source-library

TRANSGENDER ISSUES

Medical Consensus

Medical Consensus

This is an incomplete list of the reputable scientific & social organizations which affirm the validity of transgender people (that transness is not an illness, that trans people deserve access to transgender healthcare, etc). This also serves as a list of the institutions which recognize the difference between sex and gender. This list was compiled by the TLDEF and they should be cited when referring to this list.

Medical Transition

Medical Transition

Medical transition decreases dysphoria, suicide attempts, and improves depression and anxiety. However, most research on this subject is very low quality so we should be open to conducting better future research.

Long-term Follow-ups:

Important note on study quality (applicable to some other sections too):

For some research topics like medical transition, it’s very hard to get gold-standard study designs for a number of practical and ethical reasons. I’ll be pulling relevant info from this blog post which largely focuses on a different topic yet has some good info for this. In this segment it talks about how having blinded studies and control groups (two ways to improve a study’s quality) is next to impossible for researchers to do here:

So that leaves us with a much more limited set of options for how we can measure the outcomes of medical transition. These measures, while typically giving us lower quality results, are at least possible to conduct and studies have indeed been conducted with them. The blog lists a few of these options:

Another issue is that as we are dealing with a small population here (trans people make up under 1% of the US population, according to nearly all estimates) and certain subsets of this population, e.g. trans people who haven’t had medical transition or are currently going through it, are particularly hard to reach out to. This is especially true for specific topics like trans people in sports (miniscule number of trans athletes) and in the military, for example. This problem of a small population is usually bridged via convenience sampling and in general by recruiting small samples rather than going through the extra effort to get a large sample, but this also means that our samples are less useful overall. These sample issues can hopefully be avoided more in the future as more attention and funding goes towards studying trans issues. We should absolutely keep an eye out for newer, higher quality research as it comes out. In the meantime, we ought to work with the existing research and acknowledge the limitations that come with it.

Social Transition

Social Transition

Social transition improves depression, anxiety, and psychological function

Puberty Blockers

Puberty Blockers

Puberty blockers are safe, well-studied, completely reversible, endorsed by credible medical and endocrinological associations, and effective at reducing dysphoria, anxiety, and depression.

Common Puberty Blocker Myths:

Mostly taken from here

1. “Blockers are harmful to bone density”

The Endocrine Society found that medical intervention in transgender adolescents appears to be safe and effective and that hormone treatment to halt puberty in adolescents with gender identity disorder does not cause lasting harm to their bones.

Some meta-studies which show bone density and bone mineral density aren’t harmed:

2. “Young people wouldn’t want to take puberty blockers if they knew the risks”

Vrouenraets et al. 16 found that the few negative effects of puberty blockers do not change children’s minds and most adolescents stated that the lack of long-term data did not and would not stop them from wanting puberty suppression. They said that being happy in life was more important for them than any possible negative long-term consequence of puberty suppression.

3. “Puberty blockers will give trans kids osteoporosis and make them sterile”

Heger et al. 99 found that long term puberty blocker treatment of precocious puberty girls preserved genetic height potential and improved FH significantly combined with normal body proportions. No negative effect on bone mineral density and reproductive function was seen.

4. “Children are too young to know they are trans and are pushed to take blockers by parents / social media / peer pressure”

There are multiple accounts by parents and older trans people who observe that they/their child knew that they were transgender from a young age – Here is one such account and another article explaining how transgender kids aren’t rushed into transitioning. These kids seem to have a strong identity at a young age.

5. “It is not ethical to give puberty blockers to transgender children”

Focusing strictly on the ethicality of puberty blockers, Giordano argues that the general improved quality of life, including substantially reduced risk of suicide, outweighs the ethical considerations of disrupting puberty. Puberty blockers can be used to relieve stress from a patient and give them more time to get an accurate diagnosis of the situation, as was the case here - certainly more ethical to go forward with an accurate diagnosis than without one.

6. “The neutral decision is to not let minors access puberty blockers”

Case Studies:

These case studies only focus on one person at a time. While they don’t have the statistical validity that a study would have at a larger sample size, it can give us qualitative insight into how these people experience what they go through.

Prevalence of Discrimination

Prevalence of Discrimination

Discrimination against trans people is a real thing and is pervasive in many aspects of society. It’s not something that we can simply ignore when talking about trans people.

Impact of Discrimination

Impact of Discrimination

Suicidality is heavily influenced by bullying, discrimination, and poor treatment. Suicide attempt rates are also far higher among individuals who experience substantial discrimination or harrassment. The ~40% suicide attempt statistic is often misrepresented/misunderstood.

Let’s talk about the ~40% suicide statistic first.

What exactly is it referring to?

So how do people misuse it?

An extra bit on calculating successful suicide rates:

Annotated sources:

Impact of Social/Familial Support

Impact of Social/Familial Support

Family support decreases suicide attempts and drug usage while improving the mental health of trans people.

Chosen Name/Pronoun Usage

Chosen Name/Pronoun Usage

The use of trans people’s chosen name decreases suicide ideation, severe depression, and suicide attempts

Some additional notes:

Bathroom Bills

Bathroom Bills

Evidence for the public safety argument in regards to bathroom bills is unsubstantiated in data. Bathroom bills would give rise to other problems which proponents leave unaddressed as well. Also, check out this resource for additional material on the subject.

Specific Debunks:

Keep in mind that singular incidents don’t actually prove a broader statistical trend, nor do small compilations of incidents.

Other Notes:

Prisons

Prisons

Public Perception and Depiction

Public Perception and Depiction

In media, trans and LGBT people are generally depicted either negatively or in shallow, stereotypical ways. Polling usually shows a substantial minority who oppose trans-affirming policies, though fortunately most Americans are fine with trans people.

Trans Athletes

Trans Athletes

Trans athletes are at no significant advantage in athletics, especially since hormones reverse any strength discrepancies, yet face substantial discrimination in athletics. Keep in mind that specific instances of trans people winning sports competitions doesn’t actually prove anything about broader trends. Also worth noting the low quality of much of this research because there’s very few trans athletes and nobody cared about this until like 2015, which means we should be open to new research developments for this topic and a lot isn’t settled science yet

Other Notes:

On physiological differences: segregating sports based on something like height, testosterone, etc can get really messy especially when it’s tied in with the existing sex-segregation in sports. In some cases, this has led to the outright exclusion of biological females from women’s sports simply due to naturally high testosterone levels. Some of these policies need to be carefully thought through so as not to accidentally exclude people who really didn’t do anything to deserve it.

On Fallon Fox/Tamika Brents: For one, their specific match is pretty much just one match, one data point out of so many other matches and games. This one anecdote is not statistical data and is not generalizable to all trans people in sports (though let’s be real, finding any good statistical data on trans athletes is a challenge). Second, however shocking the concussion and broken skull were, these sorts of traumatic head injuries are sadly very common in MMA fighting, to the point where it’s even been banned in some countries (plus banned and relegalized in others). MMA is a relatively dangerous sport and Tamika Brents’ injuries are unfortunately not particularly out of the ordinary for that sport, so it doesn’t make much sense to hyperfocus on Fox being trans here.

On general “fairness” args: The pretty obvious rebuttal is that sex segregated sports does not somehow make everything fair. Some of this is more general (not all players of the same sex have the same testosterone levels) and some of it is specific to the sport (in basketball, taller players have an obvious advantage over shorter players). In the case of basketball, someone who is 6’4” in height has an obvious biological advantage over someone who is 5’4”, however we allow these two players to compete together while a typical cis man is barred from competing with a typical cis woman because of the man’s biological advantages. The question then comes down to what sort of fairness we want to promote, and for who, as different people benefit from different approaches to fairness in sports. This article covers the broader point fairly well.

Neurology/Biology

Neurology/Biology

Some trans individuals neurologically reflect cisgender people of their desired gender, suggesting a neurological component to their experiences. This suggests that gender has some biological basis, but not necessarily that gender is 100% biological. There’s obviously a sociological basis to gender and gender roles which complement its biological aspects.

Detransition/Regret

Detransition/Regret

Detransitioning is rare in the first place, and when it does happen it is overwhelmingly driven by various forms of discrimination, not uncertainty with regards to identity. Regret rates (distinct from detransition rates) are also very low. This seems to be true for both trans adults and trans kids. Credit for most of this stuff goes to this doc by u/Albamc35, feel free to cite it for convenience. This resource from GenderGP is also a helpful resource.

Trans Kids Detransition:

Also, trans kids are not ‘going through a phase.’ First of all, an article from a magazine from the American Academy of Pediatrics mentions how by age 4, children have a ‘stable sense of their gender identity.’ And a study on trans and cis kids (citied in this Forbes article) found gender identity — the concept of knowing whether one’s self is male, female or non-binary — is as strong in trans kids as it is among those identifying as cis. Similar results are found in this study.

General Detransition:

SRS Detransition:

What about older studies?

I will be talking about the studies on trans kids, which are the most quoted I have seen. One recent example of quotation is in JK Rowling’s essay:

“I want to be very clear here: I know transition will be a solution for some gender dysphoric people, although I’m also aware through extensive research that studies have consistently shown that between 60-90% of gender dysphoric teens will grow out of their dysphoria.”

But there are a number of flaws with these studies. An analysis of 3 of these studies found this (I’m quoting, and it’s a long quote):

“The 3 largest and most-cited studies have reported on the adolescent or adult gender identities of cohorts who had, in childhood, showed gender “atypical” patterns of behavior. Of those who could be followed up, a minority were transgender: 1 of 44, 9 of 45, and 21 of 54. Most of the remaining children later identified as gay, lesbian, or bisexual (although a small number also was heterosexual).

However, close inspection of these studies suggests that most children in these studies were not transgender to begin with. In 2 studies, a large minority (40 and 25) of the children did not meet the criteria for GID to start with, suggesting they were not transgender (because transgender children would meet the criteria). Further, even those who met the GID diagnostic criteria were rarely transgender. Binary transgender children (the focus of this discussion) insist that they are the “opposite” sex, but most children with GID/GD do not. In fact, the DSM-III-R directly stated that true insistence by a boy that he is a girl occurs “rarely” even in those meeting that criterion, a point others have made. When directly asked what their gender is, more than 90% of children with GID in these clinics reported an answer that aligned with their natal sex, the clearest evidence that most did not see themselves as transgender.

We know less about the identities of the children in the third study, but the recruitment letters specifically requested boys who made “statements of wanting to be a girl” (p. 12), with no mention of insisting they were girls. Barring evidence that the children in these studies were claiming an “opposite” gender identity in childhood, these studies are agnostic about the persistence of an “opposite” gender identity into adulthood. Instead, they show that most children who behave in gender counter-stereotypic ways in childhood are not likely to be transgender adults.”

This analysis of 4 of these studies found methodological, theoretical, ethical, and interpretive concerns. Here is their breakdown:

Methodological Concerns

  1. the potential misclassification of child research participants
  2. the lack of acknowledgement of social context for research participants
  3. the age of participants at follow-up
  4. the potential misclassification of adolescent and young adult participants lost to follow-up

Theoretical Concerns

  1. assumptions inherent in“desistance” terminology
  2. binary gender framework
  3. presumption of gender stability as a positive outcome

Ethical Concerns

  1. intensive treatment and testing of child participants
  2. questionable goals of treatment
  3. lack of consideration of children’s autonomy

Interpretive Concerns

  1. the assumption that unknown future adult needs should supersede known childhood needs
  2. the underestimation of harm when attempting to delay or defer transition

Here are the conclusions from this presentation from a WPATH conference (which is a reputable organization on gender dysphoria), which criticizes some of those studies:

  1. Evidence from these studies suggests that the majority of gender nonconforming children are not gender dysphoric adolescents or adults.
  2. It does not support the stereotype that most children who are actually gender dysphoric will “desist” in their gender identities before adolescence.
  3. These studies do acknowledge that intense anatomic dysphoria in childhood may be associated with persistent gender dysphoria and persistent gender identity through adolescence.
  4. Speculation that allowing childhood social transition traps cisgender youth in roles that are incongruent with their identities is not supported by evidence.
  5. These studies fail to examine the diagnostic value of Real Life Experience in congruent gender roles for gender dysphoric children.

I’ll also leave some links that you can look at about those poor studies and this topic in general for further reading (most reference some of the studies I have talked about):

Canada's C-16 Bill

Canada’s C-16 Bill

C-16 is about hate crimes, not pronoun usage. Misgendering doesn’t cross the threshold for being a hate crime in Canada.

Specific Debunks:

In the Military

In the Military

Transgender people should be allowed to serve in the military. There is a notable lack of evidence for transgender personnel disrupting unit cohesion, and other concerns e.g. costs and deployability disruption aren’t THAT big a deal.

Brief note on surveys that ask servicemembers how they would feel about a trans military ban: this data isn’t actually useful. Due to the politically charged nature of the topic, responses may not have reflected actual experiences within the military or whatnot, but instead may reflect the political affiliation of respondents. This could make this source useless as a result. This is something I saw in two studies.

If we do want to make a policy decision based on this, though, we could definitely consider improving unit cohesion by decreasing transphobic beliefs in the military, as more transphobic people seem to have more concerns about not being able to work with a trans person.

Trump transgender military ban:

Depathologization

Depathologization

+ its impact

Addressing Reactionary Claims

Addressing Reactionary Claims

Some claims about trans people are addressed in this doc by this person, if you want to take a look. This webpage, this document and this second webpage also have a lot of material to work with. Certain myths have also been addressed elsewhere in the Source Library on this page.

WIP section but will probably cover:

Q: What about the failed David Reimer case study, which was led by John Money, who introduced the gender-sex distinction? Doesn’t this failure not only suggest that his gender-sex distinction is flawed, gender roles are tied to nature rather than nurture, and that trans people by extension can’t change their nature via transition?

Q: Why didn’t the medical community change courses on anything or drop any bad ideas after the Reimer experiment went wrong? Doesn’t that indicate corruption and a leftist agenda?

Q: What if I identify as an attack helicopter, or as a different age? Should I be given the same respect in my identity as trans people want for themselves?

(WORK IN PROGRESS) Q: What if I identify as an attack helicopter, or as a different age? Should I be given the same respect in my identity as trans people want for themselves?

Q: What about Ray Blanchard’s theory of autogynephilia, the idea that most or all trans women are trans because of erotic arousal by the thought of being a woman?

Q: People with anorexia are treated with psychiatric help, not hormones or surgery. Why can’t we do the same for trans people?

Q: Don’t you need dysphoria to be trans?

Similar to the gender-sex distinction, the answer to this question largely comes down to semantics. It also comes down to whether or not some trans people have managed to get rid of their dysphoria. Let’s start with the semantic aspect. Below are a number of medical organizations cited where they implicitly or explicitly say that not all transgender people have to deal with gender dysphoria:

Organization Quote
American Psychiatric Association Not all transgender people suffer from gender dysphoria and that distinction is important to keep in mind. Gender dysphoria and/or coming out as transgender can occur at any age.
World Health Organization’s ICD-10 A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex.
American Psychological Organization Many transgender people do not experience their gender as distressing or disabling
American Academy of Pediatrics Some youths experience gender dysphoria when the incongruence between assigned sex at birth
Canadian Paediatric Society Some transgender children experience no distress about their bodies, while others may express significant discomfort.
World Medical Association The WMA asserts that gender incongruence is not in itself a mental disorder; however it can lead to discomfort or distress, which is referred to as gender dysphoria (DSM-5).
World Professional Association for Transgender Health The various The DSM-5 descriptive criteria for gender dysphoria were developed to aid in diagnosis and treatment to alleviate the clinically significant distress and impairment that is frequently, though not universally, associated with transsexual and transgender conditions.

If that’s not convincing, let’s go on to that second part: if you have a transgender person who used to have dysphoria, but has now gone through so-and-so procedures and now feels in line with their body, no longer feels dysphoric… is that person no longer transgender? Obviously not. So that again goes to show that you can be transgender without necessarily having dysphoria.

Q: Doesn’t transition sterilize trans people?

Not always. It depends on the aspects of transition someone chooses to go through - for example, an FTM trans man who goes through HRT will not go sterile, but he will go sterile if he goes through a hysterectomy (surgical removal of the womb). In fact, there is documented evidence of trans men going through pregnancy (this means they’re not sterile), a majority of whom had been on testosterone. It’s worth noting that some countries do not offer legal recognition to trans people unless they are sterilized, which is discriminatory and against human rights law.

Specific Studies and Articles:

Additional Resources

Additional Resources