[wk_end]

I actually don't know how much of that's especially true where doctors are involved. We as a society strictly regulate who can call themselves a doctor and the credentials that are required to do so, and then in doing so entrust them as a class to be reliable arbiters of what constitutes what's medically necessary, how public medical funds should be spent (which, even if that's something activists agitate for, is still a separate issue), and so on. We also entrust them to help monitor how parents are treating their children.

Anyway, to double back once, it actually doesn't really "assume it's a medically necessary procedure"; we can soften it to something like a "medically desired procedure" and the point in fact still stands that Shazeer's wording - which really should be the point here, not re-enacting the tired trans healthcare debate - is deliberately incendiary and manipulative. Broadly, no one is advocating for parents to be sterilizing their children as an end to itself, so it shouldn't be characterized as such.

[frollogaston]

Doctors are allowed to make judgement calls within whatever rules the insurance providers and laws give. The status quo before all this was that gender-affirming care was never covered, which changed to always covered in discrete steps across the 2000s and 2010s. Doctors didn't get to decide that on their own. Before that even, medical schools instill rules and values that come mostly from the outside, while the medical knowledge and experience is from the inside.

Another controversy is physician-assisted s–... euthanasia. Some doctors would consider it medically necessary, but they can't legally perform or even recommend it, as it's considered murder. They can in Canada. Abortion of a viable fetus not threatening the mother is illegal in all 50 US states, but legal in many states in earlier stages, again based on what the states consider murder (but the doctor judges what is viable or a threat to the mother).

Anyway if gender-affirming care is just medically desired but not medically necessary, the sterilization is accepted but not necessary. I agree with the spirit of the wording, even though it's imprecise, because it highlights that children are taking on an irreversible side effect. It's a short quote and not a whole essay where he gets to clarify.

[gen220]

I’m curious, do you personally know anybody who’s gone through gender-affirming-care?

For me it was a really confusing issue until I became close friends with someone whose childhood best friend is trans.

If he was born a decade earlier, he probably would have killed himself (this was the path he was on, which is incredibly tragic and all too common); the gender dysphoria invoked depression was unbearable.

Instead, he was able to work through therapy and medical care to understand his gender dysphoria and receive gender affirming care in his late teens.

Now (over a decade post treatment) he’s among the most cheerful people I’ve ever met. He inspires joy as a band teacher, is inspiringly happily married, and is raising a beautiful baby girl.

I often think about him when people talk about the issue in the abstract. The hundreds of children whose lives he’s impacted for the better, let alone the lives of his friends and family. Removing gender affirming care is implicitly saying you don’t want any of that to happen, because the logical conclusion of removing is people like him in a pit of depression and despair that often ends in suicide, all over an affliction that they did not choose.

This is where the “medically necessary” part of gender affirming care comes from.

I didn’t understand it before I knew him and his story so I don’t begrudge people who are in shows I used to walk in. But I’d encourage people to try to understand and lead with empathy and meet people where they are.

[frollogaston]

Since you ask, I know three. One guy I knew in high school transitioned to female around 2013, and requested I say "she." She was bullied a bit for it, not too much thankfully, but it was clear she was never comfortable with being male before. Another was similar but later.

It's different now and children are being encouraged to transition. They aren't just told that some are naturally uncomfortable with their gender, but that conforming to a gender is abnormal. Way more are doing it than before, and even afterwards are committing suicide at high rates. So I can't support it. I still think people should have the right to do it on their own dime, and won't judge them for it either way. I can't trust any studies on this anymore because it's become politicized and weirdly speech-policed. This isn't a unique or nuanced opinion, it's probably the majority one and I sound like the rest.

[gen220]

> It's different now and children are being encouraged to transition. They aren't just told that some are naturally uncomfortable with their gender, but that conforming to a gender is abnormal. Way more are doing it than before, and even afterwards are committing suicide at high rates

The range of human (mis-)behavior is extremely wide, so I wouldn’t doubt that some doctors and patients are doing what you fear here. I don’t think we should form opinions on such a broad situation on the basis of a few extreme people and situations.

The question I would ask is would you rather have more people suffer from not having care, than some people suffer from receiving care that they later regret? The latter is something that’s incredibly sad, no doubt, but it’s an intractable and tragic side effect of offering major medical treatments and interventions in general; the “false positive” aspect is not unique to gender affirming care, either in its existence or its magnitude. (The politicizing of the false positive is, though, because gender in general is incredibly politicized).

Gender dysphoria solved by one-way-door gender affirming care is quite rare (there are many intermediary steps people can try and ultimately be helped with), but education about the issue and the availability of treatment helps people like my friend. I think it’s pretty unambiguously positive to universalize the availability of that care in the same way as any other form of healthcare and education, because it’s genuinely the only way some people can feel comfortable in their skin. And although there may be problems with the standard of care, the standard for care can only improve with time and experience.

[frollogaston]

I would rather have some people suffer from not having care, than have way more people suffer from regretting the care, or more likely having no care but just mental anguish from being pushed into internal conflict about this at an early age. Bad as it sounds, we've already had to make plenty of calls like this.

Maybe 15 years ago there was an option to have neither, maybe we can go back to that. As it already is in some other countries.

[zozozk]

That's analogous to how frontal lobotomies were justified as a medical procedure. But it still caused significant, lifelong harm to tens of thousands of people, most of them children and young women.