Transgender identity in kids.

[Babbylonian]

I am less concerned with how society should respond and more concerned with how it does and will respond. If it was just as you described it between a doctor and a patient, there would be no pro-life movement. There is a transgender community. There is a homosexual community. There isn't a auditory hallucination pro-rights community (that I know of).

Of course there's a "hallucination pro-rights community." It's what one might call people who choose not to take prescribed medications to suppress/resolve their hallucinations and those who ensure that such isn't against the law unless the condition presents an unacceptable risk to human life.

 

[Professor Yaffle]

Of course there's a "hallucination pro-rights community." It's what one might call people who choose not to take prescribed medications to suppress/resolve their hallucinations and those who ensure that such isn't against the law unless the condition presents an unacceptable risk to human life.

http://www.hearing-voices.org/

 

[Dessi]

What criteria do we use to identify what is the appropriate path for treating a disorder?

You might be interested in this comment on homosexuality:

And it would be reasonable to assume that the same applies to homosexuality, right? Wasn't homosexuality grouped together with 'paraphilias' before? In what way is it reasonable to consider homosexuality anything but another paraphilia, beyond mere ideological and social ones?

Largely because homosexuality is not maladaptive, there's no obvious impairment in social functioning, gay people are often quite happy with themselves. In other words, there are no signs of psychopathology.

Some gay people are disturbed by their attraction and wish to change it, but almost always these are tied to societal, family, or religious disapproval. Since there's no "cure" for being gay, and reparative therapy is quack medicine of a profoundly damaging sort, the best course of treatment is to help these people accept themselves and rid themselves of self-hatred.

Since the DSM is intended to list psychopathologies, instead of all variations of human function, there's no reason to pathologize homosexuality. It is, at best, a descriptive of a particular form of sexual behavior.

Gender identity is pretty much immutable, you can't change it or even suppress without driving a person to suicide or a lifetime of unrelieved depression. Transitioning to one's target gender, on the other hand, is very effective at relieving gender dysphoria; and unlike, say, helping an anorexic to lose weight, being a transman or transwoman is not maladaptive.

That is the part that makes no sense to me. Is it the right course or merely the most convient? If a pill came out tomorrow that suppressed gender identity disorder is that any more or less more moral/ethical than current procedures?

Earthborn said it better than I can:

People can be mentally stuck in so many different thinking patterns, including religions, phobias, compulsive obsessions, pedophilia, violence, whatever. My starting point is that the physical is the default position, and the psychological is a programmable unit.

Psychology is a poorly developed science so far, which is why manipulating a person's mind is much harder than manipulating a person's body. The psychological is not a "programmable unit", far from it; and even if it were psychology as poorly developed as a science as it is so far doesn't provide us with the knowledge to program it. I think a medical treatment should try to fix a problem with the least invasive and best understood methods, and that doesn't include messing with the brain if that can be avoided.

If in the future treating transsexuals by manipulating their minds becomes as effective as treating them by manipulating their bodies, I think the starting point should be the patient's wishes, not some philosophical debate whether the "physical" or the "psychological" represents a person's "true identity".

 

[Checkmite]

Cosmetic procedures, particularly the kinds to correct deformities in children, have an incredible therapeutic benefit. Case in point:

6 months old:
[qimg]http://upload.wikimedia.org/wikipedia/commons/thumb/2/2f/13900470_3PREOPERATION0.jpg/114px-13900470_3PREOPERATION0.jpg[/qimg]

1 year old:
[qimg]http://upload.wikimedia.org/wikipedia/commons/thumb/6/60/10_months.jpg/90px-10_months.jpg[/qimg]

8 years old:
[qimg]http://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Cleft_Palate.JPG/89px-Cleft_Palate.JPG[/qimg]

Many, many parents get their kids cosmetic procedures at some point in their life. Braces for teeth, acne medication, are common. Sometimes more serious issues like cleft lip and palate, ear deformities, hand deformities, burn scars, tumors. Many of these issues will never physically impair a person, only cause emotional and social distress.

I'm sorry, but a transgender identity is not a disease or deformity, or the result of an injury, that needs "correction" or "treatment". *Like any adolescent with body features they dislike, what they need is emotional support and to be assured that there's no such thing as a "perfect body"; that if they consider themselves a girl they're a girl and they don't need to hack off or inject things to wither away body parts in order to substantiate that.

It seems unnecessarily cruel, especially when medical intervention is safe and available, "sorry kid, purely cosmetic". Its like you object out of principle simply for the sake of objecting without justifying your opinion.

Still *not convinced it's safe (see below); and in any case what is the logical progression of medical intervention against perfectly normal and healthy body parts and functions in children? *Are you fine with the aforementioned forced early puberty for 8-year-old girls who just have to have *breasts right this minute? *Or extra testosterone for similarly aged boys who have somehow become convinced their genitals are "too small"? *Do you support breast implants, facelifts, and Botox for prepubescents? I'm sure these will also have a tremendous "therapeutic effect" in lieu of the proper emotional parental support they should be receiving instead, too.

No part of this statement makes sense. Every transgender woman self-identifies as a girl regardless of their body parts, and their simultaneously interested in their physical appearance. This is true for transgender children as well: they self-identify as a member of their target gender in spite of their body parts, they nearly always adopt the social norms appropriate for their target gender and age, and they (and in general all kids) have a very strong interest in their physical appearance, their clothes their wear, their hair, etc.

And in general all kids have things about their body they don't like. *It's a parent's job to help children get through and past this stage while avoiding imbuing them with a fixation on anatomical appearance as the base of their self-esteem.

Hormone blockers in transgender kids can avoid the development of secondary sexual characteristics, such as breasts in girls, lowered voice and facial hair in boys. Puberty can be absolutely horrific. Being a girl, but watching your body "man up" is the worst possible fear, its like watching your body physically mutilate itself and there's absolutely nothing you can do to stop it.

It's the result of improper parenting, as stated above. *These physical things can all be fixed once the child reaches the age of majority if they so choose. *Anorexic patients believe that a healthy body weight is akin to "self-mutilation" too. *It's a normal physiological process; they need to be reassured, not "treated". *If transgender children feel like the normal puberty that everybody goes through is effectively their body "mutilating itself", then that's an emotional health issue and if there's treatment it should be emotional health treatment, not physical treatment. *Surely not this chemical counter-mutilation.

The child in the OP acknowledges that she has "boy parts" and is adamant that they simply don't make a difference; she's a girl and that's it. *That's an excellent attitude, I'm sure her mother helped develop it. *Hopefully she keeps it throughout her childhood instead of falling into depression when she starts growing pubic hair - but if she doesn't, I argue for treating the depression, not the perfectly healthy and completely normal body.

You want to know a large part of my principled objection to allowing hugely impactful decisions like this on the rationale that the child really wants it? *The same innate problem that lies behind my objection to allowing sex between adults and children even if the child claims to really want it and believes they're mature enough to decide: there is simply no way to control for the fact that children are extremely malleable and susceptible to undue influence by adults, whether it be their parents or others. *Children can very easily be made to really, really want things by adults they trust. *There's no way to reasonably assure that a given parent who brings a 10 year old boy (for example) in to a clinic for a procedure to stop him from maturing isn't simply attempting to "keep him a child" (for one of a few possible reasons) or attempting a little post-facto "child customization" and has convinced the kid it's what he really wants anyway. *Is that unfair to transgender people who really have formed their own opinions independent of influence? Absolutely, I will never deny that. *But when our choices of results are an adult with an unhappy childhood who can still get all the same changes done for roughly the same expense, and an adult with an unhappy childhood who will never regain the function that they want but were medically prevented from developing, I cannot help but support the interests of the latter over the former.

Seriously, what conceivable advantage do you gain putting anyone through that? Especially when its easy and safe to avoid?

Avoiding permanent and irreversible damage should the transgender person change his or her mind. *We do allow that possibility, of changing one's mind, yes?

Or they'll just do what 41% of other untreated transgender people do and attempt suicide.

Yes, I'm sure those 41% of "untreated" transgender people were given the kind of support I describe and killed themselves anyway...actually wait, I don't think a single one of them likely did. *I think they were told that they were their biological sex no matter what they thought, and were made fun of rather than supported. I think that's why they killed themselves, and not because they were supported but cruelly "forced" to go through puberty.

Yes we can. Gender identity is NOT tied to biological sex, and simultaneously hormone blockers to delay puberty and secondary sexual characteristics have an enormously positive therapeutic advantage and promote emotional health.

Just like catalyzing early puberty in a girl who really really really wants *breasts before all the other girls in her class get them. *It could only benefit her state of mind, right?

There are 1000s of kids who grow up into physical healthy adults as a result of hormone therapy before puberty. The Harry Benjamin Standards of Care, which are used by all endocrinologists, surgeons, and counselors who specialize in transgender health, as well as all scholarly literature on the topic indicate that the maximum therapeutic advantage occurs when it is given as early in life as possible, preferably before puberty.

It's funny that you say this, and then link me to this:

I'm at work right now and not able to search, but what you're interested in is documented in the Standards of Care:

Which clearly states that children should have begun puberty and advanced to at least "Tanner stage 2" before beginning this kind of treatment for this reason.

Now, I'm not 100% sure why they so conspicuously wouldn't want to begin such therapy until after the pubertal process is fairly well underway; but if I had the money, I'd be willing to bet that more likely than not it's because sabotaging puberty before it starts does after all have irreversible consequences, whereas merely throttling it down after it's underway allows for the eventual resumption of normal physiological growth and function should the participant change his or her mind.

By the way, I asked for a case study of children who had begun hormone blocking therapy before puberty, but later decided to remain their biological sex, stopped the treatment, and grew up to have completely normal sexual function; the link you provided does not give any such case studies.

 

[Dessi]

Checkmite,

Let's start at the hormone blockers. According to Standards of Care, transgender children are given hormone blockers to delay the onset of puberty:

Biologic males should be treated with LHRH agonists (which stop LH secretion and therefore
testosterone secretion), or with progestins or antiandrogens (which block testosterone secretion
or neutralize testosterone action). Biologic females should be treated with LHRH agonists or
with sufficient progestins (which stop the production of estrogens and progesterone) to stop
menstruation.

These medicines are more commonly prescribed to treat precocious puberty (see study here).

The effects reverse when the medicines are no longer taken, puberty runs its normal course.

I'm sorry, but a transgender identity is not a disease or deformity, or the result of an injury, that needs "correction" or "treatment". *Like any adolescent with body features they dislike, what they need is emotional support and to be assured that there's no such thing as a "perfect body"; that if they consider themselves a girl they're a girl and they don't need to hack off or inject things to wither away body parts in order to substantiate that.

No one in this thread, apart from you, mentioned anything about "hacking off" body parts. The normal treatment for transgender children is based on reversible interventions, such as delaying the onset of secondary sexual characteristics, waiting and observing a child to see if their gender identity is persistent.

And yes, every major psychological and psychiatric association in the world asserts that gender dysphoria is a serious problem which requires treatment. In practical application, arguments that transgender care is "purely cosmetic" have failed. See here:

I'll admit, I don't understand how it is a bona fide medical expense, rather than merely something cosmetic.

I can understand that the cosmetic changes may be necessary for your mental well-being, but they are still cosmetic in nature; you're not suffering from any physical disorder that needs to be fixed for your body to operate as it is medically expected to.

In my mind, it compares to plastic surgery for burn victims. Once skin grafts and other reconstructive work has made it so that the patient has a properly functioning face, even a normatively "ugly" one (mis-shapen, asymmetrical, etc), further surgeries really are cosmetic rather than medical. This doesn't imply the surgeries aren't important for the person to function socially or psychologically. But I think it's reasonable to make a distinction between surgeries that are necessary for proper medical health and surgeries that may be important for personal happiness or self-esteem but are nonetheless not medically necessary.

I don't know about other countries, but recently in the US, O'Donnabhain v US Tax Court established that gender altering surgeries are a tax deductable medical expense.

Summary of the case is as follows:

- A transgender woman deducted the cost of her GRS (gender reassignment surgery) on her taxes, IRS stated that GRS was a cosmetic procedure.

- IRS argued that GID is not a "disease" because tg people are physically healthy, that there's no known cause, and that GRS does not "cure" it.

- O'Donnabhain, represented by the Gay & Lesbian Advocates and Defenders (GLAD), asserted that GID is a diagnosable medical condition, which is accepted by all major psychiatric and psychiatric organizations in the US and elsewhere. GLAD argued that numerous court cases regarding transgender prisoners have ruled that GID is a serious medical condition which requires treatment, and it is well established that some mental illnesses (e.g. anorexia) have no known cause yet are treated as diseases for the purposes applying tax code.

More importantly, GLAD argued that every psychiatric reference recognizes GID as a serious disease and endorses
the triadic therapeutic sequence from Harry Benjamin Standards of Care, which recommends gender reassignment surgery as a therapeutic intervention required for the treatment of GID, as the authoritative guide regarding transgender care.

GRS is therefore a therapeutic treatment required to alleviate the distress of GID.

- 8 judges agreed with GLAD.

- 5 judges dissented on the basis that GRS does not treat the underlying cause of transsexuality. Speaking for myself, I find this line of thought disturbing, as it could imply that wheelchairs, crutches, painkillers, reconstrucive surgery, and such are not tax deductible medical expenses as they don't treat the underlying disease and/or cosmetic in nature.

A very good discussion of the case is here:
http://newyorklawschool.typepad.com...-taxpayer-on-surgical-expense-deductions.html

and in any case what is the logical progression of medical intervention against perfectly normal and healthy body parts and functions in children? *Are you fine with the aforementioned forced early puberty for 8-year-old girls who just have to have *breasts right this minute? *Or extra testosterone for similarly aged boys who have somehow become convinced their genitals are "too small"? *Do you support breast implants, facelifts, and Botox for prepubescents? I'm sure these will also have a tremendous "therapeutic effect" in lieu of the proper emotional parental support they should be receiving instead, too.

To all your questions, any children with symptoms of body dysmorphic disorder serious enough to constitute a mental disorder need to be taken absolutely seriously. What's the nature of their disorder, what's the best way to treat it, what are the effects of untreated disorder?

Seriously, its not a joke. People with these disorders develop major depression, social phobias, may be unable to form lasting relationships, around 80% of them contemplate suicide. Extreme cases can lead to dissociation, self-mutilation, suicide, diminished quality of life.

Yes, all kids have things they don't like about their bodies, and they need support and reassurance. However, for some kids, particularly transgender children, their dysphoria can be so severe that it has a significant, unrelieved distress on mental life.

To me, it sounds like your argument is based on glib rhetoric, rather than the sound, established recommendations of psychiatric organizations. What single piece of information do you have that no other person on the planet have access to regarding the best way to treat gender dysphoria?

Hormone blockers in transgender kids can avoid the development of secondary sexual characteristics, such as breasts in girls, lowered voice and facial hair in boys. Puberty can be absolutely horrific. Being a girl, but watching your body "man up" is the worst possible fear, its like watching your body physically mutilate itself and there's absolutely nothing you can do to stop it.

It's the result of improper parenting, as stated above. *These physical things can all be fixed once the child reaches the age of majority if they so choose. *Anorexic patients believe that a healthy body weight is akin to "self-mutilation" too.

Regarding comparisons to anorexia, see here:

Gender identity is pretty much immutable, you can't change it or even suppress without driving a person to suicide or a lifetime of unrelieved depression. Transitioning to one's target gender, on the other hand, is very effective at relieving gender dysphoria; and unlike, say, helping an anorexic to lose weight, being a transman or transwoman is not maladaptive.

*It's a normal physiological process; they need to be reassured, not "treated".

Transgender identities are a normal variation in gender identities, and its appropriate treatment depends on what's best and most therapeutic for that individual. Your remark that puberty is normal is therefore not meant to be treated is, at best, a thinly veiled appeal to nature, and should be dismissed as such.

*If transgender children feel like the normal puberty that everybody goes through is effectively their body "mutilating itself", then that's an emotional health issue and if there's treatment it should be emotional health treatment, not physical treatment. *Surely not this chemical counter-mutilation.

What "counter-mutilation" are you talking about? Presumably by "mutiliation", you mean to say that being transgender is maladaptive, impairs a person, harms their mental or physical health, has some negative properties that we otherwise would like to avoid. If you have an argument that delaying puberty or prescribing hormones to transgender people is any of those things, I'd like to hear it.

The child in the OP acknowledges that she has "boy parts" and is adamant that they simply don't make a difference; she's a girl and that's it. *That's an excellent attitude, I'm sure her mother helped develop it. *Hopefully she keeps it throughout her childhood instead of falling into depression when she starts growing pubic hair - but if she doesn't, I argue for treating the depression, not the perfectly healthy and completely normal body.

Transitioning to one's target gender does treat the depression and underlying gender dysphoria. Additionally, successfully transitioned people are perfectly normal, healthy, and well-integrated into their respective culture. The key here is understanding that being transgender is not maladaptive.

You want to know a large part of my principled objection to allowing hugely impactful decisions like this on the rationale that the child really wants it? *The same innate problem that lies behind my objection to allowing sex between adults and children even if the child claims to really want it and believes they're mature enough to decide: there is simply no way to control for the fact that children are extremely malleable and susceptible to undue influence by adults, whether it be their parents or others. *Children can very easily be made to really, really want things by adults they trust. *There's no way to reasonably assure that a given parent who brings a 10 year old boy (for example) in to a clinic for a procedure to stop him from maturing isn't simply attempting to "keep him a child" (for one of a few possible reasons) or attempting a little post-facto "child customization" and has convinced the kid it's what he really wants anyway. *Is that unfair to transgender people who really have formed their own opinions independent of influence? Absolutely, I will never deny that. *But when our choices of results are an adult with an unhappy childhood who can still get all the same changes done for roughly the same expense, and an adult with an unhappy childhood who will never regain the function that they want but were medically prevented from developing, I cannot help but support the interests of the latter over the former.

You might be interested in this comment:

When this was investigated by skeptics, there were a lot of problems found with the way in which investigators talked to children.

Those investigators were often not trained psychologists or psychiatrists, while the therapists diagnosing GID in children are, who are not basing far reaching conclusions on a few talks.

Also a misdiagnosis is not as problematic. When investigators wrongly conclude Satanic abuse someone might end up in jail while being innocent. When they wrongly conclude a child is transsexual, a child may get through a phase of innocent gender play before deciding not to go through with sex reassignment when they are an adult.

I can definitely understand your concerns. In fact, the reasons you list above are exactly why the treatment for transgender children depends on fully reversible interventions which delay puberty, rather than irreversible surgeries, because it gives more time to watch for signs that suggest a person's gender identity is permanent or transient.

Avoiding permanent and irreversible damage should the transgender person change his or her mind. *We do allow that possibility, of changing one's mind, yes?

Indeed, people can and do change their minds. That's the whole point of avoiding permanent, irreversible interventions in favor of reversible interventions in the treatment of young transgender people.

Yes, I'm sure those 41% of "untreated" transgender people were given the kind of support I describe and killed themselves anyway...actually wait, I don't think a single one of them likely did. *I think they were told that they were their biological sex no matter what they thought, and were made fun of rather than supported. I think that's why they killed themselves, and not because they were supported but cruelly "forced" to go through puberty.

The primary burden on transgender people is the lack of access to affordable care, which is exacerabated by about 50% of them experiencing employment discrimination. Numerous transgender people can talk about how they were fired after coming out at work, they are routinely discriminated and marginalized, they're denied medical care, many people lose families, the costs will exclude many trans people of any realistic chance of ever integrating into their target gender. See here.

And yes, deliberately refusing to treat a transgender person is needlessly, unnessarily cruel and otherwise easy to avoid. It causes severe depression, the cost of reversing pubertal changes can be prohibitively expensive, it serves no purpose or therapeutic advantage whatsoever.

It's funny that you say this, and then link me to this:

I'm at work right now and not able to search, but what you're interested in is documented in the Standards of Care:

Which clearly states that children should have begun puberty and advanced to at least "Tanner stage 2" before beginning this kind of treatment for this reason.

My mistake, I should have said before the development of secondary sexual characteristics (breasts and menstruation in girls, voice and facial hair in boys). Tanner Stage 2 corresponds to an age of 10 to 11.5, which seems to be pretty typical for children beginning to transition.

Also note the Standards of Care are guidelines, not categorical rules. Counselors and endocrinologists routinely tailor the treatment of people based on their individual needs. Numerous people have received treatment without necessarily adhering to every guideline.

By the way, I asked for a case study of children who had begun hormone blocking therapy before puberty, but later decided to remain their biological sex, stopped the treatment, and grew up to have completely normal sexual function; the link you provided does not give any such case studies.

I'm unable to find the fulltext of this paper, but a decent summary is provided here:

Giordano then turns to concerns about the safety of what is still an experimental treatment. First, are we putting children at risk for short- or long-term adverse events? It is worthwhile to note that exogenous continuous GnRH administration is the standard of care for the treatment of precocious puberty, and its safety and efficacy have been extensively studied [11]. Children with GID can be said to have another type of incorrect puberty and therefore qualify for GnRH agonist treatment. Research has shown that suppression of puberty is safe, causing minimal side effects [6]. If parents become concerned about this treatment, they can safely and easily stop treatment and allow development to restart normally in the biological sex. Though, as one prominent British physician points out, the fact of having given a child GnRH agonists is not reversible (i.e., we cannot make it “un-happen”); nonetheless, the effects of the treatment are both “temporary and reversible” [12].

 

[Checkmite]

Checkmite,

Let's start at the hormone blockers. According to Standards of Care, transgender children are given hormone blockers to delay the onset of puberty:


These medicines are more commonly prescribed to treat precocious puberty (see study here).

The effects reverse when the medicines are no longer taken, puberty runs its normal course.

Once again, it says puberty has to have begun before the treatment is started. Of course, treatments for precocious puberty are by definition administered after puberty has started, because if puberty hadn't started the treatment would not be needed.

And yes, every major psychological and psychiatric association in the world asserts that gender dysphoria is a serious problem which requires treatment. In practical application, arguments that transgender care is "purely cosmetic" have failed. See here:

Delaying puberty is purely cosmetic.

An adult can decide to do whatever they wish; I have no problem with an adult undertaking any alteration they see fit to undertake. As I mentioned, I could even be argued down to 16 - maybe.

To all your questions, any children with symptoms of body dysmorphic disorder serious enough to constitute a mental disorder need to be taken absolutely seriously. What's the nature of their disorder, what's the best way to treat it, what are the effects of untreated disorder?

Seriously, its not a joke. People with these disorders develop major depression, social phobias, may be unable to form lasting relationships, around 80% of them contemplate suicide. Extreme cases can lead to dissociation, self-mutilation, suicide, diminished quality of life.

All of these are mental health issues that should require mental health treatment. It's a rather crude metaphor to be sure, but you don't chop off a paranoid schizophrenic's hand in order to treat his delusion that somebody planted a bomb in it. If transgender children honestly believe their bodies are "mutilating themselves", the treatment should involve bringing them to understand that's not what's happening.

Yes, all kids have things they don't like about their bodies, and they need support and reassurance. However, for some kids, particularly transgender children, their dysphoria can be so severe that it has a significant, unrelieved distress on mental life.

Again, there's mental and emotional health services for that.

To me, it sounds like your argument is based on glib rhetoric, rather than the sound, established recommendations of psychiatric organizations. What single piece of information do you have that no other person on the planet have access to regarding the best way to treat gender dysphoria?

Whose glib rhetoric? I didn't read any websites that reflect my personal concerns with the issue as I've stated them; I came up with them on my own. Or are you capriciously assuming they're informed by some kind of political or special interest leaning?

Regarding comparisons to anorexia, see here:

Causing damage by sabotaging puberty in prepubescent children is very much maladaptive; I'm afraid I disagree with you.

Of course, there's nothing wrong with an adult getting whichever sorts of surgeries they wish.

Transgender identities are a normal variation in gender identities, and its appropriate treatment depends on what's best and most therapeutic for that individual. Your remark that puberty is normal is therefore not meant to be treated is, at best, a thinly veiled appeal to nature, and should be dismissed as such.

So is that a yes or no to my proposed scenarios?

What "counter-mutilation" are you talking about? Presumably by "mutiliation", you mean to say that being transgender is maladaptive, impairs a person, harms their mental or physical health, has some negative properties that we otherwise would like to avoid. If you have an argument that delaying puberty or prescribing hormones to transgender people is any of those things, I'd like to hear it.

Of course you would presume that; after all, I've only stated multiple times that being transgender is not a disease or disorder and shouldn't require any treatment beyond the same emotional support all parents should provide their children. It's not you who's been repeating this whole time that "GID" is a serious problem with such horrific consequences that allowing a child with it to go through puberty is tantamount to torture and mutilation.

My only objection, as stated plainly in the OP, is to giving these treatments to prepubescent children, as I believe it causes harm. You keep responding to this by citing studies, histories, and guidelines that, to a one, all deal with treatments begun after puberty has started; therefore, the concern underlying my objection has yet to be addressed and thus stands.

You might be interested in this comment:

I can definitely understand your concerns. In fact, the reasons you list above are exactly why the treatment for transgender children depends on fully reversible interventions which delay puberty, rather than irreversible surgeries, because it gives more time to watch for signs that suggest a person's gender identity is permanent or transient.

Indeed, people can and do change their minds. That's the whole point of avoiding permanent, irreversible interventions in favor of reversible interventions in the treatment of young transgender people.

Which is why pre-pubescent hormone treatments are unethical, in my opinion.

The primary burden on transgender people is the lack of access to affordable care, which is exacerabated by about 50% of them experiencing employment discrimination. Numerous transgender people can talk about how they were fired after coming out at work, they are routinely discriminated and marginalized, they're denied medical care, many people lose families, the costs will exclude many trans people of any realistic chance of ever integrating into their target gender. See here.

That's terrible, really; of course, once again, I'm referring to children and not adults; so employment discrimination is not cogent to my concerns.

And yes, deliberately refusing to treat a transgender person is needlessly, unnessarily cruel and otherwise easy to avoid. It causes severe depression, the cost of reversing pubertal changes can be prohibitively expensive, it serves no purpose or therapeutic advantage whatsoever.

Depression can be treated, and the "reversal" of pubertal changes surely can't be much more expensive considering many of the same changes are going to have to be done at some point anyway even if puberty is permanently held off by a lifetime drug regimen.

My mistake, I should have said before the development of secondary sexual characteristics (breasts and menstruation in girls, voice and facial hair in boys). Tanner Stage 2 corresponds to an age of 10 to 11.5, which seems to be pretty typical for children beginning to transition.

Tanner II isn't before the development of secondary sexual characteristics; in is in fact the beginning of obvious development of secondary sexual characteristics. Treatment can't happen until after that point because in order for it to be "safe and reversible" it needs to be applied only after puberty has started, and the development of secondary sexual characteristics is the only objective way to determine that it has started.

Also note the Standards of Care are guidelines, not categorical rules. Counselors and endocrinologists routinely tailor the treatment of people based on their individual needs. Numerous people have received treatment without necessarily adhering to every guideline.

Bothers me. Especially given mental health issues; I have a problem with doctors not adhering to diagnosis or prescription guidelines, for instance, when diagnosing many mental illnesses. Playing fast and loose with any kind of treatment "guidelines, not actual rules" is scary stuff. What is this, the Pirate's Code?

I'm unable to find the fulltext of this paper, but a decent summary is provided here:

Once again very specifically mentioning, in so many words, the use of the treatment after the start of puberty, not before (it specifically says Tanner stage 2 at least); and still lacks the example case histories I'm asking for. It's certainly not your fault if you can't find any - but that doesn't mean you can just post other things that "kind of sound similar" as if they're the same thing and still get the points.

 

[Pup]

All of these are mental health issues that should require mental health treatment. It's a rather crude metaphor to be sure, but you don't chop off a paranoid schizophrenic's hand in order to treat his delusion that somebody planted a bomb in it. If transgender children honestly believe their bodies are "mutilating themselves", the treatment should involve bringing them to understand that's not what's happening.

In theory, that sounds good. But it's my understanding that in practice, trying to change the person mentally is a less successful treatment, than trying to change them physically. Apparently the gender of the brain is not as malleable as we think.

Let's take an example of an apparently normal male infant, who loses his penis in an accident. In theory, it should be easier to do some minor plastic surgery, supplement his hormones, and raise him as a happy, normal-appearing girl, rather than to force him to live as an abnormal-looking boy-without-a-penis, if reconstructing his penis isn't possible. Because even if he was presumably born with a male brain, the gender of an infant's brain can be changed with mental health treatment, right?

Well, that's what doctors used to think. Not so much, anymore.

What we still lack is a way of ascertaining the gender of the brain objectively, if it differs from the sex of the body, the way we can diagnose a hare-lip or a scar or some other congenital problem that's best to fix with plastic surgery when the child is young, which makes this more difficult, so the next best thing is to try to make later treatment as easy as possible. Hormones to delay puberty seem like a logical solution, until better diagnostic tools are discovered.

 

[Gazpacho]

All of these are mental health issues that should require mental health treatment. It's a rather crude metaphor to be sure, but you don't chop off a paranoid schizophrenic's hand in order to treat his delusion that somebody planted a bomb in it. If transgender children honestly believe their bodies are "mutilating themselves", the treatment should involve bringing them to understand that's not what's happening.

Counseling body-dysmorphic TGs to snap out it and to ignore the stigma and humiliation they face in Western society is not clinically effective. You don't seem to grasp that basic point. TGs in the west do not face the problem of living in India or in some future western culture where gender attitudes are different. They face a problem here and now.

 

[Dessi]

Delaying puberty is purely cosmetic.

An adult can decide to do whatever they wish; I have no problem with an adult undertaking any alteration they see fit to undertake. As I mentioned, I could even be argued down to 16 - maybe.

Puberty is a horrific experience for transgender teens, a major source of suffering. At the same time, a number of changes occurs, which in transwomen include the development of androgynous facial hair, masculine voice, square jaw, height, and a number of other undesirable features which may be prohibitively expensive to correct. What possible advantage are you doing to a person to put them through that? Especially when it can be easily avoided?

To all your questions, any children with symptoms of body dysmorphic disorder serious enough to constitute a mental disorder need to be taken absolutely seriously. What's the nature of their disorder, what's the best way to treat it, what are the effects of untreated disorder?

Seriously, its not a joke. People with these disorders develop major depression, social phobias, may be unable to form lasting relationships, around 80% of them contemplate suicide. Extreme cases can lead to dissociation, self-mutilation, suicide, diminished quality of life.

All of these are mental health issues that should require mental health treatment. It's a rather crude metaphor to be sure, but you don't chop off a paranoid schizophrenic's hand in order to treat his delusion that somebody planted a bomb in it. If transgender children honestly believe their bodies are "mutilating themselves", the treatment should involve bringing them to understand that's not what's happening.

Delaying puberty, transitioning to one's target gender, and eventually starting a hormone regimen is the treatment for transgender children. There's no other effective treatment.

In all seriousness, your suggested alternative treatment, to wait until the bulk of irreversible pubertal changes have taken effect, are deliberately harmful. Its not a good strategy, its never been effective, it causes harm to children without any possible return on investment.

Believe me, I can totally understand where you're coming from, its just that proposed treatment flies in the face of the last five decades of transgender care. You can't treat gender dysphoria with anti-depressants, you can't suppress it, there seems to be no advantage to telling a transgirl to "man up" until the bulk of irreversible changes resulting from puberty are finished. Its just not effective, your suggestion tangibly harms people in an otherwise avoidable way.

Whose glib rhetoric? I didn't read any websites that reflect my personal concerns with the issue as I've stated them; I came up with them on my own. Or are you capriciously assuming they're informed by some kind of political or special interest leaning?

Do I really need to explain that your example of 8-year-old girls demanding boob jobs is facetious and offensive?

Transgender identities are a normal variation in gender identities, and its appropriate treatment depends on what's best and most therapeutic for that individual. Your remark that puberty is normal is therefore not meant to be treated is, at best, a thinly veiled appeal to nature, and should be dismissed as such.

So is that a yes or no to my proposed scenarios?

How did you infer that from my comment?

In short, people with body dismorphic disorder have a different set of needs than transgender individuals. I don't know much about the treatment of these people, but I estimate that people with an amputation fixation are generally not referred to surgeons, as lopping off your arms and limbs significantly impairs a person's mobility and health; I don't believe the same comments carry over to transgender people, where transitioning to one's target gender does not impair a person at all.

My only objection, as stated plainly in the OP, is to giving these treatments to prepubescent children, as I believe it causes harm. You keep responding to this by citing studies, histories, and guidelines that, to a one, all deal with treatments begun after puberty has started; therefore, the concern underlying my objection has yet to be addressed and thus stands

Fair enough. The guidelines recommend an age of around 10 or 11 to begin hormone blockers, it seems to be effective enough in people.

Do you have objections to hormone blockers at that age?

You might be interested in this comment:

I can definitely understand your concerns. In fact, the reasons you list above are exactly why the treatment for transgender children depends on fully reversible interventions which delay puberty, rather than irreversible surgeries, because it gives more time to watch for signs that suggest a person's gender identity is permanent or transient.

Indeed, people can and do change their minds. That's the whole point of avoiding permanent, irreversible interventions in favor of reversible interventions in the treatment of young transgender people.

Which is why pre-pubescent hormone treatments are unethical, in my opinion.

What's unethical? That the treatments are completely reversible should a person choose not to transition? That no one ever performs irreversible surgery on children?

Also note the Standards of Care are guidelines, not categorical rules. Counselors and endocrinologists routinely tailor the treatment of people based on their individual needs. Numerous people have received treatment without necessarily adhering to every guideline.

Bothers me. Especially given mental health issues; I have a problem with doctors not adhering to diagnosis or prescription guidelines, for instance, when diagnosing many mental illnesses. Playing fast and loose with any kind of treatment "guidelines, not actual rules" is scary stuff. What is this, the Pirate's Code?

Ummmmm... no. Nobody plays "fast and loose", a physician or counselor can be sued for malpractice being totally careless about the treatment of their patients. Let me clarify:

Usually, a person requires 3 months of gender counseling, 6 to 12 sessions, prior to being prescribed hormones. There are some exceptions:

- a person seeking hormones may be living full time for a year or more, its unlikely a person in this position is going to have second thoughts after couseling. These people usually get a referral after one or two visits.

- In Omaha, most counselors of this type will charge $100/hr. Many transgender people don't have the luxury of mental health insurance or large amounts of disposible income. A few people I've known have had the number of sessions reduced to provide quicker access. In one case, a transwoman had mental health insurance through her job, but she was being laid off from her job, she recieved a referral after 5 sessions before she lost her job and health insurance.

To obtain gender reassignment, a person typically needs to be 18 years of age, living a year full time in their target gender, referrals from two gender counselors. I've heard of doctors making exceptions in certain cases:

- several transwomen I know have had surgery with one referral, because they'd invested so much time and money into their transition (hair removal, facial feminization, breast implants).

- Kim Petras (see lhere) had her surgery at 16, doctors acknowledged that she was a good candidate for surgery and there was no real advantage to waiting later.

 

[Giordano]

Checkmite: I can't help but notice that your posts are simply statements of your own beliefs, whereas Dessi cites multiple medical and psychological studies. Thats okay if your goal is to let the rest of us know how you feel; fair enough. Not so convincing if your goal is to define correct medical practice for pre-pubescent transgenders. And I realize you intend only the best for these individuals. But try to imagine if you were 12 years old, and truly felt it overwhelming wrong and embarrassing to be in the body to which you were born, just as if you had a harelip. I've never had that experience, but I can imagine it.


Dessi- once again I admire your patience.

 

[Checkmite]

In theory, that sounds good. But it's my understanding that in practice, trying to change the person mentally is a less successful treatment, than trying to change them physically. Apparently the gender of the brain is not as malleable as we think.

Let's take an example of an apparently normal male infant, who loses his penis in an accident. In theory, it should be easier to do some minor plastic surgery, supplement his hormones, and raise him as a happy, normal-appearing girl, rather than to force him to live as an abnormal-looking boy-without-a-penis, if reconstructing his penis isn't possible. Because even if he was presumably born with a male brain, the gender of an infant's brain can be changed with mental health treatment, right?

Well, that's what doctors used to think. Not so much, anymore.

What we still lack is a way of ascertaining the gender of the brain objectively, if it differs from the sex of the body, the way we can diagnose a hare-lip or a scar or some other congenital problem that's best to fix with plastic surgery when the child is young, which makes this more difficult, so the next best thing is to try to make later treatment as easy as possible. Hormones to delay puberty seem like a logical solution, until better diagnostic tools are discovered.

No no, I agree with you completely. I do not propose changing the gender of the brain in the least; I don't believe that's really possible, as your data seems to back up.

I'm proposing helping TG individuals to understand that being TG is normal and doesn't need any "fixing", in any way.

See, it's like you guys are creating a mutually-exclusive pair of choices: being TG is a "problem" and the only two possible ways of "treating it" (assuming again that we're talking about young people):

1. Get the transgender person to understand that if their body is male they are male and they should give up thinking they're female, and vice versa. Let's call this "changing their minds".

2. Use medical interventions to interrupt their growth and alter the arrangement of their bodies in order to "not look too much like" the opposite of their mental gender identity. "Changing their bodies".

Both of these methods suffer from the same problem - they don't actually work. As you've pointed out, training a person who was "born mentally male" to be "female" doesn't work; even when their "male parts" are accidentally destroyed it won't change the fact of how they identify themselves. Similarly, preventing puberty does not change the fact that male genitalia or female genitalia are still there, as the case may be. So the biologically female person will never have to buy bras and the biologically male one will never need to shave - but that's quite literally the extent of it. Do these couple of conveniences in and of themselves really act as that much of a panacea to the troubled TG mind? Does the TG kid who identifies as male but is biologically female feel more secure simply by virtue of having no hair on his female sex organs? Of course not. It's a placebo.

I think 1 and 2 above are both wrong. They both proceed from the same initial and incorrect assuption: that being TG is wrong; that it's unhealthy for some reason to have a different mental gender and physical gender, and that this issue needs to be repaired by somehow bringing one into line with the other, period, end of story. Of course most of them reject 1 because they know for a fact it doesn't work; but they can reasonably pretend that 2 "works" - after all, the "treatment" only has to hold them until they're old enough for reassignment surgery - and so they endorse it heavily. Hey, treatment = a paycheck. It's that simple.

 

[Dessi]

No no, I agree with you completely. I do not propose changing the gender of the brain in the least; I don't believe that's really possible, as your data seems to back up.

I'm proposing helping TG individuals to understand that being TG is normal and doesn't need any "fixing", in any way.

See, it's like you guys are creating a mutually-exclusive pair of choices: being TG is a "problem" and the only two possible ways of "treating it" (assuming again that we're talking about young people):

1. Get the transgender person to understand that if their body is male they are male and they should give up thinking they're female, and vice versa. Let's call this "changing their minds".

2. Use medical interventions to interrupt their growth and alter the arrangement of their bodies in order to "not look too much like" the opposite of their mental gender identity. "Changing their bodies".

Or option #3, treat a person based on their specific wishes.

Being transgender means a person has a gender identity which does not match their biological sex. There's no requirement a trans person desire to live as a member of a the opposite sex, there's no requirement for them to be on hormones or even be at a specific stage in transition.

Typically, medical interventions are reserved for people who genuinely want to live full time as a member of their target gender.

Both of these methods suffer from the same problem - they don't actually work. As you've pointed out, training a person who was "born mentally male" to be "female" doesn't work; even when their "male parts" are accidentally destroyed it won't change the fact of how they identify themselves. Similarly, preventing puberty does not change the fact that male genitalia or female genitalia are still there, as the case may be. So the biologically female person will never have to buy bras and the biologically male one will never need to shave - but that's quite literally the extent of it. Do these couple of conveniences in and of themselves really act as that much of a panacea to the troubled TG mind? Does the TG kid who identifies as male but is biologically female feel more secure simply by virtue of having no hair on his female sex organs? Of course not. It's a placebo.

Transitioning doesn't work because a person still has certain genitalia? I have to very strongly disagree, since it seems you've misunderstand the point of medical interventions.

All trans therapies recognize that gender dysphoria is a serious cause of distress, serious enough that many people with untreated dysphoria commit suicide. Medical intervention is beneficial because it minimizes or eliminates gender dysphoria -- as long as it does that much, its more effective than no intervention at all, and we can appreciate the merits of transitioning on that basis alone.

Intervention early avoids a whole class of difficulties associated with transitioning well into or after puberty. Typically, people who don't transition early will develop a number of secondary sexual characteristics which they may find undesirable, prohibitively expensive to correct, or prevent them from feeling integrated into their target gender. This is bad, its exactly the sort of thing we want to avoid when treating young transgender people.

The point here is that intervention early on is profoundly beneficial to young trans people. Dismissing the merit of intervention on the basis that a person still has their biological genitalia is seriously missing the point, its about as pointless as criticizing transitioning in principle on the basis that still has the DNA they're born with.

I think 1 and 2 above are both wrong. They both proceed from the same initial and incorrect assuption: that being TG is wrong; that it's unhealthy for some reason to have a different mental gender and physical gender, and that this issue needs to be repaired by somehow bringing one into line with the other, period, end of story. Of course most of them reject 1 because they know for a fact it doesn't work; but they can reasonably pretend that 2 "works" - after all, the "treatment" only has to hold them until they're old enough for reassignment surgery - and so they endorse it heavily. Hey, treatment = a paycheck. It's that simple.

Option #1 is bad because its a product of prejudice against transgender people. The class of people who promote #1 are bigots, their opinions need not be considered.

Option #2 has absolutely nothing to do with a presumption that being transgender is "bad" and absolutely everything to do with effectively treating gender dysphoria. The criticism that a person's genitals are intact misses the point, has no bearing on the actual therapeutic benefit of early intervention.

 

[Checkmite]

Puberty is a horrific experience for transgender teens, a major source of suffering. At the same time, a number of changes occurs, which in transwomen include the development of androgynous facial hair, masculine voice, square jaw, height, and a number of other undesirable features which may be prohibitively expensive to correct. What possible advantage are you doing to a person to put them through that? Especially when it can be easily avoided?

Puberty is a horrific experience for transgender teens because their well-meaning but misguided support systems emphasize that it will make them "look" less like their mental gender and therefore is essentially some kind of biological boogeyman. It makes no sense for a person who's comfortable being a female in a male body before puberty to suddenly become horrified by being a female in a male body during puberty. Do you understand? There's no reason for such a change in attitude, unless they've been talked into being horrified.

Delaying puberty, transitioning to one's target gender, and eventually starting a hormone regimen is the treatment for transgender children. There's no other effective treatment.

In all seriousness, your suggested alternative treatment, to wait until the bulk of irreversible pubertal changes have taken effect, are deliberately harmful. Its not a good strategy, its never been effective, it causes harm to children without any possible return on investment.

What do you mean, "deliberately harmful"? Why?

I'm sorry to say, but a biologically male person who delays puberty is not trading a male figure for a womanly figure; he's maintaining a male child's figure. And even after puberty is complete, a hormone treatment can cause breasts to develop, muscle mass to reduce, and facial hair to stop growing. So the entire point is what - years of injections to prevent a square jaw? Give me a break. That can be fixed...and it doesn't even have to be; women can have square jaws and even deep voices. And again, what they're trading for isn't a womanly face anyway, but a male-childish one; it's just as far off.

Believe me, I can totally understand where you're coming from, its just that proposed treatment flies in the face of the last five decades of transgender care. You can't treat gender dysphoria with anti-depressants, you can't suppress it, there seems to be no advantage to telling a transgirl to "man up" until the bulk of irreversible changes resulting from puberty are finished. Its just not effective, your suggestion tangibly harms people in an otherwise avoidable way.

What do you mean? What happened to TG children before hormone-blocking was approved for this use? Did they all kill themselves? No; they grew up, got sex reassignment surgery, and went on to live comfortably. Of course it works just fine. The TG adult who's grown up without ever going through puberty is still going to need the exact same sex reassignment surgeries as one who did if they want to fully become their "target gender".

Do I really need to explain that your example of 8-year-old girls demanding boob jobs is facetious and offensive?

Umm...yes. Dismiss it as facetious if you want; but if you're going to claim it's offensive I'm calling BS unless you describe why. Start by explaining the differences between the two situations. An 8 year old is devastated because other girls in her school have breasts and she doesn't. She wants hormone therapy to jumpstart puberty. Explain why this analogy is "facetious and offensive".

How did you infer that from my comment?

Infer what? Your comment was a direct response to a question I asked, which you even quoted. As an answer it was ambiguous, so I asked you to explain whether it was a yes or no answer to my question.

In short, people with body dismorphic disorder have a different set of needs than transgender individuals. I don't know much about the treatment of these people, but I estimate that people with an amputation fixation are generally not referred to surgeons, as lopping off your arms and limbs significantly impairs a person's mobility and health; I don't believe the same comments carry over to transgender people, where transitioning to one's target gender does not impair a person at all.

I'm fine with transitioning to a person's desired gender; just not starting when they're small children who haven't even begun puberty yet.

Fair enough. The guidelines recommend an age of around 10 or 11 to begin hormone blockers, it seems to be effective enough in people.

Do you have objections to hormone blockers at that age?

Generally yes, for reasons of preventing a decision being made under undue influence, as stated in my last post.

What's unethical? That the treatments are completely reversible should a person choose not to transition? That no one ever performs irreversible surgery on children?

No; remember, I'm still not convinced that treating prepubescent children is "completely reversible".

- In Omaha, most counselors of this type will charge $100/hr.

Well of course they do. And that's why you'll never find one of them endorsing allowing a TG to simply grow up, with close parental support, until they become an adult and have reassignment surgery at that point: because they might have an awful, horrific, tragically (correctable) square jaw, and also because they'll miss out on a solid decade of bills for hormone blocking treatments and therapy sessions.

I would be interested to see a side-by-side cost comparison of 10 years of childhood hormone blocking therapy plus sex re-assignment surgery along with therapy at $100/hr, versus only sex-reassignment surgery as an adult (which apparently is covered by health insurance) and minor cosmetic facial surgery. Now I'm even less willing to believe it's actually a cost-saving measure over time with all things considered.

 

[Checkmite]

Transitioning doesn't work because a person still has certain genitalia? I have to very strongly disagree, since it seems you've misunderstand the point of medical interventions.

All trans therapies recognize that gender dysphoria is a serious cause of distress, serious enough that many people with untreated dysphoria commit suicide. Medical intervention is beneficial because it minimizes or eliminates gender dysphoria -- as long as it does that much, its more effective than no intervention at all, and we can appreciate the merits of transitioning on that basis alone.

Intervention early avoids a whole class of difficulties associated with transitioning well into or after puberty. Typically, people who don't transition early will develop a number of secondary sexual characteristics which they may find undesirable, prohibitively expensive to correct, or prevent them from feeling integrated into their target gender. This is bad, its exactly the sort of thing we want to avoid when treating young transgender people.

These characteristics are reversible with hormone treatments taken as adults. I question the notion that they are "prohibitively expensive to correct" when compared to the costs of an entire decade of hormone blocking and therapy.

A boy who wishes to live as a girl in America is not going to be feeling integrated into their target gender during their adolescence no matter whether they go through puberty or not. Everyone will still see them as a boy dressing up like a girl. That train leaves the station when the kid starts playing outside and the world first learns their (boy's) name, and there's no hope of calling it back.

When they're an adult and can have the actual surgeries done, that's when integration can take place. Anything before then is, quite frankly, snake oil.

 

[Pup]

I think 1 and 2 above are both wrong. They both proceed from the same initial and incorrect assuption: that being TG is wrong; that it's unhealthy for some reason to have a different mental gender and physical gender, and that this issue needs to be repaired by somehow bringing one into line with the other, period, end of story. Of course most of them reject 1 because they know for a fact it doesn't work; but they can reasonably pretend that 2 "works" - after all, the "treatment" only has to hold them until they're old enough for reassignment surgery - and so they endorse it heavily. Hey, treatment = a paycheck. It's that simple.

Not sure I'm following. As I understand it, female hormones given later in life don't really undo the secondary sexual characteristics caused by male hormones that increase at puberty. Hence the electrolysis and voice lessons that are part of male-to-female reassignment.

Catching the problem early and preventing that difficulty would, in fact, make transition a lot easier when the person is old enough.

Are you saying that even later in life, medical intervention to change the body should be considered unnecessary, and therefore it should be unnecessary to prepare for that possibility at a younger age?

I agree with the idea that being TG should be considered normal and not something to be stigmatized for.

For those who are happy being considered a third gender, androgenous, both or neither male and female, okay, cool. But for those who want to be accepted as normal members of the opposite sex, that's gonna be harder without some intervention.

I remember watching my father shave, putting on shaving cream and pretending to shave alongside him.

If I'd never grown a beard, or had been female and grown one anyway, I would have noticed. I'm not sure that being told that some men just don't grow beards or some women do grow beards and not to worry about, would have been enough to make me contented being different from most people of my gender, if there was a reasonably straightforward medical solution.

I think society is just too many years away from the day when someone with an obviously female body could go to the beach and have everyone immediately assume he's male, based only on clues like haircut and choice of bathing suit. TG's who want to be accepted as the opposite sex will want/need to give off more physical clues than that, for quite a few more generations at least, hence the need for medical treatment.

Edited to add: the last couple of posts showed up while I was typing, so I may have missed some clarification made in them.

From one of those posts:

These characteristics are reversible with hormone treatments taken as adults.

Is that true? I thought once a male's beard grew in, female hormones wouldn't eliminate it; electrolysis was necessary. Same for breasts; once a woman developed breasts, surgery was usually necessary to shrink them to a normal male size. Dunno. Am I wrong? If I'm wrong, I might change my mind and be more against early intervention.

 

[Checkmite]

Not sure I'm following. As I understand it, female hormones given later in life don't really undo the secondary sexual characteristics caused by male hormones that increase at puberty. Hence the electrolysis and voice lessons that are part of male-to-female reassignment.

And again, my understanding is that most of the secondary sexual characteristics can, in fact, be so reversed, and that voice is among the isolated few that aren't.


Let's approach this from a different angle. Dessi claims that a transgender person is inherently harmed by puberty, but that a person whose puberty is delayed for however long a period is not harmed at all should they decide against gender reassignment.

How true is that second part? Because the delayed puberty is "reversible", does that mean the person who decides against a change is not harmed at all by its delay?

I submit they are. Puberty is a process that takes several very noticeable years to complete. I would posit that a man whose voice is still cracking and has no facial hair or masculine build at 18 to 20 years old is inherently harmed and "unable to integrate with his chosen gender" just as much as an 18 to 20 year old woman who has a mustache and no breasts. I believe that the stated "harmlessness" of delayed puberty is predicated on the expectation of the patient's ultimately deciding to go through with a change, and that since puberty will restart once the blockers are stopped, that absolutely no consideration is given to the circumstances of the person that decides not to change because of the expectation "they'll get over it eventually" whenever puberty finally finishes for them in their late 20's or so.

 

[Dessi]

Puberty is a horrific experience for transgender teens because their well-meaning but misguided support systems emphasize that it will make them "look" less like their mental gender and therefore is essentially some kind of biological boogeyman. It makes no sense for a person who's comfortable being a female in a male body before puberty to suddenly become horrified by being a female in a male body during puberty. Do you understand? There's no reason for such a change in attitude, unless they've been talked into being horrified.

Yes it absolutely IS a boogeyman. Gender dysphoria is, by definition, a gender identity which does not match a person's biological sex. A huge factor in a person's a dysphoria is that their physical appearance will prevent them from successfully integrating as a member of their target gender. Not everyone, but a significant number of trans people who desire to live as a member of preferred gender have an interest in blending in.

Yes, it does make sense that a person's dysphoria increases during puberty. In biological males, they develop large hands and feet, facial hair, Adam's apple, body masculizes outside of their control.

This is what people actually go through. And they go through it whether you can understand it or not.

What do you mean, "deliberately harmful"? Why?

I'm sorry to say, but a biologically male person who delays puberty is not trading a male figure for a womanly figure; he's maintaining a male child's figure. And even after puberty is complete, a hormone treatment can cause breasts to develop, muscle mass to reduce, and facial hair to stop growing. So the entire point is what - years of injections to prevent a square jaw? Give me a break. That can be fixed...and it doesn't even have to be; women can have square jaws and even deep voices. And again, what they're trading for isn't a womanly face anyway, but a male-childish one; it's just as far off.

Well isn't that a judgemental remark. A trans person does not need to justify their desire to transition early nor do they need to be physically attractive to enjoy the therapeutic benefits of doing so.

In any case, there are three distinct advantages to transitioning early:

1) Transitioning early is to reduce years and years of untreated gender dysphoria.

2) Early interventions can prevent the development of secondary sexual characteristics which exacerbate gender dysphoria. Its much easier to masculinize a feminine body than feminize a masucline body.

Early transitioners tend to blend in extremely well (see Lynn Conways article), they tend to transition considerably easier than people later in life.

3) Early intervention can reduce the tremendous cost of fixing unwanted facial features. For transwomen, removing a beard with electrolysis takes about 150 hours at a cost of around $70/hr, facial feminization can cost between $25-40K. For transmen, double mastectomy and chest reconstruction can cost $8500. Frequently, trans women are unable to begin these surgeries until their 40s, 50s, or never.

Reducing the extraordinary costs, reducing the number of surgeries, reducing the time it takes for a woman to integrate into her target gender seem to justify early intervention on that basis alone.

What do you mean? What happened to TG children before hormone-blocking was approved for this use? Did they all kill themselves? No; they grew up, got sex reassignment surgery, and went on to live comfortably. Of course it works just fine. The TG adult who's grown up without ever going through puberty is still going to need the exact same sex reassignment surgeries as one who did if they want to fully become their "target gender".

Irrelevant. Not only is there no rational argument which precludes a person from enjoying modern medicine, the benefits of early intervention are already well-documented.

The argument that people need gender reassignment later in life is a red herring, it has nothing to do with the fact that early intervention really does help young trans people.

I'm fine with transitioning to a person's desired gender; just not starting when they're small children who haven't even begun puberty yet.

I made a mistake in saying that guidelines recommend transitioning before puberty (I forget that puberty begins so early in life). The guidelines recommend hormone blockers at around 10 or 11.

Fair enough. The guidelines recommend an age of around 10 or 11 to begin hormone blockers, it seems to be effective enough in people.

Do you have objections to hormone blockers at that age?

Generally yes, for reasons of preventing a decision being made under undue influence, as stated in my last post.

Nevermind the lack of evidence supporting that assertion, the lack of evidence that a child would incorrectly claim to be transgender for years, the complete lack of any statistics whatsoever which substantiate an argument that systematic misdiagnosis harms people.

All the treatments for trans children are safe and completely reversible. So what's the actual harm of a misdiagnosis? At worst, a brief phase of gender play before they choose not to transition.

No; remember, I'm still not convinced that treating prepubescent children is "completely reversible".

My apologies, I made an error. People should be treated at an age recommended by the standards of care, with hormone blockers beginning at around 10 or 11.

 

[Pup]

And again, my understanding is that most of the secondary sexual characteristics can, in fact, be so reversed, and that voice is among the isolated few that aren't.

I did a quick google on electrolysis, and ran into things like this:


http://www.looking-glass.greenend.org.uk/electro.htm

A typical transsexual, who has developed to adulthood with a male body, will have a typical male facial hair pattern and strong, deep-rooted hair. A large amount of treatment will almost inevitably be required, many hundreds of hours spread over a 2--3 year period, is not unusual; up to five years may be required in some cases...

Hormone treatment alone does not have a significant effect on facial hair, but coupled with electrolysis it affects the regrowth rate substantially

Do you have other cites which contradict that?

 

[Checkmite]

Yes it absolutely IS a boogeyman. Gender dysphoria is, by definition, a gender identity which does not match a person's biological sex. A huge factor in a person's a dysphoria is that their physical appearance will prevent them from successfully integrating as a member of their target gender. Not everyone, but a significant number of trans people who desire to live as a member of preferred gender have an interest in blending in.

Yes, it does make sense that a person's dysphoria increases during puberty. In biological males, they develop large hands and feet, facial hair, Adam's apple, body masculizes outside of their control.

This is what people actually go through. And they go through it whether you can understand it or not.

It's fixable. There are too many obvious examples of TG individuals who were born with male bodies that manage to look completely and indistinguishably female despite never having their bodies altered as children.

Well isn't that a judgemental remark. A trans person does not need to justify their desire to transition early nor do they need to be physically attractive to enjoy the therapeutic benefits of doing so.

I think any medical procedure performed on children that doesn't correct an obvious disease or deformity needs to be strongly justified, yes I do; especially one with such long-lasting consequences.

Adults, of course, are free to do what they want.

In any case, there are three distinct advantages to transitioning early:

1) Transitioning early is to reduce years and years of untreated gender dysphoria.

Does it, in fact? Are females with male bodies actually able to integrate and be happy once their puberty has been stopped? How about the other way around?

What happens in high school when it's time for communal showers?

2) Early interventions can prevent the development of secondary sexual characteristics which exacerbate gender dysphoria. Its much easier to masculinize a feminine body than feminize a masucline body.

At what cost? Have you truly considered it, or does the fact that puberty will eventually reverse itself make the meantime bearable for someone who chooses to remain a man? Because I don't see how it's okay to put somebody through that because as a child they wanted to be a different sex, but not okay to let somebody go through puberty and have their desires addressed with reassignment surgery afterwards.

Early transitioners tend to blend in extremely well (see Lynn Conways article), they tend to transition considerably easier than people later in life.

Those who ultimately decide not to transition - how well do they do? Are there any studies? Stats? Did anybody even bother to follow up on them, ever? Or are such individuals rare enough that it's not worth the effort to study?

3) Early intervention can reduce the tremendous cost of fixing unwanted facial features. For transwomen, removing a beard with electrolysis takes about 150 hours at a cost of around $70/hr, facial feminization can cost between $25-40K. For transmen, double mastectomy and chest reconstruction can cost $8500. Frequently, trans women are unable to begin these surgeries until their 40s, 50s, or never.

And what is the cost of a decade of "early transition" and therapy?

Irrelevant. Not only is there no rational argument which precludes a person from enjoying modern medicine, the benefits of early intervention are already well-documented.

The argument that people need gender reassignment later in life is a red herring, it has nothing to do with the fact that early intervention really does help young trans people.

What about the ones who decide not to change? "It's reversible" is a little nonspecific...

 

[Dessi]

These characteristics are reversible with hormone treatments taken as adults.

Is that true? I thought once a male's beard grew in, female hormones wouldn't eliminate it; electrolysis was necessary. Same for breasts; once a woman developed breasts, surgery was usually necessary to shrink them to a normal male size. Dunno. Am I wrong? If I'm wrong, I might change my mind and be more against early intervention.

Short answer, no.

The effects of hormones are subtle.

In transwomen (see wiki, see this NSFW overview), anti-androgens and estrogens soften the skin, reduce muscle mass, encourage development of breasts, eliminate the involuntary libido, and neutralize the masculinizing effects of testosterone. Long term use may reduce testicular volume. After puberty, hormones have absolutely no effect on:

- a woman's skeletal structure (big hands, big feet, square jaw, brow ridge, large nose, broad shoulders, narrow hips, large teeth, tall stature)
- coarse body hair (face, chest, back, neck, belly). Anecdotally I've heard it increases head hair growth, reduces but does not eliminate balding.
- no effect on voice (its kind of a neat bar trick, but almost all post-puberty transwomen can flip back and forth between voice at will, see here and here)
- no effect on sexual orientation.
- effect on breasts vary widely. Anecdotally, I've personally never met a transwoman who could, without augmentation or significant weight gain, fill an A-cup.

Typically young transwomen develop a feminine skeletal structure, retain feminine voice, never develop facial hair or an adam's apple, develop average sized breasts. Even without facial feminzation or breast augmentation, young transitioners almost always look, act, and sound like their genetic counterparts.

In transmen (see wiki article), anti-estrogens and testosterone drops the pitch of the voice, roughen skin, build muscle mass, develops body hair, increases sex drive, results in a fairly stoic emotional life, may result in male pattern balding. After puberty, it has no effect on:

- a man's skeletal structure (narrow chin, wide hips, short stature).
- no effect on sexual orientation.

Generally transmen transition attractively. Starting early can avoid the development of breasts, they're othewise indistinguishable from their genetic counterparts.