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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.
Agreeing with your point about adolescents, honestly I never understood the argument for delaying puberty. That's one of the crucial times of sex differentiation where someone is really developing into a mature man or woman, from hormones to physical changes to all the rest of it. How in the world can someone say "they don't feel like a male" when they're not done developing all the way? I don't see how it's helpful to delay this process to, I guess, "give them time to figure it out". You're literally denying them information and the opportunity for self-discovery. For a lot of people, puberty just sucks, but that doesn't mean they're transgender.
I think the part you don't understand about the argument - because it's hidden, even from the arguers themselves - is that the argument rests on a fundamental belief in dualism. That is, that a person has a soul that is some gender or another, which is only accessible to the person's mind and, as such, they are whatever gender that they believe they are. This form of argument was taken from the successful fight for gay marriage around the late 00s/early 10s, where it was deemed that gay people were "born that way," and as such, e.g. someone who comes out as gay after years of enthusiastic heterosexual sex that they didn't regret was always gay from the moment of birth to now. This, of course, also rested on a fundamental belief in dualism.
This is also why one common trans activist point of agreement is that babies can be trans before they're even verbal, which can be detected by their parents carefully observing their behaviors, a la facilitated communication. Interestingly, the belief in dualism and maximum autonomy also results in push for what seem like the complete opposite, that someone can change their gender at will, since their gender is entirely and only determined by the person's opinion.
So when a prepubescent person is confused about their gender identity, this isn't the result of them simply not having enough experience in life, or of them not having knowledge of what being a man or woman is like, or of them having been exposed constantly to social messaging about transness; it's necessarily only the result of their eternal soul expressing themselves in the truest, most genuine, real form. As such, denying them the ability to get on puberty blockers in order to transition their biology before their actual sex's puberty causes biological changes to them is cruelty. Furthermore, if they actually go through their natural puberty, they might believe that they "grew out" of their innate transness, which means one less trans person than there otherwise would have been, which is one of many forms that "trans genocide" takes place.
How often does this happen?
No, the concern is that (1) being treated as the wrong gender is extremely unpleasant, and the sooner it ends, the better, and (2) transitioning later will make it more difficult to pass. I don't think trans people think people deciding they're cis after all is bad in any way. Some might believe it never happens, but for those who accept that it does, I don't think they consider it "trans genocide". Claims of "trans genocide" focus on alleged actual killings of trans people.
They do not. Consider a representative example, which claims that bathroom bills, laws requiring people to compete in sports corresponding to their sex and elevated risk of suicide for trans people are all part of the "trans genocide" currently ongoing in the US.
Or consider the Wikipedia page about the concept (of course it has a Wikipedia page). Opening paragraph:
By their own admission, trans activists consider the "erasure" of trans people (i.e. failing to affirm them and refer to them by the names and pronouns they wish to be addressed by; refusing to make every other character in a teen drama trans) and "discrimination" against them (i.e. demanding that they be housed in the prisons and hospitals corresponding to their sex; lesbians refusing to have sex with male people who "identify as" women) to be examples of "genocide". They also consider the elevated risk of suicide trans people face as an example of "genocide" i.e. the transgender genocide might be the world's first self-administered genocide. Sui-genocide? Geno-suicide?
Some countries make a gender recognition cert conditional on having undergone bottom surgery. This argument is sort of ridiculous because a) no one is forcing you to cut your dick off: if changing the sex on your birth cert is that important to you, that's a you problem; and b) unlike ethnicity, trans identification isn't hereditary.
You'll note that there's a bit of a Morton's fork here, as elsewhere in the article they claim that banning bottom surgery for minors constitutes "genocide". If you stop a trans person getting bottom surgery, that's genocide. If you say that a trans person can change the sex marker on their driver's license only if they get bottom surgery (in order to weed out bad actors), that's also genocide. As near as I can tell it, transgender genocide is just when you don't let trans people do exactly what they want 100% of the time.
Elsewhere in the article, there's a map of the US showing which states have banned gender-affirming care. You'll notice that this has absolutely nothing to do with "actual killings of trans people". The page argues that these laws meet certain criteria mentioned in the United Nations definition of genocide, as they "[cause] serious bodily or mental harm to members of the group; deliberately [inflict] on the group conditions of life calculated to bring about its physical destruction in whole or in part". But this is assuming the conclusion: a major reason for these bans is because of researchers like Hilary Cass investigating and learning that the evidence base for the efficacy of these interventions is appallingly weak and poor quality. This whole discussion was started by you pointing out that some children's mental health worsens after they undergo gender-affirming care. If this is true in general, it implies that legalising gender-affirming care for minors constitutes "transgender genocide"!
In other words, if people stop identifying as trans, there will be no trans people left and hence trans people will have been (metaphorically) exterminated. (Note the popular slogan "death before detransition".) Again – absolutely nothing to do with "actual killings of trans people". If everyone stopped identifying as trans tomorrow, there would be no trans people left, without anyone actually having been killed. Nobody identifies as a mod or a rocker anymore, and yet it would be absurd to claim that mods or rockers have been "genocided".
There you go. When they talk about "transgender genocide", they are not talking about trans people being murdered.
I could go on and fisk the rest of the article in detail, but I think I've made my point. Only a small portion of the Wikipedia article about "transgender genocide" concerns itself with trans people actually being murdered.* The rest of it is just complaining about trans people being made to use the public facilities concordant with their sex, not being permitted to compete in opposite-sex sporting events, certain trans people no longer identifying as trans, medical bodies hitting pause on gender-affirming care for minors and so on. When you hear "transgender genocide", instead of thinking "trans people being murdered in their hundreds" you should hear "trans people being inconvenienced or failing to get exactly what they want, in any way".
Between this and Gaza, I'm starting to think the word "genocide" will need to be retired pretty soon.
*The article is 15,451 words long. "Murder" appears 15 times, "kill" 13 times, "violence" 38 times, "death" 9 times and so on.
I dislike the "trans genocide" terminology, but I'm kind of stuck on a better word that doesn't minimize the concerns. Attempts to extinguish belief systems by any means necessary up to and including forced conversion and outlawing specific rites are a well-attested historical phenomenon which seems like it'd make a better analogy, but I don't believe that idea has a more specific name than the somewhat broader umbrella of "religious persecution".
Well, at least you're acknowledging that a new religious movement is what trans is.
"Genocide" is obviously the wrong word because genocide means targeting an ethnic group for extermination, and trans people aren't an ethnic group. Over time, a religious order can become a distinct ethnic group provided they only marry each other (you'd be amazed how often I have to explain to people that the Holocaust was not an example of religious persecution, as the Nazis targeted anyone of the Jewish ethnicity, regardless of whether they were practising or were even aware of their heritage), but I don't get the impression that this description is likely to apply to trans people any time soon. Sure, members of the Blue Tribe tend to endorse gender ideology and tend to intermarry, but most people who endorse gender ideology are not themselves trans. And as a result of the medical interventions they've undergone, trans people are disproportionately likely to be unable to have children anyway.
If (as you more or less concede) taking HRT and puberty blockers is more akin to a holy sacrament than anything we think of as medical care in the ordinary sense of the term, and if top/bottom surgery are more similar to elective surgical procedures done as part of induction into a tribe (analogous to circumcision or FGM), then in my eyes this strengthens rather than weakens the case for banning these interventions for children. If communion wafers wreaked the changes on children's bodies that HRT does, I'd be in favour of banning them too. Many jurisdictions already ban FGM for teenage girls. I'm aware that this practice is closely affiliated with certain strands of the Islamic faith and hence trying to prevent it could be thought of as "religious persecution": I just don't care. Religion or no, you shouldn't cut off bits of teenage girls' genitals when not medically indicated, and a pluralistic society has to drawn the line somewhere. I haven't been circumcised, but if circumcision were to be banned outright in all Western countries I'd be delighted. I'm sure there would be much waiting and gnashing of teeth from these countries' Muslim and Jewish communities, but this is one case where even an outspoken philosemite such as myself would say "tough".
The problem is of course the US doesn't ban people making medical decisions for their kids based on religous belief generally. You can get your kid circumcised, or choose not to treat them and use prayer instead, or increase risk by not using blood products and so on. Up until imminent death, when the state may intervene.
So in a "your rules applied fairly" sense, if Trans ideology is a religion, that indicates parents who support their kids transitioning should be allowed to make that choice for them.
Otherwise its an isolated demand for rigor. My unsubstantiated belief can inform medical care and risk the life of my child, your unsubstantiated belief cannot.
Even the social contagion issue, churches have specific super-spreader events to infect children with their social contagion.
So i'm not sure treating trans ideology as a religion helps because we give huge amounts of latitude to religion.
Which is basically my stance, while we allow parents to do all kinds of crazy nonsense to their children, drawing the line at trans stuff is an isolated demand for rigor. My preferred choice would be to ban the lot of it, but thats highly unlikely so "your rules fairly applied" it is.
If Bob gets to mutilate his kids penis, and Carol gets to mutilate her kids mind, and Shemar gets to risk his kids life when they need a blood transfusion, and Marjorie gets to risk her kids life by replacing medical treatment with prayer, then Freddie gets to transition his son to his daughter.
Many of those will turn out to be awful harmful choices and terrible for the kid. But we allow them anyway.
Either unsubstantiated beliefs get to influence medical decisions or they don't. And currently many, many of them do.
If trans is a religion then at very minimum where parents want to transition their kid they should be allowed to do so. Even if all evidence suggests its nonsense. Because evidence suggests thats for a whole host of nonsense we do allow.
"Such legal exemptions in Idaho and other states mean, for example, that if a parent withholds medical treatments for an ailing child and instead opts for spiritual treatment through prayer, the child will not be considered "neglected" under the law, even if he or she dies."
If your beliefs can legally allow you to let your child die, its hard to argue they shouldn't also let you transition them.
Arguably trans activists pivoting to calling it a religion would entitle them to more protections, at least in the US.
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Not exactly, but I do concede that it's a belief system - and as a liberal atheist I believe belief systems should get the same kinds of legal protection whether or not they're grounded in supernatural beliefs, as historical belief systems tended to be. Persecuting Daoists or Buddhists for their beliefs continues to be wrong even if we're simply talking about their moral or philosophical beliefs rather than anything properly theological. I feel the same logic should apply to Transgenderism - and Vegetarianism, and Effective Altruism, etc.
I wholeheartedly agree - about FGM, male circumcision, and medical transition for children. Physical alterations to children has always been the one point where I diverge from the progressive consensus re: trans issues, though it puts me into quite a lonely place politically - my belief is that in an ideal world, children should be allowed to socially transition, but barred from making permanent changes to their bodies just yet, and this is something both sides view as unacceptable from opposite directions.
(Now, mind, I do think that there's something of the isolated demand for rigor to the scrutiny applied to transitioning children. There are a lot of other alterations to children's bodies that are currently kosher, from getting a girl's ears pierced to so-called-"corrective" genital surgery on intersex infants. I tend not to find that much common ground with a lot of anti-child-transition campaigners due to them not caring about those things, never mind their views on adult transition, which are rarely congruent with mine. But I'm leaving this as a parenthetical here, insofar as given your stated position on circumcision I think you might actually be ideologically consistent on this kind of stuff.)
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