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I got into an argument on JK Rowling recently. That was mildly annoying, but then it shifted to transgender stuff in general, and the puberty blocker discussion in particular was very vexing to me. I just genuinely don't know how anyone can be okay with the idea, especially now that we know way more about it than we did 10 years ago. The dismissal of the Cass Review on the part of the pro-trans side has increasingly looked like the stereotypical right winger doing mental somersaults to any science they dislike. But I have some questions on it, there were some things I didn't have great answers to.
What are the actual requirements for getting prescribed puberty blockers? The pro-trans tribe insists that it is a very rigorous process involving thorough checking of gender dysphoria, and it's not commonly done, despite being a readily available tool in the toolbox of clinical practice. I do not believe this after examples I have seen, but I have nothing to cite.
Is there any actual scientific evidence in favor of social contagion playing any part in transgenderism? The pro-trans tribe claims that social contagion plays no role, and to me, it's trivially true that social contagion plays an astounding part, as well as fetishism and abuse, and autism. I have no idea how many kids genuinely become gender dysphoric due to genetics, if there are any at all. And if there are any, I certainly don't think that it's a given that they need puberty blockers. How the hell did that become the default? But anyway, has The Science turned up anything on social contagion?
Are there any actually valid critiques of the Cass Review? Pro-trans tribe will cite the Yale Law retort, then when I point out the responses to it, either holes are poked in them or they just go back to their priors that the Cass Review was methodologically bad, done by a transphobe, misinterpreted studies, and went against the scientific consensus and ruined its own credibility. Actually, they say the same about the recent HHS Report. Please show me if there are any published valid critiques of the Cass Review besides the Yale thing.
What are the probabilities of serious consequences from puberty blockers? I brought up infertility, and the pro-trans tribe claimed that it's actually a very low chance and that it's not anyone's business anyway because not everyone wants to have kids. The latter half of that is completely inane when we're talking about life changing decisions for a demographic that cannot consent, but the former, I don't know. Do puberty blockers cause the infertility, the loss of ability to orgasm, and the complete lack of penis tissue with which to create a neovagina, or is it the ensuing hormones that do this?
Sadly, none of this will do anything to convince anyone on either side anyway. There's really no way out of this hole that has been created. Sometimes, I kind of hate this world. I really thought "don't give minors seriously debilitating life changing pills to solve a solely mental disorder" was an easy hill to stand on, but the fighting was just as vicious as anything else with the gender issue.
Edited to be slightly less angry.
I know two trans women.
One transitioned in her late twenties, and gets stared at wherever she goes. Anyone can instantly tell that she’s trans from her voice and appearance, she’ll need to spend a lot of money on surgery to look remotely female, and she’s at the risk of being hate-crimed just from walking in the wrong area. She doesn’t behave very femininely, perhaps from nearly 30 years of growing up as male.
The other went on puberty blockers as a teenager, she has a normal female voice, and wherever she goes, the average person just sees a normal woman. She didn’t have to spend a single dime on facial feminisation surgery, and also seems to have fairly standard straight female sexuality (no complaints about anorgasmia) as opposed to the weird fetishistic oversexualised behaviour some later transitioners have.
Without going into any studies or the difficulty of distinguishing persistence vs desistance rates, it’s unarguable that early transitioners just fit in better in society and have less chance of being perceived as “freaks” in public based on their appearance. I don’t know if that quality of life upgrade is taken into account in any studies, but that’s enough for me to support them in a broad strokes fashion, even if I don’t necessarily agree with all the details of the modern clinical practices.
What you are saying is true, but incomplete. If someone were certain to transition, it is unarguably true that it is better for them to begin pre-puberty and be in the puberty blockers -> transition pipeline. But the important word there is if.
That is because, if someone can be happy in the body they were born in, it is also unarguably true that they be so, rather than transition at any age. Your second trans friend is certainly in a better position than your first, but even so, she has had major, irreversible chemical intervention and surgery, which has left her infertile, and unable to participate in traditional family formation. She will be on medication for the rest of her life. and, of course, even as a trans woman who passes well, she will still be subject to social stigma in some form or another for being trans. Her marriage pool, for example, will be tiny.
So the real question is: what proportion of those who transition as children would have -if prevented- either transitioned later or lived a miserable life as their birth sex? That's a counterfactual, so we can't know for sure. But, if that number is lower than 90% (so 10% would have been satisfied to live as their birth sex) , then that's a false positive rate that is probably not justifiable. However, desistance studies indicate that number could be as low as 20%. I think it plausible that there are psychological interventions that could bring that number into the low single digit percentages.
How would you feel if there were a 4 in 5 chance that your trans friend could have lived happily as a normal man?
To pick a nit, that's nit necessarily true. It might turn out that early puberty blockade causes issues later on (say, early onset osteoporosis and/or dementia) that the patient might in hindsight decide weren't worth the benefits of better looks while young.
That's another "if" on my part, of course, but just wanted to point out it's not unarguable.
Historical eunuchs who were castrated pre-puberty had remarkably increased lifespans (and that’s with no sex hormones, having estrogen in your system would decrease the odds of osteoporosis), so if there’s major health issues arising from puberty blockers, it would be a side effect of the particular medications, not of blocking puberty itself.
There’s also a difference between the compromise protocol of “go on puberty blockers until age 16, then start estrogen/testosterone”, and “start HRT ASAP to go through cross-sex puberty at a normal age”. The whole point of the former was to let the minor have time to decide if they want to transition or not, but that seems to have been lost in the debate.
On one hand - good point, I think I was researching eunuchs at some point for a point of comparison, and came to similar conclusions. OTOH, bone density problems seem to be acknowledged by all the studies, and I've seen "what's up with all the canes" posts on trans forums. There's also questions of cancer risks, ovarian cysts, etc. etc. I don't know if the question has a simple answer.
Not quite. The original rationale for puberty blockers was passing, "time to choose" was a marketing strategy. It has been lost to debate when the reversibility of blockers became dubious / indefensible.
I’ve never heard “what’s up with all the canes” despite being pretty active in trans communities (I actually don’t know anybody that uses a cane or crutch), although I’m seeing that canes are popular in the broader American queer community for some reason? I do know that various disorders are more common among trans people (e.g. endometriosis, PCOS in FtMs, EDS in general) but they’re not related to puberty blockers. Delaying puberty for too long without any sex hormones is bad for bone health, that’s for sure.
To have the best chance of passing, you should skip the 2 years of puberty blocker and just go straight into opposite-sex HRT. Once you are on estrogen or testosterone, you’re not at a higher risk of osteoporosis than cis women/men respectively, and it’s conceivable your risk could actually be lower than someone who goes through menopause. Trans women that are on only puberty blockers for a while will actually grow taller and have a barrel-like chest (the classic eunuch physique), even if they avoid masculinisation.
I'm confused. By the time you reach the end of the sentence, you seem to confirm what I've said. I suppose what you mean is that the queer community in your locality has not been affected by that particular thing?
I will, once again, have to comb through the 7 zillion hours of podcasts I listened to for a source, but I solemnly swear that the original rationale for puberty blockers was passing. Even if, after some experimentation, it turned out that you get better results with just going directly to hormones, I swear that this was the original rationale, as per the Dutch researchers who kicked off the trend. This will probably take longer than the other search, but I'm planting a flag here, and I will also get back to you once I found it, or have tapped out.
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