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

[Good_Egg]

Live and let live, and stop obsessing about other people's gender, sexual orientation, sexuality, kinks n wotnot.

I'm not hearing anyone argue against the idea of "live and let live". Just about what it means in practice.

If you mean that we should be tolerant of men exhibiting traits and behaviours that are considered feminine, and vice versa, then yes.

Compared with the past, our society has relatively few male-only or female-only institutions. We have some schools that are single-sex. We have public toilets that are single-sex. We have separate sports events for males & females. And a small number of voluntary social associations - men's sheds, women's groups - where people of the same sex can choose to go to share their experiences away from any pressure to perform for the opposite sex.

Outlawing such single-sex institutions is not "live and let live". Legal action to compel such institutions to accept those of the opposite body-sex is not "live and let live".

"Live and let live" means permitting people their single-sex institutions if they want them.

[Count Lucanor]

But I am left with the mystery revealed by my own introspection. If everyone has an innate sense of gender, why am I not aware of my own? This is in stark contrast with my awareness of my innate sexuality.

By definition, innateness conveys the notion that you are born with some trait, that you do not acquire it after birth, in the social environment. That is not the same as having a trait that has been fixed to your true self and can’t hardly change without traumatic consequences, because this trait could be acquired early in life. When it’s about “the sense of” anything, it implies a perception, a part of conscious mental life, and there’s simply no “environment-free” or “culture-free” mental life. There are innate cognitive responses to environmental factors, but that’s different from conscious awareness of the world, which includes your own self. A “sense of” anything cannot be innate. OTOH, there are unavoidable social experiences that involve your own body and the body of others, from the obvious fact of genitals (primary sex characteristics) to the secondary sex characteristics coming up during puberty. There’s also a culturally-driven perception of male/female behavior that is adopted in your social persona, so you naturally, effortless, learn manners, voice inflections and habits that are more “manly” or “girly”, to fit into the social environment. Some time during your life, your “sense of” this becomes fixed to your true self and I guess you can call it gender identity, which would be your “normal” gender identity, only in the sense that it coincides with the social norm. Any deviation from it has to be the result of something that happened while being raised, in some stage of development (we don’t know how and when), it could even be linked to epigenetics, but that doesn’t mean it is not already fixed to your true self. Any other conception of gender identity as an innate perception of yourself, as a sort of internal spirit that carries your true essence as a person, is nothing but a concession to dualism and, correspondingly, to idealism. All talk about “sex assigned at birth”, which implies this notion, is bonkers.

[Sy Borg]

If you were forced into a woman's role - socially, sexually and sartorially - and not allowed to deviate without punishment, you would quickly learn about comfort in gender roles.

So, I agree that sexuality is innate and usually corresponds with our biological sex but not always.

I also agree that there are other innate differences between men and women, a predisposition to certain behaviours and thinking in different ways. So we might discover in ourselves certain tendencies and behaviours that align with what we come to expect to see in those of a certain biological sex.

But I don't see how an awareness of these things has anything to do with our "gender identity". I thought it meant some inner sense of the gender we see ourselves that transcends our sexuality or other gendered behaviours. But this doesn't seem to be what you are saying. It seems to me you are saying our gender identity is nothing more than an awareness of our own natural tendencies and how well they align with our those of others of the same biological sex.

So, when I say I'm not aware of my own innate sense of gender, I am looking for something different than you are, perhaps something you would agree doesn't exist?

But, if we reduce gender identity to an awareness of which gender our innate tendencies seem to correspond, there seems to be something missing here because, as has been discussed, having atypical gendered behaviours/tendencies doesn't necessarily correspond with a desire to become the other gender. Most gay people at peace with their own sexuality will resent the suggestion that perhaps they were just born in the wrong body (and rightfully so). They have no desire to become the opposite sex. The same goes for having other gender atypical behaviours.

Admittedly, some people obviously are uncomfortable with their biological sex. Most people feel this to some degree, especially going through the traumatic hormonal changes that accompany puberty. For most, this will be a transitory state of affairs that they will grow out of but for some it seems it runs deeper than this, that they don't grow out of this feeling, and actually becomes a real source of emotional distress for them. This might lead such people to desire to become the opposite sex. i.e. Gender Dysphoria.

But that is not the only reason people develop a desire to be seen as the opposite sex. As people such as Debbie Hayton found out about themselves, it arose out of their own innate sexual desires. Such that they were sexually aroused by the thought of themselves as a woman.

Perhaps my original question shouldn't have been "is gender identity innate?" But instead should have been "is the desire to change (or retain) gender innate?"

I think this will be more clear if we place you in an inappropriate gender situation.

A thought experiment: you lost a bet you were certain you'd won and now you have to dress and present as a woman for the next ten years and there are no loopholes.

In that time, you would experience gender dysphoria. You would feel uncomfortable and embarrassed. You would feel ridiculous and out of place. You would feel like a pretender, that you did not belong. You might even find life not worth living.

[Lagayascienza]

Interesting thought experiment, Sy Borg. It would be traumatic, exhausting, debilitating, humiliating ...

[Fried Egg]

I think this will be more clear if we place you in an inappropriate gender situation.

A thought experiment: you lost a bet you were certain you'd won and now you have to dress and present as a woman for the next ten years and there are no loopholes.

In that time, you would experience gender dysphoria. You would feel uncomfortable and embarrassed. You would feel ridiculous and out of place. You would feel like a pretender, that you did not belong. You might even find life not worth living.

Are you asking me, or telling me? I have the feeling that the only answer from me you will believe is the one that fits with what you've said above but I'll try anyway.

Quite frankly, I would not mind dressing "as a woman" and if that was expected of me, I wouldn't mind.

The only sense that I would feel uncomfortable or embarrassed is in so far as women's clothes were impractical for me or how other people around treated me. If the clothing was comfortable and the people around me were fine with me dressing as a woman then I would be fine with it. Why not?

I imagine you may retort by saying that many trans people (who don't pass) feel this way for wearing the clothes of their preferred gender - they are indeed often made to feel uncomfortable by those around them. But that misses the point - they are choosing to wear such clothes. I'm happy to wear whatever clothes are comfortable and make other people around me comfortable. I'm not precious about it.

Maybe you are. Maybe you feel that you need to be constantly asserting your gender identity in your outward appearance otherwise you experience distress? I can't relate to that but if you tell me it's true I'll believe you. I just hope you can extend me the same courtesy.

[Sy Borg]

I think this will be more clear if we place you in an inappropriate gender situation.

A thought experiment: you lost a bet you were certain you'd won and now you have to dress and present as a woman for the next ten years and there are no loopholes.

In that time, you would experience gender dysphoria. You would feel uncomfortable and embarrassed. You would feel ridiculous and out of place. You would feel like a pretender, that you did not belong. You might even find life not worth living.

Are you asking me, or telling me? I have the feeling that the only answer from me you will believe is the one that fits with what you've said above but I'll try anyway.

Quite frankly, I would not mind dressing "as a woman" and if that was expected of me, I wouldn't mind.

The only sense that I would feel uncomfortable or embarrassed is in so far as women's clothes were impractical for me or how other people around treated me. If the clothing was comfortable and the people around me were fine with me dressing as a woman then I would be fine with it. Why not?

I imagine you may retort by saying that many trans people (who don't pass) feel this way for wearing the clothes of their preferred gender - they are indeed often made to feel uncomfortable by those around them. But that misses the point - they are choosing to wear such clothes. I'm happy to wear whatever clothes are comfortable and make other people around me comfortable. I'm not precious about it.

Maybe you are. Maybe you feel that you need to be constantly asserting your gender identity in your outward appearance otherwise you experience distress? I can't relate to that but if you tell me it's true I'll believe you. I just hope you can extend me the same courtesy.

Courtesy? Nah, that would not be philosophy. I'll speak plainly.

Your response is atypical. I am very confident that your ease with being pushed into a different gender role makes you part of a tiny minority.

Most other people would feel intensely uncomfortable, being pushed into presenting as the other sex and dating those whom they don't find desirable. If you didn't pass, life would be terrible for you. It's attention grabbing, so you would have the negative aspects of celebrity, but without the money and access to elite spaces.

[Fried Egg]

Your response is atypical. I am very confident that your ease with being pushed into a different gender role makes you part of a tiny minority.

Most other people would feel intensely uncomfortable, being pushed into presenting as the other sex and dating those whom they don't find desirable. If you didn't pass, life would be terrible for you. It's attention grabbing, so you would have the negative aspects of celebrity, but without the money and access to elite spaces.

Well, you didn't mention "dating those whom they don't find desirable". That completely changes it. As I've already acknowledged, I agree that sexuality is innate and it's obviously not easy to pretend otherwise.

As for merely dressing as the opposite sex, that would make most people uncomfortable because they have been socially conditioned to having to dress differently. Although, it is interesting to note that these days (in western society), it is quite common and perfectly acceptable for women to dress in jeans and a tea shirt (i.e. not in particularly effeminate clothing). So I could actually be dressing "as a woman" without any noticeable change in clothing at all.

Of course, for trans people, they are not merely content with dressing as the opposite sex, they desire to be seen by others as the opposite sex. In any case, it is their choice to dress and present in a way that is at odds with their physical appearance, their actual sex, that is leading them into the uncomfortable. What you're trying to convince me of (and not yet succeeding) is that they are forced to do that because of an inherent uncomfortableness caused by the social expectations of others being at odds with some kind of inner sense of their "true" gender. That is what I can't relate to and I'm afraid your example doesn't do much to help me understand.

[Lagayascienza]

Do people whose gender identity is the same as their biological sex see their gender identity as innate? The vast majority of men and women have a gender identity that matches their biological sex and I think that they would say that their gender identity is innate. They would say that they could not modify their gender identity through learning or inculturation or by any other means. A man whose gender identity matches his biological sex would say he has, since his earliest memories, seen himself as male and that no influences could change his gender identity. If he is right, then gender identity is in place before inculturation. And, if that is so, then why can we not say that his gender identity is innate?

The John/Joan case and others like it seem to demonstrate that gender identity is innate. If that is so, then gender dysphoria, which can be apparent from a very young age, is an indication that a person has an innate gender identity that does not match their biological sex. In 2018 a review of family and twin studies found that there was "significant and consistent evidence" for gender identity being genetically heritable. (See, for example, the Wiki page “Causes of gender incongruence”) The evidence seems to indicate that gender identity is heritable but, even if it is a function of epigenetics rather than genetics per se, it is clear that gender identity cannot be changed with psychological or social interventions even if commenced at a young age.

Therefore, I think we can move on from the question of whether gender identity is innate or not and look at the phenomenon of gender identity itself which seems to have a degree of natural variability and which, like sexuality, is not chosen, but is in some way pre-determined and experienced as a fait accompli. And like homosexuality, an incongruence between biological sex and gender identity is not a disorder but a natural variation that affects a small minority of people in all human populations and cultures. I can only imagine the distress it causes when it is not accepted by a person’s family and wider society.

I’ve read what Fried Egg has said about his(?) lack of gender identity and I wonder what would it mean to have no sense of gender identity? Because I have had a strong sense of my own gender identity (male) for as long as I can remember, I find it hard to imagine it not being present. Fried Egg is the first person I’ve ever heard to say that they have no sense of gender identity. I have no reason to disbelieve him. I guess his lack of gender identity accounts for his assertion that he would not feel discomforted if he had to live and act as a female. I find that strange and fascinating because I know that for me it would be impossibly difficult. I imagine it is similarly difficult for a male who has a female gender identity to be forced to dress and live as a male and for a female with a male gender identity to be forced to live and dress as a female. Having no sense of gender identity would make it easier. But a jock in a frock with no gender identity would still cop a lot of flak.

[Sy Borg]

Your response is atypical. I am very confident that your ease with being pushed into a different gender role makes you part of a tiny minority.

Most other people would feel intensely uncomfortable, being pushed into presenting as the other sex and dating those whom they don't find desirable. If you didn't pass, life would be terrible for you. It's attention grabbing, so you would have the negative aspects of celebrity, but without the money and access to elite spaces.

Well, you didn't mention "dating those whom they don't find desirable". That completely changes it. As I've already acknowledged, I agree that sexuality is innate and it's obviously not easy to pretend otherwise.

As for merely dressing as the opposite sex, that would make most people uncomfortable because they have been socially conditioned to having to dress differently. Although, it is interesting to note that these days (in western society), it is quite common and perfectly acceptable for women to dress in jeans and a tea shirt (i.e. not in particularly effeminate clothing). So I could actually be dressing "as a woman" without any noticeable change in clothing at all.

Of course, for trans people, they are not merely content with dressing as the opposite sex, they desire to be seen by others as the opposite sex. In any case, it is their choice to dress and present in a way that is at odds with their physical appearance, their actual sex, that is leading them into the uncomfortable. What you're trying to convince me of (and not yet succeeding) is that they are forced to do that because of an inherent uncomfortableness caused by the social expectations of others being at odds with some kind of inner sense of their "true" gender. That is what I can't relate to and I'm afraid your example doesn't do much to help me understand.

Of course, sex changes are not just about clothes. If it's just clothes, then that is theatre - drag queens, Dame Edna and Monty Python. So, of course you'd be expected to fulfil the sexual role of woman, just as transpeople are gays are expected to fulfil their usual biological roles, not just dress as them. That's not to mention the innumerable small gendered interactions.

I am simply pointing out that gender identity is obviously real. The innate reaction of the poor lad in the John/Joan case could not make the situation more clear. I was was just riffing with a thought experiment as a corollary. If the thought experiment doesn't resonate, just keep John/Joan in mind. What the poor guy felt was gender dysphoria. He felt like an imposter, like he didn't belong. He wasn't fitting in. He disliked much of what he was expected to do and liked that which he wasn't supposed to do. The sensation was so profound that he was suicidal.

This is real. Consider the insane cost and hassle of having a sex change. Would a person do that if they felt that their regular life was viable or worth preserving. No, they would have to be absolutely freaking out and grabbing the horrific option of changing sex like a drowning person grabs floating jetsam.

Some, no doubt, need psychiatric care; maybe quite a high percentage. Any person who changes sex without any realistic hope of passing would seem to be much better off dealing with their problems or fetishes than turning themselves into ostensible freaks and laughing stocks.

Re: the topic, our focus is better placed on those who are mentally and physically androgynous or undifferentiated, whose issues are about the sense of self in the world, as opposed to the disturbed.

[Fried Egg]

I feel that I need to re-iterate that I am attempting to draw a sharp distinction between gendered tendencies and behaviours (which I do not question and accept are innate) and gender identity. So the fact that I am am attracted to women and not men (a typical male trait), liked playing with with cars, soldiers and robots when I was a child, and exhibit other behaviours and characteristics that are normally viewed as masculine I do not take as any kind of indicator of my gender identity. I imagine it to be some kind of inner sense of gender that is quite apart from all those things. Are we on the same page here?

The John/Joan case is interesting. Clearly he was distressed throughout is childhood and never really accepted the transition that was forced upon him almost from birth. But I do wonder how much of that distress was caused by the process itself. John never exactly had a fully functioning female body. He had some kind of botched attempt at a sex change operation and had to take hormone supplements throughout childhood. John never really had a good reason to think of himself as female because ... he never was.

And if we interpret the John/Joan case as evidence that you can't just socially condition someone into becoming the opposite gender, that is not the same as proving that sometimes we are born with a gender identity that doesn't match our physical body; that is not what happened with John.

I am simply pointing out that gender identity is obviously real.

Maybe I am the weird one? I'm here questioning something that seems so obvious and self-evident to most other people. But if there is a sense of gender that is just there and innate in you is somehow missing in me, it's going to be hard to understand, or to relate to each other's point of view. All I can say is what seems obvious to you isn't obvious to me.

Consider the insane cost and hassle of having a sex change. Would a person do that if they felt that their regular life was viable or worth preserving. No, they would have to be absolutely freaking out and grabbing the horrific option of changing sex like a drowning person grabs floating jetsam.

I have heard that there are significant comorbidities in people referred to gender clinics with other phycological conditions (autism for example) so it is possible that people might resort to such desperate measures in the hope that it will make them feel better. But if the real reason for their psychological distress is something else that it's not actually going to work.

And there have certainly been some examples of people who have regretted it, that it did not actually transform their lives as positively as they hoped it would. Now, I'm not saying that it won't ever help people but part of the problem here is the lack of follow up and study there has been on those who have transitioned. Plus people who do speak out about their regret can attract a lot of hate from the "community" which would naturally deter people from speaking out about it. The truth is that we just don't know how effective such surgery is.

But the fact that people are sometimes driven to such desperate measures does not in itself prove that gender identity is a real thing.

[Sy Borg]

I feel that I need to re-iterate that I am attempting to draw a sharp distinction between gendered tendencies and behaviours (which I do not question and accept are innate) and gender identity. So the fact that I am am attracted to women and not men (a typical male trait), liked playing with with cars, soldiers and robots when I was a child, and exhibit other behaviours and characteristics that are normally viewed as masculine I do not take as any kind of indicator of my gender identity. I imagine it to be some kind of inner sense of gender that is quite apart from all those things. Are we on the same page here?

The John/Joan case is interesting. Clearly he was distressed throughout is childhood and never really accepted the transition that was forced upon him almost from birth. But I do wonder how much of that distress was caused by the process itself. John never exactly had a fully functioning female body. He had some kind of botched attempt at a sex change operation and had to take hormone supplements throughout childhood. John never really had a good reason to think of himself as female because ... he never was.

And if we interpret the John/Joan case as evidence that you can't just socially condition someone into becoming the opposite gender, that is not the same as proving that sometimes we are born with a gender identity that doesn't match our physical body; that is not what happened with John.

That's just rationalisations for the clear fact that John had a gender identity at odds with his social gender.

I am simply pointing out that gender identity is obviously real.

Maybe I am the weird one? I'm here questioning something that seems so obvious and self-evident to most other people. But if there is a sense of gender that is just there and innate in you is somehow missing in me, it's going to be hard to understand, or to relate to each other's point of view. All I can say is what seems obvious to you isn't obvious to me.

You seem to have a very clear and obvious gender identity, so obvious that that you take for granted because it's never been an issue for you.

Consider the insane cost and hassle of having a sex change. Would a person do that if they felt that their regular life was viable or worth preserving. No, they would have to be absolutely freaking out and grabbing the horrific option of changing sex like a drowning person grabs floating jetsam.

I have heard that there are significant comorbidities in people referred to gender clinics with other phycological conditions (autism for example) so it is possible that people might resort to such desperate measures in the hope that it will make them feel better. But if the real reason for their psychological distress is something else that it's not actually going to work.

If the co-morbidities were that common and severe, they would have been picked up in the past. With today's current self-destructive societal movement towards postmodernism and Marxism, medical assessments are perhaps more questionable.

Remember, sex change surgery was previously not considered - and potential transpeople instead underwent lobotmies, elctro-shock therapy, CBT and any other possible alternative. Madness was always the first option when assessing people who were not normal (same with gays) but, over time, there was a growing appreciation that these variants are real.

[Fried Egg]

I feel that I need to re-iterate that I am attempting to draw a sharp distinction between gendered tendencies and behaviours (which I do not question and accept are innate) and gender identity. So the fact that I am am attracted to women and not men (a typical male trait), liked playing with with cars, soldiers and robots when I was a child, and exhibit other behaviours and characteristics that are normally viewed as masculine I do not take as any kind of indicator of my gender identity. I imagine it to be some kind of inner sense of gender that is quite apart from all those things. Are we on the same page here?

The John/Joan case is interesting. Clearly he was distressed throughout is childhood and never really accepted the transition that was forced upon him almost from birth. But I do wonder how much of that distress was caused by the process itself. John never exactly had a fully functioning female body. He had some kind of botched attempt at a sex change operation and had to take hormone supplements throughout childhood. John never really had a good reason to think of himself as female because ... he never was.

And if we interpret the John/Joan case as evidence that you can't just socially condition someone into becoming the opposite gender, that is not the same as proving that sometimes we are born with a gender identity that doesn't match our physical body; that is not what happened with John.

That's just rationalisations for the clear fact that John had a gender identity at odds with his social gender.

The scientific approach is to consider all possible interpretations of the evidence, but just to sweep aside anything that doesn't fit with one's pre-conceptions. It is certainly not as clear cut and settled as you seem to believe. For a start, we need to have a clear understanding of exactly what we mean by gender identity.

I am simply pointing out that gender identity is obviously real.

Maybe I am the weird one? I'm here questioning something that seems so obvious and self-evident to most other people. But if there is a sense of gender that is just there and innate in you is somehow missing in me, it's going to be hard to understand, or to relate to each other's point of view. All I can say is what seems obvious to you isn't obvious to me.

You seem to have a very clear and obvious gender identity, so obvious that that you take for granted because it's never been an issue for you.

My sexuality has never been an issue for me which I might take just as much for granted but never so much that I'm not aware of it. No, you need to be more explicit about exactly what gender identity is. You have constantly refrained from doing so. You can't just keep saying it is clear and obvious. Are you saying gender identity is nothing more than the set of gendered tendencies and behaviours we have? Or is that merely a part of it? Or is that completely separate to what you mean by gender identity? I don't see how we can get any further unless you clarify exactly what you mean.

Consider the insane cost and hassle of having a sex change. Would a person do that if they felt that their regular life was viable or worth preserving. No, they would have to be absolutely freaking out and grabbing the horrific option of changing sex like a drowning person grabs floating jetsam.

I have heard that there are significant comorbidities in people referred to gender clinics with other phycological conditions (autism for example) so it is possible that people might resort to such desperate measures in the hope that it will make them feel better. But if the real reason for their psychological distress is something else that it's not actually going to work.

If the co-morbidities were that common and severe, they would have been picked up in the past. With today's current self-destructive societal movement towards postmodernism and Marxism, medical assessments are perhaps more questionable.

Remember, sex change surgery was previously not considered - and potential transpeople instead underwent lobotmies, elctro-shock therapy, CBT and any other possible alternative. Madness was always the first option when assessing people who were not normal (same with gays) but, over time, there was a growing appreciation that these variants are real.
[/quote]

[Fried Egg]

I meant to add:

If the co-morbidities were that common and severe, they would have been picked up in the past.

We have had a recent explosion of people identifying as trans, and it is in this recent trend that we evidence of comorbidities. What this points to is many people (not all) being too readily diagnosed as having gender dysphoria when in fact the real problem is something else.

[Lagayascienza]

Could you point us to recent statistics from peer-reviewed studies showing an increase in people identifying as trans? Could you please also point us to studies showing the comorbidities you mention? I've search but can find little that is conclusive.

[Fried Egg]

The evidence is very easy to find. I can't post links though as I don't have the ability to do that on this site.

For instance, the British Medical Journal reported that cases increased five fold between 2000 and 2018 (and rose highest in young people).

And as for comorbidities, a quick search just now turned up:

• "Gender dysphoria and psychiatric comorbidities in childhood: a systematic review" (Taylor and Francis Online)
• "Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women" (National Library of medicine)
• "Prevalence and Comorbidity of gender dysphoria in Taiwan. 2010-2019" (Springer Nature Link)

There are many others besides. Whether you will find any of these things convincing enough I don't know but I think there's certainly enough evidence to be concerned and to be a cause for further research at the very least.

The story around closure of the Tavistock clinic in the UK should be of concern to everyone. To quote from an article in the Newstatesman (written by Hannah Barnes):

What has unfolded there over the past decade or so is quite exceptional. The service referred around 2,000 children under 18 for puberty-blocking drugs, without robust data to support that decision. When evidence emerged indicating that this medical intervention wasn’t benefiting many of the young people receiving it, the service did not change its approach. Nor did it follow up with any of its patients to see how they were faring. Faced with an exponential increase in referrals, and a fundamental shift in the demographics of those requesting its help, Gids ploughed on. However, it buckled under the pressure of growing demand. The leadership of the service – along with that of the NHS Trust that housed it – was inadequate and shut down the serious concerns of a growing number of their own staff.

60-70 percent of the children referred there were gay. The article went on to say:

For others, their trans identification had come after facing homophobic bullying and coming out as gay or lesbian. So common was this that Dr Matt Bristow, a clinical psychologist who worked there, and others came to feel that Gids was performing “conversion therapy for gay kids”.

Also:

Gids clinicians were also concerned about the levels of autism and neurodiversity they were seeing in their patients, and wondered whether this too might be impacting on their trans identification. Less than 2 per cent of children in the UK are thought to have an autism spectrum disorder (ASD). Yet, according to Gids, “around 35 per cent of referred young people present with moderate to severe autistic traits”. There were even young people presenting at Gids who didn’t just identify as another gender, but as another ethnicity too. But they were assessed for their gender identity difficulties as if the other issues were not important, or an indication that perhaps this young person might be struggling more generally.

There's been so much that has come out in recent times. I'm not even getting on to the WPATH files. So it surprises me that anyone interested in this topic would not have encountered any of this.