5 ms·

I witnessed this first hand in a close relative who, in the throws of a multi month long bipolar psychosis, concluded that the source of her mental health probl

I witnessed this first hand in a close relative who, in the throws of a multi month long bipolar psychosis, concluded that the source of her mental health problems was gender dysphoria. The internet was very influential in her reaching this conclusion. The internet also allowed her to locate a dr who didn’t restrict sexual reassignment to those without mental health comorbidities. Thankfully the very liberal dr she found was too far for her to travel, since she could not drive and Uber wasn’t yet a thing. She was stabilized on antipsychotics a few months later and completely dropped all discussion of gender dysphoria, something, to be clear, that she had never talked about or hinted at prior to her psychotic episode. It concerns me that had she had this episode a few years later, when the medical ethics had changed and Uber made it possible for a mentally ill person to travel to the city where the dr she found was located, she likely would have undergone some form of reassignment surgery with lasting physical effects and potentially catastrophic effects on her psychological well being. She has been happily married, well more or less happily, for more than a decade now, to a nice man. No sign of gender dysphoria and no recent psychotic episodes.

Breefield 4y ago
You seriously misunderstand how hard it is to have sex reassignment surgery. Even in states where beginning an HRT regimen is based on informed consent, there are many steps one must go through before having this procedure done. Multiple letters of recommendation from licensed therapists and having been on hormones for years. Not to mention the exorbitant costs even with insurance. Your suggestion that one could Uber to another city and have SRS performed is a gross mischaracterization of the reality trans people face.
- jvanderbot 4y ago
  The article provides examples of clinics offering very few steps to treatment, and discusses doctors who bias in favor of treatment. It paints a picture supporting the conclusion that it would have been easy.
  - klyrs 4y ago
    The gulf between the availability of specialist surgeons and pharmaceuticals is incredibly vast. If the article gave you the impression that you can just walk in and get your SRS did on a whim, perhaps you should reconsider its veracity or at least your understanding of the situation.
    - jvanderbot 4y ago
      I don't have a any understanding of this situation or a horse in this race, was just pointing out that ancestor comment was justified based on the article, which also addressed availability of pharmaceuticals, btw. It'd be nice to have literature or deeper investigation on this.
  - bjowen 4y ago
    The article is written from experience in one paediatric centre, when the pratice between different centres - and laws in different states - differ vastly. Information about people seeking gender affirming care in different places and stages of transition is not refutable based on this article. And it is anecdata - how many patients had positive outcomes? Article doesn’t tell you. What did the (brand new) centre learn from these cases with negative outcomes? What protocols was it using? Are they the same now? Are they common elsewhere?
    - setr 4y ago
      That’s a large part of the article’s call-out — there’s no real tracking of outcomes, and looking to do so is met hostility.
  - jonhendry18 4y ago
    "Treatment" involves a number of different options, of varying permanence. It isn't "Okay, surgery scheduled for Tuesday" at every patient's first consulation. I wouldn't be surprised if for most girls, treatment starts with wearing a binder, which is clothing.
- 2devnull 4y ago
  That’s reassuring. She did say that the doctor she found was like the only one in California, maybe even the whole country, that would treat people with mental health comorbidity. So even back then it wasn’t a widespread thing, just this one trailblazing doctor in the very lgbtqi2 friendly city of San Francisco. And it sort of makes sense. Why couldn’t someone have both schizophrenia and gender dysphoria? Shouldn’t the mentally ill be able to address other health problems like gender dysphoria? It’s very difficult thinking through the medical ethics involved.
kevingadd 4y ago
Glad to hear your close relative is doing well now, and it sounds like she was in a tough situation. If you did more research though you'd understand that the thing you feared is not especially common or even possible under normal processes, so it's not really worth fearmongering about it on a public forum. In most first-world medical systems there are years-long waiting lists for surgeries, or even to see a specialist at all. Most people I know who've seen specialists about gender issues had to wait months to even talk to someone. Getting surgery on a whim within a few months simply doesn't happen unless you're a wealthy person flying overseas for at-your-own-risk surgery, which is also available for many other purposes. This is similar to how you'll see people fear-mongering about things like teenage children getting surgeries, which simply does not happen. The processes don't allow for it because it would be wildly irresponsible, but you can still find lots of people talking about it as if it happens on a regular basis. In reality, adults in their twenties and thirties sit on waiting lists for years. Note also that even if you were to schedule surgery on short notice, in many cases they require you to have been on the relevant medications for a while because if you were to have sex-related organs removed or modified surgically without having adjusted to your own hormone levels it would be a pretty nasty adjustment.
- 2devnull 4y ago
  I’m relieved to hear that. It’s easy to get the impression that many children are now starting the process with hormones and whatnot, without too many barriers in place or a sufficient waiting period. It’s probably the most extreme cases that get the spotlight.
  - kevingadd 4y ago
    In general when medical processes are flawed, the extreme <0.1% cases get the spotlight and instead of being used to advocate for process improvements, they're generalized by people with an agenda to claim that an <0.1% case is a 1% or 10% case. It does a disservice to the outliers who suffered and the sensationalized story is (rightly) ignored by people who might otherwise benefit from the cautionary tale.
    - 4y ago

Breefield 4y ago

You seriously misunderstand how hard it is to have sex reassignment surgery. Even in states where beginning an HRT regimen is based on informed consent, there are many steps one must go through before having this procedure done. Multiple letters of recommendation from licensed therapists and having been on hormones for years. Not to mention the exorbitant costs even with insurance. Your suggestion that one could Uber to another city and have SRS performed is a gross mischaracterization of the reality trans people face.

jvanderbot 4y ago
The article provides examples of clinics offering very few steps to treatment, and discusses doctors who bias in favor of treatment. It paints a picture supporting the conclusion that it would have been easy.
- klyrs 4y ago
  The gulf between the availability of specialist surgeons and pharmaceuticals is incredibly vast. If the article gave you the impression that you can just walk in and get your SRS did on a whim, perhaps you should reconsider its veracity or at least your understanding of the situation.
  - jvanderbot 4y ago
    I don't have a any understanding of this situation or a horse in this race, was just pointing out that ancestor comment was justified based on the article, which also addressed availability of pharmaceuticals, btw. It'd be nice to have literature or deeper investigation on this.
- bjowen 4y ago
  The article is written from experience in one paediatric centre, when the pratice between different centres - and laws in different states - differ vastly. Information about people seeking gender affirming care in different places and stages of transition is not refutable based on this article. And it is anecdata - how many patients had positive outcomes? Article doesn’t tell you. What did the (brand new) centre learn from these cases with negative outcomes? What protocols was it using? Are they the same now? Are they common elsewhere?
  - setr 4y ago
    That’s a large part of the article’s call-out — there’s no real tracking of outcomes, and looking to do so is met hostility.
- jonhendry18 4y ago
  "Treatment" involves a number of different options, of varying permanence. It isn't "Okay, surgery scheduled for Tuesday" at every patient's first consulation. I wouldn't be surprised if for most girls, treatment starts with wearing a binder, which is clothing.
2devnull 4y ago
That’s reassuring. She did say that the doctor she found was like the only one in California, maybe even the whole country, that would treat people with mental health comorbidity. So even back then it wasn’t a widespread thing, just this one trailblazing doctor in the very lgbtqi2 friendly city of San Francisco. And it sort of makes sense. Why couldn’t someone have both schizophrenia and gender dysphoria? Shouldn’t the mentally ill be able to address other health problems like gender dysphoria? It’s very difficult thinking through the medical ethics involved.

kevingadd 4y ago

Glad to hear your close relative is doing well now, and it sounds like she was in a tough situation. If you did more research though you'd understand that the thing you feared is not especially common or even possible under normal processes, so it's not really worth fearmongering about it on a public forum. In most first-world medical systems there are years-long waiting lists for surgeries, or even to see a specialist at all. Most people I know who've seen specialists about gender issues had to wait months to even talk to someone. Getting surgery on a whim within a few months simply doesn't happen unless you're a wealthy person flying overseas for at-your-own-risk surgery, which is also available for many other purposes. This is similar to how you'll see people fear-mongering about things like teenage children getting surgeries, which simply does not happen. The processes don't allow for it because it would be wildly irresponsible, but you can still find lots of people talking about it as if it happens on a regular basis. In reality, adults in their twenties and thirties sit on waiting lists for years. Note also that even if you were to schedule surgery on short notice, in many cases they require you to have been on the relevant medications for a while because if you were to have sex-related organs removed or modified surgically without having adjusted to your own hormone levels it would be a pretty nasty adjustment.

2devnull 4y ago
I’m relieved to hear that. It’s easy to get the impression that many children are now starting the process with hormones and whatnot, without too many barriers in place or a sufficient waiting period. It’s probably the most extreme cases that get the spotlight.
- kevingadd 4y ago
  In general when medical processes are flawed, the extreme <0.1% cases get the spotlight and instead of being used to advocate for process improvements, they're generalized by people with an agenda to claim that an <0.1% case is a 1% or 10% case. It does a disservice to the outliers who suffered and the sensationalized story is (rightly) ignored by people who might otherwise benefit from the cautionary tale.
  - 4y ago