Social contagion hypothesis

Social contagion is a general social science concept in which behaviors, ideas, or emotions spread within friendship groups or online networks.

The hypothesis

Social contagion is a general social science concept in which behaviors, ideas, or emotions spread within friendship groups or online networks. In the context of gender, the concept was applied by Littman (2018), among others, to describe the clustering and online context of adolescent gender dysphoria.

Discussion

Critics of the hypothesis argue that the increase in referrals can be explained by greater social acceptance and improved access to care. Supporters point to the pattern of clustered referrals within friendship groups, the age and sex distribution of the increase, and international parallels.

Policy relevance

The Cass Review and the Scandinavian policy shifts explicitly take social influence into account as a factor in explaining the changing patient population. Policy therefore also focuses on careful differentiation and exploratory conversations.

The figures behind the debate

The hypothesis was prompted by a rapid change in gender clinics. At the English youth clinic, whose closure was announced in 2022, the number of referrals rose from approximately 250 per year around 2011 to more than 5,000 per year a decade later. The composition reversed: whereas predominantly young boys were referred in the past, referrals now consist mostly of teenage girls whose distress began during puberty. Clinics in the Netherlands, Scandinavia, and North America saw the same pattern. For the Netherlands, Vasterman calculated a 1,728 percent increase in transgender care since 2012. The support group Cry for Recognition has compiled the increase in referrals to gender clinics for parents.

Parallels

Supporters of the hypothesis point to phenomena known to spread among teenagers. Eating disorders and self-harm occur in clusters within schools and friendship groups. During the COVID-19 pandemic, neurologists in several countries described teenagers with sudden tic-like symptoms that they had adopted from social media. In all these cases, those affected are primarily girls going through puberty. The existence of social influence does not mean that the distress is not real: someone can genuinely suffer from something that has been shaped in part by their environment.

State of the research

Direct evidence is scarce. The study by Littman is based on parental reports. A later study using the same methodology was retracted by the publisher in 2023 because of concerns about the consent procedure. Studies that contradict the hypothesis have their own limitations. The Cass Review concluded that the increase cannot be explained by a single factor, and cited biological, psychological, and social influences alongside one another. Figures now show that fewer and fewer young people identify as non-binary or trans. See also rapid-onset gender dysphoria and peer influence and gender identity.