4 ms·

There's a huge family of "Neurosteroids"[1], which impact various receptors in the brain in lots of super complicated ways that aren't entirely understood. They

There's a huge family of "Neurosteroids"[1], which impact various receptors in the brain in lots of super complicated ways that aren't entirely understood. They are synthesized in all kinds of ways naturally, and when it comes to "what they do" in terms of personality... "probably something" is the best we can do. There is massive complexity in all these things, all kinds of feedback mechanisms, genes and enzymes involved, etc. They do something but it's hard to say what exactly. I know about this personally; one of the amazing things about transgender medicine is that there is a huge range of responses to the hormones involved, and there's honestly no way to predict what will happen with a given person. There are tendencies in aggregate - like less testosterone = less libido - but how those come about biologically is unclear and the effect varies tremendously between different people. It's a joke to pretend like we fully understand or can predict how any of these things actually impact our lived experiences beyond very rough, bulk tendencies. [1]https://en.wikipedia.org/wiki/Neurosteroid https://en.wikipedia.org/wiki/Neurosteroid

allovernow 7y ago
When we know so little, is it really ethical for a psychiatrist to prescribe these drugs to make people slightly more like the opposite gender, rather than teaching them to accept who they are and deal with the disorder like any other incurable condition?
- dpark 7y ago
  What “other incurable conditions” do doctors not even attempt to treat and simply tell patients to “accept who they are and deal with it”?
  - dr_dshiv 7y ago
    Well, helping people cope and find acceptance could be a form of treatment. I am a little scared by the number of my friends who have gone on the medical transgender journey.
  - allovernow 7y ago
    You realize that the alternative is telling people to spend the rest of their lives in an irreversible, elaborate fantasy LARP? One which potentially comes with its own burdens and eventually leads to permanent sterilization? I'm not saying don't treat it. I'm saying hormones and plastic surgery do not make a woman, and more sane treatment would acknowledge this fact and teach coping skills much in the same way we are forced to treat conditions like autism, drug resistant depression, and any other chronic disorder with no cure. A treatment which is based entirely on indulging delusion is no treatment at all, and the bottom line is that you don't get to decide how your gender is perceived. The vast majority of men have no interest in dating or marrying transgender women and it's a disservice to those with gender dismorphia to pretend like they do. What happened to past messages of learning to accept who you are and be comfortable in your own skin? Why stop here? Why not prescribe plastic surgery to teenage girls who don't feel that they're pretty enough for their gender role?
    - dpark 7y ago
      If you don’t support gender transitioning, fine, but don’t pretend that your concern is for the person transitioning as if they don’t understand the implications. Your agenda is painfully clear and has nothing to do with the ethics of prescribing hormones when we don’t fully understand them: “I'm saying hormones and plastic surgery do not make a woman”. The reality is that we don’t understand any medicine particularly well, but we do our best to treat an endless array of diseases and disorders anyway, because it’s more ethical to attempt to ease pain and discomfort than to ignore suffering. Also people do regularly get plastic surgery to address aesthetic concerns. Would you advocate that people with cleft lips should simply learn to accept who they are and we should consider it unethical to correct the deformity?
- JimboOmega 7y ago
  I didn't mean to make this about transgender medicine. The evidence is pretty strong that hormone treatment improves wellbeing for transgender patients[1], and of course, they can always stop it if it doesn't. The fact that very few do is a good indicator of satisfaction overall. There is a very strong bias towards safety in the practice of transgender medicine. I can also personally attest that transgender medicine has vastly improved my life. The changes in appearance reduce awkward interactions (I presented female almost always even before transitioning). The mental changes have all been positive and left me feeling much more in control of myself and my life. There is a lot more science to be done and things to be discovered especially when it comes to brain impacts. Transgender medicine is a new field where there is much to be discovered. It's still a super important thing I'm glad exists. In any case, I was using it as an example where these brain interactions become super visible and complicated, not trying to debate it directly. [1] (simply the first thing I found googling) https://link.springer.com/article/10.1007/s11136-006-0002-3 https://link.springer.com/article/10.1007/s11136-006-0002-3
  - allovernow 7y ago
    And where are the studies regarding post transition surgery regret? I would caution you to be very careful in forming your opinion from modern research in the field. The institution has undeniably accumulated a very strong bias with the emergent result that published results (and research direction) tends to be very one sided. But looking in from the outside, I absolutely cannot take seriously an establishment which unironically recommends permanent genital mutilation which results in a potential lifetime of pain from daily dilation of an artificial orifice which is little more than a glorified wound, which is neither self cleaning nor self lubricating. What is even the point? Surely believing that this is in any way equivalent to a vagina is a medically encouraged delusion, no? I do not mean to be insensitive to your plight. And I cannot deny that you personally have, at least in the short term, benefited from your treatment, and that's wonderful. But we have reached a point now where young adults are being lead by doctors they trust to make irreversible changes which may permanently worsen their quality of life, in a way that seemingly contradicts the standard approach to any other brain disorder (and, yes, it fits that definition, regardless of whether the fad of the day is to pretend it doesn't). I'd have been less explicit in my comments if I didn't feel that dancing around this subject with kids gloves is the reason that we're slipping into this mess.
philwelch 7y ago
Sure, but also if you neuter a cat, it'll be less prone to fight with other cats or to mark its "territory" with urine.

allovernow 7y ago

When we know so little, is it really ethical for a psychiatrist to prescribe these drugs to make people slightly more like the opposite gender, rather than teaching them to accept who they are and deal with the disorder like any other incurable condition?

dpark 7y ago
What “other incurable conditions” do doctors not even attempt to treat and simply tell patients to “accept who they are and deal with it”?
- dr_dshiv 7y ago
  Well, helping people cope and find acceptance could be a form of treatment. I am a little scared by the number of my friends who have gone on the medical transgender journey.
- allovernow 7y ago
  You realize that the alternative is telling people to spend the rest of their lives in an irreversible, elaborate fantasy LARP? One which potentially comes with its own burdens and eventually leads to permanent sterilization? I'm not saying don't treat it. I'm saying hormones and plastic surgery do not make a woman, and more sane treatment would acknowledge this fact and teach coping skills much in the same way we are forced to treat conditions like autism, drug resistant depression, and any other chronic disorder with no cure. A treatment which is based entirely on indulging delusion is no treatment at all, and the bottom line is that you don't get to decide how your gender is perceived. The vast majority of men have no interest in dating or marrying transgender women and it's a disservice to those with gender dismorphia to pretend like they do. What happened to past messages of learning to accept who you are and be comfortable in your own skin? Why stop here? Why not prescribe plastic surgery to teenage girls who don't feel that they're pretty enough for their gender role?
  - dpark 7y ago
    If you don’t support gender transitioning, fine, but don’t pretend that your concern is for the person transitioning as if they don’t understand the implications. Your agenda is painfully clear and has nothing to do with the ethics of prescribing hormones when we don’t fully understand them: “I'm saying hormones and plastic surgery do not make a woman”. The reality is that we don’t understand any medicine particularly well, but we do our best to treat an endless array of diseases and disorders anyway, because it’s more ethical to attempt to ease pain and discomfort than to ignore suffering. Also people do regularly get plastic surgery to address aesthetic concerns. Would you advocate that people with cleft lips should simply learn to accept who they are and we should consider it unethical to correct the deformity?
JimboOmega 7y ago
I didn't mean to make this about transgender medicine. The evidence is pretty strong that hormone treatment improves wellbeing for transgender patients[1], and of course, they can always stop it if it doesn't. The fact that very few do is a good indicator of satisfaction overall. There is a very strong bias towards safety in the practice of transgender medicine. I can also personally attest that transgender medicine has vastly improved my life. The changes in appearance reduce awkward interactions (I presented female almost always even before transitioning). The mental changes have all been positive and left me feeling much more in control of myself and my life. There is a lot more science to be done and things to be discovered especially when it comes to brain impacts. Transgender medicine is a new field where there is much to be discovered. It's still a super important thing I'm glad exists. In any case, I was using it as an example where these brain interactions become super visible and complicated, not trying to debate it directly. [1] (simply the first thing I found googling) https://link.springer.com/article/10.1007/s11136-006-0002-3 https://link.springer.com/article/10.1007/s11136-006-0002-3
- allovernow 7y ago
  And where are the studies regarding post transition surgery regret? I would caution you to be very careful in forming your opinion from modern research in the field. The institution has undeniably accumulated a very strong bias with the emergent result that published results (and research direction) tends to be very one sided. But looking in from the outside, I absolutely cannot take seriously an establishment which unironically recommends permanent genital mutilation which results in a potential lifetime of pain from daily dilation of an artificial orifice which is little more than a glorified wound, which is neither self cleaning nor self lubricating. What is even the point? Surely believing that this is in any way equivalent to a vagina is a medically encouraged delusion, no? I do not mean to be insensitive to your plight. And I cannot deny that you personally have, at least in the short term, benefited from your treatment, and that's wonderful. But we have reached a point now where young adults are being lead by doctors they trust to make irreversible changes which may permanently worsen their quality of life, in a way that seemingly contradicts the standard approach to any other brain disorder (and, yes, it fits that definition, regardless of whether the fad of the day is to pretend it doesn't). I'd have been less explicit in my comments if I didn't feel that dancing around this subject with kids gloves is the reason that we're slipping into this mess.

philwelch 7y ago

Sure, but also if you neuter a cat, it'll be less prone to fight with other cats or to mark its "territory" with urine.