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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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