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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.)
I think trans people can be largely divided into two groups:
People who had an affinity for the other sex from the time they were toddlers onward. A boy who prefers dolls and dresses to cars, etc. to the point of everyone around them knowing that this toddler is behaving like the opposite sex in a somewhat obsessive way. These people I have a lot of sympathy for, even if I disagree that this means that they are the opposite sex. Dr. Kenneth Zucker mostly treated this group, and in his clinical research about 80-90% went on to become normal gay men after puberty, with the remainder going through some sort of transition in adulthood. I honestly believe most have some kind of hormonal thing, maybe their mothers took estrogen during pregnancy, maybe some other endocrine disrupter got them early on. I still think the best thing is to wait and see if the desire to transition subsides after going through natal-sex puberty, but if the only group that transitioned was this group, as adults, then I would have few qualms for transition as a medical practice.
Unfortunately, there is the second group. Mostly consists of adolescents who for various reasons started thinking that transitioning will benefit them. The RODG group. The Autogynophelia group. Autistic girls who always felt something was off but never could put it into words. ETC. There might be some hormonal issues, but most of the time it's a social contagion of some kind. For this group, transitioning is probably the worst thing for them to do. It's a harsh medical intervention for something that will typically go away after puberty and therapy. Unfortunately, this group is the largest group getting medically transitioned and contains pretty much every transperson I know IRL.
I don't think any trans person is their desired gender, but that doesn't mean that they are delusional. It really is their desired gender. It's just that desiring a gender doesn't make them that gender.
I think you really need a third group: Autists for whom desiring to be the other sex is just one weird thing about them among many. These are the people who say ”I don’t understand why X should be linked to sex” and actually mean it. They are the most likely ones you’re going to run into in techie online spaces (by a massive margin).
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