6 ms·

No surgeon should be removing healthy body parts, in my opinion. You wouldn’t fit a gastric band to an anorexic person, no matter how badly the patient wanted i

by g3e0 4y ago

No surgeon should be removing healthy body parts, in my opinion. You wouldn’t fit a gastric band to an anorexic person, no matter how badly the patient wanted it, and that’s not even permanent. I sympathise with all people who have issues accepting the body they were born with. If someone believes their body should be different, but otherwise their body is healthy, I think it’s fair to say that whatever is causing the feeling of mismatch is happening in the mind. It’s no surprise to me that a significant fraction present with other mental disorders. In an ideal world, there would be some form of therapy that helps people come to terms with and accept themselves with what they’ve been given. But again I do sympathise, because contemporary medicine simply isn’t very good at treating mental illnesses.

qaz_plm 4y ago
People are terrible at analogies
kevingadd 4y ago
What is your definition of healthy? Should people born with a cleft palate be forced to leave it alone? What about people with breathing problems due to their anatomy? If a kid has teeth grow in improperly and start causing jaw problems, should they be prohibited from having their wisdom teeth removed or teeth realigned with braces? Should tonsil removal be prohibited? If a woman has severe back pain due to oversized breasts, should it be prohibited to get a reduction surgery even if it improves quality of life? Should vasectomies be prohibited if a person with testes wants to be able to have sex with their partner without the risk of pregnancy? Should it be prohibited to medically disable "healthy" body parts as well? As an alternative to vasectomies you can use drugs to similarly disable that body part, in many cases effectively forever. Should that be illegal too? What about anti-androgens like Spironolactone - used on-label for multiple different purposes - should we ban those since they are also used for MtF HRT? Birth control also is functionally disabling healthy parts of the body. Why does a problem "happening in the mind" somehow mean that no treatment can occur outside of the mind? Do you think mood stabilizers and antipsychotics should be banned because we're treating an "in the mind" problem with physical, body-altering interventions?
- Breefield 4y ago
  Thank you.
- jononomo 4y ago
  [flagged]
  - kevingadd 4y ago
    [removed]
    - 1123581321 4y ago
      Your first comment was better. This is a discussion about public health so of course people can contribute to it, and take an interest on behalf of the affected. And he does not seem at all upset.
      - kevingadd 4y ago
        [flagged]
        1123581321 4y ago
        That wasn’t at all necessary, but I appreciate it (and I also note and appreciate the sarcastic meaning here.)
        allarm 4y ago
        > mentally diseased The mentioned commenter didn’t say it though.
  - amanaplanacanal 4y ago
    My understanding is that transitioning is the best treatment we have. If you know of some other treatment the psychiatric community is unaware of, I’m sure we would all like to hear it.
jcul 4y ago
I think the key thing is that these permanent procedures should not be performed on children / minors. Personally, I was a very different person at 15 to 20 to 25. I don't really think a young person can make a rational decision on something that is going to affect the rest of their lives in such a dramatic way. A 30 year old deciding to get gender reassignment surgery is very different to a 12 year old.
- howinteresting 4y ago
  The problem is that being on the wrong set of hormones during your teenage years can fuck your body up. I'd be more open to medical intervention post-18 if this problem didn't exist.
  - filoleg 4y ago
    > The problem is that being on the wrong set of hormones during your teenage years can fuck your body up. That's pretty much the exact same reason for being against such hormonal treatments for minors as well.
    - howinteresting 4y ago
      Well, yeah, and the gold standard way of figuring out who would benefit from hormonal intervention is people's self-description.
danShumway 4y ago
> No surgeon should be removing healthy body parts, in my opinion. There are a metric ton of medical procedures surgeons do outside of medical transitioning where people alter/adjust/remove healthy body parts. This seems like a pretty blanket statement to say; and I say that as someone who would be extremely cautious about telling someone that they "should" medically transition if they feel that social transition would be sufficient for them. I'm all aboard the train of telling transgender people that they're valid whether or not they choose to transition, and I definitely would advocate that transgender identity and body dysphoria are not necessarily the same thing, and that many trans people are blessed to be able to both embrace their transgender identity and celebrate aspects of their bodies that don't "align" with their gender in strictly hetero-normative ways. Even with that perspective, this framing of "we're perverting the role of doctors/surgeons by cutting healthy flesh" -- it just doesn't really match the reality of how many procedures there are in the US that already fit that definition. Everything from the stereotypical examples of cosmetic surgery, to non-essential dental procedures, to limb lengthening, to circumcision, to sex-assignment surgery for intersex infants, the list goes on and on. Many of these procedures aren't strictly speaking medically necessary. Precocious puberty for example is primarily harmful because of its psychological and social effects. The physical consequences of early puberty are comparatively minor (not non-existant, but then-again neither are the effects of puberty blockers. We're mostly talking about stuff like "you might be shorter when you grow up"). And yet, I've never once seen someone advocate that it's morally wrong or that it should be illegal for a doctor to prescribe puberty blockers to a cisgender child with precocious puberty. There's no shortage of conditions that really don't have physical health-effects or side-effects other than that society has decided that we don't really like them or that they're inconvenient to live with (either because of social stigma or because of the increased need for accommodations that society is unwilling/unable to provide) -- and we generally don't tell people with those conditions that they need to just learn to live with them. Instead, we give them choices (including medical interventions) to address both the social effects of their conditions and the internal psychological effects of their conditions. What we don't do is we don't take a purely physical view of things. Heck, one of the justifications for why doctors prescribe puberty blockers to cisgender girls with precocious puberty is because there's limited research suggesting that delaying puberty lowers their risks of being raped. That's about as far into the "its a social problem, not a medical one" category as it's possible for a medical intervention to be. And look, all of this is even taking the most charitable view of the statement statement above and assuming that it is specifically talking about medical interventions among minors. But if I take that statement at its face value as saying that no surgeon should ever operate on healthy tissue, then it just kind of becomes absurd, honestly. There are so, so many medical procedures that fall under that umbrella. I think everyone would love to have less invasive ways of helping people who suffer from gender-disphoria and I think everyone is hoping that as social stigma continues to decrease that some of the psychological downsides of not transitioning might also decrease. That's not to say that medical transitioning is bad; it's not. But it does carry some risks, and obviously it's good to have multiple available paths for the transgender people who don't want to take those risks. But arguments that boil down to "it's in the mind, so treat it that way" sound good at face-value but are ultimately way too simplistic to work even in a purely cisgender world. Our medical profession hasn't really worked that way for a long time, if it ever worked that way at all. So any debate about whether or not a surgery procedure is moral needs to be engaging with the issue on a deeper level than just whether or not there's a physical risk involved.
howinteresting 4y ago
Your opinion, based on absolutely nothing but your armchair philosophizing, is completely incongruent with the actual science. Gender dysphoria is not a mental illness; it is a condition, like pregnancy. Unlike anorexia or body dysmorphia, when you address the issues causing gender dysphoria it simply resolves itself. Leave this to the experts, please (ie not a receptionist). Unless you're trans or an expert there is very little substance in your opinions. edit to respond: a mental illness is a disorder that causes harm to yourself or your interpersonal relationships. Gender dysphoria doesn't by itself do that. Transphobia in society does.
- __pache__ 4y ago
  [flagged]
- 0xy 4y ago
  "Resolving" gender dysphoria with surgery does not result in lower suicide rates. In fact, suicide rates are virtually unchanged after operation. "The overall mortality for sex-reassigned persons was higher during follow-up" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/
  - gdavisson 4y ago
    That study didn't compare suicide rates with and without surgery, it compared post-op trans people with the general population (i.e. mostly cisgender people). It explicitly says "This study design sheds new light on transsexual persons' health after sex reassignment. It does not, however, address whether sex reassignment is an effective treatment or not."
  - howinteresting 4y ago
    This study has been misread over and over again. It doesn't account for the fact that Sweden forced trans people to have surgery (sterilization) until 2013, even if they didn't want it. Besides, reducing suicidality is not the only goal of transitioning. I can tell you that for me, now that I've addressed the issues causing me gender dysphoria it has completely resolved itself.
silveroriole 4y ago
Would you support a woman having breast reduction surgery, or would you say “sorry your body doesn’t match your mind; get therapy”? I suppose you can argue the tissue here is not “healthy” because it’s causing physical distress for the woman, but the same seems to apply to a trans person. Distress is never ‘just’ mental, it has physical effects on the body (and vice versa - pain is ‘just’ mental). The decision of what’s healthy doesn’t seem so simple to me.
- 0xy 4y ago
  The argument you are making would hold up better if there was evidence that post-op trans people have dramatically lower suicidal thoughts, but multiple studies have shown suicidal thoughts is virtually unchanged after operation. Now the argument becomes something like 'a body part of yours is causing mental distress, let's cut it off even though there's zero evidence it'll help'. Seems very flimsy and predatory to me. As for breast reduction, there's actually evidence that large breasts can cause physical problems in women, so it seems reasonable to allow that along with the evidence that women with large breasts experience a better quality of life after surgery (absolutely not the case for trans people removing body parts). "The overall mortality for sex-reassigned persons was higher during follow-up" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/
  - silveroriole 4y ago
    There’s no therapy that helps, at least as far as I know. At best you could learn coping mechanisms, but I don’t think anyone has ever been successfully convinced out of trans-ness by therapy, similar to how gay conversion therapy didn’t actually work. So we’d be left with telling trans people “there is no treatment at all, go deal with it somehow.” Anecdotal of course, but there are a fair number of trans people on social media who seem happy with their surgery - why deny them that because someone else is convinced that according to statistics it shouldn’t have made them any happier?
    - mhaymo 4y ago
      Desistance, i.e. "being convinced out of transness" is perfectly common, as mentioned in the article. I'm not aware of any studies on how therapy can affect this, but even if the therapy was merely helping the patient cope with their dysphoria for a period before exploring other options, that seems a far cry from saying "just deal with it".

by g3e0 4y ago

qaz_plm 4y ago

People are terrible at analogies

kevingadd 4y ago

What is your definition of healthy? Should people born with a cleft palate be forced to leave it alone? What about people with breathing problems due to their anatomy? If a kid has teeth grow in improperly and start causing jaw problems, should they be prohibited from having their wisdom teeth removed or teeth realigned with braces? Should tonsil removal be prohibited? If a woman has severe back pain due to oversized breasts, should it be prohibited to get a reduction surgery even if it improves quality of life? Should vasectomies be prohibited if a person with testes wants to be able to have sex with their partner without the risk of pregnancy? Should it be prohibited to medically disable "healthy" body parts as well? As an alternative to vasectomies you can use drugs to similarly disable that body part, in many cases effectively forever. Should that be illegal too? What about anti-androgens like Spironolactone - used on-label for multiple different purposes - should we ban those since they are also used for MtF HRT? Birth control also is functionally disabling healthy parts of the body. Why does a problem "happening in the mind" somehow mean that no treatment can occur outside of the mind? Do you think mood stabilizers and antipsychotics should be banned because we're treating an "in the mind" problem with physical, body-altering interventions?

Breefield 4y ago
Thank you.
jononomo 4y ago
[flagged]
- kevingadd 4y ago
  [removed]
  - 1123581321 4y ago
    Your first comment was better. This is a discussion about public health so of course people can contribute to it, and take an interest on behalf of the affected. And he does not seem at all upset.
    - kevingadd 4y ago
      [flagged]
      - 1123581321 4y ago
        That wasn’t at all necessary, but I appreciate it (and I also note and appreciate the sarcastic meaning here.)
      - allarm 4y ago
        > mentally diseased The mentioned commenter didn’t say it though.
- amanaplanacanal 4y ago
  My understanding is that transitioning is the best treatment we have. If you know of some other treatment the psychiatric community is unaware of, I’m sure we would all like to hear it.

jcul 4y ago

I think the key thing is that these permanent procedures should not be performed on children / minors. Personally, I was a very different person at 15 to 20 to 25. I don't really think a young person can make a rational decision on something that is going to affect the rest of their lives in such a dramatic way. A 30 year old deciding to get gender reassignment surgery is very different to a 12 year old.

howinteresting 4y ago
The problem is that being on the wrong set of hormones during your teenage years can fuck your body up. I'd be more open to medical intervention post-18 if this problem didn't exist.
- filoleg 4y ago
  > The problem is that being on the wrong set of hormones during your teenage years can fuck your body up. That's pretty much the exact same reason for being against such hormonal treatments for minors as well.
  - howinteresting 4y ago
    Well, yeah, and the gold standard way of figuring out who would benefit from hormonal intervention is people's self-description.

danShumway 4y ago

> No surgeon should be removing healthy body parts, in my opinion. There are a metric ton of medical procedures surgeons do outside of medical transitioning where people alter/adjust/remove healthy body parts. This seems like a pretty blanket statement to say; and I say that as someone who would be extremely cautious about telling someone that they "should" medically transition if they feel that social transition would be sufficient for them. I'm all aboard the train of telling transgender people that they're valid whether or not they choose to transition, and I definitely would advocate that transgender identity and body dysphoria are not necessarily the same thing, and that many trans people are blessed to be able to both embrace their transgender identity and celebrate aspects of their bodies that don't "align" with their gender in strictly hetero-normative ways. Even with that perspective, this framing of "we're perverting the role of doctors/surgeons by cutting healthy flesh" -- it just doesn't really match the reality of how many procedures there are in the US that already fit that definition. Everything from the stereotypical examples of cosmetic surgery, to non-essential dental procedures, to limb lengthening, to circumcision, to sex-assignment surgery for intersex infants, the list goes on and on. Many of these procedures aren't strictly speaking medically necessary. Precocious puberty for example is primarily harmful because of its psychological and social effects. The physical consequences of early puberty are comparatively minor (not non-existant, but then-again neither are the effects of puberty blockers. We're mostly talking about stuff like "you might be shorter when you grow up"). And yet, I've never once seen someone advocate that it's morally wrong or that it should be illegal for a doctor to prescribe puberty blockers to a cisgender child with precocious puberty. There's no shortage of conditions that really don't have physical health-effects or side-effects other than that society has decided that we don't really like them or that they're inconvenient to live with (either because of social stigma or because of the increased need for accommodations that society is unwilling/unable to provide) -- and we generally don't tell people with those conditions that they need to just learn to live with them. Instead, we give them choices (including medical interventions) to address both the social effects of their conditions and the internal psychological effects of their conditions. What we don't do is we don't take a purely physical view of things. Heck, one of the justifications for why doctors prescribe puberty blockers to cisgender girls with precocious puberty is because there's limited research suggesting that delaying puberty lowers their risks of being raped. That's about as far into the "its a social problem, not a medical one" category as it's possible for a medical intervention to be. And look, all of this is even taking the most charitable view of the statement statement above and assuming that it is specifically talking about medical interventions among minors. But if I take that statement at its face value as saying that no surgeon should ever operate on healthy tissue, then it just kind of becomes absurd, honestly. There are so, so many medical procedures that fall under that umbrella. I think everyone would love to have less invasive ways of helping people who suffer from gender-disphoria and I think everyone is hoping that as social stigma continues to decrease that some of the psychological downsides of not transitioning might also decrease. That's not to say that medical transitioning is bad; it's not. But it does carry some risks, and obviously it's good to have multiple available paths for the transgender people who don't want to take those risks. But arguments that boil down to "it's in the mind, so treat it that way" sound good at face-value but are ultimately way too simplistic to work even in a purely cisgender world. Our medical profession hasn't really worked that way for a long time, if it ever worked that way at all. So any debate about whether or not a surgery procedure is moral needs to be engaging with the issue on a deeper level than just whether or not there's a physical risk involved.

howinteresting 4y ago

Your opinion, based on absolutely nothing but your armchair philosophizing, is completely incongruent with the actual science. Gender dysphoria is not a mental illness; it is a condition, like pregnancy. Unlike anorexia or body dysmorphia, when you address the issues causing gender dysphoria it simply resolves itself. Leave this to the experts, please (ie not a receptionist). Unless you're trans or an expert there is very little substance in your opinions. edit to respond: a mental illness is a disorder that causes harm to yourself or your interpersonal relationships. Gender dysphoria doesn't by itself do that. Transphobia in society does.

__pache__ 4y ago
[flagged]
0xy 4y ago
"Resolving" gender dysphoria with surgery does not result in lower suicide rates. In fact, suicide rates are virtually unchanged after operation. "The overall mortality for sex-reassigned persons was higher during follow-up" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/
- gdavisson 4y ago
  That study didn't compare suicide rates with and without surgery, it compared post-op trans people with the general population (i.e. mostly cisgender people). It explicitly says "This study design sheds new light on transsexual persons' health after sex reassignment. It does not, however, address whether sex reassignment is an effective treatment or not."
- howinteresting 4y ago
  This study has been misread over and over again. It doesn't account for the fact that Sweden forced trans people to have surgery (sterilization) until 2013, even if they didn't want it. Besides, reducing suicidality is not the only goal of transitioning. I can tell you that for me, now that I've addressed the issues causing me gender dysphoria it has completely resolved itself.

silveroriole 4y ago

Would you support a woman having breast reduction surgery, or would you say “sorry your body doesn’t match your mind; get therapy”? I suppose you can argue the tissue here is not “healthy” because it’s causing physical distress for the woman, but the same seems to apply to a trans person. Distress is never ‘just’ mental, it has physical effects on the body (and vice versa - pain is ‘just’ mental). The decision of what’s healthy doesn’t seem so simple to me.

0xy 4y ago
The argument you are making would hold up better if there was evidence that post-op trans people have dramatically lower suicidal thoughts, but multiple studies have shown suicidal thoughts is virtually unchanged after operation. Now the argument becomes something like 'a body part of yours is causing mental distress, let's cut it off even though there's zero evidence it'll help'. Seems very flimsy and predatory to me. As for breast reduction, there's actually evidence that large breasts can cause physical problems in women, so it seems reasonable to allow that along with the evidence that women with large breasts experience a better quality of life after surgery (absolutely not the case for trans people removing body parts). "The overall mortality for sex-reassigned persons was higher during follow-up" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/
- silveroriole 4y ago
  There’s no therapy that helps, at least as far as I know. At best you could learn coping mechanisms, but I don’t think anyone has ever been successfully convinced out of trans-ness by therapy, similar to how gay conversion therapy didn’t actually work. So we’d be left with telling trans people “there is no treatment at all, go deal with it somehow.” Anecdotal of course, but there are a fair number of trans people on social media who seem happy with their surgery - why deny them that because someone else is convinced that according to statistics it shouldn’t have made them any happier?
  - mhaymo 4y ago
    Desistance, i.e. "being convinced out of transness" is perfectly common, as mentioned in the article. I'm not aware of any studies on how therapy can affect this, but even if the therapy was merely helping the patient cope with their dysphoria for a period before exploring other options, that seems a far cry from saying "just deal with it".