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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:
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:
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:
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 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.
[caveat : I'm not especially concerned about hormones for 16+, 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, and combined with the drastically reduced incidence of desistance by those age ranges, the harm calculations just aren't looking that severe. I could be persuaded on these things -- I have been persuaded that use of puberty blockers were not just a minimally-harmful experiment but instead ranged from ill-advised to active malpractice, and the prominence and tolerance of bad actors from that sequence does leave me more cautious about the evidence and documentation for hormone therapy for the 16-18 range -- but I've had too many serious medical interventions before I was 18 for the 'mutilate' or 'consent' frameworks alone to really hit. Younger hormone therapy seems to have serious impact on bone health, and the long-term effects of orochidectomy and hysterectomy are much more serious and much harder for teenagers to understand.]
There are definitely clinics without surgical capabilities (or in jurisdictions that prohibit surgical intervention for minors), so psychological support and pharmaceutical interventions and such clearly can suffice for some businesses, and naively I'd expect that while the individual compensations are higher for surgical intervention, the bread-and-butter by definition is a lot more likely to come from recurring stuff. Dunno if there are any public figures, though.
Eh, I get this is playful overstatement, but the extent minor insurance tomfoolery is tolerated is pretty important to recognize. Unless you're Haim, the feds really don't get involved in Medi* stuff unless it's hilariously overt or big amounts of cash are floating around, and sometimes not even then. Just fucking up ICD codes is wrist-slap stuff at best. Which is why it's a big concern... but it also means that it's a lot less of a big overt scandal if it's proven.
Some discussion here
I'm not quite so optimistic; there was a mess of legal interplay here that would have gotten less favored political actors disbarred, and while requests for emergency relief have been denied so far, the jurisdiction charlie foxtrot is enough a mess it's possible the summary statistics will only be released if O'Connor defies procedure.
To be clear, eyepopping was more a reference to the 5k surgery interventions, but yes, the discrepancy between TRUE's claimed patient count and that available to other observers is concerning. Similarly, SEGM estimates a maximum of 1k masectomies on under-18s per year, and I'd consider them gender-critical in a way that would give higher-end estimates whenever possible. If they're vastly underestimating things, that's a concern regardless of the merits or demerits of the procedures simply because we can't possibly measure the outcomes on things that we don't know are happening.
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.
Where do you get that from? From what I understand desistence is still pretty understudied.
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.
Huh, I can't believe I didn't catch that at the time.
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).
Yeah, that's fair, and has some practical arguments in its benefit anyways. Apologies, I'm just used to seeing them merged together. I think there's some moderate arguments for reducing total surgeries in cases desistance is extremely unlikely -- an FTM with the unfortunate genetics to have D-cup breasts at 16 and who's had a stable identity since 12 is in an awkward place where they're going to go under the knife twice for something that they're pretty confident about -- but complication rates for these procedures are low enough that it's a plausible compromise from an ethical perspective.
Whether it's an enforceable one is harder. Ideally, we'd just have enough trust... but we clearly don't, and that distrust is well-founded, hence this discussion. There would definitely be aggressive action by both patients and to straddle the line of what's 'just' an aggressive reduction, and there's even some process arguments to not be entirely dishonest when doing so (afaict, 'masculinizing mastectomy' is already much more likely to leave lymph nodes in place compared to conventional mastectomy; "inverted T" procedures are structurally more similar to a breast reduction to an A or AA and are actually used by some trans men as their final masculinizing top surgery already). There's a few clear markers -- removal of the nipples, lymph nodes, milk ducts, yada -- but we can't exactly those to end up on the medical file even if there were agreement on them being the 'right' dividing line.
Which is probably the broader problem.
That's a reasonable criticism, a lot of the data is either low-confidence or coming from suspect sources, and there are adult desisters.
But if the numbers were even comparable to the most optimistic trans activists claims of 'low' pre-puberty desistance, we'd be talking 1%, and that's still well over three thousand people in the United States alone. If adult desistance were the majority or a sizable fraction, as gender-critical people claim with some support for pre-puberty, we'd have FtMtFs by the tens of thousands at this point, especially in the aftermath of the Fox Virian lawsuit.
It's hard to make that match up with reality as we see it. That's a low confidence claim -- there have been enough changes in FtM demographics that something could have changed in 2023 on the intake side, or 2026 on the outtake side; it's possible the entire measurement system is so badly corrupted we can't see a 1-in-100 signal of a 700k+ population -- but for all it's just absence of evidence, it is still signal. And the most plausible explanations are either low rates of adult desistance or very early desistance that is being handled, despite a doctrine that I agree shows insufficient patient safeguards for this specific case.
Fair.
Yeah. Not sure if that reflects coincidence, genuine number, taking from the same underlying source, or being bamboozled by the same misdirection.
EDIT:
I guess my problem's that we allow a lot of other crazy teenager years to do irreversible things without dire and traumatic medical need. Hell, we force or psuedo-force it in many circumstances. I don't buy the suicide prevention arguments and I understand that many social conservatives are opposed to other cosmetic surgeries in this age range, and I understand that this is deeper than a piercing or (most) tattoos, but it's hard for me to put it in the category of something they can't understand well enough to make decisions just because some 1:10000 or 1:1000 risk that they won't like it a few years later.
Some of that's just because this feels like salami-slicing -- if 17-year-olds are crazy, then so are 19-year-olds, and well we don't let 20-year-olds drink alcohol, and 24-year-olds can't be trusted with rental cards -- that someone will make even if you have a very principled end-state, but there are just also pragmatic arguments.
A complete ban on 'top surgery' for a trans guy is, in a large portion and probably majority of cases, going to be a serious constraint on their romantic opportunities at a time a lot of normal people start forming exactly those relationships: boobs tend to be pretty polarizing for straights and gays and lesbians alike. For the genetically (un)lucky, passing becomes impossible, and while that's not a massive value from your perspective, it's clearly something a lot of adult trans men do put a lot of effort into. These do, I recognize, become less serious if we accept significant breast reduction surgeries as a separate category.
From a practical standpoint, a surgical intervention at 17 makes it possible to 'turn a new leaf' at college, in ways that having the procedures done at college do not. That's most extreme in states that require surgical intervention to recognize legal transition, but even outside of those constraints, there's just a massive difference from 'Aiden-who-was-Alice' and 'Aiden-who's-short-and-really-shy-in-showers'. There's some downsides to this goal from a social conservative perspective -- I would argue it makes desistance a lot less likely, and soccons would argue that it's closer to love bombing -- but it's worth noticing as a motivation.
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You have to be kidding me. The possibility for incidents of testicular/ovarian cancer when on HRT should not be so easily discounted. You are also chemically castrating the child so they can get like an extra decade or two of "looking hot enough" to live a vain meaningless life. Also you can't simply undo puberty blockers, it's not a free lunch sort of deal.
It's a serious concern and something that needs to be seriously reviewed by any medical professional and the patient, especially given the impact on both fertility and hormone stability in the case of desistance. But it's not some clear threshold behavior or more dangerous for the 16-18 year age range than for 19+: while I recognize that the data is limited, the risk seems primarily tied to duration of treatment rather than age of onset, the proposed link is attenuated, and the base incidence is low to start with. As with the "vain meaningless life" aspect, an argument that generalizes to adults only persuades to the extent it would meaningfully apply to adults.
(And the testicular cancer risk seems genuinely to have not panned out? Though they would say that...)
I pretty explicitly spelled out that I've been persuaded that the data on puberty blockers is actively against their common-form use, and the extent that 'technical experts' promoted them despite or even because of severe and irrecoverable side effects have reduced my trust in both those experts and a lot of the information coming from the broader medical community on this topic.
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I find both sides of this CW rather tiresome. The pro-trans "well, if half of the class in fifth grade wants puberty blockers, just let them have puberty blockers" is obviously wrong, but the anti-trans side is just as bad.
With parental consent (PC), a 16-yo can marry a 30-yo and bear his children in a lot of states. Or a 17-yo (with PC) can enlist in the army and get blown to pieces in some war on another continent. Or he could murder someone domestically (without PC) and be executed for that, until the liberals in the SCOTUS put a stop to that in 2005. And of course every 10-yo has the ability to kill themselves (without PC), not granted by the SCOTUS but by physics (i.e., God). Sadly, suicide is the second or third most common cause of death for teens (though homicides are ahead of suicides in the 15-19 group, second only to accidental injury, which I find even more fucked up).
I think that the bodily integrity of people whom we don't consider to have the ability to fully consent is an important good, and one should not make it too easy for them to get irreversible changes done to their bodies.
That being said, I do not consider mastectomies to be that irreversibly life-altering. If you change your mind, you can still get implants, and we have the tech to prevent any kids you might have from starving to death (and arguably had the tech for 10k years or so).
Bottom surgery is a different category, but the fact that you focus on mastectomies likely means that it is exceedingly rare in minors. 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.
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 being said, I doubt that most people's lives would be improved by accepting/deciding that they are trans. A lot of kids have issues with their identity around puberty, for most of them accepting their birth gender is likely the best outcome as far as quality of life is concerned. But there is certainly a subset who have a different gender identity hardwired and would be harmed not helped by letting puberty happen.
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. Sometimes you will still decide wrongly and mess up a patient's life, either way. It also involves not being in the trenches of the CW. If you think that every trans-related intervention in minors is either good, you have not grasped the complexity of the situation. If you think every intervention is bad, likewise.
Are mastectomies more or less irreversibly life-altering than anorexia or bulimia? If schools were actively encouraging their students to pick up these habits, and hiding this fact from the students' parents, would that be more or less acceptable than the current status quo?
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So long as you're willing to get regular MRI scans to make sure the implant has not silently ruptured:
Sure, no problem. Chop off your boobs when you're too young to vote or drink, and then if you change your mind, get surgery for fake boobs which you just have to be careful about them leaking into your lungs. Great choices there!
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:
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No, the anti-trans side is not as bad as giving half of all fifth-graders chemical castration drugs that are only justified when you have advanced prostate cancer.
Nothing you wrote is anywhere near as bad as castrating ten year olds. Nothing is anywhere near that bad.
I'm so, so, so sick of dishonest hacks confusing the brutal competition between life forms with the normal development of healthy organisms. The presence of disease or predation does not make dying before adulthood "natural," and conflating them is dishonest in the extreme.
Your "healthy organism" (that adjective is doing a lot of work, there) is very much the product of billions of years of brutal competition. There is no reason to suppose that the amoral process of evolution would find something which is morally good.
I will grant you that humans evolved for being efficient, so most random alterations (like removing a hand or an eye) you do on a human will make it less efficient, so a lot of times what is good and what is natural will coincide.
As a trivial example of the natural and the good not coinciding, a good fraction of healthy humans will have their periods about once a month, a process which I understand can be very painful simply because evolution did not give a fuck about the lives of the carriers of the genomes being free of pain. It would only care about it if the pain was strong enough that women would have frequently jumped of cliffs to escape it (and probably have given rise to genes which make them more reluctant to suicide). (I mean, you could try to define a woman who has her period as an unhealthy organism who is suffering from not being pregnant (though I would despise such a world-view), but pregnancy in humans is just more body horror, so the point stands.)
As another example, per Google's LLM, about 15-30% of adult male humans are estimated to have died from human-on-human violence in the ancestral environment. A 17-yo guy who gets into fights and perhaps ends up killing another guy is not mentally ill, but simply following a genetic script which worked perfectly well in the ancestral environment. From the perspective of evolution, he is a perfectly healthy organism, and the guy who attends university to get an office job is the real weirdo.
A big part of human civilization is to take these apes evolved for scavenging in the African savanna (or whatever) and turn them into call center workers, lawyers and so on. While this thankfully does not involve physical maiming, it certainly involves denying a lot of inherited instincts -- either through nurture or by executing people for stuff like 'murder' until they become docile, if you are a HBD believer.
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Yeah. I get the argument for social transition/choosing to identify but the second you start getting medical it's pretty insane when even a great, perfectly-timed gender transition with an elite surgical team is still not going to stand up to any real scrutiny from society and has a bunch of side-effects for life.
If the drugs/surgery had any real productive ability to actually accomplish their goals I'd get the argument but for the most part they're totally inadequate so what's the point of incurring possible negative effects?
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Citation requested.
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Uh, one of these things is not like the others?
Yes, we have not implanted microchips in children's brains en masse preventing them from taking their own lives until they've reached the age of majority. Very astute observation. In the West, just about any sufficiently determined ten-year-old can kill himself. By extension, any sufficiently determined ten-year-old could probably emasculate himself if he put his mind to it.
Anti-trans posters are not complaining that we don't live in a maximally totalitarian dystopia in which no harm of any kind will ever befall minors. (If anything, I'd say the median anti-trans poster would be more in favour of minors incurring the occasional skinned knee or broken arm rather than sitting in their bedrooms staring at their phones. I'd hazard a guess that there's a significant amount of overlap between the most trans-affirming parents and this modern breed of safetyist helicopter parent. I could even map out a plausible causal pathway wherein safetyist helicopter parenting results in one's child identifying as trans.)
We are complaining about: medical organisations violating the principle of primum non nocere and being derelict in their duty of care to their patients; these organisations carrying out elective procedures on patients too young to understand the implications thereof; claiming (on the basis of extremely flimsy and far from dispositive evidence) these procedures are necessary to prevent the patients in question from taking their own lives; ignoring any evidence to the contrary; browbeating and gaslighting the patients' enormously distressed parents with emotionally manipulative slogans like "would you rather have a live daughter or a dead son?"; and flat-out lying to the public about how many such procedures have been conducted, and for what reason.
The fact that (short of having him sectioned) any sufficiently determined ten-year-old cannot be physically prevented from killing himself is not, in any way, a rebuttal to any of the above complaints. In fact, it strikes me as a complete non sequitur. It doesn't even rise to the level of whataboutism.
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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.
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.
Yes, circumcision is barbaric, next question.
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.
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.
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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It appears your problem is a dislike of making value judgements. A 16 year old getting pregnant is pretty normal. Getting an irreversible (and implants don't fix a breast to normal function) surgery is abnormal and bad. Enlisting in the Army has risks, many permanent, but it also has virtues, whereas cold blooded murder does not.
I do not like making value judgments of the form "it is normal, therefore it is good". History is full of of things which were considered normal and therefore good, which we nevertheless consider atrocities. If I were to judge behaviors good simply because they are widespread, then all the trans activists would have to do is to make teen mastectomies as common as circumcision and I would be forced to conclude that it is fine.
For the 16-yo getting a kid, it depends on the outcomes for her, the kid and broader society. Perhaps she will thrive in motherhood and raise five kids in a stable family. Perhaps she will be left by the father of the kid before it turns three, and struggle to meet the responsibilities of parenthood without any skills to earn a living, perhaps raising a kid whose trajectory through the criminal justice system is already over-determined. Perhaps if she does not have a kid she would become a brilliant medical researcher, or a serial killer.
Likewise the army. For pretty much everyone except Khorne worshippers, war is negative-sum. If people enlisting on one side of a conflict make the world a better place, then people enlisting on the other side of a conflict will make the world a worse place.
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The two are far more similar than I think is commonly realized, because the 15 year old getting her breasts removed is also doing it for reasons that have a lot to do with the dominant civil religion. This is more apparent when the kid's younger, and just like the Christian Right of the '80s, it's always the moms [including teachers, who are just state surrogate moms] pushing the kids into doing it.
It's also why the "consent" argument doesn't work here, since the "but they can't consent" has the same valence as the "don't allow children under the Age of Consent to be exposed to the destructive memes of religion" of the 2010 Atheism Wars. That didn't really get off the ground; it's an argument that's plain unworkable outside of full societal restructuring (and most people have a vague sense it's being made in bad faith), since a parent's worldview inherently influences what their child does. That is ultimately true of the same assertion when applied to kids engaging in transgenderism.
Every boy has the physical ability to chop off his own dick, and every girl has the physical ability to bind her breasts.
If the moral framework around "consent" led directly to a society where transgenderism would be declared sacrosanct, that's pretty clear evidence that this framework has serious and fundamental flaws, and should be either refined or done away with.
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In the same way as your other examples, I find it really funny that the mainstream right wing opinion is the anti vaxx naturalism bullshit, something that can and likely will kill and harm many more children than trans idealogy ever has. In just a single year, in just Samoa there was 83 newborn deaths thanks to RFK and other anti vaxxers. Samoa only has "Approximately 4,800 to 5,500 newborns" a year, which means over 1.5% of the newborns just straight up died from anti vaxxism. And some of the survivors of course may have long term damage to their lungs or brain or die from something else cause their immune system is disrupted.
Hell if you take a longtermist sort of approach, him stalling medical trials could be responsible for hundreds of thousands or millions of unnecessary preventable future deaths once we add things up like the cancer research and other tech with whatever roughly 4 years worth of deaths that could have been prevented just a little earlier if they didn't have to pause now.
Now I'm a staunch anti government libertarian and think it's wrong to force parents into vaccinating their babies, but the hypocrisy on display is ridiculous. Actually, it's worse than hypocrisy, vaccines are a settled science, at least the trans issue is still rather unexplored. Another plus also being that it's opt in from the kid themselves unlike vaccines where the kid doesn't choose illness, long term injuries or death when the parent ignores it.
Be consistent, you either think government should be used to supersede parents and childrens choices for health reasons, in which case you should oppose RFK and MAHA and things like Florida's move to end vaccine mandates vehemently or you don't and you should let kids and their parents choose transitioning if they want. Level of severity isn't an argument, the former is way more dangerous and way more proven.
But these are not the options on the table. They are parents against their kids' transition. I'm no fan of anti-vaccine sentiment in general, but they are very consistent: Trans, just like vaccines, are to them an imposition by the government, trying to supersede their parental authority "for their own/their kids good". It's not surprising that the same people oppose both. It just happens that they are correct on one count, and incorrect on another (at least from my vantage point), but there is no hypocrisy involved here.
Not to mention that of course the parents critical of trans-ideology and the parents critical of vaccines are not actually the same group, there is merely a significant overlap due to low government trust being a common reason for both.
I'm 100% convinced that if it really was entirely about liberal parents transitioning their own kids, the same people would consider that foolish and bad, but there would be very little resistance, just let them do what they want. The problem entirely comes from government institutions trying to push trans ideology as settled science and threatening & slandering any parent who is not 100% on board with their kids' transition.
When parents and children actively disagree on something, it's a far more difficult discussion that gets into balancing the rights of the parents to control their child vs the child's own right of autonomy. Personally I'm pretty strong in children having that right and 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.
Like come on, my parents told me stories of when they were in elementary school biking out miles away without supervision. Now even with phones, kids that same age can't even go to a different aisle at the grocery store. We have completely forgotten how independent and free our children can be once we start expecting it from them. It's happened to the youngest kids too! Now we just have a bunch of immature brats acting like they're still babies and aren't even potty trained yet. 12 year olds can't go to a different aisle and 5 year olds can't use a toilet.
Sure, so what about the attempts to ban transition in situations where the parents and children both agree to do it? Support for big government overruling parents and their children can't be motivated by opposition to big government.
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?
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?
You don't understand how parents overruling children's autonomy is in the same category of parents overruling children's autonomy?
I've literally argued on this site for legalizing drugs and not caring when addicts overdose because it's their responsibility. I've argued against banning kids from phones and the Internet. I've argued against vaccine mandates. I've argued for free markets and getting rid of government regulations on everything from smaller government control like zoning to larger government control like the FDA which drives up costs and hurts people with long delays or immigration restrictions or anti discrimination laws (which are also unnecessary anyway in modern society to begin with) on large companies which prevents them from proper meritocratic hiring. I've consistently said that I am a fan of people like Reagan, Thatcher and Ayn Rand.
Almost every place that government exists, I say it should be scaled back. Sometimes I acknowledge that there are benefits to some government action (tradeoffs do exist!) like I see how welfare has personally helped a person in my life while also being against welfare overall. Or how I think that social security should have never existed, but since it did exist, it should fulfill the implicit promise behind it to the people they stole money from. Even Ayn Rand famously took her social security, because being against the program doesn't mean you can't ask the government to at least fulfill the promise it made when it took your money from you. She didn't think it should be stolen to begin with, but it's not hypocritical to say "then at least do what you said you would" right?
But generally I'm pretty damn consistent here, government out individual responsibilities in.
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.
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.
So you're assuming everyone else is a Randian / bordering on ancap? Because I don't see where's the hypocrisy otherwise.
That's true for younger children. But once you get to the teens, historically parents didn't have that much control! Especially the older teens. Their children would have had a job for a number of years and might have already moved out of the house for an apprenticeship as a page or a midshipmen or traveled along as a cowboy or did general work at a factory or whatever was fitting of the time period.
It's very recently where we've started coddling teenagers like we do with babies and toddlers.
No, I didn't know the site was around back then. I am not those other people, I am just saying that I am consistent.
No, I'm saying that if you're for one form of government coercion against the parent's and child's choices, but for another where it's only the parent, despite the latter also being more severe then there's not a good explanation for that besides politicizing and hypocrisy.
On every front anti vaxx is worse.
Autonomy? Parent alone choosing for a baby vs parent and teen.
Severity? 1.5% of the newborns died with just measles alone in Samoa.
Externalities? Anti vaxx can directly spread to people with weak immune systems or help disease evolve, where as a kid choosing to get their breasts removed and regretting it only hurts them.
Reverseability? While neither are wholly reversible, death is a lot worse than getting breasts removed and regretting it.
An argument that government coercion should overrule parents that cares about transition choices but not antivaxxers is not motivated by saving lives or helping people because the latter is far worse.
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Oh how the turn tables. It used to be the liberal granola moms with their new age healing crystals who had that market cornered. Funny how brazen lies and systemic abuse can turn a population against you. (shut down everything but allow BLM to protest, jail/fired for not taking the jab or having the temerity to enjoy the beach alone without a mask)
There is a distrust of the institutions and the scientists running them far more than the science behind the concept of vaccines.
It's a good example of why I oppose government power like this from the start. What you use to suppress others and their "bad beliefs" can be used on you to suppress your "bad beliefs". Even when you have someone on "your side" in charge, what's the chance you agree with them on every topic? You will be suppressed too, just like RFK is trying to do to vaccines.
And it's not just "bad beliefs" either, plenty of other completely neutral stuff like sunscreens or life saving infant nutritional fluids gets caught in the crossfire of government regulations.
How many preventable deaths have been caused by the US's ban by default medical system forcing good meds to take years to come to market (if they aren't just blocked entirely by the price)? How many experiments on already dying terminally ill patients desperate to try out for a last chance at life never get run?
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I don't think it's actually true that "the mainstream right wing opinion is the anti vaxx naturalism bullshit". Poster who posted that likes to slip in false things, possibly in an attempt to manufacture common knowledge.
I have to agree the "mainstream" ie normies aren't as radicalized. Certain portions of the more radical fringe online right are however up there even harder than the granola moms used to be. (personal observation)
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I have no problem at all with the idea that the age of consent for marriage and military service should be 18.
That being said, I think there's an important difference: So called "transitioning" is a dumb idea for anyone at any age. A strong argument can be made that nobody should be permitted to do it whatsoever. However, there is a principle that in a free society, adults are given a lot of liberty and autonomy over their bodies. Therefore, at a minimum, "transitioning" can and should be banned for anyone under 18.
By contrast, marriage and military service are not necessarily dumb ideas.
I'm extremely skeptical of this. What is the evidence for this claim?
Agreed. If a man went around thinking he was Napoleon and chopping off his legs to match his desired height, we would lock him up in the psych ward until he stopped being a danger to himself. Transitioning should be illegal.
Arguments about personal liberty died in the fires of wokeness. It's clear now that someone's vision is going to rule society; liberalism is an unstable fantasy. We can have a culture that bans and shames transgenderism, or we can have a culture that encourages and celebrates transgenderism; there is no in-between. I know what I pick.
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It wasn’t a dumb idea for me, I’m very happy with the results and it has been overwhelmingly positive for me in my personal life. What strong argument could you make that I shouldn’t have been permitted to do it?
Dismissing an entire medical/psychiatric treatment out of hand is itself a dumb idea. This is a common attitude beyond transgenderism, I’ve heard similar takes about depression, anxiety, ADHD (another medical issue that involves children!) but if all you have to offer as alternatives are facile suggestions then you don’t really understand the level of distress some psychological conditions cause.
Is that due to the procedure or due to social avenues that wouldn't have existed without the procedure/joining that particular community? The whole egg-cracking/self-perpetuating thing make it tricky to discern where given lines are. Like personally I've got no issue with people choosing to be fluid in their gender identity, and I'd be all for a medical procedure that actually accomplished gender transition. I just don't really see how the existing medical suite is capable of anything but a very very crude facsimile that renders people permanently on the hook for treatment.
I do feel that there are people who are trying to get around legitimate social issues through opting to transition and/or joining those communities but to me the whole medical intervention thing is kind of its own separate matter.
To be honest I don’t really see a huge difference in social avenues, I haven’t joined any community and none of my close friends are trans women. It’s slightly easier to make friends with cis women now while men are harder to relate to, but it’s not a drastic change since I was seen as a gay man most of the time before. Although navigating gendered expectations is easier now, like I don’t have to constantly explain myself anymore if that makes sense?
For me the main benefit is that physical dysphoria has been hugely reduced, and I can finally look at myself in the mirror without wanting to claw my own face out. HRT was pretty effective in my case and I went from being disgusted at my own body every single day, to being at peace and even grateful for it (with one exception). It’s such a relief that I don’t have to retreat into fantasy land to make intimacy bearable anymore.
I’d love for the medical tech to be more advanced of course, who wouldn’t? But I gave what’s out there a go, and it lifted the dark cloud that was fogging my mind and causing me misery, and that’s good enough for me.
Edit: No “procedure” necessary for the above effects, just plain old HRT.
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Based on my general experience and observations, the vast majority (likely 100%) of trans people are some combination of (1) mentally ill; (2) delusional; (3) have an autogynophiliac fetish; and (4) want license to abuse other people by forcing them to play along with their fantasies. So that it doesn't help anyone (including trans people themselves) to play along with this nonsense, and it has a lot of potential to cause harm to others.
It's clear that the people on one side of the debate are deluded. Time will tell.
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The same as for suicide: it's a social contagion, the mere existence of which perpetuates itself through society.
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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.
It’s difficult to find good quality studies I suppose. A later one found a correlation between surgery and lowered psychological distress and suicidality but I don’t know if that’s the highest quality one you can find.
But in my case I was talking about HRT, not surgery.
Yeah, the Dutch stuff is about the whole shebang, from blockers to surgeries. It looks like I may have confused the source material for what the critics were saying about the same data. More recently there was a big study out of Finland looking at hormones + surgeries as well.
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We don't have a culture that encourages 16-year-old girls to marry. This is a holdover from an earlier (healthier) era; no congresscritter would vote for something like that today. All relevant changes to these kinds of laws in modern times have been to raise the age upwards.
By contrast, we do have a culture that encourages teenagers to transition. It's in media and schools and therapists and discord mods. I have never seen a married 16-year-old girl; I see trans people all the time (trans prostitutes are common at my hotel; I also saw a transwoman at an SSC meetup).
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I mean the issue is that once you get on the transition train, it’s very hard to get off. And I’m not just talking about surgeries, but cross-dressing and hormonal treatments as well. Kids just don’t have the mental capacity to understand that whatever they do today their 80 year old future self will have to live with. Most 15 year olds cannot imagine being 80. They can’t even imagine being 30. Ask them about their plans for a career and it’s not based on things that athirty year old would think about like pay and owning a house and having kids and wanting time off etc. kids at 15 just think about a job that they think sounds cool or unique. They want to study stuff they like even if there’s no real prospects for a good middle class job from a lit major. They like books, and they want to study books.
So I think trans stuff, because it’s permanent and kids dont understand that, needs to be treated with extreme caution. I’m not going to say absolutely nobody should ever let a kid get surgery. But this is the same psychiatric system that manages to massively over diagnose lots of other mental illnesses to the point that it’s crazy. I don’t think the WAPATH model works because it’s done by a system that assumes that because someone said it, that it’s a reality.
I would argue that a lot of stuff is permanent and kids (or people more generally) don't understand it fully.
At least in previous generations, dropping out of school had consequences which were pretty permanent for many. Sure, there are people who dropped out of school and still got a university degree later on, but they are the exception, not the rule. Yet few if any countries try to make 16-yo's go to school against their will.
Teenage motherhood is another example. If you get pregnant at age 14 and decide to become a mother, then that decision will very likely shape your further life trajectory. Yet few states will force a 14-yo to have an abortion against her and her parents' wishes. (OTOH, plenty of red states will try to force a 14-yo to give birth.)
More mundanely, we let 14-yo's ride bicycles in traffic or engage in sports which have some risk of permanent harm, and if there is a state which bans 14-yo's from working with circular saws I have not heard about it.
And in society more generally, it is more of the same. The physical consequences of voting are very often permanent: the dead of WW2 did not come back to life when the Germans who had voted for NSDAP in 1933 voted for CDU in '49 instead. A 30-yo who picks up smoking likely has no good concept of what it is like to die of lung cancer at age 60.
Some things are almost-all downsides, almost-no upsides, and sometimes society tries to ban these for minors (cigarettes) or generally (heroin). Gender-affirming healthcare is more ambivalent, like dropping out of school is (or was, back before AI). Some will look back and say that it was the decision which saved their lives. More of the ones who are contemplating it would see it as a grave mistake in hindsight.
Even in a perfectly accommodating society (which we very much do not have), being transgender sucks (from what I can tell, I am cis-by-default). We simply do not have the tech to fully give people a body of their chosen gender with little hassle or downsides. If someone is indifferent between gender identities, I would strongly recommend them trying to be cis-by-default. Treat trans kids in school like you would treat wheelchair-bound kids -- they got dealt a bad hand, and one should certainly respect their struggle and try to accommodate them, but for God's sake do not make speeches about how brave they are. You want an environment where kids with MS will know that they can still attend school when they require a wheelchair, not an environment where kids will want to have a neurodegenerative disorder so everyone will talk about how brave they are.
Yes, but unlike trans stuff, we were generally very very careful about allowing kids to do such things. We require kids to go to school until at least 16. We preach against those bad decisions. We put up all kinds of roadblocks where possible. We do not allow let alone celebrate it. We do not tell kids who want to be teen mothers “hey, look at how cool teenage single mothers are! Here’s how you get pregnant! And a whole week or month dedicated to making sure all of my friends think teenage mothers are super cool and brave.” We don’t do that for dropping out of school. The culture has made dropping out of school synonymous with “Loser”. It’s not okay and not something, in most cases, that kids think is cool.
With trans stuff, we kinda do the opposite. We celebrate the bravery of those who do it. We kinda make it cool, and make sure that people around them think it’s cool. We give kids a roadmap to actually doing that stuff, and make it as easy as possible— including removing obstacles to doing it. The parents who say “no” or “not yet” are threatened, the doctors are coached to never ever imply that this kid isn’t right about who they are and what they want. Hormones are given out to kids who need parental permission to go on a field trip to the history museum.
I get that naturally trans kids probably exist. I just don’t think going whole hog into a pathway that will have the kid sterilized before he hits puberty makes sense. At 17-18 I think it’s much more reasonable as the personal choice of someone who I might disagree with but is capable of making that choice. At 12-13, they have no idea what being an adult is like or what will matter to them at 30 or 40 or 80.
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It's not even 15 year olds, which is bad enough, it's the "you must let your six year old/four year old/two year old/how low can we drop the age and still get away with it? socially transition and accept that you have a daughter not a son, or else the end result will be DEAD CHILD" messaging.
This is an instantiation of a generic problem I see on the left, which is that, in practice, there appears to be no real way to repudiate or police the most extreme parts of the ideology. I think there are many causes of this problem, including the overarching one that the left has an orientation towards breaking boundaries, which cashes out in refusing to have standards*. So imposing things like "reasonableness" or "checking if the consequences of following through on such things leads to desirable outcomes" is deemed as oppressive and appropriately censured/censored. Associated with this is that the modern left has gone all-in on identity politics, which is definitionally a rejection of valuing ideas based on how they interact with objective reality but rather based on the identities of whose mouths those ideas came from. Thus, as long as one can find individuals with the right melanin content and gender identity and sexual attractions to deem some idea as true or even sacrosanct, then It Is Known.
I've said before that, when gay marriage was actually controversial, I scoffed at the notion that this was a "slippery slope" that would lead to [horrors beyond comprehension], and that I've learned since that I was completely wrong. Any push for a meaningful change to society that doesn't also have twice as much focus on determining and executing on how to stop that push seems likely to inevitably lead to a fall down the slippery slope.
* In practice, de facto standards inevitably form, of course. To be more detailed, it's that any imposed standards can be effectively argued against in a way that is orthogonal to actual truth or reality or usefulness.
I’m the same. The left has the difficulty of being unable to actually set and keep a boundary or standards of any sort. It’s not just identity stuff, but immigration, welfare, drug policy, crime laws. The default answer is radical hedonistic individualism and if anyone tells you you aren’t allowed to do anything you want to do, or says it will lead to poor outcomes or harm other people (or yourself for that matter) they are evil oppressors.
The right when it errs tends to err on the side of control, law and order, and so on. Some of which might be simply a reaction to the leftward push of the left liberals who want everything legalized and available, no ages of consent, no barriers, etc.
The right also errs by conflating progressives (as in, the right-in-waiting) and liberals. Part of that is (to borrow another comment) that their TV hasn't gotten over the fact it's not 1989 any more.
The "left" actually does keep boundaries and standards, you just either don't know what they are, don't like how they're justified, or are simply confused by the fact they call them something else (and you need a tool like POSIWID to figure that out).
For example, their criminals are their police- they're policing Racial Injustice, one taxation event (theft) at a time, until the conditions are right for the[ir] government do the stealing with that justification. So is their drug policy- after all, they couldn't help but be someone who gets addicted to drugs, and your broken window and stolen goods are their healthcare policy. Immigration's the same thing; they believe they live in exclaves threatened by the existence of the rest of the [outgroup]/nation, and open borders is the natural Uno Reverse card.
The problem with conservatism (as in, where the right-in-waiting is headed) is that there isn't actually any way to moderate it, because its moral foundations are different and thus demand an infinite contribution to its memes. Liberalism is not like that because it draws its strength from where the memes are wrong, which is why they go back and forth between estabilshment and establishment-in-waiting.
I think claims of left-liberals being accelerationists is a bit uncharitable. And really, I tend to find even within the families I know who are liberal, they are much more permissive in parenting than the conservatives I know. They’re the ones who let their kids do things they don’t like, who don’t limit their kids or insist on chores etc. conservative parents are authoritarian in a good sense, they insist that kids do chores and limit their bad behavior or vices. Conservative parents are more prone to force an adult child to move out than a liberal. Even when the child is failing to launch because of their vices, liberals will make excuses and maybe say something about it, but not really confronting the issue head on. Their child could be gaming for 16 hours a day and have no job or education they’re working on, the kid can still be living at home for a decade.
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Quibble, but the "incidence" for 2020 in the chart is scaled from the part of the year before COVID lockdowns prevented elective surgeries. But the full-year number for 2019 is in the same neighbourhood, so it doesn't affect your argument.
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.
Yeah, and post lockdowns the number picked back up anyway. This is all just a ballpark estimation
There are non-cancer-related breast reductions, but I suppose that's a fair point.
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This is a really idiotic question, but would the coding you describe distinguish between an elective mastectomy and a medically indicated one i.e. for an adolescent patient with breast cancer?
Perhaps this response is even dumber, but adolescent breast cancer/reductions due to overactive puberty or whatever, while rare, is not a new thing the way trans mostly is, so we should be able to compare baseline numbers by averaging pre-2007 statistics?
TBH that shouldn't be a thing either unless it's to stave off cancer or something. There's nothing wrong with having big boobs and we as a society should absolutely come down on the very concept of reducing breast size for cosmetic consideration.
I'm sure there is a subset of people where the breasts are a legitimate physical handicap. Either due to really precocious puberty or since they're just too big for somebody's frame and present significant discomfort for living a normal life. In both cases I think it's reasonable to reduce.
Ah well, if they are literally impossible to lug around then sure.
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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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