The United States' top transgender government official has said there is no evidence that "social contagion" is causing children and young people to think they are trans.
In a Pride Month interview with The Independent on Wednesday, assistant health secretary Dr Rachel Levine rejected the idea that peer pressure explains the long-term increase in children identifying as trans, calling the supposed evidence "flawed".
Some critics of transition healthcare for under-18s have claimed that young people are being deluded into believing they are trans by social media and influence from their friendship groups, often citing a 2018 study into so-called "rapid onset gender dysphoria" (ROGD).
But trans advocates and major medical groups have said the concept has no clinical basis, noting that the study was based entirely on the perception of parents, many of whom were recruited through anti-trans websites.
"I do not accept the idea of social contagion, and I don't feel that the evidence for it is good, and I think the article is flawed," said Dr Levine, a physician who specialises in paediatrics and psychiatrics.
"All the evidence really points to better communication and understanding about gender identity among young people, so that they understand who they are and they come out.
"There's a lexicon, there's a language, there's support, and more parents understand – and there has been more avilability of treatment."
Dr Levine was appointed to the US Department of Health and Human Services by President Joe Biden in 2021, becoming the most senior openly trans official in American history and the first to hold an office requiring Senate confirmation.
Since then she has been outspoken in support of transition healthcare for under-18s, which has come under intense political attack since the Covid-19 pandemic and is now banned in 19 states, according to the ACLU.
The 2018 study, written by Dr Lisa Littman, proposed that some apparently trans children were suffering from a distinct phenomenon known as "rapid-onset gender dysphoria" (ROGD), which could potentially spread between peers through "social contagion" and the internet.
The study further suggested that ROGD might be a "maladaptive coping mechanism" for some teenagers, and that online trans communities may be similar to pro-anorexia communities that encourage young people to harm their own bodies.
However, critics have pointed out that the study had no input from the children themselves, and that many of the parents appear to have been recruited via well-known anti-trans websites.
The journal that published the study later apologised for not ensuring that these limitations were made clear, and Dr Littman published a correction.
A large coalition of US medical groups including the American Psychological Association and the American Psychiatric Association warned in 2021 that "there are no sound empirical studies of ROGD" and that the term "further stigmatises [and] limits access to gender-affirming and evidence-based care".
"Despite the lack of evidence for ROGD and its significant potential for creating harm, it has garnered increasing attention in the general public and is being misused within and beyond the field of psychology," the coalition said, adding that it had already influenced anti-trans bills across the country.
