Difference in Gender and Sex

[DKW 86 7,419]

On 3/17/2023 at 10:13 AM, AU9377 said:

I get it.  My questioning is not intended to question why this group exists or if they in fact do exist.  I am more concerned about the desire that some have to die on this hill of defending a re-classification of individuals based on little more than a desire to do so.  To be frank, if someone has their male body parts, why is it wrong to classify them as male, or at the very least trans male or female.  That would be the correct classification.  It is even more problematic if the person wants to be classified as male if they are born female.  There is no surgery that can build a functional male penis where a vagina currently exists.  I think the discussion gets so far away from reality that the argument becomes a losing argument because it drifts so far from the truth.

If someone wants to live as a woman or a man, they shouldn't be punished for that decision. I don't like any group being signaled out and attacked based solely on who they are without justification.

The problem I see in defending every extreme view on this issue is that, at the end of the day, it diminishes the progress gay and lesbian men and women have fought so hard to earn.  The goal of every gay man I know is to be respected in the same manner as every other man.  In other words, they want to be respected for who they are.  They don't want special accommodations or recognition.  They don't want to be labeled as a mistake of some sort. Some gay men are feminine, while some are masculine.  That is also true with straight men. Regardless of their disposition, they had no choice in the matter.  If it was a choice, everyone would choose to be the team captain.  Most all would choose the easiest path to success in life. They certainly never chose to be different or to live a lifetime worried that who they are as dictated by nature could be used against them.

When the trans community asks them to defend sexual reassignment of minors or trans athletes participating in women's sports, they are asking them to speak from both sides of their mouth, to contradict their own argument for acceptance.  Many are not willing to do that and are growing resentful of being asked to do so.  Wearing heels and a dress doesn't make someone female any more than growing body hair makes someone male. Claiming otherwise is a pretty tall hill to climb.

I mostly agree with you. If you have a population of 136M athletes out there, we must have some flexibility. We cannot have 136M classes of athletes.

I would prefer they to be classified on a one-on-one basis, possibly AFTER high school? I do not pretend to know the correct answer here. But my belief would be that they all compete with the males, as a general rule, but not in every case. 

[AUDub 11,147]

On 3/16/2023 at 1:37 AM, TexasTiger said:

And the other 19,999?

I assume you’re referencing Swyer Syndrome. If you are, the numbers I’ve seen range from 1 in 80k to 1 in 100k.

It's likely around 200 of them have DSDs that manifest in their phenotype.

Your point basically boils down to the junk science of "essentialism." People like a neat, clean bifurcation regarding what makes a man a man and what makes a woman a woman. Biology is messier than that. These days we've come to more of an understanding that it's a continuum with a bimodal distribution as opposed to a binary.

What “sex” is this person that has a penis but an XX karyotype? What "sex" is this person that has a vagina and a clitoris and an XY karyotype? And if you're about to respond, “those examples are intersex, not trans,” that is correct. These are extreme ends of the continuum, but there is subtlety along the way.

The fact that some people are born with a mismatched karyotype doesn't mean that typical human development isn't "male" of "female," it's just that there's more to sex than that. Sex is a collection of traits and epigenetic pathways not exclusively defined by your karyotype. Your genitals have a say. Your various other secondary sexual characteristics have a say. Your gametes have a say. And at the end of the day your neurology also has a say.

That's not to say it isn't a good rule of thumb. The problem comes in when people extend a generalized rule of thumb to mean every person must fit into these categories, essentially denying the existence of people who don't. 

As an example, take people born with only one leg. The difference is that when someone is born with only 1 leg, you don't get people denying that fact by saying "humans are bipedal."

And that's primarily the context in which you'll hear "sex isn't binary," as a response to ignorant people claiming "sex is binary" in order to deny the existence of people with atypical sexual development. It's not saying the rule of thumb is wrong, it's saying the rule of thumb doesn't invalidate the cases that don't fit it.

[TexasTiger 12,835]

2 minutes ago, AUDub said:

It's likely around 200 of them have DSDs that manifest in their phenotype.

Your point basically boils down to the junk science of "essentialism." People like a neat, clean bifurcation regarding what makes a man a man and what makes a woman a woman. Biology is messier than that. These days we've come to more of an understanding that it's a continuum with a bimodal distribution as opposed to a binary.

What “sex” is this person that has a penis but an XX karyotype? What "sex" is this person that has a vagina and a clitoris and an XY karyotype? And if you're about to respond, “those examples are intersex, not trans,” that is correct. These are extreme ends of the continuum, but there is subtlety along the way.

The fact that some people are born with a mismatched karyotype doesn't mean that typical human development isn't "male" of "female," it's just that there's more to sex than that. Sex is a collection of traits and epigenetic pathways not exclusively defined by your karyotype. Your genitals have a say. Your various other secondary sexual characteristics have a say. Your gametes have a say. And at the end of the day your neurology also has a say.

That's not to say it isn't a good rule of thumb. The problem comes in when people extend a generalized rule of thumb to mean every person must fit into these categories, essentially denying the existence of people who don't. 

As an example, take people born with only one leg. The difference is that when someone is born with only 1 leg, you don't get people denying that fact by saying "humans are bipedal."

And that's primarily the context in which you'll hear "sex isn't binary," as a response to ignorant people claiming "sex is binary" in order to deny the existence of people with atypical sexual development. It's not saying the rule of thumb is wrong, it's saying the rule of thumb doesn't invalidate the cases that don't fit it.

I agree the rule of thumb doesn’t invalidate the rare cases that don’t fit it. But the actual anomalies don’t warrant a broadening of that category beyond what the facts support. Your argument is frequently used to indicate there’s a broad spectrum on which people fit in regard to sex. There isn’t. The binary categories of male and female apply to the vast majority of folks. It doesn’t neatly apply to a relatively small sliver of the population. I don’t deny nor diminish the folks in that category. In fact, I’ve heard some intersex people complain that their condition is misused to support a broader claim that is more ideological than scientific.

[AU9377 4,926]

2 hours ago, AUDub said:

It's likely around 200 of them have DSDs that manifest in their phenotype.

Your point basically boils down to the junk science of "essentialism." People like a neat, clean bifurcation regarding what makes a man a man and what makes a woman a woman. Biology is messier than that. These days we've come to more of an understanding that it's a continuum with a bimodal distribution as opposed to a binary.

What “sex” is this person that has a penis but an XX karyotype? What "sex" is this person that has a vagina and a clitoris and an XY karyotype? And if you're about to respond, “those examples are intersex, not trans,” that is correct. These are extreme ends of the continuum, but there is subtlety along the way.

The fact that some people are born with a mismatched karyotype doesn't mean that typical human development isn't "male" of "female," it's just that there's more to sex than that. Sex is a collection of traits and epigenetic pathways not exclusively defined by your karyotype. Your genitals have a say. Your various other secondary sexual characteristics have a say. Your gametes have a say. And at the end of the day your neurology also has a say.

That's not to say it isn't a good rule of thumb. The problem comes in when people extend a generalized rule of thumb to mean every person must fit into these categories, essentially denying the existence of people who don't. 

As an example, take people born with only one leg. The difference is that when someone is born with only 1 leg, you don't get people denying that fact by saying "humans are bipedal."

And that's primarily the context in which you'll hear "sex isn't binary," as a response to ignorant people claiming "sex is binary" in order to deny the existence of people with atypical sexual development. It's not saying the rule of thumb is wrong, it's saying the rule of thumb doesn't invalidate the cases that don't fit it.

I realize that this discussion isn't limited to a sports discussion, but that field does require a determination that other parts of society do not.  If there were no predispositions that make male and female traits produce different levels of strength and endurance, we would not separate athletes into those two fields.  Sports competition, by its very nature, is not fair.  Everyone doesn't get to participate.  Even so, I hear what sounds like a fairness argument come from those that want trans women to participate in female sports. I have never seen a trans woman that wanted to participate in female sports that exhibited the physical traits of typical female athletes.  Their bodies have been producing testosterone for years, which has given them a stronger physicality than other female athletes can achieve, regardless of how hard they work.

[TexasTiger 12,835]

“

Earlier this year, as the U.S. culture war over trans kids was reaching full tilt, Sweden’s National Board of Health and Welfare (NBHW) released new guidelines for treating young people with gender dysphoria, or what is increasingly called “gender incongruence.” That means puberty suppressants, cross-sex hormones and gender surgeries—often called “gender-affirming care”—to make one’s body appear more like the opposite sex’s—or increasingly, with nonbinary gender medicine, neither sex.

They read: “The NBHW deems that the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases.”

Finland’s Council for Choices in Health Care (COHERE) came to almost the exact same conclusion a year earlier, noting, through a translation: “The first-line intervention for gender variance during childhood and adolescent years is psychosocial support and, as necessary, gender-explorative therapy and treatment for comorbid psychiatric disorders.” And: “In light of available evidence, gender reassignment of minors is an experimental practice.” Gender reassignment medical interventions “must be done with a great deal of caution, and no irreversible treatment should be initiated,” COHERE wrote.

These guidelines were in contrast to those proffered by the World Professional Association of Transgender Health (WPATH), an advocacy group made up of activists, academics, lawyers, medical and mental health care providers, which creates “standards of care” that many providers elect to follow. WPATH, which will soon issue its 8th iteration of its SOC, is lowering recommended ages for blockers, hormones and surgeries, and adding chapters on medicine for those with gender identities like non-binary or eunuch. (WPATH did not respond to a request for comment.)

Meanwhile, in the U.S., much of the left, medical associations and activist organizations like the ACLU are claiming doctors agree that gender-affirming medical interventions are “life-saving,” and Assistant Secretary of Health Rachel Levine asserted there’s medical consensus as to its benefits—despite some European countries claiming the opposite. Some activists and gender clinicians in the U.S. still find even WPATH too restrictive.

In Sweden and Finland, the health care community itself was taking on this issue. But here in the U.S. it was playing out in legislatures and courts, the science so politicized that it had become a moral, rather than a medical, issue. This summer alone, Republican Congressmen Jim Banks and Tom Cotton introduced the Protecting Minors from Medical Malpractice Act, which would allow minors who transitioned up to 30 years to sue for malpractice. California introduced SB107, which would allow any child to come to California to medically transition without parental knowledge or consent. Texas had investigated parents of trans kids for child abuse if they transitioned children; earlier, other parents had been investigated, and some had lost custody of their kids, for not transitioning them.

In other words, the U.S. was going completely crazy over the issue of trans kids. Why, I wondered, were Sweden and Finland proceeding so differently, and without the political turmoil that has enveloped what is arguably America’s most virulent culture war? What could they teach us?…

COHERE began with a systematic review of literature of the safety and efficacy of treatments, by a neutral expert panel. They found that even studies of adult patients were of such low quality that it was impossible to claim medical and surgical reassignment improved psychiatric problems. And studies of children didn’t clearly assert a correlation between medical interventions and improved mental function. After the evidence review, Kaltiala-Heino’s team finished a paper which found that cross-sex hormones did not improve problems related to “functioning, progression of developmental tasks of adolescence, and psychiatric symptoms.”

“Scientific evidence for any interventions on minors with gender identity indication is actually zero,” Kaltiala-Heino told me. That is, there are some studies that show improvement from interventions, but they are so low quality, so low certainty, that they shouldn’t be extrapolated from. In particular, a Dutch follow-up study often cited as evidence for early hormonal interventions actually compared people who already had good mental health, other than dysphoria, to a group whose mental health was so poor they were deemed ineligible for early intervention. Yet that group was also doing better at follow-up. Other studies were small, or had short follow-ups, and none had been replicated.

Sweden’s findings were similar. Both guidelines suggest therapy as the first-line treatment for GD. “We continue to lack really reliable scientific evidence concerning the efficacy and safety,” Linden said. “We have to have better knowledge. There was really no way to properly assess risk without more and better evidence.” Thus, the focus of guidelines shifted to follow-up, caution and patient safety, with an emphasis on thorough assessment “to minimize the risk of giving the wrong treatment.” These treatments have been declared highly specialized care, requiring permission from the NBHW to conduct, and will be done only in three national university hospitals, which will help with follow-up and data collection. Puberty blockers and cross-sex hormones should be administered within research contexts only. 

In both countries, medical interventions for gender dysphoria are not banned, or completely discontinued. “It’s not stopping all treatments. It’s that the [puberty blocking and hormonal] treatment should be offered only in exceptional cases. And this is our language to communicate more risk awareness to the clinicians,” Linden said. But other health care measures such as psychosocial support, he added, “should be available for all who need it.”

In Finland, for patients who fit the profile of participants in the Dutch study, after a prolonged period of evaluation, and with a multidisciplinary team including a psychiatrist, psychologist, social worker and nurse, puberty blockers may be started near the onset of puberty and cross-sex hormones may be possible starting at age 16. Social transition for young people is not advised. But even for those with adolescent-onset gender dysphoria, medical intervention isn’t completely off the table. “It's not that nobody can get it, but it is that there is a very intensive clinical evaluation taking place with the young person and their parents,” Kaltiala-Heino said. Assessments take place at two nationally centralized gender identity clinics, which also initiate any treatments and follow-up the patients over the first years of gender identity-based treatment; gender surgeries are offered only at one center.

Swedish health care providers are still tasked with destigmatizing people with gender dysphoria and the interventions they may want or need. “This is a group of suffering people that need to be given attention. And if you don’t offer them hormonal treatment or surgery, we have to care for them in other ways,” Linden said—mostly through psychological assessment and therapy. Sweden’s guidelines encourage clinicians to “ensure that all young people suffering from gender dysphoria be taken seriously and confirmed in their gender identity.”

https://lisaselindavis.substack.com/p/letter-from-finland-and-sweden

[homersapien 11,367]

11 hours ago, TexasTiger said:

In Sweden and Finland, the health care community itself was taking on this issue. But here in the U.S. it was playing out in legislatures and courts, the science so politicized that it had become a moral, rather than a medical, issue.

This is what bothers me.

[TexasTiger 12,835]

4 minutes ago, homersapien said:

This is what bothers me.

But if you analyze the different responses in these countries you see a centralized medical approach in European countries doing scientific reviews. The medical folks are doing their own regulating based solely on an assessment of the evidence. American medicine, on the other hand, has not done that. They rely on advocacy groups for “standards” that cherry pick evidence. And advocates like Rachel Levine that say the medical community fully supports the WPATH approach while in reality the only medical establishments doing systematic reviews of evidence are actually dramatically limiting, while not banning, medicalization of minors.

[DKW 86 7,419]

3 minutes ago, TexasTiger said:

But if you analyze the different responses in these countries you see a centralized medical approach in European countries doing scientific reviews. The medical folks are doing their own regulating based solely on an assessment of the evidence. American medicine, on the other hand, has not done that. They rely on advocacy groups for “standards” that cherry pick evidence. And advocates like Rachel Levine that say the medical community fully supports the WPATH approach while in reality the only medical establishments doing systematic reviews of evidence are actually dramatically limiting, while not banning, medicalization of minors.

[I_M4_AU 7,801]

I don’t understand how anybody could not believe this would be a political issue in the US after hearing Dr Levine’s confirmation hearing.

 

Shortly after being confirmed and just after Joe taking the White House; Joe signed EO’s directing education in schools about gender identity under the guise of bullying.

In May of 2022 Dr Lavine states that there is no argument among experts about transgender care.

Transgender Assistant Secretary for Health Rachel Levineinsists “there is no argument” among doctors specializing in kids and teens about “the value and importance of gender-affirming care” — i.e. the use of hormones and puberty blockers — for the young. Bull.

In fact, Levine and the Biden administration simply refuse to listen to anyone who disagrees, including medical organizations across the globe.  

Sweden’s Karolinska Hospital — one of the world’s top hospitals — decided last May to stop treating under-18 patients with puberty blockers and cross-sex hormones. 

https://nypost.com/2022/05/03/rachel-levines-gender-affirmation-ignores-science/

Two days ago the Dr said:

Transgender Assistant Secretary of Health Rachel Levine says that gender-affirming care for minors has the 'highest support' of the Biden administration.  Levine has promised that medically changing children's gender will soon be normalized, praising the controversial medical intervention which has been banned in several states at the Pediatric Grand Rounds Session at Children's Medical Center in Hartford.

https://www.dailymail.co.uk/news/article-11871045/Dr-Rachel-Levine-says-gender-affirming-care-minors-Biden-administrations-highest-support.html

The *Dr* is an unelected bureaucrat with an agenda and that is how it become political in the US.  When the *scientist* refuse to look at the *science* so they can promote their ideology, the legislature has no choice but to intervene.  NOTE:  I am just limiting this to minor *gender affirming care* of puberty blockers,, cross sex hormones and surgery that has known to happening in the US.

[DKW 86 7,419]

I like the Euro approach in all this because if my son's research is good, And I believe it is, then we have to answer 136M possible questions about sex, AS FAR ATHLETICS is concerned. In society, it may be messy as well. How do you assess DEI Quotas if there are 136M different POV? How do we track the access to competitive sports, team and individual, with a possible 136M outcomes or POVs? 

The only option we have at hand is the generalization of classifications of likely opinions and research, Do we allow just two types of sports, IE Male and Female? Do we add more? How many more? How many can we add and the paying public care about and follow? How many before all sports see negative impacts of too little $$$ going into too many holes?

I don't have a answer, but I have to think that generalization to maybe three classifications would be best. Male-with many others mixed in, CIS-Female, Potpourri Of the Rest, maybe even CIS-Male and CIS-Female. 

[homersapien 11,367]

6 hours ago, TexasTiger said:

But if you analyze the different responses in these countries you see a centralized medical approach in European countries doing scientific reviews. The medical folks are doing their own regulating based solely on an assessment of the evidence. American medicine, on the other hand, has not done that. They rely on advocacy groups for “standards” that cherry pick evidence. And advocates like Rachel Levine that say the medical community fully supports the WPATH approach while in reality the only medical establishments doing systematic reviews of evidence are actually dramatically limiting, while not banning, medicalization of minors.

I don't want to start an argument, but those are some pretty definitive generalized statements to throw out without any real supporting data backing them.

Unfortunately, I don't know if such data even exists, which may be the problem in itself. 

BTW, here are the latest standards of care issued by the WPATH (World Professional Association for Transgender Health): 

SOC-8 FAQs - WEBSITE (wpath.org)

To me, these guidelines don't sound all that different from the various European guidelines that have been presented in this thread, so it seems a bit of a jump to just assume American practices are all that different from European ones, without having supporting data.

FWIW, I also found some information on programs the APA will feature at their annual meeting this year:   

Session Search (goeshow.com)

There are a few programs on gender dysphoria but I didn't know how to reference them directly.  You'll have to look them up day by day. (I am surprised it didn't get more attention, considering the heightened politics.)

Anyway, I am not convinced American practices in this area are all that different from European practices either currently or in the recent past.  They may be, but without data I am not prepared to simply accept they are.

I am convinced the subject has become so politicized in our country that an objective, science-based discussion is not even possible at this point. This does not bode well for the patients - and their families - who live in states who feel compelled to legislate on something which should really be regulated by data-backed science.

Edited March 19, 2023 by homersapien

[TexasTiger 12,835]

48 minutes ago, homersapien said:

I don't want to start an argument, but those are some pretty definitive generalized statements to throw out without any real supporting data backing them.

Unfortunately, I don't know if such data even exists, which may be the problem in itself. 

BTW, here are the latest standards of care issued by the WPATH (World Professional Association for Transgender Health): 

SOC-8 FAQs - WEBSITE (wpath.org)

To me, these guidelines don't sound all that different from the various European guidelines that have been presented in this thread, so it seems a bit of a jump to just assume American practices are all that different from European ones, without having supporting data.

FWIW, I also found some information on programs the APA will feature at their annual meeting this year:   

Session Search (goeshow.com)

There are a few programs on gender dysphoria but I didn't know how to reference them directly.  You'll have to look them up day by day. (I am surprised it didn't get more attention, considering the heightened politics.)

Anyway, I am not convinced American practices in this area are all that different from European practices either currently or in the recent past.  They may be, but without data I am not prepared to simply accept they are.

I am convinced the subject has become so politicized in our country that an objective, science-based discussion is not even possible at this point. This does not bode well for the patients - and their families - who live in states who feel compelled to legislate on something which should really be regulated by data-backed science.

If one knows anything about how most European countries are structured & healthcare is managed compared to our federalist system with a for profit healthcare system run across 50 different states with their own laws & licensing boards, and then reads what I’ve provided several times, one can readily see the differences. You have been given no reason to think practices in the US have been subjected to the same rigorous scientific review demonstrated in these countries and you certainly haven’t produced it. It is so decentralized and data on outcomes isn’t even tracked. You just assume it’s true because it’s what you want to believe.

[TexasTiger 12,835]

@icanthearyou ICHY Is the 🤦‍♂️👎 @Mikey of the left on this board.

[Mikey 16,578]

4 hours ago, DKW 86 said:

Do we allow just two types of sports, IE Male and Female? Do we add more? How many more? How many can we add and the paying public care about and follow? How many before all sports see negative impacts of too little $$$ going into too many holes?

Three types. It's simple.  Biological male, play male sports if you choose. Biological female, play female sports if you choose. Then a third category for whoever wants to play. I don't think there will be a problem with the "open" type pulling $ and support from the male and female sports.

[homersapien 11,367]

2 hours ago, TexasTiger said:

If one knows anything about how most European countries are structured & healthcare is managed compared to our federalist system with a for profit healthcare system run across 50 different states with their own laws & licensing boards, and then reads what I’ve provided several times, one can readily see the differences. You have been given no reason to think practices in the US have been subjected to the same rigorous scientific review demonstrated in these countries and you certainly haven’t produced it. It is so decentralized and data on outcomes isn’t even tracked. You just assume it’s true because it’s what you want to believe.

First, you are the one making the claim that practice in the US is unscientific or otherwise inappropriate, so the burden is on you to support that claim with evidence.

Otherwise, you are correct in that I have seen nothing that convinces me professional treatment of patients with gender dysphoria are treated any differently in this country than in Europe. After all - as I have repeatedly said - I don't see significant differences in the recommendations or guidelines for such treatment regardless of who issued those recommendations, in whatever country.

I am not insisting practice in general for these cases is as good as or worse than practices anywhere else.  I am certainly open to data-based arguments for either case.

You do have a point in saying there may be greater financial incentives in our system for those to profit by committing malpractice, but without at least some gross data supporting it, that's pure speculation.  But the reward/risk equation makes this seem unlikely to me.

Again, you are making assumptions without the benefit of actual data. You may be right, but don't accuse me of applying bias to the question simply for requiring actual data before I agree with you.

You are only revealing your own bias by doing so. (Which makes your last sentence rather ironic.)

Edited March 19, 2023 by homersapien

[TexasTiger 12,835]

1 hour ago, homersapien said:

First, you are the one making the claim that practice in the US is unscientific or otherwise inappropriate, so the burden is on you to support that claim with evidence.

Otherwise, you are correct in that I have seen nothing that convinces me professional treatment of patients with gender dysphoria are treated any differently in this country than in Europe. After all - as I have repeatedly said - I don't see significant differences in the recommendations or guidelines for such treatment regardless of who issued those recommendations, in whatever country.

I am not insisting practice in general for these cases is as good as or worse than practices anywhere else.  I am certainly open to data-based arguments for either case.

You do have a point in saying there may be greater financial incentives in our system for those to profit by committing malpractice, but without at least some gross data supporting it, that's pure speculation.  But the reward/risk equation makes this seem unlikely to me.

Again, you are making assumptions without the benefit of actual data. You may be right, but don't accuse me of applying bias to the question simply for requiring actual data before I agree with you.

You are only revealing your own bias by doing so. (Which makes your last sentence rather ironic.)

Believe whatever you want. You’re not tracking what I’m saying. These other countries I’m citing are far more centralized with a handful of monitored gender clinics offering treatment. Standards are capable of being standardized where procedures, data and outcomes can be monitored and tracked. None of that is true in the USA. It’s the Wild West of gender care.
 

The neighbor to my left could see their doctor and get hormones prescribed pretty easily. The doctor for the neighbor across the street may want a letter from a mental health professional— LPC or MSW may be fine. Around the corner, that neighbor’s doctor may want a letter from a PHD level psychologist. None of those professionals may have any expertise in gender care, particularly for young people. Nothing is preventing any of those doctors from prescribing those hormones or off-label puberty blockers as each sees fit in most states and no one is tracking these treatments or outcomes.

[DKW 86 7,419]

12 hours ago, TexasTiger said:

Believe whatever you want. You’re not tracking what I’m saying. These other countries I’m citing are far more centralized with a handful of monitored gender clinics offering treatment. Standards are capable of being standardized where procedures, data and outcomes can be monitored and tracked. None of that is true in the USA. It’s the Wild West of gender care.
 

The neighbor to my left could see their doctor and get hormones prescribed pretty easily. The doctor for the neighbor across the street may want a letter from a mental health professional— LPC or MSW may be fine. Around the corner, that neighbor’s doctor may want a letter from a PHD level psychologist. None of those professionals may have any expertise in gender care, particularly for young people. Nothing is preventing any of those doctors from prescribing those hormones or off-label puberty blockers as each sees fit in most states and no one is tracking these treatments or outcomes.

And this is a reasoned, logical summation of where we are at the moment. The problem is that the current politics trump all reason, logic, etc because this is just what some want to ram down everyone else's throat. They really, ultimately do not care about the damage they may do. All they care about is politics.

[homersapien 11,367]

19 hours ago, TexasTiger said:

Believe whatever you want. You’re not tracking what I’m saying. These other countries I’m citing are far more centralized with a handful of monitored gender clinics offering treatment. Standards are capable of being standardized where procedures, data and outcomes can be monitored and tracked. None of that is true in the USA. It’s the Wild West of gender care.
 

The neighbor to my left could see their doctor and get hormones prescribed pretty easily. The doctor for the neighbor across the street may want a letter from a mental health professional— LPC or MSW may be fine. Around the corner, that neighbor’s doctor may want a letter from a PHD level psychologist. None of those professionals may have any expertise in gender care, particularly for young people. Nothing is preventing any of those doctors from prescribing those hormones or off-label puberty blockers as each sees fit in most states and no one is tracking these treatments or outcomes.

First, I am not believing anything.  Actually, I am refusing to believe what you are assuming due to lack of evidence.

And again, it seems to me that the "standards" are pretty much the same everywhere.  You are just assuming U.S. professionals are abusing them (as if foreign professionals can't abuse their standards if they wanted to). 

Again, there are no hard, quantitative rules or standards in either places.  These European countries do not prohibit medications or surgeries, nor do they mandate anything.

I seriously doubt state legislative efforts will be so indeterminate, which may - or may not - benefit the majority of patients.  It's a decision best left up to the patients, their parents and the caretakers IMO.

You may be right but I - for one - am not going to accuse U.S. practitioners of widespread malpractice without some evidence that's the case.  I don't know why that seems to upset you.

If you are simply arguing European healthcare systems are more rationalized and effective than ours, I would tend to agree.  But that's not enough for me to conclude there is widespread malpractice in this country without any evidence.

 

Edited March 20, 2023 by homersapien

[homersapien 11,367]

7 hours ago, DKW 86 said:

And this is a reasoned, logical summation of where we are at the moment. The problem is that the current politics trump all reason, logic, etc because this is just what some want to ram down everyone else's throat. They really, ultimately do not care about the damage they may do. All they care about is politics.

What do you mean by "this"?

What exactly is being "rammed down everyone else's throat"?  And by whom?

[TexasTiger 12,835]

14 minutes ago, homersapien said:

First, I am not believing anything.  Actually, I am refusing to believe what you are assuming due to lack of evidence.

And again, it seems to me that the "standards" are pretty much the same everywhere.  You are just assuming U.S. professionals are abusing them (as if foreign professionals can't abuse their standards if they wanted to). 

Again, there are no hard, quantitative rules or standards in either places.  These European countries do not prohibit medications or surgeries, nor do they mandate anything.

I seriously doubt state legislative efforts will be so indeterminate, which may - or may not - benefit the majority of patients.  It's a decision best left up to the patients, their parents and the caretakers IMO.

You may be right but I - for one - am not going to accuse U.S. practitioners of widespread malpractice without some evidence that's the case.  I don't know why that seems to upset you.

If you are simply arguing European healthcare systems are more rationalized and effective than ours, I would tend to agree.  But that's not enough for me to conclude there is widespread malpractice in this country without any evidence.

 

But you’re assuming that in a country where this care is totally decentralized for an area that is quite recent— the explosion in teens experiencing the onset of dysphoria began around 2015 — and few doctors have any training, that they are following a similar approach to these highly regulated healthcare systems where such treatments only occur in specialized clinics. Okay. It doesn’t “upset” me. I just think it’s kinda amusing how you insist you won’t  engage in assumptions when you’re engaging in some pretty irrational assumptions . 😉

[homersapien 11,367]

58 minutes ago, TexasTiger said:

But you’re assuming that in a country where this care is totally decentralized for an area that is quite recent— the explosion in teens experiencing the onset of dysphoria began around 2015 — and few doctors have any training, that they are following a similar approach to these highly regulated healthcare systems where such treatments only occur in specialized clinics. Okay. It doesn’t “upset” me. I just think it’s kinda amusing how you insist you won’t  engage in assumptions when you’re engaging in some pretty irrational assumptions . 😉

No, actually I am refusing to assume anything based on the lack of objective data. That's not irrational.  Just the opposite.

If anything, I am assuming that the parents/patients of children who claim to be gender dysphoric would be referred to a pediatric psychiatrist who specializes in that area. It's up to those parents/patients to decide if they approve of his recommendations or not.  

So, I don't think your narrative of such patients going to a doctor without training or expertise in the condition is valid.  That's not the way our system works.  

(And BTW, one of the U.S. guidelines I've seen acknowledge the "false claim" issue and recommend a diagnosis account for that by extending counseling for a long time, say 18 month? -  before other treatment.  False claims tend to self-extinguish way before that.)

And we have clinics in the U.S. that treat gender dysphoria - including the Mayo clinic, and Oschner Health - so we have experienced teams of experts in the field. (Not that a clinic is necessarily required.)

You seem really convinced that these Scandinavian countries are markedly different (more conservative) than the U.S. in gender dysphoria treatment.  Yet you yourself suggested these same countries were traditionally much more liberal/aggressive than the U.S. in their approach.  Without any comparative data, what makes you assume they are now more conservative than U.S. practices? 

Maybe their new recommendations are bringing them more in line with U.S. practice?

See, that's the problem with making data-less assumptions. 

 

[TexasTiger 12,835]

10 minutes ago, homersapien said:

No, actually I am refusing to assume anything based on the lack of objective data. That's not irrational.  Just the opposite.

If anything, I am assuming that the parents/patients of children who claim to be gender dysphoric would be referred to a pediatric psychiatrist who specializes in that area. It's up to those parents/patients to decide if they approve of his recommendations or not.  

So, I don't think your narrative of such patients going to a doctor without training or expertise in the condition is valid.  That's not the way our system works.  

(And BTW, one of the U.S. guidelines I've seen acknowledge the "false claim" issue and recommend a diagnosis account for that by extending counseling for a long time, say 18 month? -  before other treatment.  False claims tend to self-extinguish way before that.)

And we have clinics in the U.S. that treat gender dysphoria - including the Mayo clinic, and Oschner Health - so we have experienced teams of experts in the field. (Not that a clinic is necessarily required.)

You seem really convinced that these Scandinavian countries are markedly different (more conservative) than the U.S. in gender dysphoria treatment.  Yet you yourself suggested these same countries were traditionally much more liberal/aggressive than the U.S. in their approach.  Without any comparative data, what makes you assume they are now more conservative than U.S. practices? 

Maybe their new recommendations are bringing them more in line with U.S. practice?

See, that's the problem with making data-less assumptions. 

 

You’re making a huge assumption based on what— your biases? Such psychiatrists are exceedingly rare. 
 

Don’t trust that my concerns are valid — trust these two experts (although I’m confident you’ll dismiss them, too and keep your head fingers firmly planted in the sand.): 

“We are both psychologists who have dedicated our careers to serving transgender patients with ethical, evidence-based treatment. But we see a surge of gender dysphoria cases like Patricia’s — cases that are handled poorly. One of us was the founding psychologist in 2007 of the first pediatric gender clinic in the United States; the other is a transgender woman. We’ve held recent leadership positions in the World Professional Association for Transgender Health (WPATH), which writes the standards of care for transgender people worldwide. Together, across decades of doing this work, we’ve helped hundreds of people transition their genders. This is an era of ugly moral panic about bathrooms, woke indoctrination and identity politics in general. In response, we enthusiastically support the appropriate gender-affirming medical care for trans youth, and we are disgusted by the legislation trying to ban it.

But the number of adolescents requesting medical care is skyrocketing: Now 1.8 percent of people under 18 identify as transgender, double the figure from five years earlier, according to the Trevor Project. A flood of referrals to mental health providers and gender medical clinics, combined with a political climate that sees the treatment of each individual patient as a litmus test of social tolerance, is spurring many providers into sloppy, dangerous care. Often from a place of genuine concern, they are hastily dispensing medicine or recommending medical doctors prescribe it — without following the strict guidelines that govern this treatment. Canada, too, is following our lead: A study of 10 pediatric gender clinics there found that half do not require psychological assessment before initiating puberty blockers or hormones.

 

The standards of care recommend mental health support and comprehensive assessment for all dysphoric youth before starting medical interventions. The process, done conscientiously, can take a few months (when a young person’s gender has been persistent and there are no simultaneous mental health issues) or up to several years in complicated cases. But few are trained to do it properly, and some clinicians don’t even believe in it, contending without evidence that treating dysphoria medically will resolve other mental health issues. Providers and their behavior haven’t been closely studied, but we find evidence every single day, from our peers across the country and concerned parents who reach out, that the field has moved from a more nuanced, individualized and developmentally appropriate assessment process to one where every problem looks like a medical one that can be solved quickly with medication or, ultimately, surgery. As a result, we may be harming some of the young people we strive to support — people who may not be prepared for the gender transitions they are being rushed into.

American opinions about transgender youth have shifted dramatically in the past 15 years. The pendulum has swung from a vile fear and skepticism around ever treating adolescents medically to what must be described, in some quarters, as an overcorrection. Now the treatment pushed by activists, recommended by some providers and taught in many training workshops is to affirm without question. “We don’t actually have data on whether psychological assessments lower regret rates,” Johanna Olson-Kennedy, a pediatrician at Children’s Hospital in Los Angeles who is skeptical of therapy requirements and gives hormones to children as young as 12 (despite a lack of science supporting this practice, as well), told the Atlantic. “I don’t send someone to a therapist when I’m going to start them on insulin.” This perspective writes off questions about behavioral and mental health, seeing them as a delaying tactic or a dodge, a way of depriving desperate people of the urgent care they clearly need.

But comprehensive assessment and gender-exploratory therapy is the most critical part of the transition process. It helps a young person peel back the layers of their developing adolescent identity and examine the factors that contribute to their dysphoria. In this stage, patients reflect on the duration of the dysphoria they feel; the continuum of gender; the intersection with sexual orientation; what medical interventions might realistically entail; social media, Internet and peer influences; how other factors (e.g., autism, trauma, eating disorders/body image concerns, self-esteem, depression, anxiety) may help drive dysphoria, rather than assuming that they are always a result of dysphoria; family dynamics and social/peer relationships; and school/academic challenges. The messages that teens get from TikTok and other sources may not be very productive for understanding this constellation of issues.

https://www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/

[homersapien 11,367]

6 minutes ago, TexasTiger said:

You’re making a huge assumption based on what— your biases? Such psychiatrists are exceedingly rare. 

Huge assumption???  

If your child was afflicted with gender dysphoria -  or any other rare psychiatric disorder - what would you do?

What would your general practitioner recommend?

If that requires a "bias" it's a bias for common sense.

[TexasTiger 12,835]

1 minute ago, homersapien said:

Huge assumption???  

If your child was afflicted with gender dysphoria -  or any other rare psychiatric disorder - what would you do?

What would your general practitioner recommend?

If that requires a "bias" it's a bias for common sense.

If anything, I am assuming that the parents/patients of children who claim to be gender dysphoric would be referred to a pediatric psychiatrist who specializes in that area.

I would hope there was the magical specialist pediatric psychiatrist you assume is available everywhere but is hardly anywhere in reality.

[homersapien 11,367]

45 minutes ago, TexasTiger said:

Together, across decades of doing this work, we’ve helped hundreds of people transition their genders. This is an era of ugly moral panic about bathrooms, woke indoctrination and identity politics in general. In response, we enthusiastically support the appropriate gender-affirming medical care for trans youth, and we are disgusted by the legislation trying to ban it.

 

Well I certainly agree with all of this. 

Supports pretty much everything I've said.

Edited March 20, 2023 by homersapien