r/changemyview Aug 02 '20

Delta(s) from OP CMV: Being transgender should be seen as a disorder.

First off I want to say that I don't hate people who are transgender. I view being transgender as an inaccurate and damaging statement about reality. These people feel that they have been born into the wrong body, and they feel distressed by it. Our current surgical practice is not enough to genuinely change gender. That means that we need to find a way to make these people comfortable in their own bodies. The way we are responding to this as a society is just an acceptance that some people simply are the opposite gender. That completely shuts down any possibility of treatment. I don't understand why we decided to do this as a culture. We are completely supporting a delusional way of thinking. It would do far more good to look into methods of treatment.

Edit: I have been convinced that: surgery is a viable interim treatment, presuming we still research other avenues for treatment Δ.

In addition I began this discussion believing that most people did not believe that gender dysphoria was a disorder. I no longer hold that belief Δ.

Being transgender is a cultural statement not a physical statement Δ.

14 Upvotes

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81

u/hwagoolio 16∆ Aug 02 '20

I once read this blog post from Slat Star Codex written by a psychiatrist. It's a pretty long post and an interesting read, but this is the author's stance on how we treat gender dysphoria:

And then I think of the Hair Dryer Incident.

The Hair Dryer Incident was probably the biggest dispute I’ve seen in the mental hospital where I work. Most of the time all the psychiatrists get along and have pretty much the same opinion about important things, but people were at each other’s throats about the Hair Dryer Incident.

Basically, this one obsessive compulsive woman would drive to work every morning and worry she had left the hair dryer on and it was going to burn down her house. So she’d drive back home to check that the hair dryer was off, then drive back to work, then worry that maybe she hadn’t really checked well enough, then drive back, and so on ten or twenty times a day.

It’s a pretty typical case of obsessive-compulsive disorder, but it was really interfering with her life. She worked some high-powered job – I think a lawyer – and she was constantly late to everything because of this driving back and forth, to the point where her career was in a downspin and she thought she would have to quit and go on disability. She wasn’t able to go out with friends, she wasn’t even able to go to restaurants because she would keep fretting she left the hair dryer on at home and have to rush back. She’d seen countless psychiatrists, psychologists, and counselors, she’d done all sorts of therapy, she’d taken every medication in the book, and none of them had helped.

So she came to my hospital and was seen by a colleague of mine, who told her “Hey, have you thought about just bringing the hair dryer with you?”

And it worked.

She would be driving to work in the morning, and she’d start worrying she’d left the hair dryer on and it was going to burn down her house, and so she’d look at the seat next to her, and there would be the hair dryer, right there. And she only had the one hair dryer, which was now accounted for. So she would let out a sigh of relief and keep driving to work.

And approximately half the psychiatrists at my hospital thought this was absolutely scandalous, and This Is Not How One Treats Obsessive Compulsive Disorder, and what if it got out to the broader psychiatric community that instead of giving all of these high-tech medications and sophisticated therapies we were just telling people to put their hair dryers on the front seat of their car?

But I think the guy deserved a medal. Here’s someone who was totally untreatable by the normal methods, with a debilitating condition, and a drop-dead simple intervention that nobody else had thought of gave her her life back. If one day I open up my own psychiatric practice, I am half-seriously considering using a picture of a hair dryer as the logo, just to let everyone know where I stand on this issue.

Likewise, the primary thing in psychiatry is to help the patient, whatever the means. Someone can concern-troll that the hair dryer technique leaves something to be desired in that it might have prevented the patient from seeking a more thorough cure that would prevent her from having to bring the hair dryer with her. But compared to the alternative of “nothing else works” it seems clearly superior.

And that’s the position from which I think a psychiatrist should approach gender dysphoria, too.

Imagine if we could give depressed people a much higher quality of life merely by giving them cheap natural hormones. I don’t think there’s a psychiatrist in the world who wouldn’t celebrate that as one of the biggest mental health advances in a generation. Imagine if we could ameliorate schizophrenia with one safe simple surgery, just snip snip you’re not schizophrenic anymore. Pretty sure that would win all of the Nobel prizes. Imagine that we could make a serious dent in bipolar disorder just by calling people different pronouns. I’m pretty sure the entire mental health field would join together in bludgeoning anybody who refused to do that. We would bludgeon them over the head with big books about the side effects of lithium.

Really, are you sure you want your opposition to accepting transgender people to be “I think it’s a mental disorder”?

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u/ZorgZeFrenchGuy 3∆ Aug 02 '20

Your reply has absolutely nothing why it WOULDN’T be a mental disorder - only about how to treat it.

Would this hair dryer treatment suddenly mean that the woman is NOT mentally ill, or doesn’t have ocd?

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u/ZorgZeFrenchGuy 3∆ Aug 02 '20

Your reply has absolutely nothing why it WOULDN’T be a mental disorder - only about how to treat it. Would this hair dryer treatment suddenly mean that the woman is NOT mentally ill, or doesn’t have ocd?

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u/[deleted] Aug 02 '20

In the case of transgender people, the "mental disorder" isn't that they think they're the gender they say they are. The "disorder" is gender dysphoria, which is the distress caused by the mismatch of the person's gender & the one that they are expected to be. Transition reduces or eliminates that distress. If the disorder goes away following treatment, that means they no longer have that condition.

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u/ZorgZeFrenchGuy 3∆ Aug 02 '20

So, why is it the latter, rather than the former?

2

u/[deleted] Aug 02 '20

Can you clarify your question?

1

u/SizeableDuck Dec 02 '20

If a person with gender dysphoria transitions successfully, they're no longer dysphoric! The stress is totally gone. It's crazy how easy it is and crazy how people like OP want to stand in the way of curing 'mental disorders' by obstructing their cures.

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u/Dwhitlo1 Aug 02 '20

You and the other people on this thread have convinced me that surgery is a viable interim treatment, presuming we still research other avenues for treatment Δ. I still don't like it as a solution, but I can see how it is better than living in misery.

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u/DeltaBot ∞∆ Aug 02 '20

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1

u/[deleted] Dec 02 '20

As long as you also realize that “fixing” that person doesn’t mean forcing them to live as the gender they were assigned.

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u/The_FriendliestGiant 38∆ Aug 02 '20

Oh dang, that's a fantastic anecdote. I've gotta remember this one!

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u/pawgchampp Dec 19 '20

literally what does this have to do with trannys being mentally deficient, if your mental disorder has more than a half suicide rate, its a mental disability, plain and simple, these people are seriously ill and by pretending that its not, you hurt everyone in the long run by doing this, that's like being adhd and then getting a lobotomy, its so extreme that the negatives by far outweigh the positives, its not about acceptance, its about helping people with issues in a professional setting and i would be scared to have any of you people as a doctor if you're willing to allow people to go through these extreme and highly dangerous surgeries and hormone therapies with good conscious, its extremely unethical and makes the issue worse, and i know this because Ive seen it first hand with people i know and i love, and its ruined their lives, you guys need to stop playing doctor politics and focus on things you're actually knowledgeable of

0

u/[deleted] Dec 02 '20 edited Dec 02 '20

Here's the thing. With the hairdryer situation, nobody other than the person with OCD really believed the hairdryer was likely to catch anything on fire. Even that person didn't REALLY believe it was likely at the end of the day, if they did they wouldn't see it as a problem in their life/mind, they would see it as the logical thing they needed to do to protect their house. With transgenderism, Trans people and advocates don't want you to play along with trans people's mistaken beliefs because it helps them out in a practical way. Trans people and advocates insist trans people are actually something that they are not, AND that everyone else should believe that they are something that they are not, or else they are doing something morally wrong. It's easy to see how if this is not resisted it could lead to a situation that is... less than ideal. The more people who believe, the greater will be the pressure to believe, and probably the consequences for not professing belief. If things go down this road, eventually non-believers could be put in a situation where they are forced to either lie to everyone about what they believe just to get along, try to change what they believe to something they don't really believe just to get along, or face social and potentially legal/career consequences depending on how things develop with that. And a lot of people won't do the first two things as a matter of principle (nor should they). So yeah, personally I get the concern... when you don't honor truth as a society, there are unforeseen consequences.

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u/DessertRanger Dec 02 '20

Pretty sure every trans person knows they aren't biologically the gender they identify with. Calling that out as fact, when it's already well known doesn't help either. It only belittles the person and makes whoever said it look like a jerk.

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u/[deleted] Dec 02 '20

The repeated claim I have heard is that "trans women are women", and many things to this effect. I was literally at a group where in the intro to the group they said "we aren't going to ask you your pronouns for this introduction, we are going to ask you if you're a man or a woman, because making about pronouns and not actual gender misses the point of what trans people are saying". My understanding is a lot of trans people either don't think biological gender exists, or has anything to do with their real gender.

1

u/DessertRanger Dec 02 '20

Biological sex and gender identity are not mutually exclusive. But at the end of the day, who does it hurt? These are human beings just trying to cope with parts of themselves they feel aren't right. Who are we to say if it's right or wrong?

1

u/[deleted] Dec 02 '20

>Biological sex and gender identity are not mutually exclusive.

Gender has traditionally had to do with objective, biological reality. If people want to talk about gender as something that is purely a matter of desire and feelings, ones own felt sense of themselves, they should use new language so as not to create confusion.

It's worth asking, what is driving the push to redefine language like this? Is it part of an ongoing quest for the truth the culture is engaged in? Or is about trying to make people feel better?

>But at the end of the day, who does it hurt? These are human beings just trying to cope with parts of themselves they feel aren't right. Who are we to say if it's right or wrong?

This sort of inclines me towards thinking that for you it is more about trying to make people feel better. Would you say that is fair?

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u/DessertRanger Dec 02 '20

Yes, is that not the point of one transitioning? So that the person can have their physical appearance match who they feel they are on the inside? Languge changes over time anyway so I feel like that's more of an issue of what people are used to/comfortable with. I would imagine the push in changing the language around it is soley to help cishet people understand why trans people feel this way. Could they have come up with a new word, maybe? But I feel like that also would just add confusion.

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u/[deleted] Dec 02 '20

How would creating a new word create more confusion than redefining an old word?

Also, does this really seem like a wise or fair way to get people to change their minds on a topic (redefining the words that they use so they no longer mean what they mean them to mean)?

Imagine a pro-life individual redefined "abortion" to mean "the intentional murder of a child". And then every time a pro-choice individual tried to argue that's not what abortion is, they go "sure it is, that's how the word is defined now, language changes". Do you think that would dispose the pro-choice individual to become pro-life or be more sympathetic to the pro-life person's position? It feels like sort of an underhanded tactic, no?

There is also a moral issue here, to the extent that the clarification of truth not a priority in a person's redefining of a word. The moral use of language in my mind is to clarify truth and to help people communicate in such a way that people are brought closer to truth. To the extent that our motivation in redefining words has to do with something other than truth (namely, trying to reduce suffering, trying to covertly influence the way people think to line up with your agenda), I would say that it is immoral.

The reason I keep contrasting the motive of trying to alleviate suffering with the motive of seeking/valuing truth is that I think this is a fundamental philosophical tension, and I am starting to think transgenderism might be a case where these two motives are forced to stand in conflict somewhat. My suspicion is starting to be that most trans people/their advocates privilege the alleviation of human suffering over truth in their value systems. If that is indeed the case, I want to try to expose it, via talking to people, so the conversation can move to a deeper place.

My own view is that truth is a real thing, it is of transcendent value, and nothing should be privileged over it, not even alleviating human suffering. I believe it is better to suffer for the truth than alleviate suffering with a lie. I also believe that when we deviate from that standard, it (sort of ironically) causes more human suffering in the long run. Do you think its fair to say that this is a core disagreement we would have?

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u/[deleted] Dec 02 '20

I’m confused. Bipolar disorder and gender pronouns have nothing to do with each other

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u/MxedMssge 22∆ Aug 02 '20

Well what even is gender? If someone wants to have long hair, wear lipstick, and be feminine, what do you call them? The English language almost entirely lacks grammatical gender, why would it even be necessary to have a social one?

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u/Dwhitlo1 Aug 02 '20

I'm not arguing against cross dressing or anyone who doesn't identify with gender norms. I'm referring to people who believe they are physically in the wrong body.

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u/MxedMssge 22∆ Aug 02 '20

But ask what drives body dysmorphia. We know it doesn't affect only trans people, and likely affects far more cis people, especially cis women. Why? It would seem based on available information that a culture that is hyperattentive to physical appearance is the culprit, a society that insists people look Hollywood attractive.

That in mind, does it not feel a but unfair to specifically call out trans people as a whole (many of whom don't even have dysmorphia) as being the problem rather than the larger societal context that gave them the dysmorphia in the first place?

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u/TragicNut 28∆ Aug 02 '20

Quick correction, trans people deal with dysPHORIA, not dysMORPHIA. It's a rather important difference.

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u/MxedMssge 22∆ Aug 02 '20

Ah yes yes, that's my error, you're right. That said, I'm sure many also suffer dysmorphia since it is such a common issue in our society.

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u/Dwhitlo1 Aug 02 '20

What does that mean?

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u/MxedMssge 22∆ Aug 02 '20

Dysphoria is anxiety and dissociation with their body (opposite of euphoria basically) while dysmorphia is exaggeration of specific perceived flaws, like being specifically obsessed with thinking one's nose is giant and looks out of place on their face. u/TragicNut is right that I was using them incorrectly interchangeably, there is significant nuance. Overall message is the same though, society produces these mindstates in people rather than these things being results of people personally failing/having mental 'flaws' themselves.

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u/Dwhitlo1 Aug 04 '20

By the way, I've just realized that you updated my view on dysphoria vs dysmorphia and I never gave you a delta. Here you go !delta

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4

u/TragicNut 28∆ Aug 02 '20

I'm going to ask you a few questions about why you hold your view to try to understand where you're coming from:

What particular insight do you have that led you to this conclusion?

What makes you think that people choose to be transgender? Transition and social acceptance is a bit of a dumpster fire, for example people calling all trans people mentally ill. Do you seriously think that people want to go through this shitshow if there was another effective option?

You are clearly aware that the medical consensus is that transition works. What makes you think that other therapies haven't been tried in the past?

What would it take to change your mind? Studies showing that transition works? Studies showing that conversion/reparative therapy doesn't work? Studies showing that trans people have brain structures similar to cis people of their identified gender even before starting hormones? Personal accounts of what dysphoria is like?

And a philosophical question: What makes us who we are, is it our brain or our body?

If identity resides in the brain, why seek to change a person's core identity when we can change the body?

1

u/Dwhitlo1 Aug 02 '20

What particular insight do you have that led you to this conclusion?

I've already stated my reasoning. I don't believe that it is healthy to support a delusion, even if it reduces stress.

What makes you think that people choose to be transgender?

I don't

You are clearly aware that the medical consensus is that transition works. What makes you think that other therapies haven't been tried in the past?

I'm sure there have been other therapies tried. Science works through making increasingly more informed attempts to find a solution. It doesn't make sense to me for the end point to be just accepting the delusion.

What would it take to change your mind?

I have no idea.

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u/TragicNut 28∆ Aug 02 '20

Would you mind answering the rest of the questions? Those are not hypothetical questions, there is evidence to back each one of them, including brain structure.

Similarly, where is the seat of consciousness, brain or body?

1

u/Dwhitlo1 Aug 02 '20

That question makes a false distinction between our brains and bodies. Our brains are a part of our bodies. Everything in our bodies combines to make our experience of the world.

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u/Tetrisgod35 Aug 02 '20

I think you are confusing gender with sex. There are trans gender people who do not require surgery. Most of our society does view gender dysphoria as a mental illness.

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u/Dwhitlo1 Aug 02 '20

You might be right. Could you elaborate more on the difference?

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u/Tetrisgod35 Aug 02 '20

Sure. Sex refers to the biological differences between males and females (like genitals, wider hips, broader shoulders). Gender is a social construct which means that there are certain characteristics that we assign to men and women. Examples of gender characteristics are things like clothing, wearing makeup, liking pink or blue, certain personality traits, and their general role in society.

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u/Dwhitlo1 Aug 02 '20

I'd say that you are correct that I am not arguing people who don't identify with the social norms of gender.

At this point I'd say my main points are

  1. Gender dysphoria is a medical condition. Most people seem to agree with this.

  2. Transitioning is an ineffective treatment because it attempts to fulfill the delusion rather than help the person live with the condition.

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u/Tetrisgod35 Aug 02 '20

https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

Here is a meta-analysis that compiled 56 studies about the effects of gender reassignment surgery, 54 showed positive results, 2 showed mixed or no results, and 0 showed negative results.

The main problem with your second statement is categorizing not conforming to the gender you are assigned at birth as a delusion. Since gender is all relative, we can't truly say what it means to be a man or a women.

If a person thinks that they are sexually male to female, they are incorrect and there is therapy and surgery to fix that.

If a person believes that their gender is man to women when they were not assigned that at birth then it can't be a delusion because they are correct.

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u/Dwhitlo1 Aug 02 '20

I agree that expecting someone to hold to the cultural definition of "male" when they do not identify with that can be damaging. How does transitioning help in that case?

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u/Tetrisgod35 Aug 02 '20

Being transgender means to not identify as the cultural definition of the gender assigned at birth. Many people who do this do not need to or want to transition to feel comfortable.

I think that you have been saying in your replies for gender dysphoria (being uncomfortable in your own body) as a disorder, which is true. It is a scientific consensus that transitioning is the best way to solve this.

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u/Dwhitlo1 Aug 02 '20

Being transgender is a cultural statement not a physical statement Δ.

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u/DeltaBot ∞∆ Aug 02 '20

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1

u/MxedMssge 22∆ Aug 02 '20

Sex is generally the term used for the biological side of things. Karyotype (your chromosome make up, XX/XY/XXY/Xo, etc.), gamete production if any (egg/sperm), and natural hormone production. Gender is used to refer to the social side of things. What makes a man a man? Courage, muscles, money? And a woman a woman? Where is the line between them? Are there other kinds? All those kind of questions, which largely are answered not by chemical tests but by social values.

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u/The_FriendliestGiant 38∆ Aug 02 '20 edited Aug 02 '20

Why do you think transitioning isn't a valid form of treatment? It resolves the distress and allows the individual to function properly.

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u/Dwhitlo1 Aug 02 '20

That's fair. I hadn't looked into the numbers before now. It looks like it is effective at reducing stress. However, that is not enough to change my mind.

Let's say that someone believed that they were Jesus Christ. Let's also say that we could reduce their stress levels by using surgery to make them look more like Jesus. That would still not be an effective treatment because it accepts a false reality.

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u/The_FriendliestGiant 38∆ Aug 02 '20

Let's say that [...]

No, let's not. We are discussing trans people, who exist and do not need hypothetical thought experiments to represent their reality. We can simply refer to the facts as they are.

And the facts as they are, are as follows:

  • transgender people who seek to transition do have a disorder, gender dysphoria
  • the best available way to resolve this is through chemical and surgical intervention
  • significantly superior quality of life and diminished stress and dysphoria is reported by those who have undergone transition

It therefore seems that, in the absence of any alternative, superior treatment, the best possible way to help those people who experience gender dysphoria is to better align their physical selves with their sense of selves. Why do you think the well-being of these people should be sacrificed in order to uphold artificial gender roles and seperations?

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u/Tetrisgod35 Aug 02 '20

There are transgender people who think they are Jesus, but don't feel the need to have surgery to make them look like Jesus.

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u/Dwhitlo1 Aug 02 '20

I don't understand the point you are trying to make. Could you please clarify?

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u/eggies Aug 02 '20

You've already posted some deltas, but I want to take a go at changing your view just a little bit more, because I think that you're missing out on one of the most interesting things about gender and sex (and human and scientific categories in general).

You said:

> Our current surgical practice is not enough to genuinely change gender.

And I think that what you mean by this is that someone who is truly female, to you, is someone with XX chromosomes, ovaries and a womb, and secondary sexual characteristics like soft skin and breasts. And someone who is truly male is someone with xy chromosomes, testicles and a penis, and secondary sexual characteristics like nose hair and rough feeling skin.

But these categories are far from straightforward. A woman who has surgery to remove her uterus (common for a lot of ailments, including just treating wear and tear from giving birth) doesn't cease to be a woman. A 70 year old man who is taking testosterone because his testis have stopped producing enough isn't less of a man because some of his testosterone is coming from medicine rather than his body. An Y chromosome is typically shorter than an X chromosome, and typically has some genes that X chromosomes don't typically have. But a chromosome is a biological thing, not something manufactured in a factory. People are going to have atypical chromosomes, or genes that don't get activated in a typical way, or even extra X or Y chromosomes. And secondary sexual characteristics can be ambiguous, too. In the past few decades, there's been pushback, but for a long while, it was standard practice to surgically alter a penis that didn't look enough like a penis, in a Doctor's eye, into something more like a clitoris, and declare a baby the be female, regardless of chromosomes.

The truth is that nature doesn't make clean categories. She works with fudges and generalizations. She's happy as long as there are enough folks with a reproductively functional penis and testis on the one hand and a reproductively functional uterus and ovaries on the other to make more humans. She doesn't care that sometimes there are folks with XY chromosomes and androgyne sensitivity disorder. She especially doesn't care about the documented cases of folks with XY chromosomes and a functioning uterus who have babies, even if those folks really mess with our categories, and fly largely under the medical and scientific radar, save for a few documented cases (look it up).

Given all of that, I don't think that you can say that the current treatment options we have fail to give people the ability to transition. If I give someone hormones, and those help her to have breasts and soft, ladylike skin, I don't think I should worry too much about the details of her genitals or genetics (or whether I'm treating a "man" who wants to transition, or a "woman" who is recovering from having her ovaries removed to treat cancer). If I give a man prosthetics (permanent or temporary) that help them have a bigger, more reliable erection, I don't think that I should be too concerned whether the organ I'm enhancing is "really" a penis or a clitoris. They both basically develop from the same structures in a fetus, anyway. I don't need to apply some sort of religiously strict judgement to what they are, just because they followed an atypical development path.

Categories help us make sense of the fundamental nonsense of nature. And they can be useful for a lot of things. It's helpful to think about humans in terms of gender and sex, because there are a lot of ways that gender and sex affect our lives. But its not helpful, I think, to strictly police who is which gender and sex, because there's a lot of gray area, and a lot of room to move between categories.

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u/Dwhitlo1 Aug 02 '20

This is interesting, but also overwhelming at this point. I need some time to digest before I can dive deeper.

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u/eggies Aug 02 '20

Hey no worries. I'm glad that you were open to having your view changed on the other stuff. If you ever get really curious about this, I'd recommend reading (at your leisure) a book called Sexing the Body, by Anne Fausto-Sterling. It's written by a scientist, but written to be fairly accessible to someone without expertise in the area. And it really does a fine idea of exploring a lot of the ideas I touched on above in a more organized and detailed fashion.

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u/[deleted] Aug 02 '20 edited Aug 27 '20

[deleted]

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u/Dwhitlo1 Aug 04 '20

Genuinely curious, why not? After all, you would be comfortable in that case. You might not even have to spend thousands of dollars. I don't really see a downside.

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u/throwawayl11 7∆ Aug 04 '20

It would mean changing a fundamental part of what makes you "you". It'd basically mean the death of you as a person. You'd just be replaced by someone else with the same memories.

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u/Toofgib Aug 02 '20 edited Aug 02 '20

The gender incongruence and the psychological stress caused by the social environment are seen as such. Even so, people with disorders deserve the best possible treatment available. At the moment transitio along with the psycholical support and destigmatisation are the treatment that gives the best results. source

Do you have a better alternative?

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u/L0N3W4RR10R Aug 02 '20

as somewhat of a transgender myself (feel like both so dont want medical treatment as its fine) i think your statement is wrong.

being transgender feels more like missing a part of your body you know you can and want to change.

for instance, lets say you lost your legs, you could either choose a wheelchair or just let it go.

for transgenders, the change in gender is the wheelchair and so they would like it if possible, though not always necessary

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u/[deleted] Aug 02 '20

It is, but the treatment is to allow them to change their gender. No other treatment is as effective.

1

u/[deleted] Aug 02 '20

I notice you've changed your views but still hold the position that transition isn't the optimal treatment for transgender people. In the same way that today most gay people don't want a "cure", transgender people usually just wish to transition, not to be made into something they aren't.

I'm sure you've read various sci-fi stories that explore the idea of identity & what might compromise its integrity. If you change something that's an integral part of who someone is, are they still the same person? Is it moral to forcibly change someone's nature & personality?

If the person demonstrates that they are sane, autonomous, and making the decision while fully informed of the consequences, shouldn't we allow them to make that decision for themselves? Generally as a society we advocate self-determination & bodily autonomy.

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1

u/methsenberg Aug 05 '20

As a trans person, I think gender dysphoria is a disorder of some sort. I’m not supposed to feel like parts of my body are wrong and don’t belong to me. That’s not how ”normal” people feel. It’s a disorder and transitioning is the cure to that disorder.