Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The Use of Methodologies in Littman (2018) Is Consistent with the Use of Methodologies in Other Studies Contributing to the Field of Gender Dysphoria Research: Response to Restar (2019)

This is a preview of subscription content, log in to check access.


  1. 1.

    See Table 1 for a list of relevant terms and definitions as they are used in this Letter.

  2. 2.

    When the article was revised after publication, PLoS ONE replaced the original version with the revised version, maintaining the same doi number. So, the revised version is the version of record and has an August 2018 publication date. The correction notice was published in March 2019. For transparency, the originally published version was made available as supporting information (in an attachment) to the correction notice. Thus, the current, revised version is Littman (2018) and the original version is Littman (2019) in the supporting information.


  1. Aitken, M., Steensma, T. D., Blanchard, R., Vanderlaan, D. P., Wood, H., Fuentes, A., … Zucker, K. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine,12(3), 756–763.

  2. Callahan, C. (2018). Unheard voices of detransitioners. In H. Brunskell-Evans & M. Moore (Eds.), Transgender children and young people: Born in your own body (pp. 166–180). Newcastle upon Tyne, England: Cambridge Scholars Publishing.

  3. Child and Adolescent Health Measurement Initiative. (2018). “Fast Facts: 2017 National Survey of Children’s Health.” Data Resource Center for Child and Adolescent Health, supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB). Revised 9/26/18. Retrieved December 20, 2019, from

  4. Clarke, A. C., & Spiliadis, A. (2019). ‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties. Clinical Child Psychology and Psychiatry,24(2), 338–352.

  5. D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry,26(5), 460–463.

  6. de Graaf, N. M., Giovanardi, G., Zitz, C., & Carmichael, P. (2018). Sex ratio in children and adolescents referred to the Gender Identity Development Service in the UK (2009–2016) [Letter to the Editor]. Archives of Sexual Behavior,47(5), 1301–1304.

  7. de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics,134(4), 696–704.

  8. de Vries, A. L. C., Steensma, T. D., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine,8(8), 2276–2283.

  9. Delamarre-van de Waal, H. A., & Cohen-Kettenis, P. T. (2006). Clinical management of gender identity disorder in adolescents: A protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology,155(Suppl_1), S131–S137.

  10. Dickey, L. M., Reisner, S. L., & Juntunen, C. L. (2015). Non-suicidal self-injury in a large online sample of transgender adults. Professional Psychology: Research and Practice,46(1), 3–11.

  11. Ehrensaft, D. (2017). Gender nonconforming youth: Current perspectives. Adolescent Health, Medicine and Therapeutics,8, 57–67.

  12. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., … T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society* Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism,102(11), 3869–3903.

  13. Herzog, K. (2017). The detransitioners: They were transgender, until they weren’t. Retrieved January 3, 2020, from

  14. Hidalgo, M. A., Ehrensaft, D., Tishelman, A. C., Clark, L. F., Garofalo, R., Rosenthal, S. M., … Olson, J. (2013). The gender affirmative model: What we know and what we aim to learn. Human Development,56(5), 285–290.

  15. Hutchinson, A., Midgen, M., & Spiliadis, A. (2019). In support of research into rapid-onset gender dysphoria [Letter to the Editor]. Archives of Sexual Behavior.

  16. Jones, R. P., & Cox, D. (2011). Most Americans favor rights and legal protections for transgender people. Retrieved January 3, 2020, from

  17. Jones, R. P., Cox, D., Cooper, B., & Lienesch, R. (2017). Majority of Americans oppose transgender bathroom restrictions. Retrieved January 3, 2020, from

  18. Jussim, L. (2019). Rapid onset gender dysphoria. Retrieved January 3, 2020, from

  19. Kaltiala, R., Bergman, H., Carmichael, P., Graaf, N. M. D., Rischel, K. E., Frisén, L., … Waehre, A. (2019). Time trends in referrals to child and adolescent gender identity services: A study in four Nordic countries and in the UK. Nordic Journal of Psychiatry.

  20. Littman, L. (2018). Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE.

  21. Littman, L. (2019). Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE.

  22. Lopez, X., Marinkovic, M., Eimicke, T., Rosenthal, S. M., & Olshan, J. S. (2017). Statement on gender-affirmative approach to care from the Pediatric Endocrine Society Special Interest Group on Transgender Health. Current Opinion in Pediatrics,29(4), 475–480.

  23. Marchiano, L. (2017). Outbreak: On transgender teens and psychic epidemics. Psychological Perspectives: A Quarterly Journal of Jungian Thought,60(3), 345–366.

  24. Olson, K. R., Durwood, L., Demeules, M., & Mclaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics,137(3), 31–38.

  25. Pew Research Center for the People and the Press. (2011). Beyond red vs. blue political typology. Retrieved January 3, 2020, from

  26. Pique Resilience Project. (2019). Retrieved January 3, 2020, from

  27. Rafferty, J., & AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics,142(4), e20182162.

  28. Restar, A. J. (2019). Methodological critique of Littman’s (2018) parental-respondents accounts of “rapid-onset gender dysphoria [Letter to the Editor]”. Archives of Sexual Behavior.

  29. Riggs, D. W., & Bartholomaeus, C. (2018). Fertility preservation decision making amongst Australian transgender and non-binary adults. Reproductive Health, 15(1), 181.

  30. Riley, E. A., Clemson, L., Sitharthan, G., & Diamond, M. (2013). Surviving a gender-variant childhood: The views of transgender adults on the needs of gender-variant children and heir parents. Journal of Sex and Marital Therapy,39(3), 241–263.

  31. Riley, E. A., Sitharthan, G., Clemson, L., & Diamond, M. (2011). The needs of gender-variant children and their parents: A parent survey. International Journal of Sexual Health,23(3), 181–195.

  32. Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health,63(4), 503–505.

  33. Spiliadis, A. (2019). Towards a gender exploratory model: Slowing things down, opening things up and exploring identity development. Metalogos Systemic Therapy Journal,35, 1–9.

  34. Tebbe, E. A., & Moradi, B. (2016). Suicide risk in trans populations: An application of minority stress theory. Journal of Counseling Psychology,63(5), 520–533.

  35. Timmins, L., Rimes, K. A., & Rahman, Q. (2017). Minority stressors and psychological distress in transgender individuals. Psychology of Sexual Orientation and Gender Diversity,4(3), 328–340.

  36. Wadman, M. (2018). New paper ignites storm over whether teens experience ‘rapid onset’ of transgender identity. Science,361, 958–959.

  37. Wagner, J., Sackett-Taylor, A. C., Hodax, J. K., Forcier, M., & Rafferty, J. (2019). Psychosocial overview of gender-affirmative care. Journal of Pediatric and Adolescent Gynecology,32(6), 567–573.

  38. World Professional Association for Transgender Health. (2018). WPATH POSITION ON “Rapid-Onset Gender Dysphoria (ROGD).” Retrieved January 3, 2020, from

  39. Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health,14(5), 404–411.

  40. Zucker, K. J. (2019). Adolescents with gender dysphoria: Reflections on some contemporary clinical and research issues. Archives of Sexual Behavior,48(7), 1983–1992.

Download references


The author would like to thank two colleagues for providing feedback on earlier versions of this Letter. The opinions expressed in this Letter are those of the author and do not necessarily reflect the position or opinions of any institution, organization, or company with which she may be affiliated.

Author information

Correspondence to Lisa Littman.

Ethics declarations

Conflict of interest

The author declares that she has no conflict of interest.

Ethical Approval

This Letter does not contain any studies with human participants performed by the author.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Littman, L. The Use of Methodologies in Littman (2018) Is Consistent with the Use of Methodologies in Other Studies Contributing to the Field of Gender Dysphoria Research: Response to Restar (2019). Arch Sex Behav 49, 67–77 (2020).

Download citation