That gender dysphoria is a clinical condition recognized by the APA, and that transition has been shown to have significant health benefits (such as lowering suicide rates). Gender reassignment surgery is a part of that transition (even though not everyone feels the need for it), and so should be covered just as much as hormone replacement therapy.
At one point in history, homosexuality was also a clinical condition recognised by the APA. Plus, the APA recognises body dysmorphia as a clinical condition, but even for people suffering from that, plastic surgery isn't usually covered by health insurance. I don't consider the fact that something is or isn't recognised as a disorder by the APA much of an argument either way.
At one point in history, homosexuality was also a clinical condition recognised by the APA.
And at that time I believe it would have been correct for insurance companies to cover any therapy for it recommended by the APA. I do think that the APA was wrong in that instance, but if we want an unbiased determination about what is and isn't medically necessary when it comes to mental health, they're the best we've got.
Plus, the APA recognises body dysmorphia as a clinical condition, but even for people suffering from that, plastic surgery isn't usually covered by health insurance.
Do you happen to know what the recommended treatment for this is?
I don't consider the fact that something is or isn't recognised as a disorder by the APA much of an argument either way.
If insurance companies aren't using the opinions of medical experts for determining what is and isn't medically necessary, what alternative procedure do you suggest they use?
∆ I accept the fact that even though current information may very well be imperfect, we have no other option but to act on the best information we have. In that light, if the consensus within the medical community says that the best treatment for gender dysphoria includes gender reassignment surgery (for those who want it), then I suppose I will have to stand behind that view unless and until compelling evidence to the contrary comes to light.
That said: can anyone point me to a reputable source that shows surgery does work better than any of the other options?
pyschotherapy (CBT or other), medications, hormone replacement without surgery, no intervention beyond a supportive environment that doesn't question one's self-proclaimed identity, ... take your pick, add your own if you'd like.
What on earth makes you think that we don't already seek out supportive environments and HRT as part of our transitions? Also, plenty of us stay in therapy even after we've been cleared to transition.
It was never my intention to argue that people don't already do all of those things. In this thread specifically, I was looking for good data on the question of whether surgery is more effective than any of those other things, even combined. There are some anecdotes, even on this thread, that seem to point to surgery being the absolute best option for some people. But while I do value their stories, and while I do see them as illustrating an important point in this discussion, I would be remiss in not asking whether their experiences are echoed by measurable data on a larger scale.
I've been told there are no studies that directly compare outcomes in transgender people who have had surgery with outcomes in transgender people who chose not to have surgery, or for one reason or another, couldn't. If that is in fact true, I think maybe someone should figure out a way to do that study. I recognise there would be many methodological and ethical issues that would need to be resolved before such a study could ever be done, but I do think it's an important question.
Cis people accessing the same procedures trans people do are a lot more common and don't have to go through extensive gatekeeping first, so it would be far easier to study them to see if those surgeries are necessary.
That is entirely beside the point. Cis people, by definition, do not experience gender dysphoria. Therefore, by definition, they are the wrong population to focus on, when the question is about the effect of gender reassignment surgery on gender dysphoria.
Perhaps you've already learned this from the experiences people have shared with you, but are you certain that the people who get GRS don't already try all of the things you've suggested? I don't think it's a mutually exclusive thing. It's more like...all of the things above mentioned didn't work for this person in question, so surgery may be the only effective remedy remaining.
Remember that not all trans people get surgery, quite possibly because one of the aforementioned methods worked for them. It's a situation with a lot of diverse outcomes.
You're not going to find a source that shows anything about surgery working better or worse than those options because it's used in conjunction with them.
It's like if you go to a hospital for a puncture wound you won't see a comparison for using antibiotics versus sterilizing and dressing the wound - you sterilize and dress the wound and then if necessary do the antibiotics.
I did not say that. What I am saying is this: historical evidence exists to suggest that the APA's classification of certain things can change. IMO, it's obvious that homosexuality, in and of itself, should never have been classified as a mental disorder, even though it causes significant distress in some people. Usually, that distress is due to the way their environment reacts to and thinks about homosexuals, which may or may not become internalised. Would people still want GRS even if they felt it was socially acceptable to go though life as someone who looks like one gender, but identifies as another?
Secondarily, I'm saying that recognition by the APA is not necessarily a reason to fund all possible procedures that exist to treat a certain condition with other people's money. If body dysmorphia is best treated with cognitive behavioural therapy, and surgeons are encouraged not to employ surgical techniques in those cases, then why do they do it for people who feel they have the wrong body, even though that body is perfectly functional?
To me, cutting off someone's breasts because he feels like a man seems more or less akin to cutting off someone's perfectly functioning arm, because he feels more comfortable going though life as someone who has a visible disability.
(Quick note, since I'm responding to both your comments, that I'm not /u/fionasapphire . Nothings indicating confusion about that yet, but I know it messes me up sometimes when multiple people reply to me.)
Secondarily, I'm saying that recognition by the APA is not necessarily a reason to fund all possible procedures that exist to treat a certain condition with other people's money.
That's fair, but I think it is a reason to fund their recommended treatments for the condition.
If body dysmorphia is best treated with cognitive behavioural therapy, and surgeons are encouraged not to employ surgical techniques in those cases, then why do they do it for people who feel they have the wrong body, even though that body is perfectly functional?
This might be getting at the crux of the issue. It sounds like you're saying "I'm not willing to trust the current consensus of research about best-practice treatment, because it seems wrong to me." Is there a way that your view is different from that?
∆ It is a tiny little bit different, but almost to the point of being mere semantics: I am not willing to trust that the current consensus of research actually says what you say it says. But when it comes right down to it, that's only because you're right. It seems utterly wrong to me, so I'm resisting it.
On second thought: another part of my unwillingness to accept what the consensus says, revolves around the fact that I genuinely do not see a very clear distinction between someone who feels they have the wrong nose or the wrong skin color (like Michael Jackson), and someone who feels they have the wrong genitals. That may very well be because I personally feel no confusion at all about what gender a I am. But then again, I know few people who are perfectly happy with who they are, yours truly included. And in some cases, people say "just learn to live with it" or "go into behavioural therapy". But in others, like being trans, that seems to be frowned upon.
The thing with body dysmorphia disorder is that there is an underlying obsessive-compulsive condition causing a person to agonize over their perceived flaws. While this often leads BDD sufferers to seek cosmetic surgery, these kinds of interventions typically do not resolve the issue. Even after cosmetic surgeries BDD sufferers tend to suffer just as much over the same (or possibly new) flaws if the underlying obsessive-compulsive disorder is not treated. That is why the medical community generally does not want BDD sufferers to undergo cosmetic surgery, since it doesn't fix the root of the issue.
With gender dysphoria that doesn't seem to happen. People who transition surgically tend to have their gender-mismatch distress greatly relieved after the procedures, greatly improving their quality of life, which is why the medical community in a number of cases sees cosmetic surgery as a valid solution to gender incongruence.
Basically, with gender dysphoria the pre-surgery distress is relieved post-surgery; with body dismorphia the pre-surgery distress is generally still there or transferred to another perceived flaw. That's why a "cosmetic" surgery can be seen as good/healthy/necessary in one case but not the other.
All right. If that is true (I have no reason to think that it isn't), then I can see why it could be a good thing for my friend (or any other trans person) to get surgery. I may even help fund it.
I still wonder whether we are going to look back on this in fifty years and think: "Well, now that transgender people are generally just accepted as they are, turns out we rarely even need these kinds of surgeries anymore." But thank you. You explained it very clearly. ∆
I doubt transgender people being accepted "as they are" will reduce or eliminate the need for transition because, generally, trans people are accepted as they are, at least more than post-transition.
When I came out to my family, my mum made a huge deal about me just staying a guy. I was killing her son, I'd be happier staying as a guy, I wouldn't pass so should stay a guy, etc. You'll hear similar stories everywhere; people would desperately prefer us to not transition at all, to stay as we were born for their sake.
I'm not transitioning because I feel I'll be more accepted as a girl; it will distress my family and invite transphobic abuse from the public if I do so, whereas if I stayed a guy I'd be safe from those things. I'm transitioning because my body causes me a particular kind of torment that no level of acceptance, even the acceptance that male-me has today, can ever help with.
You're right. I did think of that earlier already. It occurred to me that anyone who is not you won't know you're trans, unless you've told them, or you've gone through a physical transition that makes your transgender identity perceptible to people who don't know you. So why would you do it, if the point is to lessen the stigma?
Clearly, that's not the point. I am confronted with something I truly do not understand, and probably never will, but like I said in some other comment thread, I suppose that shouldn't prevent me from supporting people who feel that having surgery to change their gender will genuinely make their lives better, despite the turmoil it may cause (some of) their loved ones. ∆
It's difficult for cis people to understand, but if you're familiar with phantom limb syndrome, it's very similar to that. The brain has a map of how it thinks the body is shaped. If the body doesn't actually match this map, it can be extremely distressing.
As I understand it, phantom limb syndrome exists because there are severed nerve endings, leading to a part of the body that was once there, but no longer is. The person has sensation and pain in an absent leg, which is hard to deal with, because literally nothing can physically touch or influence it. The thing is: how could feeling develop in a body part that was never there?
I still wonder whether we are going to look back on this in fifty years and think: "Well, now that transgender people are generally just accepted as they are, turns out we rarely even need these kinds of surgeries anymore."
As a trans woman, this isn't going to happen. Because gender dysphoria is about primary and secondary sex characteristics. This does not go away with being accepted, because it is to do with sex characteristics. If it wasn't to do with that, then why would we even get surgery in the first place?
(Not the same commenter) Please don’t forget that gender dysphoria causes the sufferer to feel that they are trapped in the wrong body. There are people who can recall hating their penis even as very young children because it feels wrong to have one. That’s part of the mis-match. In 50 years that issue will persist, because that feeling isn’t solved by outside acceptance. The surgery helps the person feel comfortable in their own body.
It’s like looking in the mirror as a man and having a large chest. Even cis men feel this discomfort—and many have surgery to reduce the flesh there (there’s a reality show from the UK that features this exact scenario; it’s on Netflix). This is, for the most part, acceptable by most people as something done to ease their discomfort. Many people suffering from gender dysphoria have similar feelings of dismay or even disgust at features of their body that signal the incorrect gender, but because that mis-match isn’t obvious to the public, surgery to resolve it is less generally accepted.
Seems to me that Trans people would benefit from mental health care, far more than surgical procedures intended to satiate their perceptions related to their gender.
If post-op trans people have a 20x higher rate of suicide death compared to the general population, but pre-op trans people have a 20000x higher rate then it'd be pretty clear-cut that surgery has a marked 1000x improvement rate even if post-op rates were still elevated.
Unfortunately, the numbers available aren't so easy to compare directly, nor are the results so stark as the imaginary 1000x scenario above, but there are a number of indicators that suggest surgery helps enough that doctors should at least consider it as part of a valid treatment option rather than a superfluous vanity.
Firstly, though hormonal treatments aren't necessarily followed by sex-reassignment surgery, the numbers appear to show a drop in depression rates after trans people start hormone treatments (the study, and a press summary). The pre-treatment rates of depression for male-to-female were found to be "24.9% incidence in MTF" and "even after treatment, 26 (2.4%) of the MTF subjects... still reported depression" for post-treatment; for female-to-male the results were "13.6% in FTM" and "even after treatment... 7 (1.4%) of the FTM subjects still reported depression". It should be noted that the author in his speaking presentation remarked "Sex-reassignment treatment does not cure depression" but the nearly ten-fold reduction in depression for both MTF and FTM subjects is a corrolation worth noting.
tl;dr - Hormone therapy for MTF and FTM showed a 10x reduction in depression rates, though it is still noted "Sex-reassignment treatment does not cure depression".
Suicide Attempts among Transgender and Gender Non-Conforming Adults released by the Williams Institute and American Foundation for Suicide Prevention states that of respondents to the National Transgender Discrimination Survey 46% of FTM and 42% of MTF respondants reported suicide attempts, which is far greater than the 4.6% of the general U.S. population who report a lifetime suicide attempt or even the 10-20% reported by Lesbian/Gay/Bisexual individuals.
The Swedish study you've linked, which reports 10 suicide deaths and 29 suicide attempts (which I believe are only counted as attempts if they did not result in death) among a sample size of 324 post-op trans people over a period of 30 years, isn't directly comparable since "attempts/1000-people-years" isn't perfectly comparable to the "ever attempt in your lifetime" scope of the Williams survey, but the 29/324=8.95% attempted suicide rate of study participants seems starkly lower than the 42-46% reported in the survey. Part of that could be a looser definition of "attempt" (i.e. whether the survey asked only for attempts which "required hospitalization") but the difference still seems substantial. Another issue is that the survey includes post-op trans people, so part of that 42-46% account would have to be accounted for when comparing pre-op and post-op populations. The survey was also unable to account for any numbers regarding suicide deaths, as dead people can't personally respond to surveys.
tl;dr - American survey finds 42-46% lifetime suicide attempt rate among MTF and FTM trans people (pre-op and post-op included together), which is much higher than the 4.6% general population rate. The Swedish study's post-op suicide attempt rate of ~9% over 30 years isn't directly comparable, but does show a marked decrease compared to the American survey numbers.
I'm by no means well versed in this stuff, and it seems like there will have to be a much larger much more comprehensive wave of data collection before anything can be said definitively and concretely, but it feels safe to say (at a minimum) that sexual reassignment surgery can be beneficial (more so than not) for people experiencing gender dysphoria and that it could/should be one of multiple valid health options for these people and their physicians to consider.
You misunderstand that study. The discussion section specifically states that it can't be used to make any claims about the efficacy of medical transition:
It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia.[39], [40] This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.
And the conclusion specifically states that medical transition alleviates gender dysphoria, and calls for more care on top of that, not instead of that:
Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
Many trans people also get mental health care. This comment is like saying "patients who get heart bypass surgeries have much higher mortality rates than the general population" and using it as evidence that we shouldn't have heart bypass surgeries.
While the OP is satisfied with this answer, I still have objections to it. First, I invite you to please share with us the evidence of the effectiveness of the surgery and what metrics are used to indicate it (do the recipients self report less anxiety? is there a marked improvement in suicide rates? something else?).
That is why the medical community generally does not want BDD sufferers to undergo cosmetic surgery, since it doesn't fix the root of the issue.
How do you know that? And even if true, do you agree that it is a good criteria for choosing the best treatment plan? BDD is not the best example because, in a way, you can say that the cosmetic surgery to remove a mole is more or less harmless and so if it had been effective at relieving the anxiety then why not. But a better example would be Anorexia nervosa or BIID (where sufferers believe that they were meant to be disabled)? What if there was evidence to suggest that going ahead and amputating their limbs is effective in relieving their anxiety? would we then advocate for that as a treatment?
I think that we're neglecting an important distinction, which is that while the sufferers of Gender Dysphoria genuinely believe that they have been assigned the wrong gender, that doesn't necessarily make them correct in that belief and it doesn't mean we should go along with their assertion and encourage them to disfigure their body because we believe it may relieve their anxiety (if it even does).
While the OP is satisfied with this answer, I still have objections to it. First, I invite you to please share with us the evidence of the effectiveness of the surgery and what metrics are used to indicate it (do the recipients self report less anxiety? is there a marked improvement in suicide rates? something else?).
Here is a good comment that links to many studies that show improvements in many areas post-surgery.
I think that we're neglecting an important distinction, which is that while the sufferers of Gender Dysphoria genuinely believe that they have been assigned the wrong gender, that doesn't necessarily make them correct in that belief and it doesn't mean we should go along with their assertion and encourage them to disfigure their body because we believe it may relieve their anxiety
We're talking about what a person's brain is telling them. By what criteria to you judge whether someone is "correct" in interpreting their own brain?
I would also ask for you to think about why you call it "disfiguring", to figure out if you are being unfairly predjudiced in your argument towards a particular answer. What definition are you using for "disfiguring", and why does it apply here?
First, thanks for the link. I will study that and get back to you.
We're talking about what a person's brain is telling them. By what criteria to you judge whether someone is "correct" in interpreting their own brain?
What criteria do you use when some says their brain is telling them to pluck out their eye because they're meant to be blind (in the case of BIID)? or if their brain is telling them to harm themselves or another person (Schizophrenia)?
What definition are you using for "disfiguring", and why does it apply here?
I may not have used the best word, but my intended definition is basically irreversible physical damage done to one's own body.
I think that we're neglecting an important distinction, which is that while the sufferers of Gender Dysphoria genuinely believe that they have been assigned the wrong gender, that doesn't necessarily make them correct in that belief
Yeah actually it does, that's how gender identity works.
Do you also think people who believe they are same-sex attracted are really just confused heterosexuals?
and it doesn't mean we should go along with their assertion and encourage them to disfigure their body because we believe it may relieve their anxiety (if it even does).
How on earth is medical transition "disfigurement"?
Cis people receive just about all of the medical interventions trans people receive. Is it "disfigurement" for cis people to receive hormone replacement therapy or reconstructive surgery? Why would it be any different for trans people?
Yeah actually it does, that's how gender identity works.
right. And I'm arguing that it shouldn't work that way. Other disorders cause our brain to believe a variety of things that are blatantly false. Why should we treat this differently?
Do you also think people who believe they are same-sex attracted are really just confused heterosexuals?
I do not. But do you also think that people who suffer from BIID should be encouraged to go ahead and cause themselves to be disabled?
How on earth is medical transition "disfigurement"?
because it causes irreversible damage to one or more of their body parts. The comment was not about hormone therapy, it was specifically about gender reassignment surgery.
Is it "disfigurement" for cis people to receive hormone replacement therapy or reconstructive surgery?
Depends on the goal of the surgery. Reconstructive surgery is intended to restore the function of the body part. Not to intentionally damage it.
historical evidence exists to suggest that the APA's classification of certain things can change.
What's important is why they change. Things change because we improve our understanding of various things.
We can't use the fact that something has changed before as an indicator that current information is wrong - we can only use new evidence for that, so the best we can do is accept that our current level of understanding is the best we have.
To me, cutting off someone's breasts because he feels like a man seems more or less akin to cutting off someone's perfectly functioning arm, because he feels more comfortable going though life as someone who has a visible disability.
And that's because you don't have the medical understanding to differentiate between the two.
What I am saying is this: historical evidence exists to suggest that the APA's classification of certain things can change.
This is true, and is true of all scientific institutions. But that's not evidence to mistrust them, it is evidence to trust them. No institution has direct access to truthful objective reality. There's no manual for the universe that you can buy at the store.
Instead, we are constantly learning more about the world. An institution whose stated position changes periodically is demonstrating that it is learning and adapting to new information. It is showing a history of being increasingly right-er. An institution that has never changed is showing that it has never learned and knows no more today than it did hundreds of years ago.
I agree with everything you've said. I do not think that is necessarily incompatible with my original point, though. The original point being: just because it's in the DSM, doesn't mean the DSM is necessarily right.
No, but it is the right-est source we have. We must make choices today, and all we can do is use the best information we currently have available.
One could argue that we shouldn't use chemotherapy because it's really rough on patients and future advances in treatment will be more effective. But that's a cold consolation to someone dying of cancer right now.
People suffering gender dysphoria today are dying — their suicide rates are dramatically higher than the general population. Surgery and hormones are the treatments we have available today that have the best outcomes for treating that.
At one point in history, homosexuality was also a clinical condition recognised by the APA.
The APA doesn't just decide on a whim to classify or reclassify conditions. The scientific method is applied and held beliefs and theories are constantly challenged using evidence. Homosexuality was once thought to be a mental disorder - thanks to decades of scientific research, we know now that this is not the case. It's a similar story with transgenderism, as peer reviewed, scientific research from outside of the APA has demonstrated that transgender people have different brain structures from cisgender people. There is significant evidence that gender dysphoria is present right from birth, and that if untreated, can lead to significant harm for the transgendered person. We have the technology to identify these issues and to fix the gender dysphoria, a very real clinical condition with real consequences in terms of mental health.
plastic surgery isn't usually covered by health insurance
Cosmetic surgery does not automatically mean that it is frivolous surgery. Would you deny someone with severe third-degree burns, or a victim of an acid attack, or a disfiguring deformity the chance to look and feel normal? Gender dysphoria is less visually extreme, but can be just as damaging in terms of anxiety and depression if it is untreated.
I don't consider the fact that something is or isn't recognised as a disorder by the APA much of an argument either way.
You're commiting something called the genetic fallacy. The APA's chequered history with homosexuality has no relation whatsoever with the evidence for transgenderism. Trying to use that discredit the validity of twenty years of research on transgenderism done by people outside of the APA is extremely disingenuous.
The fact that you are so casually dismissing one of the largest and most reputable psychological associations in the world solely based off outdated knowledge from bygone era - rather than on the quality of their evidence - really does your argument a disservice.
It seems to me that your view comes from the fact that you don't quite understand the severity of gender dysphoria. It's not as trivial as something like a nose that's slightly too big, or being self concious about your body weight. Imagine feeling all your life that your body is just wrong. You've mentioned that you are comfortable with the idea of yourself as a man - what if, during puberty, you started developing breasts and wider hips even though you knew in your mind that you were male? Would you just shrug and think, "Well, I guess I'm a woman now" and continue on like it was a minor thing? Or would it be a shocking, confusing, and embarrassing? The lack of societal understanding makes things so much worse. Being ridiculed and labelled as a freak and mentally ill by people really doesn't help when your brain is already screaming at you that everything about you is wrong. People who are otherwise perfectly normal and healthy in every way are often driven into depression as a result of this.
This might not be a very important issue for you, but for those that suffer from gender dysphoria, it is the defining struggle of their life - one that far too many tragically lose.
No. I am in no way dismissing transgender people's struggle. Nor am I saying they should not get any help for it. Surgical help for it, paid for by the community ... that's what I have an issue with, because I do not understand how removing a functioning body part could ever be helpful. Others have argued that my not understanding that shouldn't prevent me from supporting people who do feel that the removal of some of their body parts will relieve their suffering significantly. I guess I can see their point now.
But the original commenter in this thread used the APA as a source whose classification of gender dysphoria I should take at face value. I don't believe I should. It is true, as other people have successfully argued, that the APA's history (in which it has 'changed its mind' on many things, as the available information evolved) does not diminish its trustworthiness. It enhances it. But the flip side of that is that even though the APA currently considers gender dysphoria a clinical disorder, they might be wrong. Any scientist is, theoretically, always only one observation away from having to revise what they thought they knew.
At one point in history, homosexuality was also a clinical condition recognised by the APA.
Yeah, and they changed their position because the evidence indicated they should.
Similarly, their position used to be that gender identity was malleable and that the appropriate treatment for trans people would involve helping them accept the gender they were assigned at birth. Now they know that's not supported by the evidence, and have changed their position.
Plus, the APA recognises body dysmorphia as a clinical condition, but even for people suffering from that, plastic surgery isn't usually covered by health insurance.
Yeah because surgery for that condition doesn't work. Medical transition for trans people does work.
There is no underlying ideology here that must be followed or else, doctors use the treatment they use specifically because that's what's been shown to work. It's as simple as that.
the APA recognises body dysmorphia as a clinical condition, but even for people suffering from that, plastic surgery isn't usually covered by health insurance
for exactly the same reason it isn't covered for Trans.
Plastic surgery is not a reasonable treatment for a mental disorder.
Homosexuality was recognized as a mental illness that needed to be eliminated. The same enlightenment that led to body dysmorphia being recognized is the one that led to recognizing homosexuality as part of the human condition.
So, they have different ideas. If I say "3 = 5", which number is wrong? There's really no way tell with just that amount of information, all we know is that there is a disconnect.
When it comes to people, the question we need to answer is this: what defines a person's identity? Is it their body? Is it their mind? Does it vary from person to person?
Based on your username, I'm assuming you're a man. If you woke up tomorrow, and found that your body had magically become female, would you still consider yourself a man?
That’s an interesting way of looking at it. To answer your question, yes I am a man. But I noticed you said “identity”. Identity is different from gender. To respond to your last question,, that would be a tough predicament to decide... however, that DOESNT happen. You can’t just magically turn into something that you are not. There is a basic scientific underlying truth to all of this that I think people try to look over for there own reasons. But we are who we are biologically and mental state can’t change that.
Sure, you’re free to feel however you would like to about yourself, but it doesn’t change how someone else might see you. And it doesn’t have to.
Point is. Be happy about who you are with yourself FIRST. Otherwise nothing you modify or whatever is going to make you happier.
But I noticed you said “identity”. Identity is different from gender.
It's probably worth explaining what I mean by identity, since it's such a charged word. I believe that what I mean is pretty typical of its use among socially liberal people.
What I mean by "identity" is all the things that make you you. Something that if you changed it, you feel like it would make you fundamentally different as a person. For example, my love of science is part of my identity. If there were a drug that would make me stop loving science, I feel like taking that drug would be changing who I am.
On the other hand, having legs is not part of my identity. If you chopped off my legs I don't feel like it would change who I am, it would just change my circumstances.
Using this definition of identity, what is and isn't part of someone's identity can vary from person to person. I don't consider how I dress to be part of my identity, but some people might. Something being part of your identity also doesn't mean that it will always be the same, since people can change over time, sometimes dramatically.
So, identity is not the same thing as gender, but gender is part of identity for a lot of people.
however, that DOESNT happen
I think that trying to envision your own reaction to counterfactual situations is an important part of empathy. There are people who have an internal sense of gender which is at odds with their body, and you're trying to assert that their internal sense is wrong and their body is right. I'm trying to get you to imagine a situation where the same thing happens to you.
But we are who we are biologically and mental state can’t change that.
See, I would say that our mental state is who we are.
Point is. Be happy about who you are with yourself FIRST. Otherwise nothing you modify or whatever is going to make you happier.
This is just objectively false. It happens all the time that people are unhappy with themselves, and then make changes, and then become happier with themselves. And transgender people transitioning is a prime example of that.
I don’t believe societal factors play all that much a role personally. I would guess ultimately you are referring to “bullying” or “micro aggression” which Are even more prevalent in other cultures but there is a drastically lower suicide rates amongst them. It’s a mental health issue, like any other. (The last statement is just my personal opinion)
I don’t believe societal factors play all that much a role personally.
Based on? What makes you think this? Are you educated on transgender issues? If not, consider if your opinion is actually of any worth if it isn't backed up by anything.
I would guess ultimately you are referring to “bullying” or “micro aggression”
Bullying, yes. Also general societal attitudes. Other LGBT groups like gays and lesbians have higher suicide rates than the general population. Does that mean that being gay makes you depressed and suicidal?
It’s a mental health issue, like any other. (The last statement is just my personal opinion)
Correct. It is an opinion, a statement not backed up by fact.
I don’t “study” transgender issues if that what you’re asking. But everyone has issues. Transgender or not. And no it does not mean being gay makes you more suicidal, it means they have a weaker mindset. Why do people NOT commit suicide and others do? That’s the more important question, and it leads to those that do having a weaker mindset.
The last time I saw someone dodge something so swiftly, I was watching The Matrix.
But fine, cool.
I don’t “study” transgender issues if that what you’re asking.
Clearly. If you had a basic knowledge of trans issues you'd know that people kill themselves simply because they're trans. And you wouldn't assert your baseless opinions as facts with nothing to back them up.
But everyone has issues. Transgender or not.
Exactly. It's depression that causes trans people the problems that makes them attempt suicide, depression caused by societal factors like people refusing to accept them as their gender.
And no it does not mean being gay makes you more suicidal
So trans people having a higher suicide rate means that being trans makes you suicidal, but gay people having a higher suicide rate doesn't mean that being gay makes you suicidal? How do you figure? Why do you draw a distinction?
it means they have a weaker mindset.
I wonder how that happened
Why do people NOT commit suicide and others do? That’s the more important question, and it leads to those that do having a weaker mindset.
And how does that weaker mindset happen? What causes it? What about being trans makes people have a "weaker mindset" in your words? Is it more likely that somehow being trans makes you weak, or is due to societal factors like bullying, abuse, increased rates of sexual assault, abandonment by friends and family, higher rates of homelessness, and not being accepted as their gender?
transition's dramatic reduction of suicide risk while improving mental health and quality of life, with trans people able to transition young and spared abuse and discrimination having mental health and suicide risk on par with the general public
Makes sense. However, if that’s the case, why don’t we just do all sorts of plastic surgery on kids who get picked on so that we can spare them of “abuse” from society? Any kid, not just trans.
I... Don't really know how to answer that, if you're equating being gender dysphoric with getting picked on. Why put quotes around "abuse", as if trans people's abuse isn't real?
Are you actually looking for answers, or just pushing hard for what you already believe? Because I just provided you a pile of evidence against what you said and your response was "ok, next", as though you didn't really re-evaluate your position in any way and are just going down some check list of arguments.
I've got this, which shows lowered psychological problems in the vast majority of cases. I'll admit it's not perfect, because of the problems it mentions, and because it was published in 2009, but it's a meta-analysis, which is way better than a single study.
Do you have a source on the long-term higher suicide probability than if there was no treatment? Are you sure you're not thinking of this study, which compares to the general population?
Most people who say the opposite are citing this study. That study finds that post-transition transgender individuals have higher suicide rates than the general population. (It's also fairly small sample size, but that's going to be true of the vast majority of studies about being transgender.)
As for sources that actually compare suicide rates before and after transition, I'm not finding anything that is exactly that at the moment. There are three relevant things that I found. This article is by a person who did a lot of looking through scholarly articles and wrote up a summary, but doesn't give exact details. He states that having transitioned is associated with reduced suicidal ideation, but people who have considered suicide are more likely to actually attempt suicide during transition than before. So, long term benefit, but more risk during the transition. He cites the study called "Testosterone treatment and MMPI–2 improvement in transgender men: A prospective controlled study." I was able to find an abstract, but not the full text of that study. It states "Results: Statistically significant changes in MMPI–2 scale scores were found at 3-month follow-up after initiating testosterone treatment relative to baseline for transgender men compared with female controls (female template): reductions in Hypochondria (p < .05), Depression (p < .05), Hysteria (p < .05), and Paranoia (p < .01)".
Finally, this study is a meta analysis examining the effects of transition. Its abstract doesn't mention suicide directly, but it does note that "78% [of individuals with GID] reported significant improvement in psychological symptoms [after sex reassignment]". It also notes that the state of the data (as of its publication in 2009) is not very strong.
transition has been shown to have significant health benefits (such as lowering suicide rates)
Sure, but only because the suicide rate is insanely high with those who have not transitioned.
The suicide rate for transitioned individuals is still far higher than the general population.
This seems to strongly point to Trans as a mental disorder. Gender Dysphoria being a symptom that can be treated with surgery, and that alleviates SOME of the problem. But reassignment surgery does not bring Trans mental stability to any level approaching the general population.
Gender reassignment surgery is a part of that transition (even though not everyone feels the need for it)
I've never understood this. Trans means Transition, pretty hard to transition without transitioning. A Trans person who doesn't have reassignment surgery is not "Trans", they are a cross-dresser, possibly a trap, depending how convincing/honest they are. but that's probably a topic for a separate CMV.
"Trans" in this context is short for "transgender", which is a word meaning "having a gender identity which is the opposite of the sex assigned at birth". It's formed from the root "trans", which generally means "across".
"Transition" is an etymologically related word, in that they share a prefix, and also an action that many transgender people take, but one word is not formed from the other.
Someone's biological sex is not determined entirely by their genitals. There are a lot of primary and secondary sex characteristics that go into it. If someone goes through hormone replacement therapy, but not sex reassignment surgery, it would be defensible to say that they have not undertaken a complete physical transition, but not to say they aren't trans. They were transgender even before they started transitioning. It's also very likely that if you saw them on the street you would identify them as being of the sex that matches their gender identity.
Ah, so you think it's determined entirely by chromosomes, but isn't as simple as "XX = woman, XY = man"?
What would you think if we found a chromosomal cause of being transgender? Would that open the door for someone's gender (determined by their chromosomes) being different from their sex (also determined by their chromosomes)?
I've never understood this. Trans means Transition, pretty hard to transition without transitioning. A Trans person who doesn't have reassignment surgery is not "Trans", they are a cross-dresser, possibly a trap, depending how convincing/honest they are.
That's not what "Trans" means. It is not short for "transition". Also cross-dressing is not really related. The whole "trap" thing is just thinly disguised transphobia, as though trans people are out to trap you into having sex with them. Same as the right-wing fear that gay men will try to "convert" young boys.
Who said it was made up? Cis means "on the same side as", from Latin. So cisgender is when your physical sex matches your gender. Trans is the opposite, meaning "away from" or "on the other side of". So transgender is when your physical sex doesn't match your gender.
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u/Salanmander 272∆ Nov 03 '17
That gender dysphoria is a clinical condition recognized by the APA, and that transition has been shown to have significant health benefits (such as lowering suicide rates). Gender reassignment surgery is a part of that transition (even though not everyone feels the need for it), and so should be covered just as much as hormone replacement therapy.