[kennywinker]

Yes, but since when do we allow the majority to dictate what healthcare options are available?

The mode for treating trans kids is puberty blockers until they’re 18 and then they can choose their own treatment - but that pathway is being blocked by more and more laws and fear mongering about kids being transitioned against their will

[Manuel_D]

"Transitioned against their will" is a very crude way of articulating the tradeoffs of prescribing puberty blockers. The core issue at hand is that absent puberty blockers, somewhere between 60-80% do not persist with a cross-sex gender identity after going through their natal puberty. Psychologists attempted to predict which patients would persist in a cross sex gender identity and which would not, but they were never able to do so.

When patients are given puberty blockers, desistence rates are miniscule, in the single digits. Proponents of hormonal intervention insist that this is proof that doctors are selecting kids that would persist in a cross sex gender absent blockers. But that's hard to reconcile with psychologists previous failures to predict persistence. While they're billed as giving "time to think", it's pretty much impossible to deny that blockers are causing patients who would have desisted in their cross sex gender identity if they went through their natal puberty.

It's not just conservative American States that are changing course on blockers for children: Finland, Sweden, the UK, Italy, Denmark, and Norway have all stopped prescription of blockers in children. Plenty of other countries never allowed it in the first place.

[heavyset_go]

The effects of puberty prevent people who are trans from living as their gender identities. Why bother when you'll need $400k in surgery post-puberty just for a chance to maybe look your gender?

If you ask trans people, "it's too late to live as my gender" is a common sentiment. You even see it in the gay community, where gay/bi people who come to acceptance of their sexualities late in life, feel like it's "too late" to live with that identity, and choose to continue to live and identify as straight people.

Hence the option for puberty blockers.

Turns out trans people will opt to go through the puberty that matches their gender if the opportunity arises, just as more people come out gay/bi/etc at an earlier age now that the opportunity arose.

[Manuel_D]

People can, and do, transition as adults. Natal puberty clearly does not prevent all people from transitioning. Effectively 100% of trans people prior to about 2010 transitioned as adults.

Same thing with gay people, as per your example. I'm sure some do remain closeted their entire lives. But plenty of them come out as gay later in life.

[Dylan16807]

> Same thing with gay people, as per your example. I'm sure some do remain closeted their entire lives. But plenty of them come out as gay later in life.

Plenty do, but the ones that don't give credence to the idea that forced closeting as a teenager makes it harder to follow your heart later. And that's in a situation where it doesn't get more difficult to come out later (if you're not married). Transitioning pre- and post- puberty is very different with current medical technology, so a lot more people will get "stuck".

[Manuel_D]

As per the linked study, the desisters tend to no longer experience gender dysphoria. It's not just that they don't transition later in life. The scenario you're describing - people struggling with gender dysphoria but reluctant to transition on account of having undergone natal puberty - does not describe the bulk of the sample.

[KittenInABox]

I don;t see a linked study...

[heavyset_go]

I never said that they don't, just that the opportunities to do so diminish post-puberty and with age, and many people give up on the dream of being themselves.

> But plenty of them come out as gay later in life.

Some do, but statistics show that the majority don't. At some point it stops making sense to identify as a gay/bi person if you've been married for 20 years and have no intention of leaving. That ship has sailed, so to speak. The same thing happens with trans people for very practical and biological reasons post-puberty.

[Manuel_D]

The majority of patients stop experiencing gender dysphoria. The analogy to a married person "stuck in the closet" is not correct: in that scenario this person is still same-sex attracted but suppresses that desire. In the case of ~80% of gender dysphoric youth, they stop desiring to be the cross-sex gender altogether. They are not refraining from transition on account of doubting their ability to pass after having gone through natal puberty.

[lelanthran]

> Some do, but statistics show that the majority don't.

Well, yeah. That's because it literally was a passing phase that the child experienced. That's why there's so many studies (some of them linked in this thread) showing that if you simply defer the decision until the minor is a major , the majority of gender dysphoria desists.

IOW, once the child has actually matured a little, their identity confusion goes away.

Deferring is the path of least harm; is it any wonder then that most of the people in the world, including highly secular countries, go that route?

[heavyset_go]

The statistics I am talking about are the rates of gay/bi identification by generation.

There's a reason there's nearly 10x as many gay identifying people in recent generations compared to past, and you can't generalize it as being a "phase". The true rates are likely the same, but people who identify that way dip off as you go back generations.

You notice the same pattern with left-handedness and those who identify as left-handed over time.

[Dylan16807]

> "Transitioned against their will" is a very crude way of articulating the tradeoffs of prescribing puberty blockers.

That is an extremely generous interpretation. I think you're giving way too much credit to the average person that uses that argument.

Also I really have to wonder how much of that desistance is giving up versus actually being satisfied.

[Manuel_D]

What do you mean by "giving up"? These patients have the opportunity to transition later in life. Patients were followed up with for 10+ years, well past puberty and into adulthood. The minority that persisted transitioned as adults.

[Dylan16807]

The initial puberty is never going to be undone. If they'd rather live with it now that it happened, then it's great that they're probably not undergoing heavy dysphoria but that doesn't mean it's zero or that this was the best outcome.

[lelanthran]

> The initial puberty is never going to be undone. If they'd rather live with it now that it happened, then it's great that they're probably not undergoing heavy dysphoria but that doesn't mean it's zero or that this was the best outcome.

Well there was never going to be a perfect solution, right? So a solution that results in the most number of satisfied adults is an okay goal.

[Manuel_D]

Given the disparity in life outcomes between trans people and cis people, the idea that the desisters would have been better off transitioning is quite the bold speculation.

[kennywinker]

Seems like you’re saying “society treats trans people badly, so we should prevent people from transitioning”

Coulda said the same about homosexuality ~30 years ago. It’s a bad reason then, it’s a bad reason now.

[KittenInABox]

How much can the disparity in life outcomes be attributed to a trans person needing to undergo a second puberty in a society where doing so is discriminated against?

I feel like as a society we put trans people in a situation where it is controversial for them to transition as children, but also controversial for them to transition as adults. (The notion of a man in a dress no longer exists if the man never had male puberty, but not only is it controversial for such a boy to never have male puberty, we villainize the now-man's attempts to become a woman!) But then we say that outcomes for trans people are bad so them staying in the closet is good. Which is weird, because the cause of the bad outcomes is that there is no stage of their life where trans people can transition noncontroversially.

[wreedtyt]

It seems like you're referring to a specific study, could you link it?

[Manuel_D]

A multitude of studies, not just one. This is the review covering the outcomes of gender dysphoric children who aren't given blockers:

https://news.ycombinator.com/item?id=44546443

[lelanthran]

> Yes, but since when do we allow the majority to dictate what healthcare options are available?

We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.)

The government, for good or bad, regulates all healthcare, and that government is guided by its voters.

The majority of voters don't see this as a bigger problem than the issue they are currently voting on.

[kennywinker]

> We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.)

As someone else pointed out, the idea of gov deciding what our doctors can and cant give us is a VERY modern concept.

But your examples: arsnic & crack

1. Cocaine is legal for doctors to prescribe and use in specific circumstances. What is legally prohibited is recreational use. Most of the restrictions on use are due to the threat of addiction, not the threat of appropriate medical use.

2. Arsnic is similarly entirely legal for medical use. Restrictions are around putting it in FOOD because it’s POISON. Nobody is saying you can’t treat cancer with it, if it’s shown to be effective.

Your examples are not examples of the majority regulating medical care for individuals.

[thaumasiotes]

> We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.)

That began in 1906; it's hardly something we've "always done".