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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 dislike the phrase "social contagion", which assumes that being trans is a negative and it's bad for it to spread. This negative connotation is, I think, what causes people to deny the obvious when they might not if the question were phrased differently. Is dyeing your hair a "social contagion"? Tattoos? The latest slang, the latest fashion? People will trivially be more likely adopt all these things if they know they're on the table, and even more so if they're popular. "People will be more likely to develop a desire to change genders if they know it's a commonly-done thing" is common sense, and I don't think "the pro-trans tribe" would deny it if the name people used for it wasn't something which implies it's a nefarious process that needs to be halted.
(Mind you, I do think we use puberty blockers on minors too cavalierly. But Rowling is not a good champion for that narrow, sensible point when she is clearly against social transition, and all forms of adult transition, as well.)
You have this backward, I think--the phrase social contagion emerges from the conclusion, not the other way around. The phrase "social contagion" refers specifically to the vector for an illness. If we accept the "mental illness" model of psychology, then mental illness that spreads via social exposure is a "social contagion." To the best of my understanding, it is pretty well established that e.g. eating disorders exhibit social contagion. So, apparently, does suicide.
If gender dysphoria isn't an illness, then it's not a social contagion. But also: if gender dysphoria isn't an illness, then there's not really any good argument that insurance companies should be required to pay for treatment. (I know Scott Alexander has written about this, though to the best of my recollection he tends to be a bit allergic to drawing the obvious conclusions on trans issues, possibly because of his geographic bubble.) So gender dysphoria ends up in this weird superposition where trans advocates want it treated as an illness when that means they get money, but definitely not treated as an illness in any other context.
There are a variety of definitions out there for "mental illness" but the usual one is something like "a psychological condition that interferes with participation or satisfaction in ordinary, every day life." The standard goal of treatment is to eliminate that interference, but the sociological angle is that "ordinary, every day life" is a culturally constructed and often moving target. So yeah--dying your hair or getting a tattoo could indeed be a matter of "social contagion" if it interfered with everyday life--people who engage in extreme body modifications that make them mostly unemployable, for example, can probably even now be fairly described as suffering from a mental illness, possibly acquired through social contagion. But the more serious we are about pluralism, the harder it is to say what "ordinary, every day life" entails.
The people who think transsexuality is (or is at least substantially) a matter of social contagion are generally agreed that it's a nefarious process that needs to be halted. Which, if it is a mental illness, seems like a fair assessment. Again, if it's not an illness, then related treatment is purely aesthetic, and very few people think health insurance or national health programs should cover body aesthetics (even when looking prettier seems likely to e.g. alleviate your depression).
Do you have a source for this? My understanding has long been that Rowling is totally fine with neopronouns, social transition, etc., and is indeed quite supportive of trans ideology in almost every context, far more so than e.g. a religious conservative. Rowling just doesn't think males should be permitted to compete against females in athletics, or placed in prison with them, or allowed into female-only shelters, or the like. Basically she has the classically feminist view that males, as a class, are dangerous to females, as a class, in ways that warrant giving certain unique recognition and advantages to females, which transsexuals born male are not; whether they are individually harmless is irrelevant to their continued membership in the suspect class. But if a male wants to put on some womanface and call himself Tina, Rowling seems happy to "yaass queen" him--just so long as he doesn't go flashing his penis in the girls' locker room.
I think the conventional way to thread that needle is that you can be transgender without having gender dysphoria (ie you have no morbidly negative feelings about your current gender, you just get gender euphoria from a switch). Thus, the spread of transgender itself is not the spread of a contagious illness; gender dysphoria simply develops organically in people who had become trans in the positive sense beforehand. If smoking becomes popular in a given population, lung cancer will rise, but "lung cancer is a social contagion" would be a rather odd way to put it; ditto "bone fractures are a social contagion" for a population that's gotten really into mountain-climbing lately.
That being said, if push comes to shove I think we should just bite the bullet that gender dysphoria isn't an illness. We just pretend it is because the government has yet to implement a decent UBI, so we unconvincingly pretend a transition budget is a natural part of healthcare. Perhaps we could see about creating separate transition grants, decoupled from health insurance? This is all pretty far out of the Overton Window, so we're stuck with the kludge. Still, internally, the trans movement takes it as implicit that you understand that much - that "transgender is a mental illness" is a convenient fiction for browbeating the government into giving money it wouldn't otherwise give, and shouldn't be taken as axiomatic in any other context.
Sorry to reverse-uno you, but I'd like a source on that. I've never, ever seen Rowling say it's good to let minors transition or refer to a MTF as a woman. My read is, she might be socially liberal enough, in the true sense of the word, to tolerate social transition as a "live and let live" kind of deal, but she is still clearly against it in the sense that it wouldn't exist in her concept of an ideal world and she'd be very put off if any friends of hers transitioned.
...have you even bothered to look?
Here is Rowling's essay on the matter, published five years ago. Just one excerpt:
This is a direct refutation of your "read" on Rowling, which you apparently never bothered to check. I would be very interested in a response from you detailing how you are now revising your priors, especially in connection with the credibility you will afford in the future to the sources of your misinformation on Rowling.
No it isn't. I read the essay long ago, and it is entirely congruent with my read of Rowling as willing to tolerate transition in certain narrow cases, but not actually in favor of it. Even assuming Rowling is telling the truth about this trans woman she "happens to know" (has she come forward and offered comment? I wonder if we're talking about a friend of many years as opposed to someone she's met once at a friend of a friend's baby shower), the essay only makes room for transition as a "solution for some gender dysphoric people", not a life choice people are free to make for any reason. She explicitly endorses the view that "candidates for sex reassignment" should go through "a long and rigorous process of evaluation", which is to say, that some adults who want to transition shouldn't be allowed to.
Moreover, she only seems to even care about medical transition. "A man who intends to have no surgery and take no hormones may now secure himself a Gender Recognition Certificate and be a woman in the sight of the law", she writes, as if that were inherently beyond the pale. I'm sorry but those just aren't the words of someone who approves of social transition for anyone, let alone for minors. Granted, it's possible to approve of social transition without thinking it should be recognized by law - but someone who held that idiosyncratic view still wouldn't start that sentence with "a man".
And again it's not that I want to crucify her for this or anything, she's entitled to her views. But it makes her a poor champion for the specific cause of "all else aside, puberty blockers are medically hazardous", a case which would be better made by someone who enthusiastically endorsed social transition, and indeed a theoretical risk-free perfectly-reversible sex-change procedure, while cautioning that we should be much more careful about the medical implications of the imperfect options that exist today.
Remarkable how quickly you drop to a motte-and-bailey doctrine here. Here is what you said, emphasis added:
Based on her own words, this is clearly false. Then, when I tried to correct you, you doubled down and asked me to be the one bringing evidence, instead of you. So I brought the evidence, and your response was to simply withdraw to a motte:
I no longer regard you as engaging honestly in this conversation, so I guess that's the end of it.
I don't know what to tell you. I think it's perfectly possible to be against something while tolerating it. For example, I would describe myself as "against religion", but I tolerate religious people, and I am willing to allow that for some people, they're probably happier for being religious than they would otherwise be. Nothing you have shown me disproves the idea that Rowling is against transition in this sense. And you certainly haven't proven her to be in favor of it in the sense that I argued would be necessary for a fitting advocate of the narrow puberty-blockers issue, which was my core point, not whatever semantic games about what it means to be "against" something.
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