Transgender and delaying puberty

[pendell]

So there is a new suggestion for treating gender dysphoria and related issues: delaying puberty (http://www.thedailybeast.com/articles/2016/08/11/can-delaying-puberty-help-transgender-kids.html)



Her child was experiencing what’s known as gender dysphoria, a DSM-5 diagnosis of significant ongoing distress, with the feeling of being assigned the wrong gender at birth. Researchers at Harvard recently found that transgender youth are at a much higher risk for mental disorders, including depression, anxiety, suicidal thoughts and self-harm. They are more than twice as likely as non-trans youth to be diagnosed with depression (50.6 percent vs. 20.6 percent) or suffer from anxiety (26.7 percent vs. 10 percent).

“These kids are saying to the world, ‘I was born in the wrong body, and there’s something just not right about living this way,’” said Scott Leibowitz, head child and adolescent psychiatrist at the Gender & Sex Development program for the Ann & Robert H. Lurie Children’s Hospital of Chicago.

Blockers “Safe and Effective”
Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable. By taking a gonadotropin-releasing hormone (GnRH) agonist, secretion of the sex hormones can be stopped and the onset of puberty suppressed, so that the body does not develop secondary sex characteristics. This has been done safely for decades to suppress sex hormones in children who develop too early, a condition known as precocious puberty. Suppressors have also been used to treat endometriosis, uterine fibroids and prostate cancer.


What do you -- especially our transgender or gender dysphoric readers -- think?

From what I've read puberty is happening earlier and earlier (http://health.usnews.com/health-news/health-wellness/articles/2015/04/17/why-kids-are-hitting-puberty-earlier-than-ever). Once upon a time, puberty didn't really kick in until the middle teens. Now, development as young as 10 is not unheard of. It makes sense to me that delaying development until a person has otherwise matured might very well ease gender dysphoria, allow people more time and emotional space to adapt to changing bodies.

Respectfully,

Brian P.

[Grinner]

I'm not in the target audience for these sorts of treatments, but I find reports on subjects like these rather confusing. With such contentious issues, it's sometimes hard to separate the science from the politics. For example, I've also heard the increased susceptibility to mental illness be attributed to social factors, so these sex hormone blockers may not actually be all that helpful.

I'm afraid we are living in interesting times.

[AmberVael]

My understanding is that puberty blockers have notable positive impact for transitioning individuals. The most common regret is "I wish I had transitioned earlier," and puberty blockers can really help with an effective and early transition.

I'd also like to highlight this part of the article:

If the suppressors are halted, puberty resumes as if there had been no treatment.
So unlike hormone therapy, its not inducing more permanent, difficult to reverse changes. Taking them even when you just feel uncertain and undecided would be fine, because if you decide that nah, you're okay, you can just stop taking them and things will carry on.

This is also a treatment that has been used for quite some time, just not in this particular fashion. So, there shouldn't be fears of it as some kind of new, untested procedure; we know how it works already.

[KillingAScarab]

This is also a treatment that has been used for quite some time, just not in this particular fashion. So, there shouldn't be fears of it as some kind of new, untested procedure; we know how it works already.Pretty much. The doctor quoted in the first post does go on to say there is some controversy regarding use before Tanner stage 2.


I'm not in the target audience for these sorts of treatments, but I find reports on subjects like these rather confusing. With such contentious issues, it's sometimes hard to separate the science from the politics. For example, I've also heard the increased susceptibility to mental illness be attributed to social factors, so these sex hormone blockers may not actually be all that helpful.

I'm afraid we are living in interesting times.If there's a button which can be pressed to turn off a society's ability to discriminate against minorities the majority is ignorant of, we should probably go and press that. Until that happens, norms need to change to reduce the chance that passing privilege determines whether or not someone is assaulted or worse, or that someone lives with the threat that something they do on a daily basis violates a law, or that someone is deemed mentally unsound.

Related to that, for an interesting look into how existing biases held by medical communities led them to limit access to transition treatment this YouTube video (https://www.youtube.com/watch?v=AVUgI1XWe-s&t=6m42s) by Zinnia Jones discusses that in some detail. I think it is relevant as it shows how important it is to not make treatments dependent upon suffering mental health problems.

[Grinner]

This is also a treatment that has been used for quite some time, just not in this particular fashion. So, there shouldn't be fears of it as some kind of new, untested procedure; we know how it works already.

I was thinking more along the lines of this specific off-label use of the drug as being the concern, not the drug itself. Societies seem to be calibrated in part along children developing into adults on a certain schedule. I'm not well-studied in developmental psychology, but experts of that field seem to prefer that children adhere to this schedule. If it's just a year that development is delayed, I guess that's not so bad, but longer than that seems like an increasingly bad idea. I was always kind of a late bloomer, and I know I had tons of trouble with mathematics in middle school (even whilst medicated for attention issues). The very idea of reciprocal functions just baffled me, but now in college, I've almost made straight A's (unmedicated) as a science major with highly technical hobbies. I can't help but wonder if my psychological development (or lack thereof) wasn't a factor in my early difficulties.

I guess the best way of describing my thoughts is that this drug might help resolve a self-perception problem for a certain fraction of the population, but only by creating other problems for them.

Edit:

If there's a button which can be pressed to turn off a society's ability to discriminate against minorities the majority is ignorant of, we should probably go and press that. Until that happens, norms need to change to reduce the chance that passing privilege determines whether or not someone is assaulted or worse, or that someone lives with the threat that something they do on a daily basis violates a law, or that someone is deemed mentally unsound.

Related to that, for an interesting look into how existing biases held by medical communities led them to limit access to transition treatment this YouTube video (https://www.youtube.com/watch?v=AVUgI1XWe-s&t=6m42s) by Zinnia Jones discusses that in some detail. I think it is relevant as it shows how important it is to not make treatments dependent upon suffering mental health problems.

You've demonstrated my point quite admirably.

[KillingAScarab]

You've demonstrated my point quite admirably.Hm. I find it difficult to believe this reply came after watching the video I linked to so soon after I posted, so I may not have been clear. I'll try again.

I think that offering a chance to delay puberty for children to sort out their gender identity is a good idea. However, I'm wary of restricting it to people who are perceived of being solely at risk of developing X, Y or Z mental illness, as not everyone who would benefit from it may fit a very exact narrative. I thought I was explicit about the former statement, but the latter would have been in that video.

I'll go ahead and state I am not a developmental psychologist.

[Grinner]

Hm. I find it difficult to believe this reply came after watching the video I linked to so soon after I posted, so I may not have been clear. I'll try again.

I think that offering a chance to delay puberty for children to sort out their gender identity is a good idea. However, I'm wary of restricting it to people who are perceived of being solely at risk of developing X, Y or Z mental illness, as not everyone who would benefit from it may fit a very exact narrative. I thought I was explicit about the former statement, but the latter would have been in that video.

I'll go ahead and state I am not a developmental psychologist.

In the interest of honest discourse, I should probably be more specific in my complaint.

See, your opening comes off as a bunch of hate and fearmongering. So already, I'm thinking "This guy is using divisive rhetoric and clearly has a chip on his shoulder. Maybe I shouldn't trust him to deal with me honestly." Then some jargon that I normally associate with unhinged Tumblr activists is mentioned. Finally, you give me a link to a half-hour long video titled "Transition as Gender Freedom" by some hair-dyed woman I've never heard of whose filmography includes titles such as "Chromosomes: cis expectations", "Trans Passing Tips for Cis People", and "Bathrooms and locker rooms: the transgender witch hunt".

Do you see the problem here? You presented your information in a way that evokes a highly-negative stereotype, that of an angry, intellectually dishonest person. Now, do I have biases? Sure. But throwing a bunch of gender studies-type stuff, the veracity of which I'm already inclined to question a great deal due to several factors, will only exacerbate those biases. It's going to demonstrate to me that all the bad things I've already heard about angry women with brightly-colored hair, liberal arts degrees, and sizable social media presences are true.

The best way to convince someone of something is to locate information they are inclined to implicitly trust and utilizing that as evidence. However, it must be done in a respectful, levelheaded manner, so as not to cause offense, and it will ideally also be short and concise. Furthermore, it is also wise to present oneself as being cool, calm, and collected. Avoid making negative statements about other people's viewpoints (which will only cause offense, entrenching them in their viewpoints) and instead focus on your position (while remaining cool, calm, and collected). Your second reply, for example, was a far better attempt at persuasion on both counts than your first.

Best of luck! :smallsmile:

[Delusion]

Denying transgender children puberty blockers is child abuse. There, I said it.

They have very little side effects while making life easier for the rest of the child's life. A lot easier. Many of the things puberty does are either not reversible or require surgery to fix.

Puberty blockers meanwhile, are reversible. If the child decides they are not trans after they can just taking them and they will have normal, if delayed puberty. (Besides the amount of people who do detransition is something like 2% and many of those detransition because of the amount of transphobia they face).

And as a transwoman who made it through wrong puberty: It was torture. Pure torture. I didn't know I was trans until my late teens but the signs were there even before (I just happened to read the description of Belt of gender changing like 50 times today. Its not like I want to be a girl or something. :smallsigh: I was not a smart child). Having my body change in the ways it did felt wrong. I didn't even know why but I just knew there was something wrong. Having hair grow on the places it did disgusted me.

If I had known that being trans woman was okay and didn't make me freak and if I had had easy access to puberty blockers I would have been saved from multiple years of pain and depression that almost made me kill myself.

Something like 41% of trans people have attempted suicide. Puberty blockers are a way we can save lives with pretty much no downsides.

[Jormengand]

So, Grinner, if you're not going to listen from arguments because of who the arguments come from, because they're specialised in a field that might actually be relevant to the debate, or because the argument isn't coming from a source such that you are already inclined to believe them, why are you here?

[Grinner]

So, Grinner, if you're not going to listen from arguments because of who the arguments come from, because they're specialised in a field that might actually be relevant to the debate, or because the argument isn't coming from a source such that you are already inclined to believe them, why are you here?

Ah, see. You've begun by presenting yourself in a passive aggressive manner. That is the mark of an enemy, not a friend. If you wish to engender goodwill, you want to present yourself as a friend.

To answer your question, however:

I was thinking more along the lines of this specific off-label use of the drug as being the concern, not the drug itself. Societies seem to be calibrated in part along children developing into adults on a certain schedule. I'm not well-studied in developmental psychology, but experts of that field seem to prefer that children adhere to this schedule. If it's just a year that development is delayed, I guess that's not so bad, but longer than that seems like an increasingly bad idea. I was always kind of a late bloomer, and I know I had tons of trouble with mathematics in middle school (even whilst medicated for attention issues). The very idea of reciprocal functions just baffled me, but now in college, I've almost made straight A's (unmedicated) as a science major with highly technical hobbies. I can't help but wonder if my psychological development (or lack thereof) wasn't a factor in my early difficulties.

I guess the best way of describing my thoughts is that this drug might help resolve a self-perception problem for a certain fraction of the population, but only by creating other problems for them.

[Jormengand]

Ah, see. You've begun by presenting yourself in a passive aggressive manner. That is the mark of an enemy, not a friend. If you wish to engender goodwill, you want to present yourself as a friend.

To answer your question, however:

I'm not in the least sorry for opposing people who decry gender studies as though it were a bad thing, assume people who dye their hair such as me don't know what they're talking about, and who respond to honest questioning in an openly hostile way. Please forgive me if I am more than a little hostile back or don't. I don't need your forgiveness.

By "Why are you here", I meant, you're clearly not here to have an intellectual debate. What are you here for, then, to tell people your opinion and claim that anything to the contrary is wrong on principle?

Do I wish to engender good will? Yes, of course. Which is why I would insist that everyone in the debate did so before climbing their own respective high horses on the subject. If you hadn't opened with a fusilade of bigotry, I wouldn't have responded by... asking a perfectly reasonable question? I mean, this is presumably meant to be a discussion thread, not a "Tell everyone they're wrong without looking at what they're saying" thread.

Given that you have posted an opinion with no evidence whatever behind it (repeat after me: the plural of anecdote is not data) I don't feel incredibly well-inclined to give it any credence, but I wouldn't care, and don't know or intend to find out in the slightest, who you are or what colour your damned hair is before I decide whether or not to listen to you in the first case. I don't like your tone in the bit but I am still engaging in debate with you, to the extent to which you've given me anything to engage with, anyway.

[Crow]

I'm not in the target audience for these sorts of treatments, but I find reports on subjects like these rather confusing. With such contentious issues, it's sometimes hard to separate the science from the politics. For example, I've also heard the increased susceptibility to mental illness be attributed to social factors, so these sex hormone blockers may not actually be all that helpful.

I've always heard it the other way around; that mental illness is the precursor to the gender dysphoria.

[Jormengand]

I've always heard it the other way around; that mental illness is the precursor to the gender dysphoria.

Unsurprisingly, it's neither, a study by Mustanki et al seems to show (although on a small group, so its accuracy isn't going to be great) shows no difference in mental disorders between cisgender and transgender individuals (actually, the frequency in transgender individuals was slightly lower than in the general population, but a slight discrepancy was going to be inevitable).

EDIT: Though, I'm not massively sure about how good this study is on more than one level, but I can't find a better one easily. Still, there is no evidence that transgender identities are caused by or linked with mental disorders.

[Keltest]

I do think somebody needs to give careful consideration to whether or not delaying puberty by more than a relatively short term isn't just going to introduce a whole different host of problems. Imagine youre a kid of 13 who is friends with other kids of 13. But theyre well into puberty, while youre just starting. And until you finish, its always going to be like that. Youll be shorter, less developed, weaker, and whatever other nasty comparisons come with having a later puberty.

Even without kids being their usual cruel selves, I can see how that could negatively impact one's mental well being, which if I understand correctly, is the problem this is supposed to help with in the first place.

[Delusion]

I do think somebody needs to give careful consideration to whether or not delaying puberty by more than a relatively short term isn't just going to introduce a whole different host of problems. Imagine youre a kid of 13 who is friends with other kids of 13. But theyre well into puberty, while youre just starting. And until you finish, its always going to be like that. Youll be shorter, less developed, weaker, and whatever other nasty comparisons come with having a later puberty.

Even without kids being their usual cruel selves, I can see how that could negatively impact one's mental well being, which if I understand correctly, is the problem this is supposed to help with in the first place.

You should be comparing that to what happens to transgender kids without puberty blockers.

Going through wrong puberty can be extremely traumatic and not all effects are reversible. At all. And many more require surgery too fix.

[noparlpf]

I wonder whether delaying puberty in the general population might be a good idea, and then inducing it on a controlled schedule a few years later on. It might help people through a tumultuous period of life to have a few extra years of life under their belts and to go through puberty on a controlled schedule.

And it would definitely help a lot of transgender kids. The kids who know young but aren't taken seriously until they're "old enough," and the kids who aren't sure yet and need a few years to figure out their identity. And there are no apparent permanent side effects to delaying puberty a few years. Seems win-win.

As for mental illness, it seems to me like depression is a pretty predictable outcome of overwhelming social stigma and prejudice, even for kids who don't innately have a significant amount of body dysphoria to deal with. That's more of a social/cultural issue that needs to be worked on than something you can fix easily with meds.

[Eirala]

I do think somebody needs to give careful consideration to whether or not delaying puberty by more than a relatively short term isn't just going to introduce a whole different host of problems. Imagine youre a kid of 13 who is friends with other kids of 13. But theyre well into puberty, while youre just starting. And until you finish, its always going to be like that. Youll be shorter, less developed, weaker, and whatever other nasty comparisons come with having a later puberty.

Even without kids being their usual cruel selves, I can see how that could negatively impact one's mental well being, which if I understand correctly, is the problem this is supposed to help with in the first place.

In case you were being serious:

So in favour of maybe having to deal with less bullying, you would rather definitely make sure the child is going through hell, possibly making them suicidal?
I don't get these kinds of arguments, at all. I don't even know if you're a troll or not.

As another trans person, let me tell you this: the wrong puberty is not something you'd want to wish on anyone. It's very much child abuse. Allowing trans people to delay puberty helps them potentially not killing themselves because yes it's that bad, and avoiding irreversible effects like hair growth etc helps a lot in making them not miserable / happier.

And as has been said before but also ignored, very few detransition again. It's not something that happens often. And we're not even talking about any irreversible effects, just delaying puberty. The concern about maybe delaying puberty for a cis child are frankly ridiculous.

[Keltest]

Lets be clear: I'm not opposed to this. By all means, if it helps people, do it. But trading one source of potential issues for another, even if its a "lesser" source, seems like it shouldn't be the end to me when the goal is to help people.

[Eirala]

The point is, we are talking so many orders of magnitude of difference here that this is very much a non-issue. Puberty blockers to help trans children are not problematic, they're life savers. You probably don't think chemotherapy is problematic either even though that very much messes your body up a lot. It saves lives.

[Lethologica]

At the very least, the fact that kids used to enter puberty later than they do now suggests that there's significant room for puberty delayers to act without harming the child's development. Meanwhile, an analysis of social side effects of use vs. non-use ends up firmly in favor of puberty delayers.


I guess the best way of describing my thoughts is that this drug might help resolve a self-perception problem for a certain fraction of the population, but only by creating other problems for them.
I agree that we should approach new therapies with appropriate caution. However, I think you are overstating the uncertainty of the benefits, while understating both the magnitude of the benefits and the certainty of the harmful side effects, with the consequence of creating a substantially negative picture of the therapy from evidence that presents at worst a mixed verdict.

I also don't think the best response to Scarab's opening post was a condescending analysis of how their presentation caused you to dismiss their post without bothering to get to its content. Your heuristics for presentation may be overdeveloped.


I've always heard it the other way around; that mental illness is the precursor to the gender dysphoria.
I'm not quite clear on what you mean by this. To me it seems difficult for mental illness to precede gender dysphoria, since gender dysphoria has significant roots in genetics and congenital factors, and a seemingly straightforward explanation for mental illnesses developing in trans people is in reaction to their body being the 'wrong' gender, or to their community abusing them for acting out the 'wrong' gender role.

[Delusion]

Lets be clear: I'm not opposed to this. By all means, if it helps people, do it. But trading one source of potential issues for another, even if its a "lesser" source, seems like it shouldn't be the end to me when the goal is to help people.

The thing is: we will never ever in thousand years stop bullying by forcing everyone to conform to certain norms so that wont be targeted b bullies; bullies will just find new reasons for their bullying.

Bullying at schools is a seperate and a major issue and there are ways to address that (mostly by tweaks to preschool etc).

[noparlpf]

Lets be clear: I'm not opposed to this. By all means, if it helps people, do it. But trading one source of potential issues for another, even if its a "lesser" source, seems like it shouldn't be the end to me when the goal is to help people.

That's literally how most of medicine works. Most drugs have side effects that aren't ideal but are significantly less bad than the thing they're treating.


The point is, we are talking so many orders of magnitude of difference here that this is very much a non-issue. Puberty blockers to help trans children are not problematic, they're life savers. You probably don't think chemotherapy is problematic either even though that very much messes your body up a lot. It saves lives.

^^^ There, that's a good example.

[cobaltstarfire]

I think it's great that this could be a use for puberty blockers.


But I also feel concerned that use of them may just be a band-aid solution, something that fixes the immediate dysphoria, but could lead to other serious problems in the future. Maybe there will be no problems, maybe they will be minor, or maybe there will be serious consequences.


But I don't really know, I'm really fuzzy on child development. We don't really understand fully how our body and brain interacts with and needs hormones for its development. And in this case it's something that may never be tested simply because testing things on children is such a huge ethical/liability problem that most people won't go near it.

The only way I can think about this because I don't have gender dysphoria, if I had a child with dysphoria. It'd be a very difficult choice to make, I'd be torn between wanting to help my child through the dysphoria, but also concern for how a treatment used in an untested way could end up being even worse for them. I would want what's best, but I have no way of knowing which is really the best. Do I take the short view, or the long view?

[Grinner]

^^^ There, that's a good example.

Except that's not an even comparison. Historically, unless people get chemotherapy, they tend to die in a predictable timeframe. We can even cut the problem out of their bodies.

The same is not true of transgender folk. Like I said earlier, I've also heard the suicide rate be attributed to social factors. It seems likely that it's some combination of many factors, but it's still much harder to account for.

[noparlpf]

Except that's not an even comparison. Historically, unless people get chemotherapy, they tend to die in a predictable timeframe. We can even cut the problem out of their bodies.

The same is not true of transgender folk. Like I said earlier, I've also heard the suicide rate be attributed to social factors. It seems likely that it's some combination of many factors, but it's still much harder to account for.

Actually, cancer is both difficult to predict and often difficult to treat surgically. That's what chemo is for: cancers that can't be removed surgically (and also to make sure that anything you missed during surgery is taken care of).

And as for social factors, that's not something you can treat with a pill anyway, so if there is a facet of the problem that can be treated medically, that's what we're concerned with here.

[Delusion]

By the way, did you know that that SRS (the dreaded "sex-change surgery") has lesser percentage of people regret having the surgery than the surgeries to remove cancer have?

And that medical transition lessen the rate of depression by rather huge degree.

So all these medical treatments for trans people have very obvious positive effects. And Puberty blockers have very few side effects. The only definate one was that for trans women they make some (but not all) forms of vaginoplasty impossible.

And without puberty blockers the medical transition later can (depending on which ones the person wishes to have) require much more dramatic procedures like masectomy. And some changes of puberty are irreversible.

I honestly do not understand why these treatments are still so difficult to get for trans children.

[Jormengand]

I honestly do not understand why these treatments are still so difficult to get for trans children.

Probably because this thread is actually abnormal in how sensible the average poster therein is about the treatments, whereas there are a lot of people with even less reasonable concerns than those posted here, and they are the kind of people making the decisions on whether to make them available.

[Grinner]

By the way, did you know that that SRS (the dreaded "sex-change surgery") has lesser percentage of people regret having the surgery than the surgeries to remove cancer have?

That is interesting, although I again think it's not an even comparison. It is consistent with the article, however.


I honestly do not understand why these treatments are still so difficult to get for trans children.

Cost and parental concern, according to the OP's article.

I, for one, am just a wee bit suspicious of anything so enthusiastically endorsed.

[Eldest]

The reason it's so enthusiastically endorsed by us is that most of us are trans people. So I can name 2 sisters that have have multiple suicide attempts. I know of one who succeeded. And I'm part of a remarkably successful support group. To use the cancer anology, you are telling a bunch of cancer survivors, who know the dead because /they were in that same place/, that some surgeries have negative and unknown effects, so we should avoid them, ban them. And then you expect friendly disagreement?

[Grinner]

The reason it's so enthusiastically endorsed by us is that most of us are trans people. So I can name 2 sisters that have have multiple suicide attempts. I know of one who succeeded. And I'm part of a remarkably successful support group. To use the cancer anology, you are telling a bunch of cancer survivors, who know the dead because /they were in that same place/, that some surgeries have negative and unknown effects, so we should avoid them, ban them. And then you expect friendly disagreement?

Expect? No, I've learned never to expect that, ever. Hope for? Sure.

I am pleased that people seem to be taking my opinion far more seriously than they should on this matter, though. I never recommended banning them, although some seem to believe otherwise. I have recommended caution, given the complex nature of the problem.

Edit: Tangential to this discussion, why do transgender women seem to like dresses so much? Whenever I hear stories about little boys telling others they're girls, the reports always seem to mention them getting really excited about wearing dresses, eliciting the question "Why do they become so fixated on dresses?". Is it genetic? Is it cultural? Perhaps there's truth to the idea of Platonic ideals, after all?

[The Succubus]

The percentage of people that regret transitioning treatments such as hormones, puberty blockers and gender affirmation surgery is much, much less than those that find them a critical element of survival. This alone should be a good enough reason to offer treatment options, even if the patient is not 100% certain.

The thing is, one of the major problems of transgender medicine and particularly with the management of the mental support of such is lack of understanding and empathy. Initial treatments for transgender people were decided upon by cis people consulting other cis people, rather like the analogy of the blindfolded people arguing over the shape of an elephant. Unlike elephants, transgender people are quite capable of talking about themselves, how they feel and how best they can be supported. Its only in very, very recent times that the field of medicine has started listening properly. Even now, we still have a very long way to go.

[wumpus]

That is interesting, although I again think it's not an even comparison. It is consistent with the article, however.

Cost and parental concern, according to the OP's article.

I, for one, am just a wee bit suspicious of anything so enthusiastically endorsed.

Is the point that they can wait until 18 for full consent to a corrected (either through artificial implants or more invasive surgery) hormonal balances or simply in hopes of future medical care?

I'd also assume that there needs to be a high bar in general for these things. They seem ideal for many abusive parents.

[Jormengand]

Edit: Tangential to this discussion, why do transgender women seem to like dresses so much? Whenever I hear stories about little boys telling others they're girls, the reports always seem to mention them getting really excited about wearing dresses, eliciting the question "Why do they become so fixated on dresses?". Is it genetic? Is it cultural? Perhaps there's truth to the idea of Platonic ideals, after all?

I know a load of trans women and about one of them likes dresses, so I don't know that this is always true.

[Grinner]

Is the point that they can wait until 18 for full consent to a corrected (either through artificial implants or more invasive surgery) hormonal balances or simply in hopes of future medical care?

Dunno. I remember the article saying they were used in some cases to delay early-onset puberty, which is in line with the original purpose of the medication. It may be prescribed to give the psychologists more time to work with the children, otherwise?


I'd also assume that there needs to be a high bar in general for these things. They seem ideal for many abusive parents.

I don't follow. Could you elaborate on that?


I know a load of trans women and about one of them likes dresses, so I don't know that this is always true.

Duly noted.

[noparlpf]

In the case of small children? Kids are taught early that dresses are "girly" and only for girls. So it makes some sense that a young trans girl who already knows that she's not supposed to be a boy would be interested in dresses as a means of showing that she's not actually a boy.

That, and cissexism means that a lot of the stories we actually hear about are the ones that fit stereotypical standards and gender roles.

[Frozen_Feet]

The biggest points of contention I've seen to this are:

1) we do not have reliable way of diagnosing transgenderism/-sexuality in prepubescents.
2) sexuality and self-identity only settle during and after puberty, and the presence/absence of hormones influences that.
3) puberty blockers and hormonal replacement theory still make a person infertile and reliant on external medical help.

Because of 1), it's easy to misdiagnose and jump the gun, because of 2) it's hard to tell after-the-fact whether the treatment was necessary, and 3) means there's still a level of bodily harm so it's not a zero sum game.

The puberty blockers themselves are not a problem. This is less a matter of technology and more that of ethics of medicine. There's other research suggesting that transsexuality is an inborn condition or can be predicted based on such, so it may be at some point we can get a reliable diagnosis before puberty.

[noparlpf]

1) we do not have reliable way of diagnosing transgenderism/-sexuality in prepubescents.

Therefore, if a kid is "maybe" trans, wouldn't it be ideal to put puberty on hold until they're "old enough" to be sure, rather than risk doing severe emotional damage?


2) sexuality and self-identity only settle during and after puberty, and the presence/absence of hormones influences that.

Arguable and not something we're sure of at this point.


3) puberty blockers and hormonal replacement theory still make a person infertile and reliant on external medical help.

Puberty blockers don't make a person sterile, they just delay sexual maturity. If you wait five years and then take them away, puberty continues as normal and the individual becomes fertile (assuming there's no other condition that would result in sterility). So again, wouldn't it be ideal to put puberty on hold and wait until they're 18 and can decide for themself whether sterility is a concern for them?

[Grinner]

Puberty blockers don't make a person sterile, they just delay sexual maturity. If you wait five years and then take them away, puberty continues as normal and the individual becomes fertile (assuming there's no other condition that would result in sterility). So again, wouldn't it be ideal to put puberty on hold and wait until they're 18 and can decide for themself whether sterility is a concern for them?

The OP's article brings up the idea of "age vs. stage". If these sex hormone blockers work as advertised, they'll prevent neural development. Thus, while they might be 18 chronologically, they won't be 18 biologically. They will still fulfill the technical legal requirements for age of consent, but will they really be able to make decisions as an 18-year old would? The question becomes a moot point, however, if they are not given the sex hormone blockers.

Now, the article does make the claim that absolutely no adolescent transgenders ever reverse their decision in adulthood (or something to that effect), so if this is true, it may be that gender is formed and solidified as a consequence of neural pruning throughout childhood and adolescence. Early signs of gender dysphoria may be a result of the neural pruning forming the beginning of a female brain while attached to a male body or vice versa. I'm not sure how the hormonal activity might work in this case, since you would expect abnormally high levels of the opposite sex's sex hormone.

The fact that that doesn't seem to be the case may indicate the presence of additional hormone activity, or it may indicate that the above hypothesis is invalid. If the former, I think we can expect a genetic cause for gender dysphoria, although this would be also problematic in a certain. It could indicate an additional "chain" of hormones which don't interact with the primary sex hormones, meaning the sex hormone blockers don't actually work as advertised. On the other hand, it could allow for neural development to proceed in spite of the inhibition of the primary sex hormones. Although since the blockers don't actually block estrogen and testosterone directly, the hypothesis could still be wrong...

[Frozen_Feet]

@noparlf: you're handily sidestepping the actual point of contention by not acknowledging that puberty is a physical condition and the mental changes we associate with "maturity" are part of it as well. This includes gender identity and sexual orientation. A person doesn't magically become better able to decide for themselves just by getting older in their number of years, because aging and maturing are two different processes.

[Jormengand]

I'm not sure that I see the evidence that puberty makes you clever or that children (whom we, with alarming frequency, trust to make decisions which will affect the rest of their lives but not to have the right to sexual or medical consent or other sovreignty over their own bodies) are universally stupid either.

[Yuki Akuma]

Immaturity is not the same thing as stupidity.

[Frozen_Feet]

@Jormengand: Fallacious generalization. I'm not talking about "stupidity" or "cleverness", I'm talking about identity and orientation. Self-identification is not a good criteria for diagnostics if we we have a reason to suspect a person's identity has not settled yet.

[noparlpf]

@noparlf: you're handily sidestepping the actual point of contention by not acknowledging that puberty is a physical condition and the mental changes we associate with "maturity" are part of it as well. This includes gender identity and sexual orientation. A person doesn't magically become better able to decide for themselves just by getting older in their number of years, because aging and maturing are two different processes.

Show me a dystopia where legal age of majority is determined by hormonal or neurological development tests and that's fair.

A kid who goes through puberty early isn't considered an adult at 15. A person with hormonal imbalances who doesn't go through puberty at all isn't considered a child at 30. Men and women go through different developmental changes during puberty and are both considered adults at 18 even though the average age at which the brain finishes developing is ~24. For that matter, male brains don't finish developing until about 1-2 years later, on average, than female brains, which suggests that testosterone (and therefore male puberty) inhibit development, but you don't see anybody proposing we raise the male age of majority or lower the female age of majority. It seems to me like we don't know anywhere near enough about neurology to assume that puberty has any inextricable role in neurological development or maturity.

[Jormengand]

@Jormengand: Fallacious generalization. I'm not talking about "stupidity" or "cleverness", I'm talking about identity and orientation. Self-identification is not a good criteria for diagnostics if we we have a reason to suspect a person's identity has not settled yet.

I was more referring to Grinner's point of "Thus, while they might be 18 chronologically, they won't be 18 biologically. They will still fulfill the technical legal requirements for age of consent, but will they really be able to make decisions as an 18-year old would?" than your concerns about being able to discover an identity that might not be present yet (though there are some very young transgender children, so there's that).

[Icewraith]

The OP's article brings up the idea of "age vs. stage". If these sex hormone blockers work as advertised, they'll prevent neural development. Thus, while they might be 18 chronologically, they won't be 18 biologically. They will still fulfill the technical legal requirements for age of consent, but will they really be able to make decisions as an 18-year old would? The question becomes a moot point, however, if they are not given the sex hormone blockers.

Now, the article does make the claim that absolutely no adolescent transgenders ever reverse their decision in adulthood (or something to that effect), so if this is true, it may be that gender is formed and solidified as a consequence of neural pruning throughout childhood and adolescence. Early signs of gender dysphoria may be a result of the neural pruning forming the beginning of a female brain while attached to a male body or vice versa. I'm not sure how the hormonal activity might work in this case, since you would expect abnormally high levels of the opposite sex's sex hormone.

The fact that that doesn't seem to be the case may indicate the presence of additional hormone activity, or it may indicate that the above hypothesis is invalid. If the former, I think we can expect a genetic cause for gender dysphoria, although this would be also problematic in a certain. It could indicate an additional "chain" of hormones which don't interact with the primary sex hormones, meaning the sex hormone blockers don't actually work as advertised. On the other hand, it could allow for neural development to proceed in spite of the inhibition of the primary sex hormones. Although since the blockers don't actually block estrogen and testosterone directly, the hypothesis could still be wrong...

I'm not sure if there is a whole lot of relationship between neural development and sex hormones. Considering that the treatment is already approved for children that start puberty too early, I don't think it's likely that there's a significant effect on neural development. Also, in high school there were a couple very late bloomers who didn't seem to be at all behind in the smarts department.

I'd assume there is some small subset of the population that never really goes into puberty due to a paartcular gene mutation, if they don't have issues with mental development then it's probably a pretty safe treatment.

For children that show signs of gender dysphoria, the ability to have a "correct", if delayed, puberty is a tremendous gift.

[Frozen_Feet]

Show me a dystopia where legal age of majority is determined by hormonal or neurological development tests and that's fair.

That's not a dystopia any more than current legal standards are. In fact, the current legal standards are based on the average rate at which people go through puberty and a person can have rights granted or revoked if their physical development is significantly behind or ahead the norm.

Ideally, each person's "legal age" would be decided on a case-by-case evaluation of their cognitive faculties. There's no deep reason why criminal culpability should start from 15, sexual consent at 16 and legal adulthood at 18 as a hard law, to use my country's laws as an example. Performing all the requisite tests on the entire population is just infeasible, so approximations are used.

[Grinner]

I was more referring to Grinner's point of "Thus, while they might be 18 chronologically, they won't be 18 biologically. They will still fulfill the technical legal requirements for age of consent, but will they really be able to make decisions as an 18-year old would?" than your concerns about being able to discover an identity that might not be present yet (though there are some very young transgender children, so there's that).

But Frozen_Feet is making a valid point, I think.

At any rate, I was going to bring up a certain adage, "The absence of evidence is not the evidence of absence". As noparlpf has implied, I think we're at an impasse for the moment.

[Jormengand]

But Frozen_Feet is making a valid point, I think.

At any rate, I was going to bring up a certain adage, "The absence of evidence is not the evidence of absence". As noparlpf has implied, I think we're at an impasse for the moment.

Well, yes, but the absence of the evidence where you would expect there to be evidence if it were true is evidence of absence.

[Frozen_Feet]

I was more referring to Grinner's point of "Thus, while they might be 18 chronologically, they won't be 18 biologically. They will still fulfill the technical legal requirements for age of consent, but will they really be able to make decisions as an 18-year old would?" than your concerns about being able to discover an identity that might not be present yet.

Grinner's point is solid, you just have to realize it applies the other way too. There are 15-year-olds who are biologically and mentally 18, and some rare cases of 20-year-olds who are biologically and mentally 10.

Calendar age is not the same thing as maturity, that is, operative mental, physical and metabolic age. The legal tresholds for adulthood etc. are calibrated based on when most people reach required cognitive benchmarks. They're not actual natural laws and relying on them in corner cases, such as a person whose puberty is chemically delayed, is nuts.


Though there are some very young transgender children, so there's that.

Of course there are. If you take some current theories at face value, some people are trans from birth.

That's not the point of contention. The contention is that we cannot reliably distinquish between cases where this treatment is necessary and case where it's not.



I'd assume there is some small subset of the population that never really goes into puberty due to a paartcular gene mutation, if they don't have issues with mental development then it's probably a pretty safe treatment.

There is such subset and they do have problems with mental development.

Just as well there's a subset where physical growth and sexual maturity is stunted, but mental development isn't. And several others where physical and sexual maturity is reached as normal, but mental development is stunted.

It's not clear cut and the obvious experiments to verify it would be highly unethical. Which is why I restate: technology is not a problem here. It's an issue of ethics of medicine.

[Delusion]

So because of the small number of people, who are actually cis but think for a while that they might be trans, might suffer harm we should be willing to cause irreversible harm to the kids who are trans?

Secondly we don't actually know that delaying puberty delays brain development.

[Frozen_Feet]

You didn't understand the point of contention. We can't tell if it's a big or small number because we can't reliably diagnose a prebuscent and we can't reliably tell if the treatment was needed after-the-fact.

EDIT: Also, since you like to throw around colourful rhetoric, here's some tit-for-tat: "irreversible harm to trans kids", from a medical viewpoint, suggests there are no mentally healthy and happy people who transitioned as adults.

Do you honestly believe so?

Also also, current methods of transitioning cause irreversible harm to everybody, whether they want or need the treatment or not. Is dodging a potentially hellish puberty worth the cost of life-long inability to have biological kids?

Some actual trans people disagree, because they've knowingly put their transitioning on hold in order to get biological kids first. (One case made the evening news in Finland, with sensationalist headlines like "First man to give birth!".)

[Delusion]

You didn't understand the point of contention. We can't tell if it's a big or small number because we can't reliably diagnose a prebuscent and we can't reliably tell if the treatment was needed after-the-fact.

Even with adults the only reliable way to diagnose the person as trans is to ask them if they are.
And there is a reliable way to tell f the treatment was needed, if the person still identifies as trans and wants to continue to full HRT when they are adults instead of just dropping the blockers, then they were needed.


EDIT: Also, since you like to throw around colourful rhetoric, here's some tit-for-tat: "irreversible harm to trans kids", from a medical viewpoint, suggests there are no mentally healthy and happy people who transitioned as adults.

Do you honestly believe so?

The fact that someone has suffered irreversible harm doesn't mean someone can't be healthy or happy, it just means that the harm, in this case the unwanted changes to body, can't be reversed.


Also also, current methods of transitioning cause irreversible harm to everybody, whether they want or need the treatment or not. Is dodging a potentially hellish puberty worth the cost of life-long inability to have biological kids?

Some actual trans people disagree, because they've knowingly put their transitioning on hold in order to get biological kids first. (One case made the evening news in Finland, with sensationalist headlines like "First man to give birth!".)

The effect of puberty blockers on fertility is reversible. So if the person decides that they want to have children they can, if they want, stop taking the blockers. If they however think that not going through wrong puberty is worth more they can remain on the blockers until they are eighteen, at which point they are adults and the decision belongs to no one but them, and start full HRT.

[Frozen_Feet]

Even with adults the only reliable way to diagnose the person as trans is to ask them if they are.

This is an extremely disingenuous way to describe the battery of psychological tests involved. It's akin to saying IQ tests work by asking the person if they're intelligent. If it was agreed that you can ask a prebuscent all the same questions as you would an adult and get exactly as good results, this point of contention would not exist.

[Delusion]

This is an extremely disingenuous way to describe the battery of psychological tests involved.

As someone who has gone through those tests and knows a lot of other people who have as well: The battery of psychological tests don't work. At all. They are based around fitting the stereotypes about trans people as well as general gender stereotypes.

And yes, letting children make decisions that affect them for the rest of their lives is not wise, but neither is not listening to those children when they tell you how they feel. The whole point of puberty blockers is that they allow the decision to be made by the person when the person is an adult.

[Eirala]

As someone who has gone through those tests and knows a lot of other people who have as well: The battery of psychological tests don't work. At all. They are based around fitting the stereotypes about trans people as well as general gender stereotypes.

This. The only way to determine the gender of someone and / or if they are trans is to ask them. If they're not sure you can help them by asking certain questions, but at the end only they themselves can know the answer. There is no test or psychologist that can just tell you if you're trans or not.

[noparlpf]

You didn't understand the point of contention. We can't tell if it's a big or small number because we can't reliably diagnose a prebuscent and we can't reliably tell if the treatment was needed after-the-fact.

Actually, there is a diagnosis called "gender dysphoria in children" which applies to pre-adolescents. A diagnosis of "gender dysphoria in adolescents and adults" can't be reliably made in pre-pubescent children.

Once that diagnosis is made, there are two courses of treatment.
1. Prescribe puberty blockers until the kid is old enough to decide to pursue HRT or until they decide to discontinue puberty blockers with no apparent lasting effects as far as we can tell from current research.
2. Wait until sufficient psychological damage is done to warrant treatment.


Also also, current methods of transitioning cause irreversible harm to everybody, whether they want or need the treatment or not. Is dodging a potentially hellish puberty worth the cost of life-long inability to have biological kids?

First of all, puberty blockers do not cause any changes to fertility. They just postpone it. After discontinuing them, puberty progresses as normal. We've been through this. It's HRT that affects fertility, and that's a different set of treatments.

Second, not everybody considers sterility to be the worst thing ever. That's a personal medical choice. If you want to say that a kid has to wait until they're 18 before making that choice, fine, but after they're 18 you don't have any right to stop them. If having biological children is important to somebody, they can do something about freezing sperm or eggs themself, but again, it's none of your business.


This is an extremely disingenuous way to describe the battery of psychological tests involved. It's akin to saying IQ tests work by asking the person if they're intelligent. If it was agreed that you can ask a prebuscent all the same questions as you would an adult and get exactly as good results, this point of contention would not exist.

Um...I guess it is similar to an IQ test in that neither yields meaningful results. IQ is a pretty bs way of measuring intelligence, and most of the (outdated) psychological tests you're referring to are based in stereotypes and gatekeeping.

Gender identity is literally only about self-identity, so the only meaningful diagnosis is self-diagnosis. (Kind of like how you don't need a doctor to tell you if you're gay or asexual.) Read the diagnostic criteria for "gender dysphoria in adolescents and adults" in the DSM5. You may note that literally all six of them (of which only two are required for a diagnosis) are about personal experience and self-identification.

[Jormengand]

Yeah, I was diagnosed as trans by... asking me if I was trans. It really is that simple. It is not "Disingenuous" in the slightest; it is simple fact that that is how anyone with the sightest iota of an idea what they're doing will tell whether someone is trans or not. Calling your debate opponent "Extremely disingenuous" without even taking the time to check whether or not they're right isn't going to get you anywhere whatever.

[wumpus]

I'd also assume that there needs to be a high bar in general for these things. They seem ideal for many abusive parents.



I don't follow. Could you elaborate on that?


I still think that while this might not be the elephant in the room, it may be at least the great dane.

I am assuming that parents exist who might:

1. Not want their children to grow up
2. Not want to deal with teenagers

Of course, if this treatment is allowed only for those who have been raised as a gender other than defined by sex organs this casts a completely different light on the subject: if the choice is the child's it makes sense to delay as noted in the thread while if the choice (of identification) is the parent's it makes sense to delay anything as drastic as puberty until the child has some degree of independence. If you allow some sort of "adolescent onset gender confusion" especially without having the child specifically live as a different gender you will have a lot more parents jumping for such medical treatment.

As far as simply "asking the patient" I am struct by the Captain of the Beagle's insistence that slaves were treated well, happy to be in slavery, and better off than being free. After all, he asked one and was told as much. To which Darwin replied that not only did he hear it as well but so did the overseer. And the overseer had his lash handy, which made Darwin far less likely to believe the statement as truth (at that point the Captain flew into a rage claiming his honor was besmirched by someone failing to agree with him). A child in such a situation isn't that far off from the slave in question. Dealing with an adult might be trivial, but I suspect that a child [or teenager, but presumably that is too late for this treatment] might not have an option coming home "wearing a dress*".

This isn't quite as far fetched as it sounds. I strongly suspect the medical/scientific community wouldn't be as accepting to trans people so easily [ok, from ground zero it might not look easy] had there not been repeated documented proof that external gender assignment (socially or medically) simply doesn't work. I'd also suspect parental meddling in anything so rare and life changing as this (or devoting all "free" time to sports/music/arts, repeated injury or sudden stabbing, etc.).

* I'm not expecting such a parent to be bothered with such issues about the accuracy of such expressions as shown in this thread.

[Jormengand]

So, you suggest denying such a treatment, which is straight-up child abuse, on the basis that it might, under vanishingly few circumstances, be used as a method of child abuse (not to mention an exceptionally risky one, as few parents would be willing to risk their child saying they were being forced to say yes to the treatment)? Not to mention that taking them is entirely reversible while not taking them is not.

[georgie_leech]

So, you suggest denying such a treatment, which is straight-up child abuse, on the basis that it might, under vanishingly few circumstances, be used as a method of child abuse (not to mention an exceptionally risky one, as few parents would be willing to risk their child saying they were being forced to say yes to the treatment)? Not to mention that taking them is entirely reversible while not taking them is not.

I don't think they're saying we shouldn't use this treatment for that reason, but that we should be careful that we don't accidentally enable other abuses through it. It wouldn't hurt to have strong diagnostic methods, for instance, though I don't know of any that rule out parental influence yet. Being careful isn't the same as not going forward.

[Siosilvar]

This is an extremely disingenuous way to describe the battery of psychological tests involved. It's akin to saying IQ tests work by asking the person if they're intelligent. If it was agreed that you can ask a prebuscent all the same questions as you would an adult and get exactly as good results, this point of contention would not exist.

Are you aware that the "battery of psychological tests" doesn't actually exist, and that self-identification is the accepted standard for determining if somebody is transgender, because it's more accurate than any other "test" we have out there and more accurate than self-identification for pretty much anything else?

[pendell]

Are you aware that the "battery of psychological tests" doesn't actually exist, and that self-identification is the accepted standard for determining if somebody is transgender, because it's more accurate than any other "test" we have out there and more accurate than self-identification for pretty much anything else?

*I* wasn't aware of that. This thread has been really educational for me.

Respectfully,

Brian P.

[Vinyadan]

Wait, 20% of youths are diagnosed with depression? Where I live it's already impressive if 2% see a doctor of any kind, not to say a psychologist or psychiatrist.

I have heard of this treatment used in Holland, in an interview with psychiatrist Annelou de Vries and psychologist Thomas Steensma, both of which work at the VU Medical Center, in Amsterdam (just to explain I am not making things up). The rationale behind it is that gender dysphoria isn't that easy to spot and that problems resulting in a wish for sex change may actually be transitory and/or of different origin from gender dysphoria. The treatment is used to halt the development of secondary sex traits and make an eventual sex change less painful and invasive when the right age for it comes about; it actually turned out that the really many people would then see their problems solved before this time and could revert to their normal life without surgery, i.e. they weren't actually affected by gender dysphoria. To be clearer: of children claiming dysphoria before 12, only 22%-30% maintains it when puberty starts; from 12 to 16 y o: 1/4 of sex change requests isn't met by recognition of gender dysphoria, i.e. there are other reasons; of those who actually enrolled in the suspension therapy, only 3 out of 300 choose not to transition sex when they reached 18.

This means that such things cannot be improvised and that they require complex support by professionals belonging to various disciplines. Another point that was made is that children do not really know what sex and gender mean, and that they are not ready to make a choice about e.g. lifetime infertility, or to imagine (or even gleam) how different sex life becomes.


I wonder whether delaying puberty in the general population might be a good idea, and then inducing it on a controlled schedule a few years later on. It might help people through a tumultuous period of life to have a few extra years of life under their belts and to go through puberty on a controlled schedule.

This sounds like a bad idea to me. Forcing people to delay their development, when all a kid wants to do is grow up, get faster, stronger, better, with no health reasons for it? You don't force humanity to eat gluten free pasta or to give up on nuts because of dangerous and widespread allergies or intolerances, the same applies here. There also are problems and collaterals, although relatively small (calcium absorption, lesser growth problems), and there still isn't any idea of what happens after 60.


@noparlf: you're handily sidestepping the actual point of contention by not acknowledging that puberty is a physical condition and the mental changes we associate with "maturity" are part of it as well. This includes gender identity and sexual orientation. A person doesn't magically become better able to decide for themselves just by getting older in their number of years, because aging and maturing are two different processes.

I think you are underestimating the value of experience and memory in decision making. A teenager, at least a male, wants to make his own decisions and makes them and learns through mistakes. A suspended kid may not be so driven against authority of others as an unsuspended pubescent, but he still will learn from experience.



I'd also assume that there needs to be a high bar in general for these things. They seem ideal for many abusive parents.

I agree. There already are people in Brazil that are given money by human traffickers to give their male children woman hormones while they grow up, so that they take on a special shape and can be sold on the roads of Europe (known around here as viados, which is a loanword that means something else in Brazil). I can see a market being developed for interrupted or suspended puberty. So I believe that there needs to be a bar, and that this kind of medicals shouldn't be sold without clearance; maybe they shouldn't even be administered outside hospitals, to make them harder to obtain from the wrong people. I don't believe simply selling them as a prescription drug would be enough: I can think of a case in which a criminal organization had a deal with a medic to write prescriptions for his patients for a psychotropic drug which was later sold on the streets as illegal recreation drug. The organization paid some 50 $ to the patients and something more to the medic.


To me it seems difficult for mental illness to precede gender dysphoria, since gender dysphoria has significant roots in genetics and congenital factors

Do we actually know that? I thought there were hypotheses, but no actual answer yet, like to why some are gay and most aren't. Are there studies which show the presence of genetic and congenital factors in gender dysphoria? Just curious.

[Lethologica]

Do we actually know that? I thought there were hypotheses, but no actual answer yet, like to why some are gay and most aren't. Are there studies which show the presence of genetic and congenital factors in gender dysphoria? Just curious.
Here's one example (http://www.hawaii.edu/PCSS/biblio/articles/2010to2014/2013-transsexuality.html) of a study suggesting significant genetic influence. Here's another (http://link.springer.com/article/10.1023%2FA%3A1019724712983). Here's a brief and non-comprehensive overview (http://qr.ae/TNeWgH) of what is known or suspected about causes of transgender identity, with a fair number of links to studies, and an emphasis on prenatal factors.

[Siosilvar]

*I* wasn't aware of that. This thread has been really educational for me.

Respectfully,

Brian P.

Yeah, to get my letter for HRT was basically a few months of traditional counseling and then basically an interview where we talked about my gender identity over time, transition status and plans, and making sure I understood all of the effects and side effects of hormone therapy. I did go into that with the stated diagnoses of gender dysphoria (from the same counselor) and mild depression (from a coworker), but those didn't come from a "test" either.

[Frozen_Feet]

Are you aware that the "battery of psychological tests" doesn't actually exist, and that self-identification is the accepted standard for determining if somebody is transgender, because it's more accurate than any other "test" we have out there and more accurate than self-identification for pretty much anything else?

Last time I checked they did exist, and if you'd tried to pass your own "two months of counselling + interview" as "just being asked", I would've called you disingenuous just as well.

Self-identification is the accepted standard, yes. It's not a particularly *good* standard, as there are other mental and medical conditions than transsexuality which can cause confusion of gender identity. Your counselling and interview? Those were tests just as much as checking boxes on a sheet of paper would've been.

[Delusion]

Last time I checked they did exist, and if you'd tried to pass your own "two months of counselling + interview" as "just being asked", I would've called you disingenuous just as well.

Self-identification is the accepted standard, yes. It's not a particularly *good* standard, as there are other mental and medical conditions than transsexuality which can cause confusion of gender identity. Your counselling and interview? Those were tests just as much as checking boxes on a sheet of paper would've been.

I am going to repeat what I said earlier. Those tests. They don't work. At all. They are nothing more than the doctors trying to see if the person fits the gender stereotypes and the stereotypes about trans people the doctor has. There is no way for the doctor to know if someone is trans than ask that actually works.

[Grek]

I'm just confused as to why this is being presented as "new". Puberty blockers have been part of the gender dysphoria treatment toolbox for over a decade now.

[noparlpf]

Self-identification is the accepted standard, yes. It's not a particularly *good* standard, as there are other mental and medical conditions than transsexuality which can cause confusion of gender identity. Your counselling and interview? Those were tests just as much as checking boxes on a sheet of paper would've been.

What other conditions are there? Honest question.

[Siosilvar]

Last time I checked they did exist, and if you'd tried to pass your own "two months of counselling + interview" as "just being asked", I would've called you disingenuous just as well.

Self-identification is the accepted standard, yes. It's not a particularly *good* standard, as there are other mental and medical conditions than transsexuality which can cause confusion of gender identity. Your counselling and interview? Those were tests just as much as checking boxes on a sheet of paper would've been.

No, really, it's self-identification: http://www.dsm5.org/documents/gender dysphoria fact sheet.pdf

The interview had nothing to do with the diagnosis, that was just to figure out what to write on the letter recommending treatment for it to convince other people that it was medically necessary. I got the diagnosis day one, because I walked in with the express intent of getting that letter to start treatment to relieve my dysphoria. It turns out that self-identification fulfills the DSM5 criteria, exactly like I said.

But slightly more importantly, why do you think you know more about my life than I do?

[Grinner]

But slightly more importantly, why do you think you know more about my life than I do?

Please don't ask such pointed, rhetorical questions. They only serve to drive wedges deeper.

[Jormengand]

Please don't ask such pointed, rhetorical questions. They only serve to drive wedges deeper.

Unless, of course, they aren't rhetorical, and Sio is actually looking for an answer, which I suspect she is.

[Grinner]

Unless, of course, they aren't rhetorical, and Sio is actually looking for an answer, which I suspect she is.

You're entitled to your opinion.

[Siosilvar]

You're entitled to your opinion.

Considering that that's exactly what I want, it's not an opinion, it's the goddamn truth. I ask pointed questions to get my point across, because it seems that nothing less has ever worked since I changed my gender marker here.

I am privileged enough to be in full possession of my faculties at all times, and I've always been very good at pattern recognition and interpreting events. I know full well what is going on around me, and Frozen_Feet hasn't even met me let alone know all the information. So why am I being told that I am wrong about my literal personal experiences?

[Jormengand]

You're entitled to your opinion.

That I am, but you are not entitled to your own facts. You're trying to be cleverer than you are in a debate full of people who know what they're about. Why not take a break from the wisecracks that always end up just showing up that you don't have a clue what's going on, in the debate or out of it?

[Grinner]

I am privileged enough to be in full possession of my faculties at all times, and I've always been very good at pattern recognition and interpreting events. I know full well what is going on around me, and Frozen_Feet hasn't even met me let alone know all the information. So why am I being told that I am wrong about my literal personal experiences?

Let's consider Frozen_Feet's perspective.

He claimed that testing for transgender status involved a fairly intensive screening process. You claimed that one merely needed to claim that one is transgender in order to be considered as such. You also provided a link to the DSM-V website to back your claim. Unless Finnish protocols for transgenders are different (I seem to recall Frozen_Feet being Finnish, and Delusion's remarks seem to intimate that they are (which would be weird, but, hey, that's what I'm seeing)) or unless the fact sheet you linked is incomplete with regards to the requirements of gender dysphoria, you've clearly and reasonably supported your argument. While some may have personal disagreements with the information presented within that fact sheet, it is the dogma of the psychiatric community. The only way anyone could do better is to rip the relevant pages out of a copy of the DSM-V.

Great. Argument resolved, more or less.

But, that question. I'm not formally educated in semantics, but I have trouble believing you expect any satisfactory answer other than silence. You two are, after all, strangers. If you were looking to make a point, it was a point well-made. However, if Frozen_Feet takes offense at such backhanded delivery and is the type to hold a grudge, he may carry this experience into the future and may come to associate this experience with transgenders. I realize you may not see things this way or may not care, but it is a contribution to public perception nonetheless.

[Delusion]

Unless Finnish protocols for transgenders are different (I seem to recall Frozen_Feet being Finnish, and Delusion's remarks seem to intimate that they are (which would be weird, but, hey, that's what I'm seeing))

Protocols do wary hugely from country to country and sometimes within a country. Some places are moving to the informed consent model while others still use the gatekeeping model.

In Finland for a diagnosis you need at least six months of visits to the gender clinic (was 2 and half years for me. Longest I have heard is three years for someone who didn't get kicked out and told to return in few years. Which is something that happens.) an evaluation by psychologist and visit to endo (I think thats the right word).

For legal gender change and surgery you also need to live one year in the "role of the opposite sex" (Finnish gender clinic use old and sometimes silly terms) and you need to get the second opinion from the other of the two gender clinics in Finland. You also need to be sterile for the legal gender change.

[Alcibiades]

Protocols do wary hugely from country to country and sometimes within a country. Some places are moving to the informed consent model while others still use the gatekeeping model.

In Finland for a diagnosis you need at least six months of visits to the gender clinic (was 2 and half years for me. Longest I have heard is three years for someone who didn't get kicked out and told to return in few years. Which is something that happens.) an evaluation by psychologist and visit to endo (I think thats the right word).

For legal gender change and surgery you also need to live one year in the "role of the opposite sex" (Finnish gender clinic use old and sometimes silly terms) and you need to get the second opinion from the other of the two gender clinics in Finland. You also need to be sterile for the legal gender change.

I think a period of counseling and living as the desired gender ( yeah idk what to call that period either) is a good thing before before going on to risky and possibly permanent procedures like hormone therapy and gender reassignment surgery. I can't speak for how long or elaborate it should be though.

Delaying puberty though, is perfectly harmless and just good practice. It's not exactly sci-fi, it's already being employed in places. (I daren't speculate on the frequency)

Re DSM5: The section specifically mentions "Clinically significant stress", which would point that identification itself could be enough but is not the only criterium, no?

And referring to the DSM as the universal standard regarding all the conditions it describes is a bit of a stretch. The DSM5 in particular is very controversial, and the fact that many countries diverge from it in practice without universal opposition from its medical professionals would point that it's not a universally agreed-upon standard here.

[AmberVael]

I think a period of counseling and living as the desired gender ( yeah idk what to call that period either) is a good thing before before going on to risky and possibly permanent procedures like hormone therapy and gender reassignment surgery. I can't speak for how long or elaborate it should be though.

I think those things could be a good idea, but I question whether they should be mandated. For one they're prone to abuse, promoting gatekeeping and questioning that cause more harm rather than good. For another... what any given trans individual will need and benefit from will drastically differ. One person might be certain from the beginning and suffer extreme dysphoria, and getting them treatment immediately would be preferable. Another person might benefit from more searching and deliberation before they settle on what they feel comfortable with. Saying both people have to wait for an extended is not a particularly great idea.

Whats more, the most common regret in trans individuals is "I wish I had transitioned sooner." Relieving people of substantial mental stress doesn't sound like something to be unduly delayed.

[Siosilvar]

-snip-

I don't need you tone policing me. I will be as backhanded as I want, because it's the only damn way that my points ever get across nowadays.

[noparlpf]

Telling a minority group that their position isn't really valid unless they bend over backwards to avoid hurting your feelings or whatever with blunt language is not particularly helpful.

[Keltest]

Telling a minority group that their position isn't really valid unless they bend over backwards to avoid hurting your feelings or whatever with blunt language is not particularly helpful.

I cant imagine that offending people with blunt language is particularly helpful either. Whether or not its a valid problem, I'm not very interested in listening to anybody who is unwilling to deal with me politely.

[noparlpf]

I cant imagine that offending people with blunt language is particularly helpful either. Whether or not its a valid problem, I'm not very interested in listening to anybody who is unwilling to deal with me politely.

That's kinda how it feels all the time when you're a member of an oppressed minority.

[Keltest]

That's kinda how it feels all the time when you're a member of an oppressed minority.

That doesn't mean you should go around offending the people who are sympathetic. Doing so is a very good way to make sure that your efforts to get un-oppressed don't gain much traction.

[noparlpf]

That doesn't mean you should go around offending the people who are sympathetic. Doing so is a very good way to make sure that your efforts to get un-oppressed don't gain much traction.

I'm not saying you should go around directly insulting people or anything, but a lot of the time fake allies use that exact rhetoric when an oppressed minority so much as mentions they're being oppressed, so you might imagine that it's a bit hard to buy that any given person using that rhetoric is actually sympathetic and not just patting themself on the back for being a "good ally." I'm not saying you specifically. (But if you specifically are offended by me talking about other people who are fake allies, you might ought to question why you're offended by me talking about those other people.)

[Lethologica]

Considering that Siosilvar wasn't the one accusing people of dishonesty for disagreeing with their (incorrect) stance, I have to wonder why she's the one being called out on tone. Certainly Frozen_Feet has a responsibility to measure his response to disagreement in accordance with his actual knowledge of the topic. It would be nice if Siosilvar restrained her objection more than FF restrained his, and elevated the tone of the discussion, but it's not her responsibility to somehow prevent FF from coming to falsely associate the tone of his own discussion with transgender people as a whole.

And frankly, it's really mean and petty to make this about how Siosilvar represents genderqueer people--a last "**** you, you're in the wrong" as the issues of substance are put to bed. So if we're gonna talk tone, I'd go after y'all first.

[Siosilvar]

That doesn't mean you should go around offending the people who are sympathetic. Doing so is a very good way to make sure that your efforts to get un-oppressed don't gain much traction.

That's not how this works. That's not how any of this works.

You know how **** gets done? By making the status quo inconvenient to maintain. It does not get done when people attempt to tone police (http://www.robot-hugs.com/tone-policing/) others, which is exactly what you're doing here.

If you are offended by the tone I use to explain the things I and others like me go through, turn that into empathy. I am strongly emotional because this is personal. If you have a problem with me showing strong emotions, you're not actually sympathetic, and you are absolutely not an ally to me in that moment.

[Delusion]

I think a period of counseling and living as the desired gender ( yeah idk what to call that period either) is a good thing before before going on to risky and possibly permanent procedures like hormone therapy and gender reassignment surgery. I can't speak for how long or elaborate it should be though.



No. Its actually a terrible thing. Especially forcing some go through RLE (real life experience. the usual term for that period) before getting hormones is downright cruel.

Secondly, what would the mandatory counseling actually accomplish? Filter out those who "are not really trans"? No, it will not succeed in that. As I have said many times the doctors have no way of knowing if someone is trans or not. Only thing gatekeeping accomplishes is denying treatment from people who need it.

If te counseling is supposed to help the person prepare for transition and provide help during it? Then why would it be mandatory? If someone doesn't think they need counseling then why force them go through it when counseling doesn't really help if the patient is not cooperative.

[Alcibiades]

Secondly, what would the mandatory counseling actually accomplish? Filter out those who "are not really trans"? No, it will not succeed in that. As I have said many times the doctors have no way of knowing if someone is trans or not.

I don't know if finding out who is or is not trans is really what medical professionals should be doing in these procedures. However there is a very small minority of trans individuals where their gender identity is part of a psychiatric condition and/or who are not helped by a transition.

I disagree with the conditions that many European countries ask of trans people to have their official genders changed - you should be able to walk into your local administration and have it changed. But when a medical procedure is involved, medical ethics become important. The first principle for most professionals these days is still Primum non nocere, "First, do not harm."

I'm a medical student and I'd be extremely uncomfortable prescribing any medication or therapy that is as significant as hormone therapy and/or Gender reassignment surgery without a proper anamnesis, examination and if needs be further tests to make sure that the procedure is the correct approach for that patient.
The period of counseling doesn't need to take as long as it does now but it's always going to be there to exclude the small number of people who aren't helped by the treatment.


I think those things could be a good idea, but I question whether they should be mandated. For one they're prone to abuse, promoting gatekeeping and questioning that cause more harm rather than good. For another... what any given trans individual will need and benefit from will drastically differ. One person might be certain from the beginning and suffer extreme dysphoria, and getting them treatment immediately would be preferable. Another person might benefit from more searching and deliberation before they settle on what they feel comfortable with. Saying both people have to wait for an extended is not a particularly great idea.

Oh, absolutely, there needs to be flexibility and even a fast track for people who experience large amounts of stress.

[noparlpf]

Again, what other conditions are there? I'm actually curious and haven't heard of them. Or forgot. Idk.

[AmberVael]

I'm a medical student and I'd be extremely uncomfortable prescribing any medication or therapy that is as significant as hormone therapy and/or Gender reassignment surgery without a proper anamnesis, examination and if needs be further tests to make sure that the procedure is the correct approach for that patient.
The period of counseling doesn't need to take as long as it does now but it's always going to be there to exclude the small number of people who aren't helped by the treatment.

So, you're looking at this as medication or treatment, and I think that may be a source of difficulty. Yes, trans individuals often use these things to address dysphoria. Yes, its a medical procedure. But its not really a medical treatment, necessarily.

Imagine instead of surgery, we were talking about a person who was depressed. Turns out they're depressed because they're wearing a shirt with a bunch of horrible things written on it, and it affects their life. Removing the shirt isn't exactly a treatment. Being trans is much the same - yes, there's dysphoria that can arise from it, but thats akin to suffering stress when you have a high workload, or being depressed when someone close to you has died. Its a natural consequence, rather than a state that directly needs addressing.
Underscoring this is that there are trans individuals who don't really suffer dysphoria. They don't need this as treatment. Its not a prescription. But HRT and SRS are what they desire, because they're trans. Why should anyone be deciding for them "if this is the correct approach?" Why should anyone be treating them as a patient?

This doesn't eliminate the need for some kind of clinical, medical approach, mind. Cosmetic surgery is entirely elective, and there are still rules and regulations around it (and for good reason). But whether or not to use HRT or SRS shouldn't be the choice of a doctor or a therapist. A therapist might suggest approaches for relieving dysphoria, or even suggest that HRT/SRS might not be effective at relieving dysphoria for a particular trans person, but thats not necessarily a reason to say "don't do HRT or SRS." Consultations with a doctor to ensure someone knows the precise effects and risks of HRT/SRS is a good idea, and a short enforced delay between request and implementation might not be a poor idea either, just to be sure this is actually what someone wants rather than a bizarre whim or drunken ramblings or something, but this is all about making sure someone has an informed, rational choice rather than a doctor making a decision for someone.

And that's the ultimate issue. Its shouldn't be someone else's choice. Yes, maybe therapy is a good idea for a trans individual given the dysphoria that can arise, the stresses our current society can put on them, and the kind of soul searching being trans may provoke. But its not necessary to go to therapy to know you're trans or be trans. And living as given gender can be a good way to experiment and understand whether that is what you want and how you identify... but thats not really necessarily to know you're trans either. Its like any other part of your identity and personality. I don't see anyone deciding for me "you're not a tattoo person, so I'm not going to give you tattoos."

[pendell]

The thought that leaps to my cis-mind is "Who pays for this?"

I was just talking to a medical group last week; it was a careful four-way discussion between the patient, the patient's insurer, the prescribing physician, and the pharmacy which supplied the aforesaid patient with prescription drugs. This group was all about creating an optimum plan which delivered the patient the drugs they needed at minimal cost. It was, as you can imagine, a fairly delicate situation and required a lot of negotiating. The patient was poor and in no position to pay for much , so the bulk of the burden fell on the insurer. You can darn well bet the insurer wasn't going to pay a dime unless the prescribing physician was absolutely certain it was necessary.

So if someone is completely paying their own way for HRT and all the rest of it, I have no objections on that score. But if you're trying to convince an insurance company to cough up -- just how much money are we talking here? Tens of thousands of dollars, isn't it? -- then you've got to be able to show medical necessity. Few plans cover optional choices like cosmetic surgery or what not.

Mind, that's in the US, but I can't imagine a government-run medical system in western europe would do things any differently.

If it's medical necessity it's one thing. If it's a purely optional choice then the patient should at least be made fully aware of the long-term consequences of their choices. Again, check me on this, but surgical reconstruction and hormone therapy are fairly major body modifications; the last thing I want is for someone to sign up for the whole set and then find out, five years down the road, it was the wrong choice. Case in point: Caitlyn Jenner (http://www.thewrap.com/caitlyn-jenner-experienced-sex-change-regret-might-de-transition-biographer-says/) .

Respectfully,

Brian P.

[Ashen Lilies]

I don't think rumors from an author with an obviously adversarial position on the Jenner/Kardashian clan, citing "sources" close to the family which have been dismissed and denied by a representative of Jenner herself, counts as a sufficiently robust 'case-in-point'.

The 'Caitlyn Jenner might de-transition' rumor is one that has been around the block. (http://www.snopes.com/media/notnews/jennergender.asp)

[Delusion]

I don't know if finding out who is or is not trans is really what medical professionals should be doing in these procedures. However there is a very small minority of trans individuals where their gender identity is part of a psychiatric condition and/or who are not helped by a transition.

I disagree with the conditions that many European countries ask of trans people to have their official genders changed - you should be able to walk into your local administration and have it changed. But when a medical procedure is involved, medical ethics become important. The first principle for most professionals these days is still Primum non nocere, "First, do not harm."

I'm a medical student and I'd be extremely uncomfortable prescribing any medication or therapy that is as significant as hormone therapy and/or Gender reassignment surgery without a proper anamnesis, examination and if needs be further tests to make sure that the procedure is the correct approach for that patient.
The period of counseling doesn't need to take as long as it does now but it's always going to be there to exclude the small number of people who aren't helped by the treatment.



I do not believe that there can be a gatekeeping system of any kind that will not be filled with abuse. How are the doctors supposed to determinate who are helped by the treatment and who aren't?
I do not think they can to reasonable degree of accuracy. A doctor deciding that person, who needs the treament, doesn't need treatment can lead to suicide. If there is a gatekeeping system, then there will be cases like that. Even if the doctors mean well.

And when the doctors don't mean well... Well I have seen first hand what a doctor on a power trip can do in situation like that. It isn't pretty.

[Siosilvar]

The thought that leaps to my cis-mind is "Who pays for this?"

Hormone therapy runs about $300 every three months for blood testing and $10 to $70 monthly for the prescription (or at least, that's the self pay cost in the US). The cost to benefit ratio is so insanely favorable that it ought as well be free, if you're trying to do the math.

Various transition surgeries do tend to run in the tens of thousands range, but they are also very effective at relieving dysphoria. Scare stories intended to discredit trans people notwithstanding, IIRC about 3% regret it, which is less than many lifesaving procedures and in a completely different world from the nearly 65% regret rate of elective cosmetic surgery. Silicone breast implants are a stupid idea no matter who they're on, but genital reconstruction, breast removal for trans men, and facial feminization surgery all work.

Frankly, though, we're talking about a condition where 41% of people with it have attempted suicide (http://www.transequality.org/issues/national-transgender-discrimination-survey), and that halves (or better) during hormone treatment and goes down to around 5% (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885) after surgery. If that's not a strong case for medical necessity and efficacy, then nothing is.

[AmberVael]

Again, check me on this, but surgical reconstruction and hormone therapy are fairly major body modifications; the last thing I want is for someone to sign up for the whole set and then find out, five years down the road, it was the wrong choice.
No one wants to make the wrong choice. But there are plenty of choices people don't want to get wrong that can affect your life forever (or for a very long time) and can cost a person or even other people tons of money, and you don't see nearly as much fear mongering, doubt casting, and peanut gallery nonsense around any of them. We take it on faith that people know what they want so that everyone has freedom to live their lives, and while in some cases its wise to make sure they clearly understand the consequences, doing more than that is unjustifiable meddling. I don't see anyone gatekeeping tattoo parlors.


Case in point: Caitlyn Jenner (http://www.thewrap.com/caitlyn-jenner-experienced-sex-change-regret-might-de-transition-biographer-says/).

So lets talk about detransition, shall we?
The incidence rate is very low. For all that it gets talked about, it doesn't happen often. See your 'case in point,' which, as Kris notes, seems to have been entirely fabricated. What's more, from what I know the rate of transition is notably going down, which is due to the reason people detransition. The most common reason for detransition is lack of societal acceptance, rather than regretting the physical aspects of transition. Turns out being trans can be kind of stressful in our society, something to do with constant doubt and questioning among other things, I bet. Most of the reasons fall into this sort of category - its not that people don't want to transition, its that there is various baggage around it that they're not as interested in, whether that baggage is rejection, health concerns, or mere timing.

Detransition is a boogeyman that distracts from the positive impact that transition has and makes gatekeeping seem more reasonable than it is. It promotes doubt and hesitation, which leads to less people getting what they need and desire. Its brought up far too often, and usually in ignorance.