I’m not an expert in the field, but I am someone who has recovered from depression. The “lack of serotonin” theory always made me laugh. It’s like if your computer was running abnormally and you said it “doesn’t have enough electricity”.
Neurotransmitters send signals. The amount of neurotransmitter tells you nothing about what information is actually encoded in those signals. You can transmit happy and sad music using electricity, for example. It seems to me that you can transmit happy and sad thoughts using neurotransmitters. (And of course the brain is much more complicated than a computer, because a computer “just” uses electricity, whereas in the brain some processing happens at each neuron, and signals coming in on one neurotransmitter can cause signals to leave in others.)
I see the term antidepressant as a bit of a misnomer. A drug that inhibits re-uptake of neurotransmitters will amplify the “loudness” of the signals. If you only have negative thoughts, and you take such a drug, your depression could realistically get worse (and this does happen to some people).
If you can get in to a positive feedback loop (e.g. an activity that leads to positive thoughts that lead to more of that activity) and _then_ start amplifying those signals, then these drugs can do wonders.
>The “lack of serotonin” theory always made me laugh. It’s like if your computer was running abnormally and you said it “doesn’t have enough electricity”.
A computer is a digital device, so it's more like all or nothing. It either powers up or not.
Analog electrical devices however can indeed behave suboptimally without enough electricity.
Digital devices can absolutely intermittently function if voltages are outside a stable range in certain places. The point was that if you encounter frequent abnormal errors with your computer, you rarely begin with boosting every one of the DRAM, core, and other miscellaneous voltages.
Its fundamentally an analog device. The concept of information being a 0 or 1 are simply one voltage level offset from one another. Its how we project the digital 'view' onto the computer and work with it. If the signal is not in the expected range of '0' and not in the expected range of '1' it should throw a hardware error and you'll end up with a BSOD (Blue Screen of Death) or equivalent.
We feed it alternating current to start with. It can partially power up, the only reason it appears to be working or not is because of all the safeguards designed in - don't power up unless voltage is at least blah, and failsafe cutout refuse to power up because voltage is over say blah*1.05. There's a subset of expect Voltage ranges (eg. 3.3V)[1].
It's literally the first thing the computer does. POST - Power On, Self Test.
When a power supply gets old, wonky things start happening and the computer becomes unstable in weird ways. I am not sure the computer/power metaphors are the best fit.
If the issue were biological lack of electricity, why would childhood trauma be linked to it? And why would it be curable through therapy?
It seems to me like saying, I started a fire that burned my house down, but the real cause of the house burning down was too much heat in the house. It’s both true and unhelpful.
Speaking personally, depression is more about the ability to manage emotions rather than the emotion themselves. In other words, remembering something that happened in the past that would cause a tiny bit of embarrassment in a "normal" condition would be unbearably painful under depression.
Therapy is useful both in recognizing when your emotional response is disproportional compared to the cause (that is, being "properly" sad or embarrassed vs being depressed), snap out of it and to "learn" to avoid being embarrassed or sad for things outside of your control that could trigger your depression, for example. Something along the same lines of the "there's no spoon" quote from the matrix, but applied to your emotions.
Speaking from my own personal experience, telling myself that the specific facts at hand were irrelevant was very tempting and totally wrong. It had everything to do, for me, with the details of the emotion and the situation, and critically what it was linked to in my history. I suspect that’s true for everyone, but I couldn’t come close to proving it.
>If the issue were biological lack of electricity, why would childhood trauma be linked to it? And why would it be curable through therapy?
Regardless if the serotonine theory of depression is real or not, something having a biological substrate doesn't mean its hardwired or only kickstarted by biological factors.
Levels of hormones, neurotransmitters, and other substances can drop due to many factors, including diet, exercize, sun exposure, vitamin uptake, issues with insulin, thyroid, and so on, but also "psychological" things like trauma response, stress, continued fight or flight mode, etc.
I know both about both (undervolting and circuitbending, the latter in the context of electronic music gear).
Undervolting doesn't change what I wrote though: the computer will still do what it does as before (with less heat). The PC either gets enough power to power up or not - it's a (pun intended) binary thing.
It's not like it's behavior will change and the OS/apps will do something different because of undervolting.
>If you can get in to a positive feedback loop (e.g. an activity that leads to positive thoughts that lead to more of that activity) and _then_ start amplifying those signals, then these drugs can do wonders.
this is how alcohol works on me and why I never drink if I'm not in a good mood. But I'd be careful about generalizing what effects drugs have on people.
Harking back to neurons compsci: neurotransmitters can modulate by their amount transmitted (saturation of the receptors, or not), so I can imagine if there's just not enough around, that certain signals will not (optimally) be transmitted.
No surgeon should be removing healthy body parts, in my opinion. You wouldn’t fit a gastric band to an anorexic person, no matter how badly the patient wanted it, and that’s not even permanent.
I sympathise with all people who have issues accepting the body they were born with. If someone believes their body should be different, but otherwise their body is healthy, I think it’s fair to say that whatever is causing the feeling of mismatch is happening in the mind. It’s no surprise to me that a significant fraction present with other mental disorders.
In an ideal world, there would be some form of therapy that helps people come to terms with and accept themselves with what they’ve been given. But again I do sympathise, because contemporary medicine simply isn’t very good at treating mental illnesses.
I think the key thing is that these permanent procedures should not be performed on children / minors.
Personally, I was a very different person at 15 to 20 to 25.
I don't really think a young person can make a rational decision on something that is going to affect the rest of their lives in such a dramatic way.
A 30 year old deciding to get gender reassignment surgery is very different to a 12 year old.
Would you support a woman having breast reduction surgery, or would you say “sorry your body doesn’t match your mind; get therapy”?
I suppose you can argue the tissue here is not “healthy” because it’s causing physical distress for the woman, but the same seems to apply to a trans person. Distress is never ‘just’ mental, it has physical effects on the body (and vice versa - pain is ‘just’ mental). The decision of what’s healthy doesn’t seem so simple to me.
The argument you are making would hold up better if there was evidence that post-op trans people have dramatically lower suicidal thoughts, but multiple studies have shown suicidal thoughts is virtually unchanged after operation.
Now the argument becomes something like 'a body part of yours is causing mental distress, let's cut it off even though there's zero evidence it'll help'. Seems very flimsy and predatory to me.
As for breast reduction, there's actually evidence that large breasts can cause physical problems in women, so it seems reasonable to allow that along with the evidence that women with large breasts experience a better quality of life after surgery (absolutely not the case for trans people removing body parts).
"The overall mortality for sex-reassigned persons was higher during follow-up"
There’s no therapy that helps, at least as far as I know. At best you could learn coping mechanisms, but I don’t think anyone has ever been successfully convinced out of trans-ness by therapy, similar to how gay conversion therapy didn’t actually work. So we’d be left with telling trans people “there is no treatment at all, go deal with it somehow.” Anecdotal of course, but there are a fair number of trans people on social media who seem happy with their surgery - why deny them that because someone else is convinced that according to statistics it shouldn’t have made them any happier?
Desistance, i.e. "being convinced out of transness" is perfectly common, as mentioned in the article. I'm not aware of any studies on how therapy can affect this, but even if the therapy was merely helping the patient cope with their dysphoria for a period before exploring other options, that seems a far cry from saying "just deal with it".
The OP article is raising the claim that most of the (recent young) people probably aren't 'trans' at all, but there's a one-way affirmation pipeline backed by no science whatsoever.
> there are a fair number of trans people on social media who seem happy with their surgery
Are the people that are unhappy embraced by the community, or are they deplatformed? Are they happy with the surgery itself, or that they're now 100% part of a community of some kind?
Once someone has surgery, do they in their mind feel completely the new gender, and go about their lives as such, or are they now some elevated status within the trans community itself?
I don't have a problem with how people decide to live their lives, and while I'm generally against unnecessary surgery, adults are free to do what they want. I am against quack science and unethical behavior that might be exploiting the mentally unwell and even just confused children. I also am against using the power of the state to levy the quack science in the case of custody battles.
The 2015 US Transgender Survey cited in your link was commissioned by the National Center for Transgender Equality (an organization that was founded by a transgender activist).
The study was performed online and links were posted exclusively in transgender support forums.
Your standards for "evidence" reach the heights of biased activist SurveyMonkey CSVs? I'm convinced!
the study was intending to measure the rate of suicidal thoughts among transgender people.
Seems like a great way to get a lot of datapoints is to use a transgender forum. Seems like a great way to measure suicidal thoughts is to ask "do you have suicidal thoughts"
So seems like a great approach to gather a lot of evidence for the question at hand?
Seems like you just don't like the evidence because it doesn't reach the rather bigoted conclusion you want it to
It's objectively isn't if it lowers suicide rates relative to pre-transition level. It does not necessarily need to lower rates to population average to be effective
This is not true. Even if your claim about the paper is true (which it isn't), there are other metrics to care about:
- suicidal ideation, which is bad in and of itself
- anxiety, e.g. social anxiety
- depression
Besides, the study does not account for the fact that until 2013, Sweden forced people to have surgery to get updated IDs. If a trans person does not want to have a particular surgery and yet is forced to have it, you can imagine why that would cause a great deal of suffering. That isn't gender-affirming care, that's forced sterilization (which is a human rights violation with a sordid history).
> As evidence for the proposition that “[t]here is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention,” the AG Opinion cites a 2011 Swedish study by Dhejne et al. that, the AG Opinion claims, “monitored transitioned individuals for 30 years [and] found high rates of post-transition suicide and significantly elevated all-cause mortality, including increased death rates from cardiovascular disease and cancer, although causality could not be established.”49 In fact, the 2011 study by Dhejne is badly out-of-date and does not support the AG Opinion’s claim.
> The Dhejne study compared post-gender-affirmation transgender individuals with cisgender individuals from the general population, as opposed to transgender individuals who did not receive gender-affirming care. Therefore, as the study’s author explicitly cautions in the body of the text, it is impossible to conclude from this data that gender-affirming procedures were a causative factor in suicidality among transgender individuals.50 Rather, the study shows only that transgender adults were more likely to experience suicidal ideation/attempts and risky behavior when compared to the general population in Sweden between 1973 and 2003. Further, the Dhejne study is not generalizable to a modern American population or to adolescents. During the study period, Swedish law required that individuals seeking gender-affirming surgery be sterilized. The presence of this law alone might account for the higher risk of suicide attempts and risky behavior in the transgender population compared to the cisgender population at the time.51
I think its worth noting that the authors of the same study conclude:
> Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
Should people born with a cleft palate be forced to leave it alone? What about people with breathing problems due to their anatomy? If a kid has teeth grow in improperly and start causing jaw problems, should they be prohibited from having their wisdom teeth removed or teeth realigned with braces? Should tonsil removal be prohibited? If a woman has severe back pain due to oversized breasts, should it be prohibited to get a reduction surgery even if it improves quality of life? Should vasectomies be prohibited if a person with testes wants to be able to have sex with their partner without the risk of pregnancy?
Should it be prohibited to medically disable "healthy" body parts as well? As an alternative to vasectomies you can use drugs to similarly disable that body part, in many cases effectively forever. Should that be illegal too? What about anti-androgens like Spironolactone - used on-label for multiple different purposes - should we ban those since they are also used for MtF HRT? Birth control also is functionally disabling healthy parts of the body.
Why does a problem "happening in the mind" somehow mean that no treatment can occur outside of the mind? Do you think mood stabilizers and antipsychotics should be banned because we're treating an "in the mind" problem with physical, body-altering interventions?
As a though experiment I've thought a lot about the black alien project. Specifically the removal of his fingers. I'm not sure I know where to stand. Should he be free to do what he wants? Should doctors be required to avoid removing healthy fingers ( I don't think they were doctors but I've altered the situation for my thought experiment)?
My conclusion is I have no idea how to even approach it.
I'd be interested in others thoughts.
I like this topic as it's less politically charged but explores similar ethics.
My understanding is that transitioning is the best treatment we have. If you know of some other treatment the psychiatric community is unaware of, I’m sure we would all like to hear it.
It would seem that the massive increase in young people opting for these procedures would lead to fundamental differences in the population that undergoes them. Assuming your understanding is based on long-term studies done before this massive increase occurred, the effects they found are likely to differ in this now fundamentally different population. Given that the currently skyrocketing rates are largely a phenomenon of the past 5 years, that assumption is almost certainly true.
As one example of such differences that we know of for certain, the ratio of patients seeking these procedures who are male vs. female has shifted massively from before the past 5 years. Even ignoring all the observed differences, the simple fact that it was once much harder to access treatment would mean those observed in older studies would be more motivated or certain of their condition, on average, than patients undergoing treatment today.
In the same period, hospitals saw an influx of patients of the same age who believed they had symptoms of Tourettes (https://www.wsj.com/articles/teen-girls-are-developing-tics-...). Johns Hopkins estimated this included up to 20% of their pediatric patients, compared to 2-3% just 2 years earlier. Much like the rise in transgender minors, this was strongly concentrated in young females with other mental health issues who had been exposed to "Tourettes content" on social media. This is despite Tourettes being about 3x more common in males prior to the recent explosion in cases.
There are clearly people who genuinely benefit from surgical/hormonal treatments for gender dysphoria. In any case, adults without major psychiatric issues have the right to most hormonal and/or cosmetic procedures should they wish to get them.
It's still worrying how vehemently many activists oppose any questioning of such a massive rise in minors seeking life-altering treatments and implicitly or explicitly promising vulnerable kids that such treatments are the solution for their problems.
Oof this isn’t even close to being proven to the point of being a reasonable recommendation. How about you wait 10 years and see if that’s real science. Dietary science is hard.
No, "try every low-impact crackpot theory on the internet for 3 months before seeking a well-established treatment" is not a reasonable suggestion for any condition.
It's obvious if you've been through a CSci program. Math, Physics, EE, and CSci are real science and Psychology and Sociology aren't. That means that topics that fall under Psychology and Sociology domains are inherently invalid and rather than retreating to a position of simply unknowing, "hard science" types feel justified in framing their personal experience as reality, science, nature, and fact[1]. I don't blame the tendency; we all want to believe what we're doing is important, but when it involves stubborn indignation, it's a maladaptive behavior.
1. To the point where these words end up being sensitive and specific to identifying the group.
I'm primarily talking about medical science (including clinical psychology) here, not "psychology" in general. You can certainly make the argument that medical science isn't as "hard" as physics, but clearly medicine generally works.
You can also make the argument that gender-affirming care doesn't have RCTs behind it, but there's no way to have an RCT that (a) isn't immediately unblinded because the physical effects of HRT are obvious within days, and/or (b) isn't a gross human rights violation. So we rely on supposedly (but not actually) "low-quality" observational studies instead.
Yeah. I think the increased salience of this issue has caused a lot of nerds to believe they can figure it out with 15 minutes of armchair thinking rather than spending weeks engaging with the scientific literature (which is all quite readable!)
First, why do you consider it to be a problem in the mind, rather than the body? It seems to me that, fundamentally, gender dysphoria is a mismatch between the mind and the body. Declaring the body to be correct and the mind wrong seems arbitrary (as would declaring the mind to be right and the body wrong). It's not really a question of right and wrong, it's the mismatch that's the problem.
Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example).
Note that not all transgender people experience gender dysphoria. Some are fine with the bodies they were born with, and for them gender reassignment would be unnecessary and irrelevant.
Also, note that this is different from treatment for e.g. anorexia nervosa. If someone with anorexia loses weight, it doesn't help; they'll continue to see themselves as overweight. Treatment for anorexia has to focus on the patient's mind. Helping them lose weight would make their outcome worse, not better, which is why it's not done.
Scott Alexander gives an interesting analogy to a case from the mental hospital where he works here: https://slatestarcodex.com/2014/11/21/the-categories-were-ma.... A woman with OCD was constantly worrying that she'd left her hair dryer on, and was having to drive home 10-20 times a day to check whether it was really off, or was on and going to burn the house down. Nothing they'd tried worked, until someone suggested she take the hair dryer with her. That effectively solved the problem for her, because she could always just look over at the dryer, see that it was unplugged, and go about her business. But caused a huge controversy among the psychiatrists between those who thought "This Is Not How One Treats Obsessive Compulsive Disorder" vs those who just said "it worked".
> why do you consider it to be a problem in the mind, rather than the body
One argument is that it's a category error to call gender wrong. Your ethnicity, gender and wealth of your parents etc. just is, it's the hand you are dealt with. You can be unhappy with it but it can't be "wrong" just like the country you are born in can't be "wrong".
If someone is distressed about the country they are born in to the point of suicide, we'd class it as a mental condition. Such a thought can be rational but it's the degree of distress that suggests disorder rather than a healthy preference/observation of one's situation. It does have a rather obvious "do what works" sticking plaster.
The concern with sticking plasters is if they end our curiosity about the underlying condition. If we normalise them such they are considered inviolable part of the culture, political sacred cows and the one true solution that cannot be questioned. I expect that hairdrier lady's OCD was not limited to just her hairdrier - the sticking plaster hopefully reduced acute disruption/distress that made more fundamental treatment tractable.
(FWIW, despite articulating this argument, I can argue against it. I don't hold any confident position in this culture war maelstrom of bigotry and questionable scientific/philosophical claims.)
> Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example).
There seems to be a prevalent problem in this area (and perhaps others too) to where the reporting on the "science" seems to be a lot more positive than the science itself. The original article alludes to this -- "stop questioning the science" like it's an open and shut case.
For that particular study, a more accurate headline would be: "In Our Pre-Registration We Expected To Find Improvements on Eight Measures but We Only Found Improvements on Two, Which Were Very Small, and Only For Natal Females."[1] It's not as snappy, but it's more accurate.
That complex and fairly ambiguous outcome gets summarised into an overall optimistic story by the press, which then in turn gets digested into "gender reassignment .. works", not just on HN but on forums all over the internet.
It's not just that study though -- whenever the field is looked at holistically the evidence for the effectiveness of these treatments is not strong.[2][3] and the evidence for such treatments on children (the subject of the article) is even weaker.
Ultimately I believe adults have the right to do as they wish with their own bodies, however when it comes to children we have to be guided by the highest standards of medicine and science.
There is no empirical way to verify if someone is actually transgender. In fact, there really is no theoretical way that a person could even be transgender unless one accepts the idea of a non-material soul that is somehow gendered. Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are transgender and try to help them.
Emperical measurement framing is a cognitive cul-de-sac. Drawing a parallel, there's no emperical way to determine someone's sexuality. Fifty years ago this argument was used to justify therapeutically changing people's sexuality. "If you're a man you're biologically attracted to women. It's biologically impossible to be homosexual." Today we have the same logic applied to people's gender. It's as invalid today as it was back then.
Of course there is an empirical way to determine someone’s sexuality. You can show someone different varieties of pornography and see which varieties make them sexually aroused. You can see sexual arousal happening in the brain with an MRI. You can also just simply observe someone’s sexual behavior.
I'm sorry, but that simply isn't true. Even if it were true, like all diagnostics, it would have a sensitivity and specificity, which of course brings us back full circle to the problem the author cannot escape.
You don't think it is possible to determine whether homosexual people actually exist???
When you said, "that simply isn't true," what exactly were you referring to?
Homosexuality is the condition of having a sexual preference for people of the same sex. We can easily observe that such people exist. Whether it is a disorder or not is a separate question.
When a man says, "I prefer to have sex with other men," we can easily check whether or not this is true. (Or do you think all gay men are just faking it?)
When a man says, "I am really a woman," he cannot point to anything empirical to back up his claim. To the extent that we can check this claim, we can easily determine that it is false.
Of course, a man can correctly say, "I wish I was a woman," "I think I would be happier if I had been born a woman," or "I really like dressing up like a woman," and all these claims can be true.
But when a man says, "I actually am a woman," we know this is false because we know what a woman is, and we know what a man is, and we know that they are distinct.
Sexuality cannot be directly measured; its consequences can however be observed. Gender, operating the same way cannot be directly measured, its consequences however can be observed.
Your argument suffers from assuming essentialism - the error of reifying your personal ontology. That's a misalignment between you on one side and facts, nature, science, and reality on the other.
But back to the sensitivity and specificity for the test you're describing, what are they?
You’re just wrong and determined, apparently. I just don’t know what to say to someone who doesn’t think it is possible to empirically verify that some people have a homosexual orientation.
An HN commenter like yourself who thinks this is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are right about this and try to help them.
I'm sorry that you are simply unable to change your mind. I hope you get the care you need.
> Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition.
Hard disagree. Even with a strictly genetic interpretation there are more than just two sex-chromosomal configurations, but leaving that aside there are many of us who believe that gender, unlike biological sex, is a social construct. Saying "you must be a man because you were born XY" is roughly equivalent to saying "you must stay home and cook dinner because you were born XX".
Let's say we had the ability to genetically re-engineer people into whichever sex they wanted. Would you still be opposed to letting them do so because they were born a different sex? Would you deny genetic treatment of debilitating diseases because people were born with them?
> These are not additional sexes.
> For example, a male with Klinefelter syndrome (XXY) is still male.
Only by arbitrary definition of the abstraction we use. If we instead defined maleness as the ability to inseminate women and produce viable offspring they wouldn't count. If we defined it by having male genitalia then people with androgen insensitivity syndrome wouldn't count.
Male and Female are human terms we've chosen to categorize animals, but nature doesn't give a flying fuck about our definitions.
> We do not, nor anything even remotely close to that.
Obviously. This is called a 'hypothetical' or a 'thought experiment'. We use these to test the suitability of our mental frameworks of understanding. In this specific instance, I'm asking you to pretend this is true to see if your reasoning holds up, of if there is cognitive dissonance suggestive of a flawed model.
That's just plain wrong. Mental properties in general (e.g. personality) are not easily measurable, but that doesn't mean they don't exist (or can't exist without a non-material soul), and I see no reason to think that an innate sense of gender would be any different.
In any case, while gender is not directly measurable, it does seem to correlate with some aspects of brain structure. A number of studies have shown that, at least in some respects, the brain anatomy of transgender people is more similar to that of cisgender people of the same gender than those of the same sex. It's clearly more complicated than trans people having one type of brain in the other type of body, but something sort of like that is going on. See https://www.scientificamerican.com/article/is-there-somethin... and the links at https://sitn.hms.harvard.edu/flash/2016/gender-lines-science....
But whatever the basis of transgender identities is, it's clear that something real is going on. Dismissing trans people as "simply mistaken" is, well, simply mistaken.
EDIT: I should probably point out that the idea of someone developing some male-type features and some female-type should not be particularly surprising. Sexual differentiation is complex and has a lot of moving parts that don't always operate completely in sync. For example, a genetic male with complete androgen insensitivity syndrome will generally develop male-type internal organs (i.e. testes) and female-style external anatomy (a vagina, generally female appearance, etc).
You are defining male and female that way.
If you go by that definition, you can define a transgender person as someone who deeply thinks and feels they ought to be of the other gender.
They are not 'mistaken' other than by your definition. If you ask them 'do you have a penis' or similar question, they will respond with your objective reality.
Yes, I believe transgender people exist if you define the condition as people who wish they were of the opposite sex or mistakenly think they are of the opposite sex. They definitely really have mental conditions that result in wishes and feelings related to sex and gender, but if they claim that they truly are of the opposite sex, they are mistaken.
We're not living in computer game or virtual reality.
Technology still far from providing us freedom to change our bodies as we want.
It's not about even transgender operations - we can't achieve even smaller goals: to be more healthy, stronger, more beateaful, younger or more mature.
Nobody likes themselves in current state - you, me , my son, my parents, everybody.
Transgender operations should not be taken lightly because they are not transgender in reality.
The one who decided on such path should that it's something heroic in self-modification of such scale.
They'll pay a lot without any guarantee they will earn something.
I think that 100 clinics .. sorry, strong words: I think it's a crime.
Literally. Those "doctors" are not helping weak and unhappy, they're selling what they can't provide, they make people even more unhappy
> Declaring the body to be correct and the mind wrong seems arbitrary...
Hardly, our understanding of the human body is more experimentally valid and much more aesthetically developed than our understanding of the human mind. If there is some kind of 'mismatch' as you say and the body appears well regulated, then the medically responsible move is to defer to it.
Your first comment was better. This is a discussion about public health so of course people can contribute to it, and take an interest on behalf of the affected. And he does not seem at all upset.
There will never be a clear cut definition of health, but most people can innately tell what a well regulated body looks like for their culture.
For instance, most Americans know they're fat or obese and that this is not good for their long term health outlooks and will have detrimental affects on other aspects of their lives. Some may choose to be okay with this, but very few sincerely argue that being fat is 'healthy'. Most will try to lose weight (excess fat) at some point in their lives.
Sometimes we remove body parts that are no longer well functioning within an understood ordering of the body. Inflamed tonsils can be removed, large wisdom teeth pulled, even ovaries can be discarded if they're found to be hosting cancers, but all of these are examples of organ dysfunction. We know what is regular, non-painful, and non-disruptive about the human body because many human beings spend a lot of time in that state and most begin life in that state before transitioning to a disordered state. When that transition happens, medical science seeks an explanation for the dysfunction: how did these tonsils become inflamed?, why do wisdom teeth crowd the mouth?, how did this woman's ovaries come to carry so much cancer?
We look for the cause of a dysfunction in order to treat it.
If instead we remove the well functioning breasts of a 15 year old, or replace a healthy penis because a patient informs us that they abhor their member, or prescribe a blocker for an otherwise well regulated puberty, then we have inverted the entire thrust of centuries of medical understanding. We are taking a healthy body and searching for a malady that we have been told must be there. Once there is no longer a discernment between the regular and the dysfunctional for a human body then an explosion of maladies abounds all begging for treatment.
If enlarged breasts are causing spinal issues then perhaps they should be reduced in order to correct those issues. But why not removal? We remove enlarged tonsils, why not enlarged breasts? Surely the removal of them would also correct any spine issues. In fact, it may even be ethically easier as the doctor and patient do not have to contemplate a correct breast size. But of course it is unlikely the patient or doctor ever considered the wholesale removal of the breasts in these cases because both approached the question with an idea already in mind of what a healthy human body would look like despite they're not having any precise agreement on the topic beforehand.
And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun. Why should either be condoned? We condemn being fat on entirely the same terms. Often Americans are fat because they eat too often and always in excess due to eating feeling good. If one doesn't praise obesity, then what ought they find desirable about self-imposed sterility?
Of course what compounds these ethical concerns is that in these cases the subjects are children. On the whole this takes the acts from merely questionable or wrong-headed to monstrous.
> And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun.
Perhaps we should question the ethics of kids playing casual sports because it’s in the pursuit or carefree pleasure and fun
Play is important to a child's development. Try to refocus and retain that the context of the conversation is about medical interventions not playground games.
It is self-evident that reversing a decision to play freeze tag is orders of magnitude easier than reversing a dental tooth cleaning; a mundane medical procedure.
How about you worry about yourself. What’s it to you if someone decides to get a vasectomy in their 40s? Or are you simply more interested in bending and controlling people with your personal moral views where “pleasure and fun” are sins.
> How about you worry about yourself. What’s it to you if someone decides to get a vasectomy in their 40s?
I don't think almost anyone in this thread, including the person you are replying to, has any issues with 40 year olds doing whatever they want to with their own body. They are adults who can accept full responsibility over their actions and consequences, no matter how irreversable or disastrous they could end up being. Children are an entirely different story, as they, by definition, have no ability to provide informed consent to a lot of things, and rightfully so.
> Or are you simply more interested in bending and controlling people with your personal moral views where “pleasure and fun” are sins [?]
You are fighting windmills here. At no point had anyone in this chain of comments exerted any moral judgement against people transitioning or even suggested that it was sinful.
And to be extra clear, I have no issues with adults transitioning, and I would have no issues with minors either, if the process was fully reversible. Most western countries don't consider minors being legally able to give consent to getting tattoos due to their (near-)permanency, but no one has any issues with adults getting those. I, personally, would consider transitioning to have a much higher bar for "minors should be able to consent to it" than I would for getting a tattoo.
> I don't think almost anyone in this thread, including the person you are replying to, has any issues with 40 year olds doing whatever they want to with their own body.
> Of course what compounds these ethical concerns is that in these cases the subjects are children. On the whole this takes the acts from merely questionable or wrong-headed to monstrous.
FROM wrong-headed TO monstrous. Sounds like they have a pretty negative and judgmental opinion regardless if it’s an adult, that just intensifies when children are involved. So yeah, I do think GP has issues with said 40 year olds. How many minors are getting vasectomies anyway? How it is comparable to a gender transition except in the most vague and useless ways?
> You are fighting windmills here. At no point had anyone in this chain of comments exerted any moral judgement against people transitioning or even suggested that it was sinful.
Not even talking about people transitioning . Why the fuck is this guy comparing it to vasectomies and obesity in the first place.
> No surgeon should be removing healthy body parts, in my opinion.
There are a metric ton of medical procedures surgeons do outside of medical transitioning where people alter/adjust/remove healthy body parts. This seems like a pretty blanket statement to say; and I say that as someone who would be extremely cautious about telling someone that they "should" medically transition if they feel that social transition would be sufficient for them. I'm all aboard the train of telling transgender people that they're valid whether or not they choose to transition, and I definitely would advocate that transgender identity and body dysphoria are not necessarily the same thing, and that many trans people are blessed to be able to both embrace their transgender identity and celebrate aspects of their bodies that don't "align" with their gender in strictly hetero-normative ways.
Even with that perspective, this framing of "we're perverting the role of doctors/surgeons by cutting healthy flesh" -- it just doesn't really match the reality of how many procedures there are in the US that already fit that definition. Everything from the stereotypical examples of cosmetic surgery, to non-essential dental procedures, to limb lengthening, to circumcision, to sex-assignment surgery for intersex infants, the list goes on and on.
Many of these procedures aren't strictly speaking medically necessary. Precocious puberty for example is primarily harmful because of its psychological and social effects. The physical consequences of early puberty are comparatively minor (not non-existant, but then-again neither are the effects of puberty blockers. We're mostly talking about stuff like "you might be shorter when you grow up"). And yet, I've never once seen someone advocate that it's morally wrong or that it should be illegal for a doctor to prescribe puberty blockers to a cisgender child with precocious puberty. There's no shortage of conditions that really don't have physical health-effects or side-effects other than that society has decided that we don't really like them or that they're inconvenient to live with (either because of social stigma or because of the increased need for accommodations that society is unwilling/unable to provide) -- and we generally don't tell people with those conditions that they need to just learn to live with them. Instead, we give them choices (including medical interventions) to address both the social effects of their conditions and the internal psychological effects of their conditions.
What we don't do is we don't take a purely physical view of things. Heck, one of the justifications for why doctors prescribe puberty blockers to cisgender girls with precocious puberty is because there's limited research suggesting that delaying puberty lowers their risks of being raped. That's about as far into the "its a social problem, not a medical one" category as it's possible for a medical intervention to be.
And look, all of this is even taking the most charitable view of the statement statement above and assuming that it is specifically talking about medical interventions among minors. But if I take that statement at its face value as saying that no surgeon should ever operate on healthy tissue, then it just kind of becomes absurd, honestly. There are so, so many medical procedures that fall under that umbrella.
I think everyone would love to have less invasive ways of helping people who suffer from gender-disphoria and I think everyone is hoping that as social stigma continues to decrease that some of the psychological downsides of not transitioning might also decrease. That's not to say that medical transitioning is bad; it's not. But it does carry some risks, and obviously it's good to have multiple available paths for the transgender people who don't want to take those risks.
But arguments that boil down to "it's in the mind, so treat it that way" sound good at face-value but are ultimately way too simplistic to work even in a purely cisgender world. Our medical profession hasn't really worked that way for a long time, if it ever worked that way at all. So any debate about whether or not a surgery procedure is moral needs to be engaging with the issue on a deeper level than just whether or not there's a physical risk involved.
> that's not what they were intending and you know it
Yes, I took the more charitable interpretation of what they said (that it was specifically about minors) and devoted the vast majority of my comment to talking about that. I spent maybe one or two paragraphs total talking about adult transitioning.
And yet, even under that charitable interpretation, saying "we should not be operating on healthy tissue" is an argument that sounds good but falls apart as soon as you try applying it to the real world and the numerous non-essential medical interventions that are supplied to children.
I am trying to be charitable in my takes, but "chopping off their reproductive organs because of a fad" is not an insightful characterization of the current debate. It grossly oversimplifies the full spectrum of medical intervention for transgender youth, and (again) ignores the reality that medical interventions for psychological/social/internal maladies, including interventions based on the possibility of future psychological/social problems, are not exclusive to transgender youth.
no. it is simple. a young boy cannot "feel like a girl" because they have no idea what that feels like, that is not a thing. you are just you. get comfortable.
all of this nonsense has lead to mass depression, anxiety, obesity, etc. go outside, get some exercise, have a reason to live, get some sun, etc.
To be blunt, I think you're honestly kind of proving my point. In order:
1. "Chopping of their reproductive organs" is itself not an accurate representation of the full spectrum of transgender care. A nontrivial portion of transgender people never get bottom surgery, and certainly bottom surgery is not the primary focus of the majority of bills being passed right now about transgender care for minors (many of which go beyond banning medical interventions and ban even non-medical gender-affirming counseling).
It's a gross oversimplification of gender-affirming care for minors to focus purely on the rarest and most invasive intervention possible, a procedure that many transgender people will never undertake in the first place.
2. "~30% of girls think they're boys" is not an accurate representation of that study. 26% of teenage girls reporting "some change in their gender identity" does not mean that they suddenly completely flipped genders. Your description misses the subtleties of how many people talk about gender identity and gender fluidity.
3. > it is simple. a young boy cannot "feel like a girl" because they have no idea what that feels like, that is not a thing
There is a lot to unpack here, so I'm just going to say that's not a great description of either transgender identity or gender dysphoria (remember, they're not necessarily the same thing). I think this is a giant oversimplification and misrepresentation of the transgender experience.
It's also (not to be too nitpicky) kind of an oversimplification of the cisgender experience? But that could be a long conversation.
4. > go outside, get some exercise, have a reason to live, get some sun, etc.
This is a massive oversimplification of mental health care in just about every category from depression to gender dysphoria. You can not cure gender dysphoria by getting more sun. Even in situations where gender dysphoria can be either alleviated or partially mitigated with counseling, what's going on in that counseling is going to be a lot more complicated than the happy-go-lucky/"natural" model of mental health that people sometimes propose nowadays.
----
Again being as charitable as I possibly can, I am sure that there are people who are genuinely supportive of transgender rights but who still have concerns about medical interventions with minors, and there certainly are people who have medically transitioned who go on to regret it -- and yeah, of course I feel for those people, of course it would be good to improve our standards of care to minimize post-transition regret. But (again, thinking charitably) I imagine it's got to be pretty frustrating for the people with genuine concerns about youth counseling if every time they try and raise those concerns, they find themselves instantly surrounded by a bunch people saying that transgender youth all just have a vitamin D deficiency. Because that's just nonsense.
> it is simple. a young boy cannot "feel like a girl" because they have no idea what that feels like, that is not a thing
please dig more into this. you are tipping towards lunacy...
people will look back on removing breasts, inverting penises, etc. as we look back on phrenology, blood letting, lobotomies, etc.
> This is a massive oversimplification of mental health care
no. no it is not. please look at areas where they do not have even close to as much anxiety. getting exercise and socializing is extremely important for humans.
wash the dye out of your hair, take out half your piercings, and call your dad.
> no. no it is not. please look at areas where they do not have even close to as much anxiety. getting exercise and socializing is extremely important for humans.
Look, ultimately, we're in a public forum, and it's not my job to personally change your mind; it's my job to engage constructively and as insightfully as possible in a way that betters the conversation for other readers.
If this is your model on mental health care, then your comment speaks for itself and I think that other people on HN have enough information to come to their own opinions about whether you're qualified to talk about "social contagions."
----
Purely in the interest of being as constructive as possible, this is a really harmful view of mental health, not because the interventions mentioned in the parent comment are useless, but because they are an oversimplification of a complicated problem. Exercise/diet/etc... can absolutely help with issues like depression, but those actions are usually taken alongside counseling and with aid, occasionally (but not always) in conjunction with medication. Psychological interventions and mental health interventions are multi-faceted and highly individual; there is no single easy universal solution that will work for everyone.
Like please, don't ever tell someone with depression that their problem would just be solved if they made more friends. Friends are important and can help in some situations, but that advice is not helpful. And similarly, while gender dysphoria is not exactly the same as depression, it is also a condition that is a lot more complicated than just whether or not someone has enough friends or exercises enough.
But again, I think in regards to the broader debate, I would just say that people who talk about psychological issues as if they're just dietary issues -- maybe those people aren't the best sources to get advice from about the proper treatment for transgender youth.
> So you disagree that exercise, socializing, etc. are extremely important for mental health?
Of course I don't disagree with that.
But with that I'm bowing out, I can't think of a better illustration of what I've been talking about then the parent comment. I think it's pretty obvious whether or not that comment is a fair characterization of anything at all that I said above.
And again, I would just suggest to readers that the type of logic that leads to someone mischaracterizing what I wrote about mental health so completely is also probably not worth paying attention to when it's applied to debates about transgender care.
You still aren't really understanding what gender dysphoria feels like, but you clearly have no want to actually understand. Your take on things like depression are also incredibly incorrect and damaging. Your position is one that can be argued effectively, and yet you are repeatedly resorting to strawmanning a very small portion of your opponent's argument.
Your opinion, based on absolutely
nothing but your armchair philosophizing, is completely incongruent with the actual science.
Gender dysphoria is not a mental illness; it is a condition, like pregnancy. Unlike anorexia or body dysmorphia, when you address the issues causing gender dysphoria it simply resolves itself.
Leave this to the experts, please (ie not a receptionist). Unless you're trans or an expert there is very little substance in your opinions.
edit to respond: a mental illness is a disorder that causes harm to yourself or your interpersonal relationships. Gender dysphoria doesn't by itself do that. Transphobia in society does.
This study has been misread over and over again. It doesn't account for the fact that Sweden forced trans people to have surgery (sterilization) until 2013, even if they didn't want it. Besides, reducing suicidality is not the only goal of transitioning.
I can tell you that for me, now that I've addressed the issues causing me gender dysphoria it has completely resolved itself.
If surgery is completely ineffective at preventing massive suicide rates, why is it an option? Post-op transgender people still have extremely elevated suicide rates, therefore the surgery is ineffective.
Then you have transgender activists routinely attacking people in their own community who regret the surgery, and papering over the inconvenient truths about hormone blocking drugs (they cause permanent bone damage in children).
I'm not taken by arguments that routinely include tactics like death threats towards campaigners who speak out against dangerous hormone blocking drugs.
It isn't "completely ineffective", there is a solid evidence base that people who want it and get it are happier than people who want it and don't.
> at preventing massive suicide rates
A large part of suicide rates is hostility from society. For example, what if society forces people who don't want surgery to get it just to update their IDs? This is a eugenicist human rights violation, and it was the case in Sweden for the time period studied.
Note that in the time period, Sweden also required trans people to prove that they didn't have any gametes in storage! This was such an egregious instance of eugenics that the Swedish government should be paying millions of USD in reparations to anyone affected.
> why is it an option?
Because it works and makes people happier.
> Post-op transgender people still have extremely elevated suicide rates
Due to hostility from society. Suicidal ideation and behavior is a well-known component of CPTSD, and almost every trans person I know has CPTSD from social hostility. (There is one trans person I know who doesn't -- she's 20 and grew up in a supportive, left-wing environment.) That doesn't reflect on any kind of surgery. Rather, it's a damning indictment of society.
> therefore the surgery is ineffective.
False. This absolutely does not follow either logically or empirically.
> Then you have transgender activists routinely attacking people in their own community who regret the surgery
First off, there is not just one "the surgery". Saying that just exposes your ignorance on the subject matter. (And you really should spend a few weeks learning about trans healthcare before commenting any further.)
Besides, your claim is false. The objections are only to the people who regret it and use that as an excuse to attack trans healthcare generally. I know trans people who were forced into a surgery they didn't want, regret it, and everyone I know has full compassion for them.
> and papering over the inconvenient truths about hormone blocking drugs (they cause permanent bone damage in children).
This is a well-known side effect of low sex hormones (also happens in post-menopausal women). There are also serious side effects to not intervening. As always, you have to balance the benefits with the costs of intervening versus non-intervening.
> I'm not taken by arguments that routinely include tactics like death threats towards campaigners who speak out against dangerous hormone blocking drugs.
Plenty of medications have side effects. Accutane can cause depression. Hormonal birth control can have serious side effects. Focusing on this over anything else shows your biases.
---
If you're engaging in good faith and would seriously like to learn more about trans healthcare, https://medicine.yale.edu/lgbtqi/research/gender-affirming-c... is a good starting point. There are over a hundred citations in the paper, and you can use any of them as a starting point. Sci-hub is your friend.
That study didn't compare suicide rates with and without surgery, it compared post-op trans people with the general population (i.e. mostly cisgender people). It explicitly says "This study design sheds new light on transsexual persons' health after sex reassignment. It does not, however, address whether sex reassignment is an effective treatment or not."
> The guy's voice is almost a whisper, the ambient sounds from the garden or the forest or the road are oddly pleasant, and he's speaking pretty slowly, with none of these glitchy quick cuts you see in a lot of YT content. It's also unusually personal-feeling, like he's just talking to you.
This sounds very much like ASMR. I find the most relaxing/entrancing videos are the ones that are unintentional/not forced, although obviously personal preferences do vary.
I watched a video of a friend of mine who's become a semi-prominent Zen teacher. After a few moments of listening to one of his (rather lovely) pandemic/Zoom group meditations, it struck me that this was weirdly close to ASMR too -- intimacy, calm, human "touch". Philosophy too, yes, but the interpersonal dynamic is a mother cooing into your ear. I wonder if this resets you into some calm, receptive mood because that's an evolutionarily advantageous state to be in, and the cooing is a shortcut to it.
It's easy for me to believe that this could have initially evolved to give babies slightly more preparation for the outside world (and therefore a slightly higher chance of survival), and that we just happen to retain the ability throughout adulthood.
This link is indeed a very good explanation of mRNA vaccines, probably the best that I've seen.
After I read it, I noticed that it was the first time anyone had ever tried to explain _exactly_ how these new vaccines worked, like down to the molecular level.
Most explanations I had seen were usually extremely high level (literally just "the RNA gets read by your cells, which then produce the spike protein, then the RNA is destroyed") or used analogies (as you have done here).
I don't consider myself a conspiracy theorist, but I admit I had been harbouring some concerns/fears over these new vaccines. This link is the only thing I have read that actually allayed those fears.
I think there is a lesson here.
I have a feeling that everyone fears stuff they don't understand, at least a little bit.
I know that the high level explanation is technically correct, but here's the problem: Many conspiracy theories are actually _extremely_ detailed. I have personally seen covid conspiracies that appear to be backed up by scientific papers.
This is what the truth is competing against. A basic, high level "ELI5" explanation is never going to convince a conspiracy theorist who is looking at a stack of science papers.
So I think this link is very important, more people need to read and share it.
I know this is an inflammatory topic that evokes visceral feelings but.. you should be aware that when you are trying to change someone's mind, aggressive arguing like this is much more likely to make the other person believe what they already believe more strongly (i.e. the opposite of what you want).
"With PCR, if you do it well, you can find almost anything, in anybody"
"If you can amplify one single molecule up to something that you can really measure - which PCR can do - then there's just.. very few molecules that you don't have at least one single one of them in your body"
"It doesn't tell you that you're sick"
My interpretation is that Kary Mullis did believe it was at least possible to "misinterpret" the results of a PCR test. It doesn't seem such a stretch to believe that you could be sick with the flu, while also having a single molecule of a coronavirus gene present in your nasal cavity (triggering a positive coronavirus test).
Note: I know this is an inflammatory topic. The views of Kary Mullis are not necessarily my own. I am posting this here because I think it is interesting.
For the benefit of anyone not in the UK, there is a marvelous Christmas advert inspired by this event, which aired in 2014 (100 years later): https://www.youtube.com/watch?v=NWF2JBb1bvM
Neurotransmitters send signals. The amount of neurotransmitter tells you nothing about what information is actually encoded in those signals. You can transmit happy and sad music using electricity, for example. It seems to me that you can transmit happy and sad thoughts using neurotransmitters. (And of course the brain is much more complicated than a computer, because a computer “just” uses electricity, whereas in the brain some processing happens at each neuron, and signals coming in on one neurotransmitter can cause signals to leave in others.)
I see the term antidepressant as a bit of a misnomer. A drug that inhibits re-uptake of neurotransmitters will amplify the “loudness” of the signals. If you only have negative thoughts, and you take such a drug, your depression could realistically get worse (and this does happen to some people).
If you can get in to a positive feedback loop (e.g. an activity that leads to positive thoughts that lead to more of that activity) and _then_ start amplifying those signals, then these drugs can do wonders.