[g3e0]

No surgeon should be removing healthy body parts, in my opinion. You wouldn’t fit a gastric band to an anorexic person, no matter how badly the patient wanted it, and that’s not even permanent.

I sympathise with all people who have issues accepting the body they were born with. If someone believes their body should be different, but otherwise their body is healthy, I think it’s fair to say that whatever is causing the feeling of mismatch is happening in the mind. It’s no surprise to me that a significant fraction present with other mental disorders.

In an ideal world, there would be some form of therapy that helps people come to terms with and accept themselves with what they’ve been given. But again I do sympathise, because contemporary medicine simply isn’t very good at treating mental illnesses.

[jcul]

I think the key thing is that these permanent procedures should not be performed on children / minors.

Personally, I was a very different person at 15 to 20 to 25. I don't really think a young person can make a rational decision on something that is going to affect the rest of their lives in such a dramatic way.

A 30 year old deciding to get gender reassignment surgery is very different to a 12 year old.

[howinteresting]

The problem is that being on the wrong set of hormones during your teenage years can fuck your body up.

I'd be more open to medical intervention post-18 if this problem didn't exist.

[filoleg]

> The problem is that being on the wrong set of hormones during your teenage years can fuck your body up.

That's pretty much the exact same reason for being against such hormonal treatments for minors as well.

[howinteresting]

Well, yeah, and the gold standard way of figuring out who would benefit from hormonal intervention is people's self-description.

[silveroriole]

Would you support a woman having breast reduction surgery, or would you say “sorry your body doesn’t match your mind; get therapy”?

I suppose you can argue the tissue here is not “healthy” because it’s causing physical distress for the woman, but the same seems to apply to a trans person. Distress is never ‘just’ mental, it has physical effects on the body (and vice versa - pain is ‘just’ mental). The decision of what’s healthy doesn’t seem so simple to me.

[0xy]

The argument you are making would hold up better if there was evidence that post-op trans people have dramatically lower suicidal thoughts, but multiple studies have shown suicidal thoughts is virtually unchanged after operation.

Now the argument becomes something like 'a body part of yours is causing mental distress, let's cut it off even though there's zero evidence it'll help'. Seems very flimsy and predatory to me.

As for breast reduction, there's actually evidence that large breasts can cause physical problems in women, so it seems reasonable to allow that along with the evidence that women with large breasts experience a better quality of life after surgery (absolutely not the case for trans people removing body parts).

"The overall mortality for sex-reassigned persons was higher during follow-up"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/

[silveroriole]

There’s no therapy that helps, at least as far as I know. At best you could learn coping mechanisms, but I don’t think anyone has ever been successfully convinced out of trans-ness by therapy, similar to how gay conversion therapy didn’t actually work. So we’d be left with telling trans people “there is no treatment at all, go deal with it somehow.” Anecdotal of course, but there are a fair number of trans people on social media who seem happy with their surgery - why deny them that because someone else is convinced that according to statistics it shouldn’t have made them any happier?

[mhaymo]

Desistance, i.e. "being convinced out of transness" is perfectly common, as mentioned in the article. I'm not aware of any studies on how therapy can affect this, but even if the therapy was merely helping the patient cope with their dysphoria for a period before exploring other options, that seems a far cry from saying "just deal with it".

[linuxftw]

The OP article is raising the claim that most of the (recent young) people probably aren't 'trans' at all, but there's a one-way affirmation pipeline backed by no science whatsoever.

> there are a fair number of trans people on social media who seem happy with their surgery

Are the people that are unhappy embraced by the community, or are they deplatformed? Are they happy with the surgery itself, or that they're now 100% part of a community of some kind?

Once someone has surgery, do they in their mind feel completely the new gender, and go about their lives as such, or are they now some elevated status within the trans community itself?

I don't have a problem with how people decide to live their lives, and while I'm generally against unnecessary surgery, adults are free to do what they want. I am against quack science and unethical behavior that might be exploiting the mentally unwell and even just confused children. I also am against using the power of the state to levy the quack science in the case of custody battles.

[howinteresting]

What exactly are your qualifications? How much of the scientific literature have you read?

[affinepplan]

> but multiple studies have shown suicidal thoughts is virtually unchanged after operation.

This was literally the first result when I googled "post op trans suicidal thoughts study" (n > 27k)

https://jamanetwork.com/journals/jamasurgery/article-abstrac...

So, seems like there is indeed evidence?

[0xy]

The 2015 US Transgender Survey cited in your link was commissioned by the National Center for Transgender Equality (an organization that was founded by a transgender activist).

The study was performed online and links were posted exclusively in transgender support forums.

Your standards for "evidence" reach the heights of biased activist SurveyMonkey CSVs? I'm convinced!

[affinepplan]

the study was intending to measure the rate of suicidal thoughts among transgender people.

Seems like a great way to get a lot of datapoints is to use a transgender forum. Seems like a great way to measure suicidal thoughts is to ask "do you have suicidal thoughts"

So seems like a great approach to gather a lot of evidence for the question at hand?

Seems like you just don't like the evidence because it doesn't reach the rather bigoted conclusion you want it to

[malf]

> “The overall mortality for sex-reassigned persons was higher during follow-up“

Higher than population average. Do you have any evidence that it is higher than people who are denied treatment?

[0xy]

The surgery is objectively a failure if it doesn't lower suicide rates.

[Lipo_Nemo]

It's objectively isn't if it lowers suicide rates relative to pre-transition level. It does not necessarily need to lower rates to population average to be effective

[howinteresting]

This is not true. Even if your claim about the paper is true (which it isn't), there are other metrics to care about:

- suicidal ideation, which is bad in and of itself

- anxiety, e.g. social anxiety

- depression

Besides, the study does not account for the fact that until 2013, Sweden forced people to have surgery to get updated IDs. If a trans person does not want to have a particular surgery and yet is forced to have it, you can imagine why that would cause a great deal of suffering. That isn't gender-affirming care, that's forced sterilization (which is a human rights violation with a sordid history).

The idea that gender-affirming care doesn't have a large evidence base behind it is preposerous. See e.g. https://medicine.yale.edu/lgbtqi/research/gender-affirming-c...:

> As evidence for the proposition that “[t]here is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention,” the AG Opinion cites a 2011 Swedish study by Dhejne et al. that, the AG Opinion claims, “monitored transitioned individuals for 30 years [and] found high rates of post-transition suicide and significantly elevated all-cause mortality, including increased death rates from cardiovascular disease and cancer, although causality could not be established.”49 In fact, the 2011 study by Dhejne is badly out-of-date and does not support the AG Opinion’s claim.

> The Dhejne study compared post-gender-affirmation transgender individuals with cisgender individuals from the general population, as opposed to transgender individuals who did not receive gender-affirming care. Therefore, as the study’s author explicitly cautions in the body of the text, it is impossible to conclude from this data that gender-affirming procedures were a causative factor in suicidality among transgender individuals.50 Rather, the study shows only that transgender adults were more likely to experience suicidal ideation/attempts and risky behavior when compared to the general population in Sweden between 1973 and 2003. Further, the Dhejne study is not generalizable to a modern American population or to adolescents. During the study period, Swedish law required that individuals seeking gender-affirming surgery be sterilized. The presence of this law alone might account for the higher risk of suicide attempts and risky behavior in the transgender population compared to the cisgender population at the time.51

[zachjustice]

I think its worth noting that the authors of the same study conclude:

> 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.

[kevingadd]

What is your definition of healthy?

Should people born with a cleft palate be forced to leave it alone? What about people with breathing problems due to their anatomy? If a kid has teeth grow in improperly and start causing jaw problems, should they be prohibited from having their wisdom teeth removed or teeth realigned with braces? Should tonsil removal be prohibited? If a woman has severe back pain due to oversized breasts, should it be prohibited to get a reduction surgery even if it improves quality of life? Should vasectomies be prohibited if a person with testes wants to be able to have sex with their partner without the risk of pregnancy?

Should it be prohibited to medically disable "healthy" body parts as well? As an alternative to vasectomies you can use drugs to similarly disable that body part, in many cases effectively forever. Should that be illegal too? What about anti-androgens like Spironolactone - used on-label for multiple different purposes - should we ban those since they are also used for MtF HRT? Birth control also is functionally disabling healthy parts of the body.

Why does a problem "happening in the mind" somehow mean that no treatment can occur outside of the mind? Do you think mood stabilizers and antipsychotics should be banned because we're treating an "in the mind" problem with physical, body-altering interventions?

[xupybd]

As a though experiment I've thought a lot about the black alien project. Specifically the removal of his fingers. I'm not sure I know where to stand. Should he be free to do what he wants? Should doctors be required to avoid removing healthy fingers ( I don't think they were doctors but I've altered the situation for my thought experiment)?

My conclusion is I have no idea how to even approach it.

I'd be interested in others thoughts.

I like this topic as it's less politically charged but explores similar ethics.

[Breefield]

Thank you.

[bruiseralmighty]

There will never be a clear cut definition of health, but most people can innately tell what a well regulated body looks like for their culture.

For instance, most Americans know they're fat or obese and that this is not good for their long term health outlooks and will have detrimental affects on other aspects of their lives. Some may choose to be okay with this, but very few sincerely argue that being fat is 'healthy'. Most will try to lose weight (excess fat) at some point in their lives.

Sometimes we remove body parts that are no longer well functioning within an understood ordering of the body. Inflamed tonsils can be removed, large wisdom teeth pulled, even ovaries can be discarded if they're found to be hosting cancers, but all of these are examples of organ dysfunction. We know what is regular, non-painful, and non-disruptive about the human body because many human beings spend a lot of time in that state and most begin life in that state before transitioning to a disordered state. When that transition happens, medical science seeks an explanation for the dysfunction: how did these tonsils become inflamed?, why do wisdom teeth crowd the mouth?, how did this woman's ovaries come to carry so much cancer?

We look for the cause of a dysfunction in order to treat it.

If instead we remove the well functioning breasts of a 15 year old, or replace a healthy penis because a patient informs us that they abhor their member, or prescribe a blocker for an otherwise well regulated puberty, then we have inverted the entire thrust of centuries of medical understanding. We are taking a healthy body and searching for a malady that we have been told must be there. Once there is no longer a discernment between the regular and the dysfunctional for a human body then an explosion of maladies abounds all begging for treatment.

If enlarged breasts are causing spinal issues then perhaps they should be reduced in order to correct those issues. But why not removal? We remove enlarged tonsils, why not enlarged breasts? Surely the removal of them would also correct any spine issues. In fact, it may even be ethically easier as the doctor and patient do not have to contemplate a correct breast size. But of course it is unlikely the patient or doctor ever considered the wholesale removal of the breasts in these cases because both approached the question with an idea already in mind of what a healthy human body would look like despite they're not having any precise agreement on the topic beforehand.

And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun. Why should either be condoned? We condemn being fat on entirely the same terms. Often Americans are fat because they eat too often and always in excess due to eating feeling good. If one doesn't praise obesity, then what ought they find desirable about self-imposed sterility?

Of course what compounds these ethical concerns is that in these cases the subjects are children. On the whole this takes the acts from merely questionable or wrong-headed to monstrous.

[the_only_law]

> And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun.

Perhaps we should question the ethics of kids playing casual sports because it’s in the pursuit or carefree pleasure and fun

[bruiseralmighty]

Play is important to a child's development. Try to refocus and retain that the context of the conversation is about medical interventions not playground games.

It is self-evident that reversing a decision to play freeze tag is orders of magnitude easier than reversing a dental tooth cleaning; a mundane medical procedure.

[the_only_law]

How about you worry about yourself. What’s it to you if someone decides to get a vasectomy in their 40s? Or are you simply more interested in bending and controlling people with your personal moral views where “pleasure and fun” are sins.

[filoleg]

> How about you worry about yourself. What’s it to you if someone decides to get a vasectomy in their 40s?

I don't think almost anyone in this thread, including the person you are replying to, has any issues with 40 year olds doing whatever they want to with their own body. They are adults who can accept full responsibility over their actions and consequences, no matter how irreversable or disastrous they could end up being. Children are an entirely different story, as they, by definition, have no ability to provide informed consent to a lot of things, and rightfully so.

> Or are you simply more interested in bending and controlling people with your personal moral views where “pleasure and fun” are sins [?]

You are fighting windmills here. At no point had anyone in this chain of comments exerted any moral judgement against people transitioning or even suggested that it was sinful.

And to be extra clear, I have no issues with adults transitioning, and I would have no issues with minors either, if the process was fully reversible. Most western countries don't consider minors being legally able to give consent to getting tattoos due to their (near-)permanency, but no one has any issues with adults getting those. I, personally, would consider transitioning to have a much higher bar for "minors should be able to consent to it" than I would for getting a tattoo.

[danShumway]

> No surgeon should be removing healthy body parts, in my opinion.

There are a metric ton of medical procedures surgeons do outside of medical transitioning where people alter/adjust/remove healthy body parts. This seems like a pretty blanket statement to say; and I say that as someone who would be extremely cautious about telling someone that they "should" medically transition if they feel that social transition would be sufficient for them. I'm all aboard the train of telling transgender people that they're valid whether or not they choose to transition, and I definitely would advocate that transgender identity and body dysphoria are not necessarily the same thing, and that many trans people are blessed to be able to both embrace their transgender identity and celebrate aspects of their bodies that don't "align" with their gender in strictly hetero-normative ways.

Even with that perspective, this framing of "we're perverting the role of doctors/surgeons by cutting healthy flesh" -- it just doesn't really match the reality of how many procedures there are in the US that already fit that definition. Everything from the stereotypical examples of cosmetic surgery, to non-essential dental procedures, to limb lengthening, to circumcision, to sex-assignment surgery for intersex infants, the list goes on and on.

Many of these procedures aren't strictly speaking medically necessary. Precocious puberty for example is primarily harmful because of its psychological and social effects. The physical consequences of early puberty are comparatively minor (not non-existant, but then-again neither are the effects of puberty blockers. We're mostly talking about stuff like "you might be shorter when you grow up"). And yet, I've never once seen someone advocate that it's morally wrong or that it should be illegal for a doctor to prescribe puberty blockers to a cisgender child with precocious puberty. There's no shortage of conditions that really don't have physical health-effects or side-effects other than that society has decided that we don't really like them or that they're inconvenient to live with (either because of social stigma or because of the increased need for accommodations that society is unwilling/unable to provide) -- and we generally don't tell people with those conditions that they need to just learn to live with them. Instead, we give them choices (including medical interventions) to address both the social effects of their conditions and the internal psychological effects of their conditions.

What we don't do is we don't take a purely physical view of things. Heck, one of the justifications for why doctors prescribe puberty blockers to cisgender girls with precocious puberty is because there's limited research suggesting that delaying puberty lowers their risks of being raped. That's about as far into the "its a social problem, not a medical one" category as it's possible for a medical intervention to be.

And look, all of this is even taking the most charitable view of the statement statement above and assuming that it is specifically talking about medical interventions among minors. But if I take that statement at its face value as saying that no surgeon should ever operate on healthy tissue, then it just kind of becomes absurd, honestly. There are so, so many medical procedures that fall under that umbrella.

I think everyone would love to have less invasive ways of helping people who suffer from gender-disphoria and I think everyone is hoping that as social stigma continues to decrease that some of the psychological downsides of not transitioning might also decrease. That's not to say that medical transitioning is bad; it's not. But it does carry some risks, and obviously it's good to have multiple available paths for the transgender people who don't want to take those risks.

But arguments that boil down to "it's in the mind, so treat it that way" sound good at face-value but are ultimately way too simplistic to work even in a purely cisgender world. Our medical profession hasn't really worked that way for a long time, if it ever worked that way at all. So any debate about whether or not a surgery procedure is moral needs to be engaging with the issue on a deeper level than just whether or not there's a physical risk involved.

[qaz_plm]

People are terrible at analogies

[howinteresting]

Your opinion, based on absolutely nothing but your armchair philosophizing, is completely incongruent with the actual science.

Gender dysphoria is not a mental illness; it is a condition, like pregnancy. Unlike anorexia or body dysmorphia, when you address the issues causing gender dysphoria it simply resolves itself.

Leave this to the experts, please (ie not a receptionist). Unless you're trans or an expert there is very little substance in your opinions.

edit to respond: a mental illness is a disorder that causes harm to yourself or your interpersonal relationships. Gender dysphoria doesn't by itself do that. Transphobia in society does.

[0xy]

"Resolving" gender dysphoria with surgery does not result in lower suicide rates. In fact, suicide rates are virtually unchanged after operation.

"The overall mortality for sex-reassigned persons was higher during follow-up"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/

[howinteresting]

This study has been misread over and over again. It doesn't account for the fact that Sweden forced trans people to have surgery (sterilization) until 2013, even if they didn't want it. Besides, reducing suicidality is not the only goal of transitioning.

I can tell you that for me, now that I've addressed the issues causing me gender dysphoria it has completely resolved itself.

[0xy]

If surgery is completely ineffective at preventing massive suicide rates, why is it an option? Post-op transgender people still have extremely elevated suicide rates, therefore the surgery is ineffective.

Then you have transgender activists routinely attacking people in their own community who regret the surgery, and papering over the inconvenient truths about hormone blocking drugs (they cause permanent bone damage in children).

I'm not taken by arguments that routinely include tactics like death threats towards campaigners who speak out against dangerous hormone blocking drugs.

[howinteresting]

> If surgery is completely ineffective

It isn't "completely ineffective", there is a solid evidence base that people who want it and get it are happier than people who want it and don't.

> at preventing massive suicide rates

A large part of suicide rates is hostility from society. For example, what if society forces people who don't want surgery to get it just to update their IDs? This is a eugenicist human rights violation, and it was the case in Sweden for the time period studied.

Note that in the time period, Sweden also required trans people to prove that they didn't have any gametes in storage! This was such an egregious instance of eugenics that the Swedish government should be paying millions of USD in reparations to anyone affected.

> why is it an option?

Because it works and makes people happier.

> Post-op transgender people still have extremely elevated suicide rates

Due to hostility from society. Suicidal ideation and behavior is a well-known component of CPTSD, and almost every trans person I know has CPTSD from social hostility. (There is one trans person I know who doesn't -- she's 20 and grew up in a supportive, left-wing environment.) That doesn't reflect on any kind of surgery. Rather, it's a damning indictment of society.

> therefore the surgery is ineffective.

False. This absolutely does not follow either logically or empirically.

> Then you have transgender activists routinely attacking people in their own community who regret the surgery

First off, there is not just one "the surgery". Saying that just exposes your ignorance on the subject matter. (And you really should spend a few weeks learning about trans healthcare before commenting any further.)

Besides, your claim is false. The objections are only to the people who regret it and use that as an excuse to attack trans healthcare generally. I know trans people who were forced into a surgery they didn't want, regret it, and everyone I know has full compassion for them.

> and papering over the inconvenient truths about hormone blocking drugs (they cause permanent bone damage in children).

This is a well-known side effect of low sex hormones (also happens in post-menopausal women). There are also serious side effects to not intervening. As always, you have to balance the benefits with the costs of intervening versus non-intervening.

> I'm not taken by arguments that routinely include tactics like death threats towards campaigners who speak out against dangerous hormone blocking drugs.

Plenty of medications have side effects. Accutane can cause depression. Hormonal birth control can have serious side effects. Focusing on this over anything else shows your biases.

---

If you're engaging in good faith and would seriously like to learn more about trans healthcare, https://medicine.yale.edu/lgbtqi/research/gender-affirming-c... is a good starting point. There are over a hundred citations in the paper, and you can use any of them as a starting point. Sci-hub is your friend.

[gdavisson]

That study didn't compare suicide rates with and without surgery, it compared post-op trans people with the general population (i.e. mostly cisgender people). It explicitly says "This study design sheds new light on transsexual persons' health after sex reassignment. It does not, however, address whether sex reassignment is an effective treatment or not."