[chlodwig]

Psychotherapy is simply not effective at changing someone’s gender identity or ameliorating gender dysphoria. The established treatment for gender dysphoria is to align the person’s gender identity and gender expression.

Can you find a randomized controlled study where the "affirmative" approach of aligning gender expression with identity has been compared to a "reparative" approach of aligning identity with biology? I have read a lot of studies on this and what you are saying simply is not backed by the evidence. Whenever I read a study that has been referenced on NPR or such, I read the details and the details do not support what the people citing the study say it supports.

In all other cases, if someone's mental conception of themselves was not aligned with the biological reality of their self, we would say the default is that the person should try to adjust their mental conception. A treatment that involved all of society changing, or even more extreme -- actual removal of body parts -- would need to pass a very high burden of experimental evidence. From what I have read, that burden of proof has not ever been close to being met. There are no studies that say that aligning gender expression works better than helping the person cope with or get over their dysphoria. If I have missed such a study, I would like to read it.

Do you feel that your gender identity could be changed using Cognitive Behavioural Therapy?

I do not have a gender identity and I do not have a gender. I a sex and I have an identity as a sexed being. I have a brain that has developed under the influence of testosterone, I have the knowledge of having a penis, I have the knowledge that society sees me as a male and penis-haver and all that entails. I have the knowledge that if I used a woman's locker room and exposed my penis, women would freak out, and so I do not do that. Etc. etc. I wear the clothes that I do because that is what society expects of me. There are all sorts of clothes and outfits from other cultures that I prefer aesthetically but I don't wear because they do not align with the norms of my current culture.

It's actually really difficult for me to understand how a person's fundamental well-being is intrinsically and immalleably tied to names and clothing.

Of all the possible forms of clothing humans have worn in the last ten-thousand years, only a tiny sliver of those clothing are socially acceptable for me to wear. And yet we all deal with that.

If someone were to intentionally call me the wrong name, while everyone else gets called the name they have asked to be called, that would bother me, but only because that is a power move that singles me out. If I were to, say, join a fraternity, where everyone had to have a name assigned to them, that would not bother me, and I would be fine being called that name while hanging out in the fraternity.

If someone were to call me a "woman" I would be upset because it is the reality of my biology that I am a man. Furthermore, saying you are a "woman" is usually saying, "You lack the positive qualities we usually associate with being a man -- you are weak, you are cowardly, you are whiny, etc."

[brandon272]

The RCTs that validate your assertion (or mine) when comparing reparative therapy and affirmation do not exist. All that we have to rely on now is the overwhelming consensus among medical and mental health professionals, and that consensus appears to exist among major reputable bodies worldwide, and is based on their many decades of collective clinical experience and research.

I understand your perspective - in a different world without ethical qualms or risk of harm we could conduct those studies and maybe have better, more conclusive answers. What I am suggesting is that we have the data and research that we have. While you have chosen to draw a line at requiring randomized controlled trials to convince you that a certain outcome is the right one, there is an abundance of research and clinical data that does exist endorsing affirmation of gender identity, and we can explore some of it, if you like.

> In all other cases, if someone's mental conception of themselves was not aligned with the biological reality of their self, we would say the default is that the person should try to adjust their mental conception.

Can you elaborate on what you mean by "other cases" that are directly comparable with gender dysphoria, and can you find some studies that support the effectiveness of this approach? Gender dysphoria seems pretty unique from a clinical perspective despite a common thread it may have with other conditions.

> I do not have a gender identity and I do not have a gender. I a sex and I have an identity as a sexed being.

I think it's great that you are very clear on your role in society when it comes to what side of the biological sex binary you are on. It's a luxury to not have to be concerned with it, but not everyone has that luxury.

> It's actually really difficult for me to understand how a person's fundamental well-being is intrinsically and immalleably tied to names and clothing.

What you are saying here is that "this is my experience and I do not understand why everyone else does not have the same experience". Do you not see a problem with that? You can have your opinion and that's fine. Other people do not have to share your opinion or approach the world in the same way.

You appear to start from your biology and work backwards, as if the mind does not exist. Others would suggest that you and your biology do not even exist without the conscious mind making them real. Thus, the power of the conscious mind is actually more critical to this whole equation than whatever your biology is.

Stop thinking about your own experience for 5 minutes and think about the experiences of other people and where they might be coming from based on their own perception, experience and biological realities - including the biology of what goes on in the brain!

[chlodwig]

The RCTs that validate your assertion (or mine) when comparing reparative therapy and affirmation do not exist. All that we have to rely on now is the overwhelming consensus among medical and mental health professionals, and that consensus appears to exist among major reputable bodies worldwide, and is based on their many decades of collective clinical experience and research.

If medical bodies are changing guidelines without basing on it solid studies and evidence, then those medical bodies should be considered compromised and corrupt. Especially when that treatments involving treatments that will permanently sterilize minors. If they are not following the evidence, then they are not "experts" or "scientists" they are ideological fanatics wearing the skin-suit of science.

In following the transgender issue, what I have noticed is that doctors who take the common sense approach, "Your child has a penis, he is a boy, you need to reinforce that and he will get over it" don't make any money. They do not open "gender identity clinics" because there is no money in dispensing common sense. The doctors who tell parents to "let the child explore their gender" and "let's help solidify their transgender identity" prolong the problem and create a recurring revenue stream for themselves. Then, because these doctors are the "head of a gender identity clinic serving thousands of children" these same doctors are the one's who are put in charge of writing the standard of care and the guidelines. It is totally perverse set of incentives.

I'd recommend reading up on how the sausage is made in coming up with the "consensus":

https://www.realityslaststand.com/p/gender-medicines-citatio...

https://www.nysun.com/article/leaked-files-from-influential-...

Can you elaborate on what you mean by "other cases" that are directly comparable with gender dysphoria, and can you find some studies that support the effectiveness of this approach?

If someone was too short, or too tall, or thought they were black (even though they were unambiguously white),

You appear to start from your biology and work backwards, as if the mind does not exist.

No, I don't believe that mind and body exist as wholly separate entities. This is very obvious in the case of sex where the hormones emitted by my testicles very clearly have all kinds of effects on my mind.

> It's actually really difficult for me to understand how a person's fundamental well-being is intrinsically and immalleably tied to names and clothing. > > > What you are saying here is that "this is my experience and I do not understand why everyone else does not have the same experience".

No, what I'm saying it is difficult to even see how an immalleabile tie between well-being and wearing a dress could have possibly evolved, when clothing has been so different throughout human history and people are thus obviously very flexible in the type of clothes they can wear.

What you are saying here is that "this is my experience and I do not understand why everyone else does not have the same experience". Do you not see a problem with that?

Until a mind reading machine exists, that is all that any of us can do. I have read various accounts of trans-people's experiences and I am not convinced that there is some immalleable preference in their mind that makes them female internally. Certainly some men have a very strong desire to act out the role of female, but that is different there actually being female in the brain. But because of the way various medical guidelines works, and the law works, there is incentive to lie about this.

[brandon272]

I am well aware of the current concerns around the incentives that exist in the medical industry when it comes to the treatment of gender dysphoric people. Some of it we should absolutely be concerned about, particularly when it comes to treatment of children.

Where the current public discourse on these issues goes off the rails is that we conclude that, because these concerns around improper incentives and improper treatment exists, or because there are some issues around social influence of children on social media, that "gender dysphoria" broadly is either not real or not a legitimate problem that people deal with.

> If someone was too short, or too tall, or thought they were black (even though they were unambiguously white)

If someone was 5'8" and underwent leg-lengthening therapy to become 6'1", would we not call that person "tall", or would we jump through strange mental hoops to justify antagonizing them based on their genetic makeup?

> Until a mind reading machine exists

Again, the problem here is that you are concluding that unless you can rationalize and validate someone else's thought process or mental condition through the lens of your own experience, then their experience is irrelevant to you, not real, and that they are worthy of mockery and derision instead of respect and consideration.

We don't need a mind reading machine to understand what gender dysphoria is, because gender dysphoric people tell us what they are thinking and feeling, not to mention they tend to know what will reduce their feelings of dysphoria.

[chlodwig]

We don't need a mind reading machine to understand what gender dysphoria is, because gender dysphoric people tell us what they are thinking and feeling

It's not this simple. For one, lots of people are all kinds of confused. There are people who think they are dysphoric, transition, then realize they totally messed up. There are people who say, "I went through a period when I was a kid where I was a tom-boy or told my parents I was the other sex -- thank goodness this kind of ideology wasn't around then because I could have been trannsed. I'm perfectly happy in my biological sex right now." If you read a lot of stories they aren't necessarily "dysphoric" they just think it will benefit them someway to transition, in the same way a weightlifter who goes on steroids is not "dysphoric" about his body, he just might think he is happier to be muscled up.

And we also have people who later admit that they lied about the nature gender identity in order to get sex change drugs and trans people who admit there is substantial political pressure to make their personal testimonials about gender identity conform to a certain script: https://nymag.com/intelligencer/article/trans-rights-biologi... https://www.nplusonemag.com/issue-30/essays/on-liking-women/

Because we do not actually have the technology to turn a man into a female (or vice versa), I think the most honest and best course is to tell that person, "Sorry, you are not a woman, and the surgery you are asking for will not actually get you want you want. Cross-dressing and wearing lipstick does not make you a woman. But if you learn to accept who you are, you can live a happy life." To be convinced that this common sense approach is not the best approach, I would need very strong evidence -- at minimum multiple randomized controlled trials by honest researchers.

[brandon272]

> There are people who think they are dysphoric, transition, then realize they totally messed up.

Some people start businesses, it doesn't go well, they then realized they messed up and totally regret it. Does this mean that all entrepreneurship should be banned?

The logical failure in your argument is that you are saying that because there are problems with current approaches to transgender care, that gender dysphoria is not real and does not need to be taken seriously or treated or accommodated.

> I think the most honest and best course is to tell that person, "Sorry, you are not a woman, and the surgery you are asking for will not actually get you want you want. Cross-dressing and wearing lipstick does not make you a woman. But if you learn to accept who you are, you can live a happy life."

There is zero evidence that your "common sense approach" works at all, and there is zero evidence that reparative or conversion therapy works at all for those with legitimate gender dysphoria.

[chlodwig]

There is zero evidence that your "common sense approach" works at all, and there is zero evidence that reparative or conversion therapy works at all for those with legitimate gender dysphoria.

Clinical psychologists Kenneth Zucker's work in getting the majority of his patients over their dysphoria is "evidence" that reparative therapy works -- https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-r...

Every random comment on Reddit that "I suffered from dysphoria and then started lifting and doing masculine things and got completely over it" is evidence that reparative therapy works.

It's not gold standard evidence, it's not proof-beyond-a-reasonable doubt, but it is evidence. But the "evidence" for "affirmation" and "medical transition" do not meet this gold standard either.

With medicine, the burden of proof is on the person doing the intervention. "First do no harm." Social transition and medical transition are both MAJOR interventions, the burden of proof is on the proponents. "You have to give people this drug, no we have never done a controlled clinical trial on it, but you have no evidence that NOT giving them the treatment works." What? You need to do a RCT before promoting a new treatment as the standard of care. "Affirmation" has never proved itself in an RCT so "Sorry, you are a man" should be the default.