Uh oh. Another trans thread

Believe what you want, but I just want kids to be healthy and happy. Having 2 kids with significant mental issues, and seeing other they associate with, gives me a different perspective than those who oppose gender affirming care because of their social views on it.

I went through most of those studies, and they were similar to the other ones I quoted. Some direct studies are very small sample size. Other larger mega analyses identify trends and correlations but not necessarily causality.

Most of the have as an outcome suicidal ideation among other things.

Here is an example of the problem of just taking some of these at face value. A study may find those that get gender affirming care, may only have 70% of the suicidal ideation of depression. That seems positive, but that also means that 70% had the intervention but had no improvement. These are not completely benign interventions. Puberty blockers, hormone therapy or even surgery. Is that a good trade off? It isn’t entirely clear to me.

I’ve said before I oppose laws of the type DeSantis and Abbot support - this is a medical issue, and should be left to the patients, families and medical providers - which is consistent with my view that this is a medical issue. But the medical evidence, of lack of it, should speak for itself. Whether these therapies are used should not be influenced by culture warriors on the right or left.

 

And by "social views on it," you mean the "social view" of keep the government out of these personal medical decisions, let the medical community develop standards, let the kids and their families make decisions, and continuously reevaluate those standards. Because that's the "social view." The other "view" is over the objections of parents, children, and the medical community, prevent them from obtaining care. If you're going to play these games, let's at least define the stakes.

So you dismiss the studies with huge sample sizes that find correlations but also dismiss the studies with smaller sample sizes intended at better understanding those correlations? What is your goldilocks? Keep in mind that transgender people are a tiny percentage of the popular, so we're already dealing with a very small number of people who are receiving treatment.

This explanation doesn't make sense to me. Making up numbers, if 40% of transgender people attempt suicide over a five-year window and gender-affirming care reduces that number to 20% (i.e., a 50% decrease), how is that not a good tradeoff? Particularly when you combine that with studies showing low detransition rates and low regret rates.

In other words, you agree with those of us whom you disparage, except you do a lot of both sidesing and misrepresenting the strength of the evidence. So it makes me wonder if your goal is less about government and more about wanting medical providers to stop offering this care.

The medical evidence does speak for itself, just not in the way you think.

 

I stated my view on this at the end of the last post. Let the medical community decide working with families. However the medical community, like anybody else, can be influenced by social pressures. Viewing this as a social issue vs medical issues can lead to different recommendations.

I don’t dismiss them at all, but they are not close to proving what you are saying, that they keep kids from killing themselves. I see mega studies all the time relating to nutrition and other things, and they often come to differing conclusions. Until you have a controlled trial measuring the outcome in question, it is hard to rely on these mega studies (which are complications of lots of studies) or some of the actual studies with very small sample sizes. I understand doing controlled trials are difficult and impractical and sometimes come with ethical issues. On the flip side now you can’t have controlled trials because many assume current therapies are effective, when they have not been proven so to any level of scientific rigor.

The studies don’t show that. They try to measure suicidal ideation by qualitative surveys. We don’t know to what degree that actually results in more suicides.

To give an exaggerated example, just to make a point, if 1000 people had gender change surgery, and another 1000 trans persons didn’t have the surgery, and 40 with the surgery kill themselves, and 50 without the surgery kill themselves, is that a success? It saved 10 lives, but 990 may have gotten a surgery they don’t need. How do you weigh those things?

No I don’t want care to stop, and I don’t want government mandating or banning care. But I’d like social warriors on both sides to GTFO of these medical issues and let the evidence speak for itself, and let doctors act based on evidence and not based upon social pressures.

 

You state your view and then you qualify it. So I'm not even sure what you're proposing. Let the medical community decide, but if they're too supportive of transgender people's rights, we should be skeptical?

How are you going to have controlled trials regarding gender-affirming care? Think about it practically. It's not a realistic demand.

Yes, that is a success. But it's not the only measure of success. How many of the people who had surgery regret it? How many seek to reverse the surgery? How many people's mental health worsens due to the surgery? Why does it worsen? How does that compare to the people who didn't have the surgery? Why did those people not have the surgery? Did they want it?

These are all important questions. But something that bothers me is your insinuation that 990 may have gotten a surgery they don't need. It ignores that this is about much more than just suicides. In treating this as purely a medical issue, you're failing to see the other dimensions. This is as much about identity, bodily autonomy, and self-fulfillment as anything else.

The government should stay out of it. We agree. Evidence is important. We agree. We must continue to study this to build the best standards to guide medical care, ensure we're using the best treatment methods, and are fully cognizant of the side effects of pursuing this care so that patients can give informed consent. We agree. Where we disagree is with your attempts to treat this as purely a medical issue. It is more than that. Healthcare is at the heart of it, but so are equality, liberty, and self-actualization.

 

As far as I know it is illegal to discriminate against people based on gender identity, and apart from the right wing medical restrictions, which we both agree are wrong, what other freedoms are they missing?

There is significant evidence that in many of the cases, including perhaps the ones whom these interventions don’t work, is that there are other mental illness issues at hand. Chasing self actualization without addressing any core mental illness is at best a waste of time and at worst harmful.

I guess the way I’d summarize my position is that medical care needs to evolve to attempt to diagnose and evaluate the totality of the patients issues when they seek medical care. For some, it will be gender affirming care. For others it may be identifying and addressing other underlying mental illnesses or other conditions. My impression is that we don’t do a good job of that and in some/many cases if a patient walks in expressing gender dysphoria, they go straight evaluating gender affirming care vs exploring other possibilities.

In a more ideal world, if 30% are helped by gender affirming care, that 30% gets it and the other 70% get something else.

 

A lot. But that discussion would require digressing from my point. Being able to make those healthcare decisions and having control of their own body and identity are at the core of all the things I just mentioned.

Where does that impression come from? Do you think patients aren't given mental healthcare that attempts to address the whole of them? This is from 2016:
Mental health considerations with transgender and gender nonconforming clients | Gender Affirming Health Program
Mental health concerns endorsed by a patient should not be automatically assumed to be related their gender identity.[1] Transgender people may be seeking mental health care for a number reasons; in addition to mental health issues relating to or resulting from one's gender identity, transgender people do experience the background rates of mood disorders and other psychiatric conditions seen in the general population. While some may be seeking specific assistance for gender-related themes, others are seeking assistance with depression, anxiety, or other clinical concerns unrelated to their gender identity.[3]

 

That tweet is just flat out wrong. The Cass Report, as well as other sources I have quoted in the past show that disproportionate percent of of those identifying as transgender autistic. That actually makes some sense.

https://www.spectrumnews.org/news/largest-study-to-date-confirms-overlap-between-autism-and-gender-diversity/

 

And how do you think that proves the tweet wrong?

 

So for his tweet to be right that would mean that gender dysphoria is leading to autism, which is patently ridiculous.

 

Not if he considers autism to be a neurodevelopmental disorder rather than a "mental health condition."

 

Ok now we are trying to get cute.

Autism, bipolar, major depression and gender dysphoria are all mental “disorders” in the DSM5. They are sometimes loosely referred to mental health disorders or mental health conditions.

Here is a list of DSM disorders that are more prevalent among trans individuals than the general population. Clearly that psychologist is full of shit.

Transgender: Gender Dysphoria and Ensuring Mental Health


Are trans people more likely to experience other mental health disorders?
Research indicates that transgender people are somewhat more likely to have a psychiatric diagnosis. The most common are anxiety and depression. But some conditions are more common among trans people, including:

• Bipolar disorder.
• Borderline personality disorder.
• Dissociative identity disorder (multiple personality disorder).
• Obsessive-compulsive disorder.
• Schizophrenia.
• Schizoaffective disorder.

 

Now, you're arguing that a psychologist who has literally studied this issue is full of shit because transgender people are more likely to have certain mental health conditions (which isn't inconsistent with his point)? This is rich after all your talk earlier in this thread. Here's an example of research the "full of shit" psychologist has published:
https://www.sciencedirect.com/science/article/abs/pii/S0165178121005679

As for autism, NAMI's discussion of it sure indicates to me that it doesn't consider autism to be a "mental health condition." Here's what it says:
Autism | NAMI: National Alliance on Mental Illness
Children with autism can also develop mental health conditions such as Anxiety Disorders, Attention Deficit Hyperactivity Disorder (ADHD) or Depression. Research shows that children with ASC are at higher risk for some mental health conditions than children without autism. Managing these co-occurring conditions with medications or behavioral therapy, which teaches children how to control their behavior, can reduce symptoms that appear to worsen a child's symptoms.

And if you look at the list of "Mental Health Conditions" on the left side of the page, it doesn't include autism. It does include autism in the "Common with Mental Illness" list.

Looking around on Google, it seems to me that there's a debate raging about whether autism is best classified as a mental disorder. Many folks argue that it is instead best understood as neurodivergence. So while you think I'm being "cute," I'm telling you that you are making assumptions about what the person meant without knowing. (And considering that person has used the term neurodivergent on Twitter, I suspect I am right.)

 

Perspectives worth considering:
Mother criticises ‘agenda from above’ after release of Cass report
Cass gender care review disappointing, says trans man

 

This thread has me convinced these decisions shouldn’t be in the hands of voters, politicians, amateur healthcare googlers, internet posters nor MAGA obsessed nuts. Instead, I’d go with medical doctors, patients, and parents. Why is that so hard to live with and go on with your life while respecting what other people decide?

 

A published psychologist should not be so sloppy with his tweets. The abstract basically says untreated gender dysphoria can lead to other mental health conditions. I am sure that is true. But he doesn’t acknowledge the opposite.

I am not interested in debating these definitional issues. It’s besides the point

1. In the prior post I listed from Cleveland clinic a half dozen dsm disorders that are at higher prevalence with gender dysphoria. I guess the debate would be which cause which. I highly doubt most of these major disorders are caused by gender identity issues
2. I have a 19year old ASD son. He just got out of his first stay at a mental hospital. I have lived all of those things you just informed me of. While you want to debate the categorization of autism I am trying to make the point that given their under developed (or differently developed) ability to detect and react to social cues it isn’t at all surprising to me that an autistic person might decide that they are a different gender. But they often a detached sense of reality among other things.

The whole “mental difference”’thing of autism is fine, but I have an adult son who will likely never be able to take care of himself and is becoming increasingly out of touch reality and violent. It would not shock me at all if he were to declare himself a different gender out of the blue. He also is angry because he views himself as a rapper and thinks I am keeping him from being published. But hey, it’s not a mental condition, he’s neurodivergent! That makes me feel so much better.

 

He said there's no evidence of it. Feel free to post the studies showing that other mental health conditions lead to gender dysphoria, not that they both can exist at the same time. It shouldn't be hard to prove him wrong if there are studies saying that.

But you believe that those disorders cause gender dysphoria? Okay. Fair enough. What studies say that or point to it?

I agree that autistic people might be more likely to question their gender. That speaks to the need to take that into account when considering healthcare options. Is that inconsistent with how doctors approach things in the U.S. (or Britain)? Based on the link I posted earlier, I don't think so.

It may not make a difference to you, but do you think it could make a difference to people with less severe autism---that they're considered neurodivergent (i.e., think differently) rather than mentally ill or disordered?

I am sorry that you are having difficulties with your son. I can't imagine how hard that is for you. I hope that things improve. I have no doubt that you are doing everything you can to be a great parent to him, and I hope that one day he sees that.

 

And they are probably more likely to experience other mental health disorders as the result of lack of treatment for they gender dysphoria combined with stigmatization. Transgender persons who receive treatment are much less likely to experience other mental health disorders than those who do not.

 

Above I linked an article from Cleveland Clinic that lists major disorders that are more common among those with gender dysphoria. I don’t think there is any debate about the higher rate of coexistence. The question is to what degree does one cause, or even precede the other. It is pretty clear that autism precedes the gender dysphoria in most cases. I don’t know if I’d say autism causes gender dysphoria (maybe it does sometimes?) but I’d certainly say it leads to a greater percentage thinking they have gender dysphoria, or at least gender difference.

I would say something similar may happen with other major mental disorders. I have seen this quite a few times with friends of my kids - either teens or young adults. They profess to be trans but they also clearly have other conditions, such as bipolar. It seems intuitive to me that if you feel you are different due to such a disorder, already have a distorted sense of reality and experience social pressures or even alienation because of it, finding an explanation such as they are trans, one provides an explanation and two actually provides a community of similar persons.

I know of one person, since early childhood, and around 18 suddenly decided he was trans. Even decided on a different name. He had never been diagnosed with any particular condition or disorder, but he clearly had some issues from an early age. He was taken to a specialist that had experience in such issues and from what I recall it wasn’t really clear. 6 months or so later he seemed to drop the whole thing best I can tell. Great kid either way and fortunately things seem to be coming together for him.

So no, I can’t point to studies, but I’ve seen enough anecdotes in real life that drive my way of thinking.

That’s the way it is supposed to happen. However the assertion by Cass and other sources is that the evaluation is not as robust as it should be, and that in many cases, especially the US, many providers essentially jump straight to evaluating gender affirming care vs evaluating the whole situation first. I can point to anecdotes of this I’ve read in the media, and Cass seems to confirm this, but I don’t have direct experience with this so I can’t prove this is happening.

like kind of like a person in a wheel chair not being disabled but “differently abled”. Whatever.

I appreciate it, and I try to avoid pulling the woe is me sympathy card. But having a bipolar daughter and an autistic son definitely informs my POV on such matters.

Also, given the above, I hold nothing but disdain for the likes of DeSantis and Greg Abbot jumping in the middle of families complex health care decisions. These situations are difficult to navigate, without easy and clear answers. The family and the medical provider are in the best decision to try to decide on the appropriate course of action.

On the other side, I become frustrated with those that seem to influence the environment such that it is harder for families and health care providers to make an honest assessment, due to social pressures. In addition to the extent they reclassify medical issues as social justice issues it can to a degree make it “fashionable” ( I use that term with hesitation because it would seem to trivialize the issue, which is not what I am doing) and make it more attractive to young people who have other disorders and spend all day long on the internet with a distorted sense of reality. I view these people as mostly well meaning, but nonetheless they make the situation more complex.

 

We've certainly heard anecdotes, but I've yet to see empirical evidence of this being a widespread problem. In fact, I'd say Cass's report actually points in the opposite direction. People who wanted gender-affirming care were having to wait years for it, and I believe the average number of appointments before patients were referred to an endocrinologist was 6.7. I didn't see significant evidence that patients were being rushed into puberty blockers or hormone therapies.

I'd say more akin to the DSM removing homosexuality from the mental disorder classification and the WHO no longer classifying simply being transgender as a disorder. But it's debatable. I think we need to account for autism being on a spectrum. Certainly, those kids on the severe side of the spectrum are affected in a major way, and reconsidering how we think about autism shouldn't be taken as a suggestion that we don't recognize them as disabled and ensure we provide them and their families the resources they need.

Rather, it's asking us to rethink how we treat the people who fall on the less severe side of the spectrum and are capable of living more normal (or normal) lives. I guess one cay say it's "political correctness." I just see it as being courteous. Those folks likely don't see themselves as mentally disordered, just different.

I think it is a complex debate that involves more than just medicine. Gender dysphoria is a healthcare issue. But I think the WHO has the right of it in saying that merely being transgender isn't. One of the things I think is worth reflecting on is how the people who say they want to "protect the patients" are in reality trying to "protect the patients" from themselves. Transgender people want access to our healthcare system. Exactly what they want out of it differs on the person. But I believe strongly that part and parcel to liberty in this country is bodily autonomy.

Does autonomy mean they get to walk in and demand a surgery at 12? No. But I think we should endeavor to create a system based on the best evidence that grants them access to the care they want and need to help them pursue what they see as their true and best selves. Should we exercise caution, particularly with the aspects that are irreversible or hard to reverse? Sure. Should we study and account for how other factors (like mental illnesses or autism) affect it? Yes. Should we consider how to ensure that there's informed consent? Yes. Should we study side effects, efficacies of interventions, risks, and detransition and regret rates? Absolutely. More information is good. It'll lead to better standards and more informed consent. But we shouldn't let a lack of absolute certainty stand in the way of people, with the help of doctors and their families, getting to make their own decisions about their bodies and their lives. Those are my two cents.

 

The above is well written, and there is nothing I find objectionable.

To the discussion of whether treatment is rushed or incomplete, I do recall this article that I posted in the other trans thread

Opinion | As Kids, They Thought They Were Trans. They No Longer Do.


At no point during her medical or surgical transition, Powell says, did anyone ask her about the reasons behind her gender dysphoria or her depression. At no point was she asked about her sexual orientation. And at no point was she asked about any previous trauma, and so neither the therapists nor the doctors ever learned that she’d been sexually abused as a child.

“I wish there had been more open conversations,” Powell, now 23 and detransitioned, told me. “But I was told there is one cure and one thing to do if this is your problem, and this will help you.”


Of course, this is one anecdote. You can find other anecdotes. I have no way of knowing if this is indicative of the average. That article rang true to me, based on the anecdotes I’ve personally seen with some gender dysphoria cases and other instances of mental illness (or disorder) that I have seen. It also lined up with some accounts I have heard through my filtered media stream. None of that of course is proof of anything.


Now that we seem to be converging in some points of consensus I’m going to stray a bit, and address the discussion of trans as a mental disorder (or not).

I’ve honestly struggled with what it means to be “trans”. I can understand the concept of gender dysphoria. Basically not being comfortable with the sex of your body you were born with. I struggle with what it means to be trans, but without gender dysphoria.

This gets to the idea that gender is a social construct. It strikes me as being at odds with the last 50 years of breaking gender stereotypes. Women can now be athletes. They can work full time. The can run companies. They can run countries. They can be weightlifters. They can like things that boys typically do, the proverbial Tom boy. They can be attracted to other women. None of those are now at odds with being a woman. 50+ years ago they were.

Now however, it seems that gender is a social construct, which to me is just another phrase for gender stereotype. If you are a boy, but act effeminately, you may actually be a girl. If girl and like girls, you may be a boy, not gay. If you are a girl that likes things that boys typically do, that may mean you are a boy.

Even if any of that makes sense, it seems like it is a lot to process for a teenager who may be autistic or have some other major mental health disorder.

Tell me what I’m missing here. What am I not getting?