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To Escape the Body: A Review of Helen Joyce’s Trans: When Ideology Meets Reality, pt. 3 – How Transgenderism Harms Women And Children

Part 1 – The History of Transgenderism: r/theschism, r/BlockedAndReported, themotte.org

Part 2 – the Causes and Rationalization of Transgenderism: r/theschism, r/BlockedAndReported, themotte.org

Part 3 – How Transgenderism Harms Women And Children: r/theschism, r/BlockedAndReported, themotte.org

Part 4 – How Transgenderism Took Over Institutions And How Some Women Are Fighting Back: r/theschism, r/BlockedAndReported, themotte.org

Part 5 – Conclusion and Discussion: r/theschism, r/BlockedAndReported, themotte.org

Last time, we discussed what Joyce thinks are the causes of transgenderism, how they render many or even most trans people as not really trans in the first place, and what gender-identity ideology (GII) says in the first place.

This time, we’ll go over what Joyce sees as the harms of transgenderism.

Think Of The Kids!

Joyce starts by reminding us that there is a fairly high desistance rate among cross-sex identifying kids and this was known since the 70s and 80s. But this is obviously an inconvenient fact for GII, Joyce asserts, so it gets ignored.

I don’t think this is a good start, I think the modern argument TRAs would offer are that you should not stand in your child’s way of deciding their identity, even if they would desist later. Jesse Singal’s famous (or infamous) 2018 Atlantic article highlights the alarming rhetoric aimed at parents skeptical of transition (“Would you rather have a live daughter or a dead son?”), but I don’t know of cases where desistance has been ignored. I do, however, see serious debate between pro-trans and anti-trans advocates on how many desist in the first place.

Anyways, let’s jump to the 1990s. Clinicians at the time began to wonder what could be done to help the kids who would not desist. It was not clear how to identify them, and if you simply waited until they were older, then you ran into a big problem.

Puberty.

Puberty has strong and lasting effects determined by your sex (really, hormones) that cannot be fully undone by surgery. A trans woman who undergoes male puberty is going to have a deeper voice, certain facial features, and larger body (notably hands and feet). Trans men don’t have as many visible leftovers if they transition (barring breasts). But going through this was obviously discomforting to these kids, so why not try to delay puberty and see who desisted?

Thus, Amsterdam clinicians decided to start injecting small groups of kids with puberty blockers. This was predicted to be a free lunch – the kids who desisted would be taken off the blockers and develop as normal, the ones who persisted could grow up until they were 16 and old enough to consent to the irreversible stuff.

Joyce details a catastrophe as the outcome.

Of the seventy children enrolled in a study between 2000 and 2007, every single one progressed to cross-sex hormones. Almost all had surgery at age eighteen…These children were all highly gender-dysphoric, and had not desisted by the start of puberty.

Joyce admits that it was possible the clinic somehow picked out only persisters, but she is highly skeptical of this. If every other study Joyce cited found major desistance, then the more likely explanation was that puberty blockers had disrupted the body’s process for resolving dysphoria.

But the results were taken up with gusto by others, and Canadian and American clinics began prescribing these blockers not long after. UK’s Tavistock was initially cautious, but began routine assignment in 2014 after, according to Joyce, they were pressed by activists.

All this might have been more acceptable if the criteria for assignment were strict, but Joyce says they’ve been assigned more and more to kids with less severe dysphoria and even those who aren’t transgender, but non-binary or gender-fluid.

I’m not sure how to verify the numbers exactly (even Joyce admits we don’t have clear counts). The number is clearly greatly increasing, but it’s not clear if this just reflects that the right number of kids are getting them, or too many are. I will say that she’s correct on the broadening of who can get blockers. The Mayo Clinic, St. Louis Children’s Hospital, and Cleveland Clinic all say that you don’t have be trans, but just questioning your gender to get it.

But is the broadening of the accepted reasons really a problem? Assume for a moment that puberty blockers worked as advertised (no interference with normal desistance processes). Is there something inherently wrong with offering kids who are experiencing discomfort with their gender puberty blockers? One might argue that categories like non-binary or genderqueer don’t exist and are artificially created for ideological reasons, but if they do, I’m not sure what the issue is.

For Joyce, however, the problem goes beyond just kids on the verge of puberty. Pro-trans messaging has come to include the idea that kids from a very early age can indicate their gender. Diane Ehrensaft, Director of Mental Health and founding member of the Child and Adolescent Gender Center, is quoted as saying that kids as young as three years old can indicate their knowledge of their gender.

This is an inversion of John Money’s ideas, though no less highly unconventional. Where Money had argued that gender was malleable in the first 2.5 years of life and then unchangeable, the modern GII argument seems to be that gender is known from birth.

Both, however, would argue for social transition at an early age. This is unacceptable to Joyce because these are always presented as reversible (both transition and blockers), but part of what she calls the “cascade of interventions”. It does not appear that kids tend to desist even if you just socially transition them. The age at which interventions are happening is lowering as well, with some kids getting cross-sex hormones and even surgery before 16.

If you want to see how nasty activists of any sort can get if you question their views, Joyce points to a controversial figure in this discussion space, the man named Ken Zucker. Zucker is one of the biggest names in gender medicine and has seen at least 1500 gender dysphoric kids. He edits Archives of Sexual Behavior but is known for authoring studies which showed the high desistance rates among kids. Zucker even introduced puberty blockers alongside someone else into Canada in 1999.

I won’t detail the entire controversy, Singal has also covered that here here. Joyce, for her part, argues that the campaign to get Zucker taken down was very much to send a message to anyone else who tried arguing like he did.

Medical Issues With Puberty Blockers

Not only is there a dearth of reliable evidence that kids benefit from taking puberty blockers, Joyce argues that there are other side effects that complicate the matter.

  1. Only your natal hormones can make your ovaries/testicles mature.

  2. There is anecdotal evidence that your sex life may be less-than-fully realized.

  3. Puberty, even if partial, is what makes your penis or vagina develop into an adult’s, blocking it can keep your genitalia child-like, leaving not enough skin to do standard reassignment surgery.

  4. Eggs and sperm cannot be frozen for later if they are never active to start with, and they only activate in puberty.

  5. Trans men and women suffer from higher rates of diseases (not the same ones for both).

The drugs themselves are another issue. Joyce claims that they’ve never been put under clinical trials and aren’t even made for that purpose according to the manufacturers. They’re meant for treating adults for hormone-related conditions or to chemically castrate sex offenders. There are concerns that they may cause a significant IQ drop and prevent calcium from being laid down in bones.

From a cursory glance, I think Joyce is correct. Google Scholar doesn’t list too many studies that actually look at the issue, I only found one meta-review, published in 2020. There was also a piece from 2019 in the BMJ that discussed possible issues with even trying to study it from an ethical perspective. Wikipedia lists some adverse effects.

Progress Is A Circle

But there is another effect in promoting transgenderism, and gender-diversity to a lesser extent, in children – the reinforcement of gender stereotypes. Joyce picks Introducing Teddy: A Gentle Story About Gender and Friendship as her example of this, where the titular Teddy becomes a girl by turning his bow tie into a hair bow.

Such stories of children for children are increasing common, and they do not endorse any explanation of a child’s alienation from their sex other than a discordant gender identity. Joyce argues for familiar explanations: homosexuality or seeking (parental) approval.

Thus, it is damning to Joyce that so many pro-trans or trans-inclusive arguments and lessons to children just enforce gender stereotypes that are the product of the culture. Why are these people acting as if these stereotypes were instead naturally implanted into people?

Parents V. The World

Even more damning is how this divides parents from children. Obviously, transphobic parents would always have a problem with any suggestion of a trans child. But with an increasingly harsh attitude towards anyone who questions their child’s identity or the idea of teaching these ideas to children, there are now stories about kids cutting contact and leaving their homes.

There is evidence to support this indirectly, at least one school district in the US said that its staff were not permitted to reveal a trans kid’s status to their parents. This was picked up last year by right-wing media, which is presumably why the district removed the document from their site.

Schools are not the only intervening institution; the government is in on it as well. Joyce refers to a 2019 British Columbia court case involving a 14-year-old trans boy named Max and his father.

In 2016, aged twelve, she was referred to the school counsellor. Unbeknownst to her parents at the time, she mentioned feeling a commonality with the transboy protagonist of a film she had seen online. The counsellor concluded that Max was trans, arranged for a change of name and pronouns in school records, and referred Max to a psychologist, who recommended testosterone and made a further referral to a paediatric endocrinologist.

A consent form was sent to the Jacksons; the father refused to sign…But under British Columbia’s Infants Act, a child of any age has the right to medical treatment that is opposed by parents if the doctor thinks it is in the child’s best interests, and that the child is ‘mature enough’ to decide. In 2019, the supreme court of British Columbia ruled that Max could consent to medical transition independently of the father’s wishes (his ex-wife was no longer opposed). His refusal to refer to his child as a boy, and continued opposition to transition, were ruled ‘family violence’, and he was banned from speaking to the press.

Tangentially, I will note my confusion over this case. The Guardian reported the following:

“I will be stranded between looking and sounding feminine and looking and sounding masculine. I would feel like a freak,” the teenager wrote in an affidavit which was read out in court on Tuesday.

But I don’t know what would cause this. This may just be a teenager not able to speak clearly, but w/o drugs or surgery, how would you be stuck in such a manner? I would understand if Max was upset about looking/sounding feminine while trying to be masculine, but the wording is…odd.

A Threat To (Cis) Women

The elephant in the room for who stands to lose, according to Joyce, is cis women. They stand to lose many things they had once relied upon, not the least of which include single-sex spaces.

You may remember the name Jessica Yaniv if you’re more online. Yaniv is a trans women and trans activist who, in 2018, began asking wax salons if they would wax her genitals. The reporting I find from this time suggests that Yaniv hadn’t had surgery, meaning she still had her penis and testicles. This doesn’t work for Brazilian waxing; testicles are simply too sensitive to some of the techniques. When she was refused, she brought anti-discrimination cases in British Columbia against the women who refused.

Joyce says it was unclear which way the case would be decided. In the end, however, the court ruled that Yaniv was in the wrong and described her as a vexatious litigant who was acting in bad faith and motivated by money over actual discrimination.

Sounds like a victory for cis women, right? No, unfortunately. The court did not decide against Yaniv on the basis of the defendants having a religious right to refuse service, but on the basis that she had made self-admitted racist remarks against them. The defendants were South and East Asian women, you see.

What I don’t quite understand is where Joyce actually falls on this idea of religious freedom to not accept the tenets of GII. Does she greatly support religious freedom in all cases, or just strategically in this one because it happens to support her view that trans women are a threat to cis women?

The more classic problem, of course, is the bathroom question – is it okay to ban trans women from women’s restrooms? Here, I’ll point to there being no evidence that it’s problematic, but this may be because the culture hasn’t really caught up yet. I don’t think we can really extrapolate from the present to the near future.

Joyce, however, goes a different route – crime statistics.

The little evidence that exists shows that at least some of the males who identify as women are very dangerous indeed. Of the 125 transgender prisoners known to be in English prisons in late 2017, sixty were transwomen who had committed sexual offences, a share far higher than in the general male prison population, let alone in the female one.

So either transwomen are more likely than other males to be sexual predators, or – more probable in my view – gender self-identification provides sexual predators with a marvellous loophole. Whichever is true, allowing males to self-identify into women’s spaces makes women less safe.

Of course, prisoners are perhaps not representative of the overall trans population. But I would agree that self-ID is a dangerous thing and shouldn't be the basis by which we decided transgenderism. I would say that it specifically applies to spaces like women's restrooms, but I don't know of any practical way to allow for people to critically evaluate whether someone is trans that also accommodates self-ID.

There’s then a really uncharitable attempt at showing TRA hypocrisy.

Arguing that vulnerable males must be allowed to identify out of male spaces because males are so dangerous undermines any argument that males should be admitted to female spaces on demand.

Obviously, she and her opponents disagree on many things. But it’s not a contradiction if your opponents believe that sex is malleable like gender to also believe that trans women and women should therefore be kept in the same space, segregated away from cis men.

There are more arguments Joyce makes for the preservation of single-sex (basically only women’s) and the dangers of allowing trans women to enter those spaces, but they’re not very interesting or worth expounding on. If you understand the argument that males tend to be more violent, especially sexually, towards females, you’ve read about a dozen or so pages in this book already.

Mods are mean and limit me to 20k characters, check the comments for the rest of this post.

That's all for this part. Next time, we'll go over some more modern history and how some cis women are fighting back against this. Thanks for reading, I hope you enjoyed!

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That claim is absurd on its face. Is there any actual evidence for it?

What do you think would compell Dr. Marci Bowers, a board member of the WPATH, to make such an absurd claim publically?

There's no evidence that there is any impact on the brain to minimize in the first place.

This response makes this entire exchange rather confusing:

But they halt puberty, the process that changes a kid brain into an adult brain.

That's why WPATH recommends not using them until after puberty has begun:

There's no evidence that there is any impact on the brain to minimize in the first place.

And "no evidence" is a bit of a strong statement, anyway.

I suppose it would prove that, if it were true that blockers permanently halted the development of sexual function.

How many examples of people who were blocked still in Tanner stage 1 can you give that had no issues with developing sexual function?

Anyway, there's plenty of evidence for blockers not being reversible. They have permanent impact on growth, and bone density, and even brain development as cited above. Blockers halting sexual development is more of a written confession on top of the evidence.

If you're saying there's no evidence that transition is easier, safer, and more effective for people who haven't completed natal puberty, then that's simply absurd - such a claim would imply a total unfamiliarity with both human sexual development and the procedures involved in transition. So I have to assume that's not what you mean.

If it's so absurd, it should be trivial to point out the issues with this statement.

The argument for puberty blockers is supposed to be that, particularly for trans women, going for male puberty causes a host of changes that would have to be reversed later on, be it dropping of the voice or changes to the body structure. Fair enough, except their are trade-offs. Puberty blockers are not a magical pause button, they just block the body's interaction with certain hormones, while development continues. So maybe your body, your face, and your voice will be more feminine thanks to puberty blockers, but your penis will be smaller making vaginoplasty more difficult, your bones will be weaker putting you at high risk of early onset osteoporosis, and you might end up with a few IQ points shaved off, putting a bit of an asterisk around that "easier" and "safer" part.

Further, while puberty blockers for trans women come with trade-offs, puberty blockers for trans-men make no sense. A Trans man can take testosterone at 50, and their voice will drop just the same, they will develop a lot of the same secondary sex characteristics, and it's easier to cut off your breasts after they grow, and you decide you don't want them when you're mature, than it is to have them re-grow if you decide you wanted them after all when you're mature. Given that trans men are currently a majority of referrals to gender clinics, it would seem on average puberty blockers do not make transition "safer" or "easier".

Further still, your original statement was "easier, safer, and more effective, with minimal impact on the ones who decide to resume natal puberty". To the extent puberty blockers help trans women, the statement is clearly false for trans-curious men who end up going the cis route. If puberty blockers were the magical pause button they are advertised, it would be one thing, but you don't get your development window back. If you allow me a bit of hyperbole: ending up as a dim, brittle midget with micropenis is not what I'd call "minimal impact". And here the downsides affect trans-curious women as well, while offering no benefit.

It helps inform you about how committed you really are to living as the other gender. If you can't stand being called by a girl's name or being treated as a girl, you might wanna think twice about becoming a girl, right?

Yes, but the question was in the other direction: how does not being bothered by being called a girl's name, or being treated as a women show you you'll be satisfied with hormones or surgery? Go ahead and "treat me like a girl", and see if I care. Not letting you come close to me with hormones or a scalpel, though.

What do you think would compell Dr. Marci Bowers, a board member of the WPATH, to make such an absurd claim publically?

As I wrote earlier, a more reasonable interpretation of her words would be that people who start puberty blockers at Tanner stage 2 had never experienced orgasm prior to going on blockers.

To claim that no one who started blockers at Tanner stage 2 has ever experienced an orgasm, even after stopping blockers and resuming natal puberty or starting cross-sex hormones (and thus proceeding past Tanner stage 2 in either case), is quite an extraordinary claim. It sounds like you have no evidence for that claim, and you simply believe it because you heard someone else say it and you liked the conclusion they drew from it. Is that accurate?

How many examples of people who were blocked still in Tanner stage 1 can you give that had no issues with developing sexual function?

What does Tanner stage 1 have to do with anything in this discussion?

WPATH recommends not starting puberty blockers until Tanner stage 2. That's the same time that GnRH agonists are used in kids with precocious puberty (precocious puberty is defined as early onset of Tanner stage 2). Do you believe that kids treated for precocious puberty never develop the ability to orgasm?

The argument for puberty blockers is supposed to be that, particularly for trans women, going for male puberty causes a host of changes that would have to be reversed later on, be it dropping of the voice or changes to the body structure. Fair enough, except their are trade-offs.

Those trade-offs don't change the conclusion that transitioning is easier, safer, and more effective for people who haven't completed natal puberty and therefore don't need to undergo any procedures to reverse those changes.

So maybe your body, your face, and your voice will be more feminine thanks to puberty blockers

Yes, that was my point. Thank you for conceding it.

but your penis will be smaller making vaginoplasty more difficult,

In reality, the quantity of penile skin is only an issue for some vaginoplasty techniques, not all. Peritoneal pull-through doesn't require the use of penile skin, and arguably gives better results anyway (self-lubricating and requiring less dilation and other maintenance).

Further, while puberty blockers for trans women come with trade-offs, puberty blockers for trans-men make no sense.

Since you seem to be unaware that women undergo skeletal changes during natal puberty, which can be avoided with the use of GnRH agonists, I suppose my prediction of total unfamiliarity with both human sexual development and the procedures involved in transition was correct on both counts.

If you allow me a bit of hyperbole: ending up as a dim, brittle midget with micropenis is not what I'd call "minimal impact".

On this point, I'll defer to your expertise.

Yes, but the question was in the other direction: how does not being bothered by being called a girl's name, or being treated as a women show you you'll be satisfied with hormones or surgery?

No, the question was, "How does the experience of changing your name, dressing a different way, or going to the other bathroom help to inform you about making permanent modifications to your body?" And I answered that question. Since the body modifications are undertaken as one of several steps toward the goal of living in a particular gender role, learning whether the less invasive steps are tolerable does indeed help to inform you about whether the more invasive steps are worth taking.

As you may recall, that point started as a response to the claim that "We still have kid brains making the final decision to go on HRT, it's just a 16 year old kid brain instead of a 12 year old kid brain": I pointed out that the 16 year old with 4 years of experience living in that gender role still has more information with which to make that decision than the 12 year old did.

As I wrote earlier, a more reasonable interpretation of her words would be that people who start puberty blockers at Tanner stage 2 had never experienced orgasm prior to going on blockers.

Sorry seems like I'm not getting notifications from your responses for some reason, so I didn't see your other comment.

It is an interesting interpretation, but I wouldn't call it more reasonable. For one, it doesn't look like the number of kids aged 9-11 that had an orgasm is 0. For another, why would she ask "But are they going to be able to achieve sexual satisfaction" (future tense) directly after that sentence. And for a yet another, why would she say similar things like "If you’ve never had an orgasm pre-surgery, and then your puberty's blocked, it's very difficult to achieve that afterwards", in other interviews with the media?

It sounds like you have no evidence for that claim, and you simply believe it because you heard someone else say it and you liked the conclusion they drew from it. Is that accurate?

No. As far as I can tell this hasn't been directly studied (feel free to correct me!), so I couldn't find hard evidence one way or the other. But when you hear first person testimony of specialists in the field, particularly one who seems to be pretty invested in the pro-trans side, and if anything has bias against admitting problems with blockers, that's something worth listening to, I think

What does Tanner stage 1 have to do with anything in this discussion? WPATH recommends not starting puberty blockers until Tanner stage 2.

Which was my point, they do so in order to avoid that issue.

Do you believe that kids treated for precocious puberty never develop the ability to orgasm?

No idea. I could come up with a couple reasons for why they could or could not, but I haven't looked into it.

Those trade-offs don't change the conclusion that transitioning is easier, safer, and more effective

Yes they do. If you're putting them at risk of other diseases and disorders, they are not "safer". If you have to use a more complicated technique for vangioplasty, it's not "easier".

for people who haven't completed natal puberty and therefore don't need to undergo any procedures to reverse those changes.

I remind you again that your original statement was "easier, safer, and more effective, with minimal impact on the ones who decide to resume natal puberty", not "easier, safer, and more effective for people who haven't completed natal puberty".

Yes, that was my point. Thank you for conceding it.

I never questioned that point, so there's nothing to concede. I'm questioning the point that they make transition "easier, safer, and more effective, with minimal impact on the ones who decide to resume natal puberty".

In reality, the quantity of penile skin is only an issue for some vaginoplasty techniques, not all. Peritoneal pull-through doesn't require the use of penile skin, and arguably gives better results anyway (self-lubricating and requiring less dilation and other maintenance).

Is it easier, and safer?

Since you seem to be unaware that women undergo skeletal changes during natal puberty, which can be avoided with the use of GnRH agonists, I suppose my prediction of total unfamiliarity with both human sexual development and the procedures involved in transition was correct on both counts.

It's starting to sound like you're more interested in winning internet slap fights than getting to the bottom of things. I'm perfectly aware of that, but I'm also perfectly aware that trans blokes still look like blokes, even when they transition late. And as mentioned before, any point about skeletal changes will directly contradict your "with minimal impact on the ones who decide to resume natal puberty" point.

On this point, I'll defer to your expertise.

Oh my.

No, the question was, "How does the experience of changing your name, dressing a different way, or going to the other bathroom help to inform you about making permanent modifications to your body?" And I answered that question.

Not really. I still don't know whether or not I should transition if I am not bothered by being treated like a girl.

learning whether the less invasive steps are tolerable does indeed help to inform you about whether the more invasive steps are worth taking.

Not tolerating a less invasive step might show a more invasive step is not worth taking, but how does tolerating it show that it is worth taking?

I pointed out that the 16 year old with 4 years of experience living in that gender role still has more information with which to make that decision than the 12 year old did.

And my point that those extra years you get while your puberty is blocked, don't actually give you the experiences necessary to tell whether or not surgery is the right choice for them. To be fair, nothing short of a magical rewind button and trying both options could give you those experiences, so I understand working with what we have, but let's not oversell it.

But when you hear first person testimony of specialists in the field, particularly one who seems to be pretty invested in the pro-trans side

By "specialists in the field", you mean "Marci Bowers", right? And by "particularly one" you mean "no one else"?

I've tried to find supporting evidence for her/your claim, but every reference seems to lead right back to that same quote from her as the original and only source.

Which was my point, they do so in order to avoid that issue.

All right, progress! Since we both agree it isn't an issue as long as WPATH guidelines are followed, I guess there's no need to discuss it any further. Moving on.

If you're putting them at risk of other diseases and disorders, they are not "safer".

I'd expect such a statement to be uttered only by someone who believes all risks are equal.

It falls apart as soon as we give it a moment's thought, because in reality, some risks are more serious than others. The risks of major surgery, for example, are far more serious than any of the risks of puberty blockers, which means trading the former set of risks for the latter is safer.

If you have to use a more complicated technique for vangioplasty, it's not "easier".

Again, that statement falls apart as soon as we give it a moment's thought, this time in a couple ways:

First, we're talking about whether transition as a whole is easier, not whether any single procedure is easier. If going on blockers means someone can avoid one or more surgeries in the future, then their transition will be easier overall, even if the remaining procedure uses a more complicated technique.

(And to be clear, PPT is mainly only more complicated from the surgeon's perspective, not from the patient's. Since it doesn't require lengthy hair removal procedures, it's likely to be easier from the patient's perspective.)

Second, only about 5%-13% of trans women have had vaginoplasty anyway; of those who haven't, only about half want to have it in the future (source). For the rest, having to use a more complicated surgical technique simply isn't an issue.

It's starting to sound like you're more interested in winning internet slap fights than getting to the bottom of things.

Nah, I'm mostly interested in correcting misinformation.

I've been part of this community for three or four iterations now, depending on how you count them. I share its disdain for the shoddy arguments and emotional pressure put forth by trans activists.

But I've also spent several months getting to know dozens of actual trans people, observing their concerns, researching more medical and surgical options than I even knew existed, and implementing my own transition.

I'm interested in sharing what I've learned from all that with this community, because I've noticed that every time trans issues come up in a thread like this, and particularly whenever someone is arguing the anti-trans side of them, the evidentiary standards seem to slip -- to the point where, say, one ambiguous quote from one lady is held up as proof for an extraordinary claim about sexual development.

I'm also perfectly aware that trans blokes still look like blokes, even when they transition late

Personally, I agree -- but in my experience, many of them seem to be just as bothered by the width of their hips and shoulders as trans women are (with the desired proportions reversed, of course).

Not tolerating a less invasive step might show a more invasive step is not worth taking, but how does tolerating it show that it is worth taking?

It doesn't, and I never claimed it would. Not all tests work that way. Some tests can only rule a possibility out, but they can't definitively rule it in; nonetheless, such tests can still be extremely valuable.

By "specialists in the field", you mean "Marci Bowers", right? And by "particularly one" you mean "no one else"?

You're really gonna jump from “she didn't say it!” to “no one else saying it!” without skipping a beat, huh? Bold strategy, but the problem with that combative attitude you can't seem to drop, is that it you don't know the full extent of evidence your interlocutor might have. So it might make you look a bit silly if, after going full-"you mean it's only Marci Bowers, right?! No one else, right?!" it turns out I have something like the audio from the 2017 Seattle Gender Odyssey Conference with Dr. Johanna Olson-Kennedy saying something like:

But we have to ask ourselves if you have Tanner II male genitals are you going to be able to use them, are you going to want to be able to use them? Or we are we just assuming that everybody is now going to have to say “Well I either need to go through puberty to get adult sized genitals or I’m going to have these genitals that I have or I’m getting surgery.” (…) If we are judging the success of vaginoplasty by post-surgical orgasm how do we know people are having orgasms prior to surgery if we are blocking them at Tanner II?

At about 8m30s mark.

I've tried to find supporting evidence for her/your claim, but every reference seems to lead right back to that same quote from her as the original and only source.

Like I said, it hasn't been directly studied, trans activists concede as much themselves, and are disappointed by the fact. This means that while, for some reason, you confidently stated the claim is “absurd” you'll have hard time falsifying it at present time.

The other important thing to consider here is the question of bias. People making these claims have every incentive to promote the usage of puberty blockers, if they're actually helpful for trans people. If they have their reservations, there's probably a good reason for them.

But they halt puberty, the process that changes a kid brain into an adult brain.

That's why WPATH recommends not using them until after puberty has begin

The reason they do that is because starting them too early permanently halts the development of sexual function

(...)

Also keep in mind that this proves blockers are not reversible, contrary to what is often claimed by professionals in trans case.

I suppose it would prove that, if it were true that blockers permanently halted the development of sexual function.

How many examples of people who were blocked still in Tanner stage 1 can you give that had no issues with developing sexual function?

WPATH recommends not starting puberty blockers until Tanner stage 2.

Which was my point, they do so in order to avoid that issue.

All right, progress!

Is it? It sounds like you are having trouble keeping track of the conversation. It was about why WPATH makes the recommendations it does, and you were claiming my explanation for why they're making these recommendations is “absurd”.

Since we both agree it isn't an issue as long as WPATH guidelines are followed

I have not said that either. How did you get that impression?

It falls apart as soon as we give it a moment's thought, because in reality, some risks are more serious than others. The risks of major surgery, for example, are far more serious than any of the risks of puberty blockers?

Is it? How sure are we a major surgery is going to be necessary absent puberty blockers? How was it determined that getting osteoporosis when you're 30, or your IQ dropping, is better than getting that surgery? How is potential future desistence weighed against the risks of each of those? Keep in mind I'm not going full reddit-brained here and asking for a peer-review study. A blog post where all these concerns are taken seriously, without sneering, will do quite well for me.

First, we're talking about whether transition as a whole is easier, not whether any single procedure is easier. If going on blockers means someone can avoid one or more surgeries in the future, then their transition will be easier overall, even if the remaining procedure uses a more complicated technique.

Well, if you want to be precise, we're talking about whether puberty blockers make transition "easier, safer, and more effective, with minimal impact on the ones who decide to resume natal puberty", and the issue you are having is that the first part of that statement is in direct contradiction with the last. Secondly, you'll see I already pointed this out in the comment you claimed I'm conceding the argument. The question is are the benefits worth the potential risks, and disadvantages, and how did we come to that conclusion.

Second, only about 5%-13% of trans women have had vaginoplasty anyway;

Yes, and according to Olson-Kennedy, that makes it worse. Apparently you're not going to have much fun with a Tanner II penis either.

Nah, I'm mostly interested in correcting misinformation.

These:

That claim is absurd on its face

Yes, that was my point. Thank you for conceding it.

Since you seem to be unaware that women undergo skeletal changes during natal puberty

On this point, I'll defer to your expertise.

By "specialists in the field", you mean "Marci Bowers", right? And by "particularly one" you mean "no one else"?

All right, progress! Since we both agree

I'd expect such a statement to be uttered only by someone

Again, that statement falls apart as soon as we give it a moment's thought,

Seems to me you're just trying to define your hypocrisy out of existence

Do not sound like statements of someone interested in correcting misinformation. They sound like someone desperate for scoring points.

Not judging by the way, we've all been there.

I'm interested in sharing what I've learned from all that with this community, because I've noticed that every time trans issues come up in a thread like this, and particularly whenever someone is arguing the anti-trans side of them, the evidentiary standards seem to slip

I'm interested in hearing you out. What I'm not interested in is playing this game where you get to be right be default, and everyone else has to prove everything to your satisfaction.

-- to the point where, say, one ambiguous quote from one lady is held up as proof for an extraordinary claim about sexual development.

Well, it's not one ambiguous quote, it's one that's maybe ambiguous if I'm being charitable, and one that's absolutely clear. It's not exactly “one lady” it's a doctor of medicine running a gender clinic, and who's trans herself. Oh, and now there's two of them.

And if the claim is so extraordinary, why do you think these doctors of medicine, who if anything are biased towards the pro-trans side, are making these claims publicly?

Personally, I agree -- but in my experience, many of them seem to be just as bothered by the width of their hips and shoulders as trans women are (with the desired proportions reversed, of course).

Yeah, body dysmorphia is a bitch. Same thing happens to people getting plastic surgeries. You get that nose job, and you start looking at your chin more critically all of a sudden.

It doesn't, and I never claimed it would.

Ok cool. So that's the issue I'm raising in the entire process of transitioning kids.

You're really gonna jump from “she didn't say it!” to “no one else saying it!” without skipping a beat, huh?

It's both. I still think you're misinterpreting her, and your new quote makes that seem even more likely:

it turns out I have something like the audio from the 2017 Seattle Gender Odyssey Conference with Dr. Johanna Olson-Kennedy saying something like: [...] "If we are judging the success of vaginoplasty by post-surgical orgasm how do we know people are having orgasms prior to surgery if we are blocking them at Tanner II?"

You should try actually listening to that audio, instead of stopping the moment you hear something that you think supports your preconceived conclusion.

The question she was asking was rhetorical. If you had listened a little longer, you would've heard her answer it (starting around 9m30s) by citing a study that documented orgasms in kids prior to Tanner stage 2.

Like I said, it hasn't been directly studied, trans activists concede as much themselves, and are disappointed by the fact. This means that while, for some reason, you confidently stated the claim is “absurd” you'll have hard time falsifying it at present time.

Actually, as noted above, you falsified it yourself just now with that recording. Thanks!

Since we both agree it isn't an issue as long as WPATH guidelines are followed

I have not said that either. How did you get that impression?

Wow - you quoted yourself saying it twice, then repeated it a third time, and now you're denying that you ever said it at all? Interesting tactic.

Here, from your very own post, with bracketed insertions for context:

You quoting yourself saying: "The reason they [WPATH] do that [recommend not using puberty blockers until Tanner stage 2 has begun] is because starting them too early permanently halts the development of sexual function"

Then you quoted yourself saying: "Which was my point, they [WPATH] do so [recommend not using puberty blockers until Tanner stage 2 has begun] in order to avoid that issue [of purportedly never developing sexual function]."

And then you said, unquoted: "It was about why WPATH makes the recommendations it does [not using puberty blockers until Tanner stage 2 has begun], and you were claiming my explanation for why they're making these recommendations [i.e. to avoid the purported issue of never developing sexual function] is “absurd”."

In other words... like I said, although we disagree about whether the purported issue of people who go on puberty blockers at Tanner stage 2 never developing sexual function is a real thing that happens in real life, and although we disagree about whether WPATH's true reason for recommending waiting until Tanner stage 2 is what you say it is rather than what they say it is, we both agree that following WPATH's recommendation avoids the issue.

How sure are we a major surgery is going to be necessary absent puberty blockers?

Essentially no natal males will make it through puberty without testosterone leaving at least some outwardly visible effects on their bodies that can't be reversed with hormones alone. Those changes are well-documented, and you can look them up yourself if you need a refresher.

Of course, it's ultimately up to the patient to decide what their goals are in terms of having feminine features, and up to genetics to determine exactly how far away from those goals their natal puberty will deposit them. But given a particular goal, someone who went through natal puberty will virtually always need more surgery to get there.

Yes, and according to Olson-Kennedy, that makes it worse. Apparently you're not going to have much fun with a Tanner II penis either.

As noted above, that's actually not what she said, which is clear if you listen for just a few more seconds.

Well, it's not one ambiguous quote, it's one that's maybe ambiguous if I'm being charitable, and one that's absolutely clear.

As noted above, that's incorrect. It's now one ambiguous quote (which, either way you interpret it, is contradicted by the second one) and one that you've misinterpreted as saying the opposite of what it actually says.

Yeah, body dysmorphia is a bitch. Same thing happens to people getting plastic surgeries. You get that nose job, and you start looking at your chin more critically all of a sudden.

We're talking about gender dysphoria here, not body dysmorphia. A key difference is that gender dysphoria gets better when the issue is corrected. If you spend some time getting to know people who are transitioning, you can even witness that happening -- at least for the features that can be corrected, which is why I think it's so important to ensure that young trans people have the opportunity to prevent natal puberty from progressing to the point where those features can't be corrected.

I'll collapse all the conversation about blockers, since it won't be possible to make progress without agreeing on what it actually says. But First:

You should try actually listening to that audio, instead of stopping the moment you hear something that you think supports your preconceived conclusion.

The question she was asking was rhetorical. If you had listened a little longer, you would've heard her answer it (starting around 9m30s)

Why do you have to keep talking like that? I'm trying to keep an open mind here, but you are not making it easy. We can't have a normal conversation?

by citing a study that documented orgasms in kids prior to Tanner stage 2.

Yes, I listened to the entire thing before posting. I really don't see how this can be interpreted as rhetorical if you take everything they said into account. To recap, Marci Bowers told the following to Abigail Shrier when she was writing her piece in FP:

If you’ve never had an orgasm pre-surgery, and then your puberty's blocked, it's very difficult to achieve that afterwards

Then in a follow up on her substack, Shrier gives the full uneditorialized quote:

When you block puberty, the problem is that a lot of the kids are orgasmically naive. So in other words, if you've never had an orgasm pre-surgery and then your puberty's blocked, it's very difficult to achieve that afterwards. And I think that I consider that a big problem, actually. It's kind of an overlooked problem that in our informed consent of children undergoing puberty blockers, we've in some respects overlooked that a little bit.

That's pretty much 100% clear, and aligns with my interpretation. At no point did Bowers claim to be misrepresented or contest the quote, which she could have done on other platforms, or by asking Shrier for a clarification, since they remained in contact after the piece was published:

(After the piece came out, Bowers asked me to qualify that although she told me she was “not a fan” of early puberty blockade, it might still be appropriate in very severe cases of gender dysphoria.)

Then we have the clip I linked with the quote:

Every single child or adolescent, who was truly blacked at Tanner stage 2 (ages 9-11) has never experienced orgasm

I could see where you're coming from if I relied on that quote alone, but if you take into account what she told Shrier, I'd say that tips the balance in favor of my interpretation. She's saying the same thing here, but she stated it less clearly.

Then, if you keep listening, she says the following:

So blockers prevent the rise of testosterone, and they don't really go on testosterone at or around surgery, or into adulthood. And so we don't know. They're gonna have the sensation, there's no question about that, but are they going to be able to achieve sexual satisfaction?

(...)

I know Jo (possibly Olson-Kennedy, I don't know if the subtitles come from the people doing the video conference, or the channel that clipped it) and many others reported to me they've changed their approach a little bit in their informed consent models in that we're talking about masturbation now. We're talking about, okay, it's an area of the body that's dysphoric for you, but you know what? All a penis is, is just a large clitoris. It's all the same material. It really is. Use it for the pleasurable purposes, partially that it was intended, and we'll see what happens. But these are to be answered questions. So can we avoid puberty, and get good adult results? And secondly, how do we assure someone that they're going to be able to be sexually responsive? Do we remove the blockers during the course of their adolescence, and let a bit of puberty come back? Do we delay it a little bit? Maybe into Tanner stage 3 or 4, maybe before they have their first orgasms?

So she's recommending that adolescents play with their naughty bits to see if they can orgasm before they go on blockers. Why would she do that if my interpretation was wrong? Why would she be talking about delaying blockers until Tanner 3 or 4?

Then in the audio of Olson-Kennedy, she asks the same question about being able to achieve sexual satisfaction, you claim it's done rhetorically because she brings up that Saudi study. But that study does nothing to resolve the question of what happens if you block someone who has never had an orgasm. It's about toddlers with an unusual hormone profile, not adolescents who never masturbated, and were blocked.

Further, after bringing up the study she says the following:

But that was really important, right? Because you can have conversations with people about masturbation. I need to have conversations with people about orgasms. I need to give prescriptions to masturbate. Right? Cause they're so worried, if I enjoy my body it means I'm not a girl.

So it's the same “play with your naughty bits before blockers” approach Bowers recommends.

If you still think I'm wrong, the only thing I can think of is bringing this to a top level post in the CW thread and asking others to resolve it. If there's a mod or a high-profile user you hold in high esteem, I'll be happy to have them as an arbiter.

Actually, as noted above, you falsified it yourself just now with that recording. Thanks!

A study attempting to directly answer the question would look like this:

  • Take a bunch of adolescents that never had an orgasm

  • Put them on blockers

  • See how easy or hard it is for them to get an orgasm later

  • Compare to a control group

Can you link me one that does that?

Wow - you quoted yourself saying it twice, then repeated it a third time, and now you're denying that you ever said it at all?

Because I haven't, I was talking about their motivation, not about whether or not those guidelines are successful at achieving that goal. In the quotes you brought up:

  • "*The reason* they [WPATH] do that [recommend not using puberty blockers until Tanner stage 2 has begun] is because starting them too early permanently halts the development of sexual function"

  • "Which was my point, they [WPATH] do so recommend not using puberty blockers until Tanner stage 2 has begun] *in order to* avoid that issue [of purportedly never developing sexual function]." (It's a bit trickier to emphasize my point here, but I meant “In order to” as motivation, not a statement of effectiveness)

  • "It was *about why* WPATH makes the recommendations it does [not using puberty blockers until Tanner stage 2 has begun], and you were claiming my explanation for why they're making these recommendations [i.e. to avoid the purported issue of never developing sexual function] is “absurd”."

I do have an opinion of effectiveness, but not enough confidence in it to debate it, so I take an agnostic stance here.

Sorry if it was unclear.

Of course, it's ultimately up to the patient to decide what their goals are in terms of having feminine features, and up to genetics to determine exactly how far away from those goals their natal puberty will deposit them. But given a particular goal, someone who went through natal puberty will virtually always need more surgery to get there.

But that's my point, why should we hold the goal static when considering this? Are the disadvantages of blockers usually worth being able to achieve a better transition? How was that determined?

A key difference is that gender dysphoria gets better when the issue is corrected.

Is there a way of telling which is which before medical intervention?