All: Is physically transitioning ethical?

submitted by Penultimate_Penance from self.GCdebatesQT

Given that 80 - 95 percent of kids with gender dysphoria outgrow it naturally without puberty blockers how is it in any way shape or form ethical to give them serious drugs that can have lifelong catastrophic health consequences?

Even for the kids that do persist with the dysphoria, the health consequences are so severe is it really worth it for mere vanity? Superficially looking more like the opposite sex is not a greater good than living a long healthy life.

Is it ethical to give people with mental health issues life altering drugs and surgery that will permanently affect their health negatively? Surely it makes more sense to solve the psychological issue instead of chasing after fools gold by changing the body. Also ethically as an individual in a society, if you cripple yourself chasing after a pipe dream and cause yourself to become a burden on others isn't that morally bad? There are disabled and sick people who would love to have a healthy body, that make the best of what they got. It's quite a contrast compared to the trans movement where people are deliberately putting themselves in harms way to change their superficial appearance.

I'm too tired to list all of terrible health consequences of many of the measures taken by people who choose to physically transition, but there are many consequences that get progressively worse the further extremes people go to to modify their body to make it look more similar to the opposite sex.

The Consequences of puberty blockers particularly Lupron "In addition to preventing the development of secondary sex characteristics, GnRH agonists arrest bone growth, decrease bone accretion, prevent the sex-steroid dependent organization and maturation of the adolescent brain, and inhibit fertility by preventing the development of gonadal tissue and mature gametes for the duration of treatment.

Rosenthal also insists that the effects of Lupron and other such drugs are “100 percent reversible,” a claim the true believers at WPATH support. Is this true? Mounting evidence suggests the answer is no.

If this weren’t enough reason for parents to refuse such treatment for their minor children, Laidlaw says that “what parents should find truly terrifying is the psychological effect of this medication.” Under the traditional treatment for gender dysphoria, which involves “watchful waiting or pursuit of family and individual psychotherapy,” between 80 and 95 percent of adolescent patients outgrow their dysphoria naturally."

Source

Breast Binding Source

Testosterone - Hormone Therapy "In women, a high level of testosterone was tied to a 37% increased risk for type 2 diabetes and a 51% increased risk for polycystic ovary syndrome." Source

Hysterectomy "However, the Mayo team reported that -- compared to women who hadn't had a hysterectomy -- women who had the procedure experienced an average 14 percent higher risk of abnormal blood fat levels; a 13 percent higher risk for high blood pressure; an 18 percent higher risk for obesity and a 33 percent greater risk for heart disease.

Long-term health issues associated with hysterectomy were especially pronounced for younger women. The study found that women younger than 35 had a 4.6-fold higher risk of congestive heart failure and a 2.5-fold greater risk of coronary artery disease, or a buildup of plaque in the arteries." Source

all 46 comments
sorted by:
top
newinsightfulfun

[–]HouseplantWomen who disagree with QT are a different sex 16 insightful - 1 fun16 insightful - 0 fun17 insightful - 1 fun -  (3 children)

Transitioning as an adult is fine. Your body, your money, your right. As long as the adult in question is capable of rational decision-making and understands the risks they are exposing themselves to, no problem.

It is unethical imo to believe that these surgeries should be publicly funded or should be prioritised ahead of medically necessary procedures. Nobody has died directly due to not having breasts, many have died without rapid mastectomy.
Suicide is not directly caused by waiting for surgery. It may be a factor in someone’s choice to end their life, but it is emotionally manipulative and disingenuous when people claim suicide counts as a death from not getting surgery.

There is no ethical way to experiment on children if we accept exposing children to harm is ethically wrong.

People can argue til they are blue in the face that it isn’t experimentation but they also cannot produce documentation of long term results of puberty blockers in healthy children, and they cannot provide evidence of puberty blockers being harmless in children who had precocious puberty.

It might not be set up as an experiment according to scientific method, but it is experimental. It has not been done before and the long term outcomes are unknown.

Halting a child’s development to, paradoxically somehow allow them to develop, is unethical imo. It is taking a physically healthy child and interfering with the healthy functions of their body to focus further on gender identity. Anything short of guiding the child to understanding that their body is healthy and acceptable as it is, and that their sex does not prevent them from being the people they want to be, is too close to conversion therapy for my comfort.

Encouraging a child to think that they have the wrong body is cruel and unusual. We recognise this when parents foster eating disordered behaviour or shame visible conditions like cleft lips, strabismus, limps, palsies, etc etc. Changing the specific flaw to the child’s sex does not change the fact that the idea encouraged is a vile one.

[–]MarkTwainiac 16 insightful - 1 fun16 insightful - 0 fun17 insightful - 1 fun -  (2 children)

Transitioning as an adult is fine. Your body, your money, your right. As long as the adult in question is capable of rational decision-making and understands the risks they are exposing themselves to, no problem.

Since the vast majority of adults who "transition" by far are autogynephilic men, I have to disagree. When men take CSH, get surgeries to alter their appearance and dress as the "girls" they imagine themselves to be in order to live out their sexual fetishes FT and in public, it has negative impacts that are far-reaching. What these men are doing isn't just about them - it has traumatic, harmful effects on their wives, their children and the rest of their families, such as their parents and siblings. Moreover, when men "transition" into their "sexy girl" selves it's especially insulting to their mothers, sisters, daughters and the women who bore, birthed and have raised their chidlren.

The "transitions" of AGP men affects their work colleagues and communities too, and often the strangers they encounter as well, such as the store clerks, restaurant workers, TSA agents and other low-wage service personnel they tend to to lay into and try to get fired for such crimes as "misgendering" them. And because so many AGP men who "transition" are in powerful positions in business, politics, law, the media, sports and Western culture & society generally - and today they are lionized for "transitioning" - what they do affects social, legal and political policy and shapes the entire culture too.

"Transitioning" is an inherently social, attention-seeking enterprise that always requires an audience just as much as it requires looking glasses and costume changes. Even the least demanding, most low-key "transitioners" always require a degree of participation from the audience - ranging from acquiescence to affirmation. Accommodating people's "transitions" always mean some other people - girls & women especially, but many boys & men too - will be subtly coerced or forced into censoring their own feelings & biting their tongues. It always means that some other people will end up having to give up some of their own rights & positions in order to make sure that the people who've "transitioned" are centered and their demands & needs invariably come first and are always met.

Even "part-time transitioners" of the male sex who choose to "live in girl mode" only when it suits them like Eddie Izzard and Pips Bunce have a negative impact, particularly on girls & women. Coz they are telling the world that being female is simply an idea in men's heads, that being a woman means conforming to sexist stereotypes and the most regressively misogynistic caricatures, and that any man can become a woman simply by donning long locks, some lippy and a frock and saying so. And coz when "in girl mode" these men feel it's their right to use spaces for female people like ladies loos and locker rooms, and to apply for and accept awards & positions meant for female people.

"Transitioning" amongst both males and females is only done by people who are deeply sexist, misogynistic and often very homophobic too - and the the view that "transitioning" is A-OK so long as the "transitioners" are adults is basically saying that expressing and perpetuating the sexism, misogyny and homophobia that underlies and drives transgenderism is perfectly fine. I don't agree. Most "transitioners" and their "allies" today embrace and espouse the most regressive, extreme sex stereotypes that I've encountered in more than 50 years. Many of them also display strong animus against homosexuals - lesbians especially, but increasingly against gay boys & men too - that is worse than the homophobia rampant in the 60s, 70 and 80s, whilst at the same time they malign and express unprecedented hostility fro heterosexuals, whom they deride as "genital fetishists" for basing their attraction on sex rather than on "gender." Moreover, as events this week in the UK once again demonstrated, those who "transition" and who support "transitioners" tend to be extremely racist - particularly against black people and Jews - and prejudiced against the disabled as well.

In short, I can't agree that it's simply a matter of

Your body, your money, your right.

Coz like John Donne famously said, no trans person is an island.

[–]adungitit 8 insightful - 2 fun8 insightful - 1 fun9 insightful - 2 fun -  (0 children)

Men screwing their families over for the sake of their dicks isn't really different from standard male behaviour, neither is men abusing women's rights for the same purpose. The fact that transitioning is regularly used by self-centered misogynistic narcissistic men doesn't make transitioning inherently misogynistic and narcissistic.

"Transitioning" is an inherently social, attention-seeking enterprise that always requires an audience just as much as it requires looking glasses and costume changes.

Therein lies the problem: requiring constant audience participation in order to reassure the trans person of something that isn't true. This isn't the issue with physical transitioning itself, though. I don't think getting plastic surgeries to imitate the physical characteristics of women is inherently misogynistic, as long as claims aren't made that said plastic surgeries and an artificially-induced hormonal imbalance count as womanhood. Certainly misogynistic ideas about men and women underline most of the motivations for transitioning, but the result, a man with plastic surgeries and an artificially-induced hormonal imbalance, isn't actively harmful to women as long as there is an awareness that this isn't what being a woman actually is.

other low-wage service personnel they tend to to lay into and try to get fired for such crimes as "misgendering" them

lol are you seriously trying to blame trans people for upholding poverty? Come on. Pandering to the customer has always been a part of work, and customers getting mad when you don't humor them has always carried risk. I've seen GC do this and it's laughable: poor people not being able to understand or keep up with (hypothetical) social progress isn't a reason to stall or negate said progress. Focus on explaining why said "progress" isn't progress at all and is harmful to women, instead of basically saying it's too hard to understand.

those who "transition" and who support "transitioners" tend to be extremely racist - particularly against black people and Jews - and prejudiced against the disabled as well.

This is just ridiculous. You might as well say that for most groups, especially any group composed of men. People can be backwards and bigoted but still deserve rights. If you believe these things aren't rights (much like how being owned a sex slave shouldn't be a male right), and if you believe that these rights are directly harmful to marginalised groups (not just "Well a lot of them happen to be racist!"), then argue that, instead of claiming that something is bad by virtue of association.

Accommodating people's "transitions" always mean some other people - girls & women especially, but many boys & men too - will be subtly coerced or forced into censoring their own feelings & biting their tongues.

Expecting people to "censor" views seen as harmful is not a bad thing. We all censor our views for social purposes, and should. I do want a white supremacist to "censor" their idea that anyone non-white is biologically inferior. The question is which views should be perceived as harmful and not normalised and spread freely, and which shouldn't.

they are telling the world that being female is simply an idea in men's heads, that being a woman means conforming to sexist stereotypes and the most regressively misogynistic caricatures, and that any man can become a woman simply by donning long locks, some lippy and a frock and saying so.

First of all, now you're talking about social transitioning. But how much resonance would these statements have if we didn't live in a society where we ARE told that this is what defines women? Trans people didn't make these things up, they are just abusing what is already in place for validation and putting it on steroids. The specifically trans rights take on it, where this is an integral part of one's being and criticising or even discussing it is violence because recognising reality makes them feel suicidal, that can be pinned onto the movement itself.

expressing and perpetuating the sexism, misogyny and homophobia that underlies and drives transgenderism is perfectly fine

These things are expressed in day-to-day life by everyone. The real point is the ways in which trans ideology is uniquely misogynistic and harmful, instead of standard misogynistic and harmful.

[–]HouseplantWomen who disagree with QT are a different sex 6 insightful - 1 fun6 insightful - 0 fun7 insightful - 1 fun -  (0 children)

Yeah, you’re right.

[–]loveSloaneDebate King 13 insightful - 1 fun13 insightful - 0 fun14 insightful - 1 fun -  (12 children)

I don’t think it’s ethical at all, for a few reasons:

Every trans person I know (admittedly not many, but quite a few) has a slew of health issues, and the health issues are pretty similar amongst them, so I’m guessing it’s possibly related to their “transition” (I acknowledge it’s an uneducated guess).

I’ve said so many times that I think it causes too many issues and is too invasive for everyone else. Treatment for a mental illness should never demand so much from others, and it shouldn’t rely so heavily on other people literally lying to and for you (and to themselves) or having to accommodate you in ways that go against their own needs and rights

We can’t really discuss the surgeries, but... the surgeries are concerning to say the least

It seems to only actually alleviate the discomfort a dysphoric person may feel (sometimes), it does nothing to address the actual mental illness itself and in fact exacerbates it

It’s a faulty solution, whether it’s effective or not relies on either experimenting on children, extensive surgery (not just bottom/top surgery, but things like ffs) or it’s hopeless for many. The need to “pass” seems both a huge desire for trans people and also almost impossible, I know some trans people do pass, but it seems to be very rare. I don’t mean at a distance or at first glance pass, but genuinely passing seems something that can only be accomplished by harming children (which- if they can’t get proper bottom surgery because their genitals didn’t develop as they should, can they ever fully pass? Idk the answer just typing as I think), even more surgery, or being fortunate enough to have bone structure and physical build that facilitates passing (literally just someone being “lucky” enough). Basically I’m trying to say that even if this is the accepted method of treatment, it sets up most trans people for a lifetime of being visibly trans. Seems counterproductive.

Everything about transitioning seems to be designed around doing whatever possible (and asking society at large to participate in doing whatever possible) to feed and protect a warped self image and pretend that someone is something they aren’t. Usually when someone gets treatment for mental illness, they learn to manage it, to cope with triggers, and take charge of their own mental health to the best degree they can. Transition is the complete opposite of that. Transitioning seems to set trans people up for a lifetime of either people lying to them to protect them, or being vilified for being honest, it puts the rest of the world in charge of someone’s mental health, while putting the trans person themselves in a mindset of either knowing they aren’t what they seem and committing to pretending they are and not being honest with others or convincing themselves they are truly something they aren’t. It’s absurd to me.

When people have to invent spectrums and new definitions and rely on pseudoscience because actual verifiable science denies what they want to be true, when the reality of biology and your own body is a trauma trigger, or you have to convince yourself that fact is bigotry (or even that sexuality or female rights as a whole are bigotry)- you’re still deeply mentally ill

I always say adults should be able to do whatever they want to their bodies (they should have to pay for it, or at the least have to pay whatever insurance policy will cover it), but I still think that it’s unethical to fuel mental illness and perform such invasive extreme surgery on people who are so mentally unhealthy that they “need” these types of surgeries to begin with

Last thing I’m gonna say because otherwise I’d just keep going and going- transition wasn’t developed to help them, it’s a result of deep homophobia. Dysphoric people deserve a treatment that will actually address the mental health issues they have, and instead they got “transitioning”, which treats nothing but their discomfort at their naturally developed body, offers them false promises, and commits them to a lifetime of either lying about who and what they are (pretty much always to other people, but also to themselves) or being “othered” because they aren’t fortunate enough to be able to lie because they are visibly trans.

[–]peakingatthemomentTranssexual (natal male), HSTS 9 insightful - 1 fun9 insightful - 0 fun10 insightful - 1 fun -  (11 children)

Every trans person I know (admittedly not many, but quite a few) has a slew of health issues, and the health issues are pretty similar amongst them, so I’m guessing it’s possibly related to their “transition” (I acknowledge it’s an uneducated guess).

Hi LoveSloane! Can you elaborate on this? I’m super curious.

[–]loveSloaneDebate King 8 insightful - 1 fun8 insightful - 0 fun9 insightful - 1 fun -  (10 children)

I only know 3 transwomen and 2 transmen on a personal level. I’ve worked with or around a few others.

Two of the three TW I know are in their 50’s, I’ve known them since I was a child, and they’d already transitioned. Both have kidney issues, migraines, and hot flashes regularly. One of them has an issue with blood clots. Im not by any means a medical expert so I can’t explain it well, I just know they told me it was related to their transition. They had a mutual friend who died of a stroke (may have been a heart attack. I can’t recall), and it seems like the TW who died had heart issues directly related to the hormones they took. (To be fair, maybe the cross sex hormones people take now are safer? Idk)

The third TW I know is around my age, I knew them before they transitioned. They have severe mood swings now, when before they were pretty mild tempered, migraines, and had some issues with their bones that I can’t really describe because I’m obviously not qualified, they also had to become an alkaline vegan (that may be the wrong term). When I saw them a year or so ago and found out they weren’t just vegan (they hadn’t been vegan before), but even had limitations within being vegan, I asked what made them decide to become vegan, and put further limits on what they’d eat, they told me their doctor told them they had to eat that way because of some complications that presented themselves. I can’t articulate it well because I didn’t quite understand it, I just know that the person I’m talking about acknowledges that they had to change their diet as a result of being on cross sex hormones. I wouldn’t be surprised if they have pre existing issues, though.

The two transmen I know- both have intense mood swings, severe acne, they both sweat like crazy- seriously, not even trying to be funny or mean just the sweating is unbelievable- one of them is losing hair (on their head, not their body) and the other seems to have all types of issues with their joints and muscles. They are always mentioning being in pain, and are on disability because of whatever these issues are, and when i asked what caused it (I assumed it was an old injury or something) they told me it was a side effect.

sorry I’m not much help, as I said, I assume their issues are related to transition, both because the issues didn’t present themselves until after they transitioned, and some are similar to each other despite them being different races, builds, different medical history etc- it could very well all be a coincidence. Im not saying that it’s for sure due to transition, just that it seems possible. I don’t know that I believe people can take cross sex hormones for extensive periods of time the way trans people do and not experience negative side effects. It seems bound to happen, but of course I could be wrong.

[–]peakingatthemomentTranssexual (natal male), HSTS 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (9 children)

Thanks for sharing! Those situations sound really difficult. I don’t know many trans people well enough to know medical issues so this super interesting. I guess I should count myself fortunate to not having any chronic problems (beyond needing ongoing hormone treatment to stay healthy, when I type it out it sounds so bad lol).

I know that blood cots are a known risk with exogenous estrogen. It can happen for females taking birth control or HRT too. Hot flashes can be a hormonal issue too, but should be happen for a trans person if everything is okay I think. Same with severe mood swings. I feel really bad for them.

For the transmen, it sounds like at least some of that could be related to T. I know it can trigger male pattern baldness if someone has that in their family. Maybe the acne too. I wondered in one of the sports threads if T might be hard on your body if it didn’t develop around it in puberty. If they started it an as adult, it might not be right for their bone structure, joints, etc. I don’t know, I’m just speculating. I feel like it would make sense though. That sounds really tough.

[–]loveSloaneDebate King 11 insightful - 1 fun11 insightful - 0 fun12 insightful - 1 fun -  (8 children)

I think my main concern as far as the blood clots and the hot flashes is that women can/will eventually go off of birth control, or can find alternative methods if they encounter complications. And when they take hrt it’s temporary, whereas with TW they have to take hormones to intentionally alter their body, and they have to take them long term (longer than women even on birth control, as far as I know).

Ive always been curious about the long term effects, particularly because it’s cross sex hormones, rather than hormone levels your body used to produce/is supposed to produce.

[–][deleted] 8 insightful - 1 fun8 insightful - 0 fun9 insightful - 1 fun -  (7 children)

The chronic pain can be from orthopedic or neurological side-effects from the meds, or it can be from surgery itself completely apart from the meds -- it's a risk for all surgery, especially invasive procedures. Depending on individual health and genetics, post-surgical pain can become chronic in a way that physically changes nerves and pain processing pathways -- it's usually a reversible progression, but I wonder how many trans surgery patients are given thorough enough info or guidance on pain management, post-procedural physical therapy, and the like.

(ETA major surgery is often a triggering event for Fibromyalgia and Complex Regional Pain Syndrome.)

[–]loveSloaneDebate King 8 insightful - 1 fun8 insightful - 0 fun9 insightful - 1 fun -  (6 children)

They haven’t had surgery, just hormones. Only one of the two older TW has had bottom surgery, all of them had implants, but both TM are pre op/non op

Eta- actually the transman who I mentioned first had top surgery, the second one hasn’t had any (idk about any surgeries in general, but they haven’t had top or bottom surgery, I think they want top surgery though)

[–][deleted] 5 insightful - 1 fun5 insightful - 0 fun6 insightful - 1 fun -  (5 children)

Top surgery can do this too, sadly. It's even a risk for women getting cosmetic implants.

[–]loveSloaneDebate King 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (0 children)

I know. I’m saying the one with the chronic pain hasn’t had any surgeries.

Eta to clarify- I mentioned two transmen. the tm who is losing hair had top surgery. The one who’s always in pain has had no surgery at all, just hormones, they’re saving for it.

[–]adungitit 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (3 children)

Removing breasts can cause pain?

[–]MarkTwainiac 9 insightful - 1 fun9 insightful - 0 fun10 insightful - 1 fun -  (0 children)

Most of what is known about pain following and caused by removal of breasts and breast tissue comes from women who've had mastectomies as well as less radical breast surgeries such as lump removal coz of cancer. AFAIK, no follow-up is being done on all the teen girls and young women having double mastectomies today for gender identity issues. But what is well known and documented from long-term research on patients who've had breast tissue removed in whole or part due to cancer is worrying:

Post-mastectomy pain syndrome (PMPS) is a type of chronic pain that occurs after breast cancer surgeries such as mastectomy, lumpectomy and axillary lymph node dissection, which involves removing lymph nodes in the underarm region. Pain from PMPS has been described as a burning sensation; a shooting, stabbing pain; or a throbbing, aching or oppressing pain. Study results vary, but show that anywhere from 20 to 68 percent of breast cancer survivors experience PMPS. This condition can develop up to several months after surgery and can persist for three to six or more years.

Direct injury to the intercostobrachial nerve and other sensory nerves in the underarm (axilla) and breast areas during surgery causes PMPS. Subsequent formation of scar tissue from surgery for breast cancer may also be a cause. And, contrary to its name, studies have shown that PMPS may occur more often after breast-conserving therapy (lumpectomy) than after modified radical mastectomy.

Studies have also shown that the risk of PMPS may increase with the extent of axillary intervention, as axillary dissection has been shown to be a critical component in chronic pain following breast cancer surgery. Other factors that increase the risk of PMPS include treatment with radiation or chemotherapy after surgery, younger age (under 40)...

https://www.curetoday.com/view/post-mastectomy-pain-hits-a-nerve

Estimates of prevalence of the pain syndrome range from 25% to 60% of all mastectomy patients. What causes the pain is unknown, but surgical injury to peripheral nerves in the axilla or chest wall is the main explanation.

Despite its commonness, the pain syndrome has been little researched, and there is no consensus on treatment, the review authors say.

https://www.medscape.com/viewarticle/891845

Phantom breast syndrome is a type of condition in which patients have a sensation of residual breast tissue and can include both non-painful sensations as well as phantom breast pain. The incidence varies in different studies, ranging from approximately 30% to as high as 80% of patients after mastectomy. It seriously affects quality of life through the combined impact of physical disability and emotional distress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902108/

[–]AlexisK 6 insightful - 3 fun6 insightful - 2 fun7 insightful - 3 fun -  (0 children)

Removing breasts almost always will cause long lasting pain.

[–][deleted] 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (0 children)

Correct. Any surgical procedure where innervated tissue is manipulated can cause pain.

[–]peakingatthemomentTranssexual (natal male), HSTS 10 insightful - 1 fun10 insightful - 0 fun11 insightful - 1 fun -  (4 children)

I feel like it’s only ethical when it’s treated as a last resort. I don’t think everything about transitioning is unhealthy, but some of it is and there are so many other areas where we just don’t know long term. There were many transsexuals before me, but I’ve asked questions with my doctor where they would say they didn’t know because there just aren’t that many people who’ve been of hormones that long. It’s still experimental in many ways and there is even less known for trans natal females. We shouldn’t encourage it or treat it like it’s a good thing. I’m really not comfortable with the way culture celebrates it now and praises people.

That said, I feel like I wouldn’t still be here today if I hadn’t been allowed to transition. Maybe that’s wrong and I can’t know what might have happen in the years after if I hadn’t been given treatment, but I was not in a happy place and couldn’t see a future for myself if I wasn’t allowed to live as a girl. I always feel like if medical treatments didn’t exist, I’d probably still be trying to live the same way, but just with a worse quality of life because I wouldn’t have been able to pass as I got older.

I feel strongly that children should be allowed to go through puberty naturally so they can desist. The data shows that most of them will, but not if you interfere with blockers. Blockers themselves aren’t safe either.

[–]MarkTwainiac 12 insightful - 1 fun12 insightful - 0 fun13 insightful - 1 fun -  (3 children)

There were many transsexuals before me, but I’ve asked questions with my doctor where they would say they didn’t know because there just aren’t that many people who’ve been of hormones that long.

I think your doctor and the medical community in general are being disingenuous. Coz your observation that "there were many transsexuals before" you is true. Or at least it's true when it comes to male transsexuals.

Lots of males going back to the 1960s and 70s have "transitioned" by taking CSHs, T blockers & getting various kinds of surgeries. Their health over the intervening decades could easily have been tracked and studied by medical professionals. If it had been, then today in 2021 there would be a wealth of well-documented medical evidence to draw on to guide males of younger generations like you about the efficacy and health drawbacks of the various "gender confirming treatments" being so widely prescribed today.

But there is no documented body of evidence because earlier generations of male transsexuals did not want their medical histories to be tracked & studied. Surprisingly - or perhaps predictably? - the male doctors who treated earlier generations of male transsexuals also had little to zero interest in tracking the health histories and outcomes of their male patients to gauge the longterm efficacy - and downsides - of the hormone treatments they prescribed, the surgeries they performed and the lifestyle changes they recommended.

I've often found it decidedly odd that prominent early male transsexuals like Jan Morris, who died last year at 94, and Renee Richards, who is now 86, publicly pushed for males like themselves be able to use female spaces, participate in women's sports, and benefit from programs meant for women, yet they and other male transsexuals of their same age and era never advocated that their own physical health and the health of male transsexuals as a group be monitored and studied so that information could be gathered to help out the generations of male transsexuals who would follow them.

I've always found older male transsexuals' reluctance to be studied and their lack of concern for those of their sex who would follow in their footsteps to be quite telling - and not in a way that is to their credit. In fact, it seems to reveal that despite all the CSH and surgeries, at heart they remained decidedly male and incredibly self-centered in their outlook.

This becomes glaringly apparent when you contrast their unwillingness to participate in research for the benefit of future generations with the way that masses of women of their same era clamored for - and volunteered en masse for - research into the impact on women's health of once-standard medical interventions like DES in pregnancy, the use of high-dose hormonal BC pills that were common in the 60s & 70s, copper IUDs, HRT for menopause, radical mastectomy for breast cancer, annual Pap smears for cervical cancer, annual mammograms for breast cancer across age groups, various forms of anesthesia in labor & childbirth, use of forceps in childbirth and many, many other practices.

One of the peculiar - and to me, unfair - results of this decided lack of symmetry is that since the preliminary results of the big US research study known as the Women's Health Initiative were published in 2002, it has become impossible or extremely difficult for the majority of female patients going through menopause in the Western world to get prescriptions for estrogen replacement therapy - and those few who do get prescriptions only get them for very low dose estrogen and for very brief periods of time. Similarly, women well past menopause who develop serious medical issues caused by low or no estrogen - like painful vaginal atrophy, low bone density/frequent fractures, chronic UTIs, urinary incontinence, balding, memory problems - are pretty much plain out of luck nowadays, as it's widely believed by GPs, gynecologists, gerontologists, urologists and even many endocrinologists that prescribing estrogen to female people past a certain age is too dangerous to be worth all the proven and widely-recognized benefits. Yet at the same time, any male person - whether age 18 or 80 - who wants to take estrogen today to "confirm" and "affirm" his opposite-sex gender identity, even when it's clearly just an expression of the sexual fetishism of autogynephilia, can easily get estrogen prescribed on demand - and in extremely high doses too.

[–]peakingatthemomentTranssexual (natal male), HSTS 6 insightful - 1 fun6 insightful - 0 fun7 insightful - 1 fun -  (2 children)

Thanks for sharing your thoughts! I think there should be more information about outcomes than there is. Like you say, there were many male transsexuals years ago. It seems like it easily could have been studied so that we’d have more information. Maybe you right about them being self-centered. I’ve always been surprised when doctors can’t tell me things because it seems like the knowledge would be there. I’ve been treated medically for two decades, which is long time to some I guess, but there are transsexuals older than me would have been treated for a lot longer. Maybe it will become more of priority. I worry about it all being so politicized now though and I feel like maybe researchers would be afraid to publish it if the outcomes were bad.

That does seem really unfair about menopause. I wonder if it’s any better since 2002. I know my mother-in-law is receiving HRT for that, but she is no where near 80. There are a lot of medical issues that can treated with it and every woman should have the option I feel like. It shouldn’t be on demand for male people. That seems crazy to me. It used to not be that way.

[–]MarkTwainiac 11 insightful - 1 fun11 insightful - 0 fun12 insightful - 1 fun -  (1 child)

Getting HRT for menopause has become easier since 2002. Now doctors will prescribe HRT for severe menopause symptoms, but only for a short-term period - and at much lower doses than what's being prescribed to trans-identified males. Moreover, to get an Rx women have to beg, jump through hoops, try every other possible remedy under the sun first; often women's complaints are just pooh-poohed & we're told to suck it up. Googling "hormone replacement for menopause" just now, one of the first results is this, which is full of caution and warnings: https://www.fda.gov/consumers/free-publications-women/menopause-medicines-help-you

By contrast, when I googled "estrogen for transgender" I got page after page after page of clinics and encouraging articles, which tell of all the "feminizing" changes males can look forward to on E whilst minimizing the risks and being rather nonchalant about the lack of research:

The risk of things like blood clots, heart attacks, strokes, diabetes, and cancer as a result of hormone therapy are minimal, but may be elevated, especially for those with co-existing health conditions or starting hormone therapy after age 50. Generally, the size of any increase in risk for those in good health is small, and may be offset by improvements in quality of life and reductions in stress levels once they taking hormone therapy has begun. The biggest increase in risk when taking estrogen is when it is combined with cigarette smoking. In this case there is an increased risk of blood clots, and probably strokes and heart attacks. For those with an elevated risk of these conditions, or over the age of 50, forms of estrogen that are delivered through the skin, such as a patch, are generally the safest option.

There is not much scientific evidence regarding the risks of cancer in transgender women. We believe the risk of prostate cancer will go down, but we can’t be sure. The risk of breast cancer may increase slightly, but will still be at less of a risk than a non-transgender female. Since there is not a lot of research on the use of estrogen for feminizing treatment, there may be other unknown risks, especially for those who have used estrogen for many years.

https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy

https://www.goodrx.com/blog/estrogen-gender-affirming-hormone-therapy-transgender-care/

I'm of the cohort of women that got royally screwed by the change in attitude towards HRT. I had to have my ovaries removed in the late 1990s coz of a serious medical condition, and since I was still in my 40s I was prescribed HRT (a combo of estrogen with a bit of testosterone; the brand name was Estratest). But after the WHI study results came out in 2002, I was told by all my doctors I'd have to stop right away - no one would prescribe HRT any more. No chance to gradually titrate down by lowering the dose bit by bit; it was no more meds, cold turkey, tough noogies. So boom I was forced into sudden menopause practically overnight.

Since turning 60, I've had increasing problems with painful vaginal atrophy and equally painful, sometimes disabling chronic UTIs, both of which are known to be due to lack of estrogen - but all anyone will prescribe to me is a very low-does cream to apply topically that doesn't help. And all I can get is one single tube, no refills. I have a number of friends my age with similar problems all in the same boat. The medical profession does not care much about women generally, but old women are the bottom of the heap. The way we are treated compared to the way men are treated is night and day. It's one of the many reasons why I have zero sympathy for all the young people today who claim that immediate access to cross-sex hormones is a "human right" for trans-identified people, and that not giving trans-identified people scripts for CSH on demand is tantamount to killing them.

As for the health problems that might be in store, I am worried for people your age. As we have discussed before, it seems that exogenous testosterone is very hard on the female body - perhaps harder than exogenous estrogen and T blockers are on the male body. But I am concerned about the young males too who think they'll be able to take exogenous estradiol and drugs like spiro for 50-60 or more years without any negative effects.

BTW, my schoolmate's father who "transitioned" in 1974 ended up having a number of strokes in the late 80s and early 90s. But his health was shot from all sorts of other problems too - alcoholism, IV drug use, Hep C, Hep B, HIV. He died in the 90s of complications from AIDS.

[–]peakingatthemomentTranssexual (natal male), HSTS 6 insightful - 1 fun6 insightful - 0 fun7 insightful - 1 fun -  (0 children)

I’m so sorry the happened to you. The way women are treated by the medical establishment continues to be really awful.

[–]BiologyIsReal 10 insightful - 1 fun10 insightful - 0 fun11 insightful - 1 fun -  (0 children)

There is a lot ethical issues around "transition". Gender dysphoria seems to exist outside the usual practices of medicines. Criteria diagnostics rely on sexists stereotypes and, nowadays, you can't question a patient's "identity" without risking accusations of transphobia and conversion therapy. In other words, proffessionals have to accept trans people's self-diagnosis. Hormones and surgeries must be provided on demand, too. Many trans people seem not to have interest in research regarding what causes dysphoria or alternative treatements despite there is no evidence that "gender affirmement treatment" works as a cure or the many health complications that follow from exogenous hormones and/or surgeries. As result, research is very lacking and heavily politized.

Doctors often also minimize the risk and overstate the results. Many seem to care more about ideology and profit than science and ethics. Many don't seem to care much about all the other co-morbidities that trans identified patients present and "transition" is often sold as a panacea that may resolve all their problems.

Furthermore, I don't know of any other mental health issue that is treated like gender dysphoria. Nobody thinks anorexic people should be given liposuctions, for example.

Another important issue is that after "physical transition" many trans identified individuals become more entitled to be treated as the opposite sex in all aspects.

Finally, when in comes to minors, I don't think "transition" should be allowed at all. Most of them will desist if left alone. However, even if we could tell which children would persist in adulthood, as the judges in the Keira Bell's case said, they are too young to understand all the consequences.

[–][deleted] 9 insightful - 1 fun9 insightful - 0 fun10 insightful - 1 fun -  (0 children)

Is it ethical to give people with mental health issues life altering drugs and surgery that will permanently affect their health negatively?

In accordance with basic medical and psychiatric ethics, only as a last resort, after eliminating the likelihood of other disorders through differential diagnoses and exhausting conservative treatments. We can stop there regarding ethics because a) transitioning protocols are pharmaceutically off-label and surgically invasive, b) off-label categorically does not mean harmless, and c) similarly invasive surgical procedures progress from conservative to extensive because of the risk-to-efficacy ratio. That's how medicine is designed to work.

Commonly practiced invasive procedures showing similar results over time (high resolution rate when left untreated -- during adolescence in the case of transitioning, low followup remediation rates, high risk for multiple complications) are abandoned. Surgery for nontraumatic rotator cuff issues, intra-articular "flushing" for osteoarthritis, routine discectomies and fusions are recent examples (that's not remotely an all-inclusive list).

Short answer: as practiced and advocated for, no, it's not ethical. It's highly experimental and disingenuously pushed as necessary and curative in opposition to med/psych criteria for all other conditions outside of elective cosmetic surgery.

[–]kwallio 9 insightful - 1 fun9 insightful - 0 fun10 insightful - 1 fun -  (12 children)

I don't know about what is ethical. I am different from I guess most GC women in that I think if you are over 18 and capable of making decisions for yourself then do whatever you want to do with your own body. Whether it is ethical or not I would leave to the doctors and whether they think it is ethical. Is cutting off a healthy women's breasts ethical because they cause her mental distress? I honestly don't know.

There was an article in Vice about men who desire orchiectomies and penectomies and resort to back alley procedures in order to get them. Is it ethical to not do procedures on demand when the consequence of that is people may do unsafe things to access them? I mean I'm in favor of safe injection sites for addicts, even though injecting drugs is very dangerous. I'm not really trying to make a coherent argument here, just sort of typing my thoughts as they occur.

I do think that it is unethical to represent medical transitioning as healthy or free from side effects when that is manifestly not true or in some cases there just isn't a lot of evidence that it is safe. I would feel a lot better about medical transition if the negative aspects weren't glossed over so much. And TRAs have a lot to answer for in this regard - it seems like every time someone proposes a study on the long term effects of cross sex hormones or GRS the mob comes out to cancel them. If studies might show that GRS doesn't help dysphoria in the long run don't you think people might want to know that before they commit to a lifelong body altering procedure?

We're not to comment on the possible negative outcomes of the surgeries themselves per sub rules but it seems in many cases that surgeons are not well trained in even what seems like basic surgery techniques and I'll just leave it at that. There is no standard or board certification and it seems like many TRAs prefer it that way? It can be hard sometimes to distinguish who might come to a particular position due to industry lobbying or who just has certain political views. In any case it seems like the medical industry has taken notice of the potential market for medical transition and I'll just leave that thought there.

I'm against insurance/govt paying for medical transition. Its essentially cosmetic (imo) and is potentially harmful.

tldr - medical transition seems like the wild west in terms of money to be made and potential ethics violations, I'm basically a libertarian in terms of what people do with their own money and body, but I think that full disclosure of side effect/long term consequences should be more of a thing than it is. Some standardization of best practices and certs of doctors providing this care would go a long way.

[–]MarkTwainiac 10 insightful - 2 fun10 insightful - 1 fun11 insightful - 2 fun -  (7 children)

I think if you are over 18 and capable of making decisions for yourself then do whatever you want to do with your own body.

Do you think that this is just as true for people who have children, particularly minor children still living at home and dependent on their parents for care and financial support? What about parents of grown children? Some men decide to "transition" after their wives die, and there have been cases where the dads insisted their grown children still grieving the loss of their mothers start calling the dads "mom" from now on - and where the dads started calling themselves by the dead wives' names too. Doesn't what these individuals do to/with their own bodies have major impacts on others in such instances?

What about the impact on the non-transitioning partner in couples are married? Don't you think that when a person decides to alter his/her sex characteristics and so as to "live as" the opposite sex, it might have an effect on the spouse? What about married people who decide to "transition" when their partner is pregnant, or just recently had a baby - which happens a lot?

[–]kwallio 11 insightful - 1 fun11 insightful - 0 fun12 insightful - 1 fun -  (2 children)

All of that sounds heinous for the people involved but its not the fault of transition, its the person transitioning that has caused all of those problems. These people sound so self-involved that if it wasn't transitioning they would manage to blow up their lives some other way. Like I said before, I really don't care what other people do with their bodies. And other people doing shitty things to their families, while sucky, doesn't affect me in any way either. I wish the best for the families of shitty middle aged transitioners, no contact is probably the way to go with someone that narcissistic.

ETA - I also think that more attention paid regarding the social aspects of transitioning and its effects on other people would be a good thing. The trans widows, children of late transitioners, etc all of this gets swept under the rug except to occasionally call them transphobic for having feelings about it. But again, being considerate or inconsiderate regarding your transition is nowhere near the same thing as "medical transition itself is unethical".

[–]MarkTwainiac 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (1 child)

I see where you're coming from, but I think the issue goes beyond the matter of whether you "really don't care about what other people do with their bodies" coz it "doesn't affect me in any way." Which your ETA suggests you might somewhat agree with.

As I see it, a central issue to consider is whether what you or I decide to do with our bodies might affect other people, such as our families, friends and colleagues. The potential conflicts become clear when it comes to children. I don't know if you have children yourself, but for a lot of people the idea that adults should be free to do whatever we want with our bodies isn't so simple and clear-cut when we decide to bring kids into the world.

For example, I felt I forfeited my right to eat, drink, take & do certain things when I was pregnant, breastfeeding and had young children utterly dependent on me in every way. I thought that it was irresponsible for my partner to do certain dangerous activities when our kids were young and dependent too. Even though my kids are now adults, I feel that certain options of what it's okay for me to do with my body are closed coz of the impact it would have on them. Things I feel it would be unethical for me to do coz of the impact on my kids include threatening & committing suicide, developing a heroin or opiate habit, turning into a drunk, joining a cloistered religious order, getting cosmetic surgery so that I look like Jocelyn Wildenstein the "cat lady" heiress of NYC, getting my face covered in tattoos & other forms of extreme body modifications, be they giant breast implants or severe body sculpting to totally alter my shape in pursuit of some impossible & ridiculous "ideal."

I have a friend who've had a face lift that drastically altered her appearance, and it's had a terrible experience on her kids coz while she looks more youthful, she looks so different it's very jarring to them. Of course, most of us old people look nothing like we did in our youth, and many people get disfigured coz of accidents & medical conditions. But still, there are some elective body modifications that can change adults' looks in unnatural ways, and those changes might be especially hard for one's children to deal with, even when those children are adults themselves.

[–]kwallio 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (0 children)

I think I get what you're trying to say, but I differ in that I don't think it has bearing on whether a certain procedures are ethical vs a good idea for an individual person. I don't really have a problem with cosmetic surgery, the practice. I do have a problem with the narrowness of how beauty is defined and the lengths to which some people go to achieve it.

Paying someone to inject fix a flat into your butt to make it bigger is a super bad idea, and people who do this to other people for money are subject to the law because people have collectively decided that doing this procedure is unethical because its harmful. Paying someone to inject botox is not because botox isn't really harmful in the way its used. There are legit medical uses to botox. Some people might object to this cosmetic use but I don't think its unethical because its not harmful (to the person getting the treatment).

You can argue harm is being done societally by perpetuating harmful beauty standards, but the procedure itself isn't imo a moral wrong. Like I said, I don't care what other people do. That there are consequences to an action, socially or otherwise, imo doesn't really factor into whether an act is ethical. Those consequences will have to be borne by the person who decides to get cosmetic surgery or what have you. I think that people should be free to do what they want with themselves, even if it gets kind of out of hand like Michael Jackson or Wildenstein. Generally speaking I don't think people should be protected too much from their own stupidity. I think people should be able to get accurate information about what they are going to do with themselves, tho.

[–]adungitit 8 insightful - 2 fun8 insightful - 1 fun9 insightful - 2 fun -  (3 children)

By this logic divorce should be unethical because it ruins families and because men use it to skip out on parental responsibilities. Or really anything that might make other people or family members uncomfortable. Being attracted to the same sex has made a ton of people uncomfortable and ruined marriages and friendships. That doesn't make it unethical.

[–]MarkTwainiac 5 insightful - 1 fun5 insightful - 0 fun6 insightful - 1 fun -  (2 children)

Yes, but in the case of other behaviors that adults engage in that screw up/over their families, there's usually acknowledgment of the downsides and harms - or potential harms - to other family members. Whereas when adults "transition" nowadays, all of society is supposed to applaud and "affirm" it as brave, stunning and completely positive. No one - not even spouses or kids - is allowed to point out that transition in many cases does not occur in a social vacuum and that it also often comes with downsides, particularly for close family members and for work colleagues who now are expected to share toilet, changing and shower facilities with someone of the opposite sex. In fact, spouses and even young children of adult transitioners have been shamed as bigots, transphobes, TERFs and Nazis for not being 100% enthusiastic about their partners' and dads' decision to adopt an opposite-sex identity, and children distressed over this dramatic change in their home lives have actually been taken aside in school to be "educated" into providing their parent with the 100% supportive response that gender ideologues consider proper.

Being attracted to the same sex has made a ton of people uncomfortable and ruined marriages and friendships.

I don't think this is analogous. When adults divorce or end friendships for any reason, including one party coming to the realization that he or she is same-sex attracted, those with children, particularly young children, still usually place a great deal of emphasis on the wellbeing of their children and try to manage the split in ways that won't cause undue harm and pain to the kids. This is actually something separating and divorcing parents agonize about regardless of the cause of the marital breakup - and in the West, the courts, family law experts, social workers and the care system have a great deal to say about how adults should conduct their breakups so as to minimize the negative impact on kids. Parents - be they moms or dads - who take an attitude of "I'm gonna do what I want, no one can stop me, tough shit about how it affects my kids" are usually regarded as selfish dickheads and penalized by family law courts as well as by child protection agencies and personnel.

No one is arguing that divorce and severing friendships and other relationships are unethical - in fact, staying in an unhappy, abusive marriage or friendships or partnerships that don't work for all parties is often the unethical tack. But there are ways to go about ending a marriage, partnership or friendship so that the negative impact on all parties who might be affected is minimized. There's actually a huge amount of literature and fields of study concerned with the most ethical way(s) to end marriages, as well as how best to end business partnerships and manage changes in corporate ownership and structure, and to a far lesser extent similar concern about how best to cut ties with friends, acquaintances, neighbors and others.

[–]adungitit 8 insightful - 4 fun8 insightful - 3 fun9 insightful - 4 fun -  (1 child)

including one party coming to the realization that he or she is same-sex attracted, those with children, particularly young children, still usually place a great deal of emphasis on the wellbeing of their children and try to manage the split in ways that won't cause undue harm and pain to the kids.

lol yeah, no. Men tend to run off and leave women and children to fend for themselves because the man's gotta live his new life to the fullest. Stories of women abandoned by their gay husbands are a dime a dozen, and as usual, they are expected to support their husbands for the sake of the family and looking tolerant, and are called homophobes if they don't show endless support and compassion towards the men who lied to them (and frequently cheated on them) for years and ran off with their male lovers. Men constantly show disregard for their spouses and children, treat them as accessories and abandon them when their dicks get distracted by something, regularly skip out on providing any financial support and claim that they shouldn't even be expected to do it. Hence why the number of single fathers is miniscule compared to single mothers. This still does not make homosexuality or divorce unethical. Things are not defined as ethical only if everyone involved is perfectly mature and civil at all times.

it also often comes with downsides, particularly for close family members and for work colleagues who now are expected to share toilet, changing and shower facilities with someone of the opposite sex.

This is the problem with "transwomen are women", not physical transitioning.

children distressed over this dramatic change in their home lives have actually been taken aside in school to be "educated" into providing their parent with the 100% supportive response that gender ideologues consider proper.

Would you treat it as equally morally reprehensible to do the same with children distressed by divorce, or homosexuality? Kids being distressed by something =/= that something being unethical. What a childish mindset.

there are ways to go about ending a marriage, partnership or friendship so that the negative impact on all parties who might be affected is minimized.

Is that why so many of them end up as traumatising disasters?

[–]MarkTwainiac 8 insightful - 1 fun8 insightful - 0 fun9 insightful - 1 fun -  (0 children)

I'm not arguing that divorce itself is unethical or "morally reprehensible". Nor did I ever say, or would I ever say, "homosexuality is unethical" or "morally reprehensible." You're the one who brought same-sex attraction into the convo and keeps trying to make this convo about homophobia, not I.

I'm simply saying that there are ways to go about divorce/family breakup in the near and long term that are more or less ethical than others. I've covered divorce cases and law as a journalist. I've gone through divorce myself, and have been part of same-sex and mixed-sex support groups and organizations for persons contemplating divorce, going through divorce, and dealing with the short-term, medium-term and longterm aftermath of divorce. I've also done a fair bit of work around the impact of divorce on kids, both in the near term and over the longer course of their lives.

Being concerned about children's feelings in the event of divorce and the aftermath of divorce is not the same as condemning their parents for the reasons they are divorcing. And it's not "childish" either, LOL.

Also, the way you keep bringing up homosexuality indicates you have a very heterosexist and old-fashioned view of marriage, families and divorce. The fact is, divorce occurs amongst people who got married (or entered into civil partnerships) & had children together as same-sex couples too. The lesbians, gay men and bi people I know with children who've split up and/or gotten divorced from same-sex marriages or partnerships are no less concerned about how their breakups affect their children than het parents are. Moreover, plenty of the people whose childhood was affected by their parents break-ups and divorces (for whatever reason) are themselves gay, lesbian or bi.

So please stop trying to equate being concerned for how divorce - or other actions that adults who are parents take, such as having mid-life crises, reneging on their parental responsibilities, transitioning - impacts children with being homophobic. It's not only a false equivalence, it's a false equivalence that erases the experience of all the gays, lesbians & bi people in same-sex relationships who've divorced/broken up themselves as well as all the gays & lesbians over time who've been affected by their parents' divorces and break-ups.

[–][deleted] 6 insightful - 1 fun6 insightful - 0 fun7 insightful - 1 fun -  (0 children)

Some standardization of best practices and certs of doctors providing this care would go a long way.

That would be hugely helpful. The surgeons doing these procedures are already way outside the scope of cosmetic surgery (by affecting organ systems) -- where are the regs?

[–]peakingatthemomentTranssexual (natal male), HSTS 6 insightful - 1 fun6 insightful - 0 fun7 insightful - 1 fun -  (2 children)

Some standardization of best practices and certs of doctors providing this care would go a long way.

That’s supposed to be what WPATH is, but a lot of trans people feel like those standards are oppressive to them even though they are looser than they’ve ever been. Years ago when I was treated, it was strictly under those standards (they were call HBGIDA Standards of Care then). The doctor who treated me was a member and attended their meetings. I feel like a lot of doctors just ignore them now since they aren’t enforced. Things like informed consent for hormones or top surgery would never be allowed even under the current WPATH I don’t think.

[–]MarkTwainiac 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (1 child)

The testimony of Stephen Levine, MD to various state legislatures and in at least once court case sheds light on what's happened with the standards of care. Levine, a psychiatrist specializing in this area, was a member of the HBGIDA since the early 70s and the head of its SOC committee in the 1990s.

I was a member of the Harry Benjamin International Gender Dysphoria Association from 1974 until 2001. From 1997 through 1998, I served as the Chairman of the eight-person International Standards of Care Committee that issued the fifth version of the Standards of Care. I resigned my membership in 2002 due to my regretful conclusion that theorganization and its recommendations had become dominated by politics and ideology, rather than by scientific process, as it was years earlier. In approximately 2007, the Henry Benjamin International Gender Dysphoria Association changed its name to the World Professional Association for Transgender Health.

WPATH is a voluntary membership organization. Since at least 2002, attendance at its biennial meetings has been open to trans individuals who are not licensed professionals. While this ensures taking patients' needs into consideration, it limits the ability for honest and scientific debate, and means that WPATH can no longer be considered a purely professional organization.

WPATH takes a decided view on issues as to which there is a wide range of opinion among professionals. WPATH explicitly views itself as not merely a scientific organization, but also as an advocacy organization. WPATH is supportive to those who want sex reassignment surgery ("SRS"). Skepticism as to the benefits of SRS to patients, and strong alternate views, are not well tolerated in discussions within the organization. Such views have been known to be shouted down and effectively silenced by the large numbers of nonprofessional adults who attend the organization's biennial meetings.

The Standards of Care ("SOC") is the product of an enormous effort to be balanced, but it is not a politically neutral document. WPATH aspires to be both a scientific organization and an advocacy group for the transgendered. These aspirations sometimes conflict. The limitations of the Standards of Care, however, are not primarily political. They are caused by the lack of rigorous research in the field which allows room for passionate convictions on how to care for the transgendered.

In recent years, WPATH has fully adopted some mix of the medical and civil rights paradigms. It has downgraded the role of counseling or psychotherapy as a requirement for these life-changing processes. WPATH no longer considers preoperative psychotherapy to be a requirement. It is important to WPATH that the person has gender dysphoria; the pathway to the development of this state is not. (Levine, Reflections, at 240.) The trans person is assumed to have thoughtfully considered his or her options before seeking hormones, for instance.

Most psychiatrists and psychologists who treat patients suffering sufficiently severe distress from gender dysphoria to seek inpatient psychiatric care are not members of WPATH. Many psychiatrists and psychologists who treat some patients suffering gender dysphoria on an outpatient basis are not members of WPATH. WPATH represents a self-selected subset of the profession along with its many non-professional members; it does not capture the clinical experiences of others. WPATH claims to speak for the medical profession; however, it does not welcome skepticism and therefore, deviates from the philosophical core of medical science.

His comments about the evolution (deterioration?) of WPATH & the SOC start on page 18. I'd love to hear what you think of what he says.

https://www.legis.state.pa.us/WU01/LI/TR/Transcripts/2020_0046_0001_TSTMNY.pdf

[–]peakingatthemomentTranssexual (natal male), HSTS 7 insightful - 1 fun7 insightful - 0 fun8 insightful - 1 fun -  (0 children)

Hi MT! Thanks for sharing! I feel like I read something about Dr. Levine on Ovarit.

I agree with his ideas about childhood gender dysphoria. He refers to Dr. Zucker a lot who is someone who also makes sense to me. I feel like the watchful waiting approach is best, but I get so angry because we can’t have it because what is being pushed now is about trans adult unfulfilled wishes or need to feel validated and not what is best for the children involved. It makes me crazy.

I had read before that WPATH had become really politicized and captured by the trans community. Transsexuals are either mentally ill or motivated by something much worse. Decisions about the best treatments shouldn’t be made by the trans community because they will just be what the trans community wants the most not what is really best. We know what trans people have the power too and it’s the same group that always has the power (i.e. affluent older white males). I feel like everything about modern “trans rights” is about what flatters how those people want to see themselves.

All that said, I feel like even if standards of care aren’t perfect, it’s still much better than informed consent or allowing people to self-ID. My experience with the standards of care (as it existed then) was positive in retrospect even though I didn’t like being made to wait at the time. It was little different though too because there had to be parental consent to even be treated by that doctor so like I spent years in other therapy before having those standards applied.

[–]strictly 9 insightful - 1 fun9 insightful - 0 fun10 insightful - 1 fun -  (0 children)

Children can't consent but I believe in body autonomy for adults, their body, their choice. Demanding others to lie is not within their right though as the minds of others is not the trans person's body. I think societal no tolerance for lies would make transitioning seem less fun for many, if they can't demand others to call them the opposite sex and are rightfully reproached by society as a whole for demanding that then many probably wouldn't bother taking cross-sex hormones even without a ban.

[–]worried19 9 insightful - 1 fun9 insightful - 0 fun10 insightful - 1 fun -  (0 children)

I don't believe it's remotely ethical for children. But adults are a different matter. I think it's not ideal, but it may be ethical in cases where the person suffering has been through actual therapy and explored other avenues first. If a person's distress cannot be alleviated any other way, then I don't believe it's wrong to pursue medical transition as long as the person is properly and fully informed of all the potential risks.

[–]censorshipment 6 insightful - 6 fun6 insightful - 5 fun7 insightful - 6 fun -  (0 children)

No. "Billy" Tipson lived as a man without unethical cosmetic surgeries. If "he" passed for decades by just wearing flannel shirts and rocking a masculine haircut, so can others.

[–][deleted] 6 insightful - 5 fun6 insightful - 4 fun7 insightful - 5 fun -  (0 children)

It seems ethical in some instances, like if nothing else is working to alleviate that kind of distress and life disruption, and the person is well-informed and it would likely do more good than harm.

It might not be ethical for most people, though. It doesn't seem at all ethical for children and adolescents. It's more comforting to think that most people could resolve whatever their issues are by other means--that seems like it would be a bit healthier.

To some it might be hard to grasp any reasons to do this that isn't beyond just wanting to have a healthy, functional life. I think it's difficult for most to comprehend why it would take such extreme measures to have that. If for some people that is what it takes and nothing else will do, then that seems to be the best thing to do.

[–]NerveActive 8 insightful - 1 fun8 insightful - 0 fun9 insightful - 1 fun -  (0 children)

It should be forbidden for underage people to take blockers, hormones or get surgeries. For adults, I don't think it's really ethical because it often causes a lot of health issues and is based on bad science. It's inevitable that some trans people will realise they can't become the same as a cis person and will give up on living. I don't think it should be banned though, just better regulated and also invest in alternative treatments for dysphoria.

[–]questioningtw 5 insightful - 5 fun5 insightful - 4 fun6 insightful - 5 fun -  (0 children)

I am very pro gatekeeping, and honestly, I think the only way transitioning can be fully ethical is to have it. I don't agree with this idea that everything should be ok as long as you have the money. Transitioning should be seen as serious, and if someone wants to go through with it, they have to show that they are mentally healthy and actually need it.

[–]dradra 6 insightful - 1 fun6 insightful - 0 fun7 insightful - 1 fun -  (1 child)

It is almost universally understood that the surgical and/or hormonal modification of a physically healthy person in service of conforming to regressive cultural norms [e.g. masculinity and femininity] is unethical and harmful to the individual and society as a whole…I don’t know why/how it should be any different in this instance.

[–]peakingatthemomentTranssexual (natal male), HSTS 5 insightful - 1 fun5 insightful - 0 fun6 insightful - 1 fun -  (0 children)

in service of conforming to regressive cultural norms

Do you feel like this is the only reason someone would medically transition? I don’t necessarily, but I could see how if you did it might always be bad.

[–]HeimdeklediROAR 1 insightful - 6 fun1 insightful - 5 fun2 insightful - 6 fun -  (0 children)

It is absolutely 100% ethical to allow trans children and adults to access transition care, and it is 100% abuse to keep them from such care.