DoctorOW12 days ago
As a transgender woman myself, I have been witness to many in my community reduce some recreational drug use with HRT. I think it's unlikely that estrogen literally causes euphoria, but gender euphoria is real, lasting happiness. When you compare to the health effects of letting someone waste away on recreational drugs to dull dysphoria, it paints a visceral picture of transition as healthcare.
nyanpasu6412 days ago
It's chilling watching the latest political powers openly declare that trans people are not who they are inside and must never be allowed to become what they are inside, while eliminating legal recognition and protection and criminalizing life-saving transition healthcare. I find myself retreating into dissociation because to feel the horrors is more than I can bear.
wahern12 days ago
The glass-is-half-full take is that no states have prohibited gender affirming care for adults. All the present bans in the U.S. only proscribe treatments for minors. But one would be forgiven for not knowing this because it's not how it's reported.
Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.[1] Which is not nothing considering how many were so quick to ban abortion.
Also, it's not just the U.S.; plenty of "liberal" Western European countries have reversed course on care for minors. Even the Netherlands, the origin of the WPATH protocol, has pulled back on the reigns for minors, though they haven't yet instituted any prohibitions.
IMO, the trans advocacy rhetoric that equivocated hurdles to gender affirming care for minors as murder backfired. The fact there seems little motivation to limit treatment for adults suggests substantial openness to the issue among even conservative populations. And there are many in the LGTBQ community, include trans community, who share similar sentiments, at least regarding the rhetoric.
[1] Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.
panic12 days ago
The problem with adult-only transition is that it dooms trans people (at least, those who go on HRT) to go through two puberties, which has visible physical effects that then have to be undone or worked around (breast growth, facial hair, deeper voice, etc.). The ideal for most people is that you'd just go through one.
Manuel_D11 days ago
The issue with this framing is that it ignores blockers' influence on desistence rates. Without blockers, 60-90% of kids presenting with gender dysphoria desist in cross sex gender identity by adulthood. But when put on blockers, nearly 100% continue living as the cross sex gender.
Even with a suppressed puberty, being transgender is extremely hard with high rates of depression and suicide. Any responsible analysis of the aggregate benefits of prescribing blockers needs to factor in the rates of desistence with and without blockers, but proponents of blockers almost always try to frame this discussion as though all kids with gender dysphoria persist in a cross sex gender. And indeed many try to claim that desistence is a "myth", despite most research into the topic.
seethedeaduu11 days ago
This is why I hate online "debates". Because over and over people will repeat the same stuff that have been debunked thousands of times before.
The DSM criteria for gender dysphoria aren't particularly useful when you are diagnosing kids that play with dolls despite not expressing a trans identity or wish to switch sexes by themselves.
In addition to that, when you are dealing with a conversion therapist it is only natural to depress, but this doesn't mean that it's healthy for you eeither mentally or physically. This is something that was forced onto me as well.
Finally, you seem to be considering transitioning to be inherently something that should be avoided, otherwise why would less kids desisting be considered a negative?
Manuel_D11 days ago
The same criteria used to approve patients for puberty blockers were used in the study. Heck, the author of the study helped write the DSM criteria for gender dysphoria. This is not at all "debunked", as much as activists try to insist that it is
Transition is indeed something that should be avoided if a patient can become comfortable in a same sex gender identity, because even with a suppressed puberty trans people have negative health outcomes across a variety of measures. To say that transition is best avoided if possible isn't a moral judgment against trans people, it's an accurate statement about the disparities in health outcomes.
This is a simplistic model, but imagine trans people have 10% risk of suicide if they don't get blockers, 5% if they do, and cis people have 1%. If I have a cohort of 10 patients with gender dysphoria 8 will desist and 2 will persist without prescribing blockers. And if you do prescribe blockers all of them will persist and transition. The former achieves the optimal health outcomes for the group as a whole. Again this is hugely simplistic, as suicide is not the only healthcare outcome we care about, but it illustrates that desistence rates are relevant to measuring whether blockers improve overall health outcomes.
Of course ideally we'd be able to know which patients will and won't persist. Psychologists attempted to do this for decades, but were never able to reliably predict which patients would and would not persist. People like to point to the extremely low rates of desistence among people prescribed puberty blockers as proof that psychiatrist are predicting correctly. But of course it's also consistent with blockers serving as a determining factor in persistence, and not merely offering "time to think".
a_shovel10 days ago
The fact that you think 90% desistence is credible discredits you.
Most people who pass by a bus stop don't get on a bus, but if they stop and wait at a bus stop then the probability they soon get on a bus is above 90%. Do you think standing at a bus stop caused them to get on a bus?
Manuel_D10 days ago
First of all, thank you for being upfront about the fact that your rejection of these studies is not based on their methodology, but because your don't like their results.
It's more like I have two different buses. When kids get on bus A, ~80% of them arrive at destination X and 20% at destination Y. When kids bet on bus B, 2% of them arrive at destination X and 98% of them arrive at destination Y. It sure looks like bus B isn't merely affording the kids "time to think" but is in fact altering their destination, does it not?
The patients in the study are diagnosed with the same criteria for gender dysphoria in the DSM. Heck, the author in the study I linked wrote the criteria for gender dysphoria in the latest iteration of DSM. I'm always puzzled by people who insist that the study was including patients that weren't actually experiencing gender dysphoria.
a_shovel10 days ago
It's less that I "don't like" the results and more that the results are completely unrealistic. Trans people tend to make friend groups with other trans people, and I trust that they would notice if on average 90% of their friends stopped being trans.
I don't get your bus analogy. Surely the people who get on bus B which goes to destination Y do so because they want to get to destination Y? The act of getting on the bus doesn't cause them to want to go its destination.
Manuel_D10 days ago
It's not the child picking the bus. The choice of whether a medical professional chooses to affirm a patient or take a neutral, observational stance is a choice made by the medical professional, not the patient.
And how does that choice seem to affect the outcome? When gender dysphoric children are met with a neutral model of care that primarily seeks to observe the child, about 4 in 5 desist by young adulthood. When they're affirmed, and especially if put on chemical treatment to suppress puberty, 98% or more persist with a trans identity. Even with a suppressed puberty, transgender people experience worse health outcomes than cis people across a variety of measure. To say that the former approach is a better healthcare outcome in aggregate is not a denigration of trans people but a recognition of the challenges they face. To justify affirmation, the improvement has to be demonstrated not only against an adult transition, but also against the population that desist and live life as cis people.
The studies presented above took a sample of the patients that visited a a clinic that voiced distress of their gender over the span of a period of time - the majority of them meeting the criteria for gender dysphoria in the DSM - and tracked which of them desisted or persisted in expressing a non-cis gender identity decades or more after the fact (average time from first visit to last follow up was 13 years). The lowest rate of desistance was 70%, 3 out of the 4 were above 80%.
To call the results of a study "unrealistic" indicates that one already knows a "realistic" result would be. This is essentially admitting to bias approach to the data: if it doesn't conform to your predetermined "real" result, and your criticism is solely based on that and not any methods in the study. By comparison, the studies that show extremely low rates of desistance are either studies with kids on blockers, or they are not cohort studies. E.g. studies recruiting respondents from the internet is vastly more susceptible to reporting bias than taking the group of patients visiting a gender clinic over the course of a year.
If you want to actually post and discuss a study finding high rates of persistence under a neutral model of care, I'd be very interested in reading. But my approach towards deciding what a realistic result is leans more heavily towards published research than anecdotal claims.
viamiraia11 days ago
> Without blockers, 60-90% of kids presenting with gender dysphoria desist in cross sex gender identity by adulthood. But when put on blockers, nearly 100% continue living as the cross sex gender.
You say "most research" shows this. From which source(s) do you draw these claims? If I recall correctly there were a lot of methodological issues with drawing this type of conclusion from those studies.
Manuel_D11 days ago
This is one of the more recent studies: https://pmc.ncbi.nlm.nih.gov/articles/PMC8039393/
The desistence rate for this study was 87%. Most other studies fall in the range of >70%
> At the time of follow-up, using different metrics (e.g., clinical interview, maternal report, dimensional measurement of gender dysphoria, a DSM diagnosis of GID, etc.), these studies provided information on the percentage of boys who continued to have gender dysphoria (herein termed “persisters”) and the percentage of boys who did not (herein termed “desisters”).2 Of the 53 boys culled from the relatively small sample size studies (Bakwin, Davenport, Kosky, Lebovitz, Money and Russo, Zuger), the percentage classified as persisters was 9.4% (age range at follow-up, 13–30 years). In Green (47), the percentage of persisters was 2% (total n = 44; Mean age at follow-up, 19 years; range, 14–24); in Wallien and Cohen-Kettenis (52), the percentage of persisters was 20.3% (total n = 59; Mean age at follow-up, 19.4 years; range, 16–28); and in Steensma et al. (51), the percentage of persisters was 29.1% (total n = 79; Mean age at follow-up, 16.1 years; range, 15–19). Across all studies, the percentage of persisters was 17.4% (total N = 235), with a range from 0 to 29.1%.3
You can find studies that find a very low rate of desistence, in the single digits. But those are among children that were put on puberty blockers.
d6e11 days ago
Those studies were mostly from the 80s-2000s when things were really different. Kids were often referred just for being gender nonconforming (like boys playing with dolls), not necessarily having serious gender dysphoria. Plus the treatment back then was often trying to make kids more "gender typical" - which obviously might push some kids toward appearing to "desist" even if they still had gender issues. Many of the kids in those studies didn't even meet what we'd now consider the criteria for gender dysphoria. So saying "80% of trans kids desist" might be more like "80% of gender nonconforming kids don't turn out to be trans" - which is pretty different.
Manuel_D11 days ago
The majority of the sample met the criteria for gender dysphoria as listed in the DSM. Gender non-conforming behavior is just one criterion, multiple of which need to be met to categorized as gender dysphoric. This is the same set of criteria that a medical professional would use to approve a patient for puberty blockers.
The predominant approach back then was not to suppress incongruent gender identity. The approach was to take a neutral stance and neither foster not suppress the patient's gender identity, called "watchful waiting".
d6e11 days ago
> The predominant approach back then was not to suppress incongruent gender identity. The approach was to take a neutral stance and neither foster not suppress the patient's gender identity, called "watchful waiting".
The clinic involved in this study actively was known for conversion therapy. Zenneth Zucker is one of the authors and is famous for it.
https://en.wikipedia.org/wiki/Kenneth_Zucker#Therapeutic_int...
The head of the child and adolescent gender identity clinic at Toronto’s Centre for Addiction and Mental Health, Dr. Kenneth Zucker, has made a career promising the parents of intersexed and transgender children that he can make them “normal”. His method, called reparative therapy, in which children are pushed into assigned gender roles and discouraged from behaving or dressing in a way that’s counter to their ‘assigned’ sex, was once standard practice, but in recent years, has been increasingly scrutinized. A 2003 report in the Journal of the American Academy of Child and Adolescent Psychiatry called his techniques “something disturbingly close to reparative therapy for homosexuals,” and author Phyllis Burke has questioned the idea that transgendered children should be treated as mentally ill, saying, “The diagnosis of GID in children, as supported by Zucker and [his colleague J. Michael Bailey] Bradley, is simply child abuse.”
https://www.queerty.com/dr-kenneth-zuckers-war-on-transgende...
I imagine a conversion therapy clinic would issue a study that their conversion therapy works. I wonder how long those kids stayed "desisted" or if they were just pressured into the closet again only to transition later in life.
Manuel_D11 days ago
Kenneth Zucker won over half a million dollars in a defamation lawsuit over these false claims. Your own link covers his successful defamation lawsuit, but you seem to have ignored this:
> After his dismissal, Zucker sued CAMH for defamation and wrongful dismissal.[3] In October 18, CAMH settled with Zucker for $586,000 in damages, legal fees, and interest and released an apology for the report falsely stating he called a patient a "hairy little vermin".[3][46] CAMH removed the report from its website and apologized, and replaced it with a summary of the report which has not survived a move to its new website.
Is it intellectually honest to post CAMH's accusations against Zucker, but neglect to mention that they were sued, paid out a settlement, apologized, and removed this report?
And again, what about the other three studies that all saw desistance rates over 70%? Even if you want to ignore Zucker's results on the grounds that he practiced "conversion therapy" (despite winning his defamation case...) it's not the only study conducted on desistance rates absent puberty blockers.
> I wonder how long those kids stayed "desisted" or if they were just pressured into the closet again only to transition later in life.
You don't need to wonder, just read the study: they followed up with patients over a decade later. By comparison, much of the research attempting to study the benefits of puberty blockers only follow up 1 or 2 years later, yet few seem to point out that this is a small duration of time in the context of a child's entire future adult life.
d6e11 days ago
I'm sorry, I don't want to spend my whole friday evening getting into this.
For me, the topic is personal because I was one of those young transgirls who was forced to go through male puberty. I transitioned the moment I was 18. I'm in my thirties now and still trans and still a woman. There's aspects of my body that are still permanently altered by the fact that I was forced to go through male puberty. I still resent the adults in my life, particularly the psychiatrist who strung me a long for years while I had to go through body horror. I would have done literally anything for hormone blockers back then.
I'm sure this is personal for you too. That's why you spend so much effort replying. Maybe we can see common ground? Neither of us want children to be forced to go through the wrong puberty.
Anyways, hope you have a good evening
Manuel_D11 days ago
A child put on blockers that would have desisted absent hormonal intervention is also a child that goes through the "wrong puberty". Chances are a good number of your psychiatrist's patients that became comfortable in their same sex gender, who would have been put on blockers and set on a track towards transition if your psychiatrist took a permissive approach towards hormonal intervention. Any responsible cost-benefit analysis of blockers has to weigh the effect it has on persistence rates.
And the cohort studies among gender dysphoria patients that don't receive blockers do show a majority desistence. This isn't just Zucker's practice finding majority rates of desistence. And your personal stake is still no justification to repeat defamatory statements about him.
jart12 days ago
Yeah but if you're a trans woman for instance, there are benefits to going through some male puberty. You understand men better. You understand yourself better, to know that's not what you want. Also you never go through a puberty in exactly the same way as a cis woman. A lot of the effects are reversible, especially if you start at 18, since I don't think maleness fully develops until at least age 25. Treating people under 18 is a politically losing issue. When policies around it changed, that tipped the scales from the public ignoring trans women or seeing them as victims, towards many members of the public seeing them as monsters who are out to get their children. It's illegal in 27 states and the White House calls it child mutilation. Can you imagine what a burden it must be to live in a world where many ignorant individuals hold such a perception of you, due to no fault of your own, but rather physical characteristics about yourself you can't change?
hemogloben12 days ago
> Treating people under 18 is a politically losing issue.
Treating people as 'a politically losing issue' is weird to me. There are certainly some nuances to <18 transgender care, but that statement doesn't address any of them and just suggests we embrace political cowardice.
> When policies around it changed, that tipped the scales from the public ignoring trans women or seeing them as victims, towards many members of the public seeing them as monsters who are out to get their children.
This is worse. It wasn't because politics around it changed, it was because republicans (upset that they could no longer target gay people), reused the same crappy arguments against trans people, and then wrapped it in a pedophilic flag.
The change in policy is just effective propaganda making people concerned that random doctors are allowing their children to get sex change operations without consent, when that isn't how ANY of this works. Children <18 can socially transition, get puberty blockers, and MAYBE get hormone treatment. WITH parent consent.
The fact that the media and comments like yours continues to pretend its a reasonable 'discussion' perpetuates the nonsense.
jart12 days ago
We? Political cowardice? Have you considered that trans people might just want to live their lives, and not be force-teamed into your war? Trans has been a thing since the 1950s and that whole time flew under society's radar, happy minding their own business and not be noticed, until around 2020 when your war started.
hemogloben11 days ago
Trans has been a thing since a whole lot longer than that.
Discussions like this often end up at WW2 and that's not what I'm saying here, but Germany in the 1920s was essentially the Gay/Trans hub of the world until it wasn't: https://www.netflix.com/title/81331646.
But even that's not the beginning of 'trans'.
The reason trans isn't 'flying under the radar', isn't because trans people got too proud. Its because one political party decided to shine the magnifying glass to turn trans into a political issue.
Alghranokk12 days ago
Have you considered that trans people just want to live their lives? As we all know, transitioning, social, hormonal, reduces incidence of suicide. This also applies to under 18 individuals. Should such options and approaches suddenly be revoked and discontinued, it will naturally follow that some will die who otherwise would not have.
How many do consider reasonable to sacrifice in the name of political expedience?
jart11 days ago
Back in the days when there were gatekeepers, doctors would actually refuse to treat you for gender dysphoria if you were suicidal. Because suicidal people aren't thinking clearly enough to be making such an important choice, and their actions could be seen as abusing the treatment as a means of self-harm. I think people also make that argument because they feel they need to be manipulative so that others will let them do what they want to do. If the world were more enlightened, we wouldn't have such issues.
seethedeaduu11 days ago
> happy minding their own business
Trans women until VERY recently were forced to go into prostitution and were excluded by the wider society. Trans people were not force teamed into any war, or rather, this is partially right, they were forcefully forced to pick a team by the side that aims to take away their bodily rights, protections, and mark them as undesirables again.
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actualwitch11 days ago
As a person born in a country on the very same trajectory Trump is pushing US into now, let me share some insights written in our blood with you. In my country, there were people who thought like you, thinking you can give them an inch and that they will be satisfied by it. But the truth is they always need more to keep the fire of hate going. First, they will take the <18 care because it was the point with weakest support. Next, when that is done, the weakest point becomes your legal identity. Then, your legal care at all. Then other lgbtqi+ groups. There is this poem about "first they came for _", this is a great illustration of it in action. It ends with transgender people pushed into conversion therapy or exile, like in my country. You should really look into how life for us was like in "1950s" and up to now, because if you don't fight for this happy life you want to live they will just take it without asking you, like they did throughout the history. The only answer to authoritarianism is to make sure there are no weak points to attack, stand united and you have a path to win. You can learn from our mistakes, or you can learn from yours. The choice is up to you.
jart11 days ago
There's no weak point here in California. Even Trump bends the knee to our governor.
I hope you make it out here one day, if you haven't already.
actualwitch11 days ago
Based on my perception of where US is now in terms of government, where its going and how seriously people are taking what is happening, I don't plan on going anywhere near it today or in the ~10 years to come. That is an optimistic timeline where trumpism is eventually stomped, btw. If you think it matters what individual states legislate when the entire country's government is being transformed into authoritarianism before your eyes, you are well on your way into pessimist timeline.
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HK-NC12 days ago
Odd that the idea of a child making permanent life changing decisions about their body hasn't been mentioned, you're so convinced you're right about all this.
Llamamoe12 days ago
> Also you never go through a puberty in exactly the same way as a cis woman. A lot of the effects are reversible, especially if you start at 18, since I don't think maleness fully develops until at least age 25. Treating people under 18 is a politically losing issue.
Imagine trying to make the same argument about forcing cis women to go through male liberty to "understand men better". It's ridiculous.
Further, studies show that the main predictor of bone structure is whether you started HRT before or after the beginning of puberty, and that outcomes get worse the more it progresses. At 18 you still get some change, but you really need to either block puberty or start HRT before it for optimal outcomes.
And if you don't want to give HRT to trans children, at least get them on puberty blockers. There's pretty much zero evidence suggesting they do anything worse than temporary and reversible reductions in bone density.
jart12 days ago
The first rule of medicine is to do no harm. It's an ethically grey area to intervene with something the body is doing naturally that isn't putting the person's life at risk. The technology available today for gender transition is crude compared to what will be available in the future. I know intersex people who are pretty unhappy because medical professionals chose the wrong intervention in childhood. Only adults of sufficient mental faculties who are under the care of a doctor should be making these tradeoffs. That's how trans worked for ~70 years before recent political activism forced the medical industry to loosen its standards.
seethedeaduu11 days ago
Kids can't consent to being forcefully and irreversibly mutilated under the wrong puberty.
Llamamoe9 days ago
Puberty blockers are routinely prescribed for other indications, and there are countless other treatments with more risks that are prescribed to children every day.
viamiraia12 days ago
As a trans woman who has talked with many other trans women, the majority, including me would prefer not having gone through male puberty at all. The benefits do not outweigh the gender dysphoria. We would love to go through puberty the exact same way as a cis woman, but it's not like we don't realize HRT and current methods have room for improvement.
The effects are only partially reversible, and only after tens or hundreds of thousands of dollars in surgeries, hair removal, voice training, other treatments.
I understand it's a politically losing issue now, but I believe it's due to misinformation, outrage porn, and unfair application of rigor, from mostly the anti-trans side but even allies and trans folk themselves sometimes. To that end I hope this does not feel like an attack - let me know if you have any questions that you think my perspective would help.
jart12 days ago
Look forward to the future. Superintelligence will invent better treatments for trans people. However there's not going to be any better treatments if trans becomes illegal due to the backlash caused by folks agitating for the use of the comparatively crude treatments available today on children. Trump has setup a legal regime for annihilating everyone in the medical community who's been providing trans care. You better hope there are still people around who are willing to help when the dust settles from all this political fighting.
znpy12 days ago
> Treating people under 18 is a politically losing issue.
This is the key point, imho.
In the transgender rights discourse no margin for error is admitted, but there is like in any other human field (of course).
There have been several cases of people being given a "gender disphoria" blanket diagnosis (eg: the case of Chlementine Breen[1]), which later caused issues. And of course some of those people are transitioning back and started doing activism against the trans rights movement.
It's weird that minors are not allowed to do something trivial as drinking a beer or driving a car yet they're allowed to take on irreversible changes (sometimes involving surgery) to their bodies.
This is hurtful to all people involved, and until this point is not understood, the attrition will continue.
[1]: that case is a textbook example of "no margin error admitted" because in order for their voice to be heard they had to resort to talking to the extreme opposite political side.
seethedeaduu11 days ago
The convenience of a hypothetical cis peerson is worth more than the lives of 100 trans people it seems.
The wrong puberty is irreversible mutilation. It's not weird at all given that kids are being given treatment for cancer.
znpy10 days ago
> The convenience of a hypothetical cis peerson is worth more than the lives of 100 trans people it seems.
Complete nonsense. The ratio is generally the inverse: there are 100 cis people and 1 trans person. Those are just the numbers, otherwise trans people wouldn't be a considered a minority.
Actually you're the one arguing that the convenience of one trans person is worth more than the life of 100 cis people.
seethedeaduu8 days ago
I didn't know that the ratio of cis to trans people who were "falsely" "convinced" to take hormones were 100 to 1.
Having the right hormones and not being permenantly mutilated by the wrong ones isn't simply "a convenience".
calico9612 days ago
Those of us transitioning with hormones willingly go through puberty twice.
Damn the social consequences, it's who we are. If transitioning were available as a minor it would greatly reduce suffering.
seethedeaduu11 days ago
This is true, but also, going through the wrong puberty and being forced to live as the wrong gender afterwards is also an inherently traumatic experience, even if it would be possible to fully reverse the mutilation caused by the first puberty.
Fire-Dragon-DoL10 days ago
Is mutilation the right term here? Mutilation is altering the physical appearance. Puberty by default follows what the body was designed to do, it seems confusing calling it mutilation: I couldn't tell if surgery is involved or this is just talking about the natural process of going through puberty
amanaplanacanal12 days ago
It's clear that earlier intervention with gender affirming care leads to better outcomes. There are fewer suicides when people start getting care earlier. This means puberty blockers early, and HRT in late teenage years. Are we just ignoring that?
Manuel_D11 days ago
The Cass review, most notably, pointed out that the research supporting these claims are extremely weak. In particular there have only been two randomized controlled trials studying blockers in minors, and neither of them saw improvements over the control group. To date, the UK, Finland, Sweden, Italy. Norway, and Denmark have stopped prescribing puberty blockers to minors with gender dysphoria.
viamiraia11 days ago
The Cass review has been widely rejected by reputable medical associations. In addition, reviews of the Cass review have found several flaws and instances of bias: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186...
Don't get me wrong, trans issues do need more study, but this is also an example of isolated demand for rigor. Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
In addition, trans healthcare in Sweden has historically been behind the US. Trans people were forcibly sterilized up until 2013, and trans healthcare underfunded. In Finland the sterilization was required until 2023!
Manuel_D11 days ago
The Cass review was not, in fact, rejected by most reputable medical institutions. Unless, if course, your criteria for "reputable medical institution" includes support for puberty blockers and hormones treatment in minors.
The UK, Italy, Denmark, and Sweden all stopped prescribing puberty blockers to gender dysphoric children following the Cass review. Other countries, like Finland, has stopped earlier. It's not possible to continue insisting that this is settled science, when much of the developed world has broken with the US's approach towards gender care in minors.
> Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
Such as? Furthermore, there were RCTs conducted studying the effects of puberty blockers. They didn't decrease gender dysphoria.
Also, put the evidence (or lack thereof) in the context of the certainty and urgency that proponents of gender medicalization were conveying: People were claiming that gender dysphoric children were going to kill themselves if they don't get blockers. Doctors like Joanna Olson-Kennedy repeatedly claimed that parents had the choice of a dead son or alive daughter, a statement parroted by politicians.
This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers [1]. And now she's trying to argue that no benefit is actually a good result because the patients would have fared even worse absent blockers. But of course, without a control group there's no substance to that claim.
1. https://www.nytimes.com/2024/10/23/science/puberty-blockers-...
a_shovel10 days ago
> This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers
> "“They’re in really good shape when they come in, and they’re in really good shape after two years,”"
So a treatment that causes a change to not happen does not cause those who are doing well to do even better? Is this the evidence that's supposed to make me want to ban a widely-accepted medical treatment?
Manuel_D10 days ago
Correct. A treatment that causes no change in well-being, and has negative side effects on bone density, mental development, and more, is not a net positive treatment. This isn't even touching on the effect puberty blockers have on persistence rates. The justification for puberty blockers is that they lead to better outcomes, and the research doesn't show that.
Even stronger evidence for stopping the prescription of blockers are the randomized control trials conducted in Finland and the UK. The patients who received blockers fared no better that those that did not. Without a control group, there's no way to prove or disprove Olson-Kennedy's claim that the patient would have fared worse absent blockers. But the few studies on blockers that did have a control group found no improvement over the control.
And you're wrong that these treatments are widely accepted. In about half of the US they're already banned. In Europe, the UK, Finland, Sweden, Italy, Norway, and Denmark have all stopped prescribing puberty blockers. It is no longer correct to call this treatment widely accepted.
a_shovel10 days ago
"Gender-Affirming Medical Treatments for Pediatric Patients with Gender Dysphoria", College of Pharmacy University of Utah, https://le.utah.gov/AgencyRP/reportingDetail.jsp?rid=636 , states:
> Page 116: "... the consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric GD patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer."
If you could cite these randomized controlled trials, that would be great.
In how many US states were pediatric gender treatments suspended or phased out by medical bodies because doctors examined the evidence and determined that the treatments were not beneficial? That's what I would expect if the treatments really didn't work. From what I know, this isn't the case for any of the bans. The bans are all laws passed by state legislatures, especially conservative ones, and aren't meaningful evidence of anything except conservative lawmakers' political incentives.
Manuel_D9 days ago
You didn't link to a randomized controlled trial. You linked to a meta review. This is just reading and summarizing past research publications, not a RCT.
To date, no American study has been conducted that randomly assigned patients into groups put on blockers or not. That's the best way to study the effects of blockers: Have psychiatrists identify a group of 100 people that they think should be put on blockers. Flip a coin to assign 50 of those patients into a control group that doesn't receive blocker and the other 50 do. And then monitor their lifetime outcomes.
This is how the Finnish 2019 study functioned, and they found no improvement over the control group (and the country stopped providing blockers a year later). American gender medicine researches argue that it's unethical to conduct an RCT and deprive have the patient sample access to life-saving care. But of course, they don't know that this care is beneficial - let alone "life-saving" - until they actually compare the outcomes against a control group.
It's unfortunate that the rollbacks in America had to come from politicians instead of an internal process from the medical establishment. But ultimately, North American gender medicine has thus far refused to conduct effective research into the efficacy of medicalized youth gender care like their European colleagues. Politicians, and the public, have recognized this.
If proponents of medicalized youth gender care want to try and justify that this treatment is necessary, they ought to actually do randomized controlled trials. If we have cohorts of children expressing the same levels of discomfort with their gender, and the randomly-assigned treatment group sees better outcomes than the control group, that is a much stronger piece of evidence than only having a treatment group and baselessly claiming that the control group would have fared worse.
Redoubts12 days ago
There’s no evidence for any of those statements
ghushn312 days ago
Here's a study that shows evidence that puberty blockers reduce lifelong suicidal ideation: https://pmc.ncbi.nlm.nih.gov/articles/PMC7073269/
Here's a study showing evidence that gender dysphoria treatment in children improves well-being and mental health: https://pubmed.ncbi.nlm.nih.gov/25201798/
There's loads more.
ghostpepper12 days ago
If I'm reading that first study correctly, "Ideation" and "Ideation with plan" are lower but "Ideation with plan and attempt" is higher and "Attempt resulting in inpatient care" is almost twice as high.
Neither the discussion nor the conclusion mention this, so maybe I'm misinterpreting something?
viamiraia11 days ago
The results for attempts are underpowered and they acknowledge this (note the p-values too), but not for ideation. From the discussion:
> We did not detect a difference in the odds of lifetime or past-year suicide attempts or attempts resulting in hospitalization. It is possible that we were underpowered to detect these differences given that suicide attempt items were less frequently endorsed than suicidal ideation items (Table 3). Given this study’s retrospective self-report survey design, we were unable to capture information regarding completed suicides, which may have also reduced the number of suicide attempts we were able to account for. Given that suicidal ideation alone is a known predictor of future suicide attempts and deaths from suicide, the current results warrant particular concern.
michtzik11 days ago
The study also doesn't include the successful suicides.
NewJazz12 days ago
Yeah but the whole point so far has been to pass laws under the guise of "protecting children" because that was easy to justify politically. Now that SCOTUS has green-lit denying healthcare on the basis of assigned gender at birth, the gates are wide open.
wahern12 days ago
> Now that SCOTUS has green-lit denying healthcare on the basis of assigned gender at birth, the gates are wide open.
Yes, we're at a juncture. But my point is I don't think bans for adult care are inevitable, nor that strict prohibitions for minors need be permanent. If trans advocates and their supports took a breather and figured out how to reframe things, the backslide (such as it is) could be arrested and even reversed. But that will require, at a minimum, taking back the microphone from the most radical "advocates". And probably to depoliticize it. The issue has become highly politically polarized, but that's a relatively recent thing. I was gobsmacked by the generally tame and sympathetic conservative response to Caitlyn Jenner among conservatives 10 years ago. The turn was avoidable and, arguably, reversible.
titanomachy12 days ago
“Denying healthcare on the basis of assigned gender at birth” seems like a deliberately loaded way to state this. Isn’t it more accurate to say it’s a blanket denial of a certain type of treatment to all minors?
wahern12 days ago
Much of the majority and most of the dissenting opinions in the recent SCOTUS case are exactly about that--is it sex discrimination?: https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf All the opinions are worth a read. The best arguments for both sides are there. Though, I thought all the best arguments on both sides kind of sucked; it's just a very difficult issue. Transgender questions lay to waste 100 years of sex and gender discourse on both the right and left.
titanomachy12 days ago
Thanks for sharing. SCOTUS basically said the same thing I was trying to point out in my comment: it’s not discriminating based on sex, but rather on age and “medical purpose”.
I agree with your assessment, and I am suspicious of anyone (on either side) who claims that there is an obvious “correct” answer to this issue.
KittenInABox12 days ago
I think where it's ambiguous, it should be left to the parents to decide. Parents can already decline life-saving treatment on their child in the US due to their moral beliefs. Why not let parents also decide if they want to let a 16 yo have hormone treatments. It surely can't be more serious than declining blood transfusion.
stickfigure11 days ago
This is, of course, the voice of sanity. Unfortunately it's not encoded into our legal system in these terms. On the other hand, if your religion explicitly requires that everyone "art theretofore honest with thy sentiment of masculinity or womanhood" (dress it up in colorful language, ideally quoted from old books with ambiguous authorship) you might have something you can sell to the Supreme Court.
DoctorOW12 days ago
Personally I think it's less accurate to rephrase medical treatment as "a certain treatment". It's also false to say all minors, since cisgender minors are still approved to receive puberty blockers (and are regularly prescribed them for various reasons).
It's the same medicine from the same medical professionals and the only difference is your gender identity.
titanomachy12 days ago
According to the Supreme Court, the difference is the “medical purpose” of the treatments. Presumably trans-identifying individuals can get the treatments if they meet the same criteria as cis-identifying ones (e.g. premature puberty). If they treated the sexes differently (e.g. those born male can get hormones for gender dysphoria, and those born female can’t) then it would be clear-cut discrimination.
DoctorOW12 days ago
First off, I fully understand that discriminating on gender identity isn't the same thing as discrimination based on sex however they are both discrimination.
Even if you were to convince me of this legal fiction that gender identity has nothing to do with idemitiy and is in fact just a medical condition the Supreme Court doesn't care to treat, I still would call it a life threatening attack.
If the Supreme Court denied chemotherapy for cancer patients, it'd be perfectly justified to call it life threatening denial of care. The fact that it's available for cancer patients with other diseases that are treatable via chemotherapy is irrelevant.
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const_cast12 days ago
The elephant in the room here is why is the Supreme Court even concerned with how prescription drugs are used? I'm sure are justices are very smart - but they're not doctors. And they're certainly not my doctor or your doctor or every single child's doctor.
It should be up to a doctor to decide if a prescription makes sense for a particular patients symptoms and diagnosis. The Supreme Court should not concern itself otherwise.
At least with Roe v Wade there's an argument to be made about it involving a second hypothetical person. But this? This is strictly between patients, their medical care, and their parents.
titanomachy12 days ago
The Supreme Court is only involved because a state passed a law banning these treatments, and someone brought a case against the state saying the law is unconstitutional. Deciding which laws are unconstitutional is like the main purpose of the Supreme Court.
But I guess what you’re saying is why is the state passing these laws, which is a fair enough question. The Supreme Court says they are allowed to, and they are the authority on which laws are allowed, so I expect the states will keep doing this sort of thing until the voters tell them not to.
Plato did try to warn us that democracy was a terrible idea.
Manuel_D11 days ago
There's a very big difference between giving a child undergoing precocious puberty blockers until they're 11, and giving a child blockers with the goal of preventing them from every undergoing a same-sex puberty. The latter has a whole host of risks, including infertility and inability to orgasm. To say that the only difference is gender identity is not even remotely honest.
nyanpasu6412 days ago
I'm pretty sure they're still allowing puberty blockers for premature puberty, inducing puberty in cis teens, and surgically and medically forcing intersex people into a binary sex without consent.
KittenInABox12 days ago
No, because puberty blockers can be assigned to children (in fact, children are the only applicable group here). They just can't be assigned to children specifically because they are transgender. Similarly, mastectomies are available treatment for teens... they just can't be used as a treatment for teens assigned female at birth.
titanomachy12 days ago
Allowing mastectomies for male-born but not female-born individuals seems like pretty clear-cut gender discrimination. (Not as murky as the hormone issue, at least.) Has that one hit the Supreme Court yet?
NewJazz12 days ago
Yes, very recently.
https://www.npr.org/2025/06/18/nx-s1-5421276/scotus-transgen...
TJSomething12 days ago
Florida and Missouri have been working on it, to some success. Florida's laws have decreased access by requiring in-person appointments with doctors instead of telehealth or nurse practitioners, which has eliminated access for 80% of transgender adults [1]. Missouri has banned Medicaid funding for transgender care for adults. [2]
At the national level, The One Big Beautiful Bill Act as passed by the House cuts all federal funding for transgender care for adults via Medicaid [3], though that's still pending what the Senate does.
[1] https://apnews.com/article/florida-transgender-health-care-a...
[2] https://www.pbs.org/newshour/health/missouri-governor-signs-...
[3] https://www.politifact.com/article/2025/jun/02/medicaid-bill...
Grimblewald12 days ago
the "there's a hole in the glass" take is that this is just where they start, it's easier to argue it shouldn't be possible for children to get adequate care (for some reason) than for adults.
nyanpasu6412 days ago
I think that trans people, being the ones with firsthand experience of dysphoria and misgendering, and being a disadvantaged minority (https://www.mckinsey.com/featured-insights/sustainable-inclu...) threatened by right-wing rhetoric, should be the ones to speak for what is right for them ("nothing about us without us"), individually and as a group.
dragonwriter12 days ago
> The glass-is-half-full take is that no states have prohibited gender affirming care for adults.
Given that a number have prohibited it from being paid for by the state Medicaid program for adults when it previously was, that is, maybe, a glass quarter full take. (There is also the issue that wrong-gender puberty is a particularly significant suicide risk factor for trans youth, so restricting gender affirming care for youth is a particularly strong assault on trans lives.)
And even then, its not strictly true, as while most states with restrictions that have passed have only restricted care to minors, Nebraska did so for persons under the age of 19, which includes some adults.
> Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.
They have not only sought to do so, they have actually done so (as mentioned above). They have not yet implemented broad prohibitions (except Nebraska's for adults under 19), but "limit" and "broad prohibition" are not the same thing, and mere limitations can have the same practical effect as broad prohibitions, as many states demonstrated by making it nearly a practical impossibility to provide (and therefore access) abortion services, even before the Supreme Court overturned Roe; conservative states are following the same playbook with gender-affirming care.
> Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.
No, legally-imposed waiting periods for adult (or even youth) gender affirming care were not present (and still are not present) in the most liberal states. That's a very strange thing to invent to minimize the restrictions being imposed by conservative states.
If you are equating the fact that it can take time, for some services beyond HRT, to save up money and/or jump through whatever hoops are established by your insurance, and find and schedule time with the required provider(s) with legislatively imposed waiting periods and other access restrictions, that's incredibly dishonest (for one thing, the legislative restrictions don't overlap the other ones, they add on top, and, by making it more difficult for providers to operate and thereby reducing the number of providers, make the other issues worse as well.)
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aucisson_masque12 days ago
From the point of view of a conservative and non us citizen, you have a good life there compared to the rest of the world.
Technically, most countries don’t allow people to be openly gay. In some countries, being gay even privately means you get beaten to death or your head chopped off.
Needless to say that transgender people are not even taken into consideration.
If I was gay or transgender, god knows I would rather be in the USA or maybe north Europe than any other country and especially not Africa, Arabia, South America.
xiande0412 days ago
Ah, the old "it could be worse" fallacy.
So to recap, you're saying, "don't worry about what's going on in the US right now, because you still have it better than most of the world"
Just because something could be worse does not mean that 1. It's nothing to be concerned about 2. That we shouldn't take steps to improve the situation.
Things can always be worse, so this "logic" is always applicable. It's a vacuous argument. Even if you lived in the country with the worst homo/transphobia in the world, you could tell the person, "well, at least your alive."
Moreover, there's nothing constructive about this line of thinking. If people actually lived by this logic, we would live in a static world, because "it could be worse."
nyanpasu6412 days ago
On top of that, legislatures, courts, and right-wing agitators are pushing to repeatedly worsen living conditions for trans people.
int_19h11 days ago
It should be noted that the two don't necessarily go hand in hand the way you'd expect. E.g. in Iran, homosexuality is a crime that can be punishable by death depending on circumstances, but sex reassignment surgery is legal (and, indeed, can be de facto mandated in cases of anything perceived as gender dysphoria).
aucisson_masque9 days ago
Indeed, I’m surprised to see it’s possible in Iran.
> The Legal Medicine Organization performs a number of tests, including at least six months of individual and group therapy sessions, interviews with family members, physical examinations, hormone tests, and chromosomal tests, in a process known as "filtering". Filtering is the separation of homosexuals, who are deemed "deviant", from transsexuals, who are deemed "curable" by undergoing surgery
Also, after further research, Iran is the only Muslim country in the Persian Gulf region that gives trans citizens the right to have their gender identity recognized by the law.
I don’t understand how such a country can be so open on trans right, but it’s really an exception in the world.
dsadfjasdf11 days ago
there's no science on souls. which is what you are basically talking about
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karcass12 days ago
I lost interest in psychedelics after transitioning.
somsak212 days ago
trading one drug for another?
d6e11 days ago
Everyone has estrogen, half the population is estrogen dominant. It's a normal human hormone, not a recreational drug.
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Zardoz8412 days ago
I have a friend that sometimes described having good trips when she got a strong dose of hormones.
I wonder how I would feel when I begin with hrt.
deadbabe12 days ago
Is gender dysphoria thus caused by the body craving testosterone or estrogen hormones, when it doesn’t have?
kelseyfrog12 days ago
That's one way to think of it, but the root of it (imho) is a mismatch between ones internal sense of inalienable gender identity and the embodiment of that identity physically - think clothing, bodily form, social perception, etc.
It might be difficult to imagine how those two things are separable if one has lived their whole life with them in congruence. If perhaps, you close your eyes and concentrate on your being, there is a part of you that feels that your sense of manness of womanness is part of who you are? What would you do if you retained that sense, and woke up in the body of the opposite sex and were expected to behave in congruence with that contrary to your internal sense of self? It can be a bit like that.
deadbabe12 days ago
I think that is the best way to think about it. Because if not, then gender dysphoria sounds mostly like it’s just about fashion.
I wouldn’t want to wake up and be a man, but not for any reasons that are biological. I work in a male dominated field, and most of my interactions are with men, I like the things I can do and get away with, where a man would not have the same experience. The male experience sounds lonely, tough, and a lot of your success seems to just depend on chance and grit. My life has some bad parts, but it’s softer and more comfortable. Would I have dysphoria as a man? I don’t know, to me it sounds like it’d be something closer to envy, but maybe that’s just dysphoria by another name. Maybe that’s the root cause of why so many men lash out at women.
DoctorOW12 days ago
I haven't studied gender dysphoria but I've been diagnosed with it. In my experience, it's an incongruence between your idea of yourself and your perceptible form. In some ways it could be argued your body is "craving" it but not in the same way it may crave a specific nutrient. Instead, you're sort of surprised and often upset by the way that you are.
tasuki12 days ago
Would you say it is similar to how some people with no legs want to have legs? Or fat people who want to be skinny?
DoctorOW11 days ago
I guess it's kind of similar to how people without legs feel. I've heard that people without legs sometimes have "phantom legs". While they're consciously aware they're missing legs, their brain is still wired to have them. Similarly, my brain is wired for a female body.
Every trans person's experience is different, I know that the "wrong body" terminology doesn't apply to everyone.
deadbabe11 days ago
What about more like a poor person wishing they were rich?
deadbabe12 days ago
How do you cope?
DoctorOW12 days ago
Honestly I truly believe that I will reach a point where my body feels like mine. The changes with HRT do a whole hell of a lot to minimize dysphoria in my experience. I also live with, work with, and am friends with people who genuinely see me as the way I see myself, as a woman. You can tell from the way people interact with you, how they see you. Being perceived as a woman fits with my perception of myself.
tasuki12 days ago
> Honestly I truly believe that I will reach a point where my body feels like mine.
There are two ways to achieve that: changing the body, and changing the mind.
(I'm not claiming one to be easier than the other, but I've noticed most people have a strong preference for changing their body rather than changing their mind)
DoctorOW11 days ago
I believe you have to do both. On the rest of my comment I tried to convey that in addition to changing my body, my female mindset is a key part of expressing my gender identity.
a_shovel12 days ago
This is something I've been thinking too (though it seems clear to me it's only one factor out of many). I've heard at least two anecdotes from trans women I follow on social media that led me to this theory. One was prescribed estrogen doses too infrequently, and the other had lost access to medication, and they both started feeling like total crap when they went off estrogen, without any associated perceptible changes to their bodies.
4gotunameagain12 days ago
[flagged]
AzzyHN12 days ago
I'm pretty sure you're being transphobic, but for the life of me I can't understand what this statement is supposed to mean.
PartiallyTyped12 days ago
They are, they are also being intentionally obtuse and claim it to be a "novel" affliction.
Plenty of evidence showing that Nazis murdered trans people and destroyed the first sexology clinic that provided health care to said people [1]; as well as evidence from history [2] and mythology [3] in support of trans people existing throughout history.
To claim otherwise is to lie or regurgitate disinformation. Either way, not HN-worthy content.
[1] https://www.scientificamerican.com/article/the-forgotten-his...
4gotunameagain12 days ago
[flagged]
DoctorOW12 days ago
Your writing is so incredibly smug as to be incoherent. Both comments are so thickly coated in irony, that an actual point can not be derived.
mzajc12 days ago
There is no point, both comments were made purely to discredit trans people.
ghushn312 days ago
This person is uneducated and angry, and is choosing to be deliberately obtuse in hopes of irritating people they disagree with. Probably not worth the time to even respond to them.
antithesizer12 days ago
Amen
MondayGravity12 days ago
Perhaps this is an insensitive question/comment, but do trans women feel like they have the wrong body or the wrong wholesale gender? In my experience with trans women I know, they still seem to relate primarily to men (they still gravitate towards male dominated interests) whereas many gay men I know seem to relate primarily with women, and gravitate towards women interests.
So this reconciliation is hard, and the topic too sensitive for me to dare asking people I know in real life.
heterodoxlib12 days ago
A slightly different but closely related question for those who are answering: what do you attribute the difference to? Is it biological in basis, spiritual/metaphysical, or cultural?
I keep hearing people say "gender is a social construct" and those same people then go on to emphatically support transgender as a concept. This leads me to wonder: if gender is a social construct, is identifying as transgender the result of feeling pressure to conform to a cookie-cutter definition of what someone with male/female parts is meant to be like? If so, is being transgender also just a social construct that can and maybe should be addressed by loosening up our tight expectations for gender roles? Or is being transgender more biological than cultural for you?
viamiraia12 days ago
I want to quickly address your last two coupled questions. Just loosening tight expectations for gender roles is not enough. For many of us there is a physical component. When puberty hit I started plucking out any facial hair, grew out my hair, lamented my deepening voice, and became extremely depressed. At that time I had no idea what the word transgender even meant.
Also, not saying you are asking this, but why do trans people have to be the ones always asked to break gender roles? Trans women are so often pressured to be feminine men instead, but our mental health depends on both seeing ourselves as women and being seen as women (depending on the individual). Passing, which is a difficult but reliable path to relieve dysphoria, requires some degree of conforming. And knowing lots of trans women, there are plenty that don't conform. I feel like trans people are held to an unfair standard here.
ghushn312 days ago
You are asking a good question (it reads to me like a good faith question that comes from a desire to learn more about how others think).
> Is it biological in basis, spiritual/metaphysical, or cultural?
Personally, I view it as cultural leading to physiological -- what does it mean to be a man? What is "manly"? I think everyone can agree that "manliness" is different globally. Is Bill Gates manly? He's very successful, but is that something that's manly? Is Tom Cruise manly? Or Kid Rock? What about George Takei? Manliness has some multi-axis definition that exists in each culture around the world.
We call that set of vectors "being a man", and we push people who are born with penises into it because it seems to fit most people who are born with XY chromosomes. Personally, I think it's useful to decouple the two ideas -- what my body is, and what the cultural expectations are in how I should behave because I have that body. This is what people mean when they say gender is a social construct -- they are saying, "The piece we call 'manliness' is a separate concept from the piece we define by bodies."
Now, say I experience anxiety, fear, and revulsion about the set of vectors that define "manliness". I have a penis, but absolutely all the vectors for "womanliness" line up with my understanding of how the world works. Clothing, presentation, speech patterns, interests, activities, etc. etc. etc. What do I do in such a case?
I could just live my life in pursuit of the 'wrong' set of vectors -- but socially that's quite dangerous. When people who are "supposed" to maximize one set of vectors try to live with another set, they tend to get bullied (if not violently attacked.) This puts me in a bind -- either live a miserable life pretending to be manly OR push my body to try and match the set of vectors associated with womanliness. (Or, change society to stop caring so much about people who fall outside of the traditional vector space, but that's a lot harder than either of the two other approaches.)
> is being transgender also just a social construct that can and maybe should be addressed by loosening up our tight expectations for gender roles?
For me, absolutely! That's the exactly the sort of ideal world I'd love to be in -- let people just... pursue what makes them feel happy. If someone with a penis wants to get way into makeup and the color pink, stop beating the shit out of them for it.
titanomachy12 days ago
It sounds like for you personally, the “body dysphoria” is less of an issue than the “social expectations of a man” dysphoria? I wonder how common that is. Maybe a lot of people’s gender dysphoria would be lessened if society can decouple behavioral expectations from physical appearance.
viamiraia12 days ago
Decoupling behavioral expectations from physical appearance would be great! But that would be a titanic task, and shouldn't fall solely onto trans people, whose mental health often depends on seeing oneself as and being seen as the gender they identify as.
In addition, there is an undercurrent here that suggests "changing your body is bad," or perhaps some appeal to nature. If you hold these ideas, I would like to ask why, and perhaps reexamine why you believe so.
titanomachy12 days ago
I don’t think that’s a belief I hold: I support people changing if that’s what they want. But not all the people who experience gender dysphoria choose to change, and it would be nice to make life easier for them as well!
ghushn312 days ago
I'm non-binary. Some days the body dysphoria hits hard. Some days it's not a big deal at all. I am mostly unhappy I can't just float between them day by day. The body dysphoria I feel is mostly a dissatisfaction with how permanent bodies are. (There's a reason so many trans folks are also transhumanists. Gimme that cyber body please.)
titanomachy12 days ago
That’s funny, most of my existential crises revolve around how impermanent my body is.
tasuki11 days ago
It seems to me this is much more general than just the gender?
radicalriddler12 days ago
I think about it like this...
Fundamentally, I believe it's how they want to be treated culturally, but in our society, we tie gender and sex so closely together, that to be treated the way you want to be treated culturally in society, you need to change some of the sex based features you have.
In a better society, a medical approach wouldn't be needed. In our society, we _should_ accept that it is.
That's my opinion, and it's a pretty weakly held opinion, someone could dissuade me from it.
heterodoxlib12 days ago
This is basically the conclusion I've come to, which is why I wanted to ask.
If this is accurate (which is a big if, and I'm asking the question to try to figure out if it is) then we could make a lot of progress in trans acceptance very quickly by just reframing the whole thing in these terms.
The woman-in-a-man's-body concept sounds mystical and metaphysical in a way that triggers religious objections from substantial portions of the US population, even those in the middle politically. But arguing that males shouldn't need to live up to an artificial and incredibly outdated standard of masculinity? That would be a much, much easier sell.
So I guess the followup to my question is: if for most trans people it is cultural and not biological, why are we doubling down on gender binaries and talking about switching genders instead of creating a campaign that would both get at the root of the issue and be easier to swallow for a larger portion of the country?
(I say this fully aware that biological intersex is a thing, but from what I understand most trans people are not biologically intersex in any measurable way. Correct me if I'm wrong.)
antonfire12 days ago
> We could make a lot of progress in trans acceptance very quickly by just reframing the whole thing in these terms. [...] But arguing that males shouldn't need to live up to an artificial and incredibly outdated standard of masculinity? That would be a much, much easier sell.
It's an "easier sell" of a different thing.
I'm not seeing a "we" forming here as far as "trans acceptance" is concerned.
Judging from your comment history, your perspective on this seems to basically be grounded in an objection to (more generously: apprehension about) transgender healthcare practices. On purportedly scientific grounds, while ascribing a "politically-driven" motivation in terms of groupthink to people who support these practices. So I think your motivation to ascribe this to a "cultural thing" is grounded in a desire to decouple it from the healthcare thing, because you think it serves an overall political project better.
I'm with you on loosening gender roles. I'm not with you on reducing trans acceptance to that.
> why are we doubling down on gender binaries and talking about switching genders instead of creating a campaign that would both get at the root of the issue and be easier to swallow for a larger portion of the country?
In my personal life, I am probably about as far from "doubling down on gender binaries" as anyone you are likely to encounter. In my experience, I find many more people who are genuinely working past "doubling down on gender binaries" in transgender spaces than I do outside them.
My not-doubling-down-on-gender-binaries approach to it is not an easy pill to swallow for a large portion of the country. It may not even be an easy pill to swallow for you. (E.g. "which" bathroom do you want me in? How easily do you think the rest of the country will swallow that?)
heterodoxlib12 days ago
I'm here trying to understand your and others' perspectives. I appreciate that this is a sensitive topic for you and many others, which is why I'm trying very hard to be careful in my framing. I'm sorry if I failed in that.
With regard to my comment history: yes. Similar to OP at the root of the thread, I created this account specifically to ask questions that I have about our collective approach to helping trans people in need. At the time I wrote that other comment 9 months ago I had concerns about feeling shut out of the progressive movement entirely because I have doubts about some of its principles. Today I'm here to try to understand better why those principles are so ironclad.
I want to help make a difference in people's lives, but I live in a deep red state and know intimately what kinds of rhetoric would work to accomplish which ends. I want to know what I can share with the fiercely conservative people around me that would best help people like you, and for that I need to understand your goals and needs.
I'm here trying to collect information to better understand people's perspectives on this topic, and so I really do appreciate your feedback. It sounds like for you reducing the rigidity of the binary and freeing up people to be male or female in whatever way works best for them would not be sufficient, and that's good to know. Thank you.
viamiraia12 days ago
I addressed this in another comment, but for most trans people there is some component of both physical and social dysphoria. I have physical dysphoria to the extent that I had signs when I didn't even know what the word transgender meant. Untested of course but growing up feral on a desert island I believe I would still have physical dysphoria.
My opinion is that the root of the issue is a combination of misinformation, outrage porn, cognitive and attentional biases, scapegoating, and isolated demands of rigor.
gitremote12 days ago
> I keep hearing people say "gender is a social construct" and those same people then go on to emphatically support transgender as a concept.
I say that "race is a social construct" but not "gender is a social construct", because gender has both social and biological components.
Gender having a biological component does mean that gender stereotypes that the average person learns are based on biology. The concept that pink is for girls and blue is for boys is social and cultural, not biological. Gender having a biological component is more complicated. A good book that explains this is Whipping Girl by biologist and trans woman Julia Serano:
https://en.m.wikipedia.org/wiki/Whipping_Girl
The first tenet of this model, the model's core that everything that follows is built upon, is the fact that "subconscious sex, gender expression, and sexual orientation represent separate gender inclinations that are determined largely independent of one another."
Just like cisgender women, not all trans women are "girly".
The fourth and final tenet of this model states that "each of these inclinations roughly correlates with physical sex, resulting in a bimodal distribution pattern (i.e., two overlapping bell curves) similar to that seen for other gender differences, such as height." This idea is what allows for the natural exceptions to gender expression to exist within the system without attempting to claim that they exist in as high of numbers as typical gender expression.
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seec10 days ago
Yes, I think there is a lot of social pressure that is driving all of this. I doubt it's only about body dysphoria, because after all you may alter it a bit but still you cannot deviate that much from what you were given in the first place. Extensives surgery procedure seems to be really hit or miss and it is largely impossible to fully rework the features that you were given at birth (especially facial or the pelvis). Some are luckier than others in these matters because they are "in the middle" but still, physically passing for one sex doesn't really alleviate the need to conform to that gender expectation.
I think it's a losing battle because you cannot make people change their minds about who/what others are. The real solution is true acceptance of differences but that seems very hard to create culturally, people are still tribal no matter what.
I am somewhat pissed off by all this gender culture ward around LGBTQ, trans and feminism because people constantly assume I am gay from my physical appearance and demeanor when I am definitely not.
I am dumbfounded around the trans issue because they make it look like they are the only one being socially pressured into conforming to one cookie cutter identity or another. I believe that most people feel that pressure, just to differing levels and only the outlier at the extreme are considered a "true" man or woman.
The political discourse obliviate the fact that we cannot all be that close to what is deemed the "ideal" in the current culture and everyone is worse off for it.
antonfire12 days ago
Kind of a tangent, but I think the cultural/social side is bigger and messier than your questions suggest, and I think boiling this down to "biological vs cultural" misses that.
> If gender is a social construct, is identifying as transgender the result of feeling pressure to conform to a cookie-cutter definition of what someone with male/female parts is meant to be like?
I suspect "identifying as" cisgender is the outcome of this kind of cookie-cutter pressure to much the same degree, if not more. This tends to go unnoticed even in conversations where people are directly engaging with the ideas. (Even though that's part of what "gender is a social construct" is meant to suggest.)
A rhetorical question for cis people: to what degree do you feel your cisgenderness is a result of feeling pressure to conform to a cookie-cutter definition of what someone with male/female parts is meant to be like? I suspect there's more meat to genuinely unpacking this than you might think. Trans people's answers to this might not be that different from cis people's.
"It's a social construct" is an invitation to peek behind (or at least recognize) an abstraction; but it's just a peek into a quite complex story.
"Social construct" doesn't necessarily mean something to rise above, or to dismantle, or to deny. Money is a social construct. Human rights are a social construct. Friendship is a social construct. Sure, one can usefully imagine oneself "above" those things at times, but it's unclear whether aspiring to that is a good idea, and realistically most people won't attain it even if they do. Culturally we must find some relationship to those things anyway, we cannot ignore them.
As I see it, gender is an aspect of a messy evolving cultural system. Yes, the concept of "transgender" is part of that system, though it certainly doesn't fit into that system in quite the same way as "man" and "woman". Trans people tend to challenge or pressure many aspects of this system in some ways that cis people tend not to, but that's not the same thing as denying the system in whole. (Some people do see "gender abolition" as an aspirational ideal; many don't.)
Broadly, I think "is being transgender also just a social construct that can and maybe should be addressed by loosening up our tight expectations for gender roles" vastly underestimates the scope and scale of this cultural system, the degree to which it's tangled up in our lives, and the difficulty of untangling it.
heterodoxlib12 days ago
> Broadly, I think "being transgender also just a social construct that can and maybe should be addressed by loosening up our tight expectations for gender roles" vastly underestimates the scope and scale of this cultural system, the degree to which it's tangled up in our lives, and the difficulty of untangling it.
This makes sense, but I guess my question is rooted in my sense that the front that we've chosen to engage to push for re-evaluating gender is the absolute most controversial front we could have chosen. A subtler approach at re-evaluating rigid gender stereotypes—taken decades ago when we instead began to push for reassignment surgery and pronouns—could have already paid off in spades by now.
As is, the rhetoric surrounding transgender issues essentially demands that we accept that there are boxes—male and female—which people ought to be sorting themselves into, and it terrifies social conservatives because it actively encourages people to sort themselves into the boxes rather than accepting the lot they were handed. A subtler approach that started with "why shouldn't boys wear pink?" and progressed from there would have already finished the job by now, instead of creating the polarized warzone we have today. As a bonus we'd have been making life more comfortable for everyone in the middle, people who don't feel the brokenness of rigid gender norms strongly enough to want to switch entirely but still suffer from feeling the need to live up to them.
If most transgender people experience a strong biological component that demands reassignment for biological reasons, I can understand why our chosen approach was necessary. But if sufficiently changing and making flexible our expectations for what it means to be male and female would have been sufficient to make most transgender people comfortable, why did we choose the much harder sell instead?
antonfire12 days ago
You said "this makes sense", but the rest of your comment is essentially still in disagreement.
> A subtler approach that started with "why shouldn't boys wear pink?" and progressed from there would have already finished the job by now.
That's happening. There's been a lot of progress, and it hasn't finished the job. Not even as far as cis people are concerned.
(I guess it would be coherent to believe that the subtler approach hasn't worked because of less-subtle approaches like a push for transgender health care. I think that's naive.)
It's a bit cliche, and you might be tired of hearing it, but for what it's worth this conversation brings to mind the "disappointed with the white moderate" paragraph in MLK's Letter from Birmingham Jail.
> But if sufficiently changing and making flexible our expectations for what it means to be male and female would have been sufficient to make most transgender people comfortable, why did we choose the much harder sell instead?
I think your sense of "sufficiently changing" isn't aligned with the sense of "sufficiently changing" I would need to tentatively grant that, if you think such a change is an easier cultural sell than "some people are born in the wrong body".
RebeccaTheDev12 days ago
I can't speak for other trans women, but is kind of how I describe my experience with this. And this is from someone who is a later-transitioner, talking about this specific type of social dysphoria [0].
It took me enormous effort to relate to other men, and I was never sure if I was doing it correctly. I would go out of my way to try to learn "how to man," including having typically male-coded interests (like sports, or home repair) that I really didn't actually care about but knew I had to because it was socially expected of me. I knew I had to, because I had to operate in that world, but I was never comfortable, none of it ever came naturally and all of it just felt wrong.
I was desperate to relate to women. It would hurt that I wouldn't be able to participate in that world even though I longed to be a part of it. Often my wife and I would have grill out parties, and I would be at my expected place outside with the guys, talking stuff I hated, but I longed to be chatting with the other women inside. I feel comfortable as a woman, and much more comfortable relating to other women in my life.
Do I still have male friends? Of course. I have men I worked with for decades and that I'm still friends with. Our relationships definitely changed a bit, but we still have shared experiences that bind us together. At the same time, with my female friends, our relationships definitely changed as well. Things felt different. Our conversations got deeper and more meaningful, and I feel like I "know" some of them better than I ever knew any of my male friends.
I also kept some of my male interests because I'm interested in them.. I still love aviation and trains. Definitely male-coded interests (though there are quite a few more women than one might expect.) I also picked up, or in some cases learned to stop repressing, typically feminine-coded interests. I have far more fun with dress than I ever cared about doing as a guy. Or, now I proudly own that I read romance novels instead of sheepishly hiding my kindle.
aucisson_masque12 days ago
Can’t you just be a man that loves spending time with women instead of a woman ‘trapped’ in the body of a man ?
I have known several men, non gay, that just behaved more like women than men. that was fine, and as far as I know they didn’t swapped gender.
Like you can be a duck, happy when around dogs but still be a duck.
RebeccaTheDev12 days ago
You can do whatever you like. Many do, and are totally happy about that.
Note, again, I am talking about one specific "type" of gender dysphoria, social dysphoria. There are usually far more facets that come into play as well.
And that's also a way you know you're trans, and not just a man that loves spending time with women. Because the relationships dynamics and social expectations are totally different regardless, we feel out of place. And not being seen in the correct way causes ... pretty deep negative feelings.
foxmoder12 days ago
Will share my personal experience here--honestly, I thought about this a long time personally for my own case, for years before and after my own transition.
To be honest? I ultimately arrived at the fact that I just feel happier when I present femme-ish. Usually still jeans and a t-shirt though--I'm not particularly hyperfeminine, as that's just not who I am.
I've decided that it works better for me, and that's enough for me.
Is it silly to "swap gender"? Absolutely. All notion of gender is silly, in my experience. We're told to perform certain appearances and actions and ideas, to socialize and be around people in a certain way. People treat you wildly differently (trust me, sigh) when they look at you and bin you as a woman versus a man--you wouldn't believe how stark of a difference it was even with old friends the minute they started physically perceiving me as a woman.
All of us are just trying to get through a wildly gendered world in a way that makes us happy--the least we can do is allow people their choice of the role they play in this grand performance, as all of us everywhere are acting.
'Transition' for me was just finally deciding that I got to pick how I socialize, how I act around people, how I dress, and so on. Someone could call me a man, perhaps--I wouldn't particularly be fond of it, and it would probably come across as unusual to others given my appearance, but surely it's a thing that could be said to me.
srinivgp12 days ago
Some people certainly can simply enjoy spending time with people not of their assumed cluster of traits. But that's not what's going on with trans women. They aren't doing some sort of "going overboard when you'd be perfectly happy with less" or whatever you're asking. Is it really so hard to believe trans women? Brains do _all sorts_ of things that seem weird if your own brain doesn't do it. Aphantasia, synesthesia, plurality, autism all come to mind immediately.
aucisson_masque11 days ago
Yes it’s so hard to understand how it’s even possible.
10 years ago I was one of those who believed it to be a mental illness but with age i start to realize that being judgmental without understanding is often a recipe for disaster. Or maybe that’s my testosterone level dropping that make me soft… who knows.
viamiraia12 days ago
I am a trans woman. For me it's closer to wrong body, as I do get a lot of physical dysphoria, but I'm always careful when talking about gender. I like to split it into three components - gender identity, gender expression, and gender roles.
Currently, my gender identity and feminine expression feel (very) correct, but when I was repressing and thought I was a man, both my gender identity and masculine expression felt wrong.
Gendered interests are gender roles. On this topic there seems to be a double bind applied to trans people. Conforming to roles is viewed as bad (see other comments in this thread), but not conforming to them (such as keeping "male" interests) is viewed as evidence our identities are invalid. A lot of trans people do retain the interests they grew up with, but to me, at least, that's just inertia. We are encouraged or often coerced into interests stereotypically related to our birth sex. I felt heavily restricted and unable to explore feminine interests growing up, due to a combination of society, culture, family, and other relationships.
Feel free to ask more, I'm pretty comfortable talking about these things as long as I have the energy.
d6e11 days ago
I'm a transwoman who had dysphoria the moment puberty started. Before puberty I as fine with my body, but once it started it became complete body horror. The word dysphoria is used a lot, but I think body horror is a more relatable concept. Have you ever seen the movie The Fly? It's like that. It's not that I felt I had the wrong body, it's that my body was literally changing into something I did not want and did not fit me. When my voice changed it wrecked me. I begged the adults around me for hormones or blockers something to make it stop and they all refused. If I was born a girl, people would think it was fucked up if the adults forced me to take testosterone and develop male characteristics. But because I was born a boy, that means I'm forced to take testosterone even if I know 100% I'm not? I know they were trying their best and wanted to make sure I didn't make the wrong choice, but by doing that, they deprived me of being able to make the correct choice. I started estrogen at 18, the moment I had autonomy, and haven't once had a doubt and that was back in the late 2000s.
As for male interests, I like computers and programming. I think of it as less of a "male interest" as a "nerd interest" since most of the males I grew up with were into sports, something I'm very much not.
As for relating to men, I'm attracted to men. I like programming which is male dominated. But I wouldn't say I fully relate to them. I don't really understand a lot of things about men and I think outside of some interest overlap, I don't relate that much.
Fraterkes12 days ago
I haven’t really found that to be true in my friend groups, but also it is really common for people on the spectrum to be trans, and a lot of autistic people in general tend to have interests that we view as male-coded.
aaaja12 days ago
> In my experience with trans women I know, they still seem to relate primarily to men (they still gravitate towards male dominated interests) whereas many gay men I know seem to relate primarily with women, and gravitate towards women interests.
Interestingly, this has also been observed and researched by clinical psychologists who study sexuality and gender dysphoria.
A decent summary of the research can be read here: https://4thwavenow.com/2017/12/07/gender-dysphoria-is-not-on...
Note the difference in presentation the authors describe between "childhood-onset gender dysphoria" and "autogynephilic gender dysphoria". The males you refer to as relating primarily to men and gravitating towards male-dominated interests are more likely to be in the latter category.
antonfire12 days ago
> Perhaps this is an insensitive question/comment, but do trans women feel like they have the wrong body or the wrong wholesale gender?
It varies.
> In my experience with trans women I know, they still seem to relate primarily to men (they still gravitate towards male dominated interests) whereas many gay men I know seem to relate primarily with women, and gravitate towards women interests.
For whatever it's worth, I think observations like this are as useful a cue to look inward for an explanation as they are to look outwards.
For one thing, part of the whole "gender" thing is the way people's preconceptions lead them to parse information about others (and themselves!), and your sense of trends is probably influenced by that. (E.g. when a (gay) man gravitates towards "women interests" that may just be more salient than when a woman does, so you notice it more.) For another, you might be in a lot of male-dominated spaces (e.g. this one), so the set of trans women you know is probably not that representative. These might not be the whole story, but they certainly have a role to play in whatever reconciliation you're seeking. Gender is difficult to navigate: we're all swimming in it.
For me personally: I'm "nonbinary", whatever that means. As I see it today, for me being trans feels like more of a "wrong wholesale gender" thing than a "wrong body" thing. (But I'm open to the idea that I'm just not in touch with my body.) Part of the "wholesale gender" thing is the realization at some point in my life that "gender" was playing a much bigger role in my life than I had realized, including how I relate to people, what interests I gravitate towards, and so on. Something I find deeply aversive.
But I'm also averse to, like, rearranging my whole life to retroactively "fix the gender story" around it, just to make myself more legible. You might parse me as gravitating towards interests that line up with my assigned gender at birth (AGAB), and maybe even as relating to people primarily of my AGAB, and so on. I'm sure some people go further and functionally take this as an excuse to continue to relate to me through the lens of my "birth gender" or what have have you. I'm sure it's easier. From my perspective, I suspect those people are underestimating how much of a clusterfuck the whole "gender" thing is.
mos_basik11 days ago
>For another, you might be in a lot of male-dominated spaces (e.g. this one), so the set of trans women you know is probably not that representative.
Damn.
I'm ashamed I didn't think of that framing myself.
Yep, I'm cis het male. Yep, I studied stem and I program and video game and dabble in motorsport and have experience with in-person and online spaces for all of the above. And yep, most of the trans women I know or have interacted with have been in these contexts. And I've seen a lot of "why are there so many trans women in programming?" "why are there so many trans women in video game dev?" etc.
But yeah, of course I (and the people asking the above questions) don't know how many trans women are in women-dominated spaces, cause we're not in those spaces.
Heck, I don't even know enough about those spaces to posit a plausible example of the mirror phenomenon. Grad school? Fiction writing? uhhhh needlecrafts? Are there forums somewhere where cis women are posting "how come there are so many trans men running needlecraft content creation channels?"?
Anyway, thanks for the food for thought.
mos_basik11 days ago
1h later, self-comment bc too late to edit.
Realized I mentioned mirroring on one axis, but not on the other (perhaps more relevant) one - i.e., I also don't know how many trans women there are in women-dominated spaces, and therefore can't really have an informed opinion about whether trans women (or trans people in general) are more likely to prefer spaces dominated by the gender they left or the one they went to.
Obviously, still thinking about this.
kunai8 days ago
Interests are not inherently gender-specific. I know many women who gravitate towards wargames, sports, and the like, typically male-dominated hobbies. We need to stop pursuing this notion that an activity is inherently male or inherently female.
Most trans women I know are the exact opposite, they gravitate towards extremely feminine interests, like makeup, fashion, design, etc. Inherent attraction towards a particular interest only dictates your personality type, I don't think it's meaningful insofar as it relates to gender dysphoria -- I think that stems from a much deeper, much more subconscious phenomenon which is adjacent to body dysmorphia. But I digress.
I proffer a question to those skeptical about gender transition: with the rise of GLP-1 blockers, many have found holes in the body positivity movement, in that a lot of formerly obese people who found solace in Ozempic and lost a lot of weight -- this accounts for a body transformation. Many report their symptoms of body dysmorphia disappeared entirely. Is this not the same for HRT and trans people? The other issue is that many are quick to compare the plight of a trans person to that of an anorexic -- but it's already established that anorexia nervosa is a special class of eating disorder that is multifactorial in origin and etiology.
If you're content with GLP-1 blockers and Ozempic being used to combat obesity, then you should have no issue with HRT. It's essentially the same thing, being used to treat a very similar condition. A lot of obese people don't necessarily want to be skinny, they just want to feel comfy in their own skin, and that's a trait they share with trans people.
FatalLogic12 days ago
I guess (I really do mean 'guess') that they experience a disorienting sense of disassociation which is comparable, though much more shocking, to the situation of other people who realize, late in life, that their difficulties in relating and connecting to other people are not imaginary.
Most commonly, this is comparable to people who realize that they have been having problems, for years, because they are "on the spectrum" or have Asperger's or autism-adjacent conditions or, perhaps, some ADHD/ADD challenges. I'm sure that there are many people in the HN community who have been surprised to discover this about themselves.
For example, this man, who has been successful in very many ways: https://www.bbc.com/news/world-us-canada-57045770
For people who discover challenges related to gender identity and dysphoria though, the great difference is that they're not only realizing that they have the "wrong" mind, but they even have the "wrong" physical body, too! [In that sentence, my opinion is that the definition of "wrong" is based more on the traditional viewpoints of conventional culture, and not so much on reality].
davmar12 days ago
don't forget that socialization plays a role. boys are guided to certain activities in their youth, girls to others.
panic12 days ago
One possible resolution is that these interests are male-dominated not because of an inherent gender-based preference, but because women (or, more precisely, people who are perceived to be women) are excluded from them. Trans women who are still perceived as men are able to avoid some of these exclusionary processes, and they maintain their interest even after they start to be seen as women.
brooke2k12 days ago
I don't think it's an insensitive question at all. To answer - As a trans woman, interests/hobbies are not really a marker of gender that I feel is important to me. I would say the same is true of all my trans friends, although ofc that is not a representative sample, so take it with a grain of salt.
For me, in no particular order, these are the elements of sex/gender that I find important (and which were crucial for me to align during my transition):
* My body. This was perhaps the single most important one. Hormones worked wonders here, as well as growing out my hair, shaving, learning to take care of my skin, etc.
* Clothing/makeup went a long way towards making me feel better about myself. It takes a very long time and a lot of practice and skill-building to be "good" at fashion/makeup/etc, but it was worth it.
* My personality. This one is the hardest to describe. I can only say that when my body ran on testosterone, I was miserable, antisocial, arrogant, and annoying, and after switching over to estrogen, I am much happier, better at conversation, more empathetic, and by all reports much more likeable.
* My relationship to other women. It's hard to describe, but as I transitioned I became a lot closer to the women in my life, and grew apart slightly from the men in my life.
I think in part this emerges from the negative side of being a woman in society (being leered at/catcalled/harassed/stalked/patronized/discriminated against/etc). It leads women to stick together and trust each other more implicitly than men. So as a trans woman, gradually being welcomed into this "club" was very gender-affirming (although the negative stuff still sucks :/)
* Name and pronouns. At this point (~4 years) I pass enough in public that I am essentially never misgendered, but on the rare occasion I am, it certainly ruins my day. Pronouns matter more than cis people might think.
* Relationship to my family. Being called "daughter" by my parents, doing mom/daughter stuff with my mom, etc.
There are probably other factors that I'm not thinking of right now, but this is what comes to mind as I write this. And notably, my interests/hobbies aren't really included there. I do software development, I'm into skateboarding and punk music and videogames, I play dungeons and dragons. All "male-coded" hobbies for the most part, but I really just attribute that to the fact that I developed my hobbies as a kid, and as a kid I was a boy with friends who were boys and who did boyish stuff.
I personally don't find that that affects my perception of my gender at all. Hopefully this helps clear up your confusion! Let me know if there's anything I can clarify further.
PartiallyTyped12 days ago
The people I know couldn't relate to men at all, felt like completely different species. While they may have some interests from their "past" life, many of them felt that they could now enjoy things women did without judgement, and so they did.
seethedeaduu11 days ago
This seems to be yet another one of the antitrans throwaway accounts that keep being created on this site.
gherkinnn12 days ago
What an interesting read. I wonder, are these reports a reliable way to begin to understand what it feels like to be of the other sex? Insofar as such a thing is possible, of course. The anecdotes of smell and the sensation of powering up a hill are fascinating.
On a different note,
> At smoothbrains.net, we hold as self-evident the right to put whatever one likes inside one’s body;
I never thought of it that way, but I agree.
dehugger12 days ago
Yes, they're reliable. Source: I am trans femme, have spoken to many others who transitioned the opposite way (trans masc). We compare notes.
znpy11 days ago
I mean no disrespect, but anecdotal evidence is not evidence.
cosmojg11 days ago
You can certainly take notes on all that anecdata and use them to design some proper experiments! But until someone gets the resources and willpower together to do all of that, the anecdata is all the evidence we have.
aaaja11 days ago
When a male takes estrogen it doesn't undo a lifetime of male sex development and existing as a male, nor does it give him a female reproductive system. So how could taking estrogen grant him an understanding of what it feels like to be the opposite sex?
znpy11 days ago
> But until someone gets the resources and willpower together to do all of that, the anecdata is all the evidence we have.
Still not evidence.
aaaja12 days ago
[flagged]
calico9612 days ago
Lynn Conway, fellow (former) MIT student documented her biochemical journey with estrogen therapies of the 1960s: https://ai.eecs.umich.edu/people/conway/LynnsStory.html
calico9612 days ago
In 1966 Dr. Harry Benjamin (who worked with Lynn) documented early 20th century hormone research and treatment options in his book, "The Transsexual Phenomenon": https://en.wikipedia.org/wiki/The_Transsexual_Phenomenon
[deleted]12 days agocollapsed
[deleted]12 days agocollapsed
pazimzadeh12 days ago
> It’s as if I took the entire volumetric representation of the space around me and increased the degree to which every point within that could influence the location of every other point, recursively. This allows everything to elastically settle into a more harmonious equilibrium.
What does this mean? There has to be a simpler way to get this idea across..
> Perhaps taste could be built out of something like dyadic vibrations, tuned by evolution towards consonance or dissonance in order to generate an attractive or aversive response in the organism?
Same here
ghushn312 days ago
> What does this mean?
My understanding was like... you know those spring diagrams, where edges of a graph are all attached by a spring, and physics sorta causes nodes to cluster naturally? I think this is saying, "I wish all the space around me could order itself into a more natural and pleasing shape."
> Same here
Dyads are like... imagine you had two vectors, represented by lego bricks. After attaching them, rather than having a red brick and a blue brick, you have a particular Red-Blue brick. So, one can imagine these unique shapes move and vibrate in ways that are unique to that pair.
The author is saying, I think, "Individual preferences aren't composed of atomic units, but rather subtle adjustments in all the combinations of those individual pieces. Evolution probably looks for places where those combinations line up nicely (and avoids places they don't line up nicely), and tunes the organism to seek those combinations."
jhanschoo12 days ago
I didn't understand that sentence, but from the subsequent descriptions I gathered that details became "less loud" and less noticeable. Do you know the so-called "OCD"-annoying memes where you have images with something just slightly improper or off? I gather that these bother the OP less now.
trenbologna12 days ago
I used to be into bodybuilding and the best I ever felt was when I was high testosterone and high estrogen. When I was not taking any aromatase inhibitors I felt amazing, happy, loving, and emotional in a way I can't explain but I felt more connected with my wife. I feel like it was a little glimpse into the female mind. When I crashed my estrogen I felt psychotic. Very interesting experience
marcellus2312 days ago
Does this suggest at all that these changes could also be differences in the way (cis) men and women perceive the world? In other words, do cis women experience sweet food tasting sweeter, colors being more vibrant, etc, compared to cis men?
Edit: I’m aware there’s evidence for differences in color discrimination and taste preferences between the sexes. But seeing the differences described from a first person perspective of someone used to being a male is fascinating. It’s a common cliche that women laugh much more than men, for example — and here’s someone saying that being on estrogen made funny things seem much funnier. I wonder what the experience is like for FtM who take testosterone?
foxmoder12 days ago
Anecdotal, but I found that my sense of smell improved significantly after a long time taking estrogen, and I've heard many similar one-off stories from other people who've done so too. It certainly does change your physical perception of the world in a few ways, as well as the general feeling of existing in one's body.
One recurring theme I've heard from people going from majority testosterone to majority estrogen is a feeling like a continuous 'buzzing' sensation in their head had finally stopped; this is something I personally experience, and there's a certain degree of relaxed serenity that comes with it for me. (This said, experiences vary a lot, and many who have had both primary hormones prefer the feeling of testosterone.)
I personally think that it's a beautiful opportunity to get to experience life through both sets of hormones; it's offered a lot of interesting perspective on my personal notions of 'self', and allowed me to develop empathy for different experiences others experience in their bodies.
marcellus2312 days ago
> many who have had both primary hormones prefer the feeling of testosterone.
This is super interesting! Do you know what they prefer about testosterone?
> One recurring theme I've heard from people going from majority testosterone to majority estrogen is a feeling like a continuous 'buzzing' sensation in their head had finally stopped
This is also fascinating. As a cis man is there a buzzing constantly that I don’t even notice, that none of the women in my life have?
foxmoder12 days ago
It's a good question! My personal experience (which mostly echoes those I've heard) is that it tends to be a lot more of a rush in some ways; I recall feeling a lot more alert in some ways, and a lot more eager to quickly make decisions/launch into things.
I get a somewhat similar sensation with enough caffeine now, but the experience of testosterone in my experience is a lot more of a head-rush than caffeine is for present me.
It's kind of neat, because at the end of HRT cycles as the levels shift, it lets me experience varying proportions of one versus the other--it honestly surprised me a lot to experience for the first time how much hormones play into what it's like to be in my head day-to-day.
Ooh, and re: the last question, it's possible that that's something that not everyone experiences--I will say though that that's probably the best way I have to describe what I felt, even though I wouldn't say I actively noticed a buzzing sensation before I started HRT (when my doses are late though, it's definitely something I pick up on).
Fraterkes12 days ago
Gendered cliches are incredibly common, but I’ve never heard one that involves women liking sweet food more or less than men, which you’d expect if there were actual differences in taste I think
vinoveritas12 days ago
It’s an extremely common pattern for alcoholic drinks, to the point that a man ordering a very sweet drink or a woman ordering neat whisky is likely to draw comments (not even necessarily negative ones, especially in the case of a woman preferring usually-masculine drinks). It’s also present in wine marketing—the lower end of the market has heavily feminine-coded marketing and tends to be very sweet (at least in the US), and in fact that aligns with actual preferences I’ve observed (I’m not sure I know a single woman who prefers dry wines?)
Chocolate (dark vs milk) and coffee drinks (heavy on milk and sugar versus light on them, or black) follow similar patterns in perception (and actual observed preferences, IME)
Of course, how much of that is nature versus socialization is another matter… but also, the kind of risk-taking and one-upsmanship behavior that might drive men to be more willing to acquire tastes for things that aren’t initially appealing and to so-expand their palates may itself be hormonal, so even one plausible “nurture” cause for this might actually be “nature” one step removed.
But either way, and even if data doesn’t bear any of that out (pretty sure it would, though), the perception that all that’s generally true is certainly common.
wahern12 days ago
Reminds me of the paper, "Stereotype accuracy: One of the largest and most replicable effects in all of social psychology": https://gwern.net/doc/psychology/cognitive-bias/2016-jussim....
TL;DR: Group stereotypes, at least on their face, tend to be quite accurate. It's the implications people draw from or apply to them that can be problematic.
jacobgkau12 days ago
> I’ve never heard one that involves women liking sweet food more or less than men,
It's somewhat ingrained in (traditional) Japanese culture that women prefer sweet foods and men prefer spicy foods. Young boys enjoying sweets is seen as "funny" since they don't "know" it's a feminine thing yet (not necessarily in a "you can't do that" way, but more in a "cute that he hasn't picked up on it yet" way).
mintplant12 days ago
Women are generally better at perceiving and distinguishing colors and smells, according to the studies we have. Anecdotally, my sense of smell has gone from dull to vibrant over the course of my (MtF) transition, and I have a friend who no longer experiences the color-blindness she used to before hers, though I'm not aware of any scientific evidence or inquiry in this area.
tofof12 days ago
Women (here I mean XX individuals) have two different alleles present for each of the green (OPN1MW, also the OPN1MW2 duplication) and red cones (OPN1LW), since these are found on the x chromosome. X-inactivation means that only one gets expressed in a particular cell, but this means individual photoreceptor cells can express either allele. The individual proteins and gene encodings of the cones can differ, and small variations shift the spectral sensitivity to slightly shorter or slightly longer wavelengths. It's possible, then, for a woman to express as many as five unique-ish cones in theory -- though there's only been one 'true' tetrachromat found so far. Still, having red and green cone variants that respond with a peak preference shifted 10-20 nm in addition to another unshifted cone (or, better, shifted the opposite direction) provides a biological basis to expect women (again, specifically XX individuals) to have finer color differentiation. This explanation, however, could not occur following a hormone replacement.
mintplant11 days ago
Like I said, unfortunately I'm not able to ground this in any kind of existing scientific research or provide a biological explanation! I can only self-report and relay the experiences of others that I know to be factual. It's a shame that this sort of thing seems under-studied.
DoctorOW12 days ago
> Women (here I mean XX individuals)
This can be shortened to "XX individuals" since the word applies neither to all XX Individuals nor does your use of the word apply to all women.
RebeccaTheDev12 days ago
I was not prepared for my food tastes to change! I used to love candy. But now I’m rarely drawn to it, but I will absolutely INHALE fruit. It has so much incredible depth of flavor now!
blindriver12 days ago
You are assuming that people mostly experience the world in exactly the same way. That is a huge assumption that's likely to be wrong.
marcellus2312 days ago
What? How in the world did I make that assumption?
TheOtherHobbes12 days ago
There are some established differences. Women have better colour, taste, and smell discrimination. Some women are tetrachromats with an extra colour sense, while men are more likely to have red/green colour blindness.
Men have better night vision, are more aware of motion, and are better at tracking location and judging distances.
antonfire12 days ago
> Some women are tetrachromats with an extra colour sense, while men are more likely to have red/green colour blindness.
If I'm not mistaken, red/green color blindness is more common in men because it's caused my a mutation on the X chromosome (which men tend to have fewer of). I would guess a similar thing about tetrachromacy.
So those are probably unrelated to color-perception changes due to exogenous estrogen.
looneysquash12 days ago
> when prompted to state my gender identity or preferred pronouns, I fold my hands into the dhyana mudra and state that I practice emptiness on the concept of gender.
That's fine, but when I tell people "Cube Flipper wrote this great blog post!", what pronouns do you want me to use actually use?
I guess I'll refer to you as "they" since you didn't otherwise specify. But the "unknown/unspecified" version of "they" and not the "prefers they" version of "they".
Looks like a great article. I didn't quite make it to the end. The science is interesting, but that isn't a trip I am considering, so I skimmed a little.
antonfire12 days ago
As a fun aside on language, I prefer "they", explicitly, e.g. I pick "they" in pronoun dropdowns, I often wear a "they" pronoun pin, and so on. But insofar as people think in terms of these different versions of "they", I prefer the "'unknown/unspecified' version" over the "'prefers they' version"! Turns out that's hard to communicate.
If being annoying by (not-)answering with "mu" to all gender/pronoun questions communicates it better, maybe it's a point in favor of being annoying!
IMO it points at some cracks in the perspective that there are different versions in the first place.
cube_flipper12 days ago
I have legitimately never asked another human being to use a specific pronoun to address me before. Use what you like.
titanomachy12 days ago
I don’t know if it’s just effective moderation of this forum, but I’m impressed that an article about a politically sensitive subject like hormone therapy for gender dysphoria, on a public forum, has such high-quality and civil discourse.
ghushn312 days ago
Honestly, historically, trans related topics on HN are full of transphobia. This one seems relatively well received, and I don't know what's changed.
karcass8 days ago
I mean, mostly, main counterexample is that Manuel_D guy who is spouting debunked TERF talking points, e.g. he thinks the Cass Report hasn't been shredded. I think it helps that there are a LOT of us trans folks in tech to represent here.
somsak212 days ago
> At smoothbrains.net, we hold as self-evident the right to put whatever one likes inside one’s body
appreciate seeing this. I've long identified as someone that's much more muscular than I have been in the past. it's interesting how steroid use for this subset is seen as so different from that same use in the gender dysphoria subset.
kushan202012 days ago
Waking up everyday and drinking monster energy drink followed by Diet Coke in theory should have some effect on your brain. Does abstaining from them have any effect on your HRT?
cube_flipper11 days ago
I completely quit coffee and energy drinks (I'd still drink jasmine and peppermint tea) for a few months last year. No effect on HRT. I did experience an increased emotional depth which I suspect should have happened independent of what hormones I was taking (wow; this caffiene shit makes me agitated, who knew)
egypturnash12 days ago
This person is having a very very different experience of gender transition than I am. Transes are "immune to optical illusions?" WTF?
They might just be looking for proof that the hormones are Doing Something a lot harder than I do after twenty-something years on them. I sure was looking for that for a while when I started. But this whole post really just reminds me of the time I got some acid that had completely evaporated by the time it got to me (if it had ever been any good in the first place) and I sat there trying to convince myself I was about to start tripping any second now.
It's certainly had an effect on me or I wouldn't have bothered with the hassle and expense of continuing to acquire and take it for more than two decades but I'm sure not seeing more colors or "changing the balance between entropy and harmony" in my awareness of the world around me. My general happiness level has changed for the better. shrug
(I'm also an artist, I was one long before the transition, so maybe I just, like, paid more attention to color and shapes in the first place, who knows.)
The estrogen-to-witch pipeline is however a real thing.
comrade123412 days ago
You're telling me you can just go to a Walgreens in the USA and get a bag of estrogen and start injecting it without the advice and monitoring of a doctor? Even though hormone replacement therapy can lead to all kinds of problems? Is this normal?
cobertos12 days ago
No. This is incorrect. OP explicitly mentions "jumping through bureaucratic hoops"
> Not long after, I had jumped through the relevant bureaucratic hoops, and subsequently found myself cycling home from the pharmacy
comrade123412 days ago
No mention of a doctor or monitoring. I don't live in the USA - bureaucratic hoops sounds like what I go through to get my id renewed.
ghushn312 days ago
I believe it's implied. Typically the bureaucratic hoops involve 1-2 mental health professionals writing letters in support, potentially 0-2 years "living as the gender" before they will write those letters, meetings with your doctor, bloodwork for baseline hormone levels (sometimes multiple times), and then finally you might get a scrip.
But if you encounter someone along the way who doesn't want to co-operate, you might need to redo those steps. It's really rather difficult, depending on where you are.
cube_flipper11 days ago
I was living maybe ten minutes' walk from the local testing clinic at the time so it was actually pretty easy to monitor my blood work.
runeblaze12 days ago
My opinion is that at least (safe, not spiro) anti-androgens should be able to be bought OTC. If some people want to place blockers on themselves they should be allowed to. I mean if you don't allow them to they DIY
wtfwhateven12 days ago
Where on earth are you getting this idea from?
comrade123412 days ago
From the first few paragraphs of the article?
> and subsequently found myself cycling home from the pharmacy with a paper bag filled with repurposed menopause medication
and then no mention after of monitoring of health effects?
roughly12 days ago
So, the beginning of that sentence is:
> I had jumped through the relevant bureaucratic hoops
comrade123412 days ago
Bureaucracy != medicine
wtfwhateven12 days ago
Informed consent is absolutely medicine and absolutely includes advice from a doctor
protocolture12 days ago
Medicine does however = bureaucracy.
foxmoder12 days ago
This isn't true.
(It should be, in my opinion--I don't believe in third parties with no stake making forced decisions for you for what can and can't enter your body--but as someone for whom this is lived experience, you can't do this, especially not at a Walgreens and not without getting LFTs and hormone levels done regularly.)
cthalupa12 days ago
Wait until you hear about how easy it is to get testosterone.
yuriks12 days ago
Ironically, testosterone in theory is harder to get. Since it is widely used for sports doping, it's considered an anabolic steroid, and is a scheduled substance in the US, and so has a bit more oversight to prescribe and dispense. (But I imagine there's probably also a larger black market for it for the same reasons.)
cthalupa12 days ago
There are a billion TRT clinics that will prescribe you testosterone with basically zero oversight and at dosages that are supraphysiological.
And yes, the black market is huge - anyone with google and the ability to purchase crypto can get it easily delivered, either domestically, or from china.
PartiallyTyped12 days ago
Not only TRT but also Tren and other anabolic steroids that work in tandem with Testosterone to boost lean mass and reduce fat.
s530012 days ago
>> You're telling me you can just go to a Walgreens in the USA and get a bag of estrogen and start injecting it without the advice and monitoring of a doctor? Even though hormone replacement therapy can lead to all kinds of problems? Is this normal?
Go chug a quarter of a McBurgerStan sized bottle of Tylenol available at near every cornerstore in our country and you’ll literally fucking die a harrowing death. I do not even mildly see your point. Quite frankly those against open access to all medicine need to die. The harm a lack of accessibility causes to society at large is incalculable, because the disabled go unseen rotting away in their homes – if they’re so lucky to even have that.
HK-NC12 days ago
I remember reading that autism was basically the brain equivalent of some roided out muscle beast. Too much testosterone in the womb or something. Given the huge crossover with trans and autism, could it just be a case of giving autistic men female hormones to try to balance this out over time? I dont really buy the rest of the fluff that comes with it, especially given the attitudes around it and my own experiences getting over dysphoria before there was a culture around taking things in another direction.
comrade123412 days ago
Interesting also that penis size is directly correlated with testosterone levels in the womb...
foxmoder12 days ago
From my understanding, it's unlikely.
Many transgender women pre-HRT have very low testosterone levels. It's possible there's some causal arrow between being transgender and having autism, but to be frank much of it could come down to reporting bias, i.e. those with autism are more likely to not care as much about societal expectations and consequently are more likely to embrace being transgender publicly.
This could also be exacerbated by the fact that autism in cisgender women is widely believed to be dramatically underdiagnosed due to gendered societal expectations around behavior and diagnostic tests that only check for traditionally 'male' autistic traits/behaviors.
It's also the case that many individuals transition long after e.g. primary brain development ceases, so it's not particularly likely in my estimation that the body is trying to compensate for past development (given the developmental stage of life is complete).
ghushn312 days ago
> before there was a culture around taking things in another direction
You are talking about a time before culture? Trans identity shows up as early as Mesopotamia, and there are cultures around the globe that have different genders than just Man and Woman.
SequoiaHope12 days ago
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FreakLegion12 days ago
NB: jart is a trans woman. That doesn't make all of her opinions automatically correct, but as far as lived experience goes, she's about as informed as a person can be.
SequoiaHope12 days ago
Oh my gosh I totally misread that then. Can’t delete my comment but I edited the incorrect comment out. I just wasn’t paying enough attention.
bdbenton525512 days ago
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mensetmanusman12 days ago
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