5 ms·

Red tribe orthodoxy has a lot of disdain for people with trans identities. Blue tribe orthodoxy has maximal dain for those people. But both tribes are willing t

by jl6 2y ago

Red tribe orthodoxy has a lot of disdain for people with trans identities. Blue tribe orthodoxy has maximal dain for those people. But both tribes are willing to promote pseudoscience to achieve their goals. Singal occupies a narrow sliver of the political possibility space where sympathy for those identities can exist at the same time as supporting evidence-based medicine.

nemomarx 2y ago
Before I started transition I read through the available literature (this would be back in 2010-2015 ish, before it was quite so hot button) and the general consensus wasn't with Singals position then. I don't think skepticism ought to be ruled out or anything, but hormone therapy is better studied than the use of most antidepressants at this point. (although it could still use better study on particular dosage and effects - no one seems to have done anything comprehensive on progestin treatment, for instance, even though it's clearly associated with the rest.)
- gadders 2y ago
  The Cass report in the UK was pretty clear that there isn't enough evidence to base decisions on https://cass.independent-review.uk/home/publications/final-report/ https://cass.independent-review.uk/home/publications/final-r... >>> While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices. The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate. The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services. The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown. The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.
  - foldr 2y ago
    The report basically said that there wasn't a lot of evidence that the treatments in question make people happy in the long run, which is an unusual standard to apply. Usually we look for evidence that medical treatments achieve their medical goals, and leave judgments about what will or won't make someone happy to doctors or patients. (For example, it's questionable whether certain cancer treatments that extend life by only a few months will be a net benefit for patients, but we generally let patients and doctors decide for themselves whether or not to go ahead with them.)
    - in_a_hole 2y ago
      Given that the treatments are meant to address gender dysphoria which is unhappiness caused by a sense of misalignment with one's sexual characteristics I struggle to think of a better measure of success than long-term happiness.
      - foldr 2y ago
        It's a good measure of success, but if we applied the same standard consistently, then all kinds of treatments for all kinds of partially psychological conditions would have to be thrown out. Also, it's taking a particular position to characterise gender dysphoria as merely a subjective feeling of unhappiness. I do not have any fixed position on what exactly gender dysphoria is, but I believe many trans people see it as far more than just that.
  - nemomarx 2y ago
    The Cass report is pretty questionable quality wise - it was written with political goals pretty directly in mind and it rules out a lot of studies for not being double blind. (Which is necessarily a hard ask here, medical ethics boards aren't going to let you give hormones to the control group children or anything.) And that criticism has come from medical boards in the UK and globally, I believe? Anyway, that's also only for children, which feels politically like a wedge issue. The NHS is very slow at providing HRT and I rather doubt they're treating more than a hundred children for gender dysphoria in any way rn.
gadders 2y ago
Yes, I think there is a middle ground. Trans people are clearly going through something, and I think a bit more sympathy from the Right, particularly for adolescents wouldn't go amiss. Puberty in the age of social media, anxiety and other mental health challenges is rough. You can hate the policies/movement and still have sympathy for the individuals. However, I'm not sure that encouraging young people to make one-way decisions (or decisions where we are not yet sure whether they are one way or not) is the correct approach.
- lukas099 2y ago
  > You can hate the policies/movement and still have sympathy for the individuals. I think people on the right (outright bigots excepted) would say they do have sympathy, and it's for kids who have been influenced by the media or whatever to think that they are the opposite gender. > However, I'm not sure that encouraging young people to make one-way decisions (or decisions where we are not yet sure whether they are one way or not) is the correct approach. And I think the response here is that not taking action is also one-way, causing irreversible changes, like to the bone structure.
- jl6 2y ago
  Yes, this is the kind of nuanced take that has been squeezed out by ideological snap-to-grid from the warring tribes.
  - yamazakiwi 2y ago
    I rarely see sympathy from anyone, it's easier to be staunch and tapped out unfortunately.
- deleted 2y ago
  [deleted]

by jl6 2y ago

nemomarx 2y ago

Before I started transition I read through the available literature (this would be back in 2010-2015 ish, before it was quite so hot button) and the general consensus wasn't with Singals position then. I don't think skepticism ought to be ruled out or anything, but hormone therapy is better studied than the use of most antidepressants at this point. (although it could still use better study on particular dosage and effects - no one seems to have done anything comprehensive on progestin treatment, for instance, even though it's clearly associated with the rest.)

gadders 2y ago
The Cass report in the UK was pretty clear that there isn't enough evidence to base decisions on https://cass.independent-review.uk/home/publications/final-report/ https://cass.independent-review.uk/home/publications/final-r... >>> While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices. The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate. The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services. The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown. The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.
- foldr 2y ago
  The report basically said that there wasn't a lot of evidence that the treatments in question make people happy in the long run, which is an unusual standard to apply. Usually we look for evidence that medical treatments achieve their medical goals, and leave judgments about what will or won't make someone happy to doctors or patients. (For example, it's questionable whether certain cancer treatments that extend life by only a few months will be a net benefit for patients, but we generally let patients and doctors decide for themselves whether or not to go ahead with them.)
  - in_a_hole 2y ago
    Given that the treatments are meant to address gender dysphoria which is unhappiness caused by a sense of misalignment with one's sexual characteristics I struggle to think of a better measure of success than long-term happiness.
    - foldr 2y ago
      It's a good measure of success, but if we applied the same standard consistently, then all kinds of treatments for all kinds of partially psychological conditions would have to be thrown out. Also, it's taking a particular position to characterise gender dysphoria as merely a subjective feeling of unhappiness. I do not have any fixed position on what exactly gender dysphoria is, but I believe many trans people see it as far more than just that.
- nemomarx 2y ago
  The Cass report is pretty questionable quality wise - it was written with political goals pretty directly in mind and it rules out a lot of studies for not being double blind. (Which is necessarily a hard ask here, medical ethics boards aren't going to let you give hormones to the control group children or anything.) And that criticism has come from medical boards in the UK and globally, I believe? Anyway, that's also only for children, which feels politically like a wedge issue. The NHS is very slow at providing HRT and I rather doubt they're treating more than a hundred children for gender dysphoria in any way rn.

gadders 2y ago

Yes, I think there is a middle ground. Trans people are clearly going through something, and I think a bit more sympathy from the Right, particularly for adolescents wouldn't go amiss. Puberty in the age of social media, anxiety and other mental health challenges is rough. You can hate the policies/movement and still have sympathy for the individuals. However, I'm not sure that encouraging young people to make one-way decisions (or decisions where we are not yet sure whether they are one way or not) is the correct approach.

lukas099 2y ago
> You can hate the policies/movement and still have sympathy for the individuals. I think people on the right (outright bigots excepted) would say they do have sympathy, and it's for kids who have been influenced by the media or whatever to think that they are the opposite gender. > However, I'm not sure that encouraging young people to make one-way decisions (or decisions where we are not yet sure whether they are one way or not) is the correct approach. And I think the response here is that not taking action is also one-way, causing irreversible changes, like to the bone structure.
jl6 2y ago
Yes, this is the kind of nuanced take that has been squeezed out by ideological snap-to-grid from the warring tribes.
- yamazakiwi 2y ago
  I rarely see sympathy from anyone, it's easier to be staunch and tapped out unfortunately.
deleted 2y ago
[deleted]