6 ms·

I agree there's probably more protections necessary. For example I'm also strongly against any religion based altering of the body of children -- circumcision i

I agree there's probably more protections necessary. For example I'm also strongly against any religion based altering of the body of children -- circumcision included -- that isn't medically necessary. Although I guess that's a much discussed topic of its own. The problem is that drawing this line isn't always simple. Make the law too strict, and you can just as easily end up barring doctors from performing surgeries that by their correct case-by-case judgement is necessary, but the law prohibits because it necessitates, say, medical consensus in general. But make the law too lax and you open the doors to purely cosmetic surgeries which I am absolutely against. What we cannot have is the ability for children whom cannot legally make medical decisions be allowed to start things like gender-affirming care. Because if we can't trust them with other less life-altering choices, how could we trust them with that? Especially given how easily influenced children are.

wizzwizz4 1y ago
Your paragraph 3 is the basic theory around medical gatekeeping: in many societies, children just plain aren't powerful enough to be in a position to give informed consent, unless special measures are taken to rule out undue influence. (In this case, that'd be: a diagnosis of gender dysphoria, which involves a psychologist asking you awkward questions for a few hours; and then ensuring all subsequent consent is informed, and in accordance with the psychologist's findings.) That's also why we have the "compromise" of puberty blockers (safe, reversible), but not any permanent treatment until the child reaches Gillick competence (in Norway, age 16). The trouble I have with this reasoning, though, is it's asymmetrical. We don't allow trans kids access to exogenous sex hormones because cis kids might hypothetically be being influenced by their parents / other authority figures to make a bad decision (e.g. Munchausen syndrome by proxy), but we know there's pressure on trans kids to repress and pretend to be cis (we have statistics about it), so why do we let any children go through puberty? How can we trust them with that? (Yes, this thought experiment is somewhat ludicrous, but why is it ludicrous?) For most people who experience it, gender dysphoria is distressing and hard to ignore. Most cis people can be put in situations where they experience it, and they report the same intense feelings of distress. I doubt you could easily influence many 12-year-olds to push through those feelings – though I'm not sure how one might test this ethically, so I'm not sure what studies to look for. Norway's current approach seems suitably-conservative to me. (And I don't see any advantage, even hypothetically, to forcing trans people into binary classifications: that seems like the "rigid gender roles" problem rearing its head again.) P.S.: You're considerably more reasonable about this than I initially thought: thinking about the right things, for the right reasons, such that with complete information I'd expect you to come to the right decisions. I long to have people like that for political opponents.
- simianparrot 1y ago
  Puberty blockers aren't reversible, because puberty has an end date. Also puberty is a natural function of the human body. We can only do our best to support children going through it, but it's not even worth contemplating whether we should "let" a child go through it or not. That makes no biological sense. For better or worse, humans are mammals whose offspring require _significant_ amount of care for much longer than any other mammal. We might not like it on a theoretical level, but practically speaking and evolutionarily, parents are responsible for their children until their children come of age. When it comes to legitimate trans kids the aim should be education of and societal support of parents to be as informed as possible, not to circumvent them if some _other_ adults deem it necessary. A doctor is not the legal caretaker of a child, only the parents are.
  - wizzwizz4 1y ago
    Saying puberty has an end date is like saying the flooding caused by the removal of a dam has an end date. It's true, but that end date depends on when you remove the dam. (Although a better analogy would be a pump filling a reservoir, sex hormones being the flow rate, puberty being flooding, and GnRH pulsing being the action of the pump.) It's more accurate to say that puberty has a duration. > puberty is a natural function of the human body The onset of puberty is way earlier than it used to be. Per http://www.mum.org/menarage.htm http://www.mum.org/menarage.htm, "In 1860 the average menarche happened at 16.6 years,"; per https://www.thetimes.com/uk/science/article/girls-now-begin-puberty-aged-9-9v8fc6x3fmk https://www.thetimes.com/uk/science/article/girls-now-begin-..., "Girls now begin puberty aged 9". Delaying puberty until age 16 could be argued as the more natural stage (though I take such arguments 'round back, and beat them to death, especially if they support my beliefs: the naturalistic fallacy is too seductive to listen to). > That makes no biological sense. Biologically, there's no reason* we couldn't make them wait until adulthood to begin puberty. You've not quite identified where the ludicrousness is – though you're close. Past that point, I think you're doing what I did earlier, and arguing against a position I haven't taken. (Unfortunately, I'm less eloquent than you, so I'd spend several paragraphs if I were to correct you: I'll trust in your ability to work it out.) > the aim should be education of and societal support of parents to be as informed as possible A thousand agreements: this is the ideal. All other situations are pathological special-cases – though, like antivax parents, they're special-cases that the medical system does have to take into consideration. (I don't know whether you have a general-purpose equivalent of Gillick competence in Norway, but see https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines https://learning.nspcc.org.uk/child-protection-system/gillic....) This isn't a point I've been trying to focus on, since it follows once correct handling of the ideal "everyone's informed and with the child's best interests at heart" case is established. --- *: Biiiig asterisk here: abnormal pubertal timing is associated with health problems (see https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/ https://www.endocrinology.org/endocrinologist/134-winter19/f... and citations), but we don't have solid data on the arrow of causation, nor good data on confounders (social attitudes seem to be a problem in the US, and https://doi.org/10.1542/peds.2005-2939 https://doi.org/10.1542/peds.2005-2939 strongly suggests that social/psychological effects have a big impact on onset of puberty), so that would be a separate point. There are no known problems caused by the use of GnRH modulators to postpone puberty (except low bone density, which per https://doi.org/10.3389/fped.2022.968485 https://doi.org/10.3389/fped.2022.968485 and https://doi.org/10.1210/jcem.87.2.8202 https://doi.org/10.1210/jcem.87.2.8202 is temporary and goes away in puberty, and per https://doi.org/10.6061/clinics/2012(06)08 https://doi.org/10.6061/clinics/2012(06)08 doesn't occur at all – and can be ameliorated with calcium and vitamin D supplementation), and afaik there's no theoretical expectation of such problems (except, again, bone density: I'm not sure that anyone knows why that isn't more of an issue, since it is sometimes an issue when GnRH modulators are used post-puberty – though the patient information leaflets I've read still stress the treatment as extremely safe in adults (with more assurance than I'd have given, but hey, I'm not an expert)). For the sake of the thought experiment, please pretend there are no such issues.

wizzwizz4 1y ago

Your paragraph 3 is the basic theory around medical gatekeeping: in many societies, children just plain aren't powerful enough to be in a position to give informed consent, unless special measures are taken to rule out undue influence. (In this case, that'd be: a diagnosis of gender dysphoria, which involves a psychologist asking you awkward questions for a few hours; and then ensuring all subsequent consent is informed, and in accordance with the psychologist's findings.) That's also why we have the "compromise" of puberty blockers (safe, reversible), but not any permanent treatment until the child reaches Gillick competence (in Norway, age 16). The trouble I have with this reasoning, though, is it's asymmetrical. We don't allow trans kids access to exogenous sex hormones because cis kids might hypothetically be being influenced by their parents / other authority figures to make a bad decision (e.g. Munchausen syndrome by proxy), but we know there's pressure on trans kids to repress and pretend to be cis (we have statistics about it), so why do we let any children go through puberty? How can we trust them with that? (Yes, this thought experiment is somewhat ludicrous, but why is it ludicrous?) For most people who experience it, gender dysphoria is distressing and hard to ignore. Most cis people can be put in situations where they experience it, and they report the same intense feelings of distress. I doubt you could easily influence many 12-year-olds to push through those feelings – though I'm not sure how one might test this ethically, so I'm not sure what studies to look for. Norway's current approach seems suitably-conservative to me. (And I don't see any advantage, even hypothetically, to forcing trans people into binary classifications: that seems like the "rigid gender roles" problem rearing its head again.) P.S.: You're considerably more reasonable about this than I initially thought: thinking about the right things, for the right reasons, such that with complete information I'd expect you to come to the right decisions. I long to have people like that for political opponents.

simianparrot 1y ago
Puberty blockers aren't reversible, because puberty has an end date. Also puberty is a natural function of the human body. We can only do our best to support children going through it, but it's not even worth contemplating whether we should "let" a child go through it or not. That makes no biological sense. For better or worse, humans are mammals whose offspring require _significant_ amount of care for much longer than any other mammal. We might not like it on a theoretical level, but practically speaking and evolutionarily, parents are responsible for their children until their children come of age. When it comes to legitimate trans kids the aim should be education of and societal support of parents to be as informed as possible, not to circumvent them if some _other_ adults deem it necessary. A doctor is not the legal caretaker of a child, only the parents are.
- wizzwizz4 1y ago
  Saying puberty has an end date is like saying the flooding caused by the removal of a dam has an end date. It's true, but that end date depends on when you remove the dam. (Although a better analogy would be a pump filling a reservoir, sex hormones being the flow rate, puberty being flooding, and GnRH pulsing being the action of the pump.) It's more accurate to say that puberty has a duration. > puberty is a natural function of the human body The onset of puberty is way earlier than it used to be. Per http://www.mum.org/menarage.htm http://www.mum.org/menarage.htm, "In 1860 the average menarche happened at 16.6 years,"; per https://www.thetimes.com/uk/science/article/girls-now-begin-puberty-aged-9-9v8fc6x3fmk https://www.thetimes.com/uk/science/article/girls-now-begin-..., "Girls now begin puberty aged 9". Delaying puberty until age 16 could be argued as the more natural stage (though I take such arguments 'round back, and beat them to death, especially if they support my beliefs: the naturalistic fallacy is too seductive to listen to). > That makes no biological sense. Biologically, there's no reason* we couldn't make them wait until adulthood to begin puberty. You've not quite identified where the ludicrousness is – though you're close. Past that point, I think you're doing what I did earlier, and arguing against a position I haven't taken. (Unfortunately, I'm less eloquent than you, so I'd spend several paragraphs if I were to correct you: I'll trust in your ability to work it out.) > the aim should be education of and societal support of parents to be as informed as possible A thousand agreements: this is the ideal. All other situations are pathological special-cases – though, like antivax parents, they're special-cases that the medical system does have to take into consideration. (I don't know whether you have a general-purpose equivalent of Gillick competence in Norway, but see https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines https://learning.nspcc.org.uk/child-protection-system/gillic....) This isn't a point I've been trying to focus on, since it follows once correct handling of the ideal "everyone's informed and with the child's best interests at heart" case is established. --- *: Biiiig asterisk here: abnormal pubertal timing is associated with health problems (see https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/ https://www.endocrinology.org/endocrinologist/134-winter19/f... and citations), but we don't have solid data on the arrow of causation, nor good data on confounders (social attitudes seem to be a problem in the US, and https://doi.org/10.1542/peds.2005-2939 https://doi.org/10.1542/peds.2005-2939 strongly suggests that social/psychological effects have a big impact on onset of puberty), so that would be a separate point. There are no known problems caused by the use of GnRH modulators to postpone puberty (except low bone density, which per https://doi.org/10.3389/fped.2022.968485 https://doi.org/10.3389/fped.2022.968485 and https://doi.org/10.1210/jcem.87.2.8202 https://doi.org/10.1210/jcem.87.2.8202 is temporary and goes away in puberty, and per https://doi.org/10.6061/clinics/2012(06)08 https://doi.org/10.6061/clinics/2012(06)08 doesn't occur at all – and can be ameliorated with calcium and vitamin D supplementation), and afaik there's no theoretical expectation of such problems (except, again, bone density: I'm not sure that anyone knows why that isn't more of an issue, since it is sometimes an issue when GnRH modulators are used post-puberty – though the patient information leaflets I've read still stress the treatment as extremely safe in adults (with more assurance than I'd have given, but hey, I'm not an expert)). For the sake of the thought experiment, please pretend there are no such issues.