ArjinFerman's profile

ArjinFerman Tinfoil Gigachad 11m ago

Oh, it gets better. On the off chance you decide to have a kid after all this, you can look forward to stuff like this:

I'm numb on the top of my chest, and I continue to be unable to feel on my skin [my son], or myself, or my boyfriend or anyone... But there's like chest tissue that is becoming engorged and filling with milk that is trapped in between scar tissue that's under my chest. I got these, like, rocks in my chest. When it happens, you can see it physically, like my chest getting large rocks in it, but it's not two, like breasts... it's little rocks and lumps and they're hot, and they're painful, and you can physically see it.

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ArjinFerman Tinfoil Gigachad 29m ago

You don't understand how parents overruling children's autonomy is in the same category of parents overruling children's autonomy?

Yeah. Parents overrule children's autonomy all the time, arguably that's what they're for. Overriding it to the point where they can't leave their house unaccompanied is so extreme that it does belong in a separate category, in my opinion.

I've argued against vaccine mandates.

Really? You were here during the Covid era? My memory isn't great but I feel like I would have made a note given how vicious the Blues were at the time.

But generally I'm pretty damn consistent here, government out individual responsibilities in.

So you're assuming everyone else is a Randian / bordering on ancap? Because I don't see where's the hypocrisy otherwise.

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ArjinFerman Tinfoil Gigachad 37m ago

and I don't really get the object to 17+ mastectomies. These processes do have risks and side effects, but they're relatively well-bounded and understood.

They're irreversible, 17 is still in the "crazy teenager" years, and even for the purposes of gender dysphoria, they don't seem like something that can't wait a few years. I of course have my issues with blockers / hormones, but I at least understand the logic, that at a certain age you have to pick a path, and it will be very complicated to roll it back if you do it later. There's a potential compromise I could see, where instead of mastectomies they'd be doing breast reduction, with preservation of function.

and combined with the drastically reduced incidence of desistance by those age ranges

Where do you get that from? From what I understand desistence is still pretty understudied.

Eh, I get this is playful overstatement, but the extent minor insurance tomfoolery is tolerated is pretty important to recognize

I appreciate you been evenhanded on this, and I was trying to do the same. I wouldn't have anything against asserting general minor insurance tomfoolery, but asserting tomfoolery that conveniently supports my point didn't feel fair, and I wanted to make it clear I find any potential skepticism completely valid.

Some discussion here

Huh, I can't believe I didn't catch that at the time.

Similarly, SEGM estimates a maximum of 1k masectomies on under-18s per year

This would be lower than the STH number, but not by much (and that's expected as they include other forms of surgery, including the infamous laser hair removal).

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ArjinFerman Tinfoil Gigachad 56m ago

Personally I'm pretty strong in children having that right but the trend has been consistently towards more and more helicopter parenting and coddling children so much even teenagers aren't allowed to leave their neighborhoods so that's just been lost.

You think parents not letting their kids leave their neighborhood, and parents not letting their kids chop off healthy body parts belongs in the se category?

Sure, so what about the attempts to ban transition in situations where the parents and children both agree to do it

We can probably work out some sort of a compromise. Say, we make it illegal for doctors to put pressure on parents with made up nonsense like "would you rather have a happy daughter or a dead son?" or lie about the reversibility of the procedures, but otherwise allow it for people who know what they're signing up for.

There's lots of possible compromises, but it requires the other side coming to the table. Currently, they still refuse, and insist on censoring us instead.

Finally, what I want to know why is this literally thr only subject where people's libertarianism comes out? Why haven't I seen your principled anti-government libertarianism around during the Covid era?

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ArjinFerman Tinfoil Gigachad 10hr ago

What strong argument could you make that I shouldn’t have been permitted to do it?

I'd need to dig out the study where this came from, I think it was one of the early Dutch ones (so definitely from pro-trans side), but I recall someone making a remark that it's very typical for transgender people to report satisfaction with the procedure, but that it doesn't seem to be reflected by their mental health actually improving.

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ArjinFerman Tinfoil Gigachad 11hr ago · Edited 7m ago

With parental consent (PC), a 16-yo can marry a 30-yo and bear his children in a lot of states.

As others pointed the entire culture is against such marriages, and even sees pregnancies from low age gap relationships as something to be prevented. I don't know how it is now, but it looked like a sizeable amount of money was being spent when I was an adolescent, to stop this from happening.

That being said, I do not consider mastectomies to be that irreversibly life-altering. If you change your mind, you can still get implants

I'm sorry, that's deranged. That's the sort of stuff that makes me want to go to the local feminists and say "I'm sorry, you were right". What you said only makes sense if you believe the breasts' only function is decorative, for the enjoyment of men.

And while we are discussing genital surgery without medical indication in minors, we should probably acknowledge that the median case is not the 15-yo getting her breasts removed, but the baby getting circumcised for religious reasons of his parents.

Yes, circumcision is barbaric, next question.

With regard to puberty and interventions, I will notice that 'natural' is not the same as 'good'. 'Natural' is when half of the kids die before puberty, and nobody remotely sane would suggest we go back to that. We have seen how God has planned out human life, and collectively decided "fuck that guy". The natural fate of a 12-yo with no health anomaly is not puberty. It is death through asphyxiation within minutes -- basically everywhere in the observable universe.

That's a pretty absurd argument, if that's where you want to leave it at. When a kid loses their baby teeth, we don't try to halt that process because "natural is not the same as good". When a kid grows, and experiences growing pains, we also don't try to halt the process no matter how much he whines about it. These things are a normal part of healthy development, and we recognize an argument needs to be made to intervene in it, not to defend allowing the process to take place.

But there is certainly a subset who have a different gender identity hardwired and would be harmed not helped by letting puberty happen.

If it's certain, what sort of evidence do you have for the claim? Every systematic review of pediatric gender care that I'm aware of, came out saying the evidence is of low or very low quality. As far as I recall the history of these interventions, this isn't even a case of small studies showing promising initial results, but failing to scale, the results have been pretty poor from the start, but we went ahead with it for ideological reasons.

This means that medical interventions must be made based on trade-offs. Anticipate how the patient would view the intervention with 20 years of hindsight. Try to minimize the excepted reduction in QALYs -- no matter if it is due to suicide, sterility, surgical interventions etc. This involves guesswork, but every moral decision in the real world involves guesswork

Ok, and when it turns out they're not doing it, can I point that out? When it, in fact turns out that they might be maximizing the reduction in QALY's, can I point that out? When it turns out they're not even so much interested in figuring out whether any of these things are medically justified to begin with, as they are an autonomy and self-expression, can I point that out? When it turns out that the approach you're proposing is not only not being followed, but is pretty much impossible under the current framework, because by definition anyone who wants a trans-surgery is trans, and thus justifies the surgery being performed, can I point it out? Can I point all of these things out without being called "just as bad" as the side that's doing them?

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ArjinFerman Tinfoil Gigachad 23hr ago

But the full-year number for 2019 is in the same neighbourhood, so it doesn't affect your argument.

Yeah, and post lockdowns the number picked back up anyway. This is all just a ballpark estimation

Also, I don't understand why you care about the diagnostic code for elective mastectomies on minors. The rate of breast cancer in teenage girls (whether or not pretending to be boys) is so low that you can reasonably treat all mastectomies on minors as transgender surgeries.

There are non-cancer-related breast reductions, but I suppose that's a fair point.

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ArjinFerman Tinfoil Gigachad 23hr ago

Definitely not a stupid question, and I'm not be the right person to ask (I think we have a few doctors here). The procedure codes seem to be descriptive of what the surgeon is about to do, rather than the purpose. For this post I was listening to an interview with Dr. Haim and the way he was describing it sounded like they go together with the ICD diagnostic codes, which explain why you're doing it, and than the insurer decides if they want to cover it. But I'm not an American, not a doctor, not an insurer, take with loads of salt.

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ArjinFerman Tinfoil Gigachad 1d ago · Edited 1d ago

One of the open questions on the trans issue is just how big is the problem, really, particularly as it relates to children, and how often they're prescribed irreversible medical procedures. One attempt to answer it is the Stop The Harm Database, they go over insurance / Medicaid / VA claims and try to find procedure and NDC codes relevant to gender affirming care. According to them something to the tune of 14,000 minors received hormones, blockers, or surgeries between 2019 and 2023, with 5,747 of them getting some form of surgery. That report is not without criticism, we discussed it before and it was pointed out that the number includes laser hair removal as a surgery, so at first glance it looks like the "central example" of the kind of gender surgery that would cause people to freak out is actually a lot less frequent. However, evidence keeps accumulating that the numbers are just as bad a trans-skeptics are indicating, and perhaps even worse.

First, a small sanity check. The first pediatric gender clinic in the US opened in 2007, Stop The Harm now has 54 in it's database. These 54 clinics have to pay their bills somehow, and that implies a throughput that is probably more consistent with the 14K number being accurate, rather than an overestimate. Of course that alone tells us nothing, a clinic can offer a wide range of non-invasive services, like psychological support, or hell perhaps they do keep the lights on with laser hair removal.

If you followed the culture war for a while, you might remember that originally the argument was "no one is doing gender surgeries on minors, chud", but the actual healthcare providers are sometimes so far away from the culture war front, that they don't realize what they're doing is controversial, and proudly show it off. Here's Keiser Permanente's paper on how many gender-affirming mastectomies they performed on minors between 2013 and 2020. In that period they had 209 patients, the majority taking place at the end, as the trans trend was gaining momentum. They helpfully provide a chart of the incidence rate, and point out it increased 13-fold during that period, to a rate of 47.7 per 100K. The incidence rate gives us an opportunity to run another sanity check. If we take the population statistics by age and sex from 2020, add up the girls aged 13-17 (the age group from the paper; about 3.18% of the total population), multiply that by the total population from the 2020 census (331,449,281), we get 10,540,087 girls matching the demographic from the paper, and when we multiply that by the incidence rate, w get a grand total of 5027 potential mastectomies in the whole country, for 2020 alone. Now, again, that's just a sanity check. Kaiser Permanente is in California, the bluest of blue states, so I'm happy to grant that the incidence rate in other parts of the country is likely lower*, but it does hint at the Stop The Harm numbers not being insane, and the surgery statistics not being carried by laser hair removal.

So has someone tried to run a proper estimate for the whole country? On one hand we have a JAMA paper - National Estimates of Gender-Affirming Surgery in the US giving us 3.7K mastectomies for the 12-18 age group, between 2016 and 2019. Now there's a bit of an issue here in that the authors decided to include 18 year olds in the group, so we have no clue as to how many surgeries were done on minors. I'm pretty sure this is deliberate obfuscation on the parts of the authors, as I've seen multiple people ask one of them for the 12-17 numbers, and them going "oh, haha, sorry that's how we grouped, and it would be too much trouble to go back and recalculate it now". When other academics (from SEGM, I think) asked for the raw data, they went with "lol, no". I wish I could link it, but this was in a Twitter thread that took place around the time the paper got published (3-ish years ago), so I don't even know how to begin looking for it.

On the other hand we have the Manhattan Institute's """report""" giving us from 5,288 to 6,294 mastectomies between 2017 and 2023, and I put it in quote marks because it looks more like an article to me. They say they got their hands on an insurance database, and presumably they ran the right queries, but I'm still salty about the lack of detail on methodology. That said, this number does not actually contradict the JAMA paper. Note that in that paper they ran the numbers for 2016-2019 - the period when the trans trend was just picking up. 2019 was without doubt the year with the most mastectomies in their paper, not just by the Manhattan Institute's chart, but by Kaiser Permanente's as well. Further the MI chart would give us between 1700 and 2500-ish mastectomies for the years 2017-2019 - well within the bar given in JAMA. It's in fact lower, as 2016 saw a lot fewer mastectomies, if you go by KP's incidence rate, and you wouldn't reach 3.7K even if 2016 was exactly equal to 2017. This however is expected because, like I mentioned, the JAMA paper includes 18 year olds. All in all, despite my gripes with how the article is written, the numbers seem perfectly consistent with the numbers given by """mainstream""" sources.

We brought up a few factors that could imply they numbers are overestimated, but are there any pointing to them actually being underestimated? The MI believes even their liberal estimates are undercounting the actual numbers:

Two caveats should be mentioned. First, 2023 data are incomplete, making it premature to conclude that a dip occurred that year, relative to previous years. Second, even the liberal estimates are an undercount, as the data are limited by two constraints: the procedures had to be covered by insurance, and patients had to have a preexisting diagnosis of gender dysphoria. The out-of-pocket costs of “top surgery” can be as low as $3,000, a sum many middle-class families can afford. Further, if it is true, as is being alleged, that gender clinicians are using false diagnostic and procedural codes for insurance billing, these cases would not show up in our data.

That last bit might raise an eyebrow. Normally, I'd say it reminds me of a bit I once saw in an Adam Curtis documentary, about how the OG Neocons were screaming about the USSR building up a massive fleet of submarines, and when it was investigated and they found no such thing, they started screaming that this means the Soviets have a massive fleet of stealth submarines. In this case, however, well bear with me...

The link at the end of the quoted paragraph leads to a story about Dr. Ethan Haim and Vanessa Sivadge, whistleblowers from the Texas Children’s Hospital who exposed it for still providing gender-affirming care, even as the hospital officially announced it's putting a stop to them. For their trouble, they were rewarded by Biden siccing the FBI on them. The case of Dr. Haim is one of the biggest affronts to justice I saw in recent years, but I'd need an entirely separate effort post to go over that. The article slowly builds a decent-ish case that the hospital may have illegally billed Medicaid for the gender affirming procedures, but it's not directly relevant to my argument. The interesting bit is when you followed these two down the rabbit hole. They testified in congress about this matter, and Vanessa Sivadge, as far as I understood her testimony claims to have personally witnessed the doctors putting down the wrong ICD code in their diagnoses:

Mr. ONDER: Tell me a little bit, what was going on? They were downright putting the wrong ICD–10 code in these patients’ charts?

Ms. SIVADGE. Yes. Thank you for that question. Yes, Texas Children’s Hospital, through two particular doctors, were intentionally misdiagnosing patients, and I saw this with my own eyes. They were, for example, labeling a male with a testosterone deficiency to administer testosterone. They would do this because, on the medical chart, they would put the preferred gender identity of the patient and not the biological sex. This makes it very difficult to detect fraud for any insurance company who gets the billing code. It’s very difficult to distinguish what is actually happening.

Now, these congressional testimonies always felt a bit too generic to me, so we don't get much beyond a "trust me, bro", even if it's backed by a threat of perjury. Dr. Haim for his part never claimed to see it personally, but the issue seems to have become a personal hobby horse of his, and if you follow him you can see he dug out a lot of interesting things, like, for instance this fact-sheet, which he also testified about, from the Campaign For Southern Equality. They sent it out to gender clinics, and outright come out and say "hey, these (gender dysphoria related) codes are commonly rejected by insurance providers, try using ones like 'E34.9 Endocrine disorder, other' instead". Or how about this coding update from the American Medical Association where they recommend doctors stop using the code for gender affirming breast reduction/removal and use either the one for "treatment or prevention of breast cancer", or "reduction mammaplasty"?

Ok, so we have a few institutions encouraging the use of alternative diagnosis / procedure codes, how much of an impact could that have on the national estimates of incidence. Well, much like with Kaiser Permanente happily informing us on how many mastectomies they performed, some pro-trans researchers happily estimated the impact of using alternative codes for us:

The ICD-10 code was the most common way we identified GDY – 97% of patients were identified using either E34 or F64. Utilizing billing codes is an imperfect but practical way of identifying transgender patients for chart review, which has been used by multiple previous studies.23,31–33 Some codes used in similar adult studies, such as F65.1 “Transvestic Fetishism,” or Z87.890 “Personal History of Sex Reassignment,” were not present in our population. While the exclusion of the latter is likely due to the age, multiple interviews with gender-affirming care providers in our adolescent clinic revealed that providers prefer to use E34.9 “Endocrine disorder, other” for patients, as it is a less stigmatizing diagnosis. The use of E34.9 was specific to providers in the adolescent clinic, who indicated they did not use this code for patients other than those in the gender program. Together, these codes captured more patients than gender identity fields would alone (Table 2).

From what I'm seeing, about half of the trans patients taking hormones might be hiding under E34.9 “Endocrine disorder, other”, which is pretty important as Stop The Harm might include laser hair removal, but it does not include code E34.9 (they do did manage to grab all the relevant mestactomy codes, despite the AMA recommendation, however).

As a side note, the hospital, that the authors of the second paper are affiliated with, recently received a subpoena from the DOJ, demanding records related to pediatric gender-procedures, which they decided to completely ignore, almost like they have something to hide. The DOJ's petition to enforce compliance has now been granted, so I suppose we will, at some point, find out if they were on the up and up.

Ironically legal issues might be yet another way of providing us with yet another sanity check. One more interesting thing that popped up on my feed from following Dr. Haim is this court case, here's the interesting bit:

The Court finds the following facts were proven by a preponderance of the evidence for the purposes of the hearing on preliminary injunction:

16. The TRUE Center saw 1140 patients under 18 in 2025. Of those, 257 patients were prescribed puberty blockers and 549 patients were prescribed hormone therapy. In 2024, the TRUE Center saw 1203 patients under 18. Of those, 260 were prescribed puberty blockers and 549 were prescribed hormone therapy.

The TRUE Center is in Colorado. According to Stop The Harm Colorado saw a combined total of 240 patients taking hormones or puberty blocker. In other words, the numbers found by the court, for a single clinic, for a single year, were 2-3x greater than the numbers from Stop The Harm for the entire state for the entire period from 2019 to 2023. @gattsuru called their numbers eyepopping, it might their own they were being conservative.

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ArjinFerman Tinfoil Gigachad 1d ago · Edited 1d ago

Back when I was a young lad I would have told you "yeah the drivers in Germany are great". Nowadays, between Germany getting diversified, and the driving culture in my country improving, the contrast is not so stark. Some time ago I also saw a video from an Indian guy saying that Italy, of all places, has good driving culture (though I suppose it makes sense if India is the reference), and when he was driving there he felt this subtle pressure to perform up to the standards of the rest of the country.

You're right that everyone might complain about their neighbors, but different groups definitely perform differently.

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ArjinFerman Tinfoil Gigachad 1d ago · Edited 1d ago

It helps when the footage actually refutes the allegation.

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