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I said two months ago I would reply to a comment about this study on the mental health effects of gender transition. I have only now managed to find the time, so I'm going to post my reply as a top-level comment lest it get buried. You can find the previous discussion here.
To be honest, some of the statistical manipulation seems dubious, but that's above my pay grade, so I'm going to assume the study was conducted in good faith with no shenanigans.
In short, the study finds that, contrary to assumptions that transitioning should improve mental health, the share of people needing mental health treatment rises drastically after transition. Anti-trans people conclude that this means transition actually worsens mental health, and, hence, people should not be allowed to transition.
There's some nitpicking to be done here, for example, maybe the patients already needed mental health treatment and just found out they needed it at the same time as they found out they're transgender, or that just seeing a mental health professional regularly doesn't necessarily mean that your mental health is worse than it used to be.
But my fundamental objection is to the conclusion that no one should be allowed to transition. Suppose the anti-trans side is completely correct on the facts, that transitioning did, in fact, directly worsen the mental health of many or even most patients. There are still some patients who are better off. There are countless anecdotal reports online of people who are happier after transitioning. The most you can conclude is that the criteria for who should transition need to be changed. (If I'm interpreting the data right, the likelihood of needing mental health treatment after transitioning was higher in those born later, consistent with the rapid-onset gender dysphoria (ROGD)/social contagion hypothesis.) But if you care about people's happiness, some people should still be supported in transitioning.
Obviously if you believe all trans people are delusional and object to transition and treating people as their stated gender regardless of the effect on their mental health, this does not apply to you. But in that case the study isn't an argument you can use.
Speaking of ROGD, its rhetorical use by anti-trans people is a peculiar example of a self-contradictory motte-and-bailey: usually the bailey is a stronger version of the motte, and thus necessarily consistent with it, but here the bailey ("all trans people are delusional and none of them are their stated gender") contradicts the motte ("some trans people with a specific presentation – primarily adolescent girls – are not actually their stated gender") because the latter presupposes that some trans people are, in fact, their stated gender. If you believe all trans people are delusional, why do you care about the specific etiology of the transness of a specific subgroup of trans people? The treatment, whichever you prefer, should be the same.
I consider myself pro-trans, but I believe ROGD/social contagion may well be a real thing. If you agree about the possibility of social contagion, you should try to minimize the attention trans people receive, yet anti-trans activists have been the main publicists of transness for about a decade now – trans people really entered the mainstream with the North Carolina "bathroom bill". It used to be that you would only find information about transness if you went looking for it because you were questioning your gender, but now that trans people are everywhere (thanks to anti-trans activists), you get impressionable young people who were not predisposed to questioning their gender hearing about it and joining in for the standard reasons impressionable young people join trends. (Cf. media coverage of school shootings encouraging more school shootings – a common argument among anti-gun-control people.)
Neither of those argument doesn't work. There are 3 groups in the study:
The conclusion isn't based on just comparing trans people to controls It's based on how theie mental health deteriorated after transition. I also remember the author of the interview saying all students get a regular (yearly?) mental health assesment in Finland.
I agree that this study is not enough to conclude that, but I don't I've seen anyone say "this study clearly shows that no one should transition". Instead, it is a rebuttal to the pro trans narrative that claims they are able to accurately diagnose dysphoria, and that these interventions not only help, but are medically necessary. This conversation has a long running context, where the pro-trans side was deliberately misleading people and attacking skeptics for years, so I don't think it's right to try and portray them as saying "well, we just think there's a non-zero number of people who might benefit from this"
The kind of people who say "no one should transition" don't so much believe some one "isn't their stated gender", they question the very concept of gender. I think it's a strong argument, "gender" is effectively a religious belief. Specifically it seems that it's a secular version of the belief in a soul, and I think it's fair to say that this is not a valid basis for a medical intervention
I also don't see the contradiction. You can say "no one should transition", and "this social contagions seems to be affecting mostly adolescent girls". I see no presupposition of validity of other people's gender dysphoria.
That's the certainly the impression I got from people citing the study, even if none of them said so explicitly. Do you agree some people should transition?
I am not the pro-trans side; I am one person on this website. You are arguing with my claim that some trans would benefit from, and should be allowed to, transition.
A simple concept of "gender" that avoids any metaphysical or spiritual claims is that "my gender is 'woman'" means "I want to be treated, in most social situations, as you would treat the average person with XX chromosomes (however you refer to such a person)". I realize this is not the version typically advocated, but I am not the typical pro-trans advocate.
You might be picking up correctly what their opinion is, but not their justification for it. It's particularly strange you claim that it has something to do with the study, when they don't say anything of that sort explicitly.
Depends what exactly you mean. There are scenarios where I believe people should be allowed to transition if they want to, but I don't think they should. But either way my opinion is not based on that study, nor am I using it the study to back that particular opinion.
I think that if you're going criticize the arguments people are making, you should take the context in which they are made, and what they're responding to, into account.
If "gender" is just a desire for being treated that way, than clearly that desire exists, but then people who say "no one should transition" aren't saying "X isn't their stated gender", which would have to mean "they don't actually have that desire", they're saying they're refusing to fulfill it.
Here I said trans people are happier if they are allowed to transition and get treated as their preferred gender, and that therefore they should be allowed to transition and get treated as their preferred gender, and someone pointed to the study to rebut my claim.
Yes, the terminology would have to be adjusted. Other than that, do you agree that that view of gender is reasonable?
You made a general empirical (which you emphasized yourself) claim, and the study was used to refute it. It was not used to make a normative claim applicable to everyone, including the most exceptional cases.
Reasonable in what sense? In a descriptive one, in that there indeed are people who have such a preference? Sure. Or reasonable in a prescriptive sense, in that adopting such view of gender, and doing everything in your power to fulfill such desires would somehow be good for society? No, I disagree with that.
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One problem is that when considering the effect of an intervention, this is basically an apples-to-oranges-to-licorice comparison.
The gold standard for determining the effect of an intervention would be a randomized controlled trial (RCT). Take a patient and then prescribe them either a puberty blocker or a placebo, so that neither you nor they know what they got, and then follow up on the outcome years later.
Obviously this is hard to do for ethical reasons. But anything else risks simply measuring confounders. Perhaps the people opting for intervention simply had a higher trust in their medical system, and consequently were also more likely to seek psychiatric help with other problems. Or a million other things.
This is not my experience. The anti-trans side believes very strongly in their conception of gender, hence all the bathroom bans. Someone who actually rejected the concept of gender might preach some kind of pansexuality where you simply do not care what kind of sex bit your partners have. They might reject the very concept of straight and gay couples because There Is No Gender, Man.
By contrast, the people most offended by trans people believe very strongly in the existence of gender, they just happen to think that it is identical to sex-assigned-at-birth.
This is a weird framing. I wouldn't say I believe in gender, but think it's identical to sex (not "sex-assigned-at-birth", just "sex"). I would say that, of the two, sex is the only thing that actually exists. No one actually has a "gender identity" (hell, no one can even provide a cogent, non-circular definition of what "gender identity" even is), but even if they did, it's a bad idea to design public policies around unfalsifiable claims people make about their own inner experiences. "Gender identity" meets this description, "sex" does not, ergo "sex" is a good basis on which to design public policies and "gender identity" is not.
I think we are just arguing over semantics. Of course, if "gender" and "sex" are co-extensive, then there is no need for two different words.
If we were in a society of peafowl or nudists, that would work. You just see the colorful plumage (or the penis) of the person you meet, and you know for certain that you are dealing with a male.
In most human societies, it is not as easy to identify the sex of another person. Asking them to show you their genitals is mostly frowned upon, so you rely on Bayesian evidence -- beards, breasts under clothing, gendered clothes, height, hairstyle, behavior, voice register. All of these can be mimicked, and depending on the social setting some trans people might pass.
"Sex and gender are co-extensive" is a claim which can only be made if one has two different words. Even if it was, it might still be worthwhile to keep the two terms around to discuss this fact. Physics has a concept of "inertial mass" and "gravitational mass", even though as far as we know both are co-extensive.
If I were to ask evangelicals if they supported "traditional gender roles", I think most would affirm (even if they would prefer the vaguer phrasing of traditional family values). If I asked them if they supported "traditional sex roles", they would likely be confused. Am I some freak talking about missionary sex, or an even greater freak talking about sexual roleplay, or am I talking about some ancient environment, as in "males specialize in hunting mammoth, females in picking berries", and could I please avoid saying the s-word?
For what it's worth, I am not a gender fanboy. My (mostly underinformed) impression is that while there are some social sciences who do an admirable job of cargo-cult science, gender studies do not even rise to that level and are probably about as epistemically useful as theology. I just do not think that the main concept they are (presumably) dealing with is devoid of meaning.
Ah yes, one of those incredibly difficult tasks that babies learn to do before they can walk or talk.
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impossible to have a conversation with someone who asserts such transparently false things
I think that my statement is at least technically true, because "it is harder to sex id clothed persons than nude persons" should hardly be controversial.
Now, you could claim that it is only true in that technically sense, as in "it is more reliable to tell apples from oranges through genome analysis than it is to tell them apart through looking at them" -- which would be technically true if there is some weird apple where eyeball id is less than 100% accurate, but functionally false, because nobody is ever likely to encounter that counterexample in the wild, and insisting on running every fruit through PCR is utterly pointless from telling apples from oranges.
For pre-pubescent kids, I do not think that it is particularly easy to tell their sex absent social norms ("boys have short hair and wear blue clothes with dinosaurs, girls have long hair and wear pink clothes with unicorns").
I will grant you that after puberty, most people can reliably pass for their sex even without social cues. Voice register alone probably suffices. I will also grant you that societies can eliminate most adversarial examples by simply punishing trying to pass as a sex you were not assigned at birth by stoning: if I see a bearded Taliban gunman, I do not really have to check the inside of his pants to know what genitals he will have. It is technically possible that it is a trans-man on T, but I would expect there to be less than one such instance in all of Afghanistan.
In freer societies, people are allowed to pass as the other sex/gender, or not prominently display their beard or breasts to the world and thereby sort themselves into one of the categories.
It might be that the rest of the world is much better at id-ing sex in Western adults than I am. Perhaps the rest of you have basically a built-in millimeter wave scanner and I am just to autistic to notice. I mostly rely on secondary sexual characteristics (which can easily be acquired through HRT, or even faked through props) and social conventions.
Luckily, there is very little reason for me to know the sex of a random person in the street. The only exception would be "can we produce offspring together" (which of course also hinges on other factors). I am a member of a K-selected species, the number of times a trans-woman has tricked me into courting by pretending that she could bear my children has been exactly zero. In practice, "could we beget viable children?" is rarely the first thing on my mind when I encounter a person in the street.
The way I see it, genders have their origins in traditional sex-based roles in societies, but I do not think that it needs to stay that way. Things evolve. Ridley Scott is obviously not a mounted warrior aristocrat. To my knowledge he does not maintain any warhorses or plate armor, does not have a fief granted to him, does not follow the code of chivalry and has never been seen leading a cavalry charge against the enemies of his liege. Yet he is a Knight Grand Cross of the Order of the British Empire.
Still, I am totally fine with saying "he got a knighthood". In case there is any confusion, I can use the term GBE and everyone will know what kind of knight he is. In 1100CE this would never have been possible, but today cavalry has been obsolete in warfare for a century, so we can repurpose the term.
Human females were mostly reduced to their reproductive capability in earlier societies. This seems obvious from the quaint custom of referring to them as either Miss (eligible) or Mrs (married). (There was probably a third category of woman who had sex before marriage and was therefore ineligible to bear heirs, but I doubt there was a honorific for that role.)
Today, society has recognized that human females can also contribute in other ways than making babies. Very few people are interested in whether an unmarried woman who has her uterus removed for medical reasons should be called Miss or Mrs. Granted, gestation still happens in vivo, so the bearing of children is not yet as obsolete a concept as shock cavalry, but much less important than it was 100 years ago.
a "technically true" statement that has no bearing on reality has no value
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Oh, that's rich. When the Cass Review pointed out that the evidence for trans medicine is of low quality, the pro-trans side was claiming that it's oh-so-unfair that Cass would only declare a study "good" if it's double-blind (spoiler: she didn't), but now we're supposed apply that standard to studies with negative results, otherwise the interventions should be deemed good by default? How does that make any sense?
That sounds like your belief in gender being so strong, that you can't conceive of someone having an alternative belief, and interpreting their thoughts through your lens. Why would I need to believe in "gender" to segregate people by sex?
That makes no sense. Let's say I accept "gender" exists, even under that belief system it's possible to say "even though we sometime segregate people by gender, in this context it's more appropriate to segregate them by sex". I've been told that by pro-trans people! So if I can segregate people by sex when gender exists, I can do so when I think it doesn't.
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Gender-as-distinct-from-sex is either of nonsense or actively reifying stereotypes, take your pick. Souls are more coherent than strict self-ID gender. That sounds harsh, but for those following along at home, play this out for a minute. If your gender has no connection to the outside world, it's just your internal experience and label for yourself that you definitionally can't be wrong about, then there's absolutely zero reason for anybody to ever treat anybody else differently based upon their gender. There's no reason for gendered spaces or activities or anything at all, and so since the outside world has no reason to care, poof! Bye, gender. Trying to hold onto it is going to just wrap around into it not mattering or build up inconsistencies and nonsense. So for gender to be A Thing about which We Should Care, it has to have some ties to the outside world. Being distinct from sex, we're already ruling out biology. So that leaves social/cultural factors, which are not innate, not inherent, and indeed we see them vary by culture. So we should care about a bundle of traits and properties a particular culture has decided go together - that is a stereotype!
If women are people who X and only X, then let's just deal with X directly rather than lay an extra category on top. If women are people who X and Y, then baby you've got a
stewstereotype going! If women are people who call themselves women and nothing else, then we've no reason at all to care. Once you take the biology out of the gender, you have nothing left that anybody can or should care about but social and cultural baggage, and so by clinging to it and impressing how important it all is to you, you're just strengthening your cultural stereotypes and calling 'em sacred. Quit it.The '90s had the right idea. Boys can wear dresses and have tea parties, girls can play with monster trucks and hit one another with sticks, etc and so on, and none of those things make them not boys or not girls. Let the words refer to the biological reality underneath that is true and correct in 99+% of cases, invent special terms for the outliers if you must, drop the social/cultural barriers, and just let people do their thing. There's no reason for all the hassle, and it can't and won't get anybody any more freedom anyway.
You want to take hormones and are otherwise okay with opening the gates on letting people put stuff in their bodies if they feel like it, go for it. You want to wear 'gender inappropriate clothing' and are otherwise okay with a general lack of expected dressing standards, go for it. You want elective/cosmetic surgery so that your body is more pleasant for you and are otherwise okay with people having other such surgeries, go for it. Do What You Want, up to the limit of what you think society should allow in general, because you are not a special case. You cannot be a special case, because there is nothing special underneath. You're just a boy or a girl who wants to do an activity which is not gated by gender.
Wasn't this at least part of the motivation behind the thing with the drag queens?
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IMO trying to completely separate gender from its biological aspect is partly cope for the fact that transition is an imperfect technology and not everybody ends up passing, and no surgery can make you have the reproductive functionality of the opposite sex yet.
Most trans people desperately want to be the opposite sex on a biological level and a trans woman being allowed to wear dresses because boys can dress however they want won’t help with the fact that her hips are too narrow and she hates having stubble and that having a penis means most men will be uninterested in dating her, and that she won’t be able to have a normal sex life regardless, or have children the normal way, etc.
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