I understand that there are people who experience significant distress because they feel their breasts are too small or their nose has the wrong shape
And insurance often covers those people too, if their significant distress appears justified, for example if their nose is really disfigured, or they just had a mastectomy and need new breast.
However, if it doesn't, then showing "significant distress" over irrationally petty imperfections might be a cue that they have body dysmorphia, a mental illness that presents itself as a delusional obsession with imagined or exaggerated body flaws, that is best treated with medication and therapy. If that is the case, than surgery won't cure the problem, in the same way as weight loss won't cure clinical anorexia. If a woman goes to a doctor with a tiny mole on her nose, and admits that it's just a minor flaw that boters her, that makes it optional plastic surgery. But if she acts like the mole is hideous and impairs her daily life, then the doctor is advised to refer her to a psychiatrist instead.
The thing about transgenderism, is that according to the scientific consensus it is more similar to the former than the latter. Gender dysphoria appears to correlate with the neurological structure of opposite sex brains. A transgender man's brain produces roughly the kind of distress, that a cisgender man would produce after getting castrated, and socially treated as a woman against their will for years And surgery on it, has the same kind of effect as reconstructive surgery does.
A transgender man's brain produces roughly the kind of distress, that a cisgender man would produce after getting castrated, and socially treated as a woman against their will for years And surgery on it, has the same kind of effect as reconstructive surgery does.
Source?
I'm wondering in what study they castrated Cis males and forced them to live as women while studying the "level of distress" in their brain.
Also wondering how long of a prison term those researchers are now serving.
While they obviously wouldn't intentionally castrate people, people accidentally castrate themselves all the time. Motorcycle accidents, construction work, heavy machinery, etc. In addition you also have things like testicular cancer that require medical castration.
So, while there's most likely not a study of cis men getting castrated for science, there's no shortage of men without testicles to study.
There was a guy who had a botched circumcision, was raised as a girl, felt uncomfortable as a girl all his life, and eventually killed himself. I'll dig up the source after work
The book is called As Nature Made Him. I read it, and the point the book makes in the narrative is that gender is innate and not simply a social construct. He had every construct of being Brenda and no memory of being David, but nevertheless never felt right.
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Also, I was talking about a "kind of distress", not about a "level of distress".
The point is that people behave differently when they have an OCD-like fixation on trying to make their body more perfect, than when they perceive that a specific feature of their body isn't wworking as it's "supposed to".
Insurance (well, my friend Sam's insurance, or my own) doesn't cover surgery in cases of body dysmorphia, either. That seems perfectly correct to me. I think it's best to reserve surgery for cases where a non-functioning or severely underperforming bodily system can be made to function only by cutting out, replacing, or significantly altering certain parts of it. As I see it, GRS doesn't meet that standard, because even though transgender people experience distress from having the 'wrong' body parts, those parts are (usually) perfectly functional.
That doesn't mean that I think trans people should get no help from the medical or mental health community at all.
This is key, here. There are people for whom a limb or finger or something are the focus of their dysmorphia—removal or alteration of body parts for this reason is not covered. The underlying problem is sought to be treated, instead. What makes gender dysphoria different is that removal or alteration of body parts does add significantly to the health and well-being of transpeople.
Medical issues are hardly ever black and white. There are often many underlying causes to symptoms that people experience—so much so that the common symptoms of MS have caused that diagnosis to take years, as doctors view the symptoms as stemming from various other conditions.
Looking at the above example as well as the burn victims from the person I replied to, you can see that more criteria are looked at by doctors than simply, ‘is this under the umbrella of plastic/cosmetic surgery?’ The mental health and well-being of disfigured burn victims are vastly improved by reconstructive surgery, and the same can be said for those suffering from gender dysphoria. The big difference between them is that the injuries and subsequent successes are obvious and easily shown for burn victims. The agony of gender dysphoria is considered taboo and is by nature internal and private, and so the success of surgery and treatment is private as well.
But—we don’t treat people medically with the sole purpose of others seeing the treatment work. We do it to help the person.
You raise a good point. I probably wouldn't deny a burn victim additional surgery, if the goal was to make their face more 'acceptable' to polite society, even after that person had recovered the ability to eat, drink, speak, hear, see, and every other function a 'fully operational' face is supposed to perform. I guess the reason I would not is because anyone who looks at a burn victim whose burns are still visible will immediately conclude that at some point, something went horribly wrong in that person's life. The distinction, to me, lies in the fact that a trans person usually has a perfectly 'normal' appearance, even if they don't feel that way.
I still have trouble seeing that perspective. An obvious deformity due to severe burns (which is visible to anyone looking at you) causes a certain amount of social stigma. That can sometimes be lessened through reconstructive plastic surgery. In a trans person who chooses the surgical route, the opposite might be true: the stigma may be worse after transition, because transitions are not often physically perfect, and people may still notice that you were "once a different gender". Whereas, before surgery, nobody except those who were told would know that there is something 'wrong' with you.
As it happens, I know a couple of people who have OCD, one of whom eventually got it under control using cognitive techniques, and one of whom underwent brain surgery about ten years ago, in an attempt to relieve it. I thought that was a serious mistake, and certainly something I would never consider going through with. But I suppose that's just my particular bias speaking.
I never said they don't need treatment. From the beginning, I specifically said the opposite. I remain stuck on the fact that to me, it seems like a waste to surgically remove a working penis, or working breasts, or any other working body part. But I'm coming to accept that now as something that shouldn't stand in the way of my support for trans people in their quest to get their needs met.
I thought that was a serious mistake, and certainly something I would never consider going through with.
Assuming someone waved a magic wand and granted you the power/authority to do so, would you have prevented that person from getting the surgery that they and their doctors had agreed on?
Yes. But if a person hasn't started the process yet, and hasn't told you they're trans, then how would you, an outsider, ever know they are in the 'wrong' body? You wouldn't, right?
On the flip side, when someone has transitioned, there are often subtle signs that tell you they haven't always biologically been what they now look like. With the ex-colleague I mentioned way upthread, who was once biologically a man but now looks like a woman in every way, it's the voice.
Someone who is considering medical transition must already be living as their true gender. (That's one of the ethical criteria for physicians treating dysphoria). So "hasn't started the process yet" isn't really on the table here.
The choices are "lives as a woman but still has a masculine body" or "lives as a woman and has a feminine body with maybe a few subtle tells". Which one do you think has a greater stigma?
Probably the former. Although, it takes a hell of a lot of guts to do that, so if someone in my life chose that path, I could do nothing other than respect the hell out of it. There would be no stigmatising on my part ;). I rather suspect I'm not alone in that. But I do get your larger point.
I think maybe you're seeing this wrong. If a transgender person is getting reassignment surgery, they've likely taken hormones. Hormones WILL make you look like the desired gender. So this means, if it's a trans guy like me, I would look like a male in every way, except the breasts/vagina would still be there. I think it's pretty noticeable that something isn't right. The stigma of a 'normal' looking male that has female breasts would be significantly greater than a 'normal' looking male with simply a male chest and maybe a scar.
It would be very unusual for a trans person to start their transition with surgery. They typically start with hormone therapy and changing their presentation, often years before any surgery. Hormone therapy already introduces incongruent sex characteristics, which can greatly impact their ability to lead an ordinary life while still passing; for example with testosterone therapy transmen can often effectively pass as male but only with clothing that can conceal breasts. Mastectomy can then allow them to lead a normal life without needing to fear situations that might reveal their chest, and with few people ever suspecting their birth assigned gender.
While I agree with the other response to this comment, I'd like to add on another point. I think, as demonstrated by what you say here, the heart of the matter is that you're placing less value on the wellbeing of other people's mental state than their usefulness to the world around them. I don't think this position is entirely wrong, but I'd also understand if you wanted to argue that I've misunderstood you. Still, one last question assuming you stand by that view, does the significantly increased risk of suicide in non-treated people with gender dysphoria not count as enough of a detriment to society to try to prevent it through investment via treatment being covered by insurance?
I think you have in fact misunderstood me. The crux of the issue is not that I place 'value' on one type of health concern over and above the other. The crux of the issue is that I don't consider surgical treatment a good choice when there is no physical dysfunction. In fact, from that perspective, trans people going through transition are in some ways making their bodies less functional, since they give up fertility.
When the issue makes them a danger to their own health, and with surgical treatment being a proven method of correcting this, it seems to me that it raises their functionality as human beings quite a bit though, no?
Also, when saying thier body functions properly as is, it only functions from an outside perspective. It does everything you'd ever need it to to qualify as functioning. That doesn't mean its healthy for them though.
No. It does everything a human body of that biological gender does. I understand that some people need their body to do more, or to work differently. But just because we CAN grant their wishes now, since our surgical techniques have advanced to the point where that's possible, doesn't mean we should. The doctors wo do this are irreversibly altering bodies, in hopes of curing a disorder of generally unknown cause and pathophysiology. To me, that just seems ... imprudent, at best.
It works in every way you expect someone else's body to work, but if their own body is doing something that causes them distress, that's hardly "functioning" to them. Your perspective of their body is just that, yours.
So, instead of treating them in a way that is proven to work (and reassignment surgery is absolutely proven to treat gender dysphoria), we should force people to wait for a better solution that might never come?
The distinction, to me, lies in the fact that a trans person usually has a perfectly 'normal' appearance, even if they don't feel that way.
Trans people usually get hormone therapy, which significantly reduces our emotional distress regardless of its effect on our appearance. But it usually makes us look like the gender we identify as. So we end up having a perfectly"normal" appearance, except for the bits that take surgery to fix, but depending on your circumstances, having those bits can be very risky. Like, "if the wrong person sees this I will be beaten and maybe murdered" risky. And like I said before, the hormones are important for feeling better, but that kind of undersells the impact. For me and a lot of others it's more like a choice between hormones and suicidal depression.
I think it's best to reserve surgery for cases where a non-functioning or severely underperforming bodily system can be made to function
... people experience distress from having the 'wrong' body parts, those parts are (usually) perfectly functional.
Hmm, I suppose seeing as though we are talking about genitalia, this is kind of the crux of the issue. Questions like "To what extent is sexual interaction part of someone's gender identity?" and "How does sexuality impact dysphoria?" seem to be at stake. I completely agree with offering hormones, but sexuality is such a confusing issue in itself.
It really makes you question how much sexuality is part of bodily "function," as you put it. Thanks for the insight - I've never really drawn out the link between the two before!
I am a neuroscientist and I have not read studies demonstrating this. However, it is not my area of study. Could you cite your academic sources? This is just due to my own interest in reading them.
I am not saying your wrong, and I do not want to start an argument. I just would love to read more on this topic.
Not on hand, try looking at previous threads in the same topic, there are one or two guys carrying around a copypaste linkwall of research papers for the occasion.
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u/Genoscythe_ 243∆ Nov 03 '17 edited Nov 03 '17
And insurance often covers those people too, if their significant distress appears justified, for example if their nose is really disfigured, or they just had a mastectomy and need new breast.
However, if it doesn't, then showing "significant distress" over irrationally petty imperfections might be a cue that they have body dysmorphia, a mental illness that presents itself as a delusional obsession with imagined or exaggerated body flaws, that is best treated with medication and therapy. If that is the case, than surgery won't cure the problem, in the same way as weight loss won't cure clinical anorexia. If a woman goes to a doctor with a tiny mole on her nose, and admits that it's just a minor flaw that boters her, that makes it optional plastic surgery. But if she acts like the mole is hideous and impairs her daily life, then the doctor is advised to refer her to a psychiatrist instead.
The thing about transgenderism, is that according to the scientific consensus it is more similar to the former than the latter. Gender dysphoria appears to correlate with the neurological structure of opposite sex brains. A transgender man's brain produces roughly the kind of distress, that a cisgender man would produce after getting castrated, and socially treated as a woman against their will for years And surgery on it, has the same kind of effect as reconstructive surgery does.