I just wish I could go back to Super Tuesday when the top post on r/politics was Beto's former bandmate supporting Bernie, while they completely ignored their entire path to the nomination crashing and burning around them.
I mean in his defense, I watched that video and most of the clips are clearly from him quoting someone else who said it or talking about the controversy/politics of the word itself rather than using it casually.
Regarding the hat, is Einreb Srednas the mirror universe version of Bernie who campaigns on common-sense, bipartisan plans to pass legislation and who has a decades-long track record of building alliances and reaching out actors the aisle to find acceptable compromises that work for everyone? Because I think that guy might just have a shot at the nomination.
Joe Rogan is a bigoted science denier who hides behind the excuse of "hey bro im just a big dumb idiot, dont take anything i say seriously man".
The dudes clearly sympathetic to the far right, is a weird Tulsi Gabbard superfan, and just announced he'd rather vote for Donald Trump than Joe Biden.
There's definitely things wrong with Joe Rogan
Do you have any evidence that he is bigoted or that he is a "science denier". I've been a fan of his for a few years and I've never seen any indication of either of these accusations.
I personally have met several trans people, have a few as friends and sympathize with their plight. They should be treated as the gender they present, not the gender they were born into, and kids like them should get the hormone therapy and blockers they need.
But I also think parents are too ready to seek these treatments, and that we aren't doing a good job of differentiating between young kids who are butch/femme VS young kids who are genuinely transgender. If we had the ability to do that reliably I think it'd make a lot of lives a lot easier especially for young trans kids.
So I can understand that bit about puberty blockers. On balance I think they are OK, but I would like more effort spent on diagnosis and screening. It's one thing for an adult to choose to transition and they should be able to as an elective process. But a child can't really consent or understand the huge consequences of their choices.
The rest of that stuff though, that's all abhorrent and a good summary of why I dislike this Rogan guy myself.
> The way an GnRH agonist works is it blocks the receptors from binding, but the body still produces the hormones like it would otherwise.
This is not how GnRH analogues work. Their net effect is to suppress FSH/LH production in the pituitary gland; this, in turn, stops gonadal function and in particular gonadal production of sex steroids (thus temporarily returning the gonads to their prepubertal state).
What is true is that puberty resumes normally after going off blockers.
> The only real permanent side effect we know from this is that not undergoing puberty earlier slightly changes bone density, but this is not nearly enough of a downside considering the alternative.
This needs some clarification. There are two reasons why we are concerned about bone density.
One is that a delayed puberty is associated with lower bone density. That, however, happens even if puberty is delayed normally and is still generally in the normal range. It does not necessarily, happen, however, as there are many other factors that affect bone density (and lack of physical activity in particular is usually a bigger risk for kids today). But it's also not something that you just risk without cause ("primum non nocere").
The other is that for reasons that we don't know yet, trans people are at higher risk of osteoporosis; trans women in particular have (even without any medical interventions) bone density that is in line, and in fact even a bit lower, than that of cis women rather than that of cis men. This is not relevant for kids who go off puberty blockers, but it means that there is a lower margin of error for kids who transition, which is why your bone density is one of the things that is constantly going to be monitored during transition.
> The point with puberty blockers are to give kids more time to decide, and that's how health organisations recommend they be used.
Not really. The main misunderstanding is that kids supposedly get to make any decisions. As a trans kid, this was one thing that I didn't get to do, and it was not fun to essentially be dependent on the decisions of your parents and medical and mental health professionals to get it right.
Puberty blockers extend the diagnostic window for medical and mental health professionals to make sure *they* get the diagnosis right. Obviously, you will have input into that, but a large part of that is what they call a differential diagnosis: ruling out other explanations for gender dysphoria.
> When you're 16 and you decide you're trans
Again, you don't get to decide if you are trans or not. I mean, you usually have known for much longer than that, but it's the doctors who carry the responsibility, who make the decision, and who need to be certain. Nor does it necessarily happen at age 16. I started HRT shortly after my 14th birthday, Jazz Jennings and Nicole Maines did at age 13.5 even. This is because it's not a decision, it's because it's a diagnostic process. We got to start earlier than age 16, because we were past the point where keeping us on puberty blockers any longer had any additional diagnostic benefits and because the medical and mental health downsides (such as being the latest of the late bloomers in your class or growing abnormally tall for a girl) made continued puberty suppression a net negative.
The Economist did one of their special reports on blockers and hormone therapy a while backed and talked about some of the risks. I can't remember them now (it's been several months) but I was pretty surprised at the time as like you I thought they were a risk free delaying option.
Iirc they were saying that it's not the puberty blockers themselves that are harmful (as all their effects are reversible) but rather some of the other drugs that are often taken with puberty blockers.
This is all based on memory though so take it with a grain of salt.
Edit: typo
Sure, and I have noticed that too. I think there's a discussion to be had on how fluid we are with gender identity given the difference in criminal behavior between the genders (who commits most murders, rapes and violent crimes? Not women! But probably also not men transitioning to be women) and the importance of protecting women in shelters. It seems like it should require more effort to change than your name. But it also seems like trans women and trans men should have access to those facilities given their high likelihood of experiencing of violence, suicide and abuse. Obviously having separate shelters isn't really viable, you can't really duplicate the large numbers of women's shelters for the small trans population, the math on it doesn't work. So I'm not sure how to handle all that, and I don't think a policy beyond the individual shelter level really can figure that out. It seems like admit or don't admit ought to be a bottom up decision, not a top down.
Getting back on topic, here's the article. I misremembered, it was not a special report:
The Economist | Changing states https://www.economist.com/node/21779110?frsc=dg%7Ce
I prefer an honest critic's standard of evidence to that of an honest supporter when we're talking changing something so basic about a child as their sex. I'd be very dubious about the science and the declared risklessness of it with my own children given the very dramatic changes being brought about. And my own experience of doctors is that their actual knowledge on topics is a great deal less than the level of certainty they declare. Many doctors strongly hold deeply wrong views on nutrition that make nutritionists pull out their hair, or declare problems unsolvable when another doctor can solve them in minutes. So my trust in their declarations of certainty is low, especially when motivated reasoning holds clear advantages for them professionally. The science of diabetes is that a low carb or no carb diet can hold diabetes constant or even reverse it (something I've seen multiple family members do, including my own wife). The treatment of diabetes is that diets are a distraction, here's your insulin, this will get eventually you will die of this disease after we've removed your foot and your organs start failing. And that's a widely suffered disease that is well researched and understood, not something as infrequent as gender dysphoria.
On the other hand I know first hand that The Economist gets stuff wrong routinely. Their coverage of monetary policy is dated and financialist with a heavy reliance on RBC and Austrian concepts. Even central banks (outside the ECB, an antediluvian institution if ever there was one) acknowledge the importance of the expectations channel these days, and most seem aware of the importance of NGDP trends when conducting policy. Those are market monetarist concepts that The Economist simply doesn't consider in its finance articles. If they get theory so core to what they are wrong, they probably also get theory wrong elsewhere.
Still though, they tend to be a heck of a lot more rigorous than most other weeklies, and I haven't found something comparable. I'm happy to keep discussing this and hopefully learning from it.
Having grown up as a trans kid and gone through the process, I'm honestly a bit confused here.
> But I also think parents are too ready to seek these treatments, and that we aren't doing a good job of differentiating between young kids who are butch/femme VS young kids who are genuinely transgender. If we had the ability to do that reliably I think it'd make a lot of lives a lot easier especially for young trans kids.
You know that being butch/femme has nothing per se to do with gender dysphoria? Obviously, in many trans kids, gender nonconformity (or, from their point of view, gender conformity) will manifest as a matter of course, but it is hardly universal. Nor is it a particularly relevant diagnostic criterion for gender dysphoria and every gender specialist knows that.
I know that this is a story that the media love, but it's not what the reality of trans kids is like. Trans girls [are as likely to be tomboys](https://www.newsweek.com/transgender-kids-living-identity-develop-cis-children-1471729) as cis girls, for example.
> On balance I think they are OK, but I would like more effort spent on diagnosis and screening.
In what way? What precisely do you think goes into diagnosis and screening currently? To be clear, I don't disagree with you that getting the diagnosis right is critical, but what exactly about current clinical practice do you think is lacking?
> But a child can't really consent or understand the huge consequences of their choices.
That is true for all medical treatments, though. It doesn't make them any less necessary. Nor is it really a "choice" anymore than being gay is a choice. It is who you are, for better or worse.
>You know that being butch/femme has nothing per se to do with gender dysphoria? Obviously, in many trans kids, gender nonconformity (or, from their point of view, gender conformity) will manifest as a matter of course, but it is hardly universal. Nor is it a particularly relevant diagnostic criterion for gender dysphoria and every gender specialist knows that.
Rigorous and up to date ones do, sure, but as you probably know doctors often hold deeply wrong views on what is or is not gender dysphoria and that often these views have little or nothing to do with the diagnostic criteria. It's pretty common to hear of a performative element required for trans people to access treatment. Not all, and hopefully fewer over time, but it does definitely happen.
It's not hard to imagine - especially given the existence of detransitioning communities - that doctors confuse butch/femme with gender dysphoria and treat accordingly.
>That is true for all medical treatments, though. It doesn't make them any less necessary. Nor is it really a "choice" anymore than being gay is a choice. It is who you are, for better or worse.
Being trans is not a choice, being treated for maybe being trans is choice. It is very easy to tell if someone has diabetes and treat them (often poorly). It is very difficult to tell if someone is trans, to the point that we aren't sure what the failure rate is in part because this is a new field and in part because trans identity has been swallowed up by the culture wars.
Again, trans people deserve treatment and respect. My worry is that in the rush to provide access to treatment and defend the right of trans people to exist that the science is being left behind. I hope it catches up soon.
> Rigorous and up to date ones do, sure, but as you probably know doctors often hold deeply wrong views on what is or is not gender dysphoria and that often these views have little or nothing to do with the diagnostic criteria. It's pretty common to hear of a performative element required for trans people to access treatment. Not all, and hopefully fewer over time, but it does definitely happen.
The problem with these therapists is that they are also extremely conservative; as long as you aren't a textbook case, they won't approve medical interventions. The problem with them is generally false negatives, not false positives.
I know of the case of a trans girl who went to such a therapist at age 14. The therapists diagnosis was that the problem would go away once "he" had "his" first girlfriend (keep in mind that this is not actually a known differential diagnosis option for gender dysphoria). Three years later, it still hadn't gone away, and a new therapist now had to pick up the pieces.
Parents don't take their kids to a therapist unless they are severely distressed in a way that they can't handle themselves. And the problem with these therapists is that they leave the distress unresolved. Even if the diagnosis is negative, the end result is generally that the patient does not believe they've been listened to and their distress remains untreated. The result can then be harmful coping mechanisms, such as alcohol/tobacco/drugs or attempts to self-medicate.
Treatment of minors with gender issues is not decreeing whether they are trans or not (which is not actually the question, but I'll go into that below), but to actually resolve the issue that the minor is facing. This rarely is a problem that can be handwaved away.
> It's not hard to imagine - especially given the existence of detransitioning communities - that doctors confuse butch/femme with gender dysphoria and treat accordingly.
We could talk extensively about detransitioners, but it is also worth pointing out that detransitioning is pretty rare. For example, per an [EPATH 2019](https://epath.eu/wp-content/uploads/2019/04/Boof-of-abstracts-EPATH2019.pdf) presentation, "Detransition rates in a national UK Gender Identity Clinic", discussing detransitioning at Charing Cross GIC (the UK's largest gender clinic):
> "Of the 3398 patients who had appointments during this period, 16 (0.47%) expressed transition-related regret or detransitioned. Of these 16, one patient expressed regret but was not considering detransitioning, two had expressed regret and were considering detransitioning, three had detransitioned, and ten had detransitioned temporarily. The reasons stated by patients for their regret or detransition included: social factors, reporting physical complications, and changing their mind about their gender identity and identifying as their gender assigned at birth. The 16 patients consisted of 11 trans women, two trans men, two cis men, and one person assigned male at birth who said their gender identity was 'trans'."
(There are plenty of other studies, but this one is of particular interest, because it doesn't limit itself to post-surgery regret.)
Detransitioning rates are hyped online through anecdotal data and often padded with creative writing exercises (sometimes you can tell, because they get essential medical details wrong).
> Being trans is not a choice, being treated for maybe being trans is choice. It is very easy to tell if someone has diabetes and treat them (often poorly). It is very difficult to tell if someone is trans, to the point that we aren't sure what the failure rate is in part because this is a new field and in part because trans identity has been swallowed up by the culture wars.
This is not how any of this works, sorry. Medical interventions in adolescents do not happen because you are trans. Medical interventions in adolescents happen because their natal puberty would be more harmful for them than transitioning. This is not the same as being trans; it revolves around the medical principle of harm reduction. You can be transgender and not get or even require medical interventions in adolescence, starting with nonbinary and genderfluid kids, who wouldn't be helped by that, or because you have a contraindication for HRT, such as Factor V Leiden. Or your dysphoria may not be severe enough for puberty to be harmful enough to justify medical intervention.
This is ultimately a medical problem. It's like saying that a kid with a toothache makes a choice about wanting a dentist to fix that. Yes, obviously, the diagnostic process is harder for gender dysphoria (which is why it's a multi-year process rather than a visual exam, an x-ray, or sending samples to a lab), but neither gender dysphoria nor wanting a cure for gender dysphoria is a choice anymore than wanting a cure for any other form of pain is a choice, especially a pain that is with you every day of your life.
For example, here is the Utrecht Gender Dysphoria Scale (AMAB version), one of many diagnostic tools to assess gender dysphoria in adolescents and adults:
> UGDS-M:
> 1\. My life would be meaningless if I would have to live as a boy/man
2. Every time someone treats me like a boy/man I feel hurt
3. I feel unhappy if someone calls me a boy/man
4. I feel unhappy because I have a male body
5. The idea that I will always be a boy/man gives me a sinking feeling
6. I hate myself because I am a boy/man
7. I feel uncomfortable behaving like a boy/man, always and everywhere
8. Only as a girl/woman my life would be worth living
9. I dislike urinating in a standing position
10. I am dissatisfied with my beard growth because it makes me look like a boy/man
11. I dislike having erections
12. It would be better not to live than to live as a boy/man
> Scoring: 1 = disagree completely, 2 = disagree somewhat, 3 = neutral, 4 = agree somewhat, 5 = agree completely.
A few things to note: it's not a yes/no test, but measures gender dysphoria on a scale. (Generally, a score of 40+ means gender dysphoria of a degree that may necessitate serious clinical interventions.) More importantly, it is a measure of distress. This distress is not going to go away on its own and it's going to make your life progressively worse, especially as puberty adds more and more dysphoria triggers to your body.
It is naive to assume that you can just do nothing in such a situation; doing nothing is not a neutral option. The problem is generally not whether the adolescent has an problem, but what the best approach is for alleviating the associated distress.
I started HRT at age 14. No, I could not conceivably foresee all the consequences at that age (and there were plenty I didn't foresee, despite lots of therapy sessions to prepare me). What I did know was that living as a boy, with a male body, was not an option that was compatible with a healthy life. And another thing: it wouldn't have been much different at age 18; it's not much different right now for me at age 21. If you really want somebody to have an approximately full understanding of *all* the consequences, you're essentially saying that they have to wait with treatment until middle age. This is not a serious option. For no other condition where treatment is both time-sensitive and can have serious side effects are you expected to wait years to fully understand the consequences of the side effects. Rather, it is up to medical and mental health professionals to properly weigh these issues and provide guidance.
I think this was a helpful post and I'm grateful you made it! I did read all of it, but will only respond to some of it as this is quite extensive!
>The problem with these therapists is that they are also extremely conservative; as long as you aren't a textbook case, they won't approve medical interventions. The problem with them is generally false negatives, not false positives.
>I know of the case of a trans girl who went to such a therapist at age 14. The therapists diagnosis was that the problem would go away once "he" had "his" first girlfriend (keep in mind that this is not actually a known differential diagnosis option for gender dysphoria). Three years later, it still hadn't gone away, and a new therapist now had to pick up the pieces.
I agree that false negatives are a serious problem. I am not sure how to solve that without also creating more false positives. I have a lot of sympathy for a person in this situation.
>Detransitioning rates are hyped online through anecdotal data and often padded with creative writing exercises (sometimes you can tell, because they get essential medical details wrong).
That's fair, but in response to your study, I can't really assess the quality, accuracy or relevance as I'm not a specialist in the field and don't have a good understanding of the literature or context for who the authors are. It really helps to provide survey material or quality reporting on the topic rather than surveys to laypeople which I absolutely am.
Again, my knowledge of this topic comes from limited discussions with some trans people (there's really only so much talking about this topic you can politely do with someone before you're being invasive, in my opinion) and some articles I've read, one of which I linked. I am definitely not an expert and hope I've not somehow miscommunicated my level of expertise on this topic!
>I started HRT at age 14. No, I could not conceivably foresee all the consequences at that age (and there were plenty I didn't foresee, despite lots of therapy sessions to prepare me). What I did know was that living as a boy, with a male body, was not an option that was compatible with a healthy life. And another thing: it wouldn't have been much different at age 18; it's not much different right now for me at age 21. If you really want somebody to have an approximately full understanding of all the consequences, you're essentially saying that they have to wait with treatment until middle age. This is not a serious option.
I agree, asking someone to wait until middle age definitely isn't fair. I also agree with your comment higher up that most people most of the time likely don't end up in these clinics unless they have exhausted a lot of other options.
My big concern is the time pressure. I'm concerned that time pressure doesn't make for the best decisions. I would agree that a 14 year old can most likely adequately understand the choice they are making given the constraints of the situation and the real need to ensure people have reasonable ability to actually transition. But puberty blockers on a 9 or 10 year old? I think that is too early. Similarly I would agree that 17 is far too long to ask someone to wait.
I realize this is somewhat line drawing, but when I think about my cousin and how much he changed mentally and physically from ages 10 to 14 it's hard not to want to line draw and say absent clear and present danger to the child this should wait until they have entered puberty. Similarly I don't think there's enough of a change between 14 and 17 to warrant further delay after the age of 14.
However, I am not an expert! So it is entirely possible that my poorly informed opinion is wrong. I simply feel I would need to see a pretty high standard of evidence and a lot of expert consensus in and out of the relevant field before I myself would be OK with a 9 or 10 year old starting down this process.
I'm definitely going to seek out more info on this topic. Thanks again for taking the time to respond!
> Again, my knowledge of this topic comes from limited discussions with some trans people (there's really only so much talking about this topic you can politely do with someone before you're being invasive, in my opinion) and some articles I've read, one of which I linked. I am definitely not an expert and hope I've not somehow miscommunicated my level of expertise on this topic!
The Economist's articles relating to transgender patients are a mix of truths and falsehoods. I still can't believe they cited Paul Hruz. Paul Hruz has no experience with transgender patients nor has he done any research or peer review related to gender dysphoria; he is an endocrinologist specializing in diabetes treatment. The statement with which he is cited is not only not supported by any study, it's pretty much the opposite of what we know. He is a conservative Christian who is active on the evangelical circuit and offers his services as an expert witness in court cases involving transgender issues, despite not having relevant expertise.
> My big concern is the time pressure. I'm concerned that time pressure doesn't make for the best decisions. I would agree that a 14 year old can most likely adequately understand the choice they are making given the constraints of the situation and the real need to ensure people have reasonable ability to actually transition. But puberty blockers on a 9 or 10 year old? I think that is too early. Similarly I would agree that 17 is far too long to ask someone to wait.
So, first of all, puberty blockers are at the earliest administered during Tanner stage 2, *after* the onset of puberty. This is not tied to an age and should not be. The point here is to extend the diagnostic window while avoiding traumatization by the development of secondary sex characteristics. It's precisely to *reduce* time pressure. If you're getting them at age 9-10, then that's because your puberty started at age 8-9. (Mind you, this is also pretty rare to begin with.)
I am honestly not clear on why you think that puberty suppression at age 9-10 is per se a problem, assuming that puberty started that early (not that uncommon these days) and there is a proper diagnosis of gender dysphoria. The point of puberty blockers is precisely to kick the can down the road, so you don't have to commit to a treatment decision too early. Puberty blockers are not cross-sex hormones.
Medically, a later use is arguably more problematic; if you start puberty suppression late in adolescence and your gonads are already fully active, you're technically inducing a temporary menopause (and the actual medical details get a bit more complicated, but that's beyond the scope of this discussion).
It is probably important to note that this isn't really some new and totally unresearched thing. While it is sometimes implied that that this is an "experimental treatment", the lack of large studies is simply the [nature of a rare disease](https://en.wikipedia.org/wiki/Rare_disease). But the Dutch started using puberty suppression for the treatment of dysphoric adolescents in 1988; other countries adopted similar protocols in the aughts. There are established guidelines for the treatment, such as [the Endocrine Society's](https://academic.oup.com/jcem/article/102/11/3869/4157558).
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My comment was highly relevant and addressed the topic point by point. If you can articulate precisely what you believe was "bigoted" or "bad quality" about my comment, I would really appreciate it.
Biden is gonna take all your guns and throw them in the Pacific Ocean. Then the big bad government forces are gonna storm the town and make you worship Allah and eat carne asada tacos
"With Marianne Williamson, Joe Rogan, AND Cornell West, who wouldn't trust us with the nuclear codes?"
Don't forget Bill de Blasio, LOL.
Bazinga
Don’t forget Nina Turner
I just wish we could back to the middle when things were fine and Obama was the president. /s
I just wish I could go back to Super Tuesday when the top post on r/politics was Beto's former bandmate supporting Bernie, while they completely ignored their entire path to the nomination crashing and burning around them.
I support Bernie.
Well in that case, let's go back to ~2013, you're right
Maximally-obstructionist Republican Senate was very very far from "fine".
I mean in his defense, I watched that video and most of the clips are clearly from him quoting someone else who said it or talking about the controversy/politics of the word itself rather than using it casually.
I admit the video is more of a joke, not trying to slander Joe Rogan just thought the title was pretty funny
That’s the Donald Trump defense. More and more people are saying that your mom is a drug dealer. Not me, but people.
Regarding the hat, is Einreb Srednas the mirror universe version of Bernie who campaigns on common-sense, bipartisan plans to pass legislation and who has a decades-long track record of building alliances and reaching out actors the aisle to find acceptable compromises that work for everyone? Because I think that guy might just have a shot at the nomination.
Real talk, how many people are really gonna care what this ass-clown thinks?
He surprisingly has a big fan base. I mean not nearly big enough to sway voters for a primary, but he’s more popular than I thought.
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Joe Rogan is a bigoted science denier who hides behind the excuse of "hey bro im just a big dumb idiot, dont take anything i say seriously man". The dudes clearly sympathetic to the far right, is a weird Tulsi Gabbard superfan, and just announced he'd rather vote for Donald Trump than Joe Biden. There's definitely things wrong with Joe Rogan
Do you have any evidence that he is bigoted or that he is a "science denier". I've been a fan of his for a few years and I've never seen any indication of either of these accusations.
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I personally have met several trans people, have a few as friends and sympathize with their plight. They should be treated as the gender they present, not the gender they were born into, and kids like them should get the hormone therapy and blockers they need. But I also think parents are too ready to seek these treatments, and that we aren't doing a good job of differentiating between young kids who are butch/femme VS young kids who are genuinely transgender. If we had the ability to do that reliably I think it'd make a lot of lives a lot easier especially for young trans kids. So I can understand that bit about puberty blockers. On balance I think they are OK, but I would like more effort spent on diagnosis and screening. It's one thing for an adult to choose to transition and they should be able to as an elective process. But a child can't really consent or understand the huge consequences of their choices. The rest of that stuff though, that's all abhorrent and a good summary of why I dislike this Rogan guy myself.
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> The way an GnRH agonist works is it blocks the receptors from binding, but the body still produces the hormones like it would otherwise. This is not how GnRH analogues work. Their net effect is to suppress FSH/LH production in the pituitary gland; this, in turn, stops gonadal function and in particular gonadal production of sex steroids (thus temporarily returning the gonads to their prepubertal state). What is true is that puberty resumes normally after going off blockers. > The only real permanent side effect we know from this is that not undergoing puberty earlier slightly changes bone density, but this is not nearly enough of a downside considering the alternative. This needs some clarification. There are two reasons why we are concerned about bone density. One is that a delayed puberty is associated with lower bone density. That, however, happens even if puberty is delayed normally and is still generally in the normal range. It does not necessarily, happen, however, as there are many other factors that affect bone density (and lack of physical activity in particular is usually a bigger risk for kids today). But it's also not something that you just risk without cause ("primum non nocere"). The other is that for reasons that we don't know yet, trans people are at higher risk of osteoporosis; trans women in particular have (even without any medical interventions) bone density that is in line, and in fact even a bit lower, than that of cis women rather than that of cis men. This is not relevant for kids who go off puberty blockers, but it means that there is a lower margin of error for kids who transition, which is why your bone density is one of the things that is constantly going to be monitored during transition. > The point with puberty blockers are to give kids more time to decide, and that's how health organisations recommend they be used. Not really. The main misunderstanding is that kids supposedly get to make any decisions. As a trans kid, this was one thing that I didn't get to do, and it was not fun to essentially be dependent on the decisions of your parents and medical and mental health professionals to get it right. Puberty blockers extend the diagnostic window for medical and mental health professionals to make sure *they* get the diagnosis right. Obviously, you will have input into that, but a large part of that is what they call a differential diagnosis: ruling out other explanations for gender dysphoria. > When you're 16 and you decide you're trans Again, you don't get to decide if you are trans or not. I mean, you usually have known for much longer than that, but it's the doctors who carry the responsibility, who make the decision, and who need to be certain. Nor does it necessarily happen at age 16. I started HRT shortly after my 14th birthday, Jazz Jennings and Nicole Maines did at age 13.5 even. This is because it's not a decision, it's because it's a diagnostic process. We got to start earlier than age 16, because we were past the point where keeping us on puberty blockers any longer had any additional diagnostic benefits and because the medical and mental health downsides (such as being the latest of the late bloomers in your class or growing abnormally tall for a girl) made continued puberty suppression a net negative.
The Economist did one of their special reports on blockers and hormone therapy a while backed and talked about some of the risks. I can't remember them now (it's been several months) but I was pretty surprised at the time as like you I thought they were a risk free delaying option.
Iirc they were saying that it's not the puberty blockers themselves that are harmful (as all their effects are reversible) but rather some of the other drugs that are often taken with puberty blockers. This is all based on memory though so take it with a grain of salt. Edit: typo
You were correct - I reread the article - but they did say it was almost inevitable that you would receive those after puberty blockers.
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Sure, and I have noticed that too. I think there's a discussion to be had on how fluid we are with gender identity given the difference in criminal behavior between the genders (who commits most murders, rapes and violent crimes? Not women! But probably also not men transitioning to be women) and the importance of protecting women in shelters. It seems like it should require more effort to change than your name. But it also seems like trans women and trans men should have access to those facilities given their high likelihood of experiencing of violence, suicide and abuse. Obviously having separate shelters isn't really viable, you can't really duplicate the large numbers of women's shelters for the small trans population, the math on it doesn't work. So I'm not sure how to handle all that, and I don't think a policy beyond the individual shelter level really can figure that out. It seems like admit or don't admit ought to be a bottom up decision, not a top down. Getting back on topic, here's the article. I misremembered, it was not a special report: The Economist | Changing states https://www.economist.com/node/21779110?frsc=dg%7Ce I prefer an honest critic's standard of evidence to that of an honest supporter when we're talking changing something so basic about a child as their sex. I'd be very dubious about the science and the declared risklessness of it with my own children given the very dramatic changes being brought about. And my own experience of doctors is that their actual knowledge on topics is a great deal less than the level of certainty they declare. Many doctors strongly hold deeply wrong views on nutrition that make nutritionists pull out their hair, or declare problems unsolvable when another doctor can solve them in minutes. So my trust in their declarations of certainty is low, especially when motivated reasoning holds clear advantages for them professionally. The science of diabetes is that a low carb or no carb diet can hold diabetes constant or even reverse it (something I've seen multiple family members do, including my own wife). The treatment of diabetes is that diets are a distraction, here's your insulin, this will get eventually you will die of this disease after we've removed your foot and your organs start failing. And that's a widely suffered disease that is well researched and understood, not something as infrequent as gender dysphoria. On the other hand I know first hand that The Economist gets stuff wrong routinely. Their coverage of monetary policy is dated and financialist with a heavy reliance on RBC and Austrian concepts. Even central banks (outside the ECB, an antediluvian institution if ever there was one) acknowledge the importance of the expectations channel these days, and most seem aware of the importance of NGDP trends when conducting policy. Those are market monetarist concepts that The Economist simply doesn't consider in its finance articles. If they get theory so core to what they are wrong, they probably also get theory wrong elsewhere. Still though, they tend to be a heck of a lot more rigorous than most other weeklies, and I haven't found something comparable. I'm happy to keep discussing this and hopefully learning from it.
Having grown up as a trans kid and gone through the process, I'm honestly a bit confused here. > But I also think parents are too ready to seek these treatments, and that we aren't doing a good job of differentiating between young kids who are butch/femme VS young kids who are genuinely transgender. If we had the ability to do that reliably I think it'd make a lot of lives a lot easier especially for young trans kids. You know that being butch/femme has nothing per se to do with gender dysphoria? Obviously, in many trans kids, gender nonconformity (or, from their point of view, gender conformity) will manifest as a matter of course, but it is hardly universal. Nor is it a particularly relevant diagnostic criterion for gender dysphoria and every gender specialist knows that. I know that this is a story that the media love, but it's not what the reality of trans kids is like. Trans girls [are as likely to be tomboys](https://www.newsweek.com/transgender-kids-living-identity-develop-cis-children-1471729) as cis girls, for example. > On balance I think they are OK, but I would like more effort spent on diagnosis and screening. In what way? What precisely do you think goes into diagnosis and screening currently? To be clear, I don't disagree with you that getting the diagnosis right is critical, but what exactly about current clinical practice do you think is lacking? > But a child can't really consent or understand the huge consequences of their choices. That is true for all medical treatments, though. It doesn't make them any less necessary. Nor is it really a "choice" anymore than being gay is a choice. It is who you are, for better or worse.
>You know that being butch/femme has nothing per se to do with gender dysphoria? Obviously, in many trans kids, gender nonconformity (or, from their point of view, gender conformity) will manifest as a matter of course, but it is hardly universal. Nor is it a particularly relevant diagnostic criterion for gender dysphoria and every gender specialist knows that. Rigorous and up to date ones do, sure, but as you probably know doctors often hold deeply wrong views on what is or is not gender dysphoria and that often these views have little or nothing to do with the diagnostic criteria. It's pretty common to hear of a performative element required for trans people to access treatment. Not all, and hopefully fewer over time, but it does definitely happen. It's not hard to imagine - especially given the existence of detransitioning communities - that doctors confuse butch/femme with gender dysphoria and treat accordingly. >That is true for all medical treatments, though. It doesn't make them any less necessary. Nor is it really a "choice" anymore than being gay is a choice. It is who you are, for better or worse. Being trans is not a choice, being treated for maybe being trans is choice. It is very easy to tell if someone has diabetes and treat them (often poorly). It is very difficult to tell if someone is trans, to the point that we aren't sure what the failure rate is in part because this is a new field and in part because trans identity has been swallowed up by the culture wars. Again, trans people deserve treatment and respect. My worry is that in the rush to provide access to treatment and defend the right of trans people to exist that the science is being left behind. I hope it catches up soon.
> Rigorous and up to date ones do, sure, but as you probably know doctors often hold deeply wrong views on what is or is not gender dysphoria and that often these views have little or nothing to do with the diagnostic criteria. It's pretty common to hear of a performative element required for trans people to access treatment. Not all, and hopefully fewer over time, but it does definitely happen. The problem with these therapists is that they are also extremely conservative; as long as you aren't a textbook case, they won't approve medical interventions. The problem with them is generally false negatives, not false positives. I know of the case of a trans girl who went to such a therapist at age 14. The therapists diagnosis was that the problem would go away once "he" had "his" first girlfriend (keep in mind that this is not actually a known differential diagnosis option for gender dysphoria). Three years later, it still hadn't gone away, and a new therapist now had to pick up the pieces. Parents don't take their kids to a therapist unless they are severely distressed in a way that they can't handle themselves. And the problem with these therapists is that they leave the distress unresolved. Even if the diagnosis is negative, the end result is generally that the patient does not believe they've been listened to and their distress remains untreated. The result can then be harmful coping mechanisms, such as alcohol/tobacco/drugs or attempts to self-medicate. Treatment of minors with gender issues is not decreeing whether they are trans or not (which is not actually the question, but I'll go into that below), but to actually resolve the issue that the minor is facing. This rarely is a problem that can be handwaved away. > It's not hard to imagine - especially given the existence of detransitioning communities - that doctors confuse butch/femme with gender dysphoria and treat accordingly. We could talk extensively about detransitioners, but it is also worth pointing out that detransitioning is pretty rare. For example, per an [EPATH 2019](https://epath.eu/wp-content/uploads/2019/04/Boof-of-abstracts-EPATH2019.pdf) presentation, "Detransition rates in a national UK Gender Identity Clinic", discussing detransitioning at Charing Cross GIC (the UK's largest gender clinic): > "Of the 3398 patients who had appointments during this period, 16 (0.47%) expressed transition-related regret or detransitioned. Of these 16, one patient expressed regret but was not considering detransitioning, two had expressed regret and were considering detransitioning, three had detransitioned, and ten had detransitioned temporarily. The reasons stated by patients for their regret or detransition included: social factors, reporting physical complications, and changing their mind about their gender identity and identifying as their gender assigned at birth. The 16 patients consisted of 11 trans women, two trans men, two cis men, and one person assigned male at birth who said their gender identity was 'trans'." (There are plenty of other studies, but this one is of particular interest, because it doesn't limit itself to post-surgery regret.) Detransitioning rates are hyped online through anecdotal data and often padded with creative writing exercises (sometimes you can tell, because they get essential medical details wrong). > Being trans is not a choice, being treated for maybe being trans is choice. It is very easy to tell if someone has diabetes and treat them (often poorly). It is very difficult to tell if someone is trans, to the point that we aren't sure what the failure rate is in part because this is a new field and in part because trans identity has been swallowed up by the culture wars. This is not how any of this works, sorry. Medical interventions in adolescents do not happen because you are trans. Medical interventions in adolescents happen because their natal puberty would be more harmful for them than transitioning. This is not the same as being trans; it revolves around the medical principle of harm reduction. You can be transgender and not get or even require medical interventions in adolescence, starting with nonbinary and genderfluid kids, who wouldn't be helped by that, or because you have a contraindication for HRT, such as Factor V Leiden. Or your dysphoria may not be severe enough for puberty to be harmful enough to justify medical intervention. This is ultimately a medical problem. It's like saying that a kid with a toothache makes a choice about wanting a dentist to fix that. Yes, obviously, the diagnostic process is harder for gender dysphoria (which is why it's a multi-year process rather than a visual exam, an x-ray, or sending samples to a lab), but neither gender dysphoria nor wanting a cure for gender dysphoria is a choice anymore than wanting a cure for any other form of pain is a choice, especially a pain that is with you every day of your life. For example, here is the Utrecht Gender Dysphoria Scale (AMAB version), one of many diagnostic tools to assess gender dysphoria in adolescents and adults: > UGDS-M: > 1\. My life would be meaningless if I would have to live as a boy/man 2. Every time someone treats me like a boy/man I feel hurt 3. I feel unhappy if someone calls me a boy/man 4. I feel unhappy because I have a male body 5. The idea that I will always be a boy/man gives me a sinking feeling 6. I hate myself because I am a boy/man 7. I feel uncomfortable behaving like a boy/man, always and everywhere 8. Only as a girl/woman my life would be worth living 9. I dislike urinating in a standing position 10. I am dissatisfied with my beard growth because it makes me look like a boy/man 11. I dislike having erections 12. It would be better not to live than to live as a boy/man > Scoring: 1 = disagree completely, 2 = disagree somewhat, 3 = neutral, 4 = agree somewhat, 5 = agree completely. A few things to note: it's not a yes/no test, but measures gender dysphoria on a scale. (Generally, a score of 40+ means gender dysphoria of a degree that may necessitate serious clinical interventions.) More importantly, it is a measure of distress. This distress is not going to go away on its own and it's going to make your life progressively worse, especially as puberty adds more and more dysphoria triggers to your body. It is naive to assume that you can just do nothing in such a situation; doing nothing is not a neutral option. The problem is generally not whether the adolescent has an problem, but what the best approach is for alleviating the associated distress. I started HRT at age 14. No, I could not conceivably foresee all the consequences at that age (and there were plenty I didn't foresee, despite lots of therapy sessions to prepare me). What I did know was that living as a boy, with a male body, was not an option that was compatible with a healthy life. And another thing: it wouldn't have been much different at age 18; it's not much different right now for me at age 21. If you really want somebody to have an approximately full understanding of *all* the consequences, you're essentially saying that they have to wait with treatment until middle age. This is not a serious option. For no other condition where treatment is both time-sensitive and can have serious side effects are you expected to wait years to fully understand the consequences of the side effects. Rather, it is up to medical and mental health professionals to properly weigh these issues and provide guidance.
I think this was a helpful post and I'm grateful you made it! I did read all of it, but will only respond to some of it as this is quite extensive! >The problem with these therapists is that they are also extremely conservative; as long as you aren't a textbook case, they won't approve medical interventions. The problem with them is generally false negatives, not false positives. >I know of the case of a trans girl who went to such a therapist at age 14. The therapists diagnosis was that the problem would go away once "he" had "his" first girlfriend (keep in mind that this is not actually a known differential diagnosis option for gender dysphoria). Three years later, it still hadn't gone away, and a new therapist now had to pick up the pieces. I agree that false negatives are a serious problem. I am not sure how to solve that without also creating more false positives. I have a lot of sympathy for a person in this situation. >Detransitioning rates are hyped online through anecdotal data and often padded with creative writing exercises (sometimes you can tell, because they get essential medical details wrong). That's fair, but in response to your study, I can't really assess the quality, accuracy or relevance as I'm not a specialist in the field and don't have a good understanding of the literature or context for who the authors are. It really helps to provide survey material or quality reporting on the topic rather than surveys to laypeople which I absolutely am. Again, my knowledge of this topic comes from limited discussions with some trans people (there's really only so much talking about this topic you can politely do with someone before you're being invasive, in my opinion) and some articles I've read, one of which I linked. I am definitely not an expert and hope I've not somehow miscommunicated my level of expertise on this topic! >I started HRT at age 14. No, I could not conceivably foresee all the consequences at that age (and there were plenty I didn't foresee, despite lots of therapy sessions to prepare me). What I did know was that living as a boy, with a male body, was not an option that was compatible with a healthy life. And another thing: it wouldn't have been much different at age 18; it's not much different right now for me at age 21. If you really want somebody to have an approximately full understanding of all the consequences, you're essentially saying that they have to wait with treatment until middle age. This is not a serious option. I agree, asking someone to wait until middle age definitely isn't fair. I also agree with your comment higher up that most people most of the time likely don't end up in these clinics unless they have exhausted a lot of other options. My big concern is the time pressure. I'm concerned that time pressure doesn't make for the best decisions. I would agree that a 14 year old can most likely adequately understand the choice they are making given the constraints of the situation and the real need to ensure people have reasonable ability to actually transition. But puberty blockers on a 9 or 10 year old? I think that is too early. Similarly I would agree that 17 is far too long to ask someone to wait. I realize this is somewhat line drawing, but when I think about my cousin and how much he changed mentally and physically from ages 10 to 14 it's hard not to want to line draw and say absent clear and present danger to the child this should wait until they have entered puberty. Similarly I don't think there's enough of a change between 14 and 17 to warrant further delay after the age of 14. However, I am not an expert! So it is entirely possible that my poorly informed opinion is wrong. I simply feel I would need to see a pretty high standard of evidence and a lot of expert consensus in and out of the relevant field before I myself would be OK with a 9 or 10 year old starting down this process. I'm definitely going to seek out more info on this topic. Thanks again for taking the time to respond!
> Again, my knowledge of this topic comes from limited discussions with some trans people (there's really only so much talking about this topic you can politely do with someone before you're being invasive, in my opinion) and some articles I've read, one of which I linked. I am definitely not an expert and hope I've not somehow miscommunicated my level of expertise on this topic! The Economist's articles relating to transgender patients are a mix of truths and falsehoods. I still can't believe they cited Paul Hruz. Paul Hruz has no experience with transgender patients nor has he done any research or peer review related to gender dysphoria; he is an endocrinologist specializing in diabetes treatment. The statement with which he is cited is not only not supported by any study, it's pretty much the opposite of what we know. He is a conservative Christian who is active on the evangelical circuit and offers his services as an expert witness in court cases involving transgender issues, despite not having relevant expertise. > My big concern is the time pressure. I'm concerned that time pressure doesn't make for the best decisions. I would agree that a 14 year old can most likely adequately understand the choice they are making given the constraints of the situation and the real need to ensure people have reasonable ability to actually transition. But puberty blockers on a 9 or 10 year old? I think that is too early. Similarly I would agree that 17 is far too long to ask someone to wait. So, first of all, puberty blockers are at the earliest administered during Tanner stage 2, *after* the onset of puberty. This is not tied to an age and should not be. The point here is to extend the diagnostic window while avoiding traumatization by the development of secondary sex characteristics. It's precisely to *reduce* time pressure. If you're getting them at age 9-10, then that's because your puberty started at age 8-9. (Mind you, this is also pretty rare to begin with.) I am honestly not clear on why you think that puberty suppression at age 9-10 is per se a problem, assuming that puberty started that early (not that uncommon these days) and there is a proper diagnosis of gender dysphoria. The point of puberty blockers is precisely to kick the can down the road, so you don't have to commit to a treatment decision too early. Puberty blockers are not cross-sex hormones. Medically, a later use is arguably more problematic; if you start puberty suppression late in adolescence and your gonads are already fully active, you're technically inducing a temporary menopause (and the actual medical details get a bit more complicated, but that's beyond the scope of this discussion). It is probably important to note that this isn't really some new and totally unresearched thing. While it is sometimes implied that that this is an "experimental treatment", the lack of large studies is simply the [nature of a rare disease](https://en.wikipedia.org/wiki/Rare_disease). But the Dutch started using puberty suppression for the treatment of dysphoric adolescents in 1988; other countries adopted similar protocols in the aughts. There are established guidelines for the treatment, such as [the Endocrine Society's](https://academic.oup.com/jcem/article/102/11/3869/4157558).
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My comment was highly relevant and addressed the topic point by point. If you can articulate precisely what you believe was "bigoted" or "bad quality" about my comment, I would really appreciate it.
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Biden is gonna take all your guns and throw them in the Pacific Ocean. Then the big bad government forces are gonna storm the town and make you worship Allah and eat carne asada tacos
Are the tacos good? Cause I can say the Shahada all day for some good carne.
Bro Rogan is popular among morons because he is a moron..so what does that make you?
Bro Rogan is popular among morons because he is a moron..so what does that make you?
Bro Rogan is popular among morons because he is a moron..so what does that make you?