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Yes, but since when do we allow the majority to dictate what healthcare options are available? The mode for treating trans kids is puberty blockers until they’

Yes, but since when do we allow the majority to dictate what healthcare options are available? The mode for treating trans kids is puberty blockers until they’re 18 and then they can choose their own treatment - but that pathway is being blocked by more and more laws and fear mongering about kids being transitioned against their will

bobalob 1y ago
[flagged]
- wredcoll 1y ago
  > Many later detransition [Citation needed]
  - Diti 1y ago
    A simple web search could have given you the citation. “The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets” (DOI: 10.1016/j.jsxm.2018.01.016). The word “many” is misleading – it’s less than 1 %. It’s not nothing, but it’s low.
    - Manuel_D 1y ago
      https://pubmed.ncbi.nlm.nih.gov/29463477/ https://pubmed.ncbi.nlm.nih.gov/29463477/ This isn't the desistence rate of children, this is the regret rate of adults who transition.
    - bobalob 1y ago
      That ~1% figure is unlikely to reflect the full picture of regret. That paper defines regret very narrowly: only including the patients who made an appointment with their original medical team to discuss regret, and only if they regret surgical removal of their sex organs. Plus, a large number of their total cohort were lost to follow-up.
    - VBprogrammer 1y ago
      Can I just point out the irony of this statement in the context of my comment up thread.
  - Manuel_D 1y ago
    https://pmc.ncbi.nlm.nih.gov/articles/PMC8039393/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8039393/ All the studies among gender dysphoric children who are not prescribed puberty blockers show desistence rates over 70% There are studies that show very low desistence rates - many in the single digits. But those are studies among children that are given puberty blockers.
    - heavyset_go 1y ago
      You're citing a paper the Alliance for Defending Freedom regularly uses[1] to support the conspiracy theory that doctors are "turning gay kids trans". The study itself uses criteria for gender dysphoria that's been outdated for decades. Here's what more reliable studies from the American Academy of Pediatrics, the largest professional group of pediatricians in the country, say[2]: > Gender Identity 5 Years After Social Transition > We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years. [1] https://downloads.regulations.gov/ED-2022-OCR-0143-141953/attachment_12.pdf https://downloads.regulations.gov/ED-2022-OCR-0143-141953/at... [2] https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/Gender-Identity-5-Years-After-Social-Transition?autologincheck=redirected https://publications.aap.org/pediatrics/article/150/2/e20210...
      - Manuel_D 1y ago
        > The study itself uses criteria for gender dysphoria that's been outdated for decades. The study uses the DSM-III and DSM-IV criteria for gender incongruence disorder, or GID, now referred to as gender dysphoria. The sample ranges from 1989 to 2002 and those were the contemporary iterations of the DSM. The DSM-V wasn't published until 2013. At most the criteria is outdated by one decade, not "several decades". Furthermore, the author of the study would later write the criteria for gender dysphoria in the DSM-V. The criteria are not particularly different, and the author of the study I linked has stated in interviews that most of the sample would meet the criteria for gender dysphoria under the DSM-V (which, again, he wrote so this opinion should carry some weight). In short, the idea that if the psychologists had used the DSM-V the results would be substantially different is not likely. And this isn't just one study that found low rates of persistence: > In Green (47), the percentage of persisters was 2% (total n = 44; Mean age at follow-up, 19 years; range, 14–24); in Wallien and Cohen-Kettenis (52), the percentage of persisters was 20.3% (total n = 59; Mean age at follow-up, 19.4 years; range, 16–28); and in Steensma et al. (51), the percentage of persisters was 29.1% (total n = 79; Mean age at follow-up, 16.1 years; range, 15–19). Across all studies, the percentage of persisters was 17.4% (total N = 235), with a range from 0 to 29.1%.3 Are all these other studies finding low rates of persistence also tainted in some way? The study you linked is among a group that were treated with an affirming model of care, where cross sex gender identity is actively encouraged, and a sizeable chunk of the sample were put on puberty blockers. This comports with what I have written: when gender dysphoric children are met with an affirming model of care and given gender affirming care, very few of them desist in their cross-sex gender identity. When they given a neutral, observational model of care not not prescribed puberty blockers, the majority of them desist. The study you linked just reinforces the former but does nothing to disprove the latter.
- kennywinker 1y ago
  > Blocking puberty until eighteen is a harmful intervention in itself For a trans kid, going thru the wrong puberty is harmful. The best thing would be hormones at puberty. But given issues around informed consent, puberty blockers are a valid compromise. Calling them harmful without considering the harm of the alternative is not honest.
  - h4x0rr 1y ago
    And who decides if a puberty is "wrong"? The child itself certainly isn't mature enough.
    - ffin 1y ago
      I think this question concedes that there is some possibility that one could experience an incorrect puberty. Given the definition of maturity is being fully grown, this comes across as an inherently unhelpful thing to ask. If we say “only once someone is fully grown they are able to determine if they experienced the incorrect puberty” then this makes it impossible to help children who are going to experience the incorrect puberty. Unless we have some way to determine a child is trans without any input from them, there becomes no way to help them.
      - account42 1y ago
        The possibility of being unable to help people is not an excuse for hurting them or others. Generally if you can't know the correct action than you should stick to the status quo. What's next, gene therapy because the embryo might want to be a different race when it grows up?
  - fourseventy 1y ago
    [flagged]
  - bobalob 1y ago
    Puberty is a stage of natural maturation of the body. There is only one, as per your sex, and you can't go through the wrong one. The puberty of the opposite sex is not an option. This conception of the "wrong puberty" as something that needs to be blocked is as absurd as all that "born in the wrong body" ideological nonsense. Most importantly, children can't meaningfully consent to having their sexual function permanently damaged.
- heavyset_go 1y ago
  Many? You mean less than 1%[1]? > Overall, 33% underwent transmasculine procedures and 67% transfemenine procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%–<1%) and 1% (CI <1%–2%), respectively. That's less than the regret rate for life saving surgeries lol [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/
  - AlexandrB 1y ago
    If you look at the studies examined, many of them are from the 90s and all are from before 2019. The rate of transition in minors has increased rapidly in the last 10 years, and it's not very convincing to see data about mostly adults and assume it's going to apply to this new situation.
    - kennywinker 1y ago
      There isn’t much data, because not many people (child or adult) medically transition. But if you want to follow the data we need to do what we were doing before all this moral panic about trans kids kicked in: cautiously allow kids to transition(1), and collect data about outcomes. It’s disingenuous to complain about bad data in one breath, while blocking any path that would create new data. (1) by transition i mean socially transition and go on puberty blockers if they want them.
      - deleted 1y ago
        [deleted]
  - BobaFloutist 1y ago
    Better ban hip replacements ¯ \ _ ( ツ ) _ / ¯
- BobaFloutist 1y ago
  It is legal in all 50 rates for teenage girls to get breast augmentation surgery in order to better match gender expectations, but god forbid they want to remove them.
  - account42 1y ago
    They shouldn't be getting that either.
    - BobaFloutist 1y ago
      But somehow people are hardly discussing it, let alone trying to make it illegal.
lelanthran 1y ago
> Yes, but since when do we allow the majority to dictate what healthcare options are available? We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.) The government, for good or bad, regulates all healthcare, and that government is guided by its voters. The majority of voters don't see this as a bigger problem than the issue they are currently voting on.
- thaumasiotes 1y ago
  > We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.) That began in 1906; it's hardly something we've "always done".
- kennywinker 1y ago
  > We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.) As someone else pointed out, the idea of gov deciding what our doctors can and cant give us is a VERY modern concept. But your examples: arsnic & crack 1. Cocaine is legal for doctors to prescribe and use in specific circumstances. What is legally prohibited is recreational use. Most of the restrictions on use are due to the threat of addiction, not the threat of appropriate medical use. 2. Arsnic is similarly entirely legal for medical use. Restrictions are around putting it in FOOD because it’s POISON. Nobody is saying you can’t treat cancer with it, if it’s shown to be effective. Your examples are not examples of the majority regulating medical care for individuals.
Manuel_D 1y ago
"Transitioned against their will" is a very crude way of articulating the tradeoffs of prescribing puberty blockers. The core issue at hand is that absent puberty blockers, somewhere between 60-80% do not persist with a cross-sex gender identity after going through their natal puberty. Psychologists attempted to predict which patients would persist in a cross sex gender identity and which would not, but they were never able to do so. When patients are given puberty blockers, desistence rates are miniscule, in the single digits. Proponents of hormonal intervention insist that this is proof that doctors are selecting kids that would persist in a cross sex gender absent blockers. But that's hard to reconcile with psychologists previous failures to predict persistence. While they're billed as giving "time to think", it's pretty much impossible to deny that blockers are causing patients who would have desisted in their cross sex gender identity if they went through their natal puberty. It's not just conservative American States that are changing course on blockers for children: Finland, Sweden, the UK, Italy, Denmark, and Norway have all stopped prescription of blockers in children. Plenty of other countries never allowed it in the first place.
- wreedtyt 1y ago
  It seems like you're referring to a specific study, could you link it?
  - Manuel_D 1y ago
    A multitude of studies, not just one. This is the review covering the outcomes of gender dysphoric children who aren't given blockers: https://news.ycombinator.com/item?id=44546443 https://news.ycombinator.com/item?id=44546443
- Dylan16807 1y ago
  > "Transitioned against their will" is a very crude way of articulating the tradeoffs of prescribing puberty blockers. That is an extremely generous interpretation. I think you're giving way too much credit to the average person that uses that argument. Also I really have to wonder how much of that desistance is giving up versus actually being satisfied.

bobalob 1y ago

[flagged]

wredcoll 1y ago
> Many later detransition [Citation needed]
- Diti 1y ago
  A simple web search could have given you the citation. “The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets” (DOI: 10.1016/j.jsxm.2018.01.016). The word “many” is misleading – it’s less than 1 %. It’s not nothing, but it’s low.
  - Manuel_D 1y ago
    https://pubmed.ncbi.nlm.nih.gov/29463477/ https://pubmed.ncbi.nlm.nih.gov/29463477/ This isn't the desistence rate of children, this is the regret rate of adults who transition.
  - bobalob 1y ago
    That ~1% figure is unlikely to reflect the full picture of regret. That paper defines regret very narrowly: only including the patients who made an appointment with their original medical team to discuss regret, and only if they regret surgical removal of their sex organs. Plus, a large number of their total cohort were lost to follow-up.
  - VBprogrammer 1y ago
    Can I just point out the irony of this statement in the context of my comment up thread.
- Manuel_D 1y ago
  https://pmc.ncbi.nlm.nih.gov/articles/PMC8039393/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8039393/ All the studies among gender dysphoric children who are not prescribed puberty blockers show desistence rates over 70% There are studies that show very low desistence rates - many in the single digits. But those are studies among children that are given puberty blockers.
  - heavyset_go 1y ago
    You're citing a paper the Alliance for Defending Freedom regularly uses[1] to support the conspiracy theory that doctors are "turning gay kids trans". The study itself uses criteria for gender dysphoria that's been outdated for decades. Here's what more reliable studies from the American Academy of Pediatrics, the largest professional group of pediatricians in the country, say[2]: > Gender Identity 5 Years After Social Transition > We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years. [1] https://downloads.regulations.gov/ED-2022-OCR-0143-141953/attachment_12.pdf https://downloads.regulations.gov/ED-2022-OCR-0143-141953/at... [2] https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/Gender-Identity-5-Years-After-Social-Transition?autologincheck=redirected https://publications.aap.org/pediatrics/article/150/2/e20210...
    - Manuel_D 1y ago
      > The study itself uses criteria for gender dysphoria that's been outdated for decades. The study uses the DSM-III and DSM-IV criteria for gender incongruence disorder, or GID, now referred to as gender dysphoria. The sample ranges from 1989 to 2002 and those were the contemporary iterations of the DSM. The DSM-V wasn't published until 2013. At most the criteria is outdated by one decade, not "several decades". Furthermore, the author of the study would later write the criteria for gender dysphoria in the DSM-V. The criteria are not particularly different, and the author of the study I linked has stated in interviews that most of the sample would meet the criteria for gender dysphoria under the DSM-V (which, again, he wrote so this opinion should carry some weight). In short, the idea that if the psychologists had used the DSM-V the results would be substantially different is not likely. And this isn't just one study that found low rates of persistence: > In Green (47), the percentage of persisters was 2% (total n = 44; Mean age at follow-up, 19 years; range, 14–24); in Wallien and Cohen-Kettenis (52), the percentage of persisters was 20.3% (total n = 59; Mean age at follow-up, 19.4 years; range, 16–28); and in Steensma et al. (51), the percentage of persisters was 29.1% (total n = 79; Mean age at follow-up, 16.1 years; range, 15–19). Across all studies, the percentage of persisters was 17.4% (total N = 235), with a range from 0 to 29.1%.3 Are all these other studies finding low rates of persistence also tainted in some way? The study you linked is among a group that were treated with an affirming model of care, where cross sex gender identity is actively encouraged, and a sizeable chunk of the sample were put on puberty blockers. This comports with what I have written: when gender dysphoric children are met with an affirming model of care and given gender affirming care, very few of them desist in their cross-sex gender identity. When they given a neutral, observational model of care not not prescribed puberty blockers, the majority of them desist. The study you linked just reinforces the former but does nothing to disprove the latter.
kennywinker 1y ago
> Blocking puberty until eighteen is a harmful intervention in itself For a trans kid, going thru the wrong puberty is harmful. The best thing would be hormones at puberty. But given issues around informed consent, puberty blockers are a valid compromise. Calling them harmful without considering the harm of the alternative is not honest.
- h4x0rr 1y ago
  And who decides if a puberty is "wrong"? The child itself certainly isn't mature enough.
  - ffin 1y ago
    I think this question concedes that there is some possibility that one could experience an incorrect puberty. Given the definition of maturity is being fully grown, this comes across as an inherently unhelpful thing to ask. If we say “only once someone is fully grown they are able to determine if they experienced the incorrect puberty” then this makes it impossible to help children who are going to experience the incorrect puberty. Unless we have some way to determine a child is trans without any input from them, there becomes no way to help them.
    - account42 1y ago
      The possibility of being unable to help people is not an excuse for hurting them or others. Generally if you can't know the correct action than you should stick to the status quo. What's next, gene therapy because the embryo might want to be a different race when it grows up?
- fourseventy 1y ago
  [flagged]
- bobalob 1y ago
  Puberty is a stage of natural maturation of the body. There is only one, as per your sex, and you can't go through the wrong one. The puberty of the opposite sex is not an option. This conception of the "wrong puberty" as something that needs to be blocked is as absurd as all that "born in the wrong body" ideological nonsense. Most importantly, children can't meaningfully consent to having their sexual function permanently damaged.
heavyset_go 1y ago
Many? You mean less than 1%[1]? > Overall, 33% underwent transmasculine procedures and 67% transfemenine procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%–<1%) and 1% (CI <1%–2%), respectively. That's less than the regret rate for life saving surgeries lol [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/
- AlexandrB 1y ago
  If you look at the studies examined, many of them are from the 90s and all are from before 2019. The rate of transition in minors has increased rapidly in the last 10 years, and it's not very convincing to see data about mostly adults and assume it's going to apply to this new situation.
  - kennywinker 1y ago
    There isn’t much data, because not many people (child or adult) medically transition. But if you want to follow the data we need to do what we were doing before all this moral panic about trans kids kicked in: cautiously allow kids to transition(1), and collect data about outcomes. It’s disingenuous to complain about bad data in one breath, while blocking any path that would create new data. (1) by transition i mean socially transition and go on puberty blockers if they want them.
    - deleted 1y ago
      [deleted]
- BobaFloutist 1y ago
  Better ban hip replacements ¯ \ _ ( ツ ) _ / ¯
BobaFloutist 1y ago
It is legal in all 50 rates for teenage girls to get breast augmentation surgery in order to better match gender expectations, but god forbid they want to remove them.
- account42 1y ago
  They shouldn't be getting that either.
  - BobaFloutist 1y ago
    But somehow people are hardly discussing it, let alone trying to make it illegal.

lelanthran 1y ago

> Yes, but since when do we allow the majority to dictate what healthcare options are available? We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.) The government, for good or bad, regulates all healthcare, and that government is guided by its voters. The majority of voters don't see this as a bigger problem than the issue they are currently voting on.

thaumasiotes 1y ago
> We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.) That began in 1906; it's hardly something we've "always done".
kennywinker 1y ago
> We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.) As someone else pointed out, the idea of gov deciding what our doctors can and cant give us is a VERY modern concept. But your examples: arsnic & crack 1. Cocaine is legal for doctors to prescribe and use in specific circumstances. What is legally prohibited is recreational use. Most of the restrictions on use are due to the threat of addiction, not the threat of appropriate medical use. 2. Arsnic is similarly entirely legal for medical use. Restrictions are around putting it in FOOD because it’s POISON. Nobody is saying you can’t treat cancer with it, if it’s shown to be effective. Your examples are not examples of the majority regulating medical care for individuals.

Manuel_D 1y ago

"Transitioned against their will" is a very crude way of articulating the tradeoffs of prescribing puberty blockers. The core issue at hand is that absent puberty blockers, somewhere between 60-80% do not persist with a cross-sex gender identity after going through their natal puberty. Psychologists attempted to predict which patients would persist in a cross sex gender identity and which would not, but they were never able to do so. When patients are given puberty blockers, desistence rates are miniscule, in the single digits. Proponents of hormonal intervention insist that this is proof that doctors are selecting kids that would persist in a cross sex gender absent blockers. But that's hard to reconcile with psychologists previous failures to predict persistence. While they're billed as giving "time to think", it's pretty much impossible to deny that blockers are causing patients who would have desisted in their cross sex gender identity if they went through their natal puberty. It's not just conservative American States that are changing course on blockers for children: Finland, Sweden, the UK, Italy, Denmark, and Norway have all stopped prescription of blockers in children. Plenty of other countries never allowed it in the first place.

wreedtyt 1y ago
It seems like you're referring to a specific study, could you link it?
- Manuel_D 1y ago
  A multitude of studies, not just one. This is the review covering the outcomes of gender dysphoric children who aren't given blockers: https://news.ycombinator.com/item?id=44546443 https://news.ycombinator.com/item?id=44546443
Dylan16807 1y ago
> "Transitioned against their will" is a very crude way of articulating the tradeoffs of prescribing puberty blockers. That is an extremely generous interpretation. I think you're giving way too much credit to the average person that uses that argument. Also I really have to wonder how much of that desistance is giving up versus actually being satisfied.