The Use of Methodologies in Littman (2018) Is Consistent with the Use of Methodologies
Over the past decade, there have been striking changes in the demographics of patients presenting to clinics with gender dysphoria (Aitken etal., 2015; de Graaf, Giovanardi, Zitz, & Carmichael, 2018; Kaltiala etal., 2019; Zucker, 2017).1 It appears that a new subgroup of gender dysphoric individu-als has emerged—a group comprised of predominantly natal female adolescents who did not have evidence of gender dys-phoria or significant gender-variant or gender stereotyped nonconforming behaviors prior to puberty (Zucker, 2019). Littman (2018), a descriptive study of parent reports, was the first empirical study of this new subgroup. The findings of Littman raised hypotheses about the potential roles of social influence and psychological mechanisms such as maladaptive coping in the genesis and development of gender dysphoria in this new population. Since publication, several young women who identified as transgender during their adolescence and have since desisted or detransitioned have publicly stated that the phenomenon described in Littman was consistent with their own lived experiences with gender dysphoria, including that social media contributed to their transgender identification (Pique Resilience Project, 2019). Additionally, detransitioners (people who underwent medical and/or surgical transition for gender dysphoria and then detransitioned by stopping medi-cations or having surgery to reverse the changes from transi-tion) have described the roles that trauma (including sexual trauma), homophobia, misogyny, psychiatric conditions, and other psychosocial factors played in their own identification as transgender and belief that transition would be helpful to them (Callahan, 2018; D’Angelo, 2018; Herzog, 2017; Marchiano, 2017).