Philosophy Discussion Forums | A Humans-Only Club for Open-Minded Discussion & Debate

[Sculptor1]

Quoting the Cass review: "Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity." Therefore we cannot assume that every child that turns up at a gender clinic with gender related distress must have a body that does not match their gender. That is not "denigrating" to trans people. And it would be failing those young people who are mis-diagnosed as being in the "wrong" body if we did assume that.

Thanks for cherry picking one paragraph. But you do not get to imply your following "therefore... " as if it were characteristic of the report as a whole; it is not. Non one is "assuming" what you want to suggest they are. In fact none of the 33 recomendations would share your skepticism.

This is a quote from the Cass Report's summary (p. 22):

"There remains diversity of opinion as to how best to treat these children and young people. The evidence is weak and clinicians have told us they are unable to determine with any certainty which children and young people will go on to have an enduring trans identity."

With that given, aren't noninvasive, i.e. psychotherapeutic, attempts at alleviating gender dysphoria (especially in nonadults) highly preferable?
Gender dysphoria is a mental condition, so how about first trying to achieve a "mind modification" instead of a body modification?

Note that by "mind modification" I don't mean a reprehensible kind of ideological brainwashing like "gay conversion therapy", but science-based psychotherapeutic treatment! Anyway, there's a false analogy, since body modifications are a nonissue with regard to mental problems in the context of homosexuality as such.

You keep the cherry p;icking. Why not read the report?

[Sculptor1]

Do not kid yourslef you give a damn.

Ok, so clearly you are accusing me of arguing in bad faith and consider it beneath you to argue your case.

I see no point in continuing our discussion any further.

Great. Run away from the more difficult points I asked you to consider.

[Lagayascienza]

What I get from the reports I have read, and from documentaries I have seen, is that parents try everything to get help for their gender dysphoric kids. The do the psychotherapy and counselling, but when that doesn't work they often find it impossible to get any help at all, and then some of them end up losing their kids to suicide when what the child really needed was gender affirming care.

It's like when homosexuality was criminalized and treated as a mental disorder and gays were given electric-shock "therapy" to the genitals and chemical castration and put in jail. It's no wonder Alan Turing and so many like him committed suicide. These kids and their parents have enough to contend with without being punished for their gender dysphoria by being labelled as mentally ill, just as gays used to be. It is not as if gender dysphoria is some new fad. There have always been "lady boys" and "bull dykes". If they couldn't pass as the sex they felt themselves to be they just had to spend their lives in the closet and miserable, or subject themselves to the tender mercies of psychiatry.

We need to stop treating these kinds as though they are mentally ill. There is a place for psychological counselling but, when it becomes clear that the child does not have a mental illness, then what is to be done? Nothing? Refuse to acknowledge the people they feel themselves to be? Send them to "conversion therapy" at the local church?

I do not advocate irreversible medial interventions for children. That can wait until, as adults, they are fully informed and choose for themselves to go down that path. What I do advocate is that, when it becomes clear that the dysphoria is not a passing phase, the child is then supported as the person they feel themselves to be and not treated as a recalcitrant psychiatric case. If they child desists in the gender dysphoria nothing is lost. If they persist in the gender dysphoria, and are supported, then parents are less likely to lose their child to suicide.

[Pattern-chaser]

I'm not really sure to whom you are referring to with your comments, nor do I understand your analogy with homosexuality.

The analogy is a social one, I think. Some years ago, gay men* were considered dangerous perverts, a threat to children (), and to 'public decency', like paedophiles, or worse. Now, we have reached a more civilised and understanding view. Thankfully. Today, trans people are treated the same, and their issues and challenges trivialised and demeaned. Just as gay men used to be. That's what the analogy points to, I think?




* — Oddly, homosexual women were never treated quite as poorly...?

[Pattern-chaser]

It shouldn't include any unquestioning "gender affirmation" either!

Agreed, provided it also doesn't include the automatic (unthinking; unconsidered) denial/rejection of "gender affirmation"!

It depends on what exactly "gender affirmation" means. If it means telling a gender-dysphoric person that s/he really is or can really become a member of the other sex, then I reject it in principle.

I assumed you knew what it meant, and that was why you commented as you did? And please don't confuse sex with gender; that's sort of what this topic is about, yes? Understanding the difference between sex and gender?

Even with our modern surgical capabilities, no-one can *become* a member of the opposite (biological) sex, although current techniques offer a partial approach to it. But that isn't what gender, or gender dysphoria, is all about. You refer only to our imperfect remedial surgeries.

[Pattern-chaser]

My child would need, and would get, support, and in that I would be guided by experts in the field.

Here, caution is indicated. Many mental health conditions are not well understood, even by "experts in the field". Sometimes *especially* by "experts in the field". Autism is one example; gender dysphoria is very likely another.

If one wishes to develop a genuine understanding of gender dysphoria, or autism, ask people for whom it is a core feature of their everyday lives in the real world. Only *they* really know.

"Experts" are self-appointed, usually, and they often don't even bother to talk to the people who have the condition they investigate, except as robotic patients, there to be experimented on. Simon Baron-Cohen, a "world authority" on autism, has no autists on his team. None.

...I would worry that the experts I would be speaking to were not free of the influence of activists that have been trying to shape the way the medical profession deals with this condition.

Activists? Or just people who have the condition, for whom it is, and has always been, a core feature of their lives? Are they not "experts", of some sort?

[Fried Egg]

There is a lot of going around in circles in this debate so I'm just going to focus on the following point which has been made a number of times in this thread and is often cited as one of the major reasons for gender affirmative care:

We need to stop treating these kinds as though they are mentally ill. There is a place for psychological counselling but, when it becomes clear that the child does not have a mental illness, then what is to be done? Nothing? Refuse to acknowledge the people they feel themselves to be? Send them to "conversion therapy" at the local church?

I do not advocate irreversible medial interventions for children. That can wait until, as adults, they are fully informed and choose for themselves to go down that path. What I do advocate is that, when it becomes clear that the dysphoria is not a passing phase, the child is then supported as the person they feel themselves to be and not treated as a recalcitrant psychiatric case. If they child desists in the gender dysphoria nothing is lost. If they persist in the gender dysphoria, and are supported, then parents are less likely to lose their child to suicide.

There was a study published back in February om the BMJ mental health journals entitled: "All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019".

Their findings were that the difference between the rates of suicide between "gender-referred adolescents" and control groups were statistically insignificant. Furthermore, the slight difference there was disappeared entirely when "specialist-level psychiatric treatment" was controlled for (i.e. other serious mental health issues).

It is a finding with important implications because parents are often brow beaten into complying with the social and medical transitioning of their child by this claim. Certainly it is an argument used a number of times in this thread as to why we should support it.

To be clear though, I'm not advocating sending anyone to any kind of "conversion therapy".

[Lagayascienza]

I have read US studies that come to the opposite conclusion - that gender affirming care reduces suicide rates in those with GD. For example, a study by Travis Campbell, Samuel Mann, Duc Hien Nguyen and Yana van der Meulen Rodgers, in
AEA Papers and Proceedings, VOL. 113, MAY 2023 (pp. 551-55) found that supportive family environments and hormone replacement therapy that affirms a transgender child’s gender identity decrease their risk of suicide or running away from home, whereas unsupportive family environments and conversion therapy that denies their gender identity increase these risks. Other studies I have read come to the similar conclusions.

I have found no evidence that "parents are often brow beaten into complying with the social and medical transitioning of their child". On the contrary, there is evidence of certain religious and conservative groups trying to shut down gender affirming care at children's hospitals so that it is not available to young GD people and their parents. This is shameful.

[Fried Egg]

I have read US studies that come to the opposite conclusion - that gender affirming care reduces suicide rates in those with GD. For example, a study by Travis Campbell, Samuel Mann, Duc Hien Nguyen and Yana van der Meulen Rodgers, in
AEA Papers and Proceedings, VOL. 113, MAY 2023 (pp. 551-55) found that supportive family environments and hormone replacement therapy that affirms a transgender child’s gender identity decrease their risk of suicide or running away from home, whereas unsupportive family environments and conversion therapy that denies their gender identity increase these risks. Other studies I have read come to the similar conclusions.

Reading about that study you refer to is interesting although it's not quite looking at the same thing. For one thing, I'm not sure what is meant by "conversion therapy" but that seems like a bit of a false dichotomy. It is not a binary choice between gender affirming care and conversion therapy. To repeat what I have said before: I'm not advocating any kind of "conversion therapy".

But what I like about the study I referred to is that they controlled for specialist-level psychiatric treatment, they found no difference in rates of suicide. In other words, high rates of suicide correlated with mental health problems generally (which is what you might expect) and not having gender dysphoria. As far as I can tell, they didn't control for this in the above study you referred to.

Another study ("Suicidality in clinic-referred transgender adolescents" on pubmed) also came to a similar conclusion, that when you control for mental health problems (such as depression) the differences in the suicide rates between trans-identifying and other children is much closer.

The numbers of young people identifying as trans has skyrocketed in recent years. Some people believe this is due to the widespread use of social media and "social contagion". Others will say that they have always been there, they have just only recently felt safe enough to "come out of the closet". But if the latter theory were true we would expect to have seen an epidemic of suicides among gender-distressed teenagers before “gender affirming” drugs and surgeries first became available in recent years. Yet no evidence of such an epidemic exists. Indeed, rates of suicidal behaviour among youth have increased since 2011.

What we are seeing is an unprecedented mental health crisis among young people (particular among young girls) suffering from things like anxiety, depression, eating disorders, ADHD, autism, and history of sexual trauma. It seems likely that teenagers with suicidal tendencies are gravitating toward a trans identity. We need to find ways of distinguishing between them as it's not in anyone's best interest to be put on the wrong medical pathway.

I have found no evidence that "parents are often brow beaten into complying with the social and medical transitioning of their child".

It is not hard to find many instances of people claiming that the denial of access to gender affirming care is leading to suicides, a "genocide of trans people".

On the contrary, there is evidence of certain religious and conservative groups trying to shut down gender affirming care at children's hospitals so that it is not available to young GD people and their parents. This is shameful.

I agree that this is going too far - an over-reaction that is taking things too far the other way. That seems to be an American thing though, fortunately here in the UK we seem to be taking a more measured approach.

[Consul]

It depends on what exactly "gender affirmation" means. If it means telling a gender-dysphoric person that s/he really is or can really become a member of the other sex, then I reject it in principle.

I assumed you knew what it meant, and that was why you commented as you did? And please don't confuse sex with gender; that's sort of what this topic is about, yes? Understanding the difference between sex and gender?

No! I'm using these terms synonymously, i.e. "gender" as a euphemism for "sex".

"Using 'gender' to mean anything other than sex is to obscure important issues for no good reason."

(Byrne, Alex. Trouble with Gender. Cambridge: Polity, 2024. p. 195)

If "gender" doesn't simply mean "sex", then…

"'Gender' doesn't pick out any one thing; it equivocates among many."

(Briggs, R. A., and B. R. George. What Even Is Gender? New York: Routledge, 2023. p. 5)

[Sy Borg]

If transsexuals do not have issues with an innate sense of gender and they are all completely damaged and insane, why have there been so many successful transitions over many decades?

If you find that a treatment works, you keep using it. However, you don't apply it to those who have similar symptoms but do not have the same problem. That last appears to be the crux of the issue - accurate diagnoses and appropriate, useful treatment options.

Of course, like everything else, the philosophy of the issue is stripped out and replaced with ideological belief and cherry-picked science snippets used to back up said belief.

[Consul]

If transsexuals do not have issues with an innate sense of gender and they are all completely damaged and insane, why have there been so many successful transitions over many decades?

Transsexuals are not "all completely damaged and insane." They do have sex-related mental issues, but I doubt these are best described and explained in terms of (the vocabulary of) gender (identity) theory.

[Sy Borg]

If transsexuals do not have issues with an innate sense of gender and they are all completely damaged and insane, why have there been so many successful transitions over many decades?

Transsexuals are not "all completely damaged and insane." They do have sex-related mental issues, but I doubt these are best described and explained in terms of (the vocabulary of) gender (identity) theory.

Just a bit of cognitive therapy is all they need, eh?

I wonder why no one ever thought of that before.

[Lagayascienza]

One of the findings of the Cass report is that there is a lack of rigorous scientific evidence for gender affirming treatments. However, this does not mean that gender affirming treatments do not work. It is impossible for ethical reasons to do the sorts of studies on children that would give absolutely certain answers. For example, it would be unethical to provide gender affirming treatment to one group and to withhold that treatment from a control group to see which group recorded the most suicides. The best that can be done are retrospective studies that compare kids who got gender affirming treatment against those who, for whatever reason (resort to conversion “therapy”, for example) did not. These retrospective studies indicate that kids who get gender affirming treatments have lower suicide rates. A lot of people don't like this result.

The lack of more rigorous science makes this a difficult and confronting situation for parents. However, if my child did not respond to psychotherapy (because, for example, they had no mental illness) and if my chid persisted in their gender dysphoria and was in danger of suicide, then I would pursue the only avenue available to me and provide gender affirming care. But I would not resort to irreversible medical interventions.

[Sy Borg]

The complaint about "a lack of rigorous scientific evidence for gender affirming treatments is naive. Even a moment's thought makes clear that any transperson who successfully manages to meld into mainstream society will not welcome being questioned about their that from which they risked everything to escape. There is an inherent problem with studies in this area, which is no doubt why rigorous evidence is hard to find.

How do researchers get ten and twenty-year follow ups, when most of the subjects want nothing to do with researchers and just get on with life? Thus, most cases will be those who ran into trouble, who gain (or seek) attention, and it is these who tend to shape the public's opinions because they are weird enough to be newsworthy.