9 ms·

First, why do you consider it to be a problem in the mind, rather than the body? It seems to me that, fundamentally, gender dysphoria is a mismatch between the

First, why do you consider it to be a problem in the mind, rather than the body? It seems to me that, fundamentally, gender dysphoria is a mismatch between the mind and the body. Declaring the body to be correct and the mind wrong seems arbitrary (as would declaring the mind to be right and the body wrong). It's not really a question of right and wrong, it's the mismatch that's the problem. Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-hormone-treatment-see-improvements-to-their-mental-health https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example). Note that not all transgender people experience gender dysphoria. Some are fine with the bodies they were born with, and for them gender reassignment would be unnecessary and irrelevant. Also, note that this is different from treatment for e.g. anorexia nervosa. If someone with anorexia loses weight, it doesn't help; they'll continue to see themselves as overweight. Treatment for anorexia has to focus on the patient's mind. Helping them lose weight would make their outcome worse, not better, which is why it's not done. Scott Alexander gives an interesting analogy to a case from the mental hospital where he works here: https://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/ https://slatestarcodex.com/2014/11/21/the-categories-were-ma.... A woman with OCD was constantly worrying that she'd left her hair dryer on, and was having to drive home 10-20 times a day to check whether it was really off, or was on and going to burn the house down. Nothing they'd tried worked, until someone suggested she take the hair dryer with her. That effectively solved the problem for her, because she could always just look over at the dryer, see that it was unplugged, and go about her business. But caused a huge controversy among the psychiatrists between those who thought "This Is Not How One Treats Obsessive Compulsive Disorder" vs those who just said "it worked". I'm with the "do what works" crowd.

jononomo 4y ago
There is no empirical way to verify if someone is actually transgender. In fact, there really is no theoretical way that a person could even be transgender unless one accepts the idea of a non-material soul that is somehow gendered. Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are transgender and try to help them.
- okaram 4y ago
  You are defining male and female that way. If you go by that definition, you can define a transgender person as someone who deeply thinks and feels they ought to be of the other gender. They are not 'mistaken' other than by your definition. If you ask them 'do you have a penis' or similar question, they will respond with your objective reality.
  - gingfro 4y ago
    [flagged]
  - jononomo 4y ago
    Yes, I believe transgender people exist if you define the condition as people who wish they were of the opposite sex or mistakenly think they are of the opposite sex. They definitely really have mental conditions that result in wishes and feelings related to sex and gender, but if they claim that they truly are of the opposite sex, they are mistaken.
- kelseyfrog 4y ago
  Emperical measurement framing is a cognitive cul-de-sac. Drawing a parallel, there's no emperical way to determine someone's sexuality. Fifty years ago this argument was used to justify therapeutically changing people's sexuality. "If you're a man you're biologically attracted to women. It's biologically impossible to be homosexual." Today we have the same logic applied to people's gender. It's as invalid today as it was back then.
  - jononomo 4y ago
    Of course there is an empirical way to determine someone’s sexuality. You can show someone different varieties of pornography and see which varieties make them sexually aroused. You can see sexual arousal happening in the brain with an MRI. You can also just simply observe someone’s sexual behavior.
    - kelseyfrog 4y ago
bruiseralmighty 4y ago
> Declaring the body to be correct and the mind wrong seems arbitrary... Hardly, our understanding of the human body is more experimentally valid and much more aesthetically developed than our understanding of the human mind. If there is some kind of 'mismatch' as you say and the body appears well regulated, then the medically responsible move is to defer to it.
exidy 4y ago
> Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving- https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example). There seems to be a prevalent problem in this area (and perhaps others too) to where the reporting on the "science" seems to be a lot more positive than the science itself. The original article alludes to this -- "stop questioning the science" like it's an open and shut case. For that particular study, a more accurate headline would be: "In Our Pre-Registration We Expected To Find Improvements on Eight Measures but We Only Found Improvements on Two, Which Were Very Small, and Only For Natal Females."[1] It's not as snappy, but it's more accurate. That complex and fairly ambiguous outcome gets summarised into an overall optimistic story by the press, which then in turn gets digested into "gender reassignment .. works", not just on HN but on forums all over the internet. It's not just that study though -- whenever the field is looked at holistically the evidence for the effectiveness of these treatments is not strong.[2][3] and the evidence for such treatments on children (the subject of the article) is even weaker. Ultimately I believe adults have the right to do as they wish with their own bodies, however when it comes to children we have to be guided by the highest standards of medicine and science. [1] https://jessesingal.substack.com/p/the-new-highly-touted-study-on-hormones https://jessesingal.substack.com/p/the-new-highly-touted-stu... [2] https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=282&bc=ACAAAAAAQAAA& https://www.cms.gov/medicare-coverage-database/view/ncacal-d... [3] https://www.cochrane.org/CD013138/TOBACCO_does-hormone-therapy-help-transgender-women-undergoing-gender-reassignment-transition https://www.cochrane.org/CD013138/TOBACCO_does-hormone-thera...
atchoo 4y ago
> why do you consider it to be a problem in the mind, rather than the body One argument is that it's a category error to call gender wrong. Your ethnicity, gender and wealth of your parents etc. just is, it's the hand you are dealt with. You can be unhappy with it but it can't be "wrong" just like the country you are born in can't be "wrong". If someone is distressed about the country they are born in to the point of suicide, we'd class it as a mental condition. Such a thought can be rational but it's the degree of distress that suggests disorder rather than a healthy preference/observation of one's situation. It does have a rather obvious "do what works" sticking plaster. The concern with sticking plasters is if they end our curiosity about the underlying condition. If we normalise them such they are considered inviolable part of the culture, political sacred cows and the one true solution that cannot be questioned. I expect that hairdrier lady's OCD was not limited to just her hairdrier - the sticking plaster hopefully reduced acute disruption/distress that made more fundamental treatment tractable. (FWIW, despite articulating this argument, I can argue against it. I don't hold any confident position in this culture war maelstrom of bigotry and questionable scientific/philosophical claims.)

jononomo 4y ago

There is no empirical way to verify if someone is actually transgender. In fact, there really is no theoretical way that a person could even be transgender unless one accepts the idea of a non-material soul that is somehow gendered. Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are transgender and try to help them.

okaram 4y ago
You are defining male and female that way. If you go by that definition, you can define a transgender person as someone who deeply thinks and feels they ought to be of the other gender. They are not 'mistaken' other than by your definition. If you ask them 'do you have a penis' or similar question, they will respond with your objective reality.
- gingfro 4y ago
  [flagged]
- jononomo 4y ago
  Yes, I believe transgender people exist if you define the condition as people who wish they were of the opposite sex or mistakenly think they are of the opposite sex. They definitely really have mental conditions that result in wishes and feelings related to sex and gender, but if they claim that they truly are of the opposite sex, they are mistaken.
kelseyfrog 4y ago
Emperical measurement framing is a cognitive cul-de-sac. Drawing a parallel, there's no emperical way to determine someone's sexuality. Fifty years ago this argument was used to justify therapeutically changing people's sexuality. "If you're a man you're biologically attracted to women. It's biologically impossible to be homosexual." Today we have the same logic applied to people's gender. It's as invalid today as it was back then.
- jononomo 4y ago
  Of course there is an empirical way to determine someone’s sexuality. You can show someone different varieties of pornography and see which varieties make them sexually aroused. You can see sexual arousal happening in the brain with an MRI. You can also just simply observe someone’s sexual behavior.
  - kelseyfrog 4y ago

bruiseralmighty 4y ago

> Declaring the body to be correct and the mind wrong seems arbitrary... Hardly, our understanding of the human body is more experimentally valid and much more aesthetically developed than our understanding of the human mind. If there is some kind of 'mismatch' as you say and the body appears well regulated, then the medically responsible move is to defer to it.

exidy 4y ago

> Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving- https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example). There seems to be a prevalent problem in this area (and perhaps others too) to where the reporting on the "science" seems to be a lot more positive than the science itself. The original article alludes to this -- "stop questioning the science" like it's an open and shut case. For that particular study, a more accurate headline would be: "In Our Pre-Registration We Expected To Find Improvements on Eight Measures but We Only Found Improvements on Two, Which Were Very Small, and Only For Natal Females."[1] It's not as snappy, but it's more accurate. That complex and fairly ambiguous outcome gets summarised into an overall optimistic story by the press, which then in turn gets digested into "gender reassignment .. works", not just on HN but on forums all over the internet. It's not just that study though -- whenever the field is looked at holistically the evidence for the effectiveness of these treatments is not strong.[2][3] and the evidence for such treatments on children (the subject of the article) is even weaker. Ultimately I believe adults have the right to do as they wish with their own bodies, however when it comes to children we have to be guided by the highest standards of medicine and science. [1] https://jessesingal.substack.com/p/the-new-highly-touted-study-on-hormones https://jessesingal.substack.com/p/the-new-highly-touted-stu... [2] https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=282&bc=ACAAAAAAQAAA& https://www.cms.gov/medicare-coverage-database/view/ncacal-d... [3] https://www.cochrane.org/CD013138/TOBACCO_does-hormone-therapy-help-transgender-women-undergoing-gender-reassignment-transition https://www.cochrane.org/CD013138/TOBACCO_does-hormone-thera...

atchoo 4y ago

> why do you consider it to be a problem in the mind, rather than the body One argument is that it's a category error to call gender wrong. Your ethnicity, gender and wealth of your parents etc. just is, it's the hand you are dealt with. You can be unhappy with it but it can't be "wrong" just like the country you are born in can't be "wrong". If someone is distressed about the country they are born in to the point of suicide, we'd class it as a mental condition. Such a thought can be rational but it's the degree of distress that suggests disorder rather than a healthy preference/observation of one's situation. It does have a rather obvious "do what works" sticking plaster. The concern with sticking plasters is if they end our curiosity about the underlying condition. If we normalise them such they are considered inviolable part of the culture, political sacred cows and the one true solution that cannot be questioned. I expect that hairdrier lady's OCD was not limited to just her hairdrier - the sticking plaster hopefully reduced acute disruption/distress that made more fundamental treatment tractable. (FWIW, despite articulating this argument, I can argue against it. I don't hold any confident position in this culture war maelstrom of bigotry and questionable scientific/philosophical claims.)