I've definitely noticed a trend of people on the spectrum suffering from mental health problems, self-diagnosing as gender dysphoric and then launching themselves down a one-directional, miserable path that ends in their suicide.
Being Autistic myself, and having goine through complete dysregulation as a 15-16 year old (it's way more common than you'd think, especially as most government support just stops when the kids turn 18), I completely understand the mental processes that both lead to the depression/anxiety/emotional dysregulation as well as the absolute certainty with which the epiphany of gender dysphoria is reached.
Hearing the specific linguistic choices common on trans reddit/twitter/tttt, and knowing the exact state of mind that cause this language to be used just sends a shiver down my spine. All it would have taken is for me to have been born 5 years later, and I'd be a dead trans woman rather than a fulfilled husband and father of two.
If there's anyone reading this who's on the spectrum themselves, or has a kid on the spectrum who's talking about gender issues, feel free to reach out and I can elaborate a bit more on exactly how this specific failure works.
As a child I was diagnosed with a slurry of ADHD/ODD/ADD/OCD/many more.
I came to your exact same conclusion but with a 15 year difference. I am also quite confident I would be on the spectrum instead with a 5 year difference.
The medication I was put on at age 8 permanently fucked me. I went from teaching my grade 8 buddy algebra while completing his homework for fun (at age 8) to a completely fucked education from grade 5-8 and I cannot even remember grade 4 because I was in and out of hospitals for various new potions.
I have a file from my family doctor at the time, Dr. Karen Lo of London Ontario. Where she stated that as an 8 year old I was manipulating/controlling my mother, teacher, and multiple other adults. That was the basis for the medication.
The reality was that my Mom was so drunk off her ass that she couldn't stand up most of the time. I had to cook my own meals or starve, among other things.
I recall the look of one of my "special" teachers when she asked for ways to cook french fries. I told her to fry it in a pan with a tiny bit of oil. That's how I did it after all, she fucking laughed. Laughed.
You'd think you've heard the worst of it maybe but the reality is far far worse. Worse than being illegally and forcefully injected with drugs even. I would know.
My heart goes out to the victims of this treatment. You certainly don't deserve it.
Why do so many stories of psychotherapistic fuckery come out of Canada? There's your story here, there's the tragic story of David Reimer, there's the Montreal Experimemts by Donald Ewen Cameron... It's like something has been ideologically and institutionally wrong for a long time. It's like there's no human dignity or sovereignty, but instead people are just objects or problems to be managed. Some horrible Skinnerian-Taylorist worldview.
It might just be a metaphor, but would you treat people this way if you thought they had actual souls?
I will say, autism is super common among trans folk, as is ADHD. There is a high rate of comorbidity between them.
Having said that, I do not believe that it is fair to assume a person who believes themselves trans to be mistaken based purely on a personal hypothetical anecdote.
Isn't it at all possible that having a more detached view of your own brain, and a disconnection from society causes one to be more likely to be aware of the distinction between gender and biological sex.
And therefore be more willing to go through transition, instead of being more concerned with the impact the process has on your social standing, your friendships, your relationships.
I genuinely wonder if the incidence rate of transgenderism amongst autistic folks is actual the real incidence rate in humanity, but the rest of us (I am mostly neurotypical, just ADHD, and cis-hetero) are more likely to repress any transgender thoughts or worries.
> I've definitely noticed a trend of people on the spectrum suffering from mental health problems, self-diagnosing as gender dysphoric and then launching themselves down a one-directional, miserable path that ends in their suicide.
Are you saying that the gender dysphoria self-diagnosis was the only factor in the suicide, and without it the mental health problems and difficulties of being neurodivergent in society wouldn't have been an issue? If not, why is it the important one of the three?
Every problem a person deals with will contribute to stress and influence their choices, but it feels a little weird to list 3 big challenges and then say "and the last one is why they killed themselves".
>Are you saying that the gender dysphoria self-diagnosis was the only factor in the suicide, and without it the mental health problems and difficulties of being neurodivergent in society wouldn't have been an issue?
No, not at all.
I think the real reason that so may Autistic people end up depressed, anxious and suicidal is a mix of social difficulties (leading to isolation), coupled with an inability to recognise our own emotional states (making self-care a lot more difficult).
The real problem in misdiagosis of gender dysphoria amongst Autistics isn't so much the additional stress caused by transitioning (not just medical issues, but things like the discrimination that non-passing trans people experience too) but the fact that it provides a false solution to the problem of our depression/anxiety.
So many young Autistics really, genuinely, believe that the solution to their problem isn't learning the hard way how to achieve a certain level of social success, or ceding some of their independence to people they trust to help manage their physical and emotional needs, but instead hormones and surgery.
And once someone's gone down that path, that's it. No coming back.
It may be reassuring to know that most early and mid-stage trans care interventions are fully reversible, other than surgery and some more powerful forms of HRT. Surgery is pretty late on the road and many people never get surgery. So you don't need to be worried if someone you care about starts seeing a specialist about gender concerns, since at least for quite a few months, nothing serious is going to happen.
For younger people it's often preferred to use fully reversible blockers that don't even nudge someone along the transition path, which further reduces the risk of any kind of long-term regret.
Once blockers are suspended they will go through puberty. I'm not sure what other definition of "reversible" you think would be possible here, some sort of accelerated catch-up puberty? That would be incredibly traumatic and possibly harmful.
Keep in mind that blockers can be prescribed for reasons other than transgender identity, do you think that should be prohibited too?
Many advocates are essentially saying it moves the age range for puberty to a later range. As in "just delaying it"
And it makes no sense to me to ban the prescribing for what the medicine was actually developed for, too early puberty.
Also, why is it that almost always when I voice my dislike for puberty blockers as a form of trans treatment there is the "counter argument" that I want it blocked for all purposes? Just because I dislike one use of it, doesnt mean I dislike all uses.
The reason "do you want it blocked for all purposes" comes up is because when blockers are being prescribed as part of gender care, the purpose of the blocker is to prevent irreversible potential harm to the child. Your argument is that the blockers themselves somehow inflict irreversible harm - this is possible, to be clear, but as yet I've not seen it proven - and if that were so, it would make sense to always prohibit them unless the advantage seriously outweighs the irreversible harm inflicted by the blockers, no? The blockers are far more reversible by any standard than allowing the trans child to go through a puberty they view as traumatic, because that is irreversible by almost any measure I can think of.
Some people probably are just fully resistant to the idea that blockers shouldn't be used. I think guardrails are appropriate, but it's quite common to see people oppose a given treatment in gender care when it is freely used in other - often quite similar - circumstances and the opposition is ultimately rooted in discomfort with gender care and not based on any unusual or serious proven harms.
In the end a lot of this is between the child, their parents, and their physicians. It doesn't matter much how we feel about it as uninvolved individuals as long as safety processes are being followed and there's appropriate consent.
A good point of comparison for blockers, IMO, would be Spironolactone - frequently prescribed for trans HRT and other forms of gender care, but also used on-label for other purposes. This drug has lots of very inconvenient side effects, people dislike it, and it can in some cases cause serious harm due to the side effects. You could argue that it shouldn't be prescribed for any purposes due to those side effects, but at that point, you have to weigh one harm against another. Physicians have generally decided it's worth it.
Honestly, that's not hugely reassuring in the context of what I was talking about.
The problem isn't the medical effects but the fact that the certainty a misdiagnosis brings blocks people with mental health issues from actually treating the root of the problem. And this decision, practically speaking, isn't reversible. Once someone on the spectrum decides to go down this path, there's no stopping them.
If you have an Autistic kid and they're asking questions about gender, you should absolutely be worried. Hell, I'd be worried about an Autistic 25 year-old.
Misdiagnosis are common when trying to get treated for almost any medical issue, because humans are not orderly, rational machines with well defined inputs and outputs. Gender issues are perhaps an easier one to look at and go "I'm pretty sure you got it wrong, doc" because you can look at someone and instinctively think "that's a man" or "that's a woman". But whether it's back pain that's actually caused by an incredibly rare knee cancer or a doctor misdiagnosing the cause of an ultimately harmless migraine, you run the risk of this any time you go to a physician. I've personally lost people I care about to misdiagnosis but it's still just a fact that I decide to accept: Physicians may try hard, but they're not perfect.
If a problem isn't severe, that might be a reason to avoid medical intervention so you don't take on that risk. But if you're really struggling to cope or it seems like you might have a serious problem, you should probably see a doctor. If their diagnosis makes you ask more questions, get a second opinion, or a third one!
Similarly, basically any surgery has the risk of complications, and lots of interventions we perform on a regular basis have a small but real risk of harm. It's something that comes with medicine, and overall, people live longer and happier lives because medicine usually works out. I postponed wisdom teeth extraction for years because the first dentist I saw about it put the fear of god into me about the terrifying risks of anesthesia, and ended up regretting it because they had to come out eventually anyway. But if I had been that rare statistic to die from anesthesia, maybe it would've been the right choice? I lean towards no, personally.
As far as blocking people from treating the root of the problem - while this is a real issue, if the secondary problem is seriously lowering someone's quality of life, there's something to be said for stopping the bleeding (so to speak) long enough to start working on everything else that's causing issues. It's a matter of triage - sometimes root causes simply cannot be dealt with fast enough to postpone dealing with everything else. A non-surgical gender intervention like blockers to get someone onto stable footing for a year or two could be a great step in order to refocus on everything else, and maybe at the end of that time they decide they don't need meds or surgery.
On the contrary, it's becoming common among doctors to make a 180 on the subject. It was a major scandal in Sweden last year when several who had transitioned went to the news and attacked the doctors for allowing them to go through with it. As a result, transition at a young age seem to have been stopped. Because the science is lacking, it's heavily associated with health issues, you'll need treatment for the rest of your life and you can't go back.
Sweden is a white ethnostate that did forced sterilization of trans people until 2013, so it is unsurprising that it has center-right views on transitioning. I know some trans teens who left Sweden and moved to the US over the medical protocols there.
It's far more important that someone resolve their gender dysphoria than concerns like needing lifelong treatment. Plenty of political detransitioners are still dysphoric, they've just chosen alternative treatment modalities that we know lead to less happiness (which is fine as an individual decision, it's just bad to set public policy based on that).
>I would love to hear more about you're experiences growing up and especially the dysregulation.
Dysregulation[1] was Hell on Earth, in the literal sense. Very little in life works the way you think it should, and the reaction to these things constantly going wrong is extremely intense, negative, emotional unable to be controlled in any real sense. You lose the ability to reliably form even basic episodic/autobiographical memories, and with it any sense of the past or future. Entire chunks of your life go missing and you don't know what day it is, where you've been or where you're going. All you know is that you're constantly exhausted, nothing makes sense and everything just feels wrong. You don't know how long you've felt like this, and you don't know how long you'll continue to feel like this. As far as you're aware, past and future suffering will keep going on for eternity. And you will do anything, literally anything, to make it stop.
For me, I was fortunate that my mum took me to a sleep specialist, who recommended getting my adenoids removed and prescribing an extremely specific sleep schedule which I followed to a T (all screens off at 9:00, in bed by 10:00, I don't remember if there was a specific constant time I needed to wake up by but I suspect that was part of it to. As an adult, I now supplement this routine with melatonin). This was enough to get me from a state of complete dysregulation to "garden-variety" depression, which eventually I overcame with the help of a supportive network of friends and parents who (semi-forcefully) steered me down a path where I could succeed.
A hypothetical AussieWog98 might have convinced himself that the cause of the dysregulation was gender dysphoria, cut himself off from the people who really care and spent all his time online with other people just like himself until one day he couldn't take it any more.
I really, genuinely believe that this is what is happening today, at least in the case of some people. For others (especially people who transition later in life), it really can help them be comfortable in their own skin, and this is of course where the trans "debate" gets hairy.
[1] This is not technical language, but is the best and most concise word I can use to decribe it. There may be a more appropriate technical term, or a more scientific description of what is happening (seizures in the amygdala?). Feel free to comment if you have any scientific information or proper terminology, I'd love to read the literature on it.
My fear is not really with the misdiagnosis, but with the lack of the precise support you received being so common. It's hugely common in North America, where I am from, to adopt a "child as asset or liability" mindset that leads to parenting based solely around achieving normative goals, which accumulate with increased intensity around adolescence, and are further bolstered by today's media environment. Ours is a consumer culture, and part of that is that your identity is very product-driven.
In this light, gender comes to the fore not in the sense of being "tempted" after seeing something online, but as a particular mask to wear 24/7, regardless of which one you choose; something which autistic people have long been known to struggle with. It isn't outrageous to conclude that switching masks might be a relief if the assigned one isn't working out; consider that autistic women are historically underdiagnosed, and then flip it around to the context of MTF transition: suddenly, autistic man behavior would "pass" as neurotypical woman behavior. That makes it seem like transitioning is the way to be normal!
Of course, normative masks have consequences for people who lean into their assigned gender, too, creating a context for all kinds of medical interventions: steroids to look big, diet drugs and surgeries to look small, study pills to pass exams, and so on. It's a promise of purification which has gradually targeted younger and younger ages. Gender in this light isn't so unique, it's just a particularly scapegoated expression of the culture.
The parents bear some responsibility because in happily going along with a diagnosis of this sort, they're most likely being all too eager to make their child be a better product on the market. Whatever the intervention was, they can go to bed that evening telling themselves "my kid will be successful now." Which in turn results in prolongment of mental health issues and ad-hoc coping mechnaisms.
You linking depression and exhaustion to this dysregulation state and the cure being sleep related sounds like your describing a really bad case of sleep deprivation. But I also get the sense that it is not that? And somehow related to autism and you can recognize people in that kind of state based on their word choice? Like if they could sleep a lot and go camping in nature with not many people and not many expectations for a month and avoid overstimulation, would a lot of these problems clear then?
I think you're not 100% wrong - it was chronic sleep deprivation.
Where the Autism comes in, though, is that a young person on the spectrum won't know how to recognise internal signs that they need to sleep, possibly won't even understand that they need to sleep (unless they've explicitly read/been told about sleep health/hygeine), and likely have difficulty sleeping as is.
The net result is, where a neurotypical person would just realise the early warning signs and slow down/go to bed earlier, the Autistic person can literally continue to ruin their mental health for a decade or more without ever putting two and two together.
The reason I specifically mentioned the Autism rather than the sleep deprivation is that this failing to meet needs can occur in many aspects of one's life and present itself in weird ways. You might see Autistics socially isolate themselves for years on end, then assume that the reason they're plagued with depression and anxiety is because they're not getting laid.
> Like if they could sleep a lot and go camping in nature with not many people and not many expectations for a month and avoid overstimulation, would a lot of these problems clear then?
Do you have a kid in a situation like this? Getting away from technology would probably be an effective treatment temporarily, but you'd need to follow it up with solid, rigorous information about sleep hygeine and its importance.
Poor sleep leads to worse stress regulation (also in neurotypical people), and chronic stress leads to difficulties in situational and bodily awareness, which leads to poor sleep hygiene, which reinforces the stress regulation problems, rinse and repeat until your life is in ruins.
I personally don't have a kid or know of one with ASD, but I was putting a bunch of previous info in my head plus what you describe as a potential solution. AFAIK ASD often comes with sensory processing issues, within and without as you described.
So by putting someone in nature, which can be sensorily calming for some, along with the social expectations and such, and nature being known to help people's sleep I would put it all together with what I suggested.
For me it would more be a debugging thing. Like if sleep in nature worked, then that is a hint, if it didn't and an indoor equivalent didn't work, since for some the nature stuff can be anxiety provoking for other reasons, then it's something else, etc.
No surgeon should be removing healthy body parts, in my opinion. You wouldn’t fit a gastric band to an anorexic person, no matter how badly the patient wanted it, and that’s not even permanent.
I sympathise with all people who have issues accepting the body they were born with. If someone believes their body should be different, but otherwise their body is healthy, I think it’s fair to say that whatever is causing the feeling of mismatch is happening in the mind. It’s no surprise to me that a significant fraction present with other mental disorders.
In an ideal world, there would be some form of therapy that helps people come to terms with and accept themselves with what they’ve been given. But again I do sympathise, because contemporary medicine simply isn’t very good at treating mental illnesses.
I think the key thing is that these permanent procedures should not be performed on children / minors.
Personally, I was a very different person at 15 to 20 to 25.
I don't really think a young person can make a rational decision on something that is going to affect the rest of their lives in such a dramatic way.
A 30 year old deciding to get gender reassignment surgery is very different to a 12 year old.
Would you support a woman having breast reduction surgery, or would you say “sorry your body doesn’t match your mind; get therapy”?
I suppose you can argue the tissue here is not “healthy” because it’s causing physical distress for the woman, but the same seems to apply to a trans person. Distress is never ‘just’ mental, it has physical effects on the body (and vice versa - pain is ‘just’ mental). The decision of what’s healthy doesn’t seem so simple to me.
The argument you are making would hold up better if there was evidence that post-op trans people have dramatically lower suicidal thoughts, but multiple studies have shown suicidal thoughts is virtually unchanged after operation.
Now the argument becomes something like 'a body part of yours is causing mental distress, let's cut it off even though there's zero evidence it'll help'. Seems very flimsy and predatory to me.
As for breast reduction, there's actually evidence that large breasts can cause physical problems in women, so it seems reasonable to allow that along with the evidence that women with large breasts experience a better quality of life after surgery (absolutely not the case for trans people removing body parts).
"The overall mortality for sex-reassigned persons was higher during follow-up"
There’s no therapy that helps, at least as far as I know. At best you could learn coping mechanisms, but I don’t think anyone has ever been successfully convinced out of trans-ness by therapy, similar to how gay conversion therapy didn’t actually work. So we’d be left with telling trans people “there is no treatment at all, go deal with it somehow.” Anecdotal of course, but there are a fair number of trans people on social media who seem happy with their surgery - why deny them that because someone else is convinced that according to statistics it shouldn’t have made them any happier?
Desistance, i.e. "being convinced out of transness" is perfectly common, as mentioned in the article. I'm not aware of any studies on how therapy can affect this, but even if the therapy was merely helping the patient cope with their dysphoria for a period before exploring other options, that seems a far cry from saying "just deal with it".
The OP article is raising the claim that most of the (recent young) people probably aren't 'trans' at all, but there's a one-way affirmation pipeline backed by no science whatsoever.
> there are a fair number of trans people on social media who seem happy with their surgery
Are the people that are unhappy embraced by the community, or are they deplatformed? Are they happy with the surgery itself, or that they're now 100% part of a community of some kind?
Once someone has surgery, do they in their mind feel completely the new gender, and go about their lives as such, or are they now some elevated status within the trans community itself?
I don't have a problem with how people decide to live their lives, and while I'm generally against unnecessary surgery, adults are free to do what they want. I am against quack science and unethical behavior that might be exploiting the mentally unwell and even just confused children. I also am against using the power of the state to levy the quack science in the case of custody battles.
The 2015 US Transgender Survey cited in your link was commissioned by the National Center for Transgender Equality (an organization that was founded by a transgender activist).
The study was performed online and links were posted exclusively in transgender support forums.
Your standards for "evidence" reach the heights of biased activist SurveyMonkey CSVs? I'm convinced!
the study was intending to measure the rate of suicidal thoughts among transgender people.
Seems like a great way to get a lot of datapoints is to use a transgender forum. Seems like a great way to measure suicidal thoughts is to ask "do you have suicidal thoughts"
So seems like a great approach to gather a lot of evidence for the question at hand?
Seems like you just don't like the evidence because it doesn't reach the rather bigoted conclusion you want it to
It's objectively isn't if it lowers suicide rates relative to pre-transition level. It does not necessarily need to lower rates to population average to be effective
This is not true. Even if your claim about the paper is true (which it isn't), there are other metrics to care about:
- suicidal ideation, which is bad in and of itself
- anxiety, e.g. social anxiety
- depression
Besides, the study does not account for the fact that until 2013, Sweden forced people to have surgery to get updated IDs. If a trans person does not want to have a particular surgery and yet is forced to have it, you can imagine why that would cause a great deal of suffering. That isn't gender-affirming care, that's forced sterilization (which is a human rights violation with a sordid history).
> As evidence for the proposition that “[t]here is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention,” the AG Opinion cites a 2011 Swedish study by Dhejne et al. that, the AG Opinion claims, “monitored transitioned individuals for 30 years [and] found high rates of post-transition suicide and significantly elevated all-cause mortality, including increased death rates from cardiovascular disease and cancer, although causality could not be established.”49 In fact, the 2011 study by Dhejne is badly out-of-date and does not support the AG Opinion’s claim.
> The Dhejne study compared post-gender-affirmation transgender individuals with cisgender individuals from the general population, as opposed to transgender individuals who did not receive gender-affirming care. Therefore, as the study’s author explicitly cautions in the body of the text, it is impossible to conclude from this data that gender-affirming procedures were a causative factor in suicidality among transgender individuals.50 Rather, the study shows only that transgender adults were more likely to experience suicidal ideation/attempts and risky behavior when compared to the general population in Sweden between 1973 and 2003. Further, the Dhejne study is not generalizable to a modern American population or to adolescents. During the study period, Swedish law required that individuals seeking gender-affirming surgery be sterilized. The presence of this law alone might account for the higher risk of suicide attempts and risky behavior in the transgender population compared to the cisgender population at the time.51
I think its worth noting that the authors of the same study conclude:
> Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
Should people born with a cleft palate be forced to leave it alone? What about people with breathing problems due to their anatomy? If a kid has teeth grow in improperly and start causing jaw problems, should they be prohibited from having their wisdom teeth removed or teeth realigned with braces? Should tonsil removal be prohibited? If a woman has severe back pain due to oversized breasts, should it be prohibited to get a reduction surgery even if it improves quality of life? Should vasectomies be prohibited if a person with testes wants to be able to have sex with their partner without the risk of pregnancy?
Should it be prohibited to medically disable "healthy" body parts as well? As an alternative to vasectomies you can use drugs to similarly disable that body part, in many cases effectively forever. Should that be illegal too? What about anti-androgens like Spironolactone - used on-label for multiple different purposes - should we ban those since they are also used for MtF HRT? Birth control also is functionally disabling healthy parts of the body.
Why does a problem "happening in the mind" somehow mean that no treatment can occur outside of the mind? Do you think mood stabilizers and antipsychotics should be banned because we're treating an "in the mind" problem with physical, body-altering interventions?
As a though experiment I've thought a lot about the black alien project. Specifically the removal of his fingers. I'm not sure I know where to stand. Should he be free to do what he wants? Should doctors be required to avoid removing healthy fingers ( I don't think they were doctors but I've altered the situation for my thought experiment)?
My conclusion is I have no idea how to even approach it.
I'd be interested in others thoughts.
I like this topic as it's less politically charged but explores similar ethics.
My understanding is that transitioning is the best treatment we have. If you know of some other treatment the psychiatric community is unaware of, I’m sure we would all like to hear it.
It would seem that the massive increase in young people opting for these procedures would lead to fundamental differences in the population that undergoes them. Assuming your understanding is based on long-term studies done before this massive increase occurred, the effects they found are likely to differ in this now fundamentally different population. Given that the currently skyrocketing rates are largely a phenomenon of the past 5 years, that assumption is almost certainly true.
As one example of such differences that we know of for certain, the ratio of patients seeking these procedures who are male vs. female has shifted massively from before the past 5 years. Even ignoring all the observed differences, the simple fact that it was once much harder to access treatment would mean those observed in older studies would be more motivated or certain of their condition, on average, than patients undergoing treatment today.
In the same period, hospitals saw an influx of patients of the same age who believed they had symptoms of Tourettes (https://www.wsj.com/articles/teen-girls-are-developing-tics-...). Johns Hopkins estimated this included up to 20% of their pediatric patients, compared to 2-3% just 2 years earlier. Much like the rise in transgender minors, this was strongly concentrated in young females with other mental health issues who had been exposed to "Tourettes content" on social media. This is despite Tourettes being about 3x more common in males prior to the recent explosion in cases.
There are clearly people who genuinely benefit from surgical/hormonal treatments for gender dysphoria. In any case, adults without major psychiatric issues have the right to most hormonal and/or cosmetic procedures should they wish to get them.
It's still worrying how vehemently many activists oppose any questioning of such a massive rise in minors seeking life-altering treatments and implicitly or explicitly promising vulnerable kids that such treatments are the solution for their problems.
Oof this isn’t even close to being proven to the point of being a reasonable recommendation. How about you wait 10 years and see if that’s real science. Dietary science is hard.
No, "try every low-impact crackpot theory on the internet for 3 months before seeking a well-established treatment" is not a reasonable suggestion for any condition.
It's obvious if you've been through a CSci program. Math, Physics, EE, and CSci are real science and Psychology and Sociology aren't. That means that topics that fall under Psychology and Sociology domains are inherently invalid and rather than retreating to a position of simply unknowing, "hard science" types feel justified in framing their personal experience as reality, science, nature, and fact[1]. I don't blame the tendency; we all want to believe what we're doing is important, but when it involves stubborn indignation, it's a maladaptive behavior.
1. To the point where these words end up being sensitive and specific to identifying the group.
I'm primarily talking about medical science (including clinical psychology) here, not "psychology" in general. You can certainly make the argument that medical science isn't as "hard" as physics, but clearly medicine generally works.
You can also make the argument that gender-affirming care doesn't have RCTs behind it, but there's no way to have an RCT that (a) isn't immediately unblinded because the physical effects of HRT are obvious within days, and/or (b) isn't a gross human rights violation. So we rely on supposedly (but not actually) "low-quality" observational studies instead.
Yeah. I think the increased salience of this issue has caused a lot of nerds to believe they can figure it out with 15 minutes of armchair thinking rather than spending weeks engaging with the scientific literature (which is all quite readable!)
First, why do you consider it to be a problem in the mind, rather than the body? It seems to me that, fundamentally, gender dysphoria is a mismatch between the mind and the body. Declaring the body to be correct and the mind wrong seems arbitrary (as would declaring the mind to be right and the body wrong). It's not really a question of right and wrong, it's the mismatch that's the problem.
Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example).
Note that not all transgender people experience gender dysphoria. Some are fine with the bodies they were born with, and for them gender reassignment would be unnecessary and irrelevant.
Also, note that this is different from treatment for e.g. anorexia nervosa. If someone with anorexia loses weight, it doesn't help; they'll continue to see themselves as overweight. Treatment for anorexia has to focus on the patient's mind. Helping them lose weight would make their outcome worse, not better, which is why it's not done.
Scott Alexander gives an interesting analogy to a case from the mental hospital where he works here: https://slatestarcodex.com/2014/11/21/the-categories-were-ma.... A woman with OCD was constantly worrying that she'd left her hair dryer on, and was having to drive home 10-20 times a day to check whether it was really off, or was on and going to burn the house down. Nothing they'd tried worked, until someone suggested she take the hair dryer with her. That effectively solved the problem for her, because she could always just look over at the dryer, see that it was unplugged, and go about her business. But caused a huge controversy among the psychiatrists between those who thought "This Is Not How One Treats Obsessive Compulsive Disorder" vs those who just said "it worked".
> why do you consider it to be a problem in the mind, rather than the body
One argument is that it's a category error to call gender wrong. Your ethnicity, gender and wealth of your parents etc. just is, it's the hand you are dealt with. You can be unhappy with it but it can't be "wrong" just like the country you are born in can't be "wrong".
If someone is distressed about the country they are born in to the point of suicide, we'd class it as a mental condition. Such a thought can be rational but it's the degree of distress that suggests disorder rather than a healthy preference/observation of one's situation. It does have a rather obvious "do what works" sticking plaster.
The concern with sticking plasters is if they end our curiosity about the underlying condition. If we normalise them such they are considered inviolable part of the culture, political sacred cows and the one true solution that cannot be questioned. I expect that hairdrier lady's OCD was not limited to just her hairdrier - the sticking plaster hopefully reduced acute disruption/distress that made more fundamental treatment tractable.
(FWIW, despite articulating this argument, I can argue against it. I don't hold any confident position in this culture war maelstrom of bigotry and questionable scientific/philosophical claims.)
> Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example).
There seems to be a prevalent problem in this area (and perhaps others too) to where the reporting on the "science" seems to be a lot more positive than the science itself. The original article alludes to this -- "stop questioning the science" like it's an open and shut case.
For that particular study, a more accurate headline would be: "In Our Pre-Registration We Expected To Find Improvements on Eight Measures but We Only Found Improvements on Two, Which Were Very Small, and Only For Natal Females."[1] It's not as snappy, but it's more accurate.
That complex and fairly ambiguous outcome gets summarised into an overall optimistic story by the press, which then in turn gets digested into "gender reassignment .. works", not just on HN but on forums all over the internet.
It's not just that study though -- whenever the field is looked at holistically the evidence for the effectiveness of these treatments is not strong.[2][3] and the evidence for such treatments on children (the subject of the article) is even weaker.
Ultimately I believe adults have the right to do as they wish with their own bodies, however when it comes to children we have to be guided by the highest standards of medicine and science.
There is no empirical way to verify if someone is actually transgender. In fact, there really is no theoretical way that a person could even be transgender unless one accepts the idea of a non-material soul that is somehow gendered. Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are transgender and try to help them.
Emperical measurement framing is a cognitive cul-de-sac. Drawing a parallel, there's no emperical way to determine someone's sexuality. Fifty years ago this argument was used to justify therapeutically changing people's sexuality. "If you're a man you're biologically attracted to women. It's biologically impossible to be homosexual." Today we have the same logic applied to people's gender. It's as invalid today as it was back then.
Of course there is an empirical way to determine someone’s sexuality. You can show someone different varieties of pornography and see which varieties make them sexually aroused. You can see sexual arousal happening in the brain with an MRI. You can also just simply observe someone’s sexual behavior.
I'm sorry, but that simply isn't true. Even if it were true, like all diagnostics, it would have a sensitivity and specificity, which of course brings us back full circle to the problem the author cannot escape.
You don't think it is possible to determine whether homosexual people actually exist???
When you said, "that simply isn't true," what exactly were you referring to?
Homosexuality is the condition of having a sexual preference for people of the same sex. We can easily observe that such people exist. Whether it is a disorder or not is a separate question.
When a man says, "I prefer to have sex with other men," we can easily check whether or not this is true. (Or do you think all gay men are just faking it?)
When a man says, "I am really a woman," he cannot point to anything empirical to back up his claim. To the extent that we can check this claim, we can easily determine that it is false.
Of course, a man can correctly say, "I wish I was a woman," "I think I would be happier if I had been born a woman," or "I really like dressing up like a woman," and all these claims can be true.
But when a man says, "I actually am a woman," we know this is false because we know what a woman is, and we know what a man is, and we know that they are distinct.
Sexuality cannot be directly measured; its consequences can however be observed. Gender, operating the same way cannot be directly measured, its consequences however can be observed.
Your argument suffers from assuming essentialism - the error of reifying your personal ontology. That's a misalignment between you on one side and facts, nature, science, and reality on the other.
But back to the sensitivity and specificity for the test you're describing, what are they?
You’re just wrong and determined, apparently. I just don’t know what to say to someone who doesn’t think it is possible to empirically verify that some people have a homosexual orientation.
An HN commenter like yourself who thinks this is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are right about this and try to help them.
I'm sorry that you are simply unable to change your mind. I hope you get the care you need.
> Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition.
Hard disagree. Even with a strictly genetic interpretation there are more than just two sex-chromosomal configurations, but leaving that aside there are many of us who believe that gender, unlike biological sex, is a social construct. Saying "you must be a man because you were born XY" is roughly equivalent to saying "you must stay home and cook dinner because you were born XX".
Let's say we had the ability to genetically re-engineer people into whichever sex they wanted. Would you still be opposed to letting them do so because they were born a different sex? Would you deny genetic treatment of debilitating diseases because people were born with them?
> These are not additional sexes.
> For example, a male with Klinefelter syndrome (XXY) is still male.
Only by arbitrary definition of the abstraction we use. If we instead defined maleness as the ability to inseminate women and produce viable offspring they wouldn't count. If we defined it by having male genitalia then people with androgen insensitivity syndrome wouldn't count.
Male and Female are human terms we've chosen to categorize animals, but nature doesn't give a flying fuck about our definitions.
> We do not, nor anything even remotely close to that.
Obviously. This is called a 'hypothetical' or a 'thought experiment'. We use these to test the suitability of our mental frameworks of understanding. In this specific instance, I'm asking you to pretend this is true to see if your reasoning holds up, of if there is cognitive dissonance suggestive of a flawed model.
That's just plain wrong. Mental properties in general (e.g. personality) are not easily measurable, but that doesn't mean they don't exist (or can't exist without a non-material soul), and I see no reason to think that an innate sense of gender would be any different.
In any case, while gender is not directly measurable, it does seem to correlate with some aspects of brain structure. A number of studies have shown that, at least in some respects, the brain anatomy of transgender people is more similar to that of cisgender people of the same gender than those of the same sex. It's clearly more complicated than trans people having one type of brain in the other type of body, but something sort of like that is going on. See https://www.scientificamerican.com/article/is-there-somethin... and the links at https://sitn.hms.harvard.edu/flash/2016/gender-lines-science....
But whatever the basis of transgender identities is, it's clear that something real is going on. Dismissing trans people as "simply mistaken" is, well, simply mistaken.
EDIT: I should probably point out that the idea of someone developing some male-type features and some female-type should not be particularly surprising. Sexual differentiation is complex and has a lot of moving parts that don't always operate completely in sync. For example, a genetic male with complete androgen insensitivity syndrome will generally develop male-type internal organs (i.e. testes) and female-style external anatomy (a vagina, generally female appearance, etc).
You are defining male and female that way.
If you go by that definition, you can define a transgender person as someone who deeply thinks and feels they ought to be of the other gender.
They are not 'mistaken' other than by your definition. If you ask them 'do you have a penis' or similar question, they will respond with your objective reality.
Yes, I believe transgender people exist if you define the condition as people who wish they were of the opposite sex or mistakenly think they are of the opposite sex. They definitely really have mental conditions that result in wishes and feelings related to sex and gender, but if they claim that they truly are of the opposite sex, they are mistaken.
We're not living in computer game or virtual reality.
Technology still far from providing us freedom to change our bodies as we want.
It's not about even transgender operations - we can't achieve even smaller goals: to be more healthy, stronger, more beateaful, younger or more mature.
Nobody likes themselves in current state - you, me , my son, my parents, everybody.
Transgender operations should not be taken lightly because they are not transgender in reality.
The one who decided on such path should that it's something heroic in self-modification of such scale.
They'll pay a lot without any guarantee they will earn something.
I think that 100 clinics .. sorry, strong words: I think it's a crime.
Literally. Those "doctors" are not helping weak and unhappy, they're selling what they can't provide, they make people even more unhappy
> Declaring the body to be correct and the mind wrong seems arbitrary...
Hardly, our understanding of the human body is more experimentally valid and much more aesthetically developed than our understanding of the human mind. If there is some kind of 'mismatch' as you say and the body appears well regulated, then the medically responsible move is to defer to it.
Your first comment was better. This is a discussion about public health so of course people can contribute to it, and take an interest on behalf of the affected. And he does not seem at all upset.
There will never be a clear cut definition of health, but most people can innately tell what a well regulated body looks like for their culture.
For instance, most Americans know they're fat or obese and that this is not good for their long term health outlooks and will have detrimental affects on other aspects of their lives. Some may choose to be okay with this, but very few sincerely argue that being fat is 'healthy'. Most will try to lose weight (excess fat) at some point in their lives.
Sometimes we remove body parts that are no longer well functioning within an understood ordering of the body. Inflamed tonsils can be removed, large wisdom teeth pulled, even ovaries can be discarded if they're found to be hosting cancers, but all of these are examples of organ dysfunction. We know what is regular, non-painful, and non-disruptive about the human body because many human beings spend a lot of time in that state and most begin life in that state before transitioning to a disordered state. When that transition happens, medical science seeks an explanation for the dysfunction: how did these tonsils become inflamed?, why do wisdom teeth crowd the mouth?, how did this woman's ovaries come to carry so much cancer?
We look for the cause of a dysfunction in order to treat it.
If instead we remove the well functioning breasts of a 15 year old, or replace a healthy penis because a patient informs us that they abhor their member, or prescribe a blocker for an otherwise well regulated puberty, then we have inverted the entire thrust of centuries of medical understanding. We are taking a healthy body and searching for a malady that we have been told must be there. Once there is no longer a discernment between the regular and the dysfunctional for a human body then an explosion of maladies abounds all begging for treatment.
If enlarged breasts are causing spinal issues then perhaps they should be reduced in order to correct those issues. But why not removal? We remove enlarged tonsils, why not enlarged breasts? Surely the removal of them would also correct any spine issues. In fact, it may even be ethically easier as the doctor and patient do not have to contemplate a correct breast size. But of course it is unlikely the patient or doctor ever considered the wholesale removal of the breasts in these cases because both approached the question with an idea already in mind of what a healthy human body would look like despite they're not having any precise agreement on the topic beforehand.
And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun. Why should either be condoned? We condemn being fat on entirely the same terms. Often Americans are fat because they eat too often and always in excess due to eating feeling good. If one doesn't praise obesity, then what ought they find desirable about self-imposed sterility?
Of course what compounds these ethical concerns is that in these cases the subjects are children. On the whole this takes the acts from merely questionable or wrong-headed to monstrous.
> And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun.
Perhaps we should question the ethics of kids playing casual sports because it’s in the pursuit or carefree pleasure and fun
Play is important to a child's development. Try to refocus and retain that the context of the conversation is about medical interventions not playground games.
It is self-evident that reversing a decision to play freeze tag is orders of magnitude easier than reversing a dental tooth cleaning; a mundane medical procedure.
How about you worry about yourself. What’s it to you if someone decides to get a vasectomy in their 40s? Or are you simply more interested in bending and controlling people with your personal moral views where “pleasure and fun” are sins.
> How about you worry about yourself. What’s it to you if someone decides to get a vasectomy in their 40s?
I don't think almost anyone in this thread, including the person you are replying to, has any issues with 40 year olds doing whatever they want to with their own body. They are adults who can accept full responsibility over their actions and consequences, no matter how irreversable or disastrous they could end up being. Children are an entirely different story, as they, by definition, have no ability to provide informed consent to a lot of things, and rightfully so.
> Or are you simply more interested in bending and controlling people with your personal moral views where “pleasure and fun” are sins [?]
You are fighting windmills here. At no point had anyone in this chain of comments exerted any moral judgement against people transitioning or even suggested that it was sinful.
And to be extra clear, I have no issues with adults transitioning, and I would have no issues with minors either, if the process was fully reversible. Most western countries don't consider minors being legally able to give consent to getting tattoos due to their (near-)permanency, but no one has any issues with adults getting those. I, personally, would consider transitioning to have a much higher bar for "minors should be able to consent to it" than I would for getting a tattoo.
> I don't think almost anyone in this thread, including the person you are replying to, has any issues with 40 year olds doing whatever they want to with their own body.
> Of course what compounds these ethical concerns is that in these cases the subjects are children. On the whole this takes the acts from merely questionable or wrong-headed to monstrous.
FROM wrong-headed TO monstrous. Sounds like they have a pretty negative and judgmental opinion regardless if it’s an adult, that just intensifies when children are involved. So yeah, I do think GP has issues with said 40 year olds. How many minors are getting vasectomies anyway? How it is comparable to a gender transition except in the most vague and useless ways?
> You are fighting windmills here. At no point had anyone in this chain of comments exerted any moral judgement against people transitioning or even suggested that it was sinful.
Not even talking about people transitioning . Why the fuck is this guy comparing it to vasectomies and obesity in the first place.
> No surgeon should be removing healthy body parts, in my opinion.
There are a metric ton of medical procedures surgeons do outside of medical transitioning where people alter/adjust/remove healthy body parts. This seems like a pretty blanket statement to say; and I say that as someone who would be extremely cautious about telling someone that they "should" medically transition if they feel that social transition would be sufficient for them. I'm all aboard the train of telling transgender people that they're valid whether or not they choose to transition, and I definitely would advocate that transgender identity and body dysphoria are not necessarily the same thing, and that many trans people are blessed to be able to both embrace their transgender identity and celebrate aspects of their bodies that don't "align" with their gender in strictly hetero-normative ways.
Even with that perspective, this framing of "we're perverting the role of doctors/surgeons by cutting healthy flesh" -- it just doesn't really match the reality of how many procedures there are in the US that already fit that definition. Everything from the stereotypical examples of cosmetic surgery, to non-essential dental procedures, to limb lengthening, to circumcision, to sex-assignment surgery for intersex infants, the list goes on and on.
Many of these procedures aren't strictly speaking medically necessary. Precocious puberty for example is primarily harmful because of its psychological and social effects. The physical consequences of early puberty are comparatively minor (not non-existant, but then-again neither are the effects of puberty blockers. We're mostly talking about stuff like "you might be shorter when you grow up"). And yet, I've never once seen someone advocate that it's morally wrong or that it should be illegal for a doctor to prescribe puberty blockers to a cisgender child with precocious puberty. There's no shortage of conditions that really don't have physical health-effects or side-effects other than that society has decided that we don't really like them or that they're inconvenient to live with (either because of social stigma or because of the increased need for accommodations that society is unwilling/unable to provide) -- and we generally don't tell people with those conditions that they need to just learn to live with them. Instead, we give them choices (including medical interventions) to address both the social effects of their conditions and the internal psychological effects of their conditions.
What we don't do is we don't take a purely physical view of things. Heck, one of the justifications for why doctors prescribe puberty blockers to cisgender girls with precocious puberty is because there's limited research suggesting that delaying puberty lowers their risks of being raped. That's about as far into the "its a social problem, not a medical one" category as it's possible for a medical intervention to be.
And look, all of this is even taking the most charitable view of the statement statement above and assuming that it is specifically talking about medical interventions among minors. But if I take that statement at its face value as saying that no surgeon should ever operate on healthy tissue, then it just kind of becomes absurd, honestly. There are so, so many medical procedures that fall under that umbrella.
I think everyone would love to have less invasive ways of helping people who suffer from gender-disphoria and I think everyone is hoping that as social stigma continues to decrease that some of the psychological downsides of not transitioning might also decrease. That's not to say that medical transitioning is bad; it's not. But it does carry some risks, and obviously it's good to have multiple available paths for the transgender people who don't want to take those risks.
But arguments that boil down to "it's in the mind, so treat it that way" sound good at face-value but are ultimately way too simplistic to work even in a purely cisgender world. Our medical profession hasn't really worked that way for a long time, if it ever worked that way at all. So any debate about whether or not a surgery procedure is moral needs to be engaging with the issue on a deeper level than just whether or not there's a physical risk involved.
> that's not what they were intending and you know it
Yes, I took the more charitable interpretation of what they said (that it was specifically about minors) and devoted the vast majority of my comment to talking about that. I spent maybe one or two paragraphs total talking about adult transitioning.
And yet, even under that charitable interpretation, saying "we should not be operating on healthy tissue" is an argument that sounds good but falls apart as soon as you try applying it to the real world and the numerous non-essential medical interventions that are supplied to children.
I am trying to be charitable in my takes, but "chopping off their reproductive organs because of a fad" is not an insightful characterization of the current debate. It grossly oversimplifies the full spectrum of medical intervention for transgender youth, and (again) ignores the reality that medical interventions for psychological/social/internal maladies, including interventions based on the possibility of future psychological/social problems, are not exclusive to transgender youth.
no. it is simple. a young boy cannot "feel like a girl" because they have no idea what that feels like, that is not a thing. you are just you. get comfortable.
all of this nonsense has lead to mass depression, anxiety, obesity, etc. go outside, get some exercise, have a reason to live, get some sun, etc.
To be blunt, I think you're honestly kind of proving my point. In order:
1. "Chopping of their reproductive organs" is itself not an accurate representation of the full spectrum of transgender care. A nontrivial portion of transgender people never get bottom surgery, and certainly bottom surgery is not the primary focus of the majority of bills being passed right now about transgender care for minors (many of which go beyond banning medical interventions and ban even non-medical gender-affirming counseling).
It's a gross oversimplification of gender-affirming care for minors to focus purely on the rarest and most invasive intervention possible, a procedure that many transgender people will never undertake in the first place.
2. "~30% of girls think they're boys" is not an accurate representation of that study. 26% of teenage girls reporting "some change in their gender identity" does not mean that they suddenly completely flipped genders. Your description misses the subtleties of how many people talk about gender identity and gender fluidity.
3. > it is simple. a young boy cannot "feel like a girl" because they have no idea what that feels like, that is not a thing
There is a lot to unpack here, so I'm just going to say that's not a great description of either transgender identity or gender dysphoria (remember, they're not necessarily the same thing). I think this is a giant oversimplification and misrepresentation of the transgender experience.
It's also (not to be too nitpicky) kind of an oversimplification of the cisgender experience? But that could be a long conversation.
4. > go outside, get some exercise, have a reason to live, get some sun, etc.
This is a massive oversimplification of mental health care in just about every category from depression to gender dysphoria. You can not cure gender dysphoria by getting more sun. Even in situations where gender dysphoria can be either alleviated or partially mitigated with counseling, what's going on in that counseling is going to be a lot more complicated than the happy-go-lucky/"natural" model of mental health that people sometimes propose nowadays.
----
Again being as charitable as I possibly can, I am sure that there are people who are genuinely supportive of transgender rights but who still have concerns about medical interventions with minors, and there certainly are people who have medically transitioned who go on to regret it -- and yeah, of course I feel for those people, of course it would be good to improve our standards of care to minimize post-transition regret. But (again, thinking charitably) I imagine it's got to be pretty frustrating for the people with genuine concerns about youth counseling if every time they try and raise those concerns, they find themselves instantly surrounded by a bunch people saying that transgender youth all just have a vitamin D deficiency. Because that's just nonsense.
> it is simple. a young boy cannot "feel like a girl" because they have no idea what that feels like, that is not a thing
please dig more into this. you are tipping towards lunacy...
people will look back on removing breasts, inverting penises, etc. as we look back on phrenology, blood letting, lobotomies, etc.
> This is a massive oversimplification of mental health care
no. no it is not. please look at areas where they do not have even close to as much anxiety. getting exercise and socializing is extremely important for humans.
wash the dye out of your hair, take out half your piercings, and call your dad.
> no. no it is not. please look at areas where they do not have even close to as much anxiety. getting exercise and socializing is extremely important for humans.
Look, ultimately, we're in a public forum, and it's not my job to personally change your mind; it's my job to engage constructively and as insightfully as possible in a way that betters the conversation for other readers.
If this is your model on mental health care, then your comment speaks for itself and I think that other people on HN have enough information to come to their own opinions about whether you're qualified to talk about "social contagions."
----
Purely in the interest of being as constructive as possible, this is a really harmful view of mental health, not because the interventions mentioned in the parent comment are useless, but because they are an oversimplification of a complicated problem. Exercise/diet/etc... can absolutely help with issues like depression, but those actions are usually taken alongside counseling and with aid, occasionally (but not always) in conjunction with medication. Psychological interventions and mental health interventions are multi-faceted and highly individual; there is no single easy universal solution that will work for everyone.
Like please, don't ever tell someone with depression that their problem would just be solved if they made more friends. Friends are important and can help in some situations, but that advice is not helpful. And similarly, while gender dysphoria is not exactly the same as depression, it is also a condition that is a lot more complicated than just whether or not someone has enough friends or exercises enough.
But again, I think in regards to the broader debate, I would just say that people who talk about psychological issues as if they're just dietary issues -- maybe those people aren't the best sources to get advice from about the proper treatment for transgender youth.
> So you disagree that exercise, socializing, etc. are extremely important for mental health?
Of course I don't disagree with that.
But with that I'm bowing out, I can't think of a better illustration of what I've been talking about then the parent comment. I think it's pretty obvious whether or not that comment is a fair characterization of anything at all that I said above.
And again, I would just suggest to readers that the type of logic that leads to someone mischaracterizing what I wrote about mental health so completely is also probably not worth paying attention to when it's applied to debates about transgender care.
You still aren't really understanding what gender dysphoria feels like, but you clearly have no want to actually understand. Your take on things like depression are also incredibly incorrect and damaging. Your position is one that can be argued effectively, and yet you are repeatedly resorting to strawmanning a very small portion of your opponent's argument.
Your opinion, based on absolutely
nothing but your armchair philosophizing, is completely incongruent with the actual science.
Gender dysphoria is not a mental illness; it is a condition, like pregnancy. Unlike anorexia or body dysmorphia, when you address the issues causing gender dysphoria it simply resolves itself.
Leave this to the experts, please (ie not a receptionist). Unless you're trans or an expert there is very little substance in your opinions.
edit to respond: a mental illness is a disorder that causes harm to yourself or your interpersonal relationships. Gender dysphoria doesn't by itself do that. Transphobia in society does.
This study has been misread over and over again. It doesn't account for the fact that Sweden forced trans people to have surgery (sterilization) until 2013, even if they didn't want it. Besides, reducing suicidality is not the only goal of transitioning.
I can tell you that for me, now that I've addressed the issues causing me gender dysphoria it has completely resolved itself.
If surgery is completely ineffective at preventing massive suicide rates, why is it an option? Post-op transgender people still have extremely elevated suicide rates, therefore the surgery is ineffective.
Then you have transgender activists routinely attacking people in their own community who regret the surgery, and papering over the inconvenient truths about hormone blocking drugs (they cause permanent bone damage in children).
I'm not taken by arguments that routinely include tactics like death threats towards campaigners who speak out against dangerous hormone blocking drugs.
It isn't "completely ineffective", there is a solid evidence base that people who want it and get it are happier than people who want it and don't.
> at preventing massive suicide rates
A large part of suicide rates is hostility from society. For example, what if society forces people who don't want surgery to get it just to update their IDs? This is a eugenicist human rights violation, and it was the case in Sweden for the time period studied.
Note that in the time period, Sweden also required trans people to prove that they didn't have any gametes in storage! This was such an egregious instance of eugenics that the Swedish government should be paying millions of USD in reparations to anyone affected.
> why is it an option?
Because it works and makes people happier.
> Post-op transgender people still have extremely elevated suicide rates
Due to hostility from society. Suicidal ideation and behavior is a well-known component of CPTSD, and almost every trans person I know has CPTSD from social hostility. (There is one trans person I know who doesn't -- she's 20 and grew up in a supportive, left-wing environment.) That doesn't reflect on any kind of surgery. Rather, it's a damning indictment of society.
> therefore the surgery is ineffective.
False. This absolutely does not follow either logically or empirically.
> Then you have transgender activists routinely attacking people in their own community who regret the surgery
First off, there is not just one "the surgery". Saying that just exposes your ignorance on the subject matter. (And you really should spend a few weeks learning about trans healthcare before commenting any further.)
Besides, your claim is false. The objections are only to the people who regret it and use that as an excuse to attack trans healthcare generally. I know trans people who were forced into a surgery they didn't want, regret it, and everyone I know has full compassion for them.
> and papering over the inconvenient truths about hormone blocking drugs (they cause permanent bone damage in children).
This is a well-known side effect of low sex hormones (also happens in post-menopausal women). There are also serious side effects to not intervening. As always, you have to balance the benefits with the costs of intervening versus non-intervening.
> I'm not taken by arguments that routinely include tactics like death threats towards campaigners who speak out against dangerous hormone blocking drugs.
Plenty of medications have side effects. Accutane can cause depression. Hormonal birth control can have serious side effects. Focusing on this over anything else shows your biases.
---
If you're engaging in good faith and would seriously like to learn more about trans healthcare, https://medicine.yale.edu/lgbtqi/research/gender-affirming-c... is a good starting point. There are over a hundred citations in the paper, and you can use any of them as a starting point. Sci-hub is your friend.
That study didn't compare suicide rates with and without surgery, it compared post-op trans people with the general population (i.e. mostly cisgender people). It explicitly says "This study design sheds new light on transsexual persons' health after sex reassignment. It does not, however, address whether sex reassignment is an effective treatment or not."
More research should be done around detransitioners. Doctors need to evaluate the whole patient and in the case of informed consent they should confirm that the patient is aware of all the potential changes.
That being said, gate keeping what I do with my body is wrong. I knew all the potential side effects when I transitioned. I read the wpath in full. I was comfortable with all the risks.
This type of critical judgment of children's health care is needed and I hope the doctors are being more rigorous than what the author suggests.
I feel terrible for the girls who made a decision they regret and lost parts of their body that made them happy. Their doctors, and parents failed them. I am also happy that so many people were able to successfully transition.
The timing of the article is concerning with so many states trying to withhold life saving care I worry that the nuance of this article will be lost.
Gatekeeping is one of the central aspects of modern medicine. Maybe a hundred years ago, when we had a free country and you could buy heroin over the counter, there was nobody gatekeeping what you did to your own body. But now we’ve corrected a pretty long way in the other direction.
In principle I think consenting adults should be able to do whatever they want with their own bodies, but consent needs to be informed and the person needs to be mentally capable of consent. You need some degree of gatekeeping just to reach that bar. And this is going to be an even bigger concern with children.
> heroin over the counter, there was nobody gatekeeping
I wasn't there, though I have learned that generally the local pharmacy would do the gate-keeping. Now the local pharmacy does what the computer says to do based on whatever regulations were input by the back office.
The local pharmacy at that time didn't look anything like its current counterpart. Let's not forget that the 1920s was the start of the "Soda Fountain Pharmacy" thanks to prohibition, so I wouldn't put much stock into the quality of professional pharmacology at the time. It would be decades before regulation caught up.
Children do stupid things. Gate keeping them from touching a flame or walking off a balcony or any other experience they have no concept of is what parents do. It is to indoctrinate until children learns their own way and that generally happens once they understand the world better.
If we let children do as they do because it was their body then where would we be as responsible parents.
I hate the idea of making a kid take a test of knowledge on what transitioning entails before starting or going through some other form of gatekeeping, but my gut tells me that only people who are enthusiastic about the process and all of the nitty gritty details should be candidates for medical transitioning.
What's missing from this post is a sense of timescale and the steps taken throughout a patient's journey. There was no mention of patients publicly presenting as their preferred gender as a first step towards transitioning, prior to any medical intervention; I'm not sure if that's a red flag or if I just have outdated knowledge on treatment practices. I understood that the doctors seemed to be improvising with the treatment of patients, but the inconsistencies between patients' treatment weren't highlighted.
If a seventeen year old bio female comes to a 40 year old doctor and is prescribed chemicals that alter her genitalia for life, it is “gate keeping” to prosecute or regulate said doctor.
However, if a seventeen year old decides to have sex with a 40 year old, we would find it morally reprehensible and all agree that she could not consent to use her body that way.
I don’t know how to rectify these two commonly held beliefs.
>I don’t know how to rectify these two commonly held beliefs.
In the former case the doctors conflicts of interest don't seem so strong, in the latter case the doctors conflict of interest is overwhelmingly self-evident, so there is much higher risk of the doctor consciously working against his patients interests when the patient is still a minor in a major power differential.
One causes sterilisation, one causes pregnancy, western society is specifically very very against 17 year olds being pregnant and are anti-natalist and sex-negative more broadly.
I'm curious whether earlier accommodations or therapy can ease the pressure to move forward with surgical transition, and thus reduce the number of people who feel regret for their decision.
That said, I'm not sure these articles are intended to improve treatment options. Rather, the goal seems to be eliminating transgender care altogether.
"Until 2015 or so, a very small number of these boys comprised the population of pediatric gender dysphoria cases. Then, across the Western world, there began to be a dramatic increase in a new population: Teenage girls, many with no previous history of gender distress, suddenly declared they were transgender and demanded immediate treatment with testosterone."
That's what's so striking. Why is that happening? There's a controversy over this.[1] It's been observed in (at least) Australia, Canada, the UK, France, Sweden, and the US. People involved in studying this have been attacked, and as a result, there's not much new data since the big controversy in 2018.
I witnessed this first hand in a close relative who, in the throws of a multi month long bipolar psychosis, concluded that the source of her mental health problems was gender dysphoria. The internet was very influential in her reaching this conclusion. The internet also allowed her to locate a dr who didn’t restrict sexual reassignment to those without mental health comorbidities. Thankfully the very liberal dr she found was too far for her to travel, since she could not drive and Uber wasn’t yet a thing.
She was stabilized on antipsychotics a few months later and completely dropped all discussion of gender dysphoria, something, to be clear, that she had never talked about or hinted at prior to her psychotic episode.
It concerns me that had she had this episode a few years later, when the medical ethics had changed and Uber made it possible for a mentally ill person to travel to the city where the dr she found was located, she likely would have undergone some form of reassignment surgery with lasting physical effects and potentially catastrophic effects on her psychological well being. She has been happily married, well more or less happily, for more than a decade now, to a nice man. No sign of gender dysphoria and no recent psychotic episodes.
You seriously misunderstand how hard it is to have sex reassignment surgery.
Even in states where beginning an HRT regimen is based on informed consent, there are many steps one must go through before having this procedure done. Multiple letters of recommendation from licensed therapists and having been on hormones for years. Not to mention the exorbitant costs even with insurance.
Your suggestion that one could Uber to another city and have SRS performed is a gross mischaracterization of the reality trans people face.
The article provides examples of clinics offering very few steps to treatment, and discusses doctors who bias in favor of treatment. It paints a picture supporting the conclusion that it would have been easy.
The gulf between the availability of specialist surgeons and pharmaceuticals is incredibly vast. If the article gave you the impression that you can just walk in and get your SRS did on a whim, perhaps you should reconsider its veracity or at least your understanding of the situation.
I don't have a any understanding of this situation or a horse in this race, was just pointing out that ancestor comment was justified based on the article, which also addressed availability of pharmaceuticals, btw.
It'd be nice to have literature or deeper investigation on this.
"Treatment" involves a number of different options, of varying permanence. It isn't "Okay, surgery scheduled for Tuesday" at every patient's first consulation.
I wouldn't be surprised if for most girls, treatment starts with wearing a binder, which is clothing.
The article is written from experience in one paediatric centre, when the pratice between different centres - and laws in different states - differ vastly.
Information about people seeking gender affirming care in different places and stages of transition is not refutable based on this article.
And it is anecdata - how many patients had positive outcomes? Article doesn’t tell you. What did the (brand new) centre learn from these cases with negative outcomes? What protocols was it using? Are they the same now? Are they common elsewhere?
That’s reassuring. She did say that the doctor she found was like the only one in California, maybe even the whole country, that would treat people with mental health comorbidity. So even back then it wasn’t a widespread thing, just this one trailblazing doctor in the very lgbtqi2 friendly city of San Francisco. And it sort of makes sense. Why couldn’t someone have both schizophrenia and gender dysphoria? Shouldn’t the mentally ill be able to address other health problems like gender dysphoria? It’s very difficult thinking through the medical ethics involved.
Glad to hear your close relative is doing well now, and it sounds like she was in a tough situation.
If you did more research though you'd understand that the thing you feared is not especially common or even possible under normal processes, so it's not really worth fearmongering about it on a public forum.
In most first-world medical systems there are years-long waiting lists for surgeries, or even to see a specialist at all. Most people I know who've seen specialists about gender issues had to wait months to even talk to someone. Getting surgery on a whim within a few months simply doesn't happen unless you're a wealthy person flying overseas for at-your-own-risk surgery, which is also available for many other purposes.
This is similar to how you'll see people fear-mongering about things like teenage children getting surgeries, which simply does not happen. The processes don't allow for it because it would be wildly irresponsible, but you can still find lots of people talking about it as if it happens on a regular basis. In reality, adults in their twenties and thirties sit on waiting lists for years.
Note also that even if you were to schedule surgery on short notice, in many cases they require you to have been on the relevant medications for a while because if you were to have sex-related organs removed or modified surgically without having adjusted to your own hormone levels it would be a pretty nasty adjustment.
You can consult virtually anyone who's gone through normal gender transition processes under government care or insurance care, or examine the process documentation yourself. It simply does not happen through normal processes unless the rules are broken. There are long waiting lists and safeguards, the standards of care don't approve of this.
If it happens, it's people breaking the rules and possible medical malpractice - both of which can happen in all areas of care.
You can't simply dismiss reality based on one or two outliers. For example, if you look at the typically used standards of care https://www.wpath.org/publications/soc :
* Criteria for surgery
a. Gender incongruence is marked and sustained;
b. Meets diagnostic criteria for gender incongruence prior
to gender-affirming surgical intervention in regions
where a diagnosis is necessary to access health care;
c. Demonstrates capacity to consent for the specific
gender-affirming surgical intervention;
d. Understands the effect of gender-affirming surgical
intervention on reproduction and they have
explored reproductive options;
e. Other possible causes of apparent gender incongruence have been identified and excluded;
f. Mental health and physical conditions that could
negatively impact the outcome of gender-affirming
surgical intervention have been assessed, with risks
and benefits have been discussed;
g. Stable on their gender affirming hormonal treat-
ment regime (which may include at least 6 months
of hormone treatment or a longer period if
required to achieve the desired surgical result,
unless hormone therapy is either not desired or
is medically contraindicated).*
This simply does not support any claims that teenagers are easily getting surgeries, if at all. Any doctor following these standards of care would not approve it. People breaking the rules to approve it is tragic, but generalizing based on this is unhelpful because it distracts from the real problems.
I’m relieved to hear that. It’s easy to get the impression that many children are now starting the process with hormones and whatnot, without too many barriers in place or a sufficient waiting period. It’s probably the most extreme cases that get the spotlight.
In general when medical processes are flawed, the extreme <0.1% cases get the spotlight and instead of being used to advocate for process improvements, they're generalized by people with an agenda to claim that an <0.1% case is a 1% or 10% case. It does a disservice to the outliers who suffered and the sensationalized story is (rightly) ignored by people who might otherwise benefit from the cautionary tale.
Excellent point. My sense is that this issue, similar to many Covid related issues, has gotten so political that the ordinary scientific processes and discussions have ceased operating as they should. I tend to therefore think greater caution and deference to past practice, and therefore more conservative practices are prudent. That seems to be the currently unpopular view unfortunately. I am very wary of trendy medicine and medical hubris generally. Too many historical examples of trailblazing medicine getting things, often horrifically, wrong.
There are a few non-controversial reasons that this could be the case:
1. The study on Rapid-onset gender dysphoria could be flawed -- it asked parents, and not youths themselves, which might skew the data on the prevalence and incidence of gender dysphoria
2. The number of transgender youth in the US is small[1], estimated at around 300,000. A small absolute increase would result in a large relative increase, even though transgender-identifying youth are a small percent of the population
3. Improved acceptance, awareness, diagnostics and treatment may result in transgender youth seeing more options for themselves, and thus being more public in announcing their status or seeking treatment. It's not that more people are trans or genderfluid, but rather that they're more comfortable being public with their status
I agree with all of these points. "Rapid-onset gender dysphoria" is a bunch of baloney, but I do think there is probably a decent amount of teenagers who misdiagnose based on the internet, since this happens with a lot of other mental disorders as well.
I think the issue is that the annoying culture of the left of rejecting all "transphobic" arguments, (i say this as one of these people), means that some clinics are going too far and not being as careful as they should. The answer is probably government regulation, but we have to be careful not to be like the UK, and not just to "ban everything associated with trans healthcare at all" like Republican states are currently trying to do.
This quote from the source you linked seems to suggest an obvious reason why it might be a controversial "diagnosis":
> Lisa Littman, at the time an adjunct assistant professor at the Icahn School of Medicine at Mount Sinai, coined the term rapid-onset gender dysphoria in a 2018 study based on an online survey of parents on three anti-trans websites who believed that their teenage children had suddenly manifested symptoms of gender dysphoria and begun identifying as transgender simultaneously with other children in their peer group.
Doesn't sound terribly scientific. I do look forward to seeing a robust conclusion drawn from studies over the coming years, though, so we can find out how real it is!
I noticed it happening to the pre-teen kids of friends that played a lot of online games. When I asked the kids about it, they said they felt more comfortable online being a different gender because it better matched their personality and expectations.
I've known a couple of people who masqueraded as the opposite gender online and eventually discovered that they fit more as that gender in reality as well. Online is an interesting playground to experiment with gender identity, because there's less stakes and you can experience people referring to you as a different gender.
As a current medical student, I can confirm that school in the US teaches us “gender affirming” ideology acceptance without really much question or giving alternative perspectives. There was an entire required session where a “gender affirming” care doctor said we should imagine “cis people” as being “just as weird as trans people” and to reflect on our own idea of self-gender. When a Q&A question was posed about if gender transition is medically necessary (which is not easy to post about, btw, as during these sessions you are recorded in a zoom and anonymous questions are turned off; so everyone can see the full name of the person who asked, and it is recorded in a transcript also). The doctor responded dismissively about any doubt in the necessity of gender transition.
Medical education and the medical institution is full of agenda pushing and ideology by the way, do not get me started on the day they introduced nurse practitioners as fellow “providers” who only want to make our jobs easier, while laws are being passed giving them full practice authority and expanding their scope to the detriment of doctors.
Do you object to the “cis people are also weird, gender is weird” bit? Why? It’s always seemed very weird to me that the vast majority of people DO align with gender roles and DO enjoy the sexually dimorphic body they have, even though that body had a 50-50 chance of being the other sex and cultural ideas of gender seem to be pretty randomly assigned (the clothes men and women are supposed to wear change over time, for example). Why aren’t more people unhappy because they are not the other sex? Either there’s something innate that tells you you are a certain sex and makes you want to imitate others of that sex - in which case obviously it can go wrong, hence transgenderism, and that’s a completely neutral thing to happen - or it’s all cultural brainwashing and we might as well let people choose their bodies and gender expression anyway.
>It’s always seemed very weird to me that the vast majority of people DO align with gender roles and DO enjoy the sexually dimorphic body they have, even though that body had a 50-50 chance of being the other sex
Prior to conception there is a 50/50 chance of being a man or a woman, but once a child enters development, being non-gender-conforming is very rare. I think people confuse the little arbitrary cultural details here (eg: girls like pink) for deeply-seated traits which are innate to gender. (eg: women have periods, and can carry children)
As a non-Muslim, I wonder about the medical necessity of male or female circumcision, especially as it is commonly practiced without the consent of the patient. The latter is illegal in the US as of 2021, but the former seems a much larger and more pressing issue than gender affirming care.
I just don't get the obsession with this topic. If you're a parent, your kids are being told things you don't like all the time, including being propositioned or being offered recreational drugs. This is very low on my list of worries. Talk to them to help them make better decisions, using logical arguments instead of groundless religious commandments. Problem solved.
As I detailed in another comment, I definitely think that the pendulum has been swinging too far to the unsafe side of medical opinion about trans people, because of the somewhat toxic culture of the left. (this is an introspective by one of these people). I think the answer is probably more government regulation that strikes a balance between requiring diagnosis and the crazy stuff like the UK NHS or banning all trans healthcare.
Comprehensive mental health treatment needs to be generally available in a non-threatening, universal, single-payer way. "Managed care" has an awful ring to it when you are mistrusting. I suspect that many cases being treated as gender dysphoria are actually other mental health disorders, such as self-loathing, borderline, schizoid personality disorder, substance abuse, or one or a combination of many others.
I personally believe that only a licensed, Ph.D. psychologist, or in some cases psychiatrist providing short courses of medicine, without pecuniary interest, is qualified to treat these kinds of non-gender dysphoria disorders.
Transgender medical care usually involves medicine, and the trans rights movement had a moment in the 2010s. I believe it inappropriate to use victim status to force others to provide an inappropriate treatment. It is also inappropriate to rush an inappropriate treatment because of the ticking clock argument.
I draw a comparison to how many people go to the emergency room, which cannot turn them away, because they do not have first-line care like a family doctor, or basic health upkeep such as not smoking and eating healthy food.
For clear or severe cases of gender dysphoria, early treatment is essential. Pharmaceutical and surgical. However gender transition only changes your gender! You still have to deal with whatever mental issues you had, integrate into society, and work hard to become a whole person.
The gay rights movement came of age around 1980 in my view, but everybody agreed that how inappropriate it is to attempt to treatment that medically, except for self-harm or AIDS.
I suspect that what we need is mental health to have its moment. Not "pride", or boasting about how many pills you are on. Maybe psychology programs need to be subsidized and promoted. We spent the past decade focusing on our smartphones, and I don't think it made us much happier. I suspect that we have the courage to turn some of that focus inward.
While I personally think gender related care is far too restricted in most places, I agree that comprehensive mental health treatment is the biggest priority. People will have a much easier time dealing with gender-related stresses and issues if they're not ALSO staring down a bunch of other problems in their lives without access to care.
It's also my understanding that trans and non-binary individuals tend to have other co-morbid problems going on, mental health or otherwise. This may be a data problem - the other problems being diagnosed more often because they go for treatment, etc - but from the specialists I've spoken to, it probably is an actual connection, induced by stress or otherwise.
As with gender dysphoria, patients flipped from being majority male to overwhelmingly female in just a few years. They also tended to know others with the symptoms either directly, or from social media feeds whose algorithms fed them more and more content around the topic.
And ADHD. Could be that there is a lot of it, but I know a few folks self-diagnosing. At least two of them went off meds and are fine, which raises questions if they were truly ADHD in the first place.
this... seems insane. Tourettes is a genuine syndrome that the annoying TikTok and internet culture is causing teenage girls to misdiagnose themselves.
Experiments are supposed to be carefully designed. Hypotheses are supposed to be tested ethically. The doctors I worked alongside at the Transgender Center said frequently about the treatment of our patients: “We are building the plane while we are flying it.” No one should be a passenger on that kind of aircraft.
Late to the party, so no one is going to read this comment, but I can't help but wonder how much the explosion in Trans stuff is related to changing gender roles generally. We used to have fairly clearly separated roles, clothing styles, etc and I wonder if we just lack an adequate framework for sorting that out properly and it helps nudge some vulnerable individuals down odd pathways in unfortunate ways.
I'm really not expecting progress. That suggests improvement and it's nigh impossible to even have a meaningful discussion about anything having to do with sex or gender without it going sideways.
My magic 8 ball does not predict good things here.
In my experience, it takes at least a few days before a popular HN story fully burns out. There is a huge peak of activity in the first few hours, and then a looooong period of simmering. I've seen up/downvotes for comments days after I wrote them.
Besides, there is empirical evidence that at least 1 person read this comment ;-)
I am gay, 34, and I still can't understand HOW doctors can justify severing breasts, a penis, or altering chemical systems permanently in someones body to make them feel better about themselves, especially in youth! This is like treating Schizophrenia by playing into their delusions to give them comfort. There is also something extremely concerning about gender dysphoria or being trans becoming essentially a pop culture within more blue-leaning states while other states have statistically low occurrence of gender dysphoria(which is in line with modern psychiatry and historically). Are blue-leaning states producing trans people, why are most trans people in the USA under 25(by more than 43%!)? Is this our generations medical grift(snake oil)? In 40 years will we have a derogatory reference to it in our history books(gender med)?
Sounds super insensitive, but I don't mean to be. I feel awful for these people that are truly miserable and need help, but there is more going on here from a crony-capitalism and big-pharma perspective than people are willing to admit. It seems like every where I turn I am trying to be convinced it IS the answer and Gay or Lesbian people are also being forced to get in line on what is happening(if you're a gay male who only dates other biological males, you're transphobic...yeah)...
I feel this is so damaging to a large group of a future generation of our youth and creating contention even between communities that are otherwise united on the other 98% of issues that we face.
Gender dysphoria is easy to shove down if you're in an environment where others around you won't be accepting. It's unsurprising that blue states have a lot more REPORTED trans people.
However, the general internet culture of teenagers misdiagnosing medical disorders means that there is indeed too many of the wrong people receiving gender affirming care.
In regards to the biological male thing, no sane person would say that this is transphobic. Attraction has many factors, it's just being mean about it to trans men that is hurtful, not "not being attracted to them," which is normal imo.
I am not sure of where you hang, who you know, but it is absolutely a trend in trans-politics right now that gay biological men only dating biological males is considered transphobic. It also applies to lesbians who refuse to accept transwomen as lesbian and essentially a new branch of feminism has been formed, dubbed 'terf'(trans-excluding radical feminist). It's the latest thing right now in gay politics world and its splitting the community up very quickly.
It's a ridiculous concept. As a gay man I prefer bio male partners because not only do I like everything that comes with being a man (ie male behaviour) which a trans guy often has (but not always), but I love penis; and I love the flexibility that often comes with a male partner in that regard. Pretty simple.
If that's transphobic then surely as a gay man I'm a misogynist for not wanting female partners as well.
Yeah, I am going out on a limb and I'm going to say that "you're never obligated to have sex with someone or pretend you're attracted to them" is probably the mainstream opinion of the vast majority of transgender people.
It's the Internet, I'm not going to say that nobody feels that way, but... I mean, the LGBTQ+ movement is not traditionally a fan of the argument "pretend you're attracted to someone." That was historically a pretty big issue for them. So it's certainly not an argument that I run into, but I'm sure it's popped up on forums before.
I have seen some conversations talking about the degree to which the question of "are they datable" reveals some level of both societal transphobia and serves to reinforce gendered roles and expectations about women. I've seen people suggest that an aversion to dating transgender men/women might be something to self-examine, the same way that an aversion to dating Asians would be. But that's a very far cry from saying that someone should be obligated to date someone even though they're not attracted to them.
----
TERFs are... well, that's a different subject. I think a lot of it is exclusion and community policing of gender norms and gender alignment dressed up as feminism. That would have to be a longer conversation, but it's hard for me to understand what the "feminist" angle is of a philosophy that often strays into biological essentialism; and I've seen even cisgender women get caught in the cross-fire of communities deciding whether they present too masculine or work out just slightly too often and are therefore worthy of suspicion. I don't want to paint with too broad of a brush, but I don't think TERFs are as a whole are tearing down gender norms; I think they're reinforcing them.
It's curious how often when I read TERF literature that it falls into this trap of describing men and women as almost different species, and species that are naturally hostile to each other. I very often have to take a step back and check on what I'm reading. If someone had sent me "Pronouns are Rohypnol" before I knew that it was an influential piece, I would have assumed the piece was trying to set up a straw-feminist to tear down. If somebody had sent me passages of "Irreversible Damage" to read without the full context of the entire book, I would have assumed the book was intended primarily to argue for Christian Complementarianism.
But again, much longer conversation to have there.
I am not shocked at all, that for them, allowing men to colonize their personal life is unacceptable. Do these Women not have the right to avoid a penis?
Bathrooms are a messy issue, and personally I'm in favor of a pivot towards individual genderless stalls, but one important thing to consider is that trans women are much more at risk when using the men's room than women are when trans women use the women's. There's also the issue of how you're going to legislate passing trans women from using the women's room.
I also generally dislike TERFs because they're partnering with right wing reactionary groups that might be helping now but don't want women's rights in the end either.
You're talking about body dysmorphia, which can be a component of gender dysphoria but it's not at all the same thing.
Your experience of pain in relation to your body shape is also valid, but it's different than your psychological gender and brain not matching up with your body.
I don't feel anguish over having the body I have, and I don't feel like I would be a better "man" if I had the body of Schwarzenegger. I can honestly say that I am happy with my body; I'm not perfect and I'm not muscular, but I am fairly healthy and I don't have a huge number of complaints about myself. I don't dislike seeing myself and I don't really want to look like a body-builder. Certainly I'm not covering up mirrors in my house.
I would not describe any experience I've had wanting to exercise more or to be able to get away with shaving less often as "painful" and I wouldn't say it gives me mental anguish. Not to say that anyone who says otherwise about themselves is lying, but... I don't know, I'm not sure that's as completely universal or typical as people are suggesting. Maybe if you're in that boat that's something to talk to someone about.
I think body positivity among transgender communities can be a real issue, and there's a huge number of ways that issue can be tackled and there are a number of real conversations to be had about how society reinforces body dysphoria among trans people. My understanding is that self-acceptance is a really big part of being trans and I've seen accounts of transgender people talking about how transitioning was only one part of accepting. And not to make the issue too grey, but I have seen transgender people talk about how self-acceptance and self-acknowledgement of their gender did lesson their dysphoria; that learning to stop saying "I would be gender X if I did Y" and to start saying "I am gender X regardless of whether I do Y" helped them accept their own body more. So of course there's a role for counseling in this.
But that's a conversation that HN is really just not ready to have at all. Looking at this post and looking at the amount of people arguing about whether or not gender dysphoria exists -- I did not realize that was a thing that this community was still debating; that's a pretty large amount of disconnect for this forum to have from the real world. There is room for subtlety and nuance in talking about how self-image affects transgender identity, and if you go into transgender communities, you will see people having that conversation. Genuinely, medically transitioning isn't the right choice for every transgender person and it doesn't magically solve every problem for every person, there is a psychological level of acceptance that needs to happen for a lot of transgender people.
But if you want to have that conversation... I mean, you've got to get the basics out of the way first; you have to be able to understand that there's a difference between general disappointment with your body or goals about your body and full-on dysphoria and disconnection from that body.
It's a little bizarre to read and it reminds me a lot about the conversations that happen sometimes about ADHD. "Everyone has trouble focusing", "everyone gets distracted", "I get distracted all the time constantly and can never follow up on tasks and I feel intense anguish about it and am constantly restless and need to be moving to feel calm and I don't have ADHD" (well maybe you should get that checked, friend). If someone is genuinely feeling dysphoria about their body to the same degree as a transgender person going through puberty, that's not normal and you should talk to someone about it.
It doesn't mean you're transgender or that you need surgery (although there is a lot of gender affirming care that we offer to cisgender people, from laser hair removal to hair growth/plugs, and honestly the assumption that people need to be transgender or have dysphoria to get gender-affirming care is not really accurate in our modern-day society, we spend an intense amount of time in our society consuming products and taking actions that are primarily designed to make ourselves look a certain way). But I want to get across that most people don't have a physical reaction when they see themselves in the mirror. That level of extreme experience is not universal, it's not something that everyone goes through.
Sure, lots of people have aspects of their body that they would change, but... not to that level of extreme. Not to the level where it interferes with their daily life or increases their risk of self-harm.
Well, in Iran and South Asia, gender correction is supported due to homophobia (if I am sexually attracted to a man, maybe I should become a woman instead).
Hijras/Transgender are still relegated to an inferior status and it is still treated as a "mental illness" in Iran legally speaking.
But, then again, if you are a closeted gay man in a very traditionalist household in a conservative town and from a lower class background, you could either remain closeted your whole life, openly come out and get lynched, or choose to transition and then "only" get shunned and stigmatized.
You're right; there are a lot of places where gay men transition purely because they could be killed for being gay, but transitioning is an easy out to be with the man that they love without dying for it (because heterosexual relations are legal and transitioning is legal, but being gay is not).
People don't truly know what they want until they get it. They don't appreciate the grass often looks greener, but actually isn't.
Add that to raging often teenage hormones and you get this result.
Misdiagnosis of a genuine need to change gender is just adding justification for transphobia - it allows people to say "look, these people were wrong in their decision", which can then be misused as an argument in all cases.
The law needs tightening - this isn't to prevent the changes, this is to assess proper mental faculty in separating the perceived post transition fantasy of what it's like Vs the reality, and not provide fuel for the anti trans fire.
Yeah, the more of these too extreme clinics we have, the more it hurts the overall case for the genuine trans person who has been on hormones for years medically transitioning.
FTA: “Left handedness also exploded when left handed people were accommodated…”
This is in general why I’m always skeptical of these moral panics. When something is destigmatized and it’s a thing that has been there beneath the surface the whole time, it is going to suddenly look like there’s an epidemic of it.
The history of left handedness is a rabbit hole I encourage people to go down. It’s truly bizarre and fascinating and sometimes downright sadistic.
Do you have a refutation that's a length most people would be willing to read? I don't need to keep hearing about the author's problems with misgendering.
Thanks for pointing that out. I was watching for "misgendering" when reading it. And I did read the whole thing!
I actually found the misgendering part relevant. If Jamie Reed was as progressive as she claims, wouldn't that be something she would do "correctly?" I suppose you could say she no longer believes in trans identities, so that's why she isn't willing to do it anymore. But it feels like she is attacking the medical establishment and not the people, and as such would support what I'm assuming 100% of her patients desire, no? And, if you were to accept that she is writing for a conservative audience, it follows that that crowd would be turned off by using she when talking about someone born with a penis.
I found the rebuttal compelling and I'm struggling a lot with this issue. The fact that so many medical organizations support the current care guidelines feels very contradictory to the assertions made by JR.
And as the rebuttal author notes, JR was an intake worker, with limited access to the full story of these patients, and without proper medical training to do a full assessment.
All in all, both articles are worth a read.
After reading them both, I did feel like JR's was a well coordinated hit piece with dubious assertions, but would love to hear a rebuttal of the rebuttal!
> I actually found the misgendering part relevant. If Jamie Reed was as progressive as she claims, wouldn't that be something she would do "correctly?"
The thing is we don't know what "correct" is; we don't know the patients, we don't know how she interacted with them, we don't know what they preferred, etc. The author sees patients in quite early stages, and many may well have referred to themselves by the biological pronouns.
It gets much more complicated around the edges than some people pretend. It's an easy enough cudgel to use, and sometimes it's appropriate, but here it's just a distraction at best, and FUD at worst.
> And as the rebuttal author notes, JR was an intake worker, with limited access to the full story of these patients, and without proper medical training to do a full assessment.
There's a lot of FUD surrounding that in the rebuttal; obviously the author of that knows even less about the case than Jamie Reed, and there's lots of assumptions about how good she was or wasn't familiar with the case.
Besides, we can do this the other way too: is Erin Reed a doctor? Does she have medical training? Does she do full assessments? The entire point of Jamie's story was that not everyone with vague issues surrounding gender at a fairly young ages has gender dysphoria. I don't know if that's true or not, but merely being transgender doesn't mean anything here; your experience doesn't really provide any value, and is quite likely to bias you. What worked well for you doesn't necessarily work well for others.
That is probably a good summary of the entire allegation/conflict: "the trans community is very biased towards what worked well for them personally, and refuse to consider that it doesn't work for everyone".
Your last statement was interesting: "the trans community is very biased towards what worked well for them personally, and refuse to consider that it doesn't work for everyone."
You could add "non" in front of trans and it would probably be true as well, no? I just happen to know a bunch of trans people who feel like the dominant culture doesn't really serve them well. I trust that they have thought through it well, and know how it impacts them more than you have.
To me this whole conflict really seems less about trans people and non trans people. It's about people that don't trust the medical establishment and those that do. There are a lot of questions all over the place if you look there, and I'm not sure where I stand there.
Read the first one starting with "Jamie starts right out of the gate with right wing talking points designed to paint transgender people as being a “trend” or “social contagion.”"
If you are okay with the provided debunk proofs then...
I'm not asking for a tldr, and I don't need a point by point refutation of someone's personal experiences. I'm asking for them to write it in a more readable format. (Even you admit you skimmed it, and didn't really read it!)
It's missing the forest from the trees, and non persuasive to me.
That article – but it's more of a rant than article – is written in such bad faith and laced with personal insults and accusations – some of which are extremely tenuous – that any real information it may contain are lost to all but everyone who already agreed with it.
Going off on rants about "whistleblower" in scare-quotes, "manufactured controversy", "right wing talking points" and "anti-trans scree" is not helpful, it's part of the problem.
For anyone else reading along taking the parent comment to heart, having read the article I couldn't disagree more and would suggest you read it for yourself rather than take this commenters review at face value.
The write-up is comprehensive, goes through all Jamie Reed's points and discusses why she isn't a reliable narrator. It doesn't read as a rant at all to me.
They're suspected biases, suspected positions, and suspected motives, gleaned from vague hints. I think little is more corrosive to constructive discourse than trying to guess at people's motives and "true positions".
I agree with this response, but it would probably be a good idea to have government regulation on trans healthcare to some extent. Just not to this overwhelming degree of banning all of it.
Perhaps. But that's not the world we live in. Both DeSantis and Trump have recently said if elected next year they would effectively outlaw gender-affirming healthcare for everyone, of any age. This is saber-rattling --- a threat to do something that will kill people like me for no apparent reason other than they find us disgusting because we're different.
Ah, yes, the "biological pronouns" guy. Do you realize how ridiculous you sound to any reasonable person?
Gender is a model we impose on reality, not reality itself. Reality itself says that gender dysphoria, and the associated concept of gender identity, exists.
In New Zealand we have anti conversion therapy laws. The way the law is written it may not be legal for a trained councilor to suggest that a child is not trans if they present as trans. I don't know if it's possible that 100% of children claiming this are correct.
One weird thing I see (as a scientist myself) commonly in this debate is the rough idea that to intervene or to not intervene are two sides of a balanced coin, and the decision is solely the doctor’s; this naturally results in the idea that, if a doctor opposes it, then she/he is a prejudiced bigot who is personally intent on harming the person by keeping her from fulfilling some predestined fate. However, in the scientific method, the onus of evidence is always on the intervention side. Even if you happened to discover an amazing drug to cure cancer, with little to no apparent side effects, it would take years to prove that it actually works and is not harmful. Why is all this being thrown away? If a doctor stops you from messing with your body without good evidence it’s because well that’s how science should work.
When you get right down to it, "gender" is really just a categorization of behavioral traits. This is what we mean when we say that gender is a social construct. I mean, what are people so worried about with trans people? That they use the "wrong" bathroom, wear the "wrong" clothes, use the "wrong" pronoun? These are all arbitrary bullshit.
If we had genderless bathrooms and accepted that people could wear whatever they want and got rid of gendered pronouns, maybe we really wouldn't need special gender-affirming care.
I have it on good authority that having the "wrong" genitalia for your gender is legitimately distressing, but perhaps that is just part of the expression of the social construct of gender and if the person had grown up without the concept of gender they wouldn't care what their genitalia were. Regardless, it wouldn't be an different than any other form of plastic surgery as far as I'm concerned.
Increased societal acceptance of men wearing clothing and styling themselves in a way that is considered feminine, is a different type of thing to eradicating female-only safe spaces. The latter is still necessary due to human sexual dimorphism. The former is just adornments.
Sexual dimorphism in humans has significant overlap. Many females are well above average male strength and many men are well below average female strength. I therefore submit that it doesn't really make any sense to use this as a basis for what constitutes a "safe space".
Posting this from an alt because I've almost gotten in trouble for mentioning this. But the overlap is not that big:
> Hand-grip strength has been identified as one limiting factor for manual lifting and carrying loads. To obtain epidemiologically relevant hand-grip strength data for pre-employment screening, we determined maximal isometric hand-grip strength in 1,654 healthy men and 533 healthy women aged 20-25 years. Moreover, to assess the potential margins for improvement in hand-grip strength of women by training, we studied 60 highly trained elite female athletes from sports known to require high hand-grip forces (judo, handball)
> 90% of females produced less force than 95% of males. Though female athletes were significantly stronger (444 N) than their untrained female counterparts, this value corresponded to only the 25th percentile of the male subjects.
> The results of female national elite athletes even indicate that the strength level attainable by extremely high training will rarely surpass the 50th percentile of untrained or not specifically trained men.
Yet there are hundreds of female rock climbers who will kick my ass on any crag in existence. We're not like spiders where the males are super tiny and easily eaten by the females, or even cardinals where the male has really colorful plumage. The differences are not super significant.
This is comparing two entirely different things. Rock climbing is a very complex sport in which the physical advantages that females have, such as flexibility are of similar importance to strength. Being able to get a high foot will give you much more leverage on the stronger muscles of your legs which is especially important when your forearms are screaming at you. Female climbers are also usually more efficient than male climbers which is needed as they are on average less strong. The difference between female strength and male strength in climbers is still significant, but the difference in performance less.
Luckily someone already did research into this (the other commenter linked it) and it’s likely she’d only be able to kick half of men’s asses at best.
Which would still be pretty impressive and unlikely.
This whole “actually there’s a big overlap” misconception is easily defeatable by noting that no women play in the NBA, NHL, MLB, or MLS. If there is a big overlap in physical capability, why haven’t women started going for the millions of dollars available in these open leagues? Are they too lazy, or too stupid?
I'm going to need a citation on that. I very much doubt even 25% of the men in the world could do what she does.
The big overlap is with the rest of the population. Of course little advantages in a population are going to be exaggerated if you only sample the top 1% of people!
> The results of female national elite athletes even indicate that the strength level attainable by extremely high training will rarely surpass the 50th percentile of untrained or not specifically trained men.
You said "in any sport" and not bouldering, so this finding will apply. You can also consult the rest of the literature such as it is. Or spend some time in a mixed-sex group strength training program and just observe.
> Results indicate that untrained men have greater upper and lower body strength than trained women athletes in terms of both absolute and relative strength.
> The results of female national elite athletes even indicate that the strength level attainable by extremely high training will rarely surpass the 50th percentile of untrained or not specifically trained men.
Irrelevant, because it requires training, which is not at all what we're talking about when we're talking about the general population.
> Results indicate that untrained men have greater upper and lower body strength than trained women athletes in terms of both absolute and relative strength.
Let me know when half of men can iron cross their way across a difficult move with their "greater upper body strength".
The strength of strength-trained females being less than 50% of non-strength-trained males is not “irrelevant” at all.
You’ve chosen an arbitrary and niche sport and athlete because you literally don’t have any other examples at hand and have conveniently made it impossible to test. No one is foolish enough to boulder at this level without training.
She would lose a simple wrestling match against the vast majority of men regardless of their training.
Ok, so what's your point here? Men are just too dangerous to ever be allowed near women? Women need to have their own bathrooms to feel safe, even though peopel raping or otherwise assaulting the same gender happens too?
This is all a flimsy as fuck excuse to hate on trans people.
My point is that your claim that “The [strength] differences are not super significant” is clearly false (obvious to any child, really) and your climbing-specialist counterargument is insufficient to overcome that.
I don’t care about the rest of whatever you’re on about. Pseudoscientific nonsense is pseudoscientific nonsense no matter what the motivation or source, and I’m glad to see you’ve apparently conceded that your pseudoscience is nonsense and have moved on to the predictable red herring ad hominems.
> My point is that your claim that “The [strength] differences are not super significant” is clearly false
I disagree, but perhaps that's because the term "sexual dimorphism" was used, which is really a very minor effect in human biology compared to a lot of animals. Besides which, we have tools which can negate brute strength in a confrontation anyway.
> your climbing-specialist counterargument is insufficient to overcome that.
I concede this. I did not do a particularly good job making my case.
> have moved on to the predictable red herring ad hominems.
This entire thread is about trans people and the subject of "female safe spaces" was brought up as an argument against allowing people to transition. Forgive me if I assumed your arguments were ultimately in service to that, but you made no claim otherwise.
> the subject of “female safe spaces” was brought up as an argument against allowing people to transition
No, it was brought up as a counter to your claim that single-sex spaces have no value (“the ‘wrong’ bathroom… arbitrary bullshit” in your comment).
Nobody in response mentioned anything about transitioning or trans people at all.
You are welcome to make the case that the strength dimorphism shouldn’t be taken into account for individual scenarios, but the idea that it doesn’t really exist or is generally insignificant is frankly gaslighting and insulting to people born female.
The user who responded has made several transphobic posts, and this is entire discussion is inherently about trans issues.
That you and others would decide to attack my bad argument without attempting to make a statement about trans issues in itself is... well, something I can respect actually, I just find it difficult to believe, and also it is beside the point of the entire discussion thread.
> but the idea that it doesn’t really exist or is generally insignificant is frankly gaslighting and insulting to people born female.
...maybe. Worth considering. Anyway, I've conceded that I have made a bad argument, which is what you are claiming is all you care about in this instance.
I thought we did science on here. Pointing out specific examples in a population when the topic is about the average is counter-productive. Kind of a logical fallacy there.
There's a reason that sports are separated by sex. There's a reason why men are the perpetrators and victims of most crime.
You are talking about "safe spaces". A woman's ability to rock climb better than a you doesn't make her much safer. If you were in a locker room with a woman, even if she was better at rock climbing, chances are, if you attempted to physically assault her, she would easily be overpowered.
> To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription.
This is exactly what parents have been fearing. They were told that cases like this are non existent. What these clinics are doing to children is criminal.
> This is exactly what conservatives and parents have been fearing
I'm as left leaning as they come and I'm also very worried and irritated by what is happening here. I hate that I have to make a new account for plausible deniability as well.
I don't really understand what doctors and a section of society is playing at. This is an issue that needs therapy not surgery. I'm sorry you feel you're in the wrong body, welcome to the club of the ugly short bald people who have a similar problem. You can do xyz but you'll never be what you want to be. It's tough but there is is, let's do some things to make you more comfortable and make life more positive.
See feelings don't have to be dismissed, but they also don't have to be pandered to. Using state funded medical services (or insurance funded if you're USA) is immoral imo. Sure if you're rich enough you can do whatever bizarre things you like to yourself, I don't care.
At least in most Western countries, we have explicitly outlawed the same medicines (Anabolic/Androgenic Steroids) for non-trans people without a physical medical need. In other words, a man who feels dysphoric about his body not being masculine enough cannot access the same drugs that a (biological) woman who feels dysphoric about her body not being masculine enough can.
I'd guess there are biological females who genuinely benefit from transitioning with testosterone, much like how there are many males who benefit from it due to hypogonadism/similar issues. I would have a serious problem if people started pushing testosterone on vulnerable young boys and telling them it would fix their problems, while vehemently attacking anyone who remotely questions those claims. How you think that's acceptable in girls, and compare it to informed adults getting botox for wrinkles or rogaine for hair loss is astounding.
None of the drugs you listed have significant effects lasting longer than a few months after their usage is stopped. With regard to plastic surgery, I'm not aware of any widely practiced cosmetic surgery that permanently and drastically changes one's entire endocrine system. If you're talking about cosmetic surgeries like breast implants, I don't think anyone has a problem with either trans or non-trans adults spending their money to look the way they want to. There is certainly no law to prevent it.
A man with low testosterone can’t get it because it’s “cosmetic” but the state will pay £100k for a child to have their penis removed for cosmetic reasons. And a lifetime script for the same hormones that people with medical needs aren’t allowed.
The medications and treatments often prescribed for trans people typically have other uses, so unfortunately for those who want to ban trans care, it's not possible to ban the treatments entirely, just come up with policies for being really selective about it. Those policies will not be terribly fair or effective.
Otherwise you're denying other people access to the same care even though you might believe they need it - reconstructive plastic surgery for cancer survivors, androgen or estrogen suppressors for people with various hormone regulation problems, hormone replacement for post-menopausal women or men who no longer have functioning gonads, etc.
Incidentally the latter is why Californian insurance typically covers surgeries for trans people: They already cover the same surgeries for other cases.
Why don't we just force all people who make appointments with psychiatrists to take a course in how the brain works, including theoretical reasoning of how unusual thought patterns can occur just like random weather fluctuations. If people understood that their thoughts are just a chaotic product of electrical impulses instead of some undefined metaphyisical phenomenon maybe they would realize that no one is really special.
Instead we encourage magical thinking around identity and strip people of ability to reason about their feelings effectively.
It's disappointing that the generally dire state of gender care in the west - in terms of a lack of rigor (as complained about in this article), lack of consistent process, etc - is used mostly as an excuse to shut down clinics entirely or fully ban gender care even for consenting adults (in process in the US right now).
The high rates of mental health struggles and suicides in the general US population (including but not limited to people struggling with gender issues) are used as a tool for arguing that gender care somehow leads to people's deaths instead of as a tool to argue for comprehensive, no-cost mental health care for people of all races, genders and identities.
We're just handed the latest most fashionable bogeyman - drag queens doing book readings at the library, gender-questioning kids going to gender clinics, etc - and told that if only we Put A Stop To this, maybe things will be alright again. When in reality millions and millions of people are experiencing untold suffering right now, and we could make fundamental fixes to our medical system to help all of them instead of fixating specifically on a small subset of the population and helping extremist lawmakers ban entire categories of care, whether it be gender care or abortions or birth control.
Good and interesting article. Swedish TV has done several documentaries on trans care here and its findings are disturbing. The patients are put on hormores too easily, don't understand what they do etc. There was even several regrets, detransitioners.
>The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus.
Most of the evidence I've seen around transitioning is for older cohorts who were outliers in terms of their motivation to transition - most of the push I've seen is to transition younger cohorts for which the effects of transition are unknown and experimental since we are transitioning kids in populations that we never would have transitioned before. I don't think this is necessarily WRONG, just risky and experimental and requiring tracking, but I see it being portrayed as a scientific fact that putting kids on hormone blockers as preteens makes their lives better.
> A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.
Regarding the whole notion of "Transgender kids are really just confused autistics", first what is considered an Autistic child itself is a moving target since Autism is not consistently diagnosed and we diagnose autism more broadly than we did even 10 years ago and the autistic population growth is pretty rapid itself. It's hard to get insight from something poorly understood by pointing out a correlation to another thing poorly understood. Second I've seen zero evidence that autistic populations are at any particular risk of adverse effects from gender affirming treatment or whatever, this just seems to be presumed because of condescending views towards autistics and their competence to guide their own care.
>My concerns about this approach to dissenting parents grew in 2019 when one of our doctors actually testified in a custody hearing against a father who opposed a mother’s wish to start their 11-year-old daughter on puberty blockers.
Gender identity is something rather famous for changing as you hit adolescence and this is something which has been noted throughout history to the point of being ritualised in some cases, and we even have the concept of "genderfluidity", but people seem to have this very deterministic view that whatever gender identity you had at 8 years old you have forever and you should intervene early before hormones kick in. Yet fucking with somebodies hormones at like 11 years old can't help but modify somebodies natural development of their gender identity, and that makes it hard to evaluate the effectiveness of early interventions without a control. We should make the treatment open to kids from 14 up, but below that kids should with both parents consent be allowed to enter an experimental trial on the condition that some of them will be controls. Unless we do that, we're going to keep hurting kids in ignorance, either due to under treatment or over treatment.
In regards to the claims that patients aren't being informed of the risks of gender affirming care, I think political influence is fucking with proper medical care of transgender people in both directions, both outlawing supportive and sceptical medical care alike but in different areas, and I really wish politicians would frig off of such a fast changing, poorly understood, and charged issue.
Maybe this clinic is saving trans kids, maybe it's not, but I personally would like society to stop pretending that it actually understands what will happen after they subject a significantly larger slice of the population to hormone treatments at increasingly young ages when the treatment population has multiplied several times over in short-order and we literally haven't even had time to do long term retrospectives. It's an experiment being portrayed as scientifically validated best practice. I would like to see more emphasis on medical freedom for doctors, controls, and proper long term tracking and research on patient outcomes but to allow these early interventions so long as they're being conducted as ethically as possible. That way we might even be able to identify nuances like "oh, if somebody has X issue, we should be extra cautious or extra aggressive about pursuing gender affirming care"
It's so important to take these testimonials seriously, whilst also being careful we don't hurt the chances of those that are able to get the help they would have had no access to only a decade ago.
Gender reassignment has been a thing since the 70’s at least. And stopped being a thing because of these sorts of problems at John’s Hopkins where they actually did keep track of the results.
> "Gender-affirming care is evidence-based medical best practice that, for transgender, nonbinary, and gender diverse people, is essential health care that enhances quality of life and overall well-being," wrote Pierre Joanis, JHU's vice president for human resources; Kevin Shollenberger, JHU's vice provost for student health and well-being; and Inez Stewart, senior vice president and chief human resources officer for Johns Hopkins Medicine, in a message to the Johns Hopkins community.
I didn't mean to imply that it doesn't do them today. It started doing them in the 1960s, and it ended them in 1979 based on the psychiatric results not justifying the practice.
People smear Dr. Paul McHugh today for ending it, but unlike the doctors at the clinic described in this article, he cared about whether his patients were actually being benefited.
Now we've come full circle and people are beginning to study the results, just like he did in the 70's. Not surprisingly, the same conclusions seem to be popping up around the world.
> people are beginning to study the results, just like he did in the 70's.
As I showed, people studied the same results that McHugh studied and came to the opposite conclusion. After studying more results, JHU reversed his decision. Not surprisingly, people biased by religious dogma come to wrong conclusions despite evidence to the contrary, and this has been true since the time of Galileo.
It’s pretty odd that you don’t seem to see the many other ways besides religion that people are motivated to believe certain things over other things that lead to wrong conclusions.
This has been the case since… the first man.
Edited to add that the most recent studies are saying exactly what McHugh said, and you can find them discussed in other places in this thread.
> It’s pretty odd that you don’t seem to see the many other ways besides religion that people are motivated to believe certain things over other things that lead to wrong conclusions
People who aren't religious just can be swayed by logic and reason. People who are, can't. It's that simple. They have to break out of their culture of denying reality themselves.
"... the safety of children should not be a matter for our culture wars."
Unfortunately, everything attested in this article is the direct consequence of adopting philosophical tenets of the currently-victorious contender in the Kulturkampf, namely Liberalism. Save for some cataclysmic distraction (like a war total enough to drain our resources and attention to the point of bringing us back to nature, as it were), this situation will not improve unless Americans begin to challenge the liberal dogma of bodily autonomy. Of course, no one wants to do that because that would mean admitting that the will of each individual is corrupt - and that's, like, original sin, or whatevur...
Nothing. But when you are from a specific political spectrum, before they came out it was "this is a conspiracy". After they came out it was "well of course that is how it works this is nothing new."
Who would’ve been shocked to hear that governments (including the US) make requests of private companies?
Even Third Party Doctrine, which is a way more direct attack on people’s rights, is so well established that it has a name with capital letters and its own Wikipedia article and whatnot.
No way of knowing, but it was released to select, friendly journalists and it has taken other people reading between the lines to find the most important stuff. Like demands from the Whitehouse to remove tweets that disparaged the president which were not covered by those select journalists. I suspect there are a lot more, but I would only expect Elon to release information that makes him look good or his enemies look bad.
Entire article ignores trans experiences, elevates a cis "ally" who feels trans people are icky, doesn't mention that detransitoners make up a very small fraction of all cases and the vast majority of people who transition are glad to have done so.
Hand wringing about the effects of T on young girls from seeing the female body as a sexual object that is "ruined" by it.
The only thing the article gets right is that puberty blockers are generally bad, but they're used because doctors are reticent to prescribe hormones, so they delay the choice.
> elevates a cis "ally" who feels trans people are icky
Are you talking about the author, who says at the start of the article that she is married to a trans man and spent years of her life working with and helping trans people? No matter what you think of the article, that claim is obviously wrong to anyone who read it.
I’m interested in the sources you’re referring to. Loss of follow-up seems well-cited as a potential weakness by legitimate sources in my brief investigation, but more importantly they have a reasonable amount of data from very old sources as well. I didn’t have to look hard.
I completely believe all those feelings are completely real but I fail to see how changing anything related to your appearance will bring true lasting happiness. To me it seems like the pinnacle of an image obsessed society. Additionally, let's be honest, most trans will never look 100% like their desired gender, none of them will look close without hormone therapy, and many are much less fortunate even with all the pills and operations. It's a spiral of self-delusion and refusal to accept boundaries and the limits of nature.
Your comment strikes me as interesting because you mention an image obsessed society but then you make some statements about image that seem to suggest a personal endorsement of this standard. Let’s hypothetically assume that your statements about failure to be perceived as they wish are 100% true as well as the idea that we should be less image focused are true too. Why should they or anyone else care if they never look like their desired gender if they feel better and lead productive lives?
I’ve certainly gotten dressed up to go nowhere, and I know women who put on makeup just for themselves too. I realize this doesn’t lie in exactly the same realm, but I hope you can see my point. Are we deluded? It seems to me that nature is a slippery slope.
Suicide rates are the same before and after transitioning. There's something else going on that needs to be addressed, and simply screaming at and attempting to gaslight critical voices is going to end with the unnecessary deaths of a lot more people.
Are they? Where's the study? I couldn't find one on suicide rates, but this one on based on survey data (so people who are still alive to answer the survey), says that suicidal thoughts reduce after transitioning. https://jamanetwork.com/journals/jamasurgery/article-abstrac...
The study you are citing appears to have been commissioned by the National Center for Transgender Equality (an organization that was founded by a transgender activist). That's like citing a study commissioned by Exxon-Mobil on climate change.
Forgive me for being extremely suspicious, given the multitude of other research to the contrary.
"The overall mortality for sex-reassigned persons was higher during follow-up"
> The study you are citing appears to have been commissioned by the National Center for Transgender Equality
Wrong. It was funded by a grant from the Patient Centered Outcomes Research Institute, which has no affiliation with any transgender activists. https://www.pcori.org/about/about-pcori
Forgive me for being extremely suspicious of your ability to evaluate evidence to come to rational conclusions.
Your study compares sex-reassigned people to the general population, not those who had surgery against those who wanted surgery but didn't get it. It is cited multiple times with a correct interpretation by the paper I gave you. The author herself points out you're using it wrong. https://www.reddit.com/r/science/comments/6q3e8v/science_ama...
It's analysing the 2015 Transgender Study, which is an online study that was spammed in transgender online communities and was commissioned by the National Center for Transgender Equality, an activist organization.
>Forgive me for being extremely suspicious of your ability to evaluate evidence to come to rational conclusions
Did you read your own link? It cites the NCTE study clearly.
> Did you read your own link? It cites the NCTE study clearly.
Yes, I did. The study wasn't commissioned by the NCTE, unlike what you claimed. It uses data from a survey by the NCTE. The people answering the survey have no reason to lie, and the NCTE had no reason to believe that its data would be used in this study years later. You're grasping at straws trying to make your initial claim make sense.
So the study's data was provided by an activist organization with every reason to have their finger on the scale? Not to mention the numerous study issues that have been uncovered with this particular online survey including but not limited to: no protection against multiple entries, no protection against non-US entries, errors in the survey flow (multiple commenters remarked that the survey questioned them on conditions they said 'no' to -- indicating faulty survey design).
Would you trust a survey on sugar done by Coca-Cola? This is the same thing. Activist surveys are worthless. Conflict of interest doesn't even begin to describe it.
Seems likely from the evidence that gender dysphoria is a good indicator for the existence of an underlying mental condition rather than some sort of glorious lifestyle choice, whether or not the person with dysphoria actually "transitions". Unfortunately instead of helping these troubled people we are placating them and encouraging them to damage themselves (which, to be clear, should be there right if they are adults).
You've broken the site guidelines in several places here. Please don't do that, regardless of how wrong someone is or you feel they are. Those are the moments when it matters most to follow them.
I've definitely noticed a trend of people on the spectrum suffering from mental health problems, self-diagnosing as gender dysphoric and then launching themselves down a one-directional, miserable path that ends in their suicide.
Being Autistic myself, and having goine through complete dysregulation as a 15-16 year old (it's way more common than you'd think, especially as most government support just stops when the kids turn 18), I completely understand the mental processes that both lead to the depression/anxiety/emotional dysregulation as well as the absolute certainty with which the epiphany of gender dysphoria is reached.
Hearing the specific linguistic choices common on trans reddit/twitter/tttt, and knowing the exact state of mind that cause this language to be used just sends a shiver down my spine. All it would have taken is for me to have been born 5 years later, and I'd be a dead trans woman rather than a fulfilled husband and father of two.
If there's anyone reading this who's on the spectrum themselves, or has a kid on the spectrum who's talking about gender issues, feel free to reach out and I can elaborate a bit more on exactly how this specific failure works.