Continuation Transwomen are not women - part XI

[d4m10n]

Originally Posted by LondonJohn

But no, it is not disaffirming to exclude certain transwomen from certain classes of women's activities (eg sports), and nor is it disaffirming to exclude certain transwomen from certain women's spaces (eg bathrooms).

I'm fairly confident Boudicca90 would disagree with this, and I'm 100% confident Stonewall does.

Originally Posted by LondonJohn

The question around whether (and under which circumstances) transwomen should be allowed to compete in men's sports, or whether (and under which circumstances) transwomen should be granted access to certain women's spaces (eg prisons, bathroom facilities) is an entirely different matter from any question about the validity of transgender identity itself.

Where did any of the aforementioned medical associations comment on "the validity of transgender identity" apart from the process of medical diagnosis and treatment? I'd be particularly interested in what the American Academy of Pediatrics had to say.

[Francesca R]

Originally Posted by LondonJohn

But no, it is not disaffirming to exclude certain transwomen from certain classes of women's activities (eg sports), and nor is it disaffirming to exclude certain transwomen from certain women's spaces (eg bathrooms).

Glad you agree. It follows from this that it cannot be transphobic to do so either.

Indeed, one can be of the view to exclude transwomen from certain female-only activity and female-only settings and still actively support transgender identity and the affirmation of transgender people, no?

I wonder what all that fuss was about then . . . .

[Ziggurat]

Originally Posted by LondonJohn

Oops indeed.

We have covered this misunderstanding many, many times already.

It's not a misunderstanding, at least not on my part. It is an internal conflict in your own stated position.

Quote:

Gender dysphoria is indeed a mental health disorder

Yes, it is.

Quote:

But that, obviously, is a completely different (though consequential) condition from transgender identity itself.

You still haven't explained what transgender identity in the absence of gender dysphoria means, or why it deserves accommodation. But more immediately, recall this was your claim:

Originally Posted by LondonJohn

As a handy aide-memoire, here is a list of mainstream medical institutions operating within the USA which actively support transgender identity and the affirmation of transgender people (in alphabetical order):

Except when we go to the source of your list, it says nothing of the sort. Again, this is what your link says:

Originally Posted by tldef

Leading medical groups recognize the medical necessity of treatments for gender dysphoria and endorse such treatments.

Note that it specifically and ONLY addresses medical treatment for gender dysphoria. It says nothing about "support [for] transgender identity". You keep insisting that there's an important distinction between transgender identity and gender dysphoria, but then immediately ignore that difference in order to claim organizational support for your position even though no such support was actually given.

Originally Posted by LondonJohn

However mainstream medicine (including all of the institutions in my list), while believing that gender dysphoria requires diagnosis and treatment, believes in the affirmation model for transgender identity: in other words, if a person presents to a medical professional with gender dysphoria, and once that disorder has been diagnosed, the correct treatment in most cases is 1) an affirmation of the person's transgender identity and 2) therapeutic treatments to help the person resolve the conflict between their transgender identity and the gender matching their sex assigned at birth.

So what does mainstream medicine say should be done with trans people without gender dysphoria? You have curiously left that unaddressed. The only thing you've described as the "affirmation model for transgender identity" is treatment for gender dysphoria.

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And to date, no significant institution/body in any liberal democracy (nor any supranatural body, eg the WHO) has either questioned the validity of transgender identity

Why would they? That's your own personal made up term.

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or questioned the efficacy/validity of the affirmative model (which, of course, necessarily implies a belief in the validity of transgender identity itself).

Given the vagueness of your affirmation model, what's to question? The sticky points are all in the details. And BTW, nobody here is arguing that gender dysphoria shouldn't be treated. Hell, no one here is even arguing that adults shouldn't transition.

But there's a hell of a lot of gray area. For example, you say "once [gender dysphoria] has been diagnosed". But what constitutes a diagnosis? Is it purely on the say so of the patient? Because that's a bad idea, and it's how a lot of people who subsequently detransition were treated. Does insisting that a diagnosis go deeper than that constitute "questioning the validity of transgender identity"?

Or how about therapeutic treatments. What should they consist of, and when? Does not wanting to chemically castrate children who cannot meaningfully consent to such irreversible procedures constitute "questioning the validity of transgender identity"? Or is it basic prudence?

Quote:

I for one feel extremely comfortable sharing my stance on transgender identity with a) the organisations which determined the validity of transgender identity and b) all the medical institutions - with no dissent - which also believe in the validity of transgender identity

You have imputed to these institutions a position which they did not actually express. Again, by your OWN terms, your OWN sources said nothing about "transgender identity".

[Elaedith]

Originally Posted by LondonJohn

Oops indeed.

We have covered this misunderstanding many, many times already. Gender dysphoria is indeed a mental health disorder (although of course DSM5 puts it in a separate class to most other disorders, for obvious reasons).

No, DSM5 does not put GD in 'a separate class’. DSM5 covers a wide range of different types of disorders, some of which are loosely grouped in categories and some of which are not. If you are referring to GD being moved into a separate chapter in DSM5, we have been over this several times already.

The reason for separating the three classes of Sexual and Gender Identity Disorders that were in one chapter in DSM-IV and DSMV-TR is explained in Zucker et al. (2013), p903.
Memo Outlining Evidence for Change for Gender Identity Disorder in the DSM-5

“......each of these three diagnostic classes have their own specialists and the theoretical overlap among these conditions is far from complete. For example, sexual dysfunctions are of little direct relevance to GID as it manifests in children. Some critics have also complained that inclusion of GID in a section of the manual that also includes the paraphilias is somewhat stigmatizing. Although there can be a co-occurrence of one paraphilia, Transvestic Fetishism, with GID in adolescents and adults, it was the consensus of the entire Sexual and Gender Identity Disorders Work Group that the three diagnostic classes be uncoupled, with each having a separate chapter in DSM-5.”

Aside from that, transvestic disorder still remains a diagnosis in the DSM5 and is recognised as a risk factor for late-onset gender dysphoria.

Quote:

It's experienced by some - but not all - people with transgender identity. It's to do with the internal struggle, usually pre-transition, which some transgender people experience around the conflict between their trans gender and the gender that matches their sex assigned at birth (along with associated anxieties over things such as how their trans gender might be viewed by the likes of family, friends, employers etc, or how society at large views transgender identity).

The adoption of the phrase ‘sex assigned at birth’ by organisations is itself a clear sign of science being subordinate to ideology (in this case, sex denialism).
If gender is a set of social expectations about personality, roles, preference etc that society assigns based on sex, then a person who does not identify with this is simply a gender non-conforming person. The only logical difference between a GNC person who identifies with their sex but rejects the gender stereotypes associated with it, and a GNC person who wants to change their sexual characteristics, is that the latter is unhappy with their sex or sexual characteristics. However, sex denialism means that activists cannot say that somebody is unhappy with their sex.

What is being promoted is not increased acceptance of gender non-conformity or declassification of trans identity as a mental illness; it is sex denialism, or replacement of sex with gender identity.

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But that, obviously, is a completely different (though consequential) condition from transgender identity itself. Which is now viewed by mainstream medicine and medical science as NOT a mental health disorder. All of the medical institutions in my list subscribe unequivocally to that understanding.

As previously stated, following the removal of homosexuality from the DSM an additional criterion was added to many diagnoses, including gender identity disorder and the paraphilias, to require the presence of clinical distress, functional impairment, or risk of harm to others. This was to ensure that harmless conditions not requiring treatment did not get classed as disorders in future. This took place decades before, and has nothing to do with, the current rise in trans activism based on sex denialism.

Quote:

Now, transgender identity denialists would say that on top of gender dysphoria being a mental health disorder, transgender identity itself is a mental health disorder. Such people believe that there's no such thing as valid transgender identity: that all those "claiming" transgender identity are actually mentally ill. Such people subscribe to the theory that the core matter of transgender identity is an illness requiring diagnosis and remedial/"curative" treatment.

What you repeatedly do is imply that disagreeing with gender identity ideology (that gender should replace sex, and words like ‘man’ and ‘woman’ should refer to gender identities rather than sex) is equivalent to saying transgender identity is a mental illness. This is due to a fallacy of equivocation over the meaning of ‘valid’.

Moreover if gender is separate from sex, encouraging somebody to accept their biological sex cannot possibly be conversion therapy for gender identity.

Quote:

However mainstream medicine (including all of the institutions in my list), while believing that gender dysphoria requires diagnosis and treatment, believes in the affirmation model for transgender identity: in other words, if a person presents to a medical professional with gender dysphoria, and once that disorder has been diagnosed, the correct treatment in most cases is 1) an affirmation of the person's transgender identity and 2) therapeutic treatments to help the person resolve the conflict between their transgender identity and the gender matching their sex assigned at birth.

And to date, no significant institution/body in any liberal democracy (nor any supranatural body, eg the WHO) has either questioned the validity of transgender identity or questioned the efficacy/validity of the affirmative model (which, of course, necessarily implies a belief in the validity of transgender identity itself).

Every country that has undertaken an independent systematic review of the evidence for the affirmative approach in minors has changed course due to poor quality of evidence. Yet every medical organisation in the US continues to support affirmation for minors, insists that the science is ‘settled’, and portrays criticism as 'transphobic'. Both perspectives cannot be correct. When there is disagreement within medical organisations in different countries, one looks to the evidence. When organisations are shown to be ignoring evidence that is politically inconvenient, one concludes that they have abandoned science.

[TomB]

This is an interesting Reddit thread. It's transgender people complaining about pronoun use that does not match presentation:
https://www.reddit.com/r/Transmedica...e_so_confused/

It is permissible to quote a couple posts from a thread on another board? If not, please remove them.

Quote:

Last weekend I went to a meetup group for people that share my interests. We all had name tags and there was a gay guy there with "He / She" pronouns on his tag. Male name, beard, dressed like a gay guy. I honestly was kinda offended seeing that but I know this is the world we live in now.

It's just crazy that I'm a trans woman, living stealth, yet in that group all the people are probably thinking that this gay guy is the only "transgender" person. It's just so weird. And what's even weirder is that if I would share my opinions on that everyone would consider me a bigot. A woman that actually transitioned is a bigot, not a gay guy with a beard and pronouns.

I'm so confused...

Quote:

It's insulting and ironic. The LGB"T" circus has rejected the views of actual MTF/FTM people and call us transphobic for calling out appropriation.

I spent probably over 50k and 10 years on electrolysis. I did this because it was an essential aspect to being comfortable in my own skin. My discomfort with facial hair was so intense that I couldn't live with it, and the social anxiety around it was very dibilitating.

Electrolysis was also major part in my being accepted as female in society, and living as a woman. Now, I'm required to respect men's demands that they are called she while proudly wearing beards and chest hair? That's ****** up.

I'm phobic of people who have diluted the public perception of MTF/FTM people. I'm phobic of people ruining all the progress FTM/MTF people have made.

What are we going to do about this mess?

It appears that transgender people are not monolithic in their views on these issues and that some portion of them feel that activists and allies are actually doing them harm.

So...what does "transphobic mean anyway? It seems like the same range of opinion exists within the trans population as exists on this board.

[Emily's Cat]

Originally Posted by LondonJohn

As a handy aide-memoire, here is a list of mainstream medical institutions operating within the USA which actively support transgender identity and the affirmation of transgender people (in alphabetical order):

American Academy of Child and Adolescent Psychiatry
American Academy of Dermatology
American Academy of Family Physicians
American Academy of Nursing
American Academy of Pediatrics
American Academy of Physician Assistants
American College Health Association
American College of Nurse-Midwives
American College of Obstetricians and Gynecologists
American College of Physicians
American Counseling Association
American Heart Association
American Medical Association
American Medical Student Association
American Nurses Association
American Osteopathic Association
American Psychiatric Association
American Psychological Association
American Public Health Association
American Society of Plastic Surgeons
Endocrine Society
GLMA: Health Professionals Advancing LGBTQ Equality
National Association of Nurse Practitioners in Women's Health
National Association of Social Workers
National Commission on Correctional Health Care
Pediatric Endocrine Society
Society for Adolescent Health and Medicine
World Medical Association
World Professional Association for Transgender Health

Please provide supporting evidence that those organizations "support transgender identity and the affirmation of transgender people". What statements have they made that lead you to your conclusion?

Originally Posted by LondonJohn

And here is a list of US-operating mainstream medical institutions which oppose transgender identity and the affirmation of transgender people (in alphabetical order):

Well that's just silly. Nobody in this thread, nor in any medical field, opposes transgender identity.

[Emily's Cat]

Originally Posted by LondonJohn

We have covered this misunderstanding many, many times already. Gender dysphoria is indeed a mental health disorder (although of course DSM5 puts it in a separate class to most other disorders, for obvious reasons). It's experienced by some - but not all - people with transgender identity. It's to do with the internal struggle, usually pre-transition, which some transgender people experience around the conflict between their trans gender and the gender that matches their sex assigned at birth (along with associated anxieties over things such as how their trans gender might be viewed by the likes of family, friends, employers etc, or how society at large views transgender identity).

This does not seem to be supported by any of the diagnostic criteria or descriptions in the DSM-5. It appears that you are speculating, and have no basis for making this a declarative statement. Please provide evidence to support your view, or alternatively phrase it as a speculation.

Originally Posted by LondonJohn

But that, obviously, is a completely different (though consequential) condition from transgender identity itself. Which is now viewed by mainstream medicine and medical science as NOT a mental health disorder. All of the medical institutions in my list subscribe unequivocally to that understanding.]

Please provide a definition of what "transgender identity" is, and also provide support for your claim that medical science supports this definition.

Originally Posted by LondonJohn

Now, transgender identity denialists would say that on top of gender dysphoria being a mental health disorder, transgender identity itself is a mental health disorder. Such people believe that there's no such thing as valid transgender identity: that all those "claiming" transgender identity are actually mentally ill. Such people subscribe to the theory that the core matter of transgender identity is an illness requiring diagnosis and remedial/"curative" treatment.

Can you provide supported examples of statements that reflect this view? Can you identify any actual people that support these views? Of what relevance are those views to this thread and this discussion?

Originally Posted by LondonJohn

And to date, no significant institution/body in any liberal democracy (nor any supranatural body, eg the WHO) has either questioned the validity of transgender identity or questioned the efficacy/validity of the affirmative model (which, of course, necessarily implies a belief in the validity of transgender identity itself).

Well, except for Finland, Sweden, and England, who no longer support affirmation only approaches, especially when it comes to youth.

Do you consider those countries to no longer be liberal democracies?

Originally Posted by LondonJohn

I for one feel extremely comfortable sharing my stance on transgender identity with a) the organisations which determined the validity of transgender identity and b) all the medical institutions - with no dissent - which also believe in the validity of transgender identity (and thus the affirmation approach to treating gender dysphoria). I'm more than content to align with the science and with the extremely strong medical consensus.

I find it interesting that you are extremely comfortable aligning yourself with US medical associations (which are largely lobbying bodies) which have not done any clinical studies, and against the independent clinical and scientific reviews of efficacy undertaken by your own governmental bodies.

[Matthew Best]

Here's an interesting (and peer-reviewed) article in that bastion of "mainstream medicine and medical science", the British Medical Journal:

https://www.bmj.com/content/380/bmj.p382

It says: "More children and adolescents are identifying as transgender and are being offered medical treatment, especially in the US—but some providers and European authorities are urging caution because of a lack of strong evidence."

[p0lka]

Originally Posted by TomB

This is an interesting Reddit thread. It's transgender people complaining about pronoun use that does not match presentation:
https://www.reddit.com/r/Transmedica...e_so_confused/

It is permissible to quote a couple posts from a thread on another board? If not, please remove them.





It appears that transgender people are not monolithic in their views on these issues and that some portion of them feel that activists and allies are actually doing them harm.

So...what does "transphobic mean anyway? It seems like the same range of opinion exists within the trans population as exists on this board.

That will inevitably happen with the T.
Unlike the L and B and G, the T's goal is to conform to a stereotype instead of fighting against a stereotype.

[Elaedith]

BMJ Investigations has just yesterday published an analysis of gender dysphoria treatment in minors that goes into detail about divergence in approach between medical bodies in the US and other countries. It's well worth reading.

Gender dysphoria in young people is rising—and so is professional disagreement BMJ 2023;380 p382

It contrasts the statements made by representatives of US organisations with conclusions from recent reviews in other countries including Sweden, Finland, England, France, Australia and NZ.

"Guyatt, who co-developed GRADE [a system for classifying quality of evidence], found “serious problems” with the Endocrine Society guidelines, noting that the systematic reviews didn’t look at the effect of the interventions on gender dysphoria itself, arguably “the most important outcome.” He also noted that the Endocrine Society had based some strong recommendations on weak evidence.

In addition, the WPATH standards of care, while having some elements of evidence-based guidelines, lacked a grading system for quality of evidence and were not transparent about how many reviews were done and and what the results were. "Helfand....also noted several instances in which the strength of evidence presented to justify a recommendation was “at odds with what their own systematic reviewers found.”"

That includes a review which found "the strength of evidence for the conclusions that hormonal treatment may improve quality of life, depression, and anxiety among transgender people was low," and that "it was impossible to draw conclusions about the effects of hormone therapy on death by suicide".

This contrasts with statements often made by these organisations implying strong evidence of benefits.

This is very similar to problems identified in the analyses of the AAP guidelines mentioned before and suggest that evidence is presented in a way that is biased towards a preferred conclusion.

The analysis also considers the politicisation of the issue in the US.

[Matthew Best]

Meanwhile, the American College of Cardiology yesterday issued this:

https://www.acc.org/About-ACC/Press-...vascular-Risks

which says that "People with gender dysphoria taking hormone replacements as part of gender affirmation therapy face a substantially increased risk of serious cardiac events, including stroke, heart attack and pulmonary embolism"

In fact, "seven times the risk of ischemic stroke..., nearly six times the risk of ST elevation myocardial infarction (the most serious type of heart attack) and nearly five times the risk of pulmonary embolism..., compared with people with gender dysphoria who had never used hormone replacements."

[LondonJohn]

Originally Posted by Matthew Best

Here's an interesting (and peer-reviewed) article in that bastion of "mainstream medicine and medical science", the British Medical Journal:

https://www.bmj.com/content/380/bmj.p382

It says: "More children and adolescents are identifying as transgender and are being offered medical treatment, especially in the US—but some providers and European authorities are urging caution because of a lack of strong evidence."

Yes, and? The whole point is that there is currently insufficient evidence either way wrt the optimal approach to transgender identity in minors. Because the historic data set is simply too small and too recent to allow for any meaningful statistical analysis.

In addition, the BMJ categorically is not saying that affirmation is wrong for this age group. It's simply saying that in the (current) absence of sufficiently reliable evidence, clinicians should exercise a degree of caution.

I mean, I realise that people who deny the validity of transgender identity (mis)interpret the BMJ viewpoint as advocating against affirmation treatment for minors, but that simply ain't the truth.

I myself have written more than once in these threads that everyone - including clinicians in gender identity clinics for minors, administrators, legislators and regulators - recognises well that where minors presenting with transgender identity are concerned, it is (at the moment) incredibly difficult to find the right balance. It's undeniable that real harm can be caused if clinicians refuse affirmatory treatments/therapies to many transgender minors; it's also undeniable that for some minors presenting with transgender identity, affirmation treatment/therapy may end up being harmful to them.

Of course, anti-transgender-identity groups/individuals always point (with anger and hysteria, often) to those minors who a) have received affirmation therapy, and b) have, in the longer term, turned out to have been damaged by it. Unsurprisingly, those groups/individuals never consider either 1) the large majority of minors for whom affirmation treatment/therapy was correct, therapeutic and in the person's best interest, or 2) the minors who, for some reason, have not received affirmation treatment/therapy, and who have consequently been very damaged by the absence of such treatment/therapy (including, sadly, a fair number of suicides).

Obviously, in time (perhaps in as little as a few years from now), sufficient data on short- medium- and long-term outcomes for minors will be available, and this will hopefully enable clinicians to optimise their approach. At the moment, clinicians are doing the best they can in very difficult circumstances. And in the clear majority of cases, they are doing the right thing at the right time. Lessons are constantly being learned of course, and the pathway model has already evolved - even relative to a couple of years ago. May the clinicians long continue providing transgender minors with the therapy and treatment they deserve, learning from any mistakes made, and following the science as and when reliable statistical evidence becomes available.

[LondonJohn]

Originally Posted by d4m10n

I'm fairly confident Boudicca90 would disagree with this, and I'm 100% confident Stonewall does.

You seem unaware that (for example) preventing a trans woman rugby player from playing in teams containing cis women.... is not in any way whatsoever disaffirming that trans woman's identity as a trans woman.


It's as flimsy an argument as claiming that if a 6ft4 230lb man is prevented from boxing against a 5ft4 120lb man, the bigger man is somehow having his "manlyhood" disaffirmed.

Likewise (and noting that I said "certain trans women"), I'd say that it would be entirely correct and proportionate to, for example, prevent a transwoman with convictions for offences against cis women in women's bathrooms... from being allowed to visit women's bathrooms. Just as it is entirely correct and proportionate (usually) to refuse to allow trans women prisoner with a history of serious violence against cis women to move into the women's prison estate. Neither of those things is transphobic.

Quote:

Where did any of the aforementioned medical associations comment on "the validity of transgender identity" apart from the process of medical diagnosis and treatment? I'd be particularly interested in what the American Academy of Pediatrics had to say.

You could always google it to find out, you know? Took me about 14 seconds:

https://www.aap.org/en/news-room/aap...ren-and-teens/

[LondonJohn]

Originally Posted by Francesca R

Glad you agree. It follows from this that it cannot be transphobic to do so either.

Indeed, one can be of the view to exclude transwomen from certain female-only activity and female-only settings and still actively support transgender identity and the affirmation of transgender people, no?

I wonder what all that fuss was about then . . . .

There's no fuss about it (other than at the extremes, of course).

As I said: a trans woman rugby player who is not allowed to play in cis women matches doesn't suddenly become "not a trans woman". She is still positively affirmed and validated as a trans woman.

No, it's not transphobic to ban trans women from certain women's sports at certain levels, and nor is it transphobic to (for example) prohibit trans woman prisoners with convictions for serious violence against cis women from being allowed to move into the women's prison facilities. In cases such as those, there are clear and obvious issues of proportionality.

On the other hand, it is transphobic to place a blanket ban on all trans women from competing in all women's sports, and it is transphobic to place a blanket prohibition on all trans woman prisoners from being allowed to serve their time in the women's estate.

Glad I could clarify/expand.

[LondonJohn]

Originally Posted by Emily's Cat

Please provide supporting evidence that those organizations "support transgender identity and the affirmation of transgender people". What statements have they made that lead you to your conclusion?

It really is extremely simple to google this to get the answers you need. For example, I just did so for the American Academy of Pediatrics (see my previous-but-one post), and it took me about 14 seconds. And if you do the same for any of those institutions, you'll discover similar results.

Quote:

Well that's just silly. Nobody in this thread, nor in any medical field, opposes transgender identity.

Well that's just silly, because 1) I'm clearly using shorthand for "the validity of transgender identity" (the context makes that perfectly clear); and 2) even without that obvious contextual inference, one can still safely conclude that holding a position along the lines of "transwomen are mentally ill men LARPing at being women" (and others in the same vein) is fundamentally in opposition to transgender identity. Transphobia and transgender-identity denialism is in obvious opposition to transgender identity.

This all sounds suspiciously similar to another transgender-identity-denialism "argument" around the phrase "transgender people exist".

[LondonJohn]

Originally Posted by Ziggurat

You still haven't explained what transgender identity in the absence of gender dysphoria means, or why it deserves accommodation.

Eh? Seriously?

Ok.....

Suppose somebody assigned female at birth (we'll call this person Jane, and assume that he hasn't yet transitioned and changed his name) has got to the age of 26 and has realised that he has transgender identity, that he identifies as the gender "man". This causes Jane a debilitating internal conflict concerning the risks/implications of transition: what would his parents think if he told them about his transgender identity? What would his friends say? What would his employer say (he's a teacher)? This conflict is known as gender dysphoria. Jane can - and should - seek diagnosis and treatment for his gender dysphoria - in his case, the treatment/therapy should very probably centre upon helping him become comfortable in his trans gender, including any medical or surgical treatments that are appropriate for him, and helping him to transition.

Suppose now that another person assigned female at birth (we'll call this person Zara, and assume that he hasn't yet transitioned and changed his name) gets to the age of 26 and has realised that he has transgender identity, that he identifies as the gender "man". In Zara's case however, upon realising he is a trans man, he has experienced no feelings of internal conflict between his natal gender and his trans gender. He feels entirely happy and comfortable with the prospect of inhabiting his trans gender, and doesn't worry about what family/friends/employer might think or say. He visits gender identity clinicians - but not for diagnosis/treatment of gender dysphoria (because he doesn't suffer from gender dysphoria). He goes because those clinicians can potentially help him (should he require their help) with medication and/or surgery as part of his transition.

Zara's case is what transgender identity in the absence of gender dysphoria means, and why it deserves accommodation.

[LondonJohn]

Originally Posted by Emily's Cat

I find it interesting that you are extremely comfortable aligning yourself with US medical associations (which are largely lobbying bodies) which have not done any clinical studies, and against the independent clinical and scientific reviews of efficacy undertaken by your own governmental bodies.

Firstly, my own government strongly supports the validity of transgender identity. And my own legislature has introduced various pieces of legislation which a) recognises the validity of transgender identity and b) provides rights and protections for transgender people. The efficacy reviews to which you refer are nothing more than a process of optimising the way transgender people are treated and protected. None of it is remotely about questioning the fundamental validity of transgender identity.

And secondly, most of those US medical institutions are categorically not "lobbying bodies". I suggest you might look into some/all of them a bit more carefully. There are some very, very heavyweight institutions there. And there are none which deny the validity of transgender identity (eg by stating that transgender identity is actually a mental health disorder and should therefore require diagnosis and corrective treatment).

If you don't like US medical institutions though, I can add in several giant supranational institutions such as the World Health Organisation and the United Nations. Additionally, the American Psychiatric Association serves as a quasi-supranational authority.

If, however, you can find any significant mainstream medical institution anywhere in the liberal-democracy world which, for example, states that transgender identity is actually a mental health disorder and should therefore require diagnosis and corrective treatment, I'd be very interested to see it. NB I'm not looking for significant institutions which raise questions over some aspects of medical care/intervention for transgender people - I'm looking for those which reject the validity of transgender identity itself.

[LondonJohn]

Originally Posted by Emily's Cat

Well, except for Finland, Sweden, and England, who no longer support affirmation only approaches, especially when it comes to youth.

Do you consider those countries to no longer be liberal democracies?

The key to this - and the reason why you are wrong - is the word "only" in your quote.

None of those countries you've mentioned rejects the affirmation approach. They are doing no more than saying that it shouldn't necessarily be the blanket approach (ie clinicians shouldn't operate under the "affirmation-only" approach).

And that, of course, is prudent and correct. There are indeed some people presenting with gender dysphoria (or simply transgender identity) for whom affirmation may not be the correct way for clinicians to proceed. Especially, as you point out yourself, when it comes to minors.

[LondonJohn]

Originally Posted by Elaedith

BMJ Investigations has just yesterday published an analysis of gender dysphoria treatment in minors that goes into detail about divergence in approach between medical bodies in the US and other countries. It's well worth reading.

Gender dysphoria in young people is rising—and so is professional disagreement BMJ 2023;380 p382

It contrasts the statements made by representatives of US organisations with conclusions from recent reviews in other countries including Sweden, Finland, England, France, Australia and NZ.

"Guyatt, who co-developed GRADE [a system for classifying quality of evidence], found “serious problems” with the Endocrine Society guidelines, noting that the systematic reviews didn’t look at the effect of the interventions on gender dysphoria itself, arguably “the most important outcome.” He also noted that the Endocrine Society had based some strong recommendations on weak evidence.

In addition, the WPATH standards of care, while having some elements of evidence-based guidelines, lacked a grading system for quality of evidence and were not transparent about how many reviews were done and and what the results were. "Helfand....also noted several instances in which the strength of evidence presented to justify a recommendation was “at odds with what their own systematic reviewers found.”"

That includes a review which found "the strength of evidence for the conclusions that hormonal treatment may improve quality of life, depression, and anxiety among transgender people was low," and that "it was impossible to draw conclusions about the effects of hormone therapy on death by suicide".

This contrasts with statements often made by these organisations implying strong evidence of benefits.

This is very similar to problems identified in the analyses of the AAP guidelines mentioned before and suggest that evidence is presented in a way that is biased towards a preferred conclusion.

The analysis also considers the politicisation of the issue in the US.

Yes. Everybody - including the clinicians working in this particular area - understands that the evidence base is currently weak.

But minors are presenting with gender dysphoria (or, in some cases, purely transgender identity) every day. Even in the absence of a reliable evidence set, these minors deserve to be assessed and given appropriate treatment/therapy. Clinicians have to make choices and determinations regarding those minors. They will make some mistakes, for sure. But they are trying to do the correct thing, using all the information and data that's currently available.

In most instances, their intervention and treatment/therapy is extremely beneficial to the person. In a small subset, the actions of clinicians turns out to be detrimental to the person - either when their denial of affirmatory treatment causes significant distress to the person as they progress towards adulthood, or when their affirmatory treatment causes significant distress to a minor who subsequently wishes to detransition.

Doing nothing for minors with GD/transgender identity is not an option. Clinicians must make decisions - extremely difficult decisions - and hope that they are doing the right thing by the person. And as more and more outcome data becomes available, their treatment protocols will evolve accordingly.

[d4m10n]

Originally Posted by LondonJohn

You seem unaware that (for example) preventing a trans woman rugby player from playing in teams containing cis women.... is not in any way whatsoever disaffirming that trans woman's identity as a trans woman.

I certainly am "unaware" of this supposed fact. Let's see what a trans woman rugby player has to say:

Originally Posted by Julie-Anne Curtiss

I have been accepted as female by friends, colleagues, loved ones and most relevantly, by my female rugby team mates when I started playing again in 2021 as my full self.

According to Julie-Anne Curtiss, RFU policy is interfering with her acceptance as a woman in the specific context of amateur women’s club rugby, by preventing here from from playing in teams composed of cis women. Is acceptance somehow different from affirmation, in the social sense of each term?

Originally Posted by LondonJohn

https://www.aap.org/en/news-room/aap...ren-and-teens/

I'm having trouble finding the part where they address the validity of transgender identity apart from the process of medical diagnosis and treatment.

[LondonJohn]

A note on so-called "compelled speech":

Many - perhaps most - anti-transgender-identity groups/individuals declare that it's outrageous that they should be "compelled" to refer to trans men as "he" or "him". And as such, they also declare that they will be taking a stand on this issue and refuse to "succumb to compelled speech".

But these people/groups strangely fail to realise that their (deliberately inflammatory) definition of "compelled speech" already occurs right across society in various forms.

For example, if one were to deliberately misgender a weak effeminate cis man by referring to him as "she" and "her", that would potentially cause precisely the same trouble as if one were to deliberately misgender (say) a trans man by referring to him as "she" and "her". And there are countless other examples. In this comparative scenario, a person could invoke the same rhetoric as transgender identity denialists: "Why should I be compelled to refer to this weak effeminate man as "he" and "him"? I refuse to be ordered to use those pronouns; I'll continue to refer to this person as "she" and "her", OK?"

[Francesca R]

Originally Posted by LondonJohn

As I said: a trans woman rugby player who is not allowed to play in cis women matches doesn't suddenly become "not a trans woman". She is still positively affirmed and validated as a trans woman.

I agree with this. I'm not sure who (in this thread) doesn't actually.

Quote:

it is transphobic to place a blanket ban on all trans women from competing in all women's sports

I agree with this too. It is probably a matter for individual sports governing bodies, wouldn't you say?

Quote:

it is transphobic to place a blanket prohibition on all trans woman prisoners from being allowed to serve their time in the women's estate.

I'd accept what the government decided, I think you would too. It is possible that in prison environments specifically, a comprehensive prohibition is the most sensible solution. In other female-only settings, that may not be the case (For instance, the metro system in Mexico City and the suburban rail in Mumbai--among others--have women only carriages. That may be fine to admit trans women. Again probably up to the relevant municipalities' transit authorities.)

[Elaedith]

Originally Posted by LondonJohn

Yes. Everybody - including the clinicians working in this particular area - understands that the evidence base is currently weak.

Not they don't. Those pushing affirmation and transition insist that the 'science is settled', claim overwhelming evidence, and say there is no disagreement (except people they brand as equivalent to anti-vaxxers and homeopaths). There are quotes to this effect discussed in the article. Did you read it?

Quote:

But minors are presenting with gender dysphoria (or, in some cases, purely transgender identity) every day. Even in the absence of a reliable evidence set, these minors deserve to be assessed and given appropriate treatment/therapy. Clinicians have to make choices and determinations regarding those minors. They will make some mistakes, for sure. But they are trying to do the correct thing, using all the information and data that's currently available.

Clinicians are pressured to affirm or risk accusations of transphobia and conversion therapy. There are numerous quotes attesting to this in the sources cited in these threads.

Quote:

In most instances, their intervention and treatment/therapy is extremely beneficial to the person. In a small subset, the actions of clinicians turns out to be detrimental to the person - either when their denial of affirmatory treatment causes significant distress to the person as they progress towards adulthood, or when their affirmatory treatment causes significant distress to a minor who subsequently wishes to detransition.

There is no evidence that 'In most instances, their intervention and treatment/therapy is extremely beneficial to the person', especially when compared to less invasive approaches, since there are no randomised control trials and no long-term follow ups. That is what is meant by a weak evidence base.

Quote:

Doing nothing for minors with GD/transgender identity is not an option. Clinicians must make decisions - extremely difficult decisions - and hope that they are doing the right thing by the person.

Prior to the affirmation-only approach, the treatment was 'watchful waiting' with psychotherapy, not 'doing nothing'. Under this approach, most children spontaneously overcame their dysphoria and re-identified with their natal sex, avoiding the need for medical treatment, and there were no mass suicides.

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And as more and more outcome data becomes available, their treatment protocols will evolve accordingly.

There is no good outcome data happening anytime soon because there are no systematic follow-ups and no randomised control trials.

[Aber]

Originally Posted by LondonJohn

it is transphobic to place a blanket ban on all trans women from competing in all women's sports

It is misogynistic to allow men to compete in women's sport, with the caveat that it may be OK if you can prove that it does not result in unfair competition.

[Paul2]

Originally Posted by LondonJohn

. . . he has transgender identity, that he identifies as the gender "man". This causes Jane a debilitating internal conflict concerning the risks/implications of transition: what would his parents think if he told them about his transgender identity? What would his friends say? What would his employer say (he's a teacher)? This conflict is known as gender dysphoria.

My understanding is that gender dysphoria is not concern or distress about the social implications of transitioning or having a non-biological gender identity (wrt work, family, etc.), but distress given one's biological sex and one's internal gender identity, both of which have nothing to do with other people.

[d4m10n]

Originally Posted by LondonJohn

a trans woman rugby player who is not allowed to play in cis women matches doesn't suddenly become "not a trans woman". She is still positively affirmed and validated as a trans woman.

Originally Posted by Francesca R

I agree with this. I'm not sure who (in this thread) doesn't actually.

I'm a bit skeptical myself.

Suppose the trans woman rugby player wasn't excluded solely from the women's locker rooms and rugby leagues, but also from other single-sex spaces and services such as Korean spas and Hampstead Heath bathing ponds. At that point, is she still being socially affirmed and validated?

It was my understanding that a major part of the affirmation process was allowing this trans woman access to all the services and spaces which were formerly reserved for cis women. Is this not so?



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[Matthew Best]

Originally Posted by LondonJohn

Everybody - including the clinicians working in this particular area - understands that the evidence base is currently weak.

If this is the case, then how can you know that this:

Quote:

In most instances, their intervention and treatment/therapy is extremely beneficial to the person.

is true?

[Upchurch]

Originally Posted by Matthew Best

If this is the case, then how can you know that this:

is true?

Maybe talking to trans people might provide a valuable perspective.

[Samson]

Originally Posted by Matthew Best

If this is the case, then how can you know that this:



is true?

First do no harm is the medical oath.
Harm has been done by sin of commission.
Minors should not have their bodies interfered with in order to become something they can never be, women.
It is blindingly obvious to everyone on this thread it seems.

[Elaedith]

Originally Posted by Upchurch

Maybe talking to trans people might provide a valuable perspective.

No, you can't evaluate evidence for invasive medical treatment just by asking people how they feel about it, even when the benefit being sought is psychological. In fact, the difficulty in measuring psychological benefits is one of the primary reasons for so much pseudoscience in clinical psychology and allied areas.
It's also why these fields can tend to attract narcissists and grifters, who inflate their egos and build their prestige on the short-term gratitude of satisfied customers.

[Ziggurat]

Originally Posted by LondonJohn

Eh? Seriously?

Ok.....

Suppose somebody assigned female at birth (we'll call this person Jane, and assume that he hasn't yet transitioned and changed his name) has got to the age of 26 and has realised that he has transgender identity, that he identifies as the gender "man". This causes Jane a debilitating internal conflict concerning the risks/implications of transition: what would his parents think if he told them about his transgender identity? What would his friends say? What would his employer say (he's a teacher)? This conflict is known as gender dysphoria. Jane can - and should - seek diagnosis and treatment for his gender dysphoria - in his case, the treatment/therapy should very probably centre upon helping him become comfortable in his trans gender, including any medical or surgical treatments that are appropriate for him, and helping him to transition.

Suppose now that another person assigned female at birth (we'll call this person Zara, and assume that he hasn't yet transitioned and changed his name) gets to the age of 26 and has realised that he has transgender identity, that he identifies as the gender "man". In Zara's case however, upon realising he is a trans man, he has experienced no feelings of internal conflict between his natal gender and his trans gender. He feels entirely happy and comfortable with the prospect of inhabiting his trans gender, and doesn't worry about what family/friends/employer might think or say. He visits gender identity clinicians - but not for diagnosis/treatment of gender dysphoria (because he doesn't suffer from gender dysphoria). He goes because those clinicians can potentially help him (should he require their help) with medication and/or surgery as part of his transition.

Zara's case is what transgender identity in the absence of gender dysphoria means, and why it deserves accommodation.

I have made a huge error. I completely misunderstood.

I misunderstood how fundamental your misunderstanding of gender dysphoria is. It isn't what you're describing, at all. I really don't want to have to explain it to you in detail, but I'll just point to the real-world consequence of that misunderstanding, and why it invalidates what you're arguing.

It is extremely unethical to medically transition anyone who does not have gender dysphoria, regardless of their "gender identity". Medical transition is expensive, it's risky, it has MASSIVE detrimental side effects, and it is irreversible. It does significant harm. And the ONLY justification for doing that harm is to prevent or alleviate even worse harm. In cases of gender dysphoria, the distress of that dysphoria ==may be worse than the side effects of medical transition, and in such cases medical transition is justified. But if someone does not have gender dysphoria, if they are not experiencing distress, then it's completely unjustified. There is no reason to do harm when no harm is being prevented.

So your entire scenario about a non-dysphoric person undergoing medical transition makes no sense. Plus, of course, you never actually gave any reason for why that person deserves accommodation.

[Matthew Best]

Originally Posted by Upchurch

Maybe talking to trans people might provide a valuable perspective.

It might, but it wouldn't make the evidence base less weak.

[Dismember]

Originally Posted by Upchurch

Maybe talking to trans people might provide a valuable perspective.

Some trans people are strongly opposed to the current “gender affirming care” model(s) being implemented in the US/Canada/Australia.

https://www.dailywire.com/news/trans...or-of-evidence

Quote:

“Our healthcare system is failing these young people, as well as people with gender dysphoria, by robbing us of evidence-based information about what our condition is,” the press release states.

“What we are given instead of an evidence-based explanation for gender dysphoria is a postmodernist philosophy that attempts to deny biological realities,” the press release continues. “This is a political maneuver that is at odds with clinical care.”

[Elaedith]

Originally Posted by LondonJohn

In addition, the BMJ categorically is not saying that affirmation is wrong for this age group. It's simply saying that in the (current) absence of sufficiently reliable evidence, clinicians should exercise a degree of caution.

No, it isn't saying that at all. It is discussing the divergence in approach between medical organisations in the US and those in other countries that have commissioned independent reviews of the evidence. The latter have all moved away from the affirmative approach for minors. It also reports on commissioned reviews of the evidence behind the Endocrine Society and WPATH guidelines, conducted by two experts in evidence-based medicine, who found that these guidelines were not evidence-based, especially in relation to minors.

[Samson]

Originally Posted by Dismember

Some trans people are strongly opposed to the current “gender affirming care” model(s) being implemented in the US/Canada/Australia.

https://www.dailywire.com/news/trans...or-of-evidence

Great article and good comments. One said:

"The goal for treatment is to make the person comfortable in the body they have, not the body they want. "

This common sense treatment idea is apparently banned in 20 states. It may also be the case in NZ now.

[Francesca R]

Originally Posted by d4m10n

I'm a bit skeptical myself.

Well for those two quotes, sceptical would mean the barred trans woman wasn't being validated as a trans woman.

[Francesca R]

Originally Posted by Upchurch

Maybe talking to trans people might provide a valuable perspective.

That sounds rather like who needs data when you've got anecdotals, doesn't it?

[Upchurch]

Originally Posted by Francesca R

That sounds rather like who needs data when you've got anecdotals, doesn't it?

Trans people, who have gone through affirmative care, wouldn’t know if their care was beneficial to them? How else does one collect data?

[Darat]

Thread has been taken off [Moderated] status. Please ensure you post within the Membership Agreement.

Responding to this modbox in thread will be off topic Posted By:Darat

[Ziggurat]

Originally Posted by Upchurch

Trans people, who have gone through affirmative care, wouldn’t know if their care was beneficial to them?

Haven't you ever heard of placebo? It's incredibly common for people to not know whether a treatment of any sort actually made them better. Gender transition care isn't special in this respect.

Quote:

How else does one collect data?

With controlled long term trials that look at as much objective outcome measurements as possible.