This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
I'd like you guys to refrain from responding to this message (the one you are reading right now) unless you either are someone who holds the beliefs I am trying to engage with, or you can steelman how someone who holds those beliefs would respond to what I'm saying. Expressions of agreement are useless to me here. Thank you. (I have tried to get this discussion going on Twitter, but as one would expect, it hasn't worked.)
clears throat
So you, hypothetical person, believe that if a trans child has been on puberty blockers for the maximum of two years, then they should be allowed to switch over to HRT, even if they haven't reached the age of consent. So, for example, if a child starts blockers at age 12, then they should be able to switch over at age 14, even though the age of consent is no lower than 16 anywhere in the United States.
Why should the age of consent for HRT, the "real deal" of transitioning, be lower than the age of consent for sex? If you say that HRT is less harmful for children than sex with an adult, you need to be able to substantiate your claim.
It's pretty straightforward:
The kids want the treatment
The parents want the kids to have the treatment
The doctors are recommending the treatment, or are at least willing to administer it
The overall medical consensus isn't firmly against the idea of administering treatment
So we have a situation where all the relevant parties agree about a personal medical decision, but politicians should be able to override this decision and have the final say? I'm sure you can find studies suggesting this kind of treatment is a bad idea, but I'm sure you can find studies suggesting that a lot of common treatments are a bad idea. If this were the standard for politicians to cut across the grain of medical consensus then I'd expect legislators to propose banning a lot more procedures. But the reason I can't take any of these politicians seriously has little to do with the science; it's because they haven't demonstrated that they are acting in good faith. If a politician is proposing to ban transgender therapy for minors, I'm probably not going to find a history of statements and actions supportive of trans people in general but expressing concern about this particular thing. No, I'd bet dollars to donuts that if such a politician made statements about trans people in the past they were in support of, say, NC's "Bathroom Bill" and other policies directed primarily at trans adults. If a politician has a history of jumping on every bandwagon that's commonly labeled as anti-trans, I have no reason to take them at their word when they say that this is a legitimate concern that can be distinguished from a dislike of trans people or the "woke agenda" in general.
You've completely ignored the comparison to age of consent for sex. Your argument would also imply that if
-A kid wants to have sex with an adult
-The kids parents agree the kid can have sex with an adult
-The adult wants to have sex with the kid
-The overall medical consensus isn't firmly certain that having sex with the adult will be traumatic to the child
then politicians should likewise have no say in overriding this decision. Do you agree with this conclusion? Should there be an option for children and adults to override age of consent laws, maybe with explicit consent forms? And if not, where is the distinction?
The distinction is that we're not talking about sex. Or cigarettes, or tattoos, or lottery tickets, or any of the other things that kids want to do that have laws preventing them from doing, with or without parental consent. We're talking about medical treatment that a large part of the medical establishment believes is necessary. When it comes to age of consent laws, the state's interest is that young people are susceptible to being abused by older people due to the inevitable power dynamic between children and adults, and even if we were to grant that there were some situations where a fourteen year old would be able to have a sexual relationship with a 35 year old that wouldn't be abusive, that wouldn't be the case in the vast majority of situations where that happens. So given that the high likelihood of abuse and the strong state interest in preventing child abuse, the laws can be justified.
The most prevalent argument I hear against allowing teenagers to transition before 18 is that such transitioning can lead to irreversible changes that will have a permanent effect on one's body, and that teenagers are notoriously emotional and fickle and may come to regret making such a drastic decision with regard to what may turn out to have been simply a phase, in the same sense that most adults wouldn't want the clothing and hairstyle decisions they made at that age to be permanent. I'm not unsympathetic to that argument. The problem is that, unlike most phases, this isn't something you can just wait out to see if it goes away; the consequences of not taking any action are similar. If going through puberty as the undesired sex or staying on puberty blockers too long also causes irreversible effects, then the decision to transition has to be weighed in consideration of these effects. If subsequent data shows that a large percentage (i.e. at least 50%) of those who transition as young teenagers go on to regret their decision or retransition as young adults, then the argument for state involvement becomes much stronger. But I'm not aware that any such data exists apart from anecdotal examples, and that's not enough for me to think that the state should be interfering with a personal medical decision.
More options
Context Copy link
First, the argument is an If-Then statement. If A is the collection of four premises, and B is "pedophilia should be allowed", then my claim is that your argument is equivalent to A->B. I don't claim that A is true... at the moment. But is that the only barrier to your endorsement of pedophilia? Do you believe A->B? If pedophiles convinced a non-negligible number of doctors to verbally say "yeah, this is probably fine", would you agree that they're the experts and so that means it is actually fine?
And is it the verbal endorsement or the private thoughts? What if right now, like 10% of doctors secretly think that pedophilia is okay if the child agrees to it, but simply remain quiet because they'd lose their jobs if they said it out loud? Is Overton's window the only barrier between whether something is or is not immoral?
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Don't hold or agree with the views, let me try to steelman them as an Intellectual Turing Test (remember those?)
(1) Why should the age of consent for HRT, the "real deal" of transitioning, be lower than the age of consent for sex?
Because we don't strictly force compliance with the official age of consent. We have Romeo and Juliet laws because we realise that adolescent sexuality is complicated and it is unfair to stigmatise teenagers as sex offenders for ordinary sexual exploration. We don't think that 'abstinence only' education works, so why would an 'abstinence' policy around HRT be any better?
(2) If a minor has been on puberty blockers for two years and shows no desire to go through natal puberty or to socially de-transition, then it should be accepted that they are indeed genuinely trans and not simply 'going through a phase'. Thus, delaying medical intervention for an additional period of time confers no benefits and imposes penalties on the minor.
(3) Successful 'passing', to use the controversial phrase, is accomplished more easily the earlier transition begins. Forcing a trans individual to wait until they can undergo the puberty of their identified gender is a meaningless delay. Trans people of all genders have often expressed frustration and concern about how well they can 'pass' as their identified gender due to being forced to undergo natal puberty or to wait until an arbitrary cut-off age before they can commence medical and, if desired, surgical transition.
(4) With regard to other sexual health issues, several states permit minors as young as 12 to give consent - see chart here. If a minor is 14 years of age, has been on puberty blockers, understands the effects of such treatment, and it is with the agreement and consent of the parents and done under medical guidance, there is no reason to impose this arbitrary waiting period.
Naturally, individuals will differ in their level of maturity and readiness, so such provision of HRT would have to be done on a case-by-case basis, but it should be legal.
On 1), isn’t it true that abstinence only sex Ed does work at it’s actual goal(which is reducing the number of teens having sex), it just isn’t optimized for the teen pregnancy rate(which is dominated by regional trends anyways)?
How would you even measure that?
More options
Context Copy link
More options
Context Copy link
I personally am for giving minors access to gender affirming healthcare if they have gender dysphoria, and I’d say you pass the ideological Turing test as I’m pretty much in agreement with those points. Can I ask why you’re against it?
IF being the big honkin' signal here. A 12 year old may be confused and frightened about the changes puberty is wreaking on their body. 14 is still young and impressionable, and if they've been putting puberty on hold for two years, they might not be sure about reversing course when school, parents, doctors and everyone has been affirming them in their new identity. 16 is still young, but it's older that there's a better chance the kid really knows and has made up their own mind and can understand the risks.
What really puts me off is the 'experts' claiming that 2 year old kids can definitely know their gender identity. I've mentioned this before, but I work at a childcare centre and I've heard a 4 year old explaining to his granny that he was not a boy, he was a robot. Now, if parents just roll with it and don't make a big deal one way or another about "Susie doesn't want to wear dresses, she wants to wear jeans" then fine. It's the anxious parents who get chivvied into it by activist teachers and online advice that your kid will kill themselves if you don't affirm their true gender identity that make bad decisions.
Or things like this proposed bill in California, which is heavily amended but which does look to be trying to extend the meaning of "child abuse" to "doesn't affirm child's gender identity". Custody battles are already nasty enough without dragging in "Your Honour, my ex should not have custody or visitation rights because they are a child abuser because my kid is trans and they don't accept that".
(Amended sections in bold):
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
deleted
Oh, I didn't mean to imply that the parents would be culpable! They're being told by The Experts that their kids will be chronically depressed and possibly even kill themselves without treatment. It's understandable that they'd give consent. And The Experts aren't necessarily malicious, either. My post isn't about casting moral judgement on anyone, it's about what we let kids do and why.
The experts may not be malicious as such but it's interesting to note that medical professionals always seem to determine, after much sincere consideration, that the most expensive possible procedure is always required. If you go in with back pain they will find a disk out of alignment if you're over 35 or so and that will be the motivation they give for recommending back surgery despite no correlation between surgery and reduction of pain and no correlation between unaligned disks and pain.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Given that one is a medical treatment and the other a criminal offence, our prior should be that it is less harmful, and the burden of proof is on you to substantiate your claim.
But okay, I'll try. Google gives me the meta-analysis article Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review, which concludes:
It includes four studies on minors:
de Vries, 2011 reports positive outcomes, however, it only looks at puberty blockers, not cross-sex hormones
de Vries, 2014 looks at puberty blockers, cross-sex hormones and surgery, and reports positive outcomes
Achille, 2020 looks at puberty blockers and cross-sex hormones, and reports positive outcomes
López de Lara, 2020 looks at "cross hormonal therapy", which I assume is the same as cross-sex hormones, and reports positive outcomes
This post has a summary of the long-term effects of child sexual abuse, including "consensual" statutory rape, with an extensive list of references. It says, among other things:
I picked one of your studies at random (Achille) and it is garbage. They started with about 100 people and after treatment sent them questionnaires over a period of time. If someone stopped answering the questionnaire, they were dropped from the study. This left them with 50 people. Based on that, they found improvements in depression over time (though only significantly in MtF).
There are obvious problems with this study. First, those who stopped participating may not be random. It may be those who had a hard time stopped participating precisely because the intervention failed for them.
Second, the age group was quite large and was from 2013-2018. Attitudes were different back then and therefore the cohort getting the treatment back then is different from those getting treatment today. That is, is it possible that the people getting treatment back in the mid 2010s were more psychologically stable compared to trans people in general?
Third, they relied on surgery data; not what people actually did. We should be looking for actions not words.
In short, if that is among the best evidence for so called gender affirming care the evidence is very weak; especially since the study merely looked at “mental health” and ignored physical health.
Yes, the evidence is weak. That is precisely what the authors of the meta-analysis meant by:
If you look at the "Discussion" section, you will note that most of it is dedicated to pointing out problems with the studies under review. The article also notes that de Vries, 2014 has a "serious" risk of bias and the other three adolescent studies have a "moderate" risk of bias, and of the 20 studies they looked at, only three have a "low" risk. All of this means that further research is needed (it always is), but based on the evidence we have now I think it's perfectly reasonable to adopt a working hypothesis that puberty blockers and hormone therapy are beneficial.
Your points about self-selection among participants only imply that doctors should exercise care when choosing which treatments to administer to whom. Clearly some patients do benefit from hormone therapy, therefore the therapy should not be banned.
That’s not how this works. You don’t use a study that literally cannot prove anything (ie isn’t evidence of well anything) and say we should provide life altering drugs and surgeries to kids on those ground. This is an extraordinary intervention and therefore requires extraordinary evidence. Not dogshit level evidence that shouldn’t have been published.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Sure, but what would the studies look like if NAMBLA had controlled the university and government grants systems since the 60s?
Even in the current environment the studies are so bad that the meta analysis is worthless. Junk in, junk out.
More options
Context Copy link
More options
Context Copy link
A long time ago, we used to award internets for posts such as these. I don't know if I'm still qualified to issue an internet, but if I am, then you have won an internet, good sir.
More options
Context Copy link
More options
Context Copy link
So just imagine some doctor came up with "marriage dysphoria" and the whole thing is happening under medical and parental supervision as well.
There's scarcely any evidence that doctors recommending gender affirming care have the child's best interests at heart.
Arguably gender affirming care qualifies, though it's the doctors I'd be putting in prison rather than the parents.
More options
Context Copy link
Appeal to unearned authority in this case. Many major medical professionals and hospitals as a whole have been shown to be corrupt on this issue. Simply put, ideology has more likely than not trumped the Hippocratic oath in this field.
Again, the profit margins shown from looking into books at transition clinics make the same case against doctors here.
The state is currently more often on the side of the secret transers. You are as likely (probably more) to wake up one day with your daughter Jill now informing you that she is your son John, who has been conversing secretly with school officials for a year and is now on artificial hormones, as you are able to get an injunction against your ex wife from doing the same without your consent.
More options
Context Copy link
You make a very good point. To this, I counter: if a medical professional and both parents approve of a minor's marriage to an adult, shouldn't that be allowed, just as it's allowed for a minor to take opposite-sex hormones under those circumstances?
(This is not an example of the slippery slope fallacy, because I am attempting to apply meta-level reasoning across the board. The reason for the "groomer" discourse is that conservatives generally see these things as equivalent, while leftists don't.)
I mean, in order for a minor to receive HRT, a psychiatrist has to give approval, right? I don't know how it works, but I assume they ask some kind of pointed questions of both the minor and their parents in order to decide whether the issue they have is more likely to be dysphoria or something else. This power could be given to a psychiatrist, or a psychologist, or a.. yeah, this is a good question. I don't know who it would be.
Wait wait HOLD THE PHONE HERE. skims the Wikipedia article So, uh, is there an exception to statutory rape law for married couples? If so, that's quite disturbing. If not, then the only benefit for the adult would be that they would get their spouse's money.
I believe it varies by state. I think some have exceptions for marriage, some have being married as a defense in a statutory rape case (not sure how that works legally, I'm not a lawyer), and some don't allow sex below the age of consent even if you're married to the person in question.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
You don't see the cultural element of trans different from getting a knee arthroscopy? Which by the way were overdone for a period, perhaps still are, leading to increased risk of osteo-arthritis, showing the flaws of medical science. There's a long list of procedures that probably don't pass muster that are still routinely done. It takes time for standard wisdom to be overturned, think of the generations subjected to unnecessary tonsillectomies.
In fact in my experience GPs, while very good at studying aren't always particularly smart, and because of the nature of their role, high status with expectations to 'know' and 'heal', lose touch with the limits of their knowledge. They are not scientists and even medical researchers often have pretty low levels of stats knowledge relative to the state of the art. Medical specialists are generally better, but in this new phenomenon of trans, the self declared specialists are actually part of an activist intent, the science and research hasn't sufficiently developed and their isn't sufficient curiosity for an evidence-based system to develop. WPATH had a chapter on eunuchs as a gender identity, which speaks to this reality.
Oh, lazy of me not to notice the original question, apologies. As you were. Yes civil issue not criminal, though great harms can come of it regardless.
More options
Context Copy link
More options
Context Copy link
It's a bit different in that the studies (and more importantly, the medical practitioners themselves doing the prescribing here), are likely to be biased, it's not just that they don't know.
More options
Context Copy link
I would give a bit of a counter-push here.
First of all, yes, this is a medical professional, and while I don’t think they’re out to harm kids, there are a lot of things going on in trans-treatment that don’t happen for other things. First being that whether true or not (personally I suspect not) medical doctors are working from the assumption that a trans kid not allowed to transition will absolutely commit suicide. That alone would change the “is it safe?” question to “is this safer than suicide?” most treatments even with drastic side effects are preferable to death.
Second, we are already dealin* in some states with coercive power on the other side. Some liberal states have empowered CPS to step in where parents aren’t going along with transition. If they’re not going to keep a family together if the child can’t transition, I find it hard to believe that a doctor wouldn’t be under similar pressure to go along with transition to protect his license.
More options
Context Copy link
More options
Context Copy link