[crote]

The medical community didn't delegate it to society.

Transitioning is an effective and proven treatment, which has a far higher rate of success than basically any other psychiatry-related treatment. The medical part is pretty much solved, and those physical differences can be reconciled quite well.

But as it turns out, the hate from society still remains, and it still has an effect. Turns out being happy is a bit tricky when it is literally a coin flip whether the person you are talking to believes you should be murdered merely for existing.

[harvey9]

Here's a paper which suggests that the medical part might not be solved

https://journals.plos.org/plosone/article?id=10.1371/journal...

"Conclusions

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."

[crote]

That paper doesn't state what you think it does.

If you read the Discussion, you'd see that this study actually contrasts other similar studies, which saw no such outcome. It even explicitly states that the overall mortality rate was only significantly increased for the group operated before 1989, and mentions that

> However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.

This study is often used in an attempt to discredit transgender healthcare. In fact, it is used so often that there is even an interview[0] with the author about its misrepresentation. The interview links half a dozen other studies done since then which confirm that transgender healthcare does indeed work, and is in fact quite effective.

[0]: https://www.transadvocate.com/fact-check-study-shows-transit...

[mftrhu]

No. Here's a paper which is frequently misquoted by people failing to read its open-access text in its entirety, and relying on third-parties often creative interpretations of it. It has been discussed by its author - Cecilia Dhejne - multiple times over the last decade, notably during her Reddit AMA https://thewinnower.com/papers/7252-science-ama-series-i-m-c...

> Thank you for your question and I am happy I was invited to AMA.

> I am aware of some of the misinterpretation of the study in Plos One. Some are as you say difficult to keep track since they are not published in scientific journals. I am grateful to friends all over the world who notify me of publications outside the scientific world. I do answer some of them but I can’t answer all.

> I have no good recommendation what to do. I have said many times that the study is not design to evaluate the outcome of medical transition. It DOES NOT say that medical transition causes people to commit suicide. However it does say that people who have transition are more vulnerable and that we need to improve care. I am happy about that it has also been seen that way and in those cases help to secure more resources to transgender health care.

> On a personal level I can get both angry and sad of the misinterpretations and also sometimes astonished that some researcher don’t seem to understand some basics about research methology.

[roughly]

How do those rates compare to people who were not allowed the reassignment?

"Trans people have a higher rate of suicide than the general populace even after reassignment" isn't disproving either the 'innate' or the 'societally-driven' risk model here.

[notch898a]

It would be false equivalence for me to suggest this is a suitable analogue, but it is interesting to note certain amputees are able to perform more or less completely normally from a social perspective in daily life (and possible even excel in sports etc) yet they can still suffer from phantom limb syndrome and have increased risk of suicide, anxiety etc.

There is clearly a significant social aspect here but I'm not willing to toss out that the body may just really not enjoy not being naturally in the expected configuration. Going to the gender you want seems to be partially solved but, like the person with the lost limb, it's doubtful we have anything close to a full substitute. I really worry the medical community has been doing a dis-service to the development of treatment by underplaying the suicidal aspects that may be less socially related.

[crote]

One thing to keep in mind is that the opposite is happening here.

With transgender people, the "original" state is unnatural. Medical treatment fixes this mismatch by making the body match the brain. It is a voluntary treatment with an extremely high success rate and negligible regret rates.

As far as I can tell, there is zero evidence that any remaining issues are caused by the treatment itself. All evidence points that the remaining issues are primarily socially related.

[f154hfds]

What did transgender people do before the treatments and therapies? How did they live in their original state all their lives without our medical interventions? Do we know that the treatments help in the sense that treated people commit suicide less than untreated people before the treatments were available?

[mftrhu]

> What did transgender people do before the treatments and therapies? How did they live in their original state all their lives without our medical interventions?

What did diabetics do before treatment and therapies? People with asthma, myopia, or really any other health issue? What does it matter?

> Do we know that the treatments help in the sense that treated people commit suicide less than untreated people before the treatments were available?

Why do we need to know that? What's the point of it? We don't evaluate effectiveness of any treatment by comparing current data with likely non-existent, pre-treatment (read: more than a century old, in this case) data.

[f154hfds]

My statement above is asking how to test whether the treatments are contributing to a social contagion effect. If they are, we can't test treatment vs. no treatment at a snapshot in time because the very existence of the treatment adds to the contagion effect which in turn produces suicides in treated individuals! To make sure social contagion is not the bigger factor we want to look at how these disorders manifested prior to the existence of the treatment and compare that to the effect of the treatment now.

[somsak2]

The treatments I'm familiar with, especially those that are assisted by prescription drugs, are quite new and unsupported. it's hard to find any studies of this stuff at all. the amount we know about efficacy here is shockingly low.

if you have references, I'd welcome them.

[crote]

https://pubmed.ncbi.nlm.nih.gov/24344788/ https://link.springer.com/article/10.1007/s10508-009-9551-1 https://mayoclinic.pure.elsevier.com/en/publications/hormona... https://link.springer.com/article/10.1007/s10508-014-0453-5 https://www.researchgate.net/publication/23553588_Long-term_... http://europepmc.org/article/med/25690443 https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2265.... https://pubmed.ncbi.nlm.nih.gov/29463477/

If by "quite new and unsupported" you mean "pioneered in the 1920s, well-established for many decades, backed by dozends of studies, and successfully applied to hundreds of thousands of patients worldwide", then yes - it is indeed quite new and unsupported.

If you want to read just one study, why not start with the last one? The Amsterdam Cohort consists of 6,793 people since 1972. That should be plenty to start with.

If you want even more, I recommend reading the "Standards of Care for the Health of Transgender and Gender Diverse People". Currently in its eighth edition, it describes the entire process, with hundreds of additional studies cited.

[mftrhu]

> The treatments I'm familiar with, especially those that are assisted by prescription drugs, are quite new and unsupported

The treatments you are familiar with have been around since the thirties. Research on them started with the Institut fur Sexualwillenschaft, which has been since burned down, and hundreds of papers have been published on the topic since, dealing with thousands of patients all over the world, with their findings all being remarkably consistent.

How hard have you actually looked into it?

[mensetmanusman]

The horror stories from detransitioners prove that the medical part is not ‘pretty much solved’. Unclear why such disinformation spreads so much.