The Daily Signal - Transgender Series Part 1: What Is Rapid-Onset Gender Dysphoria and Why Does It Matter?

Episode Date: February 7, 2024

Studies have suggested that the number of young people who identify as transgender has exploded in recent years. While activists claim that these people are just discovering a latent truth suppressed by society, some scientists have set out to question what lies behind a phenomenon they term "rapid-onset gender dysphoria." Leor Sapir, a fellow at the Manhattan Institute, has worked with Lisa Littman, a doctor who first coined the term rapid-onset gender dysphoria and laid out her hypothesis in the medical journal PLOS One. Sapir joins "The Daily Signal Podcast" to break down what ROGD is, why some activist scientists have failed to disprove it, and what he and Littman have done to advance the theory. Enjoy the show! Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

This is the Daily Signal podcast for Wednesday, February 7th. I'm Virginia Allen. Little was known about gender dysphoria and transgenderism only five years ago. Now this topic is being debated in schools and the halls of Congress. Today, we kick off a three-part series exploring the scientific grounding for questioning the transgender narrative. And take a look at the mental health struggles that may truly lie behind many claims of the transgender identity in youth. The series will also explore the movement to hold the medical industry accountable for experimental transgender interventions through medical malpractice lawsuits. The Daily Signals, Tyler O'Neill is leading the way in this series today.

Tyler is sitting down with Leor Sapir, a fellow at the Manhattan Institute. Studies have suggested that the number of young people who identify as transgender has exploded in recent years. While activists claim that these people are just discovering a latent truth suppressed by society, some scientists have set out to question what lies behind a phenomenon they term rapid onset gender dysphoria. Sipir has worked with Dr. Lisa Lippman, who first coined the term rapid onset gender dysphoria. And Sipir joins the Daily Signal podcast today for part one of our series to break down what exactly is rapid onset gender. or dysphoria and why activist scientists have failed to disprove it and also discuss why he and Lippman have done to advance the theory.

Stay tuned for Tyler's conversation with Sphere after this. Hi, I'm John Carlo Canaparro. And I'm Zach Smith. And we host SCOTUS 101. It's a podcast where you'll get a breakdown of top cases in the highest court in the land. Hear from some of the greatest legal minds. And of course, get a healthy dose of Supreme Court trivia. Want to listen? Find us wherever you get your podcasts or just head to heritage.org slash podcasts.

This is Tyler O'Neill, a managing editor at The Daily Signal. I'm honored to be joined by Lior Sopier, who's a fellow at the Manhattan Institute, has been doing really important research on rapid onset, gender dysphoria with Lisa Littman. Lior, it's great to have you with us. Thanks. Thanks for having me. And it's Lisa Littman and Michael Biggs. And Michael Biggs. Yes. Thanks for adding. Sure. So I want to just jump right in. Rapidons at gender dysphoria. What is it and why does the medical establishment seem so dedicated to denying that it exists? Yeah, great question. So in 2018, Lisa Littman, who was then at Brown University, proposed a hypothesis based on her own observations in her own sphere of life about, you know, parents who started to say, you know, my kid out of the blue came out as trans. and they were clearly suffering from other mental health problems. And so Lisa said, you know, something is going on here.

And she decided to do a survey of these parents. And what she found was that there was actually a high prevalence of comorbid mental health problems, history of trauma and abuse, and all these kinds of co-occurring phenomena that could be associated with trans identity as a maladaptive coping mechanism. There were reports from a lot of the parents of social influence, peer influence, periods of prolonged exposure to social media, right before, you know, kind of the disclosure of a trans identity.

And so she wrote this paper to propose a new hypothesis for further study as a good scientist would. Right. She did not claim that this is settled science. She said, we seem to be observing a new pathway to gender dysphoria. Because until that point, the two known pathways, the two pathways that were the two, I should say, subtypes of gender dysphoria that were recognized in the clinical literature, were adult, gender dysphoria and childhood gender dysphoria, which starts at a very, very early age. So she said, you know, there must be, there could be, I shouldn't say must, there could be something else going on here,

a new subtype that we haven't recognized yet. Her paper was immediately attacked, viciously, by activists, yeah, and, you know, and they did not like the idea that trans identity can be anything except for an innate, immutable, authentic, you know, never to be questioned. form of self-identification. And so they put a lot of pressure on plus one, the journal that published her paper, to retract it. It wasn't retracted. They did ask Littman to issue a clarification, stating that, no, this is not an official recognized mental health diagnosis. It's a hypothesis about a pathway to gender dysphoria that requires further study and could one day become an official diagnosis, but it isn't. That's really all that happened in that whole episode.

among other critiques, I think the critique that has become the most prevalent against ROGD is that what appears to parents as a sudden onset of trans identity or of gender dysphoria is really a late disclosure by the adolescent of a trans identity that was felt, intuitive, developed much earlier in life, often in early childhood, but which the adolescent. had kept secret from the parents and from other people in his or her life. And so there have been a number of papers making this argument, and the most recent of them was published this last summer in the Journal of Adolescent Health by Jack Turbin, a psychiatrist at University of San Francisco, California, and co-authors, and his co-authors. And it's a very short paper, but what they argue in that paper is precisely this point, that what appears to to be a sudden onset and disclosure of trans identity is really a much delayed disclosure of a previously realized one. And the data set that they use to make this argument is a survey

from 2015 called the U.S. Transgender Survey of 2015. It's the largest survey of adults to date, although they're trying to renew it now. Last year they did another renewed survey. It hasn't really been published yet. But this was the largest survey of transgender adults. the sample that Turbin relies on is about 27,000 people, and they claim to find in the sample evidence of their hypothesis of late disclosure. And so when the article first came out, knowing that Turbin is one of the most dishonest figures in the world of gender medicine research,

I looked at the paper and I said, you know, there's just so many red flags here. There are things that just don't make sense. Just to give one example, Turbin relies on adult recollection of when they realize they were trans. And some of the respondents, I'm talking hundreds of respondents. I don't remember the exact number, but it's over 400 respondents, I think, said that they realized they were transgender by age two. And that includes, yeah, that is the reaction that that deserves, right? And do they remember

the color of their diaper when they were aged? Exactly. They remember nothing else, but somehow they remember that they're trans. And this included, I think it was 260-something, something respondents who said that they knew they were transgender in their first year of life. And, you know, the fact that Turbin and his co-authors just take all of this stuff at face value was a big red flag. And I saw a lot of other irregularities in their analysis. So I said, you know, something is wrong here. Let's take a deeper look. I don't think, and I'll get to this in a second, I don't think the U.S. Transgender Survey of 2015 is a good data source for a number of reasons. But let's assume that it is. Let's take a look at this data source with a more scientific

lens and see if it really supports Turbin's hypothesis or maybe the ROGD hypothesis. And so I got in touch with Lisa Letman and Michael Biggs and asked them, are you willing to do you want to write this paper with me? And they said, sure. And so we took a look at it and sure enough,

you know, we found overwhelming smoking gun evidence of ROGD. But as we point out in our letter to the editor, the sample is actually more confirming of the ROGD hypothesis than undermining of it. And I can explain in a minute why that is. And so we published this in a pretty long letter to the editor in the archives of sexual behavior, laying out the data, our analysis of what Turbin and his

co-authors omitted, all of the manipulations that they did. And in response to this, of course, the Turbin has never responded. The Journal of Adolescent Health immediately blocked me on Twitter. That was their reaction. They blocked me on Twitter. This is a medical, a professional medical journal. Well, but they ran your letter to the editor, right? No, no. This was, so our letter to the editor appeared in a different medical journal, the archives of sexual behavior. Yeah, these are both peer-reviewed medical journals. Turban's paper was peer-reviewed. Our letter to the editor was peer-reviewed. So both of them went through that process. But it just struck me as totally unprofessional. And, you know, we got a little

bit of criticism from transgender activists online. Most of it was junk criticism. But some of it actually raised some good points. And we responded to those points in a follow-up piece that we published in a substack, Colin Wright's substack, Reality's last stand. So there's kind of a, you can call it an exchange. Unfortunately, it wasn't a good faith exchange with the other side, but that's, you know, par for the course. We've come to expect that.

So I can get into some of the, you know, the details of the findings and why they're relevant for this debate. So first of all, let's just talk about the sample itself. So the sample, as I said, it was a survey from 2015 of adults. Now, if you know anything about the trajectory of ROGD, the hypothesis is that,

that this phenomena really started to emerge in the late 2000s and picked up speed in the 2010s. And actually, we know from the sample, a survey of adults from 2015 cannot possibly pick up on ROGD phenomena if that's what Turbin and his colleagues are trying to investigate. So the sample from the get-go is just too outdated. So that's the first thing that we point out.

The second thing that we point out with regard to the sample and its bias is that in order to participate in the U.S. Transgender Survey of 2015, you had to currently identify as transgender, which means that... So anyone who stopped identifying as transgender was excluded. Exactly, right? So let's say you have an adolescent who identified as trans as a maladaptive coping mechanism, out of social influence, whatever. And then by age 18, 19, 20, they stopped identifying that way. By definition, they couldn't participate in the survey. And you have no control group, so you don't even know, like, people who never identified as transgender.

and had potentially been exposed to these things. Exactly right, right. I mean, so this is a survey. A survey can never give you evidence of causation of anything. And so, you know, it's a very, very low quality. In evidence-based medicine, surveys are considered an extremely low-quality source of information. In fact, the European systematic evidence reviews exclude studies that rely on surveys precisely because there's just no way you can find any form of causal evidence of anything.

from them. So in any case, what I found interesting is that in Turbin's previous paper that he wrote also trying to debunk ROGD, he actually, he and his colleagues openly admitted that the U.S. Transgender Survey of 2015 has this limitation in it, that because it only samples adults who currently identifies trans, it can tell us nothing about those who once did but no longer do. And yet here in his new paper, he just omits that limitation because obviously it would greatly undermine his argument. So again, another one of these red flags. So that's with regard to the sample. There are other problems and reasons to see the sample as biased, but I'll leave that to the side for now. A second major problem with the survey, and this is kind of where we can get into what we found versus what they found, is the way in which they conceptualize time to disclosure of trans identity. Okay. So the U.S. transgender survey had three questions that are relevant here. The first was at what age did you start to feel like that your gender was different? from your sex assigned at birth, something like that. Second question was, at what age did you begin to feel that you were trans,

even if you didn't have a word to articulate it? And the third question is, at what age did you disclose a trans identity to a family member or somebody else in your life? Okay, so these are the three questions. Now, if the question is, at what age did you realize that you were trans? You would think, naturally, you would go to question number two, because it asks explicitly, at what age did you first start to think that you were trans, even if you didn't have a word to conceptualize it.

But what Turbin did is he chose question number one as the proxy for when people realized they were trans, meaning he chose the question, at what age did you start to feel that your gender is different from your sex? Now, there's a number of reasons why that could be highly misleading. It's obviously subject to what's known as recall bias. So just to give you a scenario here, let's say you have an autistic teenager. And this autistic teenager doesn't fit in socially, really struggles. A year later, two years later, they come across transgender content online and social influence, all these kinds of things, and they come to adopt a trans identity and they disclose it. And then let's say three years after that, they participate in the U.S. transgender survey.

And they're asked to recollect kind of the trajectory of their identity development. It could very well be that this adolescent, this now young adult will look back and say, okay, during these first two years, I felt different. I didn't know why I felt different, but I felt different. And it could be that now, as an adult, this respondent will look back and say, oh, it was because I was trans. I just didn't realize it yet. It took me another two years. Whereas if you kind of go back in time to what was actually going on in this person's head for those two years, they hadn't even heard of trans or gender. Their struggles had nothing to do with gender. So this is known as the problem of recall bias. Well, because when you adopt an identity in the present, you can often think back and read that identity into your life and into instances of your life experiences you had that otherwise, you know, if you had never made the decision later, you would never have this.

Correct. That's exactly right. Now, you know, this is a lot of speculation, right? It could be that somebody for two years thought about gender being different from sex, whatever that means. It could be. Right? We're not saying that's impossible. We're just saying using the question number one is subject to a lot more recall bias than using question number two, which asks explicitly about developing a trans identity. So why wouldn't Turbin use question number two? Well, we dug down into the data. We did some analysis. And it turns out if he had used question number two, the median time from realization to disclosure would have been one year. And a one year time of realization to disclosure supports the ROGD. hypothesis. As it is, they actually didn't even disclose the median time from realization to disclosure for those who given question number one, because they didn't even look at the adolescent group in isolation. They looked only at those who said, we first realized of this about ourselves when we were children before age 10. It gets very, very messy. They did a lot of gymnastics there in order to produce their conclusion, which was that there was a median of 14. years between realization to disclosure. But it turns out that even if we grant Turbin his assumption,

that question number one, when you start to feel your gender is different, is a reliable proxy for realization, if they had looked only at the age relevant group, which was 18 to 24 year olds, respondents to the U.S. transgender survey, right? Only the young adults who would have been young enough to be within the ROGD relevant time frame, even if we accept that assumption, if we look at this particular group, we actually found. and we didn't discuss this in our letter to the editor, we discussed it later on in our substack reply to critics. It turns out that over 2,000 respondents said that they realized that their gender was different from their sex

and then disclosed a transgender identity within one year or less. So this includes people who would have realized it and disclosed it within months or even weeks. In other words, people who chose zero, right? or who were conceptualized as zero between time from realization to disclosure. So in any case, you know, there were other indicators of RODD, I should say symptoms consistent with ROD. For example, there was a strong female skew of the sample. If we looked only at the age-relevant cohort, it was 75%, if I remember correctly,

it was 75% female. Turbin and his colleagues did not look only at the ROD. They bunched in the 18 to 24-R-R-Els with all. the other older adults who are irrelevant to ROGD, and then they found that it was still female skewed, although only 60%. We also found, looking at the survey, we found that among this ROGD relevant group of 18 to 24-year-olds, there was an extremely high prevalence of mental health problems. Fifty-six percent of the respondent said they had struggles with severe distress, severe mental health problems, versus 36 percent or lower of older generations.

And so that's very interesting, because one of the hypotheses connected to ROGD is that trans identity is adopted as a maladaptive coping mechanism for underlying mental health problems. So, you know, these were, again, these were not, this is not smoking gun, settled science evidence of ROGD. We never claimed that. Rather, these were indications of symptoms consistent with ROGD in a sample that we already believe is highly biased against ROGD. And the fact that Turbin and his co-authors never disclosed this, never discussed this, never express any curiosity with it, really shows that they were not coming at this from the perspective of scientists who are kind of interested in the truth about these issues, but that are just trying

to manipulate data to produce a political conclusion. Well, so what's the next step forward? We talk about, you know, R-O-GD is a hypothesis, but if we were to reach a stage in which someone could be diagnosed with it, what hurdles would it have to cross? And then, you know, if you know, Is it at what point, if we've passed the peak, I mean, how do you expect it to continue to be relevant for a long period of time? Sure. So just to be clear, I just want to clarify, I'm not saying I know that we've passed the peak. There is limited evidence that we might have, but we don't know that for sure. And, you know, these things ebb and flow, right? We could see a kind of tapering off of trans identification among youth, let's say in the year or two after COVID.

it could even drop a little bit and then it could skyrocket again. These things really precisely because it's primarily a culturally driven trend, there's going to be fluctuation, is my prediction here. But to get to your question, so look, many mental health conditions start off as a hypothesis based on the kind of untutored scientific observations of clinicians working in the field. They see a certain phenomena coming into their office over and over and over again. and they say, hey, there's a certain pattern here. I'm going to propose a hypothesis.

Then let's study it, hopefully, in an empirically rigorous way. And then once the mental health phenomenon is widely observed, once it's reliably identified, it can make its way into the DSM, to the diagnostic statistical manual of mental health disorders. But it could take years. So, for example, binge eating disorder, symptoms of binge eating disorder were described in the DSM-4, which came out in 1994, but it wasn't until the DSM-5, which came out in 2013, that it was officially recognized as a mental health condition. So it could take years for a phenomenon to be officially recognized. And with ROGD, because it's so politically controversial,

it could even take much longer than that. And it could even never be recognized, because if activists, you know, capture the APA, which they absolutely have, they'll, that's hill they're definitely going to die on to make sure that it's not recognized. So that's one of the barriers. But look, I mean, if you look and we go over this a little bit in our letter to the editor, R-O-G-D is associated with a particular clinical presentation. So adolescents who do not have a childhood history of gender nonconformity or gender distress or issues with their sex, right, in real language. They don't have issues with being boys or girls. And these problems seem to develop only in adolescence. They have co-acquiring mental health problems,

anxiety, depression, autism, OCD, eating disorders, history of trauma, you name it. And they are predominantly, although not exclusively, but predominantly female, right? And they belong to peer groups where some of the kids come out as trans in clusters. So there's all these kind of indicators of symptoms. And what we have seen in the medical literature, in the last few years is confirmation of these presentations. So there's plenty of evidence now showing that among adolescents who are clinically referred,

referred to gender clinics and diagnosed with gender dysphoria, something like 70% or more of them will have co-occurring mental health problems that were diagnosed before the onset of their gender dysphoria. Wow. And that gives you an indication, again, there's no smoking gun, proof here. It gives you an indication of the causal relationship between a trans identity and other

mental health problems, namely that the trans identity could very well be a maladaptive coping mechanism for, for example, an autistic kid who doesn't fit in and is using trans identity as a frame in which to explain his or her social awkwardness. So anyway, yeah, so that's the long answer to your very So we're dealing with a situation that, I'd say, the medical community is bifurcated. You have a lot of organizations that have been taken over by this ideology that says, the only possible answer is, quote, unquote, gender affirming care. And then you have the critics who are often, you know, demonized, ostracized, but also quite sizable, who are saying, no, this is damaging to kids. the real problem is we don't have a good way of scientifically determining where the full truth is. And I mean, naturally, I think you and I would fall into the skeptical camp.

But it would be interesting for the pursuit of science to actually have the ability to have a control group and people who are not being biased from the beginning saying like, this is the only path or this is evil. Right. But is there any chance that we're going to get a study that will actually give us these answers? That's a great question. I mean, are we going to get a study that will definitively resolve the ROG debate? I highly doubt it. Even if we have a very reliable study on the other side is just not going to accept it. But look, I mean, here's what I would say.

First of all, just one additional piece of evidence that I didn't mention that I think needs to be mentioned. In 2021, Lisa Littman published a study on 100 detransitioners and kind of documenting, you know, their experiences and what caused them to want to transition and to want to detransition. And one of the interesting findings there is that pretty robust part of the sample said social influence, online exposure to trans culture was a major catalyst of our, of my, you know, kind of conceptualizing my ongoing problems as related to gender and therefore my desire to identify as trans and want to transition. And what's interesting is that, you know, Turbin says we

should never rely on the reports of parents because they're just biased. We should always rely on the self-reports of people who have gender identity journeys. Well, here Lisa Littman actually consulted people who had gender identity journeys, and they themselves said social influence was a major factor in our decision to transition. But they're heretics. Yes, okay, sure, sure, of course, right? But even by their own methodology, there is evidence confirming social influence as a factor related to a trans identity. But look, I mean, to answer your question, no, I don't think we're ever going to have high quality, reliable research on these things. I just think that's, that's inevitable, but we are going to have piecemeal evidence that comes out as a trickle,

confirming aspects of the ROGD hypothesis, you know, kind of the timeline of, for example, development of a transgender identity relative to other mental health struggles, you know, the kind of the trajectory of exposure to social influence and peer groups as a risk factor, let's call it, for the development of gender dysphoria and things like that. So that's probably what we're going to have. But I do want to emphasize one really, really important point. And I try to mention this in every interview that I give. I try.

Because what's riding on this debate is the legitimacy of a medical intervention that can cause severe, irreversible lifelong harm and suffering. The burden of proof here is on those arguing that anybody who says I'm trans is eligible for medical intervention. They face the burden of proof, not us. And so that's really important because, you know, it's very easy for the other side to say, well, you know, you have to prove that ROGD exists. Yes, to some extent they're right. If we propose the hypothesis, we shoulder the...

Exactly. Right. But the burden of proof for an intervention. Exactly. That will leave someone, you know, permanently changed for the rest of their life, especially in children, like clearly aggressive. with the advocates. Exactly, right. So if you take a step back from the RUG debate and you put it in the broader context of the debate about gender medicine, which is the only reason why the RODD issue is

so controversial, right? That's the only reason why it's getting so much attention is because there's the medicalization attached to it. Then I think it's really important to say, no, no, those proposing that, you know, in quotation marks, trans kids know who they are and should be eligible for these interventions because they identify as trans. They're the ones who have. have the burden of proof. So it's really important to kind of set the presumptions of who has to prove what here. Yeah. And amid the ideological capture of America's medical institutions, we've seen these alternate medical institutions propping up, you know, for the American Academy Pediatrics, you have the American College of Pediatricians. For some, I don't know if there is an APA equivalent,

But, you know, if there were to be an alternate organization that would publish its own diagnostic and statistical menu, because, I mean, as we've noted, the field is so bifurcated right now, it's hard to imagine ROGD being added to the DSM-6. But if there was an alternate, you know, do you think there is a chance for an alternate organization to, I believe it's the APA that puts out the DSM? if there was an alternate APA that put out its own DSM and could include this, would you see treatment regimens, like responses, what would that path look like? Yeah, look, it's a good question. I mean, you know, the diagnosis of gender dysphoria is,

let's just put it this way, bad enough as it is, even without the ROGD issue, right? Even if the ROGD were not added, the existence of gender dysphoria in the DSM is a problem because the gender dysphoria diagnosis as per, you know, the fifth edition of the DSM is explicitly non-pathologizing, meaning it conceptualizes incongruence between a person's felt gender, so to speak, and their actual sex as just a normal variation of human development. And so the focus, the diagnostic focus is on the distress that accompanies gender incongruence. and the difficulty in psychosocial functioning, functioning in major areas of life. And so, you know, as long as you can show that, number one,

you feel that your sex is not really what it is, and number two, you have distress in your life for whatever reason. You're eligible for a gender dysphoria diagnosis. Now, I'm exaggerating maybe a little bit. A more scrupulous clinician might demand something a little bit higher threshold, but by and large that's how it works. and the world health organizations ICD-9, ICD-11, is even more permissive. It doesn't even require a showing of distress or difficulty functioning in society.

It just requires gender incongruence, meaning if you feel like you're a male, even though you're biologically female, you can get the diagnosis of gender incongruence and qualify for all of these mental health, sorry, all these medical interventions. Well, if you're a masculine woman or an effeminate man. Exactly, exactly, right? So, sorry, I lost track of your question, but that's kind of where we are right now. Now, you, okay, yeah, I remember. So you asked about alternatives to the APA to the American Psychiatric Association, which publishes the DSM. You know, there are a number of organizations that have sprouted out in recent years,

GenSpect, Jedda, that are really kind of dedicated to providing an alternative to the, captured mental health, psychological organizations, they're not putting out diagnostic codes, partly because they don't think that we should be pathologizing gender nonconformity. And partly because, you know, they recognized correctly, soberly, that when kids say I'm trans, when especially teenagers say I'm trans, you know, that's probably a good indication that there's something going on in their lives that needs to be explored. Right. Maybe they have ongoing trauma.

maybe they have autism and this is a way for them to cope with that. Well, these comorbidity is. Exactly. Exactly. So to some extent, I don't want to see an alternative diagnostic coding for gender-related issues because that, you know, concedes that there's something unique and special about somebody who rejects their sex. I think we just need to go back to basic principles here and the mental health profession

needs to, you know, start treating. teenagers in particular who say I'm not really my sex, they need to be applying the normal tools of therapy, trying to understand the patient in the context of that person's broader life circumstances, life history, before, you know, you don't affirm anything, right? As they would say to you, it's not my job to either affirm or deny that you are the opposite sex. Let's put that aside and talk about what else is going on in your life. And I think the unstated expectation there is, it's not good for somebody to reject a fundamental and real aspect of who they are. That's not a good thing. It could be that as an adult, that person will have such severe psychological distress due to being

in the body that they are that they might find some relief in modifying their bodies with hormones and surgeries. Fine. That doesn't mean they've transformed into the other sex. Right. Right. But I think starting from the premise of you are male, you are female, you're a boy, you're a boy, you're a girl, there's nothing you can do to change that, is absolutely essential here. So RODD is more a description of a phenomenon, not, and then working backwards, trying to find out the ultimate root of RGD is the job of a good therapist, a good clinician. As opposed to someone saying, like, oh, you have a, you have a medicalized situation. This is just a therapy is the ideal path, not diagnosis. Exactly, exactly right. And so, you know, it's important for us to kind of play their word

games or kind of argue on the terrain that they have chosen by they, I mean, you know, kind of activist, clinicians, people like Turbin, right? It's important for us to engage on their level at some point and to kind of do battle with ideas and research that they've put out, the really bad quality research that they've put out there. But we also have to just keep in mind that we're all, we've already strayed very far from basic reality and from tried and true principles of therapeutic practice. So, yeah, I mean, so that's where we are right now. I'll repeat something that I said at the beginning, which is that ROGD is a pathway to the development of, let's call it, the rejection of one's sex. Yeah. And so it's crucially important for any good therapist to want to understand

why their patients are believing, feeling, acting in certain ways. And that exploration of the why cannot take place under an affirming approach because the affirming approach says, never explore the reasons why. If a person says they're trans, they know who they are. Affirm, agree. It's anti-therapy posing as therapy. So what we want is for therapists to go back to therapy. Yeah, I think that's well said.

Where can the people follow your work? Well, two sources. One is my Manhattan Institute profile. All my stuff is published there. The other is on X. I put everything that I write do on X. Specifically, this exchange that we've had on RODD, if you just Google my name and RODD archives of sexual behavior, you know, it'll come up right away. I do urge listeners who are interested in this topic to read Lisa Lipman's original paper, which is quite long, but I think very important. Turbin and his co-authors' paper from last summer. It's called Age of Realization and Disclosure of Gender Identity among Transgender Adults in the Journal of Adolescent Health. And then our letter to the editor that came out a few weeks ago. And then after that, also our follow-up substack post in Reality's Last Stand, where we respond to critics. I think if you do that, you'll get quite an education on the debate over ROGD. Well, thank you so much, Lear Sapir.

Thank you so much for having me. Thank you. Well, that's going to do it for today's episode. Thanks so much for being with us for this first part of our series on gender dysphoria and transgenderism. Make sure to catch the conversations both on Thursday and Friday morning as we continue to dive into this topic. If you have not had the chance, make sure that you check out our evening show. It's right here in the same podcast feed. We're every weekday around 5 p.m. We bring you the top news of the day. Also take a minute to subscribe to the Daily Signal wherever you like to listen to podcast and help us reach more listeners by taking a minute.

to leave a five-star rating and review. Have a great rest of your day. We'll see you right back here around 5 p.m. for our top news edition. The Daily Signal podcast is brought to you by more than half a million members of the Heritage Foundation. Executive producers are Rob Bowie and Kate Trinko.

Producers are Virginia Allen and Samantha Asheras. Sound designed by Lauren Evans, Mark Geinney, and John Pop. To learn more, please visit DailySignal.com.