Throughout the last five years, a major question has been: “How did the anti-transgender pseudoscience movement achieve success so quickly?” In responding to this question, it is important to first note that cisnormativity is nothing new. Anti-transgender sentiment has been vocalized louder and mobilized more efficiently in recent years, but this is due to decades of countermovement activism by the institutions of the anti-LGBTQ+ religious right. Recent successes are also due in large part to the work and intersections of three groups: anti-LGBTQ+ movement organizations, and two groups of mental health practitioners – an old guard of mostly sexologists who experienced fading fortunes in the 2010s and a new guard of reactionary mental health practitioners, who have forced into the scientific record their beliefs about what caused some of their own children to come out as trans.
In the mid-2010s, the anti-LGBTQ+ movement suffered a series of setbacks, including the legalization of marriage equality in 2015, that left it dispirited, discredited and with dwindling funds. Stalwarts within the movement, however, kept the fires burning and strategized ways to reclaim the power and influence that was quickly fading. While we detail their strategy in the next chapter, it overlaps with the needs of a pre-existing cadre of gender and sexuality scholars who were losing their credibility and institutional control over LGBTQ+ health care.
Specifically, the anti-LGBTQ+ policy successes of recent years happened largely because the anti-LGBTQ+ movement was able to quickly capitalize on a budding network of researchers motivated by different experiences while pursuing the same goals. The first represents an “old guard” network of anti-trans mental health practitioners that activated in the wake of changes to the World Professional Association for Transgender Health (WPATH) standards of care and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2011 and 2013, respectively. After these changes, the “old guard” found themselves losing credibility and their clinics built by what their patients described as conversion therapy and experimentation on transgender people.
The second group represents a “new guard” network composed of several parents with academic credentials who refused to affirm their own and other transgender children in their personal orbits when they came out. This group built and expanded online communities dedicated to shoehorning their anti-trans beliefs into the scientific record. In this chapter, we chronicle the important milestones that brought each of these groups together into the contemporary anti-LGBTQ+ pseudoscience network.
As the professional and policy losses for each of these groups mounted, it became clear that a reframing of the issue of LGBTQ+ rights was necessary. Namely, they began to call into question the affirming care model, which replaced discredited conversion therapy approaches to LGBTQ+ health care in the mid-2010s. Their efforts also reinvigorated the self-described “parents’ rights” movement with fresh reasons to oppose inclusive education practices and LGBTQ+ representation in society.
WPATH was founded in 1979 as the Harry Benjamin International Gender Dysphoria Association. Since its inception, the group has promoted “care for transsexual, transgender, and gender-nonconforming individuals internationally.” One way it has accomplished this goal is by issuing Standards of Care for the Health of Transexual, Transgender, and Gender Non-Conforming People (SOC) beginning in 1979; most recently, Version 8 was published in 2020.
A committee of professional members and an international advisory group revises the SOC. WPATH standards, then, are representative of the members’ consensus understanding of the best scientific evidence for care to trans and gender nonconforming people.
In 2011, WPATH published the seventh version of its Standards of Care. SOC-7 represented a change of pace from previous versions in that it fully supported the gender-affirming care model. Gender-affirming care is “not a single category of services,” but involves “a range of services, including mental health care, medical care, and social services” that years of research shows is “medically necessary for the well-being of many transgender and non-binary people who experience symptoms of gender dysphoria, or distress that results from having one’s gender identity not match their sex assigned at birth.” Specifically, SOC-7 says, “Health professionals can assist gender dysphoric individuals with affirming their gender identity, exploring different options for expression of that identity, and making decisions about medical treatment options for alleviating gender dysphoria.”
Several members of an “old guard” of established mental health practitioners whose work with transgender people was pioneering, but also highly problematic, expressed objections. For example, Dr. Kenneth Zucker led the gender identity services for Toronto’s infamous Centre for Addiction and Mental Health (CAMH), where he focused on “helping” children “be more content in their biological gender,” although his patients later compared his practices to conversion therapy. Zucker also published controversial studies on the attractiveness of children with fellow CAMH employee Dr. Susan Bradley and claimed that parents’ “psychopathologies” can explain trans identity in kids, among other problematic beliefs detailed by researcher Andrea James.
Along with Zucker and Bradley, the network of established mental health practitioners focusing on gender identity in the 2000s included Dr. Ray Blanchard, Dr. Paul R. McHugh, Dr. James M. Cantor, Dr. J. Michael Bailey, and Dr. Stephen B. Levine.
Bailey’s work has been described as using transgender people as “guinea pigs” and has been likened to the experimentation on Black men undertaken at the Tuskegee Institute without their knowledge in the 1930s, reducing them to “expendable” pseudoscientific subjects. Bailey has been applauded by fellow members of the Human Biodiversity Institute (HBI) – a community of “neo-eugenicists” started by Steve Sailer, a contributor to the white nationalist website VDARE.
Blanchard, also a member of HBI, invented and advocated the “autogynephilia” diagnosis to explain trans identity as a form of mental disorder arising from men experiencing sexual arousal when picturing themselves as a woman.
Bailey also supports the autogynephilia diagnosis, but his most notable contribution to the field, from a 2003 book called The Man Who Would Be Queen, is based largely on Zucker’s and Blanchard’s work and chronicles the experiences of Bailey’s transgender patients. Bailey’s anecdotal accounts subsequently faced complaints for violating informed consent procedures – an accusation that, in part, led to the retraction of an article supporting new claims about gender identity that Bailey coauthored in 2023.
McHugh, an American psychologist, is closely tied to the anti-LGBTQ+ hate group American College of Pediatricians (ACPeds), a conservative Christian advocacy group founded in 2002 in response to the American Academy of Pediatrics’ position supporting marriage equality. Still, McHugh parlayed his credentials and experience at Johns Hopkins into opportunities to advance his support for autogynephilia and his view that transgender identity emerges from “guilt-ridden homosexual men.”
Levine chaired the WPATH SOC-5 committee in 1998 – the last SOC to include autogynephilia. Levine has since testified about his disagreement with the SOC over its removal of transgender identity as a mental disorder, claiming that the idea that “no form of gender identity is an abnormality” is “not true” and that there are “effective alternative approaches to affirmative care,” notably so-called gender exploratory therapies that Levine does not consider to be a form of conversion therapy for transgender people.
For this old guard that advocated treating trans identity as mental illness with associated conversion therapy-style “cures,” SOC-7 and what followed with the DSM-5 in 2015 represented professional blows to both their research agendas and to their business practices.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), is designed to “help clinicians and researchers define and classify mental disorders, which can improve diagnoses, treatment, and research,” according to the group. Like the WPATH SOC, updates to the DSM are based on the most recent and sound scientific evidence with contributions from hundreds of practitioners and researchers. In 2007, APA created a task force and 13 working groups to begin the process of revising the DSM-4. That process and committee work culminated with the publication of the DSM-5 in 2013.
Prior to publication of the DSM-5, identifying as transgender was considered a mental disorder, just as homosexuality had been considered a mental disorder prior to the publication of the DSM-2 in 1973. The DSM-5 removed the diagnosis of “gender identity disorder,” but noted “gender dysphoria” is a condition associated with the stress one feels because of a perceived mismatch between one’s gender identity and the sex one was assigned at birth.
The classification is important because it not only helps alleviate stigma associated with trans identity, but like SOC-7, also helps prevent abuse of trans people by psychiatrists and psychologists who view trans identity as a “disorder” that needs to be “cured.” To proponents of trans conversion therapies, DSM-5 was another professional loss.
Notably, Blanchard and McHugh suffered an earlier professional loss in 2010 when Rhiannon O’Donnabhain, a transgender woman, successfully sued the Internal Revenue Service (IRS) to deduct medical transition expenses from her taxes. The IRS relied on Blanchard’s notion of trans identity as mental disorder and McHugh’s work to argue that medical transition was “cosmetic” and not “necessary” under federal law. The U.S. Tax Court, however, disagreed and in its 11-to-3 ruling, determined that the IRS’s position was “thoroughly rebutted by the medical evidence.’’
These losses became even more real for the old guard when fraud cases against dangerous conversion therapy practitioners mounted, U.S. states began passing conversion therapy bans, and, in 2015, the Canadian clinic Zucker led shuttered after Ontario‘s conversion therapy ban took effect.
By 2016, with their practices discredited and academic agendas marginalized by the consensus of their respective peers, the old guard needed somewhere to turn.
Between 2015 and 2016, three websites that are crucial for shaping the narratives and research agendas of the new guard in the anti-LGBTQ+ pseudoscience network started online. These sites largely recycled the conversion narratives of the old guard but laundered them through the voices of “parents” of trans kids who refused to affirm their children. By 2017 and 2018, the “old guard,” including Bailey, Blanchard, Zucker and others, made their way into the sites’ conversations, helping lay the groundwork for the next iteration of the anti-LGBTQ+ pseudoscience “research” agenda.
The sites frequently frame affirming care and conversion therapy as issues of “parents’ rights,” with the parents on the site understood as protecting kids from an “experimental” affirming approach. Much of the writing, however, details the way parents – some of whom claim to have academic credentials – refuse to accept their transgender kids. The sites chronicle the mostly anonymous parents’ “struggles” against medical providers who encouraged them to accept their trans kids and share stories of how they thwarted their children’s attempts to seek out affirming spaces, rather than the harm inflicted on the children living in a transphobic society.
Yet, the sites would become more than just a place where supposedly concerned parents and caregivers learn to deny the reality of trans existence. The sites served an important purpose linking U.K. and U.S. trans-exclusionary feminists (often referred to as TERFs). In addition, by the end of 2016, they became sources for a pseudoscientific narrative that has since solidified the anti-LGBTQ+ movement: rapid-onset gender dysphoria (ROGD) and the spread of trans identity through “social contagion.”
In March 2015, 4thWaveNow was launched by “Denise” (also known as Denise Caignon, Marie Verite and Janette Miller), a self-described mother whose child came out as trans “after a few weeks of total immersion in YouTube transition vlogs and other trans-oriented social media.” The site bills itself as “a community of people who question the medicalization of gender-atypical youth,” but it promotes narratives derived from pseudoscientific studies of LGBTQ+ people such as detransition, desistance anecdotes and conspiratorial claims about schools and health care providers indoctrinating and “mutilating” children. The site’s authors also heavily rely on pseudonyms to share disinformation, including handles like “Marge Bouvier Simpson,” “fightingunreality,” “missingdaughter” and “skepticaltherapist.”
Despite Caignon’s claim that her child “suddenly” identified as trans, her child, Chiara, says they identified as trans at 16 and came out at 17. In a 2018 interview, Denise said, “I had thought for quite some time that she was likely a lesbian (which I fully supported)”; however, remembering “my own dead-certainties at age 17 that turned out to be mistakes when I got older” led Denise on “a research mission” she shared through 4thWaveNow.
According to the site, 4thWaveNow “frequently features posts that focus, often unflatteringly, on the activists and providers involved in pediatric transition” to expose the “harm” done “to the decades of progress achieved by the women’s and LGB liberation movements.” Caignon insists she and the 4thWaveNow community are against conversion therapy for gays and lesbians, but the same cannot be said for transgender kids; and, she argues, that the affirming care model represents a “conspiracy” targeting children across all sectors of society.
The site’s contributors sometimes claim to be “lifelong liberals” or “leaders” in LGBTQ+ affirming groups like Parents, Friends, and Families of LGBTQ+ People (PFLAG) in an apparent effort to 1) isolate transgender people from their allies and 2) further a narrative that criticism of gender-affirming care does not originate solely from conservative religious figures.
One author, “worriedmom,” claims to be a PFLAG chapter leader and lawyer with a son who works in the pharmaceutical industry. In a post on March 23, 2017,  the author argues it once “seemed logical to include the ‘T’ as part of the ‘LGB,’” but then recites a litany of anti-trans legal claims challenging gender identity protections in schools and equating trans identity with an ideology that are consistent with the legal arguments made by conservative Christian legal organizations in the U.S.
An example of the conspiratorial mindset comes from a guest post published on February 29, 2016, authored by “skepticaltherapist” – a psychotherapist with a trans child who claims to be a lifelong liberal. In the post, which is titled “Tumblr snags another girl, but her therapist-mom knows a thing or two about social contagion,” the author compares a supportive social environment for transgender people to an “alien mind control device” from Star Trek. The author refers to Tumblr as a manifestation of the “device” and refers to schools with trans-supportive staff as “cult indoctrinators.” One post in August 2017 compares gender-affirming care to Nazi eugenics programs.
In a post published on November 24, 2017,  Jenny Cyphers, a mother of a trans teen and founding board member of the group Rethink Identity Medicine Ethics, shows the power of 4thWaveNow and its partner sites in narrative construction that reinforces cisnormativity and a distrust in science that does not confirm one’s pre-existing views. In the post, Cyphers recounted her experience “asking questions” about the affirming care model from doctors after her child came out as trans. “I did get answers,” she said, “but not the sort I was looking for.”
In November 2015, about six months after 4thWaveNow appeared, educational trainer Stephanie Davies-Arai launched TransgenderTrend, a U.K.-based “organization of parents, professionals and academics” who are “concerned” about the “current trend to diagnose children as transgender.” As researcher Andrea James notes, Davies-Arai founded the blog largely in response to her revulsion to the affirming care model and argued that affirming a trans child is the equivalent of a parent “validating a child’s false belief.” Davies-Arai also characterized the blog’s founding as a “collaboration” with 4thWaveNow.
In a post celebrating the launch, Davies-Arai takes on a conspiratorial tone, asking “who gains” from the “medicalisation of children” and “whose vested interests” are “fueling the promotion of transgender ideology?” The post claims gender identity is a “new” and “untested” theory that “contradicts all we know about child and adolescent development and psychology” and welcomes contributions from supporters. In a December 2016 post, Davies-Arai returns to a conspiratorial framing of LGBTQ+-inclusive education programs, referring to them as “a well-funded dangerous social and medical experiment.”
Despite its U.K. origins, in January 2016, the group authored a letter in opposition to the U.S. Department of Housing and Urban Development’s proposed rule ensuring equal access to housing regardless of sexual orientation and gender identity. Like other anti-LGBTQ+ groups that demonize transgender people as predators who attack women, TransgenderTrend argued that HUD’s proposal gives “insufficient consideration” to the “safety and privacy of women and girls.”
In a March 2016 letter to members of the U.K. Parliament on transgender conversion therapy, Davies-Arai characterizes the end of the CAMH clinic’s conversion therapy practices – led by Dr. Zucker – as politically motivated and gives voice to the old guard’s professional losses, citing Zucker by name several times. Davies-Arai also takes issue with WPATH’s SOC-7. She claims to oppose conversion therapy for “LGB” people, but warns – again reminiscent of American anti-LGBTQ+ and “ex-gay” groups – that the affirming care model leaves no room for psychologists and psychotherapists to attempt conversion therapies with transgender people and will put them at risk of professional derision or civil liability.
In a January 2017 post, Davies-Arai refers to transgender identity as an “ideology,” and, again, advocates for counselors and therapists to use conversion therapy techniques on transgender people, claiming mental health professionals who follow the affirming care model are “merely performing a role to validate an unproven ideology and further a political campaign through their clients.”
Davies-Arai links to a site called Youth Trans Critical Professionals to help substantiate her claims. She also posts “with permission” an article by Sasha Ayad, an American counselor, publisher of the site Inspired Teen Therapy, and co-founder of Gender Exploratory Therapy Association. In the post, Ayad claims that therapists who follow the affirming care model are “wrong” and cites several members of the old guard to make her point, including Dr. James Cantor and ACPeds.
In 2020, TransgenderTrend was invited to give evidence in a U.K. case known as Bell v. Tavistock. The case came amid a campaign by another so-called parents’ group formed in 2018 known as Our Duty to end gender-affirming care, calling it “state-sponsored sterilization.” The Bell case challenged the use of hormone therapies for transgender people under age 16 and sought to declare that trans young people are not capable of providing informed consent for treatment. It was brought against the National Health Service’s (NHS) Gender Identity Development Service (also known as Tavistock clinic) in London by an anonymous parent seeking to prevent her transgender child from receiving affirming care and Keira Bell, a 23-year-old detransitioner.
In February 2020, the U.K.’s High Court agreed to review the complaint and granted permission to TransgenderTrend to submit “evidence” it claimed undermines the affirming care model. The judge refused to allow LGBTQ+ rights groups to present any supportive evidence. In December 2020, the court ruled in favor of Bell, in part citing Drs. Paul Hruz and Stephen Levine, and Tavistock stopped taking referrals for puberty blockers. In September 2021, the NHS won an appeal overturning the ruling.
Still, the coalition of anti-trans activists and pseudoscientists formed to support the case doubled their efforts. While Tavistock was closed and restructured in July 2022, in September 2023, TransgenderTrend sponsored a letter to the U.K. prime minister accusing the government of “allowing gender-identity ideology into schools” and calling for strong regulations to prevent teachers from offering any social affirmation to young LGBTQ+ people in the name of “protecting children.“ The letter was signed by Davies-Arai and several members of the advocacy groups (e.g., Genspect and Society for Evidence-Based Gender Medicine), which have become the backbone of the anti-LGBTQ+ pseudoscience movement in the U.S. and U.K.
In addition to posting original blogs and undertaking political activism in conjunction with conversion therapists, both 4thWaveNow and TransgenderTrend cite several articles as authoritative sources for information on transgender identity including the work of other old guard scholars like McHugh and his ACPeds colleague Paul Hruz. They also cite a relatively new figure on the scene, a Pennsylvania-based psychotherapist named Lisa Marchiano. Many of these scholars share a perspective that transgender identity is mental illness and is thus “curable,” as each supports banning gender-affirming care.
Youth Trans Critical Professionals
In 2016, both 4thWaveNow and TransgenderTrend posted articles welcoming the activation of a third site with a shared mission and contributor list, Youth Trans Critical Professionals (YTCP). Like the other two sites, YTCP was originally a blog open to comments that purported to bring together parents and caregivers to share information. 4thWaveNow’s story featured an interview with the site’s publisher, noting that the anonymous creator is a psychotherapist in private practice and a university professor.
In the interview, the unnamed therapist claimed to have become interested in trans identity after noticing a pattern of kids “announcing” they were transgender after “spending a lot of time on social media” and then “requesting access to cross-sex hormones.”
As researcher Zenia Jones points out, the site’s author finds common ground with Dr. Zucker on conversion therapy and advocates a ban on gender-affirming care until at least age 25 – a common political tactic of many anti-trans groups who know support for total bans on gender-affirming care are less politically viable. On YTCP, the author says that although the first reaction of most parents was to affirm their child’s identity after they come out, the “urge to support their child“ should be suppressed. Instead, “caution should be the word of the day” when it comes to transgender identity.
In a June 2016 post that makes several pseudoscientific claims, YTCP compares transgender identity to a “trend” and the affirming care model to the phenomenon of therapists fraudulently claiming to recover “lost memories.” The author also cites her fear that the internet is a source of “social contagion” through which transgender identity spreads and her belief that the media and government are colluding to normalize transgender identity. Similar themes appear in many of the articles published by YTCP and its contributors.
An email leak in 2023 exposed the author of the site as Lisa Marchiano. The psychotherapist and contributor to 4thWaveNow and TransgenderTrend is deeply connected with the anti-LGBTQ+ pseudoscience network, and is a key figure in the creation of ROGD and the myth that LGBTQ+ identity spreads through “social contagion.” Despite years of posting online claiming to be a therapist who “works with detransitioners” and offering commentary about topics such as detransitioning, Marchiano has admitted her “work” with detransitioners is not “clinical work.”
In addition to revealing Marchiano as the author of YTCP, the same email leak linked Marchiano to the pseudonym “Lisa Bell.” In June 2016, Bell signed a letter from the National Association of Scholars, a right-wing American nonprofit, claiming that children were being exploited by the inclusion of gender identity protections in federal civil rights statutes. Bell’s virtual signature appeared alongside her affiliation – the founder of Youth Trans Critical Professionals.
The letter claims “the call for transgender rights is … part of a larger movement aimed at a fundamental transformation of marriage, family, sexual relations, and ‘gender identity’ in our society, not to mention biology” and claims civil rights protections for transgender kids in schools represent a “reckless government overreach” that “rejects scientific reality.”
Along with Bell (Marchiano), the letter is co-signed by representatives of numerous hate groups, including the anti-Muslim group Center for Security Policy, and anti-LGBTQ+ groups ACPeds, Family Research Council, American Family Association, Eagle Forum and MassResistance. Members of the Center for Urban Renewal and Education (CURE) and the National Task Force for Therapy Equality also signed the letter. CURE was founded by Star Parker, who has claimed the “B” in LGBTQ+ stands for “bestiality.” The National Task Force for Therapy Equality is led by ACPeds member David Pickup and advocates conversion therapy for LGBTQ+ people.
It is difficult to know the actual number of LGBTQ+-identified people in the world. The figures we do have are estimates based on probability (or random) survey sampling techniques. The most rigorous of these estimates suggest that in the United States, there are about 10.3 million lesbian, gay, or bisexual adults and about 1.4 million transgender adults.
The estimated number of LGBTQ+ people has increased over time, but it has not increased evenly. More than half of people in the “LGBTQ+” category identify as bisexual, for example. In addition, LGBTQ+ identities are most common among the youngest generations, namely Generation Z (people born between 1997 and 2003) and millennials (people born between 1981 and 1996). Estimates have also shown that the number of people who identify as transgender has ticked up, with the best estimates suggesting about 1.4% of 13- to 17-year-olds and about 1.3% of 18- to 24-year-olds in the United States identify as trans. That means about one-fifth of all trans people in the United States are between 13 and 17 years old.
A long list of social science literature shows that despite (and perhaps because of) the relatively small percentage of the population who identify as LGBTQ+, most Americans overestimate the prevalence of LGBTQ+ people in society when asked for surveys. The phenomenon, called innumeracy, has several potential causes; however, the consequence of overestimation of the LGBTQ+ population is a decrease in support for LGBTQ+ rights.
The unfounded fear that an accepting society is creating new transgender kids and the idea that transgender identity occurs “out of the blue” are corollaries of innumeracy, as is the false belief that most young trans people eventually “desist.” Still, these ideas are frequent topics of discussion on 4thWaveNow, TransgenderTrend and YTCP. It may be unsurprising, then, that the blogs were the focus of a recruitment strategy in 2016 by Dr. Lisa Littman, then at the Icahn School of Medicine, when she sought information from the anti-trans “parents’ groups” about the development of transgender identity.
While the term ROGD was popularized in Dr. Littman’s 2018 paper in the journal PLOS ONE, the concept appears to originate from a series of recruitment posts to 4thWaveNow, TransgenderTrend and YTCP that appeared in July 2016. In the recruitment posts, Littman describes ROGD as happening “in the context of increasing social media use and/or being part of a peer group in which one or multiple friends has developed gender dysphoria and come out as transgender during a similar time frame.”
Along with Littman’s description that primed survey takers with details of the experience she was seeking to study, the request for participation Davies-Arai posted included a comment saying, “There has been a huge spike in adolescent referrals to gender clinics over the last year (predominantly teenage girls) and very little evidence of any serious critical evaluation of why this is happening coming from clinicians, other than that transgender people have become more known about and accepted.” The post implies not that an accepting social environment makes it easier for transgender people to come out, but that an accepting social environment creates new transgender-identifying people.
Denise of 4thWaveNow shared the survey request and added, “Many members of the 4thWaveNow community are parents of teens who became convinced they were the opposite sex after a steady diet of social media and/or peer influence. In most of our cases, the transgender identity came on suddenly and with little warning.” In her post sharing the link to YTCP, Marchiano noted that “sudden onset of gender dysphoric feelings in the teen years is an unusual presentation.”
Anti-LGBTQ+ groups took note of the post. Notably, the anti-LGBTQ+ and anti-abortion nonprofit law firm Alliance Defending Freedom (ADF) warned of the “danger” of ROGD in an email to supporters on August 24, 2016. Notably, this warning came during the participant recruitment phase of Littman’s study and long before the results became public. The ADF email cites a National Review column by David French, who links to TransgenderTrend and 4thWaveNow. French also links to an article from The American Conservative on “the cult of transgender [sic]” that uses the phrase “social contagion” to describe the development of transgender identity.
Titled “Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria,” Littman’s research paper appeared in the open-access journal PLOS ONE on August 16, 2018. Nonetheless, the idea and the draft paper were in circulation long before the official publication date. Notably, Lisa Marchiano published a blog post on another site under her own name in November 2016 discussing ROGD and, in the original version of the manuscript, Littman thanks Marchiano for her “feedback on earlier versions of the manuscript.” It was not disclosed that Marchiano was the publisher of the blog Littman used to recruit her subjects.
Littman’s paper was quickly embraced by the “old guard,” some of whom, including Bailey, Blanchard and Zucker, were at least acquainted with Littman prior to the publication of her paper. It was also amplified by the “new guard,” including Marchiano, who had already added her views on “social contagion” as a component of ROGD (mentioning ROGD by name nearly one year before Littman’s paper was published) in a 2017 article in the journal Psychological Perspectives.
Littman’s paper was widely rejected by the scientific community for methodological and conceptual flaws, including recruiting anonymously from 4thWaveNow, TransgenderTrend and YTCP, each infamous for hosting parents who explicitly rejected the idea that their children might be trans, never measuring experiences of the children in question, many of whom were now adults at the time the study was launched, actively recruiting even while conservative outlets covered the concept as if it were proven fact, and violating basic principles of research design by telling the participants the specific hypothesis they wanted evidence for in the recruitment materials. Despite these flaws, the paper’s central argument – that the increasing numbers of adolescents presenting for care represent a “new” subtype of gender dysphoria which is mainly instantiated by social contagion in online spaces and friend groups – is an enduring, viral argument in transphobic spaces that has been adopted en masse by online anti-trans ecosystems and conservative media.
The connections and research agendas of the old and new guard further solidified in 2018 within the context of a research community known as the Pediatric and Adolescent Gender Dysphoria Working Group (PAGDWG). Members included stalwarts of the old guard Ray Blanchard, J. Michael Bailey, James Cantor, Kenneth Zucker, Susan J. Bradley and Michael Laidlaw and new researchers and practitioners including Lisa Marchiano, Australian psychiatrist Roberto D’Angelo, TransgenderTrend contributor Sasha Ayad and Irish psychotherapist Stella O’Malley.
PAGDWG was most active between 2018 and 2020. Its webpage described the group as “an international group of psychiatrists, psychologists, clinical social workers, researchers, and psychoanalysts that have a special interest in the treatment of GD [gender dysphoria] in children, adolescents, and young people.” It also cited false claims about ROGD, social contagion and the affirming care model its members previously helped cultivate and force into scientific discourse. “Many of us have come to be concerned about the sharply rising numbers of young people presenting with gender dysphoria, and the current trend to affirm them and in many cases move toward social and medical intervention,” the webpage continued.”
Billing itself as another group asking questions about the efficacy of the affirming care model, PAGDWG claimed, “We wish to discuss the evidence for this rise in trans identified referrals and explore the evidence that social contagion may be at play, particular for those young people presenting with rapid onset gender dysphoria (ROGD) in adolescence.”
The group also helped calibrate the trajectory of research that would support their pseudoscientific claims grounded in ROGD and social contagion. In 2018, for example, the group promoted the view that most transgender people “desist” or “detransition,” a claim which often conflates “regret” over transitioning with discriminatory experiences that prevent people from accessing care. Most trans people who stop social or medical transitioning do so because of barriers to accessing care and because they experience rejection, not because they stop identifying as trans.
Regardless, PAGDWG helped generate pseudoscientific support for denying gender-affirming care since, they falsely claim, most trans people desist anyway. By 2020, the group was helping Littman, then faculty at Brown University, recruit “desisters” and “detransitioners” for a study. The group also helped the old guard attempt to recoup its professional losses by platforming calls for major medical groups to “reevaluate” the gender-affirming care model, which they claimed was too experimental.
The “parents’ rights” framework and the pseudoscientific claims generated by the old and new guards of the anti-LGBTQ+ pseudoscience network were also quickly embraced by anti-LGBTQ+ organizations and politicians eager to restrict LGBTQ+ rights – not just in medical care, but across all areas of law and society. Because ROGD operates on the assumption that gender identity is an “ideology” and a “contagion” that spreads quicker in spaces that affirm LGBTQ+ identities, in addition to making the case for restricting access to affirming health care, ROGD provides a convenient justification for restricting positive portrayals of LGBTQ+ people in schools and libraries, free expression of LGBTQ+ communities (like drag performances in public spaces) and restrictions on trans kids playing sports.
In 2018, the National Task Force for Therapy Equality (NTFTE), an organization founded by conversion therapy proponent David Pickup, sent a letter to Washington state lawmakers opposing the state’s conversion therapy ban (SB 5722), claiming that “more than 100 years of research have found the therapy is safe and effective.” The letter notes several “pro-gay organizations” that “support psychotherapy” for transgender people and cites the blogs YTCP and 4thWaveNow.
Pickup had previously challenged California’s conversion therapy ban in a case called Pickup v. Brown in 2012. His case relied on the work of Christopher Rosik of the Alliance for Therapeutic Choice and Scientific Integrity, formerly the National Association for Research and Therapy of Homosexuality (NARTH), to make its unsuccessful claims. Among other citations in NTFTE’s letter is work by Joseph Nicolosi, NARTH’s founder and the “father of ‘ex-gay’ therapy.”
While Washington banned conversion therapy in 2018, the Alliance Defending Freedom (ADF), representing therapist Brian Tingley, sued the state in 2021. That suit claimed the ban violated Tingley’s religious freedom to use conversion therapy on LGBTQ+ clients. ADF’s case heavily relies on figures in the anti-LGBTQ+ pseudoscience network for substantiation including Christopher Rosik and psychiatrist Stephen Levine.
In 2019, in another example of how pseudoscience becomes policy, Illinois state Rep. Thomas Morrison’s Youth Health Protection Act banning gender-affirming care for minors specifically cites Blanchard’s and Bailey’s support for ROGD and includes the following pseudoscientific justification for the law:
“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. ... [sic] 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.”
Framing transgender identity as especially dangerous to young girls fits neatly with pre-existing stereotypes about transgender people as predators that have pervaded the religious right’s anti-LGBTQ+ campaigns to limit civil rights protections for transgender people (commonly called bathroom bills) since at least 2015.
In 2020, ACPeds claimed to have testified in support of similar “Vulnerable Child Protection Acts” drafted in part by ADF and Liberty Counsel in at least four states. As we detail in the next chapter, by 2021, the Promise to America’s Children was launched by ADF, Family Policy Alliance and Heritage Foundation, as well as dozens of organizations, began pushing restrictions on LGBTQ+ rights with increased vigor.
What the 2015-2019 work of the anti-LGBTQ+ pseudoscience network gave the groups behind the Promise to America’s Children and the sponsors of hundreds of anti-LGBTQ+ bills in recent years was a ready-made framework for politically and pseudo-scientifically justifying their draconian measures.
Namely, researchers seem to agree that trans people have felt more comfortable coming out in recent years; but far-right and anti-trans researchers have taken control of the narrative with pseudoscience like ROGD and social contagion to argue that kids are actually identifying as trans because of social pressure from peers in LGBTQ+-affirming environments and with the help of an affirming medical model they see as criminal and equate to sex trafficking. That is, the far right translated the old- and new-guard pseudoscience into "Gender Ideology" as a talking point to claim any kind of positive affirmation of LGBTQ+ identity was a method of creating new trans kids, often through recruitment, “grooming” and surgical interventions.
Research also shows that people who identify as transgender are less likely to be white and more likely to be Latino/a/x. This suggests efforts to suppress trans people and their access to health care will be acutely felt by people of color; and anti-trans laws as well as the assumptions that underpin much contemporary anti-LGBTQ+ pseudoscience smack of racism in the vein of the ”great replacement theory,” which right-wing extremists use to suggest white people are being replaced by people of color and, now, trans people.
Treating LGBTQ+ identity as a condition to be “cured” has always fit within the Christian right’s ideology. The individualistic ethos at the heart of the conservative Christian (especially evangelical) movement has always treated certain social conditions like poverty, addiction or disease as manifestations of individual choices to do wrong. Consequently, these conditions are viewed as the product of sin. Change, then, requires the individual to do better and to live in accordance with a different standard of behavior, namely a conservative theology often referred to as a “biblical worldview.”
Pathologizing LGBTQ+ identity was acceptable to this worldview so long as it did not “excuse” sinful behavior. That is, pathologizing LGBTQ+ identity was only complementary to the aims of the anti-LGBTQ+ and religious-right political movements if it offered a pathway out of “sin.” Conversion therapy fits that bill.
Both the old and new guard continue to press for not just reevaluations of the affirming care model but for discarding it altogether. After WPATH released SOC 8, a 2022 campaign called “Beyond WPATH” was launched by therapist Dr. Joseph Burgo. The letter declares the signatories, which include representatives of groups including TransgenderTrend, the Gender Exploratory Therapy Association, ACPeds, Rethink Identity Medicine Ethics and even Moms for Liberty, are “align[ed] with” those who have “rejected the affirmative approach” to LGBTQ+ health care. Burgo’s letter calls WPATH “discredited” and instructs parents and caregivers of LGBTQ+ people to use “alternative resources that can be found online and in printed materials that are now widely available.” Many of those materials advocate conversion therapy and are pushed by the “gender critical” industry Burgo and dozens of the signatories co-founded or administer.
The professional losses of the old guard and the rise of the new guard met with the political losses of the Christian right in the mid-2010s to form a perfect storm for a relaunch of anti-LGBTQ+ movement activism targeting transgender people. That storm is yet to subside. In the next chapter, we detail the political opportunism of anti-LGBTQ+ conservative Christian right organizations as they wielded the emerging anti-trans pseudoscience to recoup some of the money and political power they lost after the legalization of marriage equality and, ironically, after their victory overturning Roe v. Wade.
 WPATH. https://www.wpath.org/media/cms/Documents/SOC%20v7/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf. (Accessed 8/25/2023).
 HRC. https://www.hrc.org/resources/get-the-facts-on-gender-affirming-care. (Accessed 8/25/2023).
 See: https://web.archive.org/web/20151019233949/http://www.bilerico.com/2015/01/meet_the_last_respectable_reparative_therapist.php. See: https://www.huffpost.com/entry/how-to-spot-antitrans-con_b_8055816. See: http://www.brynntannehill.com/the-end-of-the-desistance-myth/. See: https://www.queerty.com/dr-kenneth-zuckers-war-on-transgenders-20090206#ixzz2f9pCTnso.
 Brown, Patricia Leigh. December 2, 2006. “Supporting Boys or Girls When the Line Isn’t Clear.” https://www.nytimes.com/2006/12/02/us/supporting-boys-or-girls-when-the-line-isnt-clear.html. (Accessed 8/25/2023). See: https://web.archive.org/web/20221208162737/https://www.ourcommons.ca/DocumentViewer/en/43-2/JUST/meeting-14/evidence.
 Zucker, Kenneth J., Jennifer Wild, Susan J. Bradley, and Claire B. Lowry. February 1993. “Physical attractiveness of boys with gender identity disorder.” Archives of Sexual Behavior 22: 23-36. https://link.springer.com/article/10.1007/BF01552910.
 Kucker, Kenneth J., Susan J. Bradley, Dahlia N Ben-Dat, Caroline Ho, Laurel Johnson, and Allison Owen. “Psychopathology in the Parents of Boys with Gender Identity Disorder.” Journal of the American Academy of Child and Adolescent Psychiatry 42(1):2-4. https://pubmed.ncbi.nlm.nih.gov/12500069/.
 James, Andrea. “Kenneth Zucker vs. transgender people.” https://www.transgendermap.com/politics/psychology/kenneth-zucker/. (Accessed 8/25/2023).
 Beirich, Heidi and Bob Moser. December 31, 2003. ”Northwestern University Psychology Professor J. Michael Bailey Looks into Queer Science.” Intelligence Report. Southern Poverty Law Center. https://www.splcenter.org/fighting-hate/intelligence-report/2003/northwestern-university-psychology-professor-j-michael-bailey-looks-queer-science. Centers for Disease Control and Prevention. https://www.cdc.gov/tuskegee/timeline.htm.
 Beirich, Heidi and Bob Moser. December 31, 2003. ”Northwestern University Psychology Professor J. Michael Bailey Looks into Queer Science.” Intelligence Report. Southern Poverty Law Center. https://www.splcenter.org/fighting-hate/intelligence-report/2003/northwestern-university-psychology-professor-j-michael-bailey-looks-queer-science. (Accessed 8/23/2023). See Also the work of Lynn Conway (https://ai.eecs.umich.edu/people/conway/TS/BaileyAssociates/HumanBiodiversityGroup.htm) and Andrea James (https://www.transgendermap.com/politics/academia/academic-exploitation/). For information about VDAR, see Southern Poverty Law Center. N.d. ”VDARE Extremist File.” https://www.splcenter.org/fighting-hate/extremist-files/group/vdare. (Accessed 8/23/2023).
 https://www.washingtonpost.com/national/health-science/long-shadow-cast-by-psychiatrist-on-transgender-issues-finally-recedes-at-johns-hopkins/2017/04/05/e851e56e-0d85-11e7-ab07-07d9f521f6b5_story.html. https://www.firstthings.com/article/2004/11/surgical-sex.
 On Zucker’s practices, see: https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences.
 https://web.archive.org/web/20161105162350/https://thejungsoul.com/guidance-for-parents-of-teens-with-rapid-onset-gender-dysphoria/. See also: https://web.archive.org/web/20230905151930/https://4thwavenow.com/2018/05/30/intellectual-no-platforming-ken-zucker-pushes-back-on-the-latest-attempt-to-discredit-desistance-persistence-research/.
 Many anecdotes attempt to build community, even pride, around the label “transphobe.”
 Detransitioners are people who started social or medical transition processes and later stopped. The most common reason cited by transgender people for stopping their transition is negative social pressure – not because they no longer identify as transgender. https://politicalresearch.org/2023/01/27/combating-anti-transgender-disinformation. Desistence refers to the false idea that most young people who identify as trans “desist” or no longer identify as transgender in adulthood.
 https://web.archive.org/web/20170325204701/https://4thwavenow.com/2017/03/23/the-tortoise-the-hare-gay-rights-v-gender-identity-in-us-law/. See also: https://web.archive.org/web/20170326083313/https://4thwavenow.com/2017/03/12/lupron-whats-the-harm/.
 “Working with Parents.” https://web.archive.org/web/20160320165820/https://youthtranscriticalprofessionals.org/.
 Doyle (2023).
 Using their sites as evidence to support their claims is not unusual. In a March 2017 post, for example, Marchiano published an open letter to the American Psychological Association that linked to anecdotes on 4WN and her own YTCP as evidence of “social contagion” and to question the link between LGBTQ rejection and suicide. https://web.archive.org/web/20170309142749/https://youthtranscriticalpro....