative both easier to understand and less disturbing than the idea that some
males want a sex change because they find that idea strongly erotic.
Although many autogynephilic males find discovery of the idea of autogynephilia to

be a positive revelation–autogynephilia has been as puzzling to them as it is to you–
some others are enraged at the idea. There are two main reasons why some
autogynephilic males are in denial. First, they correctly believe that many people find
a sexual explanation of gender dysphoria unappealing–discomfort with sexuality is
rampant. Second, they find this explanation of their own feelings less satisfying than
the standard “woman trapped in man’s body” explanation. This is because
autogynephilia is a male trait, and autogynephilia is about wanting to be female.
It is good to be aware of autogynephilia’s controversial status, because transgender

activists are often hostile to the idea. You will not learn more about it from the
activists. And if your son has frequented internet discussions, he may also resent the
idea. We emphasize that autogynephilia is controversial for social reasons, not for
scientific ones. No scientific data have seriously challenged it.
Sexuality
Males with autogynephilia can have a variety of autogynephilic fantasies and

interests, from cross dressing to fantasizing about having female bodies to enjoying
(for erotic reasons) stereotypical female activities such as knitting to fantasizing about
being pregnant or menstruating. One study found that autogynephilic males who
fantasize about having female genitalia also tended to be those with the greatest
gender dysphoria.
Autogynephilic males sometimes identify as heterosexual (i.e., attracted exclusively

to women); sometimes as bisexual (attracted to both men and women), and
sometimes as asexual (i.e., attracted to no individuals). Blanchard’s work has shown
that autogynephilia can be thought of as a type of male heterosexuality, one that is
inwardly directed. Autogynephilia often coexists with outward-directed
heterosexuality, and so autogynephilic males usually say they are also attracted to
women. Some autogynephilic males enjoy the idea that they are attractive, as
women, to other men. They may have sexual fantasies about having sex with men (in
the female role); some may even act on these fantasies. This accounts for the
bisexual identification among some autogynephilic males. In some others, the
intensity of the autogynephilia–which is attraction to an imagined “inner woman”–is so
great that there are no erotic feelings left for other people. This accounts for asexual
identification. (Asexual autogynephilic males have plenty of sexual fantasies, but
these fantasies tend not to involve other people.)
When autogynephilic males receive female hormones as part of their gender

transition, they typically experience a noticeable decrease in their sex drive. Some
have reported that this has diminished their desire for gender transition as well.
Others, however, have reported no change in their desire for transition. (In any case,
hormonal therapy is a medical intervention with serious potential side effects, and we
do not recommend it as a way to treat gender dysphoria, except in cases in which
after very careful consideration, gender transition is pursued.)
Autogynephilia is a paraphilia, meaning an unusual sexual interest nearly exclusively

found in males.
We repeat: Autogynephilia is a sexual orientation–to be sure, an unusual orientation
that is difficult to understand. There is no evidence that parents can change their
children’s sexual orientations. And we don’t think they should try.
What should you do?
Consistent with our values, knowledge, and common sense, we believe that males
with autogynephilic gender dysphoria should not pursue gender transition right away,
as soon as they first have the idea. Transition ultimately requires serious medical
procedures with irreversible consequences. But we are unsure what the right
approach to autogynephilic gender dysphoria is. In part, this is because there has
been too little outcome research conducted by scientists knowledgeable and open
about autogynephilia.
First, we recommend that your son be informed about autogynephilia. The best way
to do this is up to you. There is probably no non-awkward way. Consider showing
them this blog. People should make important life decisions based upon facts, and for
males autogynephilic gender dysphoria, autogynephilia is a fact. The standard
“female mind/brain in male body” is a fiction.
Some males become less motivated to pursue gender change when they understand
their autogynephilia. However, some do not become less motivated. We know far less
about patterns of persistence and desistance of autogynephilic gender dysphoria
than we do about childhood onset gender dysphoria.
If an autogynephilic male has become familiar with the scientific evidence, has
patiently considered the potential consequences of gender transition over a non-trivial
time period, and still wishes to transition, we do not oppose this decision. It is
possible that many autogynephilic males are happier after gender transition. But
there is no rush for any adolescent to decide.
Rapid-onset Gender Dysphoria (Mostly Adolescent and Young Adult Females)
Rapid-onset gender dysphoria (ROGD) seems to come out of the blue. We think this
is because ROGD does come out of the blue. This is not to say that all adolescents
with ROGD were happy and mentally healthy before their ROGD began. But
importantly, they had no sign of gender dysphoria as young children (before puberty).
The typical case of ROGD involves an adolescent or young adult female whose
social world outside the family glorifies transgender phenomena and exaggerates
their prevalence. Furthermore, it likely includes a heavy dose of internet involvement.
The adolescent female acquires the conviction that she is transgender. (Not
uncommonly, others in her peer group acquire the same conviction.) These peer
groups encouraged each other to believe that all unhappiness, anxiety, and life
problems are likely due to their being transgender, and that gender transition is the
only solution. Subsequently, there may be a rush towards gender transition, including
hormones. Parental opposition to gender transition often leads to family discord, even
estrangement. Suicidal threats are common.*
We believe that ROGD is a socially contagious phenomenon in which a young

person–typically a natal female–comes to believe that she has a condition that she
does not have. ROGD is not about discovering gender dysphoria that was there all
along; rather, it is about falsely coming to believe that one’s problems have been due
to gender dysphoria previously hidden (from the self and others). Let us be clear:
People with ROGD do have a kind of gender dysphoria, but it is gender dysphoria
due to persuasion of those especially vulnerable to a false idea. It is not gender
dysphoria due to anything like having the mind/brain of one sex trapped in the body
of the other. Those with ROGD do, of course, wish to gender transition, and they
often obsess over this prospect.
The subculture that fosters ROGD appears to share aspects with cults. These
aspects include expectation of absolute ideological agreement, use of very specific
jargon, thinking of the world as “us” versus “them” (even more than typical
adolescents do), and encouragement to cut off ties with family and friends who are
not “with the program.” It also has uncanny similarities to a very harmful epidemic that
occurred a generation ago: the epidemic of false “recovered memories” of childhood
sexual abuse and the associated epidemic of multiple personality disorder. We
discuss these more below. First, however, we review what little we know about
ROGD.
What About Natal Males?
Why do we keep emphasizing natal females versus natal males? There are three
reasons. First, the single study that has been conducted on ROGD found
substantially higher numbers of females than males (more than 80% female cases).
Second, there has been a striking surge in the number of adolescent females
identifying as transgender and presenting at gender clinics. Third, there is a different
kind of gender dysphoria–Autogynephilic Gender Dysphoria–that likely accounts for
most or all of the apparent cases of ROGD in natal males. However, we cannot be
completely sure that the smallish number of ROGD cases in natal males are due to
autogynephilia. It’s possible, therefore, that what we discuss here applies to some
natal males as well.
What Do We Know?
ROGD is such a recent phenomenon that we know little for certain. We have four
sources of data. First, an important study of ROGD has been presented by Lisa
Littman at the annual meeting of the International Academy of Sex Research. (It has
not yet been published, but we suspect it will be soon.) This is the only systematic
empirical study to date. Second, we have had numerous conversations with mothers
of girls with ROGD. Third, we have read several case studies of the phenomenon.
Fourth, we have been in touch with clinicians who work (either as therapists or
consultants) with children with ROGD, or their families. Fortunately, the sources have
provided convergent findings. We are fairly confident about the following
generalizations:
–The large majority of persons with ROGD are female, and the most typical age of
onset ranges from high school to college ages.
–Persons with ROGD have a high rate of non-heterosexual identities before the onset
of their ROGD.
–Signs of extreme social contagion are typical. For example, this includes multiple
peer group members who all began to identify as transgender. Sometimes this occurs
after school-sponsored transgender educational programs.
–Persons with ROGD have high rates of certain psychiatric problems, especially
aspects related to borderline personality disorder (e.g., non-suicidal self-harm) and
mild forms of autism (that used to be called “Asperger Syndrome).
–In general, the mental health and social relationships of children with ROGD get
much worse once they adopt transgender identities.
–Parents resisting their children’s ROGD are not “transphobic” or socially intolerant.
These are parents who, for example, usually approve of gay marriage and equal
rights for transgender persons.
Our Current Take on ROGD
Rapid-onset Gender Dysphoria (ROGD) occurs when a young person (generally an

adolescent female) is persuaded that she is transgender, despite strong evidence
that the young person had few or no signs associated with established forms of
transgender. How and why does this happen?
Despite the very limited available research to date, we have strong intuitions and
hunches about what is going on, based on its similarity to similar phenomena in the
past: the recovered memories and multiple personality epidemics. We spend
considerable effort in this section both explaining these past epidemics and drawing
the parallels to the current one that concerns us now: Rapid-onset Gender Dysphoria.
We believe that she who forgets (or ignores) the past is doomed to repeat it.
During the 1990s there was an explosion of cases in which women came to believe
that they had been sexually molested, usually by their fathers and often repeatedly
and brutally. They believed these things even though prior to “recovering” these
“memories”–most often during psychotherapy–they did not remember anything like
them. They believed in the memories even though the memories were often highly
implausible (for example, family members would have noticed). Many women with
recovered memories cut off relationships with their families. Some developed
symptoms of multiple personality disorder. We know now that the recovered
memories were false. And multiple personality disorder doesn’t exist, at least in the
way those affected and their therapists believed. We refer to recovered memories
and multiple personality disorder, which have similar causes–and also some similar
causes to ROGD–as RM/MPD
Here are the main similarities between ROGD and RM/MPD:
1. Cases consistent with RM/MPD were very rare prior to the 1980s but became
an epidemic. The same appears to be happening with ROGD.
2. Both have primarily affected young females, although RM/MPD began
substantially later (on average, age 32) than ROGD (typically during
adolescence). (Another destructive epidemic of social contagion–witch
accusations in colonial Salem–primarily involved adolescent girls.)
3. The explanations of both RM/MPD and ROGD by “true believers” are
contradicted by past experience, common sense, and science. Memory and
personality integration did not work the way that therapists treating RM/MPD
believed they did. For example, children and adults who experienced trauma
can’t repress them–they remember them despite their best attempts. And
gender dysphoria in natal females does not begin after childhood–unless it is
the acquired condition that is ROGD.
4. Both show ample evidence of social contagion of false, harmful beliefs. In
RM/MPD, the “infection route” usually went from therapists who strongly
believed in RM/MPD to their suggestible patients, who acquired a similar belief,
applied it to their own lives, and manufactured false and monstrous accusations
against previously loved ones. (A harmful result of therapy or medical treatment
is called iatrogenic,) In ROGD, the infection route appears to be primarily
directly from youngster to youngster. To be sure, therapists get into the act after
the person with ROGD acquires the belief that she is transgender, and then
they are complicit in tremendous harm. But it seems rarely to occur (yet) for a
youngster to be talked into ROGD by a therapist.
5. Both are associated with sociopolitical ideologies. (Interestingly, both ideologies
still find comfortable homes in Gender Studies programs in many universities.)
For RM/MPD, the ideological system was that men’s sexual abuse of children
has not only been too common (true), but that it has been rampant, even the
rule (false). Couple this ideology with a belief in Freudian theory and methods
(like hypnosis), and what could go wrong? Plenty, it turned out. For ROGD, the
relevant ideology is less coherent, but includes the seemingly contradictory
ideas that gender is “fluid” (here meaning that not everyone fits into a male-
female dichotomy); that forcing people into rigid gender categories is a common
cause of societal and personal anguish; but that gender transition is an
underused way of helping people.
6. Both RM/MPD and ROGD are associated with mental health issues, generally,
and especially a personality profile consistent with borderline personality
disorder (BPD). This is not to say that all persons with either RM/MPD or ROGD
have BPD; simply that evidence suggests that it is common in these groups.
For example, the high rate of non-suicidal self-injury we have noticed from the
aforementioned sources is striking. Such behavior is strongly associated with
BPD. (For a discussion of BPD among those with RM/MPD, see this article,
pages 510ff.)
7. Adopting the belief that one has either RM/MPD or ROGD has been associated
with a marked decline in functioning and mental health.
Some of the factors that seem to be common in ROGD–and some that are similar
between ROGD and RM/MPD–likely encourage the adoption of false beliefs and
identities. These include a fragile sense of self (BPD), attention seeking (BPD), social
difficulties (BPD and autistic traits), social malleability (BPD, and adolescence), social
pressure (adolescence), and strongly held (if irrational and poorly supported) beliefs
that make embracing false conclusions especially likely (sociopolitical indoctrination).
Adolescents with an actual history of gender nonconformity, or whose sexual
orientations are non-heterosexual, may be especially vulnerable to believing that
these are signs they have always been transgender. Adolescents whose lives have
not been going well may be especially looking for an explanation and may be
especially receptive to drastic change.
Based on the aforementioned data sources with which we are familiar, and on our
informed hunches, we suspect that many persons with ROGD were usually troubled
before they decided they were gender dysphoric and many will lead somewhat
troubled lives even after their ROGD (hopefully) dissipates. Of course, ROGD can
only make things worse, both for the affected person and her family.
What to do
Because ROGD is such a recent phenomenon, there is very little guidance about
helping affected persons. Lisa Marchiano has written two excellent essays abounding
with good sense, and we recommend starting with those.
Second, set aside, for now, rapid-onset gender dysphoria. Identify your child’s
problems that existed before ROGD and that may have contributed to it. Attending to
these problems will be useful for everybody, and perhaps your child will even agree.
Third, with respect to ROGD, do what you can to delay any consideration of gender
transition. Of the different kinds of gender dysphoria, ROGD is the type for which
gender transition is least justifiable and least researched. Remember, ROGD is
based on a false belief acquired through social means. None of the aforementioned
factors that have caused your child to embrace this false belief will be corrected by
allowing her to transition.
Two Rarer Types of Gender Dysphoria
For the sake of completeness, we include two other kinds of gender dysphoria. We
suspect that both are rare, even among persons with gender dysphoria. One of us
(Blanchard) has seen cases of the first type, autohomoerotic gender dysphoria, which
appears to be an erotically motivated gender dysphoria. In this case, sexually mature
natal females (i.e., not biologically still children) become sexually preoccupied with
the idea of becoming a gay man and interacting with other gay men. Neither of us
has seen someone clearly fitting the second type, gender dysphoria resulting from
psychosis. (Our inclusion of this type was motivated in large part by the argument of
Dr. Anne Lawrence, an important scholar we both respect.) In this type, a person
(either male or female by birth) acquires the delusion that s/he is the other sex,
because s/he is suffering from gross thinking deficiencies.
Superficially, both of these conditions have some similarities to some other kinds of
gender dysphoria. For example, a female with rapid onset gender dysphoria may be
sexually attracted to males and thus strive to become a gay man, similar to
autohomoerotic gender dysphoria. The important difference is that the female with
rapid onset gender dysphoria is not primarily motivated by an erotic desire to be a
gay man. Instead, having the prospect of having sex with gay men is a by-product of
her condition, not the main point of it. The female with rapid onset gender dysphoria
acquires it via social contagion, broadly speaking (i.e., including cultural signals that
gender dysphoria is in some crucial ways desirable). With respect to the other rare
subtype, we have both known gender dysphoric persons with psychosis. However, in
these cases, the psychosis was not the cause of the gender dysphoria. It was simply
an additional problem that the gender dysphoric person had. In the case of gender
dysphoria resulting from psychosis, the belief that one is transgender (or the other
sex) is clearly a delusion resulting from disordered thinking–and not, for example,
from social contagion or autogynephilia.
Autohomoerotic Gender Dysphoria
This rare type of gender dysphoria is limited to females. Published cases have
consisted of women whose gender dysphoria began in late adolescence or
adulthood. (It is conceivable that it might begin earlier in some cases.) It occurs in
(heterosexual) females who are sexually attracted to men, but who wish to undergo
sex reassignment so that they can have “homosexual” relations with other men.
These females appear to be sexually aroused by the thought or image of themselves
as gay men. We have created the label autohomoerotic gender dysphoria to denote
this sexual orientation. There are little systematic data on this type of gender
dysphoria, although clinical mentions of heterosexual women with strong masculine
traits, who say that they feel as if they were homosexual men, and who feel strongly
attracted to effeminate men go back over 100 years.
It is well documented that at least a few autohomoerotic gender dysphorics have
undergone surgical sex reassignment and were satisfied with their decision to do so.
There is no compelling reason to question such self-reports of postoperative
satisfaction, although current surgical techniques do not produce fully convincing or
functional artificial penises, and it is difficult to imagine that autohomoerotics find it
easy to attract gay male partners who can overlook this.
This type of gender dysphoria does not appear to be the female counterpart of
autogynephilic gender dysphoria, although the differences might appear subtle.
Autogynephilic (male) gender dysphorics are attracted to the idea of having a
woman’s body; autohomoerotic (female) gender dysphorics are attracted to the idea
of participating in gay male sex. For autogynephiles, becoming a lesbian woman is a
secondary goal—the logical consequence of being attracted to women and wanting
to become a woman. For autohomoerotics, becoming a gay man appears to be the
primary goal or very close to it.
The few available case reports suggest that autohomoerotic gender dysphoria may
have ideational or behavioral antecedents in childhood. However, these females are
not as conspicuously masculine as girls with (pre-homosexual) Childhood Onset
Gender Dysphoria. For this reason, and because it is rare to start with, it is unlikely
that many parents will detect this syndrome in daughters. It is conceivable, however,
that when they occur, cases of autohomoerotic gender dysphoria may be perceived
by others as Rapid Onset Gender Dysphoria. This is not because their gender
dysphoria arose suddenly, but rather because their early, atypical erotic fantasies
were invisible to their parents.
Gender Dysphoria Caused by Psychotic Delusions
The idea that gender dysphoria can sometimes reflect psychotic delusions is certainly
plausible. Delusions in schizophrenia, for example, are often bizarre but compelling to
the person who has them. Unfortunately, neither of us (Ray Blanchard or Michael
Bailey) has had direct contact with a person clearly meeting this profile, and so we
have less confidence in this gender dysphoria category than in the others. Our lack of
direct familiarity doesn’t necessarily mean that much. Even if gender dysphoria due to
psychosis were fairly common (compared with other forms of gender dysphoria), we
wouldn’t have expected to come across it. Persons with severe mental illness have
generally been treated for their mental illness and not for gender dysphoria. Until
recently, clinics treating persons with gender dysphoria would have screened out
patients with severe mental illness, because of concerns that their diagnosis and
treatment might be compromised. But we are hesitant to embrace this kind of gender
dysphoria as “definitely existing,” because we worry that psychiatrists who have
claimed to see it may have been insufficiently trained to notice other kinds of gender
dysphoria, such as autogynephilia. Thus, they may have concluded that psychosis
caused the gender dysphoria, when in fact, psychosis may have simply occurred with
autogynephilia within the same person. One of us (Bailey) has recently been in touch
with a mother of a young man who appears to have the profile we would expect for
gender dysphoria due to psychotic delusions, and there was no evidence that this
young man was autogynephilic. Still, we are least sure about the existence–much
less the prevalence–of this kind of gender dysphoria.
Not Just One Type of Gender Dysphoria: Some Implications
It should be clear by now that “gender dysphoria” is not a precise enough term.
Parents of gender dysphoric children should know which type of gender dysphoria
their child has. To do so it is necessary to learn about all three of the most common
types. That is, in order to understand why one’s child is Type X, it is necessary to
know why s/he is not Type Y or Type Z. This is not simply academic. There are
essential differences between the different types of gender dysphoria.
If knowledge is power, then lack of knowledge is malpractice. The ignorance of some

leading gender clinicians regarding all scientific aspects of gender dysphoria is
scandalous. To do better, they should start here. We recommend against hiring
gender clinicians who are hostile to our typology. Ideally, they would agree with it.
Knowing there are very distinct kinds of gender dysphoria also raises questions–and
concerns–about transgender persons of one type using their own experiences to
make recommendations for children/adolescents of other types. Nothing in Caitlyn
Jenner’s experience allows her to understand what it was like to be Jazz Jennings–
and vice versa. Yet a number of vocal transgender activists who have histories typical
of autogynephilic gender dysphorics do not hesitate to pressure parents, legislators,
and clinicians for acquiescence, laws, and therapies that do not distinguish among
types of gender dysphoric children. Moreover, they not infrequently claim inside
knowledge based on their own experiences. Yet their experiences are irrelevant to
the two types of gender dysphoria that they don’t have. And even with respect to
autogynephilia, these transgender activists are nearly all in denial. This means that
their public recollections of their experiences are either distorted or outright lies. A
notable exception is Dr. Anne Lawrence, who has become an important researcher of
gender dysphoria, and who has been honest and open about her autogynephilia. Dr.
Lawrence has taken the time to learn the scientific literature regarding different types
of gender dysphoria and does not insist that her personal experiences apply to non-
autogynephilic gender dysphorics. The biggest victims in the attempts by
autogynephiles-in-denial to steer the narrative towards sameness are, in fact, other
persons with autogynephilia. These include honest autogynephiles, who frequently
contact us but are fearful of public attacks by those in denial. Most relevant to this
blog as potential victims are autogynephilic youngsters, who are at risk of being
swayed toward decisions they would not otherwise make, on the basis of inaccurate
fantasies embraced by those who cannot face the truth of their own condition.
To us, the most tragic group, along with their families, includes those who have
acquired rapid-onset gender dysphoria. That condition appears to be the tragic
interaction of the current transgender zeitgeist (“It’s everywhere, and it’s great!”) and
social media with the vulnerability of troubled adolescents, especially adolescent
girls. They are at risk for unnecessary, disfiguring, and unhealthy medical
interventions.
*Note. Suicide is tragic and awful, and because of this, we recommend taking
seriously your child’s suicidal ideas, threats, and gestures. We have written
elsewhere about the risk of suicide among gender dysphoric persons, and we think
that this risk is elevated compared with non-gender-dysphoric persons, but still
unlikely.
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September 8, 2017 on adolescent gender December 13, 2017
In "41% transgender dysphoria In "Michael Bailey"
suicide" February 25, 2018
In "Brie Jontry"
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[https://4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/] .
266 THOUGHTS ON “GENDER DYSPHORIA IS NOT ONE THING”
Awakened
on December 13, 2017 at 9:08 am said:
Reidentified woman. I think it is very negligent and telling that a psychiatrist

would feel you were such an “obvious case”. It shows that our society has a
very difficult time separating femininity from female. If we were honestly able
to separate the two I don’t think ROGD would be spreading as rapidly as it is.
I know everyone who affirms feel that they are being kind but as I have
pointed out to different “supportive” people maybe someone should ask why?
Why do you feel that your clothing choices and hair style and behaviors make
you any less of a female than a girl who checks all the boxes for femininity?
Women and men come in all different varieties and femininity and masculinity
are choices. We don’t have to perform these to be a real woman or man. I get
how a young person could be made to feel very badly about not wanting to be
feminine or masculine. I get how trans identity could be such a tempting
lifestyle for so many ….. especially if a butch girl or sissy boy is bullied by
peers or made to feel bad about themselves by loved ones or even just
having the constant feeling of not fitting in. I’m so happy that you stopped
listening to all the harmful messages and started listening to your gut. You are
very grave and now have a deeper appreciation for what the word woman
truly means. Therapists need to WAKE UP!!!!! You can’t label but he’s and
femme boys and girls as classic or obvious cases!! It’s cruel and harmful. I
have known lovely women in my lifetime who are butch (both lesbian and
heterosexual). They are just as much a woman as any of us. This shouldn’t
even have to be discussed in 2017!!!! This is why I feel trans ideology is so
regressive. It is reinforcing gender stereotypes. Anyway… I wish you much
happiness and health and happiness. I hope my own lovely daughter can
come to understand herself one day as you have done.
ReidentifiedWoman
on December 13, 2017 at 5:13 pm said:
It sure is. I have informed them about me detransitioning and we’re

going to have a meeting about it. I’ll take the opportunity to make them
better understand what’ makes you trans and not…
I agree with you, all of this is absurd 2017. But sometimes I think that’s
part of the problem. “There are no gender differences…” so it’s not
such a big deal to not identify as you sex socially. And after you have
made that statement you can’t really go back… and then it’s the
slippery slope and bam, you’re alone, depressed and feel like you
have no other option than transitioning.
No we’re not equal yet. No, you can’t escape societal norms by
identifying and transforming to another gender. It’s just to accept that
it’s way tougher for a GNC person. Understanding that transition is not
really an alternative would make us find strategies around this.
I hope you daughter will get the right information and make peace with
herself too some day.
Awakened
Brave not grave!! Sorry!
ReidentifiedWoman
Don’t know if this comment section is still being read, but I realized I wanted
to edit/add some things in my text.
I write a lot “It is not a choice”. What I mean by that is that you can’t chose
weather you will get strong feelings watching a youtube transformation video
and feel like that could have been you. That, I think you can’t control.
However, I do think it is a choice, especially in the beginning (I believe it’s

more difficult the longer the time goes by)
– To watch those videos and read all the blogs (if it’s triggering you).
– To Not look up (non-angled) information from statistics and research, and to
chose to Not listen to the skeptical side at all.
– To take hasty steps. One might feel like doing it, most do. But there is no
one saying it’s a good idea to rush it, not even more serious gender pro
people. It’s just common sense to not (In fact I might have that to thank that I
don’t pass as a guy today).
– To not listen to any detransition/reidentified person, instead decide that they
are all “TERFS” or fake trans.
– To not find other distractions/identities (as I wrote a little about). One should
try to build a strong identity around something else rather than gender and
identity, that might help you realize that there are environments /contexts
were gender is not that big of a deal and you could stand being seen as just
any gender. (This is something that helped me a lot when I finally found the
right education for me. It was very technical and I realized that it occupied me
/ made me feel so good and competent that gender didn’t feel very relevant
anymore.)
– An maybe most importantly: To think that you have to feel like a woman /
man in order to be a part of that social group. This is probably more difficult to
go against than what we think, cause this is very much how we talk about
gender today… what you feel is what you is. Not what’s the safest for you, or
what social group you have actually been raised in and learnt to understand,
and what will give you the necessary tools/(cis-privileges) to get through life.
(Some radfem theories might be helpful here, they base gender on social
groups. – Without saying that they are experts on gender in other regards, but
I do think they have a point here.)
Fighting for the girl that deserves to thrive

People are still reading this thread. Thank you so much for your
information. If we could get therapists to help us out, this could be
helpful to them. Or if our kids would read this, they may take some of
these ideas better from people who aren’t their parents and with whom
they identify more closely.
heteronerd
I’m late to the discussion here, but I wanted to add another voice to the
suggestion by M0506 and other commenters that more investigation of
ROGD young men is needed before jumping to the conclusion (based on
studies conducted before the rise of the modern Internet trans subculture)
that they’re invariably cases of autogynephiles in denial.
In particular, I think it’s worth investigating the ways in which the experiences
of adolescent boys on the “gifted” and/or autism spectrum interact with
“gender identity” discourse and with the psychological reinforcement effect of
24/7 social media, neither of which existed in anything like their present form
as recently as a decade ago. This investigation would be valuable for
understanding the female majority of ROGD cases too, of course!
It’s clear to me that at least some MTF discourse takes the experience of
being a geeky heterosexual male — not fitting in with “the bros,” preferring
imaginative play to competitive sports, frustrated longing for an idealized
female partner — and interprets it as evidence of a “gender identity” as a
lesbian woman.
It’s possible that all of the young men claiming a trans identity are concealing
straightforward cases of erotic autogynephilia, but I think it’s worth taking
seriously the possibility that they’re making honest self-reports of their own
experience. (You’re certainly not wrong, of course, to point out that many of
the ringleaders of online trans activism are adult autogynephiles whose
denials are profoundly unconvincing.)
My own (purely anecdotal) hypothesis is that male ROGD, as enabled by the

cultlike atmosphere of the social media trans subculture, involves an element
of lonely men becoming their own “ideal girlfriend” in a way that doesn’t
necessarily involve sexual arousal, and I suspect (again anecdotally) that it’s
incorrect to consider this a form of sexual paraphilia.
EverHopeful
Thank you for posting this. I’ve been meaning to respond on this
thread but am totally engulfed in the panic and fear of knowing my son
has taken new and serious steps to medically transition. He is naive
and gullible, lonely and depressed, and I believe his story is exactly as
you described in your post. Perhaps he recognizes the autogynephilic
elements of his story as proof that he needs to transition. Mainstream
awareness of ROGD can’t come soon enough. My son and others like
him need to know they are not alone (just as we parents need to know
this, too) so that they can see the patterns in their thinking and
behaviours. Thank you to the authors and commenters in this thread
who have given my husband and I hope that the tide may be turning.
M0506
Honestly, I hope they’re not autogynephiles in denial. I’d rather have

then be confused young men who don’t feel they fit in with other guys
than fetishists who are not-so-secretly getting turned on by people
treating them as female. You make a good point that a lot of this
research was conducted before Internet trans subculture.
M0506
*rather have THEM be
heteronerd
EverHopeful, so sorry you’re going through this, and I’m glad it’s at
least some comfort to know that you’re not alone. It’s so frustrating to
recognize that there’s a common pattern in so many of these stories
while being forbidden to discuss it in “respectable” venues.
Some additional thoughts (directed towards the discussion in general):
With all due respect to Drs. Bailey and Blanchard, I think that
approaching adolescent male ROGD with the preconceived notion
that it must be about a sexual paraphilia, and that if someone says it
isn’t they’re either lying or in denial, isn’t likely to be a productive route
of research or therapeutic inquiry.
There’s an important distinction between the claim that “heterosexual

MTFs experience sexual arousal when they imagine themself as a
woman” and the claim that “heterosexual MTFs experience a complex
feeling of longing and desire when they imagine themself as a
woman.” Indeed, the latter is close to the tautological statement that
“trans people are trans.” This seems to be what Anne Lawrence is
getting at in her paper — it’s not just about sex, although that might be
part of it in some cases.
As I said, none of this is meant to deny the fact that many adult trans
ringleaders are obvious autogynephiles. Zinnia Jones comes
immediately to mind — flaunting his autogynephilia while
disingenuously denying it seems to be part of the “game” he’s playing.
But I know plenty of MTF trans people who don’t behave like this, and
I think that responsible clinicians and researchers have a
responsibility, in cases where bad faith isn’t obvious, to take their
descriptions of their own experience at their word as honest self-
reports.
For what it’s worth (as longtime commenters here will know), while I’m
active on 4thWaveNow because I’m a father of preschool-age children
concerned about what they’re going to encounter in school in a few
years, my own experience with the rapid-onset trans phenomenon
comes from working and socializing in a STEM subfield which attracts
an unusual number of MTF trans people — so much so that it’s one of
Dr. Blanchard’s diagnostic criteria for autogynephilic dysphoria. In
many ways, these are “my people” (geeky outsider males); I like to
think that I have some sense of what makes them tick, and I’ve spent
a lot of time reading trans material in a good faith attempt to be an
“ally,” although the end result was a growing skepticism which led me
to privately hit Peak Trans even before I discovered 4WN and learned
that I wasn’t alone.
This is purely my anecdotal observational theorizing, but here’s what I

think is going on in some of these cases. There’s a pubertal
developmental stage that many gender-nonconforming boys go
through (maybe gender-conforming boys do too, though I wouldn’t
know) in which they fantasize about an imaginary perfect partner: “If
only there were a person who was into all the same comics and video
games and computer stuff I was, and who didn’t care that I was shy
and sensitive and bad at sports, but was a girl and would be my
girlfriend.” Today they can express this fantasy, among other ways, by
experimenting with playing as a female avatar in video and roleplaying
games.
Most boys eventually mature and develop a more nuanced view of

what real-life opposite-sex relationships involve. But some stay stuck
in this stage through late adolescence and young adulthood, due to
high-functioning autism or arrested development or simple romantic
bad luck. And then they encounter the online trans subculture, which
tells them that their fantasies of a “just like me, but a GIRL” alter ego
are actually evidence of a female “gender identity.”
Again, I don’t claim to have based this on any sort of rigorous study,
just my own experience as an observer of the contemporary trans
subculture. But I really do think that it captures what’s going on more
clearly than the assumption that they’re all getting off to it while saying
they don’t. In particular, I think it’s worth making a distinction between
the relatively longstanding phenomenon of middle-aged men who
transition late in life after “hyper-masculine” marriage and career
success (the Bruce Jenners and James Pritzkers), and the newer
phenomenon of geeky younger men who transition after a social
media binge in adolescence or during their awkward twenties.
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One who was taken advantage of
on January 17, 2018 at 5:59 pm said:
Thank you for writing this article. I have been dealing with this issue for nearly
two years with my now 17-year-old child, and just when I think the worst is
behind us, more gets dumped on me. Our story in short: My lovely girl told us
nearly two years ago that she was a trans boy. Shortly thereafter, she aborted
a suicide pact she had made with a kid from school and was diagnosed with
depression and anxiety–as well as gender dysphoria. My husband and I
found a therapist we thought could help her unravel the underlying “stuff” that
was causing her problems, but he turned out to be a guy who just sat there
while my kid complained about things in her daily life. We then switched to
another therapist (a straight shooter) to whom my kid refused to speak In any
substantive way. Between each of these sessions, my daughter would
complain non-stop about how she did not like the therapist–to the point of
crying and throwing tantrums. We then switched to a trans-advocate LCSW,
who my kid likes. Since going to her, we’ve changed my daughter’s legal
name and let her go on testosterone (she promised to stop cutting if we
allowed this–and has stopped). Now, this social worker is working with my kid
to have us pay for top surgery as a graduation present. I’m so angry and
frustrated I don’t know what to do. My kid is immature for her age and is a
black-and-white thinker. Abstractions are lost on her, so it’s impossible for her
consider the possible ramifications of her current actions. I’m so tired of
dealing with all this crap that part of me just wants to throw in the towel and
give her up as lost. She’s going to be 18 in 6 months, and she can do
whatever she wants then anyway, I feel defeated and don’t know where to
turn.
Scared Mum
Has anyone considered whether your daughter might be autistic?

(Immature, black and white thinking etc). I would write a very strongly
worded letter to those treating her (the social worker colluding in your
daughters emotional blackmail of you), asking whether autism has
been considered, and if not why not. And that not considering it is
negligent. Also that in your opinion as her parent, she is not
emotionally mature enough to consent to treatment, and that again
there will be a negligence claim if this has not been taken into
account.
bibbi32
I feel your pain, every last bit of it. Our daughter is 15 and for 2 years
we have been living through the same nightmare including bad
therapists who made it clear that she only had to wait until 16 to get
hormones. The school was calling her by a male name )I flipped out
about this when I wound out and had it changed back) and today I find
that they are still referring to her as “he”. I have sent a crappy letter
asking for a meeting and stating that I will remove her from the school
if it continues. I know this started at puberty, I know it is body image
and social contagion, I know also that my daughter has had some
tough times that have doubtless contributed.
I do not understand what it is about people who do not have a stake in

her life that makes them feel it is acceptable to mess more with her
mind. If she had anorexia they would not tell her she was fat and give
her a bucket. If she insisted that heroin made her feel better they
would not give her an injection.
Two years ago she told us that she thought she might be gay or
bisexual. We told her we had no problem with that…. then bam ! The
trans agenda hit like a steam train. She has a whole host of friends
from the internet, at least one of which is taking hormones who I have
met and it is absolutely the saddest thing to see. When she first visited
I said to my daughter “how lovely it would be if you could be two girls
happy together”… the r action was that they were not girls…..Our
daughters might even know each other. She is adamant that wanting a
sex change and being attracted to other girls who want a sex change
is not gay and that she is not gay…. from such an intelligent child it
beguiles belief. There is not getting through like you said.
Perhaps ask her to read this.
//4thwavenow.com/2018/01/18/i-hated-her-guts-at-the-time-a-trans-
desister-and-her-mom-tell-their-story/
I know how you feel about throwing in the towel. You’re doing
everything you can to make your child see how perfect they are and
how loved yet the people around you who are supposed to help are
just fuelling her desire. Rest in the knowledge that you are doing
everything that you can.
Much love in these hard times x
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tailcalled
on March 27, 2018 at 10:48 am said:
Continuing the discussion from here: //4thwavenow.com/about/comment-

page-8/#comment-25072
Brie,
I have not yet examined how women view sexuality and whether this interacts
with their feelings on gender. However, I have looked at body image, and
there seems to only be a tiny effect there. Autoandrophilia can generally
explain 25% of the variance in women’s desire to be male, whereas body
image issues seems to at most explain a few percent, possibly nothing.
So far, there is little evidence to distinguish between “deciding to transition

when you are AAP is socially contagious, and AAPs tend to cluster together
socially” and “gender dysphoria itself is socially contagious”, but the evidence
I’ve seen points towards the first. For example, AAP women tend to have their
AAP start at the same time as the rest of their sexuality, suggesting that it
started independently of social contagion, yet they tend to have A LOT of
trans friends.
You need to be careful when thinking about the interaction between

lesbianism and ROGD/AAP. The most-lesbian women who state that they
have zero attraction to men will be less AAP than the baseline, whereas the
almost-lesbian women who state that they have a very strong preference for
women over men will be more AAP than the baseline. When talking to a
gender critical lesbian about it, she suspected that this latter group was not
truly lesbian, but I suspect that this group accounts for much of the
overrepresentation of lesbians among ROGDs. (Of course, the true lesbian
group also transitions more than the baseline, but this is IMO through HSTS
and not ROGD etiology.)
Paul
on April 3, 2018 at 11:22 am said:
Thank you for this article. I have a child who was diagnosed with ROGD and it
has been hell for my wife and I. I have had to think and read about this topic a
lot and the breakdown of different types of “gender dysphoria” (an absurd
label) is enlightening. Before reading the post I did have the feeling that the
Autogynephilic Gender Dysphoria in males is a situation where the fetish of
being a woman is so strong that the person actually wants to become a
woman physically. The key thing is “fetish” which is intense desire. We
medicate people now for their desires – an entirely different topic.
The reason why the term “dysphoria” is absurd in this context is that it comes
from ancient Greek. Did ancient Greeks have gender dysphoria? Probably not
as it is a result of humans inventing a self in the mid-eighteenth century. See
“The Invention of the Self”, John Lyons 1978. The medical world does
everyone a disservice by using such terms as “dysphoria” as labels for
“diseases” as it gives people the impression that such ailments are timeless
maladies of the human condition when they are not. In modern times, they
are most often now an intense preoccupation with the “self” and that is why
teenage girls are so vulnerable to this “disease.”
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Rights
jeanbahana
on July 15, 2018 at 5:09 am said:
The mention of dysphoria in the context of psychosis was very interesting. I

have encountered this twice in my life – once in the context of my work (I am
a mental health professional of sorts) and once was a close friend of mine. He
had his first psychotic episode years ago now, which I supported him through
including having him admitted to an inpatient unit. One of his more intense
delusions, besides believing his apartment was haunted, was that he is in fact
transgender and transitioning would be the answer to his intense distress and
misery. He persisted with it until the anti-psychotics had well and truly taken
effect.
I asked him if he’d be interested in speaking/writing about this and he said

that he would be very open to doing so. I spoke with a social worker while he
was in there and she asked me about the gender dysphoria thing, so I would
assume it’s on his hospital records to prove his story. I have thought about
both of these experiences over the years and have always considered it to be
a primary argument against ease of self-identification, mainly because I
assumed it was common.
If 4WN or the authors of this article would be interested in hearing from my

friend I’d be happy to arrange something.
4thwavenow
Yes, please, we are interested.
Nova
Hi! I’m Nova, biologically male but with a pretty severe case of gender
dysphoria that doesn’t fit into any of these explanations. Can you help me
with figuring it out?
So I’m asexual and only attracted to nonbinary people romantically with

preferences for certain types of nonbinary people. I have no sexual fantasies
and I’m 16 and have gone through the bulk of puberty (that was hell). I feel I
have no gender at all, but I do feel more feminine. I never had any problems
in childhood with gender, mainly because of the fact that being male really
didn’t mean anything. I played with who I wanted, did sorts of playing “male”
and “female” toys (which i got almost no female toys since my parents didn’t
like that but i didn’t care since they were both good), and generally lived a
totally gender neutral childhood. I’ve always liked programming and 3D
modeling.
My dysphoria first started at about 12 or whenever I started puberty (I can’t
remember since I was on 2.5mg of Risperdal per day for autism
misdiagnosed as ADHD from 7-14). To be clear, I’ve only felt dysphoria for
secondary sex characteristics. My penis is fine and it’s just annoying in terms
of taking up space, but honestly there’s really no big deal with it. Although I
am starting to doubt me not caring, as I have had many surgeries which have
caused a lot of trauma psychologically. So it’s possible I actually would feel
better with SRS but my trauma is covering it up over fear. I do however hate
libido. It’s so badly annoying and fires at terrible times when I just wanna kill it
already! It doesn’t have any use since I don’t want to have sex with anyone. I
have issues more with body hair which is just so badly distressing, I’ve been
depersonalized from my body ever since puberty started, and I’ve been
googling since 12 about how to remove testosterone (and somehow came up
with only results of people wanting MORE testosterone which idk how that’s
possible but google is weird). I can’t stand the deeper voice, the body hair, the
bone structure, the height, or the rougher and oily skin. It’s really distressing
because I have to live with my body 24/7 and these things won’t go away no
matter how much I’d want them to. The reasons why I’d want to go on
estrogen are as follows: it reduces libido in most cases because of the
antiandrogens without progestrone (spiro for example), it makes the skin
softer and more sensitive (which would make me feel more comfortable in
general), it causes breast development (which I never really cared about until
I thought about it and realized that it actually would feel better emotionally for
me to have breasts than any of the drawbacks (in physical comfort, picking
out clothing, sexualization by other people, etc.), and lack of any more
advancement of testosterone puberty (meaning no more body hair
development, no chance for a deeper voice than what I already have, bone
structure won’t be more masculine and given my age possibly slightly
feminized, etc). Ever since I’d heard of these effects happening I couldn’t
stand the thought of them happening to me… but because of my Risperdal
(an antipsychotic) I couldn’t really understand or express these feelings to
anyone, leading my parents to think it was caused by an outside emotional
source. So as puberty hit it was essentially trapping me in these effects and I
didn’t know how to get out and feel better about myself.
As you’ve mentioned in the article, some forms of gender dysphoria are

caused when kids and adolescents read a bunch about transgender people in
the media and then start to feel they aren’t comfortable in their birth sex. That
doesn’t apply to me since my parents actively prevented me from knowing
transgender people even existed. What happened is last June (2015) I had
my first and so far only crush, on a nonbinary person, and when they told me
about themselves (they are biologically female) then I started to do research
on being transgender. I knew I didn’t feel comfortable being a girl, but I also
knew I felt more uncomfortable with being male. Then I found nonbinary
people and decided that agender fit me best, after looking through many
identities which did not feel they fit me at all. Me identifying as agender is
completely separate to my gender dysphoria, though I do very much feel
more comfortable with being called Nova and people using they/them
pronouns for me. I know they don’t have to, but it is a sign of respect for me. I
don’t annoy people to death over it though.
So to summarize: I feel extremely uncomfortable with male secondary sex

characteristics but not primary (unless my surgery trauma has hidden that), I
feel more comfortable with female secondary sex characteristics, I am
asexual and have no sexual fantasies but I do have a libido (which is
annoying), I see myself as agender, my dysphoria emerged at puberty, and I
prefer gender neutral pronouns. And I hadn’t even known trans people existed
until 3 years after puberty started in which case I promptly realized what was
happening to me.
So what kind of gender dysphoria do I have? It doesn’t seem to fit any of the
types in the article but I would like to know what is going on. If you have any
questions I’m open to answering them!
Sharon
on July 24, 2018 at 10:00 pm said:
Hi Nova
I am not sure if Dr Bailey and Dr Blanchard are still replying to questions, and
after reading your heartfelt account I felt compelled to respond.
The first thing I want to say is that at 16 you a still in the life-stage of identity
formation. Sexual identity is part of that. It is totally normal for you to be
working out how you feel about sexuality. Wait until at least 25 before you
make any decisions. The decision-making and executive functioning etc part
of your brain will not be fully developed until then. One wonderful thing about
being on the autism spectrum is that you don’t just buy the whole gender
stereotyping thing. That is so wonderful, as it is such nonsense. What toys
you preferred to play with as a child, and what interests you have, have
nothing to do with your sexuality/gender. They may be influenced by societal
pressure and norms, but you have more resistance to that than neuro-
typicals.
It is totally normal for you to have a variable degree of discomfort with the
changes to your body that you are experiencing as a result of puberty. I
should imagine that being on the spectrum may heighten that discomfort. In
time you most probably will adapt to all the changes. Teenagers on the
spectrum are often “late-bloomers” and take longer to be ready for
relationships. You do, however describe that you felt attracted to some-one
biologically female and who is now gender non-binary. I would think that
someone else also exploring sexual identity, to the extent that you are, would
be attractive to you. Shared experiences are very bonding, and you have a
deeper understanding and acceptance for each other.
It would be wonderful for you to see a therapist who specialises in autism and
body image issues etc, and who is knowledgeable about gender dysphoria
and will not just push you to transition. Someone who is experienced in
treating teenagers, and has not been influenced in the whole rush into
transition ideology. This is not easy these days as professionals are terrified
of losing their licenses to practice.
Another very important thing is to try and avoid pressure to rewrite your
history and feelings about things. I do pick up that you are conflicted about
who you really are and what you are reading on the internet. Be true to
yourself.
Try and seek out the other side of the story as well, as you may be by visiting
this site. True research does not just look at one side of things. Be aware of
bias in research and interpretation of research. Be aware of weak
methodology in research.
Try and think things through calmly and don’t rush to make any decisions. Be
aware that as humans we tend to get things terribly wrong sometimes. If
people refuse to listen to politely and respectfully delivered arguments, that
go against what they believe, there is something very wrong. Respectful
debate should always be allowed. Rushing young people into making
decisions with permanent consequences just doesn’t sit well with me.
Wishing you everything of the very best as you journey along this road.
Always remember that you are wonderful and lovable just as you are. I hope
that in time you become comfortable with your body, and embrace your future
(which sounds like may be in programming etc). Try and focus on your
interests. School/college can be tough for those that don’t conform to
stereotypes. But school/college comes to an end in a few years, and things
will be much easier for you after that, as you pursue your interests. And in
time you will find a special someone to share your life with, and special
friends. Just be patient and never give up hope.
Lillian Troubles
on August 4, 2018 at 2:57 am said:
Very interesting article! I was surprised to realize that I have gender
dysphoria. Never thought about it that way but the part about autohomoerotic
gender dysphoria described me so well.
Kyla
on August 11, 2018 at 2:55 pm said:
I’m 24 and started to transition, from m to f, whenever I was 19. I have been
“heteroflexible” (prefer muscular men; would engage sexually with other
feminine, pre-op trans women; would never engage sexually with natal
women) since I was 15 years old. I am also non-op, meaning that I don’t think
I could survive something like sex reassignment. I have always liked what I
have “down there”, maybe because I am sexually attracted to it in other
people.
Anyway, I’d definitely like to know if there’s a sub-type of gender dysphoria for
someone like myself. I was very into bodybuilding during my teen years,
which suggests that I was masculine, but I started down that path because I
was always made fun of for being small (I have been 5’9, 130 lbs. since I was
12 years old). I realized, when I was about 16, that I was into muscular men
sexually, and that encouraged me to attempt to become muscular myself,
which eventually resulted in autoandrophilia (sexual attraction to myself with
muscles).
However, I simply wasn’t progressing through puberty as a male; it pretty well

stopped at 12 or 13, so I have a higher voice (for instance) than many natal
women. When I turned 18 and went to college, the shame around being so
feminine became unbearable, and I tried oral steroids for a short time. They
caused my skin to get oily and my body to get a bit hairier… And this is where
I realized that male puberty was scary, so I went to a gender therapist and
started transitioning, male to female, which I’ve been doing nonstop for many
years now. I’m feminine to the point that you wouldn’t be able to tell I’m TS,
and I’m just really glad I caught it in time.
However, I have NO idea where I fit into all of this, as I know for a fact that
autogynephilia is legitimate (I’ve met too many trans women who share
autogynephilic fantasies with me, and creep me out). I was okay with my
gender, all throughout childhood. And when I attempted to live as a masculine
boy (i.e., going to the gym a lot), some people would have described me as
masculine, even though family says it was obvious that I was not a straight
male. My dysphoria started when I started to progress through male puberty,
and it has honestly gotten worse, the longer I’ve transitioned. Even though I’m
very feminine in appearance, I think I’ve developed something far worse than
gender dysphoria (maybe body dysmorphia). I have had two plastic surgeries
(one on my face) in the past year, and it’s simply not enough to make me feel
as feminine as I feel on the inside. I’ve wondered if my transition is driven by
body-image issues, to be honest. Regardless of why I am the way I am, you
can’t hold a conversation with me, or walk past me, without thinking I’m
obviously a female. I just wish I knew where I fit, and I know a therapist isn’t
equipped to help since they likely don’t subscribe to autogynephilia.
Michael Bailey
I’m sorry for your pain. But fascinating. Your history sounds somewhat
like that of this case of autoandrophilia:
https://link.springer.com/article/10.1007/s10508-008-9446-6
Read and let us know what you think.
Kyla
on August 26, 2018 at 12:55 am said:
Goodness, thanks for reading and responding! I cannot access

the article but read the abstract – and yeah, I am definitely
autoandrophilic. Arousal by my muscles happened frequently,
and I acted on it on a daily basis (hopefully not too much
information). However, I also want to mention also that my
attraction isn’t limited to masculine males. I like feminine, pre-
op trans women and drag queens as well. I know that I have
the erotic target location error mentioned in the article, as I get
aroused by emulating any of the aforementioned groups of
people, Consequently, I am an extremely successful TS
webcam performer, as well as a drag queen. But some things
makes me very different from the autogynephilic majority of the
trans-female community, since I could qualify as
autogynephilic myself. And that is that I’ve been bisexual my
entire life. In fact, since I am repelled by the female sexual
anatomy, I might even qualify as a “heteroflexible” trans
female. I chose to live as a woman because I really felt I had
no choice with how feminine I was, and I think the femininity
stems from a severe eating disorder i had while growing up.
My point in this huge, long post is that I 100% believe
everything you’ve shared about AGP vs. HSTS trans women,
but I do think I’m one of the few who’s in a gray area of sorts.
Nervous Wreck
Kyla, thank you for your comment. What you say – “I’ve wondered if my
transition is driven by body-image issues” – is very interesting and I’ve
wondered if this is the case for my daughter too. She is 21 and started
transitioning as soon as she turned 18. She shows signs of OCD and has
made comments that show her fixation on how she looks physically. Now that
youth are plowing ahead with any diagnostics & counseling, it seems a lot of
what is being called “gender dysphoria” is really other things…the so called
“underlying issues” that used to be treated first.
Nervous Wreck
plowing ahead with NO diagnostics & counseling….
Kyla
I’m so glad that you care enough about your daughter that you will
investigate the rationale behind her gender dysphoria/transition… I
wish my own parents were that involved, but they’re instead out of my
life. Regardless of why she’s transitioning, it’s still a gender transition
nonetheless, especially if she’s living as her target gender. It’s all very
real to her, I’m sure, just as it is to me. Even though it’s possible that
OCD is part of the equation, in my case, going on as a male simply
wasn’t possible. I was not only too inadequate, but I realized how
much I’d be missing out on socially if I had not undergone the
transition. I got my degree; and I became very outgoing, as opposed
to timid and unable to make eye contact. I’ve overcome, and all that
remains is the debilitating trauma from family not accepting what I so
obviously am. So, please always be there for her, even if the rationale
behind her decision is confusing to you.
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Lee
on September 10, 2018 at 3:11 am said:
I’m glad to see there’s a site where respected gender dysphoria researchers
are involved in disseminating information, but it’s shameful to see such a lack
of compassion for gender dysphoric males (which Blanchard and Bailey
clearly have) among readers.
Awakened
on September 10, 2018 at 11:55 am said:
Lee. Speaking for myself only… I have a lot of compassion for gender
dysphoric males. The same forces that make a gender nonconforming girl feel
bad about herself can also be applied to males. I think every parent here can
acknowledge how hard growing up can be for a feminine boy. I think where
women start to lose compassion is when transwomen publicly are posting
questionable and blatant sexual behaviors while at the same time not having
one ounce of compassion as to why women want and need single sex
spaces. A lot of the transactivists that scream the loudest appear to be
autogynephic males. They do not seem very willing to consider female points
of view and try to compare young dysphoric females to their own experience
and agitate for laws ,language and any safe guarding for dysphoric males or
females shut down or changed. Compassion and respect are a two way street
Kyla
on September 10, 2018 at 12:44 pm said:
Hi, I saw this comment and had to express my agreement. I’m a
young transitioner (transitioned into a woman at age 19), and I find
myself feeling extremely uncomfortable around the part of the
community to which you’re referring. Most of the people who are
vehemently pro-trans rights aren’t even living full-time as women. It’s
almost as if they live as women strictly on the internet, such as on
Susans.org or Second Life. Ever since I went to a trans support
meeting, got interrupted every time i would try to talk about my own
struggles as a trans woman, saw that some 40-something trans
woman was checking me out the entire meeting, and I went home and
had a flirty FB message from her, I’ve been so repelled by AGP. I don’t
want them in the same restroom, especially since part of her flirting
entailed looking at my genitals through my yoga pants. That was 3
years ago, and I still want the worst for this part of the community. And
here’s the worst part: I’m a sex worker, and I hear these types go on
about how they wish they could be the trans sex workers. So, they try
to emulate us by posting disgusting photos on social media, which
they collectively encourage. They’re sick men, and display an obvious
“us vs. them” mentality. They have their own, unique language (e.g.,
“cis”, appropriating the word “queer”, vilifying anyone who uses the
word autogynephilia, neo-pronouns), and it’s catching on at academic
institutions, which angers me.
Talon
on September 20, 2018 at 10:38 pm said:
autogynephilic gender dysphoria only occurs in males? What about if there’s

a female who is aroused at the thought of herself having sex as a man and
becomes so focused on this feeling she identifies as transgender? I believe I
know a person like this. She was really into ‘yaoi’, homosexual Japanese
anime and manga.
John
on March 4, 2019 at 6:46 pm said:
That would more likely fall under autohomoerotic gender dysphoria. (I

left a comment about my experience with this disorder below, if you
are interested.)
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gender dysphoria - Miranda Yardley
John
on March 4, 2019 at 6:43 pm said:
A word on autohomoerotic gender dysphoria:
I believe the subjective experience of this disorder is poorly understood even

by the researchers. The reason some people experience this are happy after
transition is the disorder manifests as an overwhelming desire to live as a
man. Wanting to have gay sex is certainly the psychological underpinnings,
but that desire may be so hidden from an individual that he or she does not
even realize it is there.
I’ve recently realized that I experience this type of gender dysphoria. The only
sexual-related thought I remember having is being attracted to men yet being
completely unsatisfied in all of my heterosexual relationships. Those
relationships felt wrong, and I was so uncomfortable that my partners were
attracted to me as a woman that I did not enjoy having sex with them.
However, I also experienced discomfort over being called “ma’am,” wearing
women’s clothing, and everything else that goes along with being embodied in
the world as a woman,
I knew I was unlikely to find a gay male partner after I transitioned, but the
desire to be a man was/is so strong that I would rather live a celibate life as a
man than be a heterosexual woman. I also plan to forgo genital reconstruction
due to possible complications and results that I would not be pleased with. If I
one day find a man who is attracted to me as a man, then great. However, it
is more than enough for me just to be able to live my life as a man, which
feels so much more authentic (despite having been born female).
Anyway, I wrote this in hopes that people will read it and better understand
autohomoerotic gender dysphoria. Thanks.
Caroline Davies
on May 14, 2019 at 3:18 pm said:
About the age of 16.5 my niece started saying she wanted to be a boy. She
had had a relationship with a boy from a nearby school but that had ended. At
this point she was isolating herself in her room and not going out. She was
having an internet relationship with a girl in a different country. She dropped
out of education and was becoming more and more isolated. She wouldn’t
wash or dress or leave the house without a huge amount of support.
She was referred to the gender ID clinic in London and finally saw someone
when she was 19. Within an hour the psychiatrist had established she had
been groomed and raped from the age of 11 by a close family member. We
had no idea (though we disliked the man).
The man was arrested a day or two after and as the police disclosed he
already had a history of downloading child porn and showing porn to
underage girls he went into prison on remand. He pleaded guilty and was
sentenced to 20 years. Thank God!
I can completely understand that after this horrendous experience my niece

cannot bear her female body: ishe must feel it has betrayed her and led to her
horrific treatment by this wicked man. However no one is treating the body
dysphoria. She hasn’t been given rape or trauma therapy. The Tavistock have
said this is not their responsibility and this should be offered by the local MH
services. They have, however encouraged her to change to a male name and
he has now adopted male pronouns. He is also now taking testosterone and
wants to have surgery.
The rest of the family are appalled by the 8 years of rape and sexual abuse
this poor person has experienced but also the betrayal by the Tavistock.
Surely there should be therapy offered before encouraging someone to
surgically remove healthy body parts?
Dolly
on June 20, 2019 at 11:07 am said:
I read this article months ago, was uncomfortable with the notion that the
huge increase in girls was representative of a new phenomenon, ROGD, but
the huge increase in boys was just business-as-usual AGP. It still strikes me
as wrong.
If we use available Tavistock numbers, the number of girls increased >4000%

in an 8 year period. I can see why this stands out and gets most of the
attention.
However, the number of boys increased >1200% in the same period.
Anything increasing by >1200% is huge, and not normally indicative of some

organic normal process, but something really odd and unusual going on.
You need to talk more to the parents of the ROGD boys. To dismiss us as
parents of AGP kids, with our heads in the sand, is directly equivalent to the
trans activists trying to dismiss _all_ the ROGD parents by saying, “They
were always this way but you didn’t notice.”
It’s really wrong to dismiss a whopping 1200% increase in boys, in an age

group that traditionally were NOT AGP transitioners (30-50 year old straight
men with families).
I have only talked to a few parents of boys, but there are some common
threads, and these are things that need to be looked at, not just dismissed
and lumped in with AGP.
Common threads (not common to every boy, but themes which keep coming
up for many boys) are:
Being on autism spectrum, same as some ROGD girls.
Experiencing a recent severe trauma, same as some ROGD girls.
Having a recently diagnosed mental illness, which is of a type where you

expect suffers to struggle with reality or identity (such as bipolar or borderline
personality), same as some ROGD girls.
Transitioning in clusters of friends, whether in person or (for more isolated

types) online, same as some ROGD girls.
Acquiring a belief in being trans after enormous amounts of time spent online,
often coupled with a degree of real-world social isolation or rejection, same as
some ROGD girls.
Seeming to enjoy a bit of notoriety, popularity, or support from the world for
being “special,” same as some ROGD girls.
An unthinking, almost robotic belief in and spouting of trans ideology (the

badness of cis people, how any questions = hate and transphobia, how
parents are bad influences, revisions of personal history in a rote cookie-
cutter gender non-conforming way — “I always played with dolls”) same as
some ROGD girls.
Compare this to the trajectory of AGP. Usually people with more or less typical
life trajectories who have a particular kink or fetish, which for some, usually in
middle age, has gotten so out of hand that they feel driven to transition to live
out their fetish more fully.
This does not seem to match what we’re seeing in our young sons. It’s driving
me crazy that the girls are recognized with their own new category, and the
boys are shoved into the same old category and essentially written off with,
“”Well they have a fetish and they’ll always have it. Parents just don’t want to
acknowledge that. So sad.”
This is so wrong. My kid had a severe mental illness that caused problems
with identity, had the recent severe trauma, had the cluster of in-person
friends transitioning, spouts the ideology robotically and revised his personal
history with pre-packaged talking points …but there’s no place for him as
ROGD. He’s just (in late adolescence)a middle-aged dude with a fetish who
didn’t tell mom about his true self.
***** I reject that. The boys need a second look. *****
Michael Bailey
on June 20, 2019 at 1:19 pm said:
I agree with you that we don’t know for sure what’s up with the boys.
One possibility that captures both our position and yours is that most
of the adolescent boys have AGP, but in the current transgender-
transition-heroism-encouragement environment, more of them than in
the past come to believe they should transition.
I do not think that “autism spectrum” is a scientifically solid idea,

although I certainly have met persons who appeared to be on it. I
know, clinicians diagnose, but I’m not impressed with the research
supporting it.
It is of course possible that ROGD happens in some natal males just
as it seems to happen in natal females. That seems to be your
intuition. It is not entirely clear how we will find out what’s true. Let’s
keep thinking.
Dolly
Thank you so much for your measured and kind reply. I’m at
the end of my rope with no one offering anything to help my
son — or even acknowledging this is a problem other than a
real internal, innate “identity.” He is over 18 and got hormones
on his first visit, and cut off all contact with the family, and is
hanging out with people who seem (even if you remove their
gender identities from consideration) to function at a very low
level and to have serious interpersonal and emotional
problems. It’s a mess, a total mess. No one can seem to help.
I’ve offered to do or say anything to my son, anything he
wants, to make it OK for him to be in touch with us — multiple
times. Whatever he wants, we’ll do it. We’ve always kept
promises to him — he has to know our word is good. But
because we didn’t support “transition” when he was still at
home in our care, we the parents are evil, and his friends have
convinced him contact with us will cause him to “kill himself,”
no matter what we might do or say now to try to encourage
him to have even a limited relationship with the family. This is
in so many ways like being in a destructive mind-control cult.
Lori
on January 20, 2020 at 5:02 am said:
Dolly, my son seems to be in a similar situation to yours, only he is

younger (13, almost 14). I would love to connect with you, as I am
really struggling to see where my son fits in this conversation, except
for the characteristics of ROGD. Would you consider emailing me at
frogbunmom@yahoo.com? It would be wonderful to generate more
support and research for sons like ours.
Michael Bailey
Dolly, I would like to ask you a few things, between us. Can you email me:
profjmb@gmail.com?
lori
on February 4, 2020 at 11:53 am said:
Dr. Bailey, Would you mind if I contacted you as well? I have a 13-
year-old son who tells me that he is transgender, but he does not
seem to fit the profile of any of the types you have listed above. He
tells me that it began last March, almost a year ago, after he had
spent a great deal of time online searching trans forums on Quora,
Twitter, and other social media. He showed no prior signs of gender
nonconformity or dysphoria, and had a normal boyhood of rough and
tumble play and videogames. He is also heterosexual, and has had
several girlfriends and crushes on girls. I am not dismissing out of
hand the idea that he might have autogynephelia, but cannot find any
evidence of this, and he insists that there is no sexual attraction to the
idea of being female. I am willing to consider it, but am desperate to
know what the best way to proceed is. Many articles on
autogynephelia suggest that transition is rarely satisfying to
autogynephiles, and there doesn’t seem to be a good prognosis for a
happy future adult life for them. I would really appreciate insights into
how to proceed with my son. Thank you!
Runner456
Dr. Bailey, I am also in the same quandry as Dolly, although my son is

younger. I have talked to many parents of boys anywhere between the ages
of 12-20 and almost all report very similar things. Gifted, possibly or
diagnosed as on the autism spectrum, often outcasts, quirky kids who don’t fit
in. Many are feeling very uncomfortable with puberty. And also everything
Dolly mentioned above that goes along with the girls, influence online, groups
coming out in groups together. We feel frustrated that no one is recognizing
and talking about the boys.
A lot of these boys are young and haven’t kissed anyone, let alone had sex.
From what I am hearing many of these kids are behind in the sexual
development compared to older generations. I actually think there’s a chance
my son has never even masturbated and he’s a teenager. How can we say
these kids have AGP? Wouldn’t they need some life experiences sexually to
develop that?
Michael Bailey
With respect, AGP would be a difficult diagnosis for a parent to make.

Most adolescent boys are not sharing their sexual feelings and
fantasies with their parents. And unless a parent has studied, I
wouldn’t expect them to be alert to signs of AGP. Nevertheless, I have
been in correspondence with Dolly, whose son, I think is NOT AGP but
more like ROGD. But the thing is, no one can be sure of anything right
now. We need better ways of differentiating the different pathways to
transgender. The main barriers to this are ignorance (which we have
tried to alleviate) and ideological intransigence–which I hope you don’t
think we’re guilty of. Whatever the data say, we believe. It’s just that
the data aren’t definitive right now.
susanmzam
Could you maybe list some of the signs of AGP? It may be

helpful for parents of teen boys (like me) presenting quite
abruptly with symptoms of GD and claiming to be trans.
Richard
This article has been a great asset to establish fundamental knowledge and
insights regarding a topic most people know little about – gender dysphoria. I
refer to it frequently when I reach out to people or share my story. But it really
stops there. There are no insights on what to do, what should be done,
authoritative action, how to deter a young person off the cliff when the person
has never before in their life history shown signs of this, how to address
doctors who only affirm, etc. Watching and waiting for your child to grow up
does not work. They will be medicalized before you can say boo. Waiting for
the data to come in? No thanks. Our children will be drugged and hacked up
long before that.
I do not believe the answer here will come from researchers in timely manner.
What this country needs is authoritative action ASAP. The FDA, CDC, OHRP,
HSS, Surgeon General, etc… need to put a moratorium on the madness so
the research can be evaluated.
Dolly’s experience with her son is almost identical to that of my daughter. No

one offered to actually help her, she hangs in a trans cluster she met at her
university in a heavily entrenched city as a ‘transgender man.’ She was
harbored by her university (before dropping out), encouraged by friends,
doped up on testosterone in 2 visits, cut ties with her family after that who has
done nothing but be there for her and then her breasts were severed within a
year of that. This after 18 years of being a gender conforming highly gifted
female. I wish I had had the foresight to know better than to have sent her to
college. Dolly, you hit the nail on the head. This is mind control. It is undue
influence causing young people to dissociate from themselves. You are
correct that the males and females being swayed in the trans direction are
very similar today. It is so obvious on the private boards and forums that there
is a wave of boys just like the girls. But… there are no answers for the
females and there will not be for the males either unless we get the
authorities to do something about this burgeoning transgender business
destroying our youth.
susanmzam
Richard you are exactly right. a well thought out reply.
Dolly
Richard, I’m so sorry to hear about your experience. I wish your family
the best. I’m not sure what exactly we can do. The available evidence
certainly doesn’t support “affirmation and transition” of kids and
adolescents, but somehow, nearly everyone in authority is either (1)
unaware and adopting a warped Cliff’s Notes version of reality: “Well,
the APA and AAP approve of this, so it must be valid and evidence-
based”; or (2) afraid to speak out in a direct way. In their defense,
those who speak out in a direct way are vilified and written off as
TERFs, bigots, transphobes, ignorant, etc. We need a critical mass of
enough brave people to promote the same evidence-based narrative,
and right now I don’t think we have it — but it’s easier to say “The tide
will turn…eventually” when it’s not your kid being harmed. I don’t have
any answers and don’t know when this nightmare will end. I just keep
talking to anyone who will listen, even though nothing seems to be
happening. If we believe this is harmful, we need to keep speaking
out. It’s overwhelming, though.
rheapdx1
Richard,
As for the moratorium that is needed [and I agree, there should be

one, due to the tsunami of severe medical illnesses that will arrive on
the doorsteps of hospitals in the next 10-15 years…and the fight over
resources that is sure to coincide], it may not happen through
congress. At least before 2020.
Which will also mean many more coming to the fore to say that what is
being done to children, by ANY definition is child abuse. Be those
internists, endocrinologists, nephrologists, cardiologists, psychiatrists,
etc…..they have to make a /take a stand. As well as the facts that are
stated here at this site and others, being aired.
Put another way: if NPR and others will ‘affirm’ via proxy, without
questioning one goddamned thing about why the abuse is allowed to
continue, why they give a pass to sex workers and traffickers in the
community or the overtaking of women’s sports, via the actions of the
brigade, then there is a need to go to those who WILL air these. And
do so without worrying about a group of punks.
[Speaking of the media affirming crap: if one sees that or has copies
of where their local television station, has gone out of their way to
enable kids…like as in child DQ’s…and wants to go after the station in
question, perhaps the following will help. Remember, that there are a
few little lines in the FCC license that every station has, where they
are granted the license, to act in the public interest. This does not
include affirming, enabling or encouraging child abuse…which are
illegal activities. And if the station has any MD’s on their staffs, those
are mandated reporters, who should have informed the authorities.
But if they do not, what can be done, is via an organized effort…
challenging the renewal of the license. Once there is that in motion,
the station CAN either have their license suspended or placed on a
form of probation . If there have been multiple offenses, the license
can be permanently pulled from the holder of same….and if one looks
it up, this happened to an NBC affiliate many, many, years ago, in the
south….due to to their openly vicious and racist coverage of blacks, in
their license area].
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8759
on October 23, 2019 at 11:57 pm said:
I came here looking for insight on the trend of teenaged girls identifying as
trans.
I feel like this analysis is missing something crucial about the etiology of this
trend. I agree with Dr. Bailey that ROGD is a “socially contagious
phenomenon.” But, it seems obvious (to me at least) that a contributing factor
is how demoralizing and degrading it is to go through puberty as a girl.
When I was a young teenager, I found puberty traumatic. I hated the way men
and boys leered at me. I hated the way my peers play-acted sexualized
feminine stereotypes. I wanted no part of it. I cut my hair; wore boyish clothes;
and starved myself to try to stop my body’s development of breasts and hips.
Was I “gender dysphoric”? Yeah, in a sense. I hated the way I was treated as
a woman.
It makes sense to me on a gut level that “transition” is innately appealing to

many girls who don’t enjoy being treated like sex objects. I think that if I’d
been in high school in 2016 rather than 1996, identifying as trans might have
seemed like a logical step.
I understand today (getting along fine as an adult woman) that my disgust

with my body as a teen wasn’t a sign that I’m actually a man. It was a sign
that our society sexualizes young girls’ bodies in a disturbing and upsetting
way.
I wish more attention was being paid to this side of things. It bothers me to
watch terrific girls becoming convinced that if they don’t feel comfortable
complying with gender stereotypes about femininity, it’s because there’s
something wrong with their bodies—i.e., they’re not actually supposed to be
women and they would feel better if they lived as men.
Michael Bailey
on October 24, 2019 at 8:31 am said:
Thanks for your comment, 8759. The issue I have with your
hypothesis, that the ROGD epidemic is importantly linked to puberty
difficulty, is that I do not find it plausible that puberty has gotten much
harder for girls during the past 10 years, and yet, that’s when the
epidemic of trans-identification among adolescent girls has occurred.
Dolly
I agree with you, Dr. Bailey, but I also wonder, though, whether
8579 is onto something, in this sense. Right now, “gender
dysphoria” seems to be enjoying a meteoric rise not among
the traditional groups (extremely GNC people and/or men with
an irresistible fetish) but in teen girls. Why? Right now, gender
dysphoria, for them, is an “available symptom” just like
anorexia became, or like satanic abuse or recovered
memories or multiple personalities were for a while. It’s a way
for these kids to signal their distress in a way that others
readily recognize. It’s become a common idiom of distress.
While adolescence has not become harder, the “symptom” of
GD has become much more “available ” for distressed kids to
use. And use it they do, with disastrous results when we treat it
as a medical issue.
sonnet
Consider this: being trans wasn’t even a thing ten or 15 years

ago, so whereas it was an unheard of option back then, not it’s
everywhere. So even if the puberty experience hadn’t
changed, that has, and puberty + trans trendiness could
definitely be a contributing factor.
But I also disagree with the thought that it’s not harder for girls
to go through puberty these days. Trans ideology isn’t the only
thing that’s exploded- porn has too. I heard stories of girls
going to schools where they’re bombarded by sexual
harassment from lien addicted boys daily. Asking for nude
photos, sexting, expecting sex before real emotional
intimacy… apparently they’re commonplace at schools these
days. none of that was ‘normal’ when I went though puberty (it
existed but was mostly kept to the shadows) and they
DEFINITELY would have made it more traumatic for me.
Michael Bailey
Thanks for your comment Sonnet. But I don’t think porn has
much to do with the epidemic. What does? A plausible story (
to the scientifically uninformed), and a credulous target
audience. Of course we need to make sure whether the story
is true. Work in progress.
pelicanpaul
on October 27, 2019 at 10:48 am said:
8759 you nailed it! Imagine what a nightmare highschool would be

today with all the self-absorbtion apps and websites that people are
addicted to. Facebook, Instagram, Tumblr. You are a girl. You just
gained 20 pounds because you are turning into a woman. You spend
4 hours a day self-absorbed on your phone. Youtube tells you the
problem is solved because your “dysphoria” means you need
hormones. Overweight men. No problem. Women that are too curvy.
Not OK. Barbara Ehrenreich’s book “For Her Own Good” shows how
the medical profession has been trying to solve “the woman problem”
for centuries now. Gender Dysphoria is but the latest manisfestation.
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Alejandra
I have a really interesting contribution to this article. Just a bit of context:I

transitioned, male to female, 6 years ago, at 19 years old.
I’m with a straight male, and we’ve been together for 18 months now. I also
work professionally as a webcam model. $90,000 have been spent on my
shows this year, as I’m highly feminine and have no dysphoria surrounding
the genitals I was born with. I’ve spent upwards of $40,000 on cosmetic
surgeries as well, even though I’m only 26. I just keep feminizing my face and
body, which helps with confidence, my earnings, and my sex life. So, I’m
pretty sure most people would consider me a homosexual transsexual,
especially since I literally identify as male (although I’m legally female).
However, my orientation is absolutely atypical. When I was younger, women

never aroused me in any way, until I discovered female bodybuilders. I
became addicted to watching them in high school. Occasionally, when the
FBBs weren’t enough, male bodybuilders had to suffice. But probably 85% of
the time, the muscles and faces of female bodybuilders were sufficient. Never
once did I look at female genitals and like them. So, I tried sex when I was 18,
with a genetic female, and that’s the last time I ever tried to have sex with
one. However, my first semester of college, I inadvertently discovered trans
porn, became hooked, and thought that maybe I’d lead an easier life (I’m
extremely feminine…5’8, small-framed, 135 lbs, female voice) if I became one
myself.
However, it was difficult for me because I was what would be called auto-
androphilic. Even now I am, as I have sexual dreams of doing what I did in
high school, which is sitting in front of the mirror and pleasuring myself to my
abs and chest, which obviously isn’t nearly as defined as it used to be. I didn’t
know if I’d be able to let go of my toned male body, but I was also so socially
dysfunctional as a male. I couldn’t even speak to anyone and only made
friends with gay men. But at the same time, I figured I’d enjoy pleasuring
myself to my female self as well, as I was positive I’d make an attractive
female.
So, here I am… I pleasure myself to my hyper-feminine image on cam, and I

do it for a lot of money. However, I’m strongly attracted to men as well (even
just looking at them), and I couldn’t get turned on by female anatomy if I
wanted to. Even when it comes to my own transition, I never wanted breasts
or anything (I eventually got them for my work, though). I just wanted to be
skinny, have a pretty face, and to be able to express myself without judgment.
Now straight men love me for who I am, and I lead a pretty fun life. That said,
I think I’m technically a partial-autogynephile, but you’d never guess. I can’t
NOT move or speak like a female. All mannerisms are 100% female, which is
apparently atypical for trans girls. At the same time, I think I’m partial- or
completely auto-androphilic at the same time. My identity is probably 60%
female and 40% male, but I live as a woman.
Even socioeconomically, I’m atypical. I have made AGP friends before and
stopped because some of them strike me as privileged white males, more
than anything, and ALL of them assume that I want to be with them (I only like
other FEMININE trans girls and masculine men). Anyway, AGPs almost
always seem to be Anglo-Saxon and middle-class. They also seem to be very
proud of how intelligent they are, and anti-sex worker. It seems to be a
product of having too individualistic of a culture, to be honest. However, I
myself am from an impoverished background (have never met my father, was
taken away from my mother, etc.), yet I earned a STEM degree because of
grants and scholarships I had earned in college. Even not using the degree,
I’m upper-middle-class, which is unusual for a homosexual transsexual. But
I’m a sex worker. Lastly, I’m of Latin descent, which seems unusual for AGPs.
But with a computer science degree – which I used to work in Business
Intelligence for about 3 months, before quitting and returning to my webcam
show (I earn $100/hour, very consistently) – I would probably be considered a
lot more intelligent than the homosexual transsexuals. So, I wasn’t trying to
go on about myself necessarily. I thought it would be insightful for the writers
to learn about me. I’m an example of a trans MTF who is in the middle of
being AGP and homosexual. I know a lot of trans performers, and given how
much we thrive off of exhibitionism, but are clearly hyper-feminine and have
feminine identities, I think you’d find that most of us are actually a
combination of the two parts of the MTF dichotomy. That said, it’s next to
impossible for us to take your stereotypical AGP seriously. These people are
nuts and never talk about anything but their addiction to transitioning. I feel
like I moved on from that and tend to just talk about my boyfriend or traveling.
They’re unrelatable.
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4thWaveNow

A community of people who question the medicalization of gender-atypical youth

Gender dysphoria is not one thing

by J. Michael Bailey, Ph.D and Ray Blanchard, Ph.D

Michael Bailey is Professor of Psychology at Northwestern University. His book The

The failure of so many therapists and activists to acknowledge this distinction is

Types of Gender Dysphoria

The first type—childhood-onset gender dysphoria—definitely occurs in both biological

Childhood-onset Gender Dysphoria (Boys and Girls)

Onset of gender nonconformity is childhood cases is very early, typically about as

What do we know about childhood-onset gender dysphoria?

Childhood-onset gender dysphoria has been systematically studied by two high

It is important to realize that childhood-onset gender dysphoria is the only kind of

Children with childhood-onset gender dysphoria have a much higher likelihood of

Risk Factors for Persistence of Childhood-onset Gender Dysphoria

One powerful predictor of persistence is social transition, or a child’s living as the

What should you do?

Autogynephilic Gender Dysphoria (Adolescent Boys and Men)

From a parent’s perspective, autogynephilic gender dysphoria (which occurs only in

There is an important distinction between rapid-onset gender dysphoria and

(Warning: Autogynephilia is about sex. We understand that it is awkward and

It is important to distinguish between autogynephilia and autogynephilic gender

The relationship between autogynephilia and (autogynephilic-type) gender dysphoria

What do we know about autogynephilic gender dysphoria?

Blanchard’s research identified two distinct subtypes of gender dysphoria among

Autogynephilia is a probably rare, although it is difficult to know for certain. Among

Given how important autogynephilia is for understanding gender dysphoria, it may

Although many autogynephilic males find discovery of the idea of autogynephilia to

It is good to be aware of autogynephilia’s controversial status, because transgender

Males with autogynephilia can have a variety of autogynephilic fantasies and

Autogynephilic males sometimes identify as heterosexual (i.e., attracted exclusively

When autogynephilic males receive female hormones as part of their gender

Autogynephilia is a paraphilia, meaning an unusual sexual interest nearly exclusively

What should you do?

Rapid-onset Gender Dysphoria (Mostly Adolescent and Young Adult Females)

We believe that ROGD is a socially contagious phenomenon in which a young

What About Natal Males?

Our Current Take on ROGD

Rapid-onset Gender Dysphoria (ROGD) occurs when a young person (generally an

Here are the main similarities between ROGD and RM/MPD:

Autohomoerotic Gender Dysphoria

Gender Dysphoria Caused by Psychotic Delusions

Not Just One Type of Gender Dysphoria: Some Implications

If knowledge is power, then lack of knowledge is malpractice. The ignorance of some

Suicide or transition: WPATH & The Wanting to protect my

This entry was posted in Uncategorized and tagged autogynephilia,

266 THOUGHTS ON “GENDER DYSPHORIA IS NOT ONE THING”

Reidentified woman. I think it is very negligent and telling that a psychiatrist

It sure is. I have informed them about me detransitioning and we’re

Brave not grave!! Sorry!

However, I do think it is a choice, especially in the beginning (I believe it’s

Fighting for the girl that deserves to thrive

My own (purely anecdotal) hypothesis is that male ROGD, as enabled by the

Honestly, I hope they’re not autogynephiles in denial. I’d rather have

Some additional thoughts (directed towards the discussion in general):

There’s an important distinction between the claim that “heterosexual

This is purely my anecdotal observational theorizing, but here’s what I

Most boys eventually mature and develop a more nuanced view of

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Has anyone considered whether your daughter might be autistic?

I do not understand what it is about people who do not have a stake in

Perhaps ask her to read this.

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* I reject that. The boys need a second look. *