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Culture War Roundup for the week of November 21, 2022

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I might be missing something, but this doesn't strike me as particularly restrictive? HRT doesn't magically make you pass, so one way or the other you might end up in this situation.

HRT doesn't make you pass, but the expected workflow where you were supposed to socially transition by throwing on a dress (or, to a lesser extent, bind your chest) alone didn't make passing likely for most people. The more approachable compromise was supposed to be more along the lines of crossdressing socially simultaneous with initial counseling and diagnosis, beginning HRT, and then showing as an increasingly androgynous "wrong" gender at work or unfriendly environments until they were more confident in passing, then legal transition and (optionally) surgical interventions.

((Though this didn't survive contact with the Culture War and the general paradox of forum-shopping.))

There was a lot less contemporaneous objection to the three months "counseling experience (eg, dressing and acting as the other gender in controlled or friendly environments)", and I do think that would be a lot more appropriate than 'whenever the doctor or patient slams the button'.

Isn't it better to find out if you're cut out for it before you start messing around with your body?

I think it's a good policy, but it wasn't really the effect of the "real-life experience" test, in the same way that a lot of other things don't actually follow their names in this sphere. Dealing with a legal name change that doesn't match your social presentation well isn't a particularly good emulation of what the end result -- or even most intermediate behaviors otherwise -- would have been. I think the best argument for it was a hazing, and there's some benefits to making starting difficult, but it's a different and far more controversial argument.

No, this is based on referrals to the Tavistock GIDS, not a survey of zoomer tumblrinas.

Yeah, that's fair: if you're specifically talking about just them, they do seem to be a bit of a mill compared to even other gender therapy-specialized places, especially for younger patients. I do think some people have a tendency to treat all gender stuff into one lump category that isn't getting day-one puberty blockers or HRT in /~99.8% of cases, but if you're not doing that the criticism isn't applicable.

My impression is that medical concerns abound. Increased risk of cancer, diabetes, osteoporosis, inability to orgasm if you block puberty too early... Even adult detransitioners say they feel they were mislead about the medical consequences of it all, and we're talking about pushing kids through the pipeline.

I definitely think there's enough papering over side effects to leave serious concerns about any patient's ability to give genuine informed consent, both on the surgical and pharmaceutical intervention sides, especially for longer duration of puberty blockers. Some of that's doctors not keeping up in an experimental field, which happens a lot and often in worse ways -- my 'favorite' example is the weird TNF alpha blocker interaction that might cause a pretty horrible wasting cancer that a lot of doctors in that specific field still don't recognize almost a decade later -- but it's harder to excuse in a more well-networked area.

That said, (unless you're talking about specifically Tavistock-level clinics) I do think there's a tendency to mush together too many (sometimes even incompatible) approaches together and give a list of every possible side effect of each. Eg, estrogen therapy probably tie to diabetes but probably not osteoporosis, and vice versa for testosterone therapy.

Yeah, that's fair: if you're specifically talking about just them, they do seem to be a bit of a mill compared to even other gender therapy-specialized places, especially for younger patients.

Two points: First, I want to restate this is just counting referrals. The amount of times someone goes to the doctor saying "hey doc, my kid says they're the other gender", and the doctor sends them to Tavistock. How the clinic processes them is another matter, in theory they could send them all away saying they don't meet the criteria for the diagnosis. It's possible that if they're a mill, that encourages more people to come to them, but I don't know if we can assume it's a direct causation.

Second, no I'm not talking about just Tavistock. They're a convenient source because they cover the whole country, and have good book keeping that they have to share with the public, getting comprehensive data like that from the US would be a lot more complicated. Also from the size and structure of the country, I'll be happy to concede there's a much larger variance in approaches in the US, so probably there are also many clinics there that are unreasonably restrictive. With all that said, my position is that in the West we have a systemic problem with promoting transition as a cure for all problems for a certain type of person, and waving them through the pipeline without much questioning.

Until recently, I think we had a similar view on the topic: gender dysphoria is a real thing, living with is a horrible experience, and the best way we came up to help people who suffer from it is transition. That's absolutely fine, as long we put a lot of effort into ensuring that is actually the best way forward for the person, and I've seen a few too many pictures of adolescent girls showing off their double mastectomies to believe that this is what we're doing. Combined with my anecdotal experience of a friends daughter being nudged to HRT at the age of 13 without exploring any other potential causes of her problems (this isn't day one HRT, but she's 13, for the love of god), combined with the recent happenings at WPATH, or the messaging in the media, or the various pro-Trans laws being passed the West... I think it's time to slam the breaks hard.

Or are we actually still on the same page? You mentioned swinging too far in the other direction, are you just afraid the swing back is going to be too hard as well? I understand the fear, but I don't know what we can do about it. We could probably work out a reasonable compromise very quickly between the two of us, but literally no one will listen to us.