In March 2023, the Archives of Sexual Behavior published a peer-reviewed paper, Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases. As the title indicates, the paper examined 1,655 reports from parents who reported that their previously gender-normative teens developed transgender identities and described the context in which this occurred (typically, both social influence and pre-existing mental health problems were contributing factors). Springer has just announced that the paper is to be retracted.
The sharp rise in gender dysphoria among youth with previously gender-normative childhoods has presented a challenge to clinicians worldwide. As the international clinician community grapples with how best to care for this novel group of patients, one of the key questions to answer is that of the etiology of this disorder: Why are so many young people today so profoundly distressed by their sexed bodies?
Attempts to study the etiology of gender dysphoria have proven controversial. A vocal group of activists has worked in a coordinated fashion to persistently and consistently shut down research into the factors that may contribute to the development of gender dysphoria or any non-invasive approaches to ameliorate it. When SEGM learned that a group of researchers published a study exploring parental perspectives on their children's emergence of transgender identity, we chose to fund the open access fee to ensure that the paper would be widely disseminated.
We anticipated that intense debates would ensue: The notion that transgender identity in a number of adolescents may not be innate but may arise in response to social factors fundamentally threatens the premise of "gender-affirmative" hormonal and surgical interventions in youth. While activist pressures were predictable, we could not have predicted that the publisher, Springer Nature, would yield to the pressure campaign and retract the paper entirely. The official retraction is scheduled for Monday, June 12th.
Springer's Questionable Retraction Rationale
The retraction was initiated after a group of activists and gender clinicians (including WPATH's current president Marci Bowers) wrote a letter of demand, asserting that the paper should be retracted because the authors did not obtain Institutional Review Board (IRB) approval for the study. There was also a demand to fire the Editor of the Archives of Sexual Behavior, Dr. Ken Zucker. An international community of over 2,000 researchers, clinicians, and others familiar with activist attempts to shut down academic debate defended the paper and the Editor. Ultimately, Springer cleared the editor of any wrongdoing, but decided to retract the paper.
Initially, the reason for the retraction was cited as failure to obtain IRB approval for the study. However, when it was confirmed that IRB approval was not required, Springer came up with a different reason for retraction. The official and final reason for the retraction provided by Springer is that the survey participants did not explicitly consent to have their aggregated answers shared in a “scholarly” and “peer-reviewed” publication:
It appears that Springer has evoked the requirement for such specific language post-factum, as Springer’s own policies about informed consent make no mention that the consent language must include these specific terms.
In response to Springer’s decision to retract the paper due to the alleged lack of proper informed consent, one of the paper’s co-authors, Dr. Michael Bailey, wrote a letter of appeal contesting the decision. In the letter, Bailey argued that the participants clearly consented to the survey results' publication, and that the lack of specific qualifiers for the term "publication," such as “scholarly" or "peer-reviewed," does not invalidate the consent. Further, Dr. Bailey provided an example of 19 Springer publications based on survey research that similarly lacked this specific phrasing in their consent forms. Bailey pointed out that in a number of the papers published by Springer, there is no evidence that the respondents were even aware that that their data would be aggregated for research at all. In contrast, the survey the Diaz and Bailey paper referenced made it clear to the respondents that the results would be aggregated and published. Bailey called out the double standard.
Springer Nature was unmoved by the argument and announced that it would retract the paper regardless—however, in a surprising twist, Springer committed to reviewing and potentially retracting all 19 publications cited. The following is an excerpt from the letter Springer sent to Bailey:
The possibility that this publishing giant would retract nearly two dozen papers based on failure to obtain specific consent to publication in a “scholarly” and “peer-reviewed” journal is startling. However, it is dwarfed by the implication that any paper based on survey research that did not include such specific language is at risk of retraction. Survey research is the backbone of social science and plays an invaluable role in studying underprivileged and hard-to-reach populations. The highly specific language in the consent forms, which Springer Nature now insists should have been included, is unlikely to be present in many—or any—of the papers based on respondent-provided data.
Tens of Thousands of Springer-Published Papers Vulnerable to Retraction
To assess the potential scope of such retractions, SEGM commissioned a brief analysis of the MEDLINE database to estimate the number of affected publications. According to Springer Nature licensing spreadsheet for librarians dated February 2023, Springer publishes a total of 3,139 journals, 1,880 of which were available through the MEDLINE database search. An analysis of medical subject headings (MeSH) for the presence of terms such as “Surveys and Questionnaires," "Self Report," "Health Surveys," and "Mass Screening" revealed that 73,677 Springer-published articles relied on some form of respondent-provided survey data.
Should Springer Nature commit to universally apply its policies, it is safe to say that the publisher will need to search all 3,139 of its journals, come up with an accurate way to identify all publications that may be based on respondent-supplied data, and then scrutinize the consent forms to determine whether the words “scholarly” and “peer-reviewed” appeared in the consent forms. If the identified papers failed to use this specific language in the consent forms, it would seem that Springer is looking at retracting tens of thousands of publications.
Health Authorities No Longer Waiting for Journals
In the meantime, the novel presentation of gender dysphoria among youth has been noted by a number of public health authorities in Western Europe. These public entities have engaged in their own independent research. Universally, every independent investigation of the evidence has demonstrated a sharp, poorly-understood rise in the incidence of gender dysphoria in youth, with no credible evidence that hormonal or surgical interventions improve outcomes among the struggling youth. As a result, treatment recommendations for youth with gender dysphoria in general—and adolescents with post-pubertal onset of gender dysphoria in particular—have become decidedly more cautious.
Both the new Swedish and English treatment recommendations now explicitly state that psychosocial interventions should be the first line of treatment, and both restrict hormonal interventions to research settings. The Swedish treatment guidelines state that hormonal interventions should not be routinely provided to youth with post-pubertal onset of gender dysphoria. And just this past week, England's NHS announced that puberty blockers will be only considered in a study setting for those with early-onset gender dysphoria, while issuing caution about those with late-onset gender dysphoria:
"For those children and young people with later-onset gender dysphoria, the Oversight Board asked that further engagement with stakeholders be undertaken to identify the key evidence gaps, recognising that there is even greater uncertainty in terms of the supporting clinical evidence base, less established clinical practice and less known about the natural history of gender dysphoria in this group."
The common-sense conclusion that youth with a novel and poorly-understood late-onset of gender dysphoria—the cohort described by the Diaz and Bailey paper—should not routinely be treated with irreversible hormonal and surgical interventions is precisely the outcome that activist gender clinicians fear. The swift action by American activists to retract the paper by Diaz and Bailey appears to be yet another attempt to the block the kind of information that independent public health authorities in Europe are acting on. However, given the interconnected nature of today's world, it is clear that such attempts will not be as potent going forward as they have been in the past.
In fact, the activist attempts to silence the discussion about the etiologies of gender dysphoria may have backfired. The attention that the paper's cancellation garnered has propelled it into the top-50 publications among over 400,000 scientific works tracked by Altmetric. To date, the Diaz and Bailey paper has been accessed more than 72,000 times. According to Springer, even after the retraction, the paper will remain available online, but it will be displayed along with the retraction notice.