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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.)
This is fundamentally just a really bad way to judge whether a treatment works, one that we rightly dismiss for other treatments. There are also countless anecdotal reports of people who recover from cancer after faith-healing. And unlike spontaneous remission of cancer, which is rare, regression to the mean in mental health is the norm. "My mental health got so bad that I sought out X treatment, after which I got better" is the default result.
Go read Scott's Alcoholic Anonymous post (another treatment that a lot of supposed beneficiaries swear by that some critics accuse of being cult-like). Notice both how the evidence base is a complete mess (because it's really hard to test these things) and how the ultimate conclusion seems to be that AA (and pretty much all other treatments tested) is similarly effective to your doctor spending a few minutes telling you that alcoholism is bad and you should stop. Well, the evidence regarding gender transition is even worse. If it turns out outcomes for gender transition are equal or worse than your doctor spending a few minutes telling you "puberty can be scary but you'll be fine" or "accept yourself", that's something we really want to know rather than continuing with a standard treatment with so many downsides. Really it's something we should have known before establishing it as a standard treatment, but instead it went from "so rare you can't do decent studies" to "so common and standard that it would be unethical and difficult to have a real control group" without the step where we actually find out if it works.
A lot of arguments regarding gender transition research seem similar to other arguments that you pick up reading about medical research from people like Scott or Derek Lowe, just with the additional politicized element.
A lot of treatments are based on popular theories on how things work that make the effectiveness of the treatment seem like an inevitability, then crash and burn in randomized control trials. Suggesting a biochemical pathway is bullshit is less likely to get you fired than suggesting "inborn gender identity" is bullshit, which makes it even worse.
"The trial doesn't look good but maybe it works in a subgroup" is the sort of dubious cope you see all the time. At least the p-hackers saying "efficacy was shown in middle-aged hispanic women" have some sort of evidence, saying "okay but assuming the treatment works we just need to do a better job of diagnosing the people it'll work on" is even worse. The only saving grace is that the negative studies on gender transition aren't high-quality randomized control trials because none of the studies on the subject are.
Most fundamentally, everyone knows that the vast majority of prospective treatments fail and the burden of proof is with the people who think they'll succeed. You can have a clear mechanism, anecdotes, observational trials pointing the right direction...and people know not to get too excited. Yes there are standard treatments that are grandfathered in without going through the FDA or equivalent, but the reason why that works isn't really "standard of care", it's "so incredibly obviously effective that the result was clear with much lower standards of evidence". The argument would be that gender transition is such a case, but the various negative studies (and "positive" studies that are pretty negative on closer examination) seem to show it's not really that obvious.
Because it calls into doubt both the advisability of the current standard of care and the theoretical framework the treatment is based on. If "diagnose people with gender dysphoria if they say they're trans" is an effective diagnosis method, why is it getting so many apparent false-positives? If "gender identity" is an inborn trait that people have an internal sense of, how are all these people getting it wrong? Why don't they just feel "gender dysphoria" the first time someone calls them "he" and immediately stop? For those who think they're not false-positives, why does it seem to so obviously spread socially? If the answer is something like "because the born-trans members felt more comfortable coming out", how does it get such absurdly high rates among not-very-selected subgroups? If 40% of a classroom in a private girl's high-school comes out as trans, does that mean we should believe 40% of all women throughout the world and all of history are closeted transgender people? I don't think you have be certain about whether you think "inborn transgenderism isn't real" or "inborn transgenderism is real but 99% of post-surge ones are false-positives" or "more than 1% are real but there's a large fraction of false-positives" to point out the ways the dominant theoretical framework and treatment methodology doesn't really make sense. Nor is there going to be a lot of a agreement on those among critics. Also "Are there a group of people with an inborn 'wrong gender identity' disorder that is best treated through gender transition?", "Are those people 'really' the other gender?", and "Would it be best if society did X to encourage or enforce classifying them as the other gender?" are three different questions.
It's not just mental health being vaguely "bad". It's a specific condition, gender dysphoria, that is directly alleviated by altering the person's body.
I've long thought gender dysphoria was overdiagnosed, so this isn't a "cope" I came up with on the spot.
Indeed it does, but it does not imply that no one benefits from transitioning.
So, I mean, Alzheimer's is a specific condition, it's associated with elevated amyloid-beta levels, and aducanumab reduces amyloid-beta levels. We should rush out and give all the Alzheimer's patients aducanumab, right? No need for testing!
Except, wait, they did the testing and it shows that aducanumab doesn't actually slow cognitive decline, which is the outcome we actually care about. Turns out that having an explanation for how something could work doesn't necessarily mean that that explanation is correct or that it does work.
The statistics on transsexuals that transition are awful. It is possible that they're slightly less awful than the statistics for would-be transsexuals that are prevented from transitioning. I dunno, because TTBOMK nobody's actually done the RCT. Doing the RCT would be really hard due to trans activists sabotaging the control group, sure. That doesn't make not having it done less of a problem.
I will note that I had full phantom-limb gender dysphoria and (mostly) grew out of it; it's not obvious to me that the "would benefit from transition" group can actually be distinguished from the "would be harmed by transition" group.
Incongruous genitalia or secondary sexual characteristics aren't associated with gender dysphoria, they are gender dysphoria. Gender dysphoria is the symptom to be treated, unlike in Alzheimer's, where dementia is the symptom to be treated, and it was thought that targeting amyloid-beta would treat it.
It's not realistic to expect trans people to be as happy as cis people on average. Trans women generally don't want to be trans women, they want to be cis women, they want to pass and have functioning reproductive systems, etc. But this is the best we can do with current technology. It is perfectly reasonable for someone to be unhappy about this. Ugly or infertile cis women are often unhappy, too.
IIRC the Cass Review suggested an RCT on puberty blockers. Not sure what's going on with that, or what their stance is on proper HRT, or if any of this is relevant to adult patients.
Again, many anecdotal reports of people who tried ignoring their dysphoria and it never went away.
Gender dysphoria is the feeling that they're incongruous, which is not quite the same thing. There are two ways to fix gender dysphoria: make the self-concept fit the physical body, or make the physical body fit the self-concept. Which works better? Well, I dunno. RCTs are the way to find out.
(Note that body dysmorphia doesn't respond well to surgery.)
You don't need to tell me that; I arguably was one.
We are doing transitions with transition therapy as it really exists, not Culture Cycle clarketech. If transition therapy as it really exists doesn't help actual life outcomes, then it shouldn't be the standard of care (with obvious knock-on effects regarding public funding for it, regarding medical advice to dysphoria sufferers, regarding letting minors do it, and regarding family-court judgements).
Define "never". Took over a decade for me.
Maybe for some people gender dysphoria goes away, but for many it never does. "John 50" is a meme for a reason. I mean, the claim that it will go away eventually is unfalsifiable, but at some point you can be reasonably confident. Do you think there's some kind of fancy psychotherapy, or maybe medication of some kind, that could free more people of dysphoria, that is being slept on?
I'm going to need you to clarify what exactly your condition was, because "phantom-limb gender dysphoria" doesn't mean anything. In any case, I can provide anecdotes of people "repping" (repressing) for over a decade until they gave in.
It's imperfect now, but it's going to improve as technology advances, and it's only going to improve if we keep doing it. The fact that it's imperfect now and doesn't work for everyone is no reason to give up, otherwise we wouldn't have most of modern medicine.
Apologies for taking a while; I'm not at 100% these days. Victorian winter, and trying to sort out a likely major career change.
Yeah, I phrased that overly-strongly. The point was that the amount of non-desisters looks larger than it is because some just haven't desisted yet.
There probably are some true non-desisters. How many there are I don't know, because lol nobody's done the 40-year longitudinal RCT. Almost as important, I don't know if there's any way to tell them apart from the "haven't desisted yet but will" group. I mean, sure, post-Singularity you can have an AI do it, but post-Singularity you have Clarketech reversible transitions and nigh-infinite resources so the treatment is obviously "try it, see if it works, and go back if it doesn't, no harm done" and the point is moot.
As in, I had phantom limb of having a vagina and often was a girl in my dreams. I hated my penis and once wound a hair strand around it and yanked (this left a scar internally, such that for years when I had a mild erection that part would stay floppy with the overall impression being roughly that of a broken bone).
There's more I can give, but while my cued recall's excellent my free recall is lousy so you're going to have to ask a lot more precisely to dredge it all.
A lot of those people seem to be counting from when they started showing effeminacy or the reverse, due to the human tendency to pull things together into a coherent narrative. I obviously don't see this as a coherent narrative any more, just a degree of effeminacy (which is real and still there) plus a period of intense gender dysphoria (which had a much-later start date and had an end date, and was probably the result of psychological abuse). If I were to count from first signs of effeminacy to the point where I slowly realised I wasn't trans, which would be a better fit with how they're counting, it'd be probably around 17-20 years.
Well, no, a lot of the stuff we would need for proper transition is not related to surgical technique at all, but rather to success at lab-growing new organs, which doing current SRS will not help with. Obviously, lab-grown organs would be awesome for a whole lot of other things as well (infinite cloned organs for rejection-free non-donor-limited transplant, lol) so they're something we should be (and are?) working on anyway. Potential retroviral therapies to alter tissues in situ are also a completely-different technology to what we're using now. Current transition therapy is a bad kludge with many inherent limitations, not a step on the road to the proper version. Iron lungs were irrelevant to how we beat polio.
On the other hand:
Well, maybe. Bit hard to find out when psychologists and doctors are too terrified of being cancelled for "conversion therapy" - cancellation with actual teeth, because of SJ's control of their licensing organisations! - to experiment with it, isn't it?
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