 The study was criticized by transgender activists like Julia Serano and medical professionals like developmental and clinical psychologist Diane Ehrensaft, as being politicized and having self-selected samples, as well as lacking clinical data or responses from the adolescents themselves.On March 19, 2019, PLOS One completed its review.Reviewer Angelo Brandelli Costa criticized the methods and conclusion of the study in a formal comment, saying, "The level of evidence produced by the Dr. Littman’s study cannot generate a new diagnostic criterion relative to the time of presentation of the demands of medical and social gender affirmation."