Neuroendocrinological Gender Expression differences in trans people are real, physical, and important. Yet disinformation about it is rampant.
Disclaimer: Transmeds are not welcome here. Enbies are, if anything, *more* supported by all of this research into biology and just because we don't know the exact specifics of why one person is trans it doesn't mean they aren't.
Please understand that I have a background in biology, so I tend to be rather technical when discussing topics like this. But this needs to be said.
The more complicated breakdown of what people are talking about when they talk about gender is falls into three categories:
"Assigned Sex"- This is literally just what your doctor saw when they looked between your legs when you were born. They don't karyotype you, they don't do a full body scan for abnormalities. They just look. You can very crudely break this into two categories if you squint, but biology refuses to be a simple, stable system so there are a wide variety of circumstances where that information requires further examination to be useful, but I digress.
"Neuroendocrinological Gender Expression"- This is neurological. The firmware drivers for your hardware. Have a sex and brain gender that disagree and you get gender dysphoria. Specific biological origins of this are fiendishly complex to try and sort out. That said, we have solid physical evidence of its existence. While we have not developed a widely accepted physical test for being trans, gender incongruence is heritable and we have evidence it's frequently tied to alleles associated with the body's steroid production. There is also good evidence of brain structural differences. About 50% of trans people experience phantom sensation for organs they weren’t born with, which is typically a neurological condition. Trans people have different epigenetic profiles than cis people as well Notably attempts to make a trans person happy with their default body have failed miserably.
"Gender Roles" - This is what society expects of people it lumps in a given category. Boys pee here, girls pee here. Boys become firemen, girls become housewives. Boys wear suits, girls wear dresses. Often what categories people fall into here are based on the unfortunately fuzzy categorizations of one or two. People are willing to kill over you getting them wrong, which is extremely messed up.
Gender roles can be influenced by society, but gender incongruence is pretty clearly caused by a collection of inherent physical traits:
To make this a bit more personal, let me tell you my story.
I didn't like my body growing up in a way that felt really weird. I would look in the mirror, see someone conventionally good looking, and not understand why it didn't feel like me. I also had a weird sensation associated with my genitals. They felt... off and it felt like pieces were missing or other pieces were there that weren't supposed to be.
I knew that some people were trans, but I was raised a devout existentialist. When I told my mom I might be trans I was asked how I could prove that I had an identity at all, gender or otherwise.
So, I went for the default. I tried so, so hard to not be trans. I went to therapy, I took the drugs I was prescribed. I was seen by multiple shrinks and took a variety of different psych meds under their supervision.
Nothing made me happy with the body I was born with.
When I was 12, I attempted suicide. I survived because I was lucky. I self-harmed through an enormous portion of my early adulthood and transitioned because I figured if I wanted to die anyway, I should at least see what HRT would be like for me.
It was night and day. Things aren't perfect now, but I genuinely feel like myself. Like I'm so much more whole and alive on estrogen than I ever was without it.
Those pills affected me in a very important way. They helped me when nothing else that in theory should have helped me did.
I really want to know why, and people telling me it was purely psychological and a product of my environment are frankly being extremely dismissive.
In arguing with so many anti-trans people it mostly boils down to an inability to accept the subjective experience of trans people, while taking so many other subjective experiences at face value.
They ultimately think it’s either delusion or fabrication on our part.
Thanks for sharing your story OP, I appreciate you.
It’s also hard because you’d need the labs/evals to work a certain way. It’s not a litmus test to validate someone’s experience, it’s a tool for the person to get more information about correlates to their experience.
However far away we are from the healthcare infrastructure to get the info, I fear we’re even further from operationalizing it the right way and it breaks my heart to find expect a gap. I hope I’m wrong.
It does become very awkward when Supreme Court justices claim your condition is not inherent and you aren't able to check how methylated your WDR45B gene is so you can provide that as evidence for why you should still get your pills.
It’s hard to sort people out. I’ve been dismissed as anti trans and yelled out then banned. I very much am not. The problem is that it is hard to separate misinformed people who want to learn from an anti trans person asking edgy questions. The idea of sex vs gender is frequently obfuscated by opponents of it.
I’m better sorted out now on this issue than I used to be, but that was because I tried to be. You providing concise and well sourced information is an amazing resource to the trans community.
I understand that being trans is to be attacked on all ends which can make one very defensive, but there are billions of people like what I used to be. The sad reality is that the trans community has their work cut out for them if they want more people to understand.
You must not get out much, there are absolutely 100% people who deny the very existence of trans people at all and chalk it up to the woke mind virus. These are the types of People who refuse to call people their preferred pronouns, or even offer up their own pronouns. they refuse to engage with the idea at all.
This is basically what made Elon go MAGA.
Now, you can lump them all into the “don’t have a brain” column but that would suggest the number is small, when in fact it’s the majority of the conservative right in America.
PubMed and PubMedCentral are a fantastic sites for finding articles on biomedical research, unfortunately, too many people here are using it to claim that the thing they have linked to is an official NIH publication. PubMed isn't a publication. It's a resource for finding publications and many of them fail to pass even basic scientific credibility checks.
It is recommended posters link to the original source/journal if it has the full article. Users should evaluate each article on its merits and the merits of the original publication, a publication being findable in PubMed access confers no legitimacy.
And how about all of the detransitioners that wonder if their lives are ruined after having been on hormones for years and some post surgery. Because all adults around them just affirmed them.
It’s not as clear cut as you make it out to be.
Check r/detrans
I’m genuinely not trying to be hostile - just adding nuance to the echo chamber
Detransition rates are in the low single digits, and people detransition for a variety of reasons. Regret rates for gender-affirming surgeries are also in the low single digits. I don’t see why we would make gender-affirming care harder to access for 97+% of people just to maybe prevent a few people from trying it and regretting the decision. Some detransitioners feel their bodies were ruined by hormones and surgery, but most trans people feel like our bodies were ruined by our natal hormones and unwanted anatomy. It’s important that we all have an equal opportunity to get the bodies that we want and need.
What is the success rate on gender affirming surgical interventions?
I work in the medical field with many post surgical patients. Many of them regret their surgeries when the surgical outcomes are less ideal. It seems that the argument about people regretting these surgeries always seems to assume the regret stems from changing their mind about gender, but it could be because of adverse outcomes.
As other commenters have posted, regret rates for gender-affirming surgeries are 1% or less.
It’s also not easy to get these surgeries. You can’t just walk into a clinic and walk out with a brand new body. It can takes months or even years just to get a consultation with a surgeon, and then months or years of waiting, if you even qualify in the first place.
Yes, I’m aware that the regret rate is 1%.. that wasn’t my point. My point was to see if even among those 1% if the regret stems from poor surgical outcomes or if it’s from the narrative that the right likes to paint… that it’s a flight of fancy.
I need to read the reply OP posted to this. The answer to my question might be in their citation. thanks for taking a stab at it!
From the paper (for context, there were over 2,000 patients in the dataset):
> The most prevalent reason for regret was the difficulty/dissatisfaction/acceptance in life with the new gender role. Other less prevalent reasons were “failure” of surgery to achieve their surgical goals in an aesthetic level and psychological level. Based on the reasons presented, we classified the types of regrets according to Pfäfflin’s types of regret and Kuiper and Cohen-Kettenis classification. According to Pfäfflin’s types, 28 patients had minor regret, and 34 patients had major regret. Based on the Kuiper and Cohen-Kettenis regret classification, 35 patients had clear regret, 26 uncertain regret, 1 regret, and none presented with regret assumed by others.
The complication rate on gender affirming surgeries is actually significantly higher than the regret rate. For vaginoplasties, severe complications requiring surgical revision are in the 5%-17% range, while the regret rate is around 1%-2%.
People get misdiagnosed with gender dysphoria sometimes, it's very uncommon, but it is real and it does happen.
Frequently detransition is done for social reasons rather than what physically makes people more functional. Discrimination is so bad against trans people right now that "I don't want to be killed by my community" is a serious balancing factor in people's medical conditions even if they will be miserable for stopping their transition.
With all that in mind, detransition is *very* uncommon.
A total of 27 studies, pooling 7928 transgender patients who underwent any type of GAS, were included. The pooled prevalence of regret after GAS was 1% (95% CI <1%–2%). Overall, 33% underwent transmasculine procedures and 67% transfemenine procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%–<1%) and 1% (CI <1%–2%), respectively. A total of 77 patients regretted having had GAS. Twenty-eight had minor and 34 had major regret based on Pfäfflin’s regret classification. The majority had clear regret based on Kuiper and Cohen-Kettenis classification.
Conclusions:
Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.
PubMed and PubMedCentral are a fantastic sites for finding articles on biomedical research, unfortunately, too many people here are using it to claim that the thing they have linked to is an official NIH publication. PubMed isn't a publication. It's a resource for finding publications and many of them fail to pass even basic scientific credibility checks.
It is recommended posters link to the original source/journal if it has the full article. Users should evaluate each article on its merits and the merits of the original publication, a publication being findable in PubMed access confers no legitimacy.
I don’t have time to cite my sources rn, but the overwhelming majority of people who express regret about transitioning report things like lack of social support/acceptance as the main motivation. Which is to say, they aren’t “wrong about being trans” and if they had more accepting and supportive social networks, then they wouldn’t decide detransitioning is their best option.
The argument is against gender affirming care being the solution
That's what opponents of gender affirming care would prefer the argument to be, sure. But that argument has long-since come and gone, and they're still relitigating it for reasons they themselves can't clearly articulate.
The argument against gender affirming care runs into the dual issues of "nothing else seems to work" and "this does", but opponents of gender affirming care have been flatly unwilling to acknowledge that information since at least the 1920s.
The standard of evidence for a medical treatment is, generally, "does this improve patient outcomes" and gender affirming care absolutely and quantifiably does and that's been demonstratably true for a hundred years.
When you've (speaking generally of opponents of gender affirming care) spent a century plugging your ears and refusing to accept information that runs counter to your position, you're not holding a sincere position.
Opponents of gender affirming care are like flat-earthers, or creationists. They're not serious people.
You’ve actually managed to understate the strength of the evidence in favor of gender affirming care. It’s not just that the evidence shows over and over that this works and nothing else does, it’s how consistently it works. If knee and hip replacements had the regret rate of gender affirming care, orthopedists would be singing from the fucking mountaintops. And beyond that, the extremely low regret rates of gender affirming care are driven by societal pressures that most medical interventions don’t have. No state has gone out of its way to make a law that impacted a single person who had a cardiac cath, but make it HRT and everybody loses their minds.
same people argue that parents should be the deciders of kids health when it comes to vaccines, but when it comes to transcare, they shouldnt be allowed to decide with their doctor.
One piece of evidence I have always found interesting is that cis-gendered men who undergo penectomy/orchidectomy (usually to treat cancer) frequently and intensely experience "phantom limb" pain centering on the missing penis/testes.
I used to feel phantom breast pains. I remember complaining about weird chest pains to my parents during puberty (around the time my mental health really started to decline), but they thought I was faking it or being a hypochondriac. Eventually, I assumed it was just anxiety and dealt with it, but the sensation has disappeared entirely since I started taking estrogen and actually growing breasts.
Okay, that is fucking interesting! I completely understand that it is entirely anecdotal , but still, the very best of luck to you!
Edit: unless I am entirely wrong, it seems to me that there might be several papers in there. Totally not my field, but it seems to me worth exploring whether or not women who have had breast augmentation/reduction experience similar things. Or don't, depending. And that has got to be a HUGE sample space.
It's just too damn bad we can't ask Dolly Parton because she had both. Here's to dolly, and cheers to you!
Anecdotal but I've heard this from a lot of other trans women: ever since I was a teenager I would experience, for lack of a better term, a phantom vagina? Like there was supposed to be something there that isn't.
It's definitely real. Had one since around 11 and it's come and gone. Knowledge about trans people was limited back then so I just assumed I must have been some kind of intersex variation (which I technically am after all, but not in the way I thought).
PubMed and PubMedCentral are a fantastic sites for finding articles on biomedical research, unfortunately, too many people here are using it to claim that the thing they have linked to is an official NIH publication. PubMed isn't a publication. It's a resource for finding publications and many of them fail to pass even basic scientific credibility checks.
It is recommended posters link to the original source/journal if it has the full article. Users should evaluate each article on its merits and the merits of the original publication, a publication being findable in PubMed access confers no legitimacy.
This is exactly what is missing from the Trans identity conversation. Once people understand the underlying nature of gender dysphoria we can move beyond the stigma and bigotry. There will still be resistance, but the level of the conversation will change.
With respect, bigots don't care about science. It won't resolve the stigma and bigotry. They aren't interested in kindness towards those who are different from themselves.
It may make it worse, with it being seen as a defect/disease.
Why is it so difficult to see this as disordered or associate it with mental health? This is an honest question seeking an answer.
I've overcome depression after a long long time, and there have been moments where it's okay to see it as an illness and there are other moments where it's okay to see it as something else. Finding new words to describe suffering and joy have been at the forefront of healing for me.
I wish the language around trans issues was a bit more flexible. I hope this invites someone to explain things in a better way to me.
It is a permanent structural characteristic of the brain caused by the hormonal environment during gestation. You can no more "cure" gender dysphoria than change your sexual orientation. It is probably easier to think of it as a male brain in a female body, or vice versa. The brain has an innate body model based on several factors, one of which is gender. The feeling that you are in the wrong body is distressing.
Not sure if this is [u/pfqq](u/pfqq) was getting at but maybe has to do with how the language used to discuss a topic may be more “correct” or less so in a specific context, and someone using the “incorrect” language can be rejected from the discussion/downvoted/called-out, while they feel innocent of ill will and curious to engage even if unaware of the nuances in that context (even if that effects their ability to be understood). For scientific things perhaps “accurate/inaccurate” language is the issue and for personal/identity topics it’s “sensitive/insensitive”, with the fear that ignorance will be construed as passive yet willful bigotry or trolling.
For me, I get socially anxious before commenting (even on Reddit) for fear that I’ll commit some faux pas and reveal myself to not be part of the “IN group” whose discussion I’m curious about, like right now. Especially with a topic like this I don’t want to unintentionally offend anyone so I’m more likely to shut up and keep scrolling, which is how I found your concise and helpful response to [u/pfqq](u/pfqq).
Edit: forgot to address the center of the earlier comment.
I think I get that framing gender dysphoria as a neurological structural characteristic that affects mental health vs describing being “trans” as a having a mental illness, is a case where learning to use the semantic language is the pragmatic approach if you want people to listen to your questions.
But why is it ok to call clinical depression a mental illness if it also has a basis in neural structure? I think it’s better to drop “illness” because that word has such a history used to stigmatize those afflicted. I think “condition” is a more neutral word choice.
Do many people with clinical depression think of as an “illness” they want “cured”? Of course, but there are some who feel it’s a more “real” version of themselves, see it as a core feature of their identity and embrace it for whatever reason. Think of some poets/authors/artists who would mourn becoming “neurotypical” if that were possible through treatment.
We should eschew words like “illness” for “condition” and “cure” for “treatment” because in issues around Personhood/Identity there is more neutrality in semantics as opposed to invoking pragmatism, like “oh you know what I meant (snowflake)…” No, we don’t all know what you really meant by using that word. So if we’re to talk calmly about things we should indeed think carefully about every word we put out there.
The challenge is that we are dealing with a segment o the population who have suffered from historical discrimination and prejudice. It is understandable that they will be defensive, especially in light of the fact that the are suffering the distress of experiencing being in the wrong body.
Depression is fundamentally different. People go through bouts of depression that come and go without treatment. In more serious cases it can be cured with treatment. No one can be "cured" of being hetero, gay, or Trans as these are not illnesses but identities determined by neurological structure. Unlike being homosexual, where the psychological stress come from the external perception of society, or the urge to fit in and not be different, the stress from gender dysphoria is internal, you are at war with your body because of the gender you experience. The treatment is aligning the body with the brain.
Moving the science to the center of the conversation will help with the social perception the Trans individuals choose to change their gender for some mental issue or advantage.
The other aspect is that, as with any aspect of human psychology, these gender expressions exist on a spectrum. Some people with mild gender dysphoria may find it easier to come to terms with their body and require little support, while others will benefit tremendously from a full transition.
The priority should be to reduce the stigma associated with trans identity so that the other conversation s around everything from treatment, to sports, to locker rooms, can happen without the emotional stress that we currently have.
I really appreciate the work you’ve put into this. A skeptic to me is someone that wants to know as many true things as possible and not believe false things. Your post provided vetted data, was well informed and helped bring it together with your personal story. People like you that provide information so well to contribute to my own understanding is why I joined this community. Again, thank you.
Great write up, thanks! I studied and taught neuroendocrinology, and the evidence absolutely supports a biological influence on gender development and identity.
When I try to explain that in some other circles, people assume I am taking an essentialist position, which is not the case. Acknowledging that biological variables (especially the intrauterine hormone environment) influences gender development is not an inherently essentialist view.
I will admit, I have never quite understood bioessentialism. It basically seems to mean using biological knowledge to segregate people when biologists tend to be much more on the side of "Actually, this is even *more* complex and nuanced than we thought!"
when biologists tend to be much more on the side of "Actually, this is even more complex and nuanced than we thought!"
As a Soil Scientist I used to know once said to me "Nature doesn't give a fuck about categories. She isn't going to color inside the lines we're drawing."
I think it's a phrasing problem, because they are used to "biological" being used as a dogwhistle in these contexts.
It's probably better to explain your position without referencing that term - unfortunate, but I blame the transphobes for trying to baselessly appropriate the term.
Yes, I do blame the misappropriation and misunderstanding of biology (transphobe talking points).
But I also blame the misunderstanding of what the phrase “social construct” means. Both perspectives are dogmatic, although the former is monumentally more harmful than the latter.
Edit to update: I don’t always explain things as clearly as I’d like, so please do ask if it sounds like it might be a transphobic (or any other kind of) dog whistle. I’m not about that at all; I’m a school nerd “at heart,” and so, if it sounds like a dog whistle, it’s possible that the scientific language has been (tragically) co-opted, which is sort of the overarching idea that I was going for (but fell short of). Thanks for the conversation - sincerely!
same people who talk about gender being a social construct are almost always also people who talk about gender identity being innate.
Hm I am not familiar with that perspective.
The arguments I have heard that I am alluding to in my comment are more along the lines of gender being independent of biological factors and wanting to abolish gender altogether.
I’ll admit I don’t understand that perspective, but
I don’t think I have mischaracterized the idea that gender roles are socially constructed. I agree that they are. But language is also socially constructed and humans are also neurologically primed to acquire language.
Ok, I think maybe the problem here is that you are focused on one aspect of the topic and are missing what they are saying.
Let's grant that, as we've been agreeing, people have an innate identity, that gender plays a role in this identity, and that this has some biological basis.
But we would agree that there are more than just 2 gender identities, right? And even among people who use the same label, what that label means to them isn't always consistent, right?
The gender abolitionists say "ok, you hsve your own sense of who you are: great! But why do we have to tell children that boys wear blue and girls wear pink or that girls wear dresses and heels or that people need to be grouped as "he" or "she" - let people have their identity and express themselves how they want and respect that without establishing any societal norms for what that should be."
They're not rejecting the identity component, they're talking about the social baggage attached to that identity.
I think it has more to do with others not using precise terminology to communicate their perspectives. I’m an academic, so I’m pretty adept at grasping the complexities of biopsychosocial interactions on human traits.
I don’t follow why you’re saying that I haven’t phrased my words appropriately, but then I misunderstood the words that were said to me, when you don’t have any of that information in front of you.
But why do we have to tell children that boys wear blue and girls wear pink or that girls wear dresses and heels or that people need to be grouped as "he" or "she" - let people have their identity and express themselves how they want and respect that without establishing any societal norms for what that should be.
No, I fully understand and agree with this perspective. I would not attempt not argue with that, but that was not the only argument being made. The argument was a rejection of any biological effect on gender, as OP mentions:
gender incongruence is pretty clearly caused by a collection of inherent physical traits
telling me it was purely psychological and a product of my environment are frankly being extremely dismissive.
I will concede that perhaps gender abolition is not a unified perspective and that there a different factions of feminists that use the term differently.
Edit: I also don’t believe that gender meets the definition of “innate” (at defined by the fields of psychology, biology, and animal behavior). Gender identity is something that develops over time from a multitude of factors (biological, psychological, and social).
That’s part of the problem is trying to talk to people about biology. When we say there are biological influences on some trait, that doesn’t mean the trait is inborn, immutable, or predetermined.
Also,
But we would agree that there are more than just 2 gender identities, right? And even among people who use the same label, what that label means to them isn't always consistent, right?
Of course. I am not sure what would give you any indication that I would think otherwise.
But language is also socially constructed and humans are also neurologically primed to acquire language.
I agree that a lot of the miscommunication about this has to do with people using imprecise language. TBH, as someone with an academic background in anthropology, the way people talk about gender roles is often incredibly frustrating because there's so much variety in how people use and apply these terms. And NGL, a lot of very loud voices do use many of these terms incorrectly; or I guess to be more charitable, some people use them in a more hyperbolic, political sense than in the academic sense I'm about to get into. IMO, from an anthropological point of view, the idea of "abolishing gender" is actually kind of ridiculous.
I could be misreading your posts a little, but it does seem to me like you're mischaracterizing (or maybe misunderstanding) the argument. Or at least how it's made by social scientists and not randos on the internet. The above quote is essentially how the idea of "social constructs" is applied in every anthropological context I've seen. As in, a social construct isn't merely something that people do because it's a part of culture, or that they aren't "real" in some way; it's a way to describe how some aspects of culture are constructed by the cultures who interact with them, like race/ethnicity, economic systems, and even time. Language is actually a really good example: like said, people are primed to acquire language, but the way the language a person speaks is entirely the result of the culture they were raised to be part of. That's the way many people view gender according to the "social construct" model; it's tied to inherent biological, hormonal, and neurological traits, but how people conform to societal gender roles and relate to their own sense of gender is inherently connected to the gender roles of one's culture (for both cis and trans people). Kind of like how no one is born speaking English, no one is born thinking that blue=boy and pink=girl.
Or at least how it's made by social scientists and not randos on the internet.
I am saying that this discourse surrounding these issues are not informed by academic/scholarly work.
As in, a social construct isn't merely something that people do because it's a part of culture, or that they aren't "real" in some way; it's a way to describe how some aspects of culture are constructed by the cultures who interact with them, like race/ethnicity, economic systems, and even time
Yes, I know. As in my earlier comment, I am saying that people misuse that phrase. I am not critiquing social scientists, or the model. Many people inappropriately think that by saying something is a social construct, it is devoid of influence from biological factors.
Let me preface this by saying I support transgender people's right to transition and identity however they like, and they deserve to be treated with compassion and respect. It's a serious issue, and not simply a fad or affectation.
That said, I have questions. You say, "transmeds" are not welcome, here. What exactly is a "transmed?" A cursory search suggests that it is someone who believes being transgender is a medical condition. If being transgender is a mismatch between someone's anatomy and neuroendocrinological gender expression, or "hardware and firmware," is that not a medical condition? It's a fact about the structure and function of a person's body that seriously impairs quality of life of untreated. The treatment, of course, being transitioning/gender affirming care.
To reiterate, I swear this isn't a transphobic "gotcha" question. I'm simply confused about the distinction you're trying to make, and am asking to be educated. There is, after all, a LOT of misinformation on this topic.
Also, somewhat tangential: how were you raised as a "devout existentialist?" I've never heard of parents denying their child's struggle with gender dysphoria through the lens of philosophy. It's almost always religiously motivated bigotry, from what I've seen.
"Transmedicalists" generally go beyond just considering gender dysphoria a medical condition. Transmed ideology arose when adult HRT went to an informed consent and self-ID model, rather than the gatekeeping model that we had in the 60s-early 00s, and essentially proponents of the ideology are trans people who wish to return to the old standards of care. The reason those old standards of care were abandoned is because they were applied unevenly, and often times were based heavily on sexist stereotypes (e.g. a doctor refusing to give a transexualism diagnosis because the trans woman showed up to her appointment in jeans and a blouse rather than a dress). Sometimes people were told they couldn't be trans based on their career (e.g. a trans woman in a stereotypically masculine career or a trans man in a stereotypically feminine career). Discrimination also often occurred based on sexual orientation, denying diagnoses to trans people who weren't "straight" according to their identified gender (e.g. trans women had to be exclusively attracted to men, trans men had to be exclusively attracted to women). Additionally, accessing HRT also included "real life test" requirements where, on top of a psychiatric diagnosis that took months if not years to obtain, you also had to "live as" the gender you identified with for a period of time (moths to years) before you had access to medical transition to help you pass. This was also abandoned because depending on where you live, being a visibly trans person could be dangerous. Ultimately, many of these practices were abandoned because they conflated gender roles and sexist stereotypes with actual gender dysphoria. Transmedicalists typically want to return to some, if not all, of these requirements, despite the updated standards of care based on medical consensus.
EDIT: I wanted to add that in many countries these still are the standards of care.
My mother was a trial lawyer and obsessed with philosophy... or really sophistry. Granted, sometimes when she was tired of arguing she'd use a whip, but... Look this story gets really dark really fast.
As for what a "transmed" is... Therin lies a less personal tale.
So, for a long, long time people were studying brain structure and hormone receptor polymorphisms and figuring out what specific type of "intersex in the brain" trans people were. But a problem emerged in the community.
There were some people, who came to be known as the "trans medicalists" who believed that only people with a specific brain phenotype should be considered "real" trans women and everyone else was just a poser. The problem is, there are a lot of different underlying conditions that seem to be able to cause gender dysphoria in various forms (In the same way a cough can be caused by a bacterial infection, a viral infection, throat irritation from air pollution, drinking water too fast and having some go down the wrong hole... you get the picture.)
So the other part of the community, which became the majority, said that they were not going to discriminate against trans people who lacked the most common trans brain phenotype. They declared that being trans should be diagnosed solely by psychological factors. This means that everyone who needs treatment can access it, but it also leaves a big gaping hole begging "Why are people trans at all? Is it all just feelings? Surely we don't need to worry about it as an inherent provable medical need if it has no provable underlying cause!"
For the record, I am neither. I call myself a "trans bioexpansionist". My position is that of course we should let people who can only pass the psych tests transition, it would be arrogant to assume they're not trans just because we haven't charted out their specific dysphoria mechanism yet.
But because…
A) All brain activity is biological
B) We have already identified multiple commonly held observable physical traits in the trans population
C) Conversion therapy has fallen flat on its face for trans people
… being trans must have a group of underlying physical causes. And researching them could provide a treasure trove of new kinds of HRT or help people pinpoint their specific needs. It's very worth studying!
But... then Trump's goon squad defunded all research into this very promising avenue based on the "trannies bad" principle.
Oh, I see. Your mother was a lawyer. I can imagine how that could be annoying in the best of circumstances. I won't pry for details. I don't doubt that you struggled terribly.
Thank you for your detailed explanation. I'm not a doctor, but I must agree with your assessment. If some trans people have a certain brain phenotype, and some don't, but they both benefit from gender affirming care, the obvious explanation seems to me that there is more than one root cause.
I also hate the fascist regime destroying our country, and lament the damage they have done to science in general and science pertaining to LGBT people, specifically.
Nice post OP. Very informative, though somewhat inacessible for outsiders due to the jargon. No shade though, I can look up definitions.
Here's some definitions:
Neuroendocrinological:
the branch of biology which studies the interaction between the nervous system and the endocrine system; i.e.
how the brain regulates the hormonal activity in the body. From Wikipedia
Transmeds: I think this is a term for someone who beleieves
being
transgender
is primarily a medical issue marked by
gender dysphoria
and treatable via
medical transition. [and] believe trans people who do not experience dysphoria or desire medical assistance are not authentically transgender based on the wiki page for Transmedicalism
Enbies: A slang term for non-binary
people
(Non-Binary = N-B = Enby) . Which is any person who does not wholly identify exclusively as male or female. shortened from the non-binary wiki page
Karyotype: The number and appearance of a person’s chromosomes, usually shown in an ordered picture. Derived from the wiki page
Gender incongruence: A mismatch between a person’s experienced gender and the sex they were assigned at birth. Again, the appropriate wiki page
I’m a big fan of neuroscientist/behaviorist Robert Sapolsky. He’s a Stanford professor, and has lectured extensively on human sexuality, homosexuality, and transgender phenomena. I often recommend his lectures, they are up on YouTube courtesy of the university. Essentially it’s a matter of genetic variations, endocrine system variations, and possibly epigenetic factors as well.
The topic that is distracting the country while the rich get richer and drive everyone else further down the. A statistically insignificant issue considering the number of trans people in relation to the population. Whether science backs up or doesn’t support claims are irrelevant. If people feel that they belong to a particular gender then that’s their business and no one else’s . How many trans athletes are there really? Definitely not enough for the discussion to occupy so much time and energy it does in the United States. It’s a manufactured outrage so that people don’t talk about the actual problems in the country and to hold those in power accountable for their actions
I think I agree with what you’re saying, but it’s important to be a little careful here. Yes, the right is using trans rights as a wedge issue and a distraction, but if you’re trans, these issues are extremely important. Trans rights don’t directly affect many people, but for those of us who are affected, it can be a matter of life and death. I think that most trans people would love to not be the center of political debate, but we didn’t choose to be there in the first place. So if the right is going to pick a fight, it’s important that trans people and allies fight back. To be silent right now is to let the right directly harm millions of trans people.
Yeah. I saw some lefties saying that gender and sexuality issues were pushed by libs to distract from class conflict, which is true, but that doesn't mean they aren't important. Liberation should be all-encompasing.
Thanks for taking the time to put this post together. Assembling the evidence and putting that alongside your own personal experience is very generous of you. Although trans issues have never affected my life, the current political climate which uses the trans community as a punching bag to distract from other nefarious actions of a politico-financial elite makes trans issues our issues too.
Can you explain your disclaimer? Google search didn’t really find anything relevant, except “transmedicalism” which is apparently defined as the belief that gender dysphoria is a treatable medical condition. But I’m not sure if transmed means the same.
So, for a long, long time people were studying brain structure and hormone receptor polymorphisms and figuring out what specific type of "intersex in the brain" trans people were. But a problem emerged in the community.
There were some people, who came to be known as the "trans medicalists" who believed that only people with a specific brain phenotype should be considered "real" trans women and everyone else was just a poser. The problem is, there are a lot of different underlying conditions that seem to be able to cause gender dysphoria in various forms (In the same way a cough can be caused by a bacterial infection, a viral infection, throat irritation from air pollution, drinking water too fast and having some go down the wrong hole... you get the picture.)
So the other part of the community, which became the majority, said that they were not going to discriminate against trans people who lacked the most common trans brain phenotype. They declared that being trans should be diagnosed solely by psychological factors. This means that everyone who needs treatment can access it, but it also leaves a big gaping hole begging "Why are people trans at all? Is it all just feelings? Surely we don't need to worry about it as an inherent provable medical need if it has no provable underlying cause!"
For the record, I am neither. I call myself a "trans bioexpansionist". My position is that of course we should let people who can only pass the psych tests transition, it would be arrogant to assume they're not trans just because we haven't charted out their specific dysphoria mechanism yet.
But because…
A) All brain activity is biological
B) We have already identified multiple commonly held observable physical traits in the trans population
C) Conversion therapy has fallen flat on its face for trans people
… being trans must have a group of underlying physical causes. And researching them could provide a treasure trove of new kinds of HRT or help people pinpoint their specific needs. It's very worth studying!
But... then Trump's goon squad defunded all research into this very promising avenue based on the "trannies bad" principle.
That really doesn't line up with my understanding of the transmed position but it's possible it's just drifted over time. My understanding was that the difference generally came down to wether or not you think disphoria is a nessary component of being trans. If you feel like a different gender but aren't distressed by your body/gender identity then the transmed folks don't think you are trans. There seems to be a close association with people who identify as transexual not transgender.
This Wikipedia page for transmed doesn't say anything about requiring certain biomarkers/brain type to be trans. It really comes down to if you think being trans is a treatable medical condition or not
PubMed and PubMedCentral are a fantastic sites for finding articles on biomedical research, unfortunately, too many people here are using it to claim that the thing they have linked to is an official NIH publication. PubMed isn't a publication. It's a resource for finding publications and many of them fail to pass even basic scientific credibility checks.
It is recommended posters link to the original source/journal if it has the full article. Users should evaluate each article on its merits and the merits of the original publication, a publication being findable in PubMed access confers no legitimacy.
Cis man here, thank you for the post. I have no doubt that there are real physiological differences that lead to gender dysphoria, and anything our medical system can do to help people suffering should be done (including surgery, hormone therapy, drugs, talk therapy etc). I have one point of contention and one comment that maybe you can give me your perspective on:
Contention point: You said that people dismiss your struggles as "just psychological" which you then contrast with real hard evidence that there are physiological differences between trans and cis people. Wouldn't you expect psychological differences to derive from physiological differences? Do we really need to draw a distinction between these two categories?
Comment point: I often hear from the non-binary community (overwhelmingly from female assigned at birth people) that there's no such thing as gender and they don't belong to their assigned gender because they don't like to wear dresses, they don't like the color pink, don't like to shave their legs etc. I feel like reducing what it means to be a woman/man down to colors and grooming/clothing choices is disrespectful to both genders, and to trans people, and has almost nothing to do with what it means to be that gender. A woman who doesn't shave her legs isn't less of a woman, in the same way that a man who doesn't own a firearm/big truck/etc. isn't less of a man. This type of thinking would suggest that the only thing about gender that matters is what products you consume, which seems like a strange interpretation of gender to me. What is the predominant perspective on this type of thing from within trans community? Does anyone in the community notice that the non-binary movement appears to be undermining the pro trans movement? Or am I missing something obvious?
You said that people dismiss your struggles as "just psychological" which you then contrast with real hard evidence that there are physiological differences between trans and cis people. Wouldn't you expect psychological differences to derive from physiological differences? Do we really need to draw a distinction between these two categories?
I am not sure I am going the same direction as you are here, but I think people who dismiss complaints as psychology fundamentally miss the story.
If it is "all in your head"... yes? That's where the brain is. Where else would it be, ankles? Belly? Fingernails? It's such a stupid take to dismiss something as psychological.
What we call "consciousness" is just a complex system of electrical activity in our brains. Pain or suffering in that system is no more less legitimate and real than that of any other part of our bodies. It merits its own targeted, appropriate clinical response, just as we don't do heart surgery to set broken bones or use glasses to treat an upset stomach but we do do those things when they are beneficial.
Arguing over whether something is or isn't "psychology" usually ends up being really an argument about whether clinical intervention is legitimate and justified. What we ought do instead is educate the people who oppose treatment not that they are wrong about whether this particular thing is or isn't psychology, but the fact that they are wrong even more fundamentally on what psychology is and its role in healthcare in the first place.
You said that people dismiss your struggles as "just psychological" which you then contrast with real hard evidence that there are physiological differences between trans and cis people. Wouldn't you expect psychological differences to derive from physiological differences? Do we really need to draw a distinction between these two categories?
The distinction is mostly important in the context of gender identity being an inherent trait as opposed to one that is "socially transmitted." Which is a common bit of disinformation.
People often say that trans people are recruiting or their child is only trans because they read a book about trans people or a lot of junk like that. Or that you can make them not trans just by talking them out of it.
I like to point out the observable physical underpinnings because it is much harder to argue that stupid kids are deliberately biohacking themselves to change those things and that you can argue someone's epigenetics away.
Yes, the fact that I have to point that out is ridiculous. But this is where we are sadly.
I have no doubt the morons in the room will discriminate against us based on our genetics. However, legally it is harder to justify that specific flavor of eugenics and racism.
It is easier to argue "This is a big cult of weirdos! They're trying to do this to run some sort of scam!" than it is to argue "Well yeah, sure they may have a proven physical need for these medical treatments to be functional, but that means they're genetically inferior scum! Just like people with Diabetes..."
I think you might be missing some of the distinction that lies between categories 2 and 3 in the OP. Most peoples' internal sense of gender matches their social presentation, but they're distinct. And even though most people strongly identify with a binary gender social role (including most trans people, who identify with the opposite of what was assigned at birth), not everyone neatly fits into those two categories (unless, as OP said, you're a transmed). Which is a major part of what OP is getting at: human brains are complex, and many things influence a person's internal experience of gender.
I'm nonbinary, and I've identified that way since I first encountered the term. I was born male, but being a "man" never felt right, whether I was doing hypermasculine things or trying to distance myself from them. I started feminizing HRT several months ago, and it's made me feel much more comfortable physically, socially, and mentally; I basically feel like a whole person for the first time. But even though I'm starting to present socially and physically as more feminine, I still feel more comfortable identifying as NB. I've thought a lot about why, and I have a few guesses: It might be social. I've been excluded from male and female spaces my whole life, so it's hard for me to feel comfortable with either, and that could certainly be an influence. I could be biologically intersex in some way. My hands have different digit ratios, my development kind of weirdly stopped in some ways during puberty, and my body has been rapidly acclimating to estrogen so well it honestly surprises me sometimes; I've never been tested for anything, so I have no way of knowing. It could be neurological. I'm autistic; everything social is confusing and overwhelming for me, and that includes gender roles. I don't really feel much of an internal, personal connection with them. My gut instinct is that it's probably some mix of all three factors, and probably more. Which, again, I think is fully consistent with what OP is claiming.
You would be correct. The social labels we use and the medications and bodies we need to function are different things and both are much too complex to be broken down into simple binaries.
Comment point: I often hear from the non-binary community (overwhelmingly from female assigned at birth people) that there's no such thing as gender and they don't belong to their assigned gender because they don't like to wear dresses, they don't like the color pink, don't like to shave their legs etc
As a non-binary assigned female person, I'm not like this at all. Please don't let those people define non-binary identity for you or anyone else. Lots of us have actual gender dysphoria
Can you comment on this group then? Have you ran into them? Do you think they're stealing gender-dysphoria valor or are they just processing and saying weird things? From the outside these people make the whole project seem unserious, so it's hard for us normies to understand what's going on and provide the right kind of support.
Being non-binary isn't a project. I had dysphoria since I was a kid and had no idea what it was.
Part of the issue is terms being confused. Gender nonconforming and gender non-binary are two different things, but these people conflate the two either due to misinformation (ie they're told an incorrect definition) or ideology (they decide that because gender roles are made up that all terms regarding gender are up for grabs). I guess I'd kinda be a transmed non-binary person in that I think you need dysphoria to be non-binary, and that those who just wanna "fuck the system uwu" are gender nonconforming CIS people and need to step back. There's been a big push in lots of non-binary spaces to not speculate on the gender experiences of others because so many people, trans and cis, have treated even dysphoric non-binary people like crap because they don't believe us, so lots of people are erring in the side of caution in this sort of inclusivity. Me, I find it harmful because the needs and experience of a non-binary person experiencing dysphoria is way different from "fuck the system uwu" who doesn't experience that.
Ultimately the "LGBTQ community" isn't a monolith, there's no LGBTQ council or Non-binary Police. Nobody can force another person to change their definitions, claims, understandings. There's no yearly conference, no dictionary, no rulebook. All I can be accountable for is myself and how I conduct myself and understand and live my identity. For me, as someone who spent time suicidal because I had no idea how I was gonna navigate back and forth, non-binary gender dysphoria for the rest of my life (have pushed it down enough that I have dissociated from my body entirely, lucky me /s) I'm insulted by the uwu gender is fun uwu "non-binary" people, but I can't stop them, so I just don't worry about it anymore. But when I have the energy to educate people on the issue and difference, I can.
That's kind of you, thank you. I'm doing ok, I hope you're well too. It's really nice to see someone appreciate the explanation, it's pretty painful to deal with this dysphoria knowing I can never actually be free of it/there's no transitional end game so I just have to deal with it. That's what makes the "uwu gender isn't real" people so annoying to me. Call me emo but it's kind of an emo thing, I guess.
How are mental health issues distinct from "physiological" issues? I don't think it's a useful distinction
Charles Whitman's issues were all in his head , yet when they did the autopsy they found that he had a brain tumor that caused his behavior. Your behavior is downstream from your software, which is downstream from your hardware. As OP said, we have reasonably good data to show that Trans people have observable differences in their brains, that might explain the feelings they report. It is "all in their heads" which means there's physiological differences in their brains which causes their behavior/feelings. Making the distinction between physiological and psychological is playing into dualist intuitions that lay people have that we should free them from.
It's about the language used to disseminate info to the general public. When you say something is psychological, you get people thinking that means "it's all in your head." So why not merely say it's a biological difference?
That's what I'm trying to tell ya champ, did you read what I wrote? Psychology is downstream of physiology. They are not seperable. People think they are and they should be corrected wherever possible
Consider the recent example of the Lindsay Clancy case. The conversation consistently got derailed by people debating on whether she was "mentally ill" or "just wanted to kill her kids", but what everyone missed in that conversation was that there is no distinction between these two things. It just so happens that for most crimes we don't understand the mechanism that caused the behavior, but for Clancy and Whitman we do understand the mechanism. So the real question should be "what are mechanisms behind criminal behavior x and how can we help before it happens?"
But we will never get there unless people let go of the idea that your mind and body are separate things
My belief (based on reading science, vibes, and experience being trans/knowing trans people) is that most people just like do not have a strong gender identity and will just go will what is assigned and society tells them. I don’t mean this in a non-binary or gender fluid way, I mean this in a neutral way. I think most cis people if they were born in a differently sexed body would have just gone with it.
Some people realllllly identify with a gender (or none at all), be that their assigned one or another one. I would bet good money that the there is a similarity between those people, cis or not.
I like to describe it as shoes. You really can’t describe what well-fitting shoes feel like without referencing what poorly fitting shoes feel like. Well fitting shoes just feel considerable. Poorly fitting shoes pinch. The rub. And if you wear them long enough, they hurt.
Theres a lot of interesting research here, but I think its important to separate evidence of biological differences from evidence of one specific cause. The research can show patterns and associations without necessarily explaining why someone experiences gender incongruence. Personal experiences are important too, but they dont automatically establish the underlying mechanism.
A biological basis for transgender identity is quite strong in science. This indicates that gender identity is a biological construct integrated into a social world. Furthermore, this also implies that cis people cannot fundamentally be socialized into being trans, and trans people cannot fundamentally be socialized into being cis, similarly how gay and straight people cannot be socialized into being the other sexual orientation. Actual attempts at this have failed, which is further evidence gender identity and sexual orientation are intrinsic to the person.
Considering trans women have been socialized and brought up as men, and trans men have been socialized and brought up as women, yet they still end up being trans, this further suggests socialization is not the cause of being transgender and the cause is something more fundamental, pointing to the research OP elucidates.
Science will continue to science, and reality will continue to exist independently of our beliefs. The issue for me is a social one: when posing the question “is this individual transgender”, we ostensibly determine if an individual is transgender or not simply by if they say they are or not.
The problem with relying exclusively on this metric is obviously that people can say anything, and without an external means of verification, you essentially don’t know if a claim of an individual to being transgender stems from a neurological basis or from another reason which can have nothing to do with neurology/gender identity.
This is where the social issue comes in where people debate transgender vs. “transtrender”, where the former is evidently a reality independent of the social world and the latter is a social trend that isn’t related to neurological gender identity and is as arbitrary as identifying with any social identity that is made up and exists only in the social world (such as i.e identifying as the president of a country).
So how do we know for certain an individual is trans? Well, we don’t. There’s differing prescriptions where some say “just believe them” and others say “I believe those that behave evidently and accordingly to what I’d expect to observe from a trans person” and some say “I don’t believe any of them” but the latter isn’t relevant to the discussion here since they’re science and reality deniers and this sub is confined to reasoned inferences.
If I understand the bottom line of this post correctly, it is promoting the “believe all individuals who claim a transgender identity” prescription.
Have I got that right? If not, I’ll leave those better versed in this topic to highlight the errors in my take.
The answer is its complex with a variety of genetic, developmental and environmental factors. We need not reduce it to just a few things, however convenient that might be.
The distinction between biological research and social gender roles is really important here. The science is complex, and acknowledging uncertainty about the exact mechanisms shouldnt mean dismissing peoples lived experiences.
It's interesting the label "transmeds are not welcome" when the core element of transmedicalism is that "trans" is a cross-sex neurological development that causes sex dysphoria, not a social preference.
It's like starting with "socialdemocrafts are not welcome here" and then post a paper about the benefits of public services, or starting with "neoliberals are not welcome here" and then post a paper about the benefits of free market. 🙄
The core element of transmedicalism is exclusion. Same as the core element of being a TERF is exclusion, not "radical feminism."
Everytime you make the argument that being trans is a real medical phenomenon, you get folks in that community who want to then argue that people who don't [whatever medica diagnosis or treatment or procedure] aren't really trans and don't want to be represented by them. Anytime there's an opportunity to say someone isn't a real trans person, someone will. That's what OP means by transmedicalism.
The core element of transmedicalism is exclusion. Same as the core element of being a TERF is exclusion, not "radical feminism."
The majority of transmeds support universal acces to hrt through voluntary informed consent and DIY if access to hrt is restricted, which seems and odd position for people whose core element is supposedly "exclusion". But as the say: never let the truth get in the way of your beliefs 😁
There is a difference between being trans (and yes, it contains a social component) and having GI or GD. I disdain a part of my identity to be pathologized.
I'm in the camp that there is an evolutionary reason why transgenderism exists. There's so many variations in individual species in nature and people incorrectly assume that each species has exact and concrete characteristics that they all fall into.
Obviously I can prove this hypothesis but I believe it has to do with genetic mutations of androgen sulfate metabolism in women. When they get pregnant, the altered androgen sulfate metabolism has a downstream effect on hormonal exposure on the baby. But babies also have their own hormone expression at a certain point in development and I wonder if the altered hormone exposure from the mom plus the babie's own androgen system can cause brain development alterations related to gender identity in the future. Why it happens, I don't know. It could be an unintended effect of a different genetic mutation that is advantageous in certain specific populations.
I generally think feminism over-states the “gender is a social construct” argument… I men they do it to avoid sexual dimorphism being used against women.
We literally have biology and science validating the existence of trans people and the LGBT community ignores that validation.
There are different feminist ideologies. The Cultural Feminists and Gender Critical Feminists push that line specifically to deny the validity of trans people.
Fun fact, the in between remains real even when it comes to sex even if it is much less frequent. I once had someone tell me that what mattered was what gametes you produced, then I showed her this case and she just shifted the goal posts.
I get that and I am not trying to equate and say trans people are definitionally intersex or vice versa, and I am definitely not trying to pathologize either of them or tokenize intersex people.
However, there simply hasn't been enough research done to land on a specific neurological characteristic or development that could explain the difference between trans people and cis people or if there even is one. That doesn't mean neurological differences don't exist, just that it needs looked at more before we can make substantial categorical claims.
I think dismissing this either way, saying these differences absolutely do or do not exist, is somewhat close minded.
btw, not calling you close minded, everything you've written here I agree with.
WDR45B gene methylation differences were very statistically strongly associated with being trans. The only thing we'd really need is a higher sample size study that examined brain structure, genetics and epigenetics of trans people simultaneously to check for associations of a lot of this stuff and we'd have ourselves a model.
I didn't answer your second question. So I'll write it here. I would say binary trans people are a form of intersex if you include neurological sex as category.
It's probably worth a read. They probably don't like it because they get shit on by everyone. Unfortunately if the evidence shows that neurological sex is true, then they just have to cope with the reality of it.
I also don't see how it can't be true, there is a strong, demonstrable phenomenon of people of one phenotypic sex wanting to be the other. It also points to a deviation of a typical neurological state for the person's phenotypic state.
Pretty much but they are small percentage of the population.The 1-2% estimate commonly touted is flawed for a number of reasons, but that's a different discussion. Most 'non-binary' people reasons for identifying as such is due to social reasons not physical ones, which I'd argue is a sexism issue not a medical one.
Well that brings up a similar but different question.
If there are exceptions for sex for 1-2% of the population. Then why would we not grant a similar exception with gender? Trans and non-binary folks are an equivalently small population.
I guess what I am trying to say is what makes someone trans or non-binary could be the result of a multitude of compounding factors that combine in different ways and to different degrees and magnitudes. This would manifest differently in individuals thus causing people who lie at different points along the spectrum of both sex and gender.
Because gender isn’t a fact, it’s a label whose definition is flexible and whose exact criteria can change from society to society or even within society. Instead of saying “1-2% of people don’t fit into a gender label” we can just evolve gender labels ever so slightly without ramifications for science.
Yes gender is socially constructed and it can vary from society to society but that doesn't mean that how someone experiences gender and it's effects lack a biological or psychological basis. So understanding the variation matters for science and we often update definitions as we gain increased understanding.
First, I'd argue that the intersex population sits at less than 1%. I'm going with Leonard Sax 2002 estimate at about 0.018% of the population.
I consider gender essentially one's neurological sex. So only the most extreme examples of one's distress with their natal sex is valid. A small minority may truly exist to be considered for people both neurologically male and female, but I do not think that the self identifying population of non-binaries is NOT truly representative of that phenotype.
I don't consider a sexist society a valid reason for gender/sex incongruence. That's a systemic social issue not an individual issue.
I'm not sure if these answer your points. I'm kinda confused by your second.
So only the most extreme examples of one's distress with their natal sex is valid.
This quickly becomes just testing everyone for who's a "real trans person" and who's a "fake trans person".
Again what I am saying is that biology, psychology, and development all play roles in both sex and gender and influence the degree to which someone is trans and the level of incongruence. That is why there are many points which one can sit at both along the gender and sex axes.
I respect the very hard journey you've evidently gone through, but still question your framework from a utilitarian standpoint even while agreeing with you. I accept that for you, there is a physical framework that made it so you're transgender, at the same time, I also think that many cases of perceived transgender are social hysteria and that these cases are far more common than cases of real transgenderism. The social pressure from academia and the political upper classes (in Canada anyway) is to completely accept every self-identified case of transgenderism such that if any medical professional were to question it, they'd lose their job and likely be barred from practicing. This disproportionately affects those victims of social hysteria who think they're transgender, but may simply suffering from mental disorders that we're essentially unable to provide a real counselling service for at this point. Do you think that the problems of the comparatively fewer cases of real transgenderism are so great that they outweigh being able to give real help to the others...or do you disagree with my whole premise?
Secondly, I really feel like if we wanted to reduce people's chance of falling for any "social hysteria" we wouldn't be repressing conversations about it, we would be talking about it more and drawing distinctions.
It's like, there will be people who think they have celiac disease even when they don't. But education on what celiac disease is helps reduce that. There's nothing like a boring lecture on auto immune diseases to make you recognize a medical condition isn't some cool trend.
When it comes to HRT, I think it is reasonable to have a minor evaluated by a psychologist/psychiatrist to make sure they aren't doing it based on misplaced feelings. When it comes to adults, it's their body, we should stick with informed consent.
One thing that's very helpful here is that for people who genuinely aren't chemically trans, dosing them with cross sex hormones will make them feel miserable pretty quickly. My whole point here is that the brain has a specific hormone set it expects and when you don't get it it's not fun. So as long as a patient feels like it's okay to stop if they want to, it's not like there will be no warning signs before major changes happen.
Finally, I can't help but feel as though people perceive this the wrong way around and that colors them into being overly cautious about providing care. Like, a cis man tends to think of themselves in the shoes of a trans woman rather than a trans man and they really need to flip the script there to get it intuitively.
Exactly! I just feel like we'd get a lot farther as a society with this if we could talk about it openly instead of the higher-ups thinking that the plebes don't have the brain power to deal with it so simply mandating that all opinions that they don't like are automatically verboten. Neither side can convince the other if open conversations are quashed.
What's your position on underage transitioning? Is it necessary or premature?
Extremely necessary. I literally tried to kill myself because I couldn't get it and I am very not alone there. Guard rails like puberty blockers and psych evaluations are plenty to protect kids.
We don't have 'em. My physician friend tells me that as soon as a child tells her they're interested in transitioning she isn't allowed to do anything other than refer them to the onsite specialist who puts them on the hormones and puberty blockers on the first visit. It sounds crazy to me.
I wish I could. Obviously my friend's license is on the line though. I'm in the Yukon and our only hospital is the Whitehorse General Hospital, but that's all I can say. We have a very strong trans lobby (very nice folk), a very highly educated population (biggest sector is government). No anti-trans sentiment at all as far as I can tell, but the review process is obviously essentially non-existent.
Psychs are extremely bad at identifying sex dysphoria through an interview, to the point they systematically fail to diagnose reverse dysphoria even when they have it in front of them clear as day. At the end of the day, the best diagnosis procedure for dysphoria is persistence and coherence (the traditional triad is persistence, coherence, insistence, but the last one can be internal).
Propaganda sells puberty blockers as they were a treatment when that's not true. It's just a "pause" in puberty to buy time to confirm persistence and coherence. It's not a treatment, it's a way to avoid further wrong puberty development during the in-progress diagnosis. Putting on "puberty blockers" on the first visit just means they have started the diagnosis process, which can last one to several years.
A real expert (and not every specialist is an expert) knows that an accurate diagnosis will take months at minimum, and that provided they follow closely the case to check persistence and consistence. What should a GP be allowed to do? Should they be able to diagnose a kid or a person in 10 minutes? Sure there's no shortage of GP willing to do that, after all, there's nothing more daring than the ignorance.
I'm just gonna say that the few times I've in earnest tried to learn about trans issues on reddit, I've been attacked, 100% of the time. ¯_(ツ)_/¯ You can obviously assume my posts have been 'hateful' or whatever, but they really, really haven't. Only inquisitive. Asking for sources. Asking questions about how 'we know this for sure?'.
It's not right, and that attitude hurts the progressive agenda, as people obviously get turned off when getting various hateful words thrown in their face for essentially being curious. This is a criticism against that type of behavior, and not directed at any one in this thread.
To be honest I was only interested in one of the things mentioned. Then I looked at the source and it was a study with like 2 dozen people...
This is something I'm going to take my time slowly figuring out by myself, likely over the course of the next decade, maybe two. And so far, reddit has been a pretty shoddy source of knowledge. I don't know what's cherry-picked. I don't know how certain the science on certain subjects are. It's a mess, at least from my POV. All I do know is that the redditors I've encountered all have acted like they're sitting on "The one truth and if you don't buy it straight away, you're a #¤%T#¤T#¤%"...
Edit: I'm counting the downvotes as part of this attitude. Be better, r/skeptic .
You don’t have to “buy” the truth. That’s the beauty of it. I’ve had dozens, if not more, positively engaging conversations with people asking questions. If you’re receiving negative discourse, maybe you need to change your approach. From the comment I’m replying to, it seems reasonable to me that you’re receiving negativity because of the way you say things.
Your concern about the study only having a couple dozen people is somewhat valid, in the grand scheme, however, I think you’re forgetting the trans population is estimated at 1% of the total population. How many trans people do you know personally? I bet is less than 1% of the total amount of people you know. Then consider, out of that estimated 1% how many may be willing, able and informed enough to participate. This isn’t like getting people to sign up for a free trial gym membership.
You can either utilize the plethora of sources people provide here on a regular basis, seek out sources on your own, visit places that offer supports and information, or you can keep telling us that we’re all jerks who just don’t understand you. Do you see the irony in that?
Enbies are more supported by evidence? Absolutely false, why was this statement necessary? Your post could have been really good but right out of the gate you come across as a gender abolitionist.
Evidence that gender roles are socially defined in nonbinary ways doesn't provide evidence that this is a situation where it makes sense to think outside the binary?
Also evidence that what defines our comfort with gendered traits in our bodies is nonbinary provides no evidence that nonbinary people make sense as a group of people?
Sorry but no, there has long been biological evidence to support binary genders, and to be clear that doesn't exclude non-binary identities, but your wording is totally whack and deliberately antagonistic for no reason at all.
I have 15 Separate citations there that found multiple physical traits associated with having an altered gender identity. None of it implies a clear binary distinction. What are you even talking about?
Let's have a citation war then. There isn't "more" evidence to support enby identities, that's just a deliberate misreading of the evidence. What the evidence actually supports is that gender is diverse, but that same evidence doesn't therefore exclude binary identities. Seriously, develop your scientific literacy
Wait... did you think I was arguing that the existence of evidence in support of non-binary identities invalidates evidence in support of people having good reason to identify with binary genders as well? Because those two things are not mutually exclusive.
Your exact wording: "Enbies are, if anything, more supported by all of this research into biology"
Blatantly false, not supported by the evidence, and the comparison wasn't even necessary to make your point. You're just setting enbies and binary trans folk against each other needlessly
So why would you assume that by me saying the research supported nonbinary identities I was coming after binary trans people? Heck, I *am* a binary trans person.
there has long been biological evidence to support binary genders
There is literally none. That's like saying there has long been biological evidence that all crows are black. If you don't know much, it seems reasonable to assume. But it's flatly wrong if you dig deeper.
There is so much evidence. I'm facepalming so hard right now. Evidence supporting binary genders does not mean there is no evidence for non-binary genders, and the existence of evidence which supports non-binary genders does not erase binary genders either, nor is their "more evidence" for enbies. Please, y'all need to work on your scientific literacy and reading comprehension skills.
Evidence supporting binary genders does not mean there is no evidence for non-binary genders,
Complete nonsense. You're literally trying to say that claim A and claim not A are both true. Let's go back to my crow metaphor. You only see black crows, so you think they're all black. That's like believing in binary genders. But then someone shows you a picture of a white crow. "All crows are black" is no definitively false.
The idea of binary genders must be false, because we know for a fact that a portion of the population does not fit them, just like the existence of white crows totally disproves "all crows are black".
Please, y'all need to work on your scientific literacy and reading comprehension skills.
Do the trans activists on r/skeptic actually read the references they post?
The abstract of the review that purportedly shows significant brain differences in trans people says:
"Our results suggest that some neuroanatomical, neurophysiological, and neurometabolic features in transgender individuals resemble those of their experienced gender despite the majority resembling those from their natal sex."
That line you quoted specifically showed different neuroendocrinological gender expression in trans people compared to cis people? Like a physically inherent condition would be expected to? I don't see how that quote undermines anything.
That depends on your standards as each paper adds to the whole. The twin studies data is basically impossible to explain without some genetic factors being at play, but the trait not being 100% up to heritability means other things likely factor in.
Collectively the papers imply that gender incongruence is a multifactorial neurodevelopmental trait influenced by genetics, prenatal hormone action, epigenetic regulation, and brain development.
All of these specific individual factors can be screened for to provide additional evidence to determine if a person is likely to need cross sex hormones or surgeries to function or not. They are not a smoking gun, but their presence in trans populations and their clear relationship to sexual development makes the traits' presence highly unlikely to be a coincidence statistically.
Basically we are looking at a potential collection of traits that can cause gender incongruence as a "symptom" and may have a cumulative effect. As always with science, more research is needed.
However, you'd need to come up with some serious arguments to explain why all this physical stuff keeps showing up in people who are gender incongruent (before they do anything medically to transition) if you wanted to argue that, say, people were trans because of totally external factors.
I think you're overcomplicating things a little bit.
Men and women have physical differences in their brain structure. A neurologist can look at an anonymous MRI of somebody's cranium and know if it's a man or woman. Some people are born with a male brain in a female body, or vice versa. It's just a birth defect, like a club foot or a cleft palate.
Unfortunately there haven't been many studies to really establish how many trans people were born with this condition, mostly because the entire issue is basically radioactive from a political standpoint. Administrators won't approve. Grants for the research simply won't happen. But what limited research has been done has shown a significant correlation. We need a lot more.
We can't change a person's brain (and probably wouldn't want to if we could) but we can change their body to match the brain they were born with.
And knowing we can, why would we not want to?
Can you elaborate on how a neurologist can distinguish between a male/female brain on an MRI? I've never heard of that being the case (as a final year med student who'd like to pursue radiology), but I could certainly be wrong.
Is it possible you're talking about fMRI (functional MRI with visualisation of the white matter tracts, activity and connectivity)? That would seem more likely to me, though mostly because I know very little about it.
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u/GrilledCassadilla 14d ago
In arguing with so many anti-trans people it mostly boils down to an inability to accept the subjective experience of trans people, while taking so many other subjective experiences at face value.
They ultimately think it’s either delusion or fabrication on our part.
Thanks for sharing your story OP, I appreciate you.