7 ms·

An English ruling on transgender teens could have global repercussions

42 points by johntfella 6y ago

bpodgursky 6y ago
The "medical" practice of handing out out puberty blockers and arbitrary hormones to every confused teenager who even suggests not fitting within traditional gender norms, is going to end up in the same chapter in the history books as when Inuits (apocryphally) drilled holes in skulls to let out the bad spirits. Sometimes doing nothing (at least for a while) is good medicine.
- deleted 6y ago
  [deleted]
- mmiliauskas 6y ago
  Not sure why this is downvoted?
  - dongobongo 6y ago
    sign of the times.
  - deleted 6y ago
    [deleted]
  - DanBC 6y ago
    Because it contains a number of factually incorrect statements that have no relevance to the Bell case or treatment in the UK.
- michaelmrose 6y ago
  From brief reading it seems like therapy and ensuring that the young person has arrived at a mental state and maturity prior to beginning any medical treatment while proceeding prior getting too far into puberty is the current ethical standard. Maturity isn't binary its a spectrum. I don't understand why we can't proceed sensibly according to ethical standards and help people without giving random confused preteens hormones based on a 10 minute interview. This article reads as alarmist.
vmception 6y ago
this is interesting as it is harder for an adult to get treatment to become infertile than it is for a child to get hormone drugs that can do the same thing this seems to be in the interest of not having parents make knee jerk and unhelpful reactions, instead of the doctors actually evaluating potential underlying conditions of the patient from my understanding, we are trying to accommodate body dysmorphia because it is easy to accommodate: give people what they want and the rest of us just say a pronoun so that they don’t feel marginalized, but for science this is a stopgap solution and there is interest in understanding and preventing the dysmorphia to begin with. It seems this message gets lost because people don't want to be seen as transphobic or don’t want the “mental health” research to be misconstrued as “I want to ignore those crazy people”, as a lot of transphobes do consider things that way. While this is inherently a mental incongruence, it is easy to accommodate while we work to avoid it happening.
- whyamibothering 6y ago
  Infertility as a result of puberty blockers (and hormones, but it is incredibly uncommon to prescribe them to kids in the US or the UK) is actually fully-reversible. The only long-term effect is a (very slightly) lower bone density, if you're on them for ten years. [Note on this at the end of comment for pedantic people] Pretty much nowhere is it standard practice to administer hormones to anyone below 18, and few people are advocating for that. The rate of attempted suicide in people yet to transition with gender dysphoria is 41%. That is the highest rate of any physical or mental condition we have on the books. This rate drops when you put them on hormone blockers (in cases of minors) and it drops when you put them on cross-sex hormones (in cases of adults). Getting HN to come around on this issue is likely impossible, but if you want to hear from an actual expert (effectively the expert on the topic), here's a presentation you might find interesting from a medical doctor: https://www.youtube.com/watch?v=fefu33e8O-0 https://www.youtube.com/watch?v=fefu33e8O-0 If not for compassion, you should check it out for intellectual curiosity. The talk goes into a lot of detail on how a general human's endocrine system works, has some interesting medical information even if you're not trans, and takes a really balanced approach to the issue. ----- [Note] Fertility returning by simply stopping anti-androgens isn't necessarily a given, but getting it back is actually entirely doable. If you take the time to watch the talk, the doctor goes into how he's managed to get 100% of patients desiring it fertility back.
Thorentis 6y ago
> Gender and sex are different things > I think I'm a different gender > I'm going to try and change my sex Explain to me how this isn't absurd?
- jazzkingrt 6y ago
  "Gender and sex are different" isn't intended to mean that they are completely independent concepts.
LeoPanthera 6y ago
Transphobia is common and widely accepted in the UK right now, and the UK is very culturally influential despite their current isolationist tendencies, so I suspect we're going to see a lot of transphobic misinformation here in the comments. So here's one thing that is important to remember: Lupron, also known as Leuprorelin or Leuprolide, has no permanent side effects when taken alone. It stops puberty, but it doesn't prevent it. If you stop taking the drug, the process of puberty will resume completely as normal. Its purpose is not to begin the sex change process, but to allow time for planning what the next steps are (usually, hormone replacement therapy), so you are not racing against a biological clock.
- zpeti 6y ago
  This is incorrect, and is exactly why this ruling has happened. It does have permanent effects.
- rodarmor 6y ago
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195423/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195423/
abellerose 6y ago
As a transgender person I find HN members to be somewhat transphobic in previous discussions unrelated to this article about transgender issues. So unsure if it's a good place for discussion here. It would be nice if articles like the submitted one were moderated better. Feels like HN takes a stance of ignoring these gender topics or flagging them and while being more defensive of other non-gender topics that are controversial. Puberty blockers are used for other medical issues and aren't considered dangerous or life damaging. Anyway this topic is somewhat meaningful to me because I really don't think people know how truly valuable it can be for someone to stall puberty when they desire to. I find it appalling that cis society is quick to make sure no confused cis kid is harmed while ignoring trans kids that end up permanently disfigured by their voice & appearance from the wrong puberty. It's basically comparable to a cis kid having the wrong hormones damaging their body through puberty like a boy growing breasts and people just shrug their shoulders when it's a trans kid. For context I went through the wrong puberty (I'm only 30 years old) and recently have been diagnosed with cancer. I'm choosing not to get treatment for the cancer and so I can get Medical Assistance in Dying because Gender Dysphoria sucks while all surgeries to possibly fix voice or appearance is like putting a downpayment for a house. Also was disowned by parents and struggled through university years because of constant bullying. Anyway I really hope people can take the time to consider that some kids truly know they're trans and it's not a fad to them.
- underseacables 6y ago
  A lot of the pushback is because, for you, it’s a choice that you hope will make you feel better and more accepted in the world. To the rest of us, it’s a psychiatric disorder and you need serious, long term help. No amount of surgeries, or hormone blockers is going to change that. As much as you may disagree, it’s science, and it’s absolutely irrefutable.
  - mewse 6y ago
    If it’s irrefutable, it is not science. By definition.
    - 6y ago
aristophenes 6y ago
This is a touchy subject, but I feel the need to state the obvious, that 12 year old children think and do a lot of foolish things because they are figuring out themselves and the world. We need to trust parents to help them and protect them, that is our job. We know them better than anyone, we have experience, we even share DNA with them. I know there are exceptions, but the default state should be to trust parents with their own children. Nobody is perfect and mistakes will be made. That’s life, we try to do our best. And no committee, politician, doctor, even therapist is going to be able to ensure they won’t make mistakes that are worse. And I love my kids much more than they ever could.
- underseacables 6y ago
  I disagree. Parents make irrational decisions because of emotion and stress. Children should absolutely not be transitioning anything until they’re 18. The risks are too great, and the parents are too easily manipulated by society.
  - WillYouFinish 6y ago
    I think even 18 year old are too young. When I was 18 I would do all the stupid things. I would not trust this person at all. I think something around 25 or so is a good age. Not just this subject but in general.
    - falcolas 6y ago
      If a person is old enough to die for their country (i.e. enlist as a soldier), they’re old enough to make their own decisions about their sexuality.
      - t0mbstone 6y ago
        18 year olds are dumb and easily manipulated, which is precisely why they are recruited to join the army. Someone's ability to join the army and be used as cannon fodder is hardly proof of their ability to think intelligently for themselves.
petra 6y ago
The problem with sex reassignment surgeries, is that they do not work: ”Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers." Dr. Paul McHugh, the university distinguished service professor of psychiatry at the Johns Hopkins University https://www.thepublicdiscourse.com/2015/06/15145/ https://www.thepublicdiscourse.com/2015/06/15145/
- whyamibothering 6y ago
  That's not a study. That's an anecdote. They actually have a lower rate of patient regret than LASIK. This is a study: https://link.springer.com/article/10.1007/s10508-014-0300-8 https://link.springer.com/article/10.1007/s10508-014-0300-8 n = 767. Over fifty years. Lower rate of patient regret than LASIK. Further, sex reassignment surgeries aren't the only treatment, and they aren't even one relevant to the article.
  - bobmichael 6y ago
    What other treatments are there? Do you have a good resource if I'd like to learn more?
    - whyamibothering 6y ago
      Non-surgical medical treatment is generally the most fruitful. (SRS, or GCS, is a surgical procedure involving construction of genitalia, and up until very recently there weren't any decent options for it.) Unfortunately, therapy alone generally isn't shown to make suicide rates or gender dysphoria go away. Elsewhere in this thread I posted a link to a great talk that has the leading expert in transgender care go into extreme depth on methods of treatments for transgender patients. If you want a doctor's perspective, and one that has probably the most experience tied to it (he sees an incredible volume of transgender patients), I definitely recommend checking it out.
  - dogma1138 6y ago
    You should read the study, their methodology for regret was only to account for people that requested a reversal: "The regret rate is defined as the number of sex reassigned individuals at the time period when they did their first application that will later apply for reversal to the original sex" The study also did not account for suicides or being sanctioned in their regret rate.
ygmelnikova 6y ago
Where does this end? Bestiality? How about post birth abortion. Keep the baby for a few days to determine if you really want to abort or not. How about multi-gender where the left half of your body is cis and the right is transgender? Seriously, what's next?
dongobongo 6y ago
fyi, this disappeared from the Top 120 of HN. Not a good look dang
- dang 6y ago
  https://news.ycombinator.com/item?id=25485434 https://news.ycombinator.com/item?id=25485434
Taurenking 6y ago
why is this on hacker news again?
- dang 6y ago
  https://news.ycombinator.com/item?id=25484463 https://news.ycombinator.com/item?id=25484463

42 points by johntfella 6y ago

The "medical" practice of handing out out puberty blockers and arbitrary hormones to every confused teenager who even suggests not fitting within traditional gender norms, is going to end up in the same chapter in the history books as when Inuits (apocryphally) drilled holes in skulls to let out the bad spirits. Sometimes doing nothing (at least for a while) is good medicine.

deleted 6y ago
[deleted]
mmiliauskas 6y ago
Not sure why this is downvoted?
- dongobongo 6y ago
  sign of the times.
- deleted 6y ago
  [deleted]
- DanBC 6y ago
  Because it contains a number of factually incorrect statements that have no relevance to the Bell case or treatment in the UK.
michaelmrose 6y ago
From brief reading it seems like therapy and ensuring that the young person has arrived at a mental state and maturity prior to beginning any medical treatment while proceeding prior getting too far into puberty is the current ethical standard. Maturity isn't binary its a spectrum. I don't understand why we can't proceed sensibly according to ethical standards and help people without giving random confused preteens hormones based on a 10 minute interview. This article reads as alarmist.

vmception 6y ago

this is interesting as it is harder for an adult to get treatment to become infertile than it is for a child to get hormone drugs that can do the same thing this seems to be in the interest of not having parents make knee jerk and unhelpful reactions, instead of the doctors actually evaluating potential underlying conditions of the patient from my understanding, we are trying to accommodate body dysmorphia because it is easy to accommodate: give people what they want and the rest of us just say a pronoun so that they don’t feel marginalized, but for science this is a stopgap solution and there is interest in understanding and preventing the dysmorphia to begin with. It seems this message gets lost because people don't want to be seen as transphobic or don’t want the “mental health” research to be misconstrued as “I want to ignore those crazy people”, as a lot of transphobes do consider things that way. While this is inherently a mental incongruence, it is easy to accommodate while we work to avoid it happening.

whyamibothering 6y ago
Infertility as a result of puberty blockers (and hormones, but it is incredibly uncommon to prescribe them to kids in the US or the UK) is actually fully-reversible. The only long-term effect is a (very slightly) lower bone density, if you're on them for ten years. [Note on this at the end of comment for pedantic people] Pretty much nowhere is it standard practice to administer hormones to anyone below 18, and few people are advocating for that. The rate of attempted suicide in people yet to transition with gender dysphoria is 41%. That is the highest rate of any physical or mental condition we have on the books. This rate drops when you put them on hormone blockers (in cases of minors) and it drops when you put them on cross-sex hormones (in cases of adults). Getting HN to come around on this issue is likely impossible, but if you want to hear from an actual expert (effectively the expert on the topic), here's a presentation you might find interesting from a medical doctor: https://www.youtube.com/watch?v=fefu33e8O-0 https://www.youtube.com/watch?v=fefu33e8O-0 If not for compassion, you should check it out for intellectual curiosity. The talk goes into a lot of detail on how a general human's endocrine system works, has some interesting medical information even if you're not trans, and takes a really balanced approach to the issue. ----- [Note] Fertility returning by simply stopping anti-androgens isn't necessarily a given, but getting it back is actually entirely doable. If you take the time to watch the talk, the doctor goes into how he's managed to get 100% of patients desiring it fertility back.

Thorentis 6y ago

> Gender and sex are different things > I think I'm a different gender > I'm going to try and change my sex Explain to me how this isn't absurd?

jazzkingrt 6y ago
"Gender and sex are different" isn't intended to mean that they are completely independent concepts.

LeoPanthera 6y ago

Transphobia is common and widely accepted in the UK right now, and the UK is very culturally influential despite their current isolationist tendencies, so I suspect we're going to see a lot of transphobic misinformation here in the comments. So here's one thing that is important to remember: Lupron, also known as Leuprorelin or Leuprolide, has no permanent side effects when taken alone. It stops puberty, but it doesn't prevent it. If you stop taking the drug, the process of puberty will resume completely as normal. Its purpose is not to begin the sex change process, but to allow time for planning what the next steps are (usually, hormone replacement therapy), so you are not racing against a biological clock.

zpeti 6y ago
This is incorrect, and is exactly why this ruling has happened. It does have permanent effects.
rodarmor 6y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195423/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195423/

abellerose 6y ago

As a transgender person I find HN members to be somewhat transphobic in previous discussions unrelated to this article about transgender issues. So unsure if it's a good place for discussion here. It would be nice if articles like the submitted one were moderated better. Feels like HN takes a stance of ignoring these gender topics or flagging them and while being more defensive of other non-gender topics that are controversial. Puberty blockers are used for other medical issues and aren't considered dangerous or life damaging. Anyway this topic is somewhat meaningful to me because I really don't think people know how truly valuable it can be for someone to stall puberty when they desire to. I find it appalling that cis society is quick to make sure no confused cis kid is harmed while ignoring trans kids that end up permanently disfigured by their voice & appearance from the wrong puberty. It's basically comparable to a cis kid having the wrong hormones damaging their body through puberty like a boy growing breasts and people just shrug their shoulders when it's a trans kid. For context I went through the wrong puberty (I'm only 30 years old) and recently have been diagnosed with cancer. I'm choosing not to get treatment for the cancer and so I can get Medical Assistance in Dying because Gender Dysphoria sucks while all surgeries to possibly fix voice or appearance is like putting a downpayment for a house. Also was disowned by parents and struggled through university years because of constant bullying. Anyway I really hope people can take the time to consider that some kids truly know they're trans and it's not a fad to them.

underseacables 6y ago
A lot of the pushback is because, for you, it’s a choice that you hope will make you feel better and more accepted in the world. To the rest of us, it’s a psychiatric disorder and you need serious, long term help. No amount of surgeries, or hormone blockers is going to change that. As much as you may disagree, it’s science, and it’s absolutely irrefutable.
- mewse 6y ago
  If it’s irrefutable, it is not science. By definition.
  - 6y ago

aristophenes 6y ago

This is a touchy subject, but I feel the need to state the obvious, that 12 year old children think and do a lot of foolish things because they are figuring out themselves and the world. We need to trust parents to help them and protect them, that is our job. We know them better than anyone, we have experience, we even share DNA with them. I know there are exceptions, but the default state should be to trust parents with their own children. Nobody is perfect and mistakes will be made. That’s life, we try to do our best. And no committee, politician, doctor, even therapist is going to be able to ensure they won’t make mistakes that are worse. And I love my kids much more than they ever could.

underseacables 6y ago
I disagree. Parents make irrational decisions because of emotion and stress. Children should absolutely not be transitioning anything until they’re 18. The risks are too great, and the parents are too easily manipulated by society.
- WillYouFinish 6y ago
  I think even 18 year old are too young. When I was 18 I would do all the stupid things. I would not trust this person at all. I think something around 25 or so is a good age. Not just this subject but in general.
  - falcolas 6y ago
    If a person is old enough to die for their country (i.e. enlist as a soldier), they’re old enough to make their own decisions about their sexuality.
    - t0mbstone 6y ago
      18 year olds are dumb and easily manipulated, which is precisely why they are recruited to join the army. Someone's ability to join the army and be used as cannon fodder is hardly proof of their ability to think intelligently for themselves.

petra 6y ago

The problem with sex reassignment surgeries, is that they do not work: ”Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers." Dr. Paul McHugh, the university distinguished service professor of psychiatry at the Johns Hopkins University https://www.thepublicdiscourse.com/2015/06/15145/ https://www.thepublicdiscourse.com/2015/06/15145/

whyamibothering 6y ago
That's not a study. That's an anecdote. They actually have a lower rate of patient regret than LASIK. This is a study: https://link.springer.com/article/10.1007/s10508-014-0300-8 https://link.springer.com/article/10.1007/s10508-014-0300-8 n = 767. Over fifty years. Lower rate of patient regret than LASIK. Further, sex reassignment surgeries aren't the only treatment, and they aren't even one relevant to the article.
- bobmichael 6y ago
  What other treatments are there? Do you have a good resource if I'd like to learn more?
  - whyamibothering 6y ago
    Non-surgical medical treatment is generally the most fruitful. (SRS, or GCS, is a surgical procedure involving construction of genitalia, and up until very recently there weren't any decent options for it.) Unfortunately, therapy alone generally isn't shown to make suicide rates or gender dysphoria go away. Elsewhere in this thread I posted a link to a great talk that has the leading expert in transgender care go into extreme depth on methods of treatments for transgender patients. If you want a doctor's perspective, and one that has probably the most experience tied to it (he sees an incredible volume of transgender patients), I definitely recommend checking it out.
- dogma1138 6y ago
  You should read the study, their methodology for regret was only to account for people that requested a reversal: "The regret rate is defined as the number of sex reassigned individuals at the time period when they did their first application that will later apply for reversal to the original sex" The study also did not account for suicides or being sanctioned in their regret rate.

ygmelnikova 6y ago

Where does this end? Bestiality? How about post birth abortion. Keep the baby for a few days to determine if you really want to abort or not. How about multi-gender where the left half of your body is cis and the right is transgender? Seriously, what's next?

dongobongo 6y ago

fyi, this disappeared from the Top 120 of HN. Not a good look dang

dang 6y ago
https://news.ycombinator.com/item?id=25485434 https://news.ycombinator.com/item?id=25485434

Taurenking 6y ago

why is this on hacker news again?

dang 6y ago
https://news.ycombinator.com/item?id=25484463 https://news.ycombinator.com/item?id=25484463