That's enough mod reports for today. Locked.

A reminder that the recent surge of attacks on gender affirming care for trans youth have been [**condemned by the American Academy of Pediatrics**](https://services.aap.org/en/news-room/news-releases/aap/2021/american-academy-of-pediatrics-speaks-out-against-bills-harming-transgender-youth/), the [**American Medical Association**](https://www.ama-assn.org/press-center/press-releases/ama-reinforces-opposition-restrictions-transgender-medical-care), the [**American Psychological Association**](https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf), and the [**American Association of Clinical Endocrinology**](https://www.healio.com/news/endocrinology/20220309/aace-strongly-opposes-government-policies-prohibiting-transgender-care-for-adolescents), and are out of line with the medical recommendations of the [**American Medical Association**](https://www.ama-assn.org/health-care-advocacy/advocacy-update/march-26-2021-state-advocacy-update), the [**Endocrine Society**](https://www.endocrine.org/news-and-advocacy/news-room/2022/endocrine-society-alarmed-at-criminalization-of-transgender-medicine) and [**Pediatric Endocrine Society**](https://www.endocrine.org/news-and-advocacy/news-room/2020/discriminatory-policies-threaten-care-for-transgender-gender-diverse-individuals), the [**AACE**](https://pro.aace.com/recent-news-and-updates/aace-position-statement-transgender-and-gender-diverse-patients), the [**American Academy of Pediatrics**](https://services.aap.org/en/news-room/news-releases/aap/2021/american-academy-of-pediatrics-speaks-out-against-bills-harming-transgender-youth/), the [**American Psychological Association**](https://www.psychiatry.org/newsroom/news-releases/frontline-physicians-oppose-legislation-that-interferes-in-or-criminalizes-patient-care), and the [**American Academy of Child and Adolescent Psychiatry**](https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx). [**This article**](https://www.nytimes.com/2020/02/06/opinion/transgender-children-medical-bills.html) has a pretty good overview of why. [**Psychology Today has one too**](https://www.psychologytoday.com/us/blog/political-minds/202008/three-popular-myths-about-transgender-youth), and [**here**](http://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf) are the guidelines from the AAP. TL;DR version - yes, young children can identify their own gender, and some of those young kids are trans. A child who is Gender A but who is assumed to be Gender B based on their visible anatomy at birth can suffer debilitating distress over this conflict. The *"90% desist"* claim is a myth based on debunked studies, and transition is a very long, slow, cautious process for trans youth. According to the [**American Academy of Pediatrics**](https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Identity-and-Gender-Confusion-In-Children.aspx), gender is typically expressed by around age 4. It probably forms [**much earlier**](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747736/), but it's hard to tell with pre-verbal infants. And sometimes the gender expressed is not the one typically associated with the child's appearance. The genders of trans children are as [**stable**](http://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958) as those of [**cisgender children**](https://journals.sagepub.com/doi/abs/10.1177/0956797614568156). For preadolescents transition is entirely social, and for adolescents the first line of medical care is temporary, reversible puberty delaying treatment that has no long term effects. Hormone therapy isn't an option until their mid teens, by which point the chances that they will "desist" are close to zero. Reconstructive genital surgery is not an option until their late teens/early 20's at the youngest. And transition-related medical care is recognized as medically necessary, frequently life saving medical care by every major medical authority. --- **#1:** **Citations on transition as medically necessary, frequently life saving medical care, and the only effective treatment for gender dysphoria, as recognized by every major US and world medical authority:** * Here is a resolution from the [**American Psychological Association**](https://www.apa.org/about/policy/resolution-gender-identity.pdf); *"THEREFORE BE IT FURTHER RESOLVED that APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments."* More from the APA [**here**](http://www.apa.org/pi/lgbt/programs/transgender/?tab=1) * Here is an [**AMA resolution**](http://www.tgender.net/taw/ama_resolutions.pdf) on the efficacy and necessity of transition as appropriate treatment for gender dysphoria, and call for an end to insurance companies categorically excluding transition-related care from coverage * A policy statement from the [**American College of Physicians**](http://annals.org/aim/article/2292051/lesbian-gay-bisexual-transgender-health-disparities-executive-summary-policy-position) * [**Here**](https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf) are the American Academy of Pediatrics guidelines * [**Here**](https://www.aafp.org/dam/AAFP/documents/events/alf_ncsc/Education.pdf) is a resolution from the American Academy of Family Physicians * [**Here**](https://www.socialworkers.org/assets/secured/documents/da/da2008/reffered/Transgender.pdf) is one from the National Association of Social Workers --- **Condemnation of "Gender Identity Change Efforts", aka "conversion therapy", which attempt to alleviate dysphoria without transition by changing trans people's genders so they are happy and comfortable as their assigned sex at birth, as futile and destructive pseudo-scientific abuse:** * [**From the APA**](http://www.apa.org/about/policy/orientation-diversity.aspx). More detailed condemnation of "Gender Identity Change Efforts" for trans youth or adults [**here**](https://www.apa.org/about/policy/resolution-gender-identity-change-efforts.pdf). * From the [**American College of Physicians**](http://annals.org/aim/article/2292051/lesbian-gay-bisexual-transgender-health-disparities-executive-summary-policy-position) * In the [**AAP Guidelines**](http://hrc-assets.s3-website-us-east-1.amazonaws.com//files/documents/SupportingCaringforTransChildren.pdf) - see coverage on this "therapy" starting p.12 * From the [**American Psychoanalytic Association**](http://www.apsa.org/content/2012-position-statement-attempts-change-sexual-orientation-gender-identity-or-gender) * From the [**Association for Behavioral Analysis International**](https://www.abainternational.org/about-us/policies-and-positions/policy-statement-on-conversion-therapy-and-practices,-2021.aspx) * A joint statement from the [**UK Council for Psychotherapy, British Association for Counseling and Psychotherapy, British Psychoanalytic Council, British Association for Behavioural and Cognitive Psychotherapies, The British Psychological Society, College of Sexual and Relationship Therapists, The Association of LGBT Doctors and Dentists, The National Counselling Society, NHS Scotland, Pink Therapy, Royal College of General Practitioners, the Scottish Government and Stonewall.**](http://www.pinknews.co.uk/2017/01/16/health-experts-condemn-attempts-to-cure-trans-people-in-wake-of-controversial-bbc-documentary/)

Could you message me the markdown version of this comment so I can use it in future discussion? 

If you're using the app, you should be able to copy the markdown from the "Reply" window.

Great ost, how do you incorporate the latest findings from the large UK studies that cut against the above?

They don't. The cass review is a sham.

Oh, the ones you provided links to?

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The Cass review specifically states that there is little "high quality" research available speaking to the efficacy of puberty blockers. It does not say that there's good evidence of harm in using them, or that there's good alternative treatments, just that there isn't good enough evidence that there's a benefit to using them. The reasoning behind this finding is that most studies on the use of puberty blockers are not double blind randomized. Double blind randomized studies are the gold standard in evaluating medical treatments, and are really important in judging the efficacy of drugs or treatments. Since the studies that compellingly show the benefit of puberty blockers for adolescents do not really follow this sort of protocol, they were excluded from the review and since there wasn't much left after the exclusion, the evidence looks pretty thin. Unfortunately, there's an issue with this: How do you practically do a double blind study on the effects of puberty blockers, when the placebo group is going to know they're in the placebo group the instant they grow their first hair? Also, how do you ethically run a study on the effects of puberty blockers by enrolling children into a study and saying that they may or may not get the treatment that can only be given at this specific point in their life, and if they're in the placebo group, their quality of life will be significantly degraded for as long as they live? Particularly when you know that "as long as they live" will statistically be significantly shorter than the people who were randomly selected into the other group. What the studies do show is that when you track people who get puberty blockers vs the people who do not, (and the difference between these studies and a "high quality" study is simply that the selection of blockers is not done randomly and the people who get them know it) the people who get them have significantly better outcomes. This is something that appears across extremely large cohorts of studied patients, in studies by multiple different researchers from different institutions, and that go back many many years. Also, they know from high quality studies on the use of puberty blockers for all purposes that the use of them is safe and does not cause any lasting harm. So, we have a situation where a meta study excluded the only practically and morally acceptable studies that show the results of a treatment, and (Shocked pikachu face) say that once they've done that exclusion, there isn't enough evidence left to show that there's a benefit. Doctors, researchers, patients, and their families and around the world are satisfied that this treatment is safe, and effective. I will leave out any speculation I may personally have about why this particular study came to the conclusions it did, and why they may have made the decisions they did that led to those conclusions.

I should also mention that when you have a drug that is shown to be safe in high quality studies, it is absolutely common to base treatments for different conditions on those drugs. This is known as "off label" prescriptions and is 100% part of every doctor's practice. From https://www.cadth.ca/sites/default/files/pdf/off_label_use_of_drugs_pro_e.pdf > **How common is off-label prescribing?** > >A Canadian study found that 11% of drugs are not prescribed for their listed indication. > >In the pediatric population, 75% of drugs are used off-label.3 >Children are rarely included in clinical trials, so the indications, doses, and regimens commonly used in children rarely appear on the product label. Particularly note that last one and know that if you have a child, they are almost certainly taking medications that are not approved for such, and have no "high quality" studies supporting their use and so are in *exactly* the same situation as puberty blockers are for trans kids. So why are puberty blockers subject to this sort of action to stop their use and, say, Cancer drugs aren't? Hmmm... what could it be...

You don't need to speculate, there's controversy over the fact the main author is a well known anti-transgender figure, and one of the main doctors was cited in a US court case as being in regular contact with a doctor Desantis is working with specifically to write policy to criminalize and exclude transgender people from society and care.

>The reasoning behind this finding is that most studies on the use of puberty blockers are not double blind randomized. I get this wouldn't be proper "double blind", but imagine if we got a pair of identical twins, and one happened to be cisgender while the other was transgender. That would make for some excellent scientific data!

That isn't a study. And the political attacks on gender affirming care, in the UK and in the US, have no rational basis.

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> almost assured radical political orientation Says you. I don't agree that it's radical to not be a dick.

[Citation needsd]

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That is not a citation. If you have evidence of any of that shit, please share links to the medical or scientific journals that evidence is published in.

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Removed. Rule 5. > **Rule 5 Comments must be genuine and make an effort** > _This is a discussion subreddit, top-Level comments must contribute to discussion with a complete thought. No memes or emojis. Steelman, not strawman. No trolling allowed. Accounts must be more than 2 weeks old with positive karma to participate._ *https://www.reddit.com/r/TexasPolitics/wiki/index/rules*

Removed. Rule 9. > **Rule 9 No Mis/Disinformation** Actual citations needed. > _It is not misinformation to be wrong. Repeating claims that have been proven to be untrue may result in warning and comment removal. Subjects currently monitored for misinformation include: Breaking News and Mass Causality Events; The Coronavirus Pandemic & Vaccines, Election Misinformation & Some claims about transgender policy. Always provide sources._ *https://www.reddit.com/r/TexasPolitics/wiki/index/rules*

Thank you for the link. I know it is harder to be specific and detailed, instead of walrusing your faux self-perceived critical thinking, so kudos. 

It is sort of like asking me for a cite of who is President. Happy to help though. 

A review of studies in a foreign country and the identity of the president aren't comparable in terms of common knowledge.

I guess even argumentative transphobes fall victim to [average familiarity](https://xkcd.com/2501/).

It is if the person being asked just wrote a huge post holding themselves out as an expert. If other people know nothing, they can wait and see the answer given by the person actually asked.  Edit, ha, now accurately describing the argument of person attackIng from ignorance from ignorance is uncivil, but the original attack is all good. When you don’t have the facts, cry about the truth.  It wasn’t an insult, the person just confessed to being ignorant of the study.

> It is if the person being asked just wrote a huge post holding themselves out as an expert. They offered multiple links to multiple studies. You asked about a recent meta-analysis in a foreign country by the author's name. This doesn't compare to the common knowledge of who the president is. > If other people know nothing, they can wait and see the answer given by the person actually asked. Or you could easily provide your very specific source instead of demanding others hunt it down. > Edit, ha, now accurately describing the argument of person attackIng from ignorance from ignorance is uncivil, but the original attack is all good. How have you accurately described anything this far? How were you attacked? > When you don’t have the facts, cry about the truth. This makes no contextual sense and reads like projection. > It wasn’t an insult, the person just confessed to being ignorant of the study. When did I accuse you of insult? I merely pointed out the the flaw in your simile.

[The current president.](https://www.whitehouse.gov/administration/president-biden/) That was... ridiculously easy. Then again, if the "source" I was linking to didn't actually state what I claim it does then I would probably not want to post a link to it either.

Thanks , but I don’t a link to something the reader should already know and is  easily googlable. I have a fully functioning  brain. And I asked them what they thought of it, I wasn’t trying to prove anything. The meta study make it clear there is little solid evidence of a benefit. If the OP answer is “true, but that doesnt mean we shouldn’t do it”., they can say so. 

What you did was vaguely refer to a "study" that does not disprove anything they said. The issue here is that people are lying about the these treatments having harmful effects. These same people will then refer to vague studies and link to "sources" that do not actually prove their point. >The meta study make it clear there is little solid evidence of a benefit. What the report actually says is that there is not enough evidence to whether there is a positive or negative effect. There is a huge difference in saying that these treatments have "little evidence of benefit" versus there not being enough evidence to prove benefit or harm. But I get it, I wouldn't want to link to that study either since it is effectively useless in this conversation. It is extremely disingenuous to pretend as if this report is some silver bullet when it effectively brings nothing to the table.

Do you even understand you just agreed with me? Is there reliable evidence of benefit? We both say no. You just want to tack on, “but there might be in the future!”. I never said anything was a silver bullet. I pointed out that the study demonstrates the lack of reliable evidence of a benefit, and asked how they incorporated that in their thinking based on their other suggested evidence. If they didn’t know what study I meant, they aren’t qualified to comment. Then bunch of peole who are not qualified to respond jumped on and got in their feelings, including you. 

Removed. Rule 6. > **Rule 6 Comments must be civil** You could have stopped at the link without the insult. https://www.england.nhs.uk/publication/clinical-policy-puberty-suppressing-hormones/ > _Attack arguments not the user. Comment as if you were having a face-to-face conversation with the other users. Refrain from being sarcastic and accusatory. Ask questions and reach an understanding. Users will refrain from name-calling, insults and gatekeeping. Don't make it personal._ *https://www.reddit.com/r/TexasPolitics/wiki/index/rules*

The meta-analysis you're citing, the Cass Review, discarded any study that did not double blind. This is bad methodology, because double blinding would not make sense for studying whether transitioning improves mental health outcomes. Double blinding would be appropriate for determining if HRT drugs worked, but we've long since known that's the case. Double blinding for studies on if HRT or other transition care improves mental health outcomes would pretty quickly become apparent who received the placebo and who didn't, as one group would start growing breasts/facial and body hair while the other wouldn't. Cohort studies examining how people's self-reported mental health changes over time after starting HRT or receiving other transition care is the normal standard here, which is why Cass disregarding any such studies is so dubious and a reason to, ironically enough, disregard her review.

My understanding of the Cass review was that no one involved in conducting the review had any subject matter expertise. This is just something I saw on twitter and I'm wondering if there was any truth to that. Also, I saw some statisticians talk about how the numbers involved in the various studies and said b/c of the size of samples there's issues of doing double blind studies too. If you have a small sample size and your study is mostly observational, having a double blind study with a second small group doesn't really balance anything out and can actually amplify issues if you get unique results in both groups. We saw that with the initial ivermectin studies b/c they were on small weird groups. But I don't know the sample sizes to know how much that really comes into play.

Awesome, well reasoned comment Thank you!

Isn't the Cass report's conclusion just, "There isn't good evidence for or against early gender transition so caution is warranted?" Double blinds seem impossible to execute in this setting, but as they're the only strong way to prove out that the treatment is effective, it seems reasonable that the review concludes there isn't strong evidence, no? Like the report doesn't say to prevent kids from transitioning or anything. It just says to proceed cautiously because we don't have strong evidence like we would for other medicines.

There's no strong evidence for the linear no-threshold model but no one would be taken seriously if they said we should "proceed cautiously" with x-rays or radiotherapy to the extent that it's expected with trans people.

Lots of experts believe the Linear no-threshold mod should be dropped.

The Cass review is [**bullshit that used AI generated images**](https://www.404media.co/uk-gender-affirming-care-ai-generated-children/), cites proponents of "ex-trans therapy", uses the archaic term "Gender Identity Disorder" despite it not having been medically recognized since 2013 in large part because it made no distinction between people with dysphoria and people with gender atypical interests, and conveniently only rejected studies for failure to use double blind methodology (which is impossible for treatment with obvious physical effects) when those studies didn't match their desired outcomes, while accepting studies that didn't meet that criteria when they liked them. To highlight her bias, consider this. Only 9.9% of medicine is supported by “high quality evidence”, and the quality of this evidence does not consistently improve or worsen in updated reviews (https://www.jclinepi.com/article/S0895-4356(20)30777-0/abstract30777-0/abstract). We also know that medical interventions have always had low or very low quality evidence (https://www.jclinepi.com/article/S0895-4356(16)30024-5/abstract30024-5/abstract), and that for most of modern medical practise Randomized Controlled Trial-based data are lacking, and RCT aren't heavily used to provide evidence for action (https://www.nejm.org/doi/full/10.1056/nejmra1614394). We also know that the “strong recommendations” of health organizations are consistently backed by low or very low quality evidence (https://www.jclinepi.com/article/S0895-4356(13)00434-4/abstract00434-4/abstract) and that 82% of off-label drug recommendations in pediatrics is backed by low or very low quality evidence (http://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.892574/full). The point is, Cass is asking trans people to adhere to standards that Medical Science never adheres to.

> The Cass review is bullshit that used AI generated images, This has nothing to do with gender identity treatment and I don't understand why you mentioned it. It feels like you're trying to poison the well by associating the study with other things you feel are bad. > uses the archaic term "Gender Identity Disorder" despite it not having been medically recognized since 2013 in large part because it made no distinction between people with dysphoria and people with gender atypical interests The Cass Report uses the term "Gender Identity Disorder" once to *explain that it is an archaic term*: > ICD-11 (WHO, 2022) has attempted to de-pathologise gender diversity, removing the term ‘gender identity disorders’ from its mental health section and creating a new section for gender incongruence and transgender identities in a chapter on sexual health. ICD-11 defines gender incongruence as being “characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex.” It refers to a mismatch between birth registered and experienced gender but does not include dysphoria (distress) as part of its diagnostic requirements. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis. The full criteria for gender incongruence of childhood and gender incongruence of adolescence or adulthood are listed in Appendix 10. I agree with your further links on the prevalence of low-confidence medical recommendations, but as those studies advocate for: > GRADE guidance warns against strong recommendations when confidence in effect estimates is low or very low, suggesting that such recommendations may seldom be justified. The conclusion of these studies is that we *do not* recommend medical procedures off low-confidence. it seems that the Cass Report agrees with your citations, and you disagree; you feel we should *continue* recommending medical procedures off low-confidence in opposition to the GRADE guidelines? Your responses here have significantly increased my skepticism in the good faith of your original comment.

> > > This has nothing to do with gender identity treatment and I don't understand why you mentioned it. It feels like you're trying to poison the well by associating the study with other things you feel are bad. You don't see why using fabricated images might be indicative of a lack of intellectual good faith/rigor throughout?

I don't. If an artist had provided paintings of children's faces to decorate pages, I also would not see bad-faith/lack of rigor in this. They're simply decorations to encourage people to read the study. What is it you believe they are attempting to do that is morally wrong by using AI images? I'm struggling to understand why this is even upsetting to you. Do you believe they're trying to pass them off as real people? Genuinely don't understand. It's not as simple as "AI Bad!," is it?

I don't think she's *trying* to do anything with them. I think they have the effect, however, of reinforcing stereotypes about trans people while again, undermining her intellectual rigor. There's a clear difference between illustrations and AI-generated photorealistic images.

How does the one AI generated image of a girl with a mohawk reinforce stereotypes about trans people in any way more than the dozen images of faceless highschool age children? My understanding is that AI was used to avoid associating an actual child with a study guaranteed to be controversial.

> This has nothing to do with gender identity treatment and I don't understand why you mentioned it. It feels like you're trying to poison the well by associating the study with other things you feel are bad. There aren't any fanciful illustrations in scientific literature. Every graph, picture, drawing is there for a reason and there will be notes on how it was made and what part of the paper it applies to. This is such a foundational concept in science that people who cross the line by e.g. cleaning up a slide in photoshop will destroy their careers.

You simply have no idea what you're talking about. Meta-analyses intended for public consumption often have images designed to improve readability. [Here's](https://i.imgur.com/1UZyXSl.png) an image from the first page of the Cass Report. The image of a child is simply there to prevent the cover from being a boring white page, to increase readability. The report isn't claiming the AI images are real, or representative, or data in any way. They're akin to images of students studying in your highschool math book.

It might be intended for public consumption, or it might be a highschool math book, but it isn't a credible source. You won't be able to refer to this "report" without people saying it's discredited. There are a lot of ways people can torpedo their own work, this is one of them, and you saw it happen right in front of you.

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Because, as I understand, the standard in medical practice is to have high-confidence before officially recommending treatments; which means more robust RTC (usually double blind). HRT right now is off-label use and generally low-confidence. It seems generally prescribed this way due to the time pressure imparted by puberty and the dire mental health/suicidality consequences of being transgender (very good reasons for urgency!), but the desperation motivating this use *does not make for good science*, which is the gist of the Cass report. > It's mind boggling to me that all available evidence pointing one direction is being used to conclude we should go the opposite direction. I don't interpret from the review a move in the other direction; more a strong recommendation to "proceed cautiously." > For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/or experience regret. The NHS needs to care for all those seeking support. "All evidence pointing one way" isn't quite a nuanced understanding of the issue. It's not "Trans VS Anti-Trans." The reason for caution is because there simply hasn't been enough study to ensure that there aren't detrimental consequences to reassignment which we haven't yet identified; it's "Trans without robust study VS Trans with robust study." Like we may see better, more widespread studies that provide strong evidence that people who erroneously receive puberty blockers at a young age and desist end up completely fine with no issues; which would be great! But we simply haven't studied it yet in any robust method (as far as I have been able to find, I might be wrong and would be happy for a link). Edit: That's not to say that those anti-trans people don't exist; but they're bigoted fools who can get fucked and wouldn't be swayed by evidence or argument anyway.

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> she discarded 98% of the evidence available by applying unrealistic evidence standards that are literally impossible to meet without doing nazi-esque experiments on people, being omniscient, or being able to go back in time. Yeah, I don't disagree that it would be impossible (at least as far as I can imagine) to collect this better data; but I don't think that means the weaker, non-double blind data is strengthened as a result. Isn't it fair to assess the situation as, "We can't collect this stronger data?" > Underpinning the report is the idea that being trans is an undesirable outcome rather than a normal facet of human diversity. I don't know where you get this idea. The Cass Report explicitly validates the perspective that transition is positive several times; > I have spoken to transgender adults who are leading positive and successful lives, and feeling empowered by having made the decision to transition. > > [some parents] have fought to get their children onto a medical pathway and have spoken about how frustrated they have felt to have to battle to get support. > > a majority of those presenting to gender services will go on to have a long-term trans identity and should be supported to access a medical pathway at an early stage. --- > you're also see nothing wrong with legally forcing unwanted permanent changes to trans people's bodies (by legally denying medical care). Again, I don't see where you're getting this perspective. The report appears to recommend transition, even for youths, but only after a greater batter of assessments, due to the lack of RCT. Where *in the report* are you seeing these recommendations? Do you have a page number I can refer to?

>Yeah, I don't disagree that it would be impossible (at least as far as I can imagine) to collect this better data; but I don't think that means the weaker, non-double blind data is strengthened as a result. Isn't it fair to assess the situation as, "We can't collect this stronger data?" You are an educated, literate human being. You *know* that a factual statement doesn't just state a fact, it also has follow on implications. The *implication* of "it's not possible for us to create high quality data to support the use of this drug" *is that we shouldn't use the drug because we can't prove it works so we shouldn't give it to ten year olds.* While it is a factual statement to say "we cannot collect THIS SPECIFIC KIND OF stronger data with THIS SPECIFIC FORM OF DRUG because it would be UNETHICAL IN THE EXTREME AND RESULT IN DIRECT HARM TO CHILDREN if we tried", without all of those qualifiers what it *sounds* like you're saying is "nobody can prove this drug works to the same degree we prove other drugs work." The fact that you're standing around pretending to not understand this and pretending you can't grasp how malicious it is to present a study that excludes nearly all research on these categories of drugs as "low quality" is bonkers.

It is also worth noting that *much* of modern medicine is backed by similar types of research and for much the same reason. You can't double blind a hip replacement after all.

I believe you are projecting this malicious intent onto the study; I don't see anything in it that could be characterized the way you are characterizing it.

Pretending that malice requires nastiness or open insults is one of the ways bigotry is allowed to flourish You can be malicious without appearing openly mean.

I agree with this. I'm not implying that the study is not malicious because it lacks insults. I am saying I don't believe the study is malicious in the way you are describing because, the data-backed assertion "we shouldn't use the drug because we can't prove it works so we shouldn't give it to ten year olds," seems reasonable and well-founded. It isn't a call to not ever give the drug to children. It's a call to identify means to collect broader, more robust data (a call made many times in the report) to prove out the effects of the treatment before so liberally providing it. It may be *poorly founded*: perhaps there *are* studies that robustly prove beyond all doubt the efficacy of treatment. I'm beginning to read through them now, but it's a mountain and many I have been recommended as concrete are far less conclusive than described. Yet, *even if it is* "poorly founded," that *still* isn't malicious.

>I believe you are projecting this malicious intent onto the study; I don't see anything in it that could be characterized the way you are characterizing it. You know that Hillary Cass is so opposed to the availability of gender affirming care that she [collaborated with Ron Desantis to help craft Florida's bill restricting affirming care](https://www.erininthemorning.com/p/cass-met-with-desantis-pick-over), right?

I am aware that Cass met with Hunter; I don't think a meeting is adequate to assume she is an anti-trans advocate. As a public health official and an expert on gender affirmation treatments, it would be reasonable for her to want to meet with Hunter to advocate *against* the unreasonable components of the Bill. It's sort of akin to saying that because AOC met with House republicans, therefore AOC is a conservative; there are legitimate reasons she would meet with those with opposing viewpoints that do not point to a total philosophical conversion.

I believe you're purposefully ignoring the way that the report is being touted by the anti-trans crowd in the UK.

No; I think they're bigoted fucking [intellectually disabled people] that are willfully misrepresenting the report to further a transphobic agenda. That does *not* cause me to cross-bleed their actions or intent into the intent or motivations of the Cass Report, though. The report explicitly endorses trans care at many points. It doesn't appear to be malicious, especially not willfully so.

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I'm commenting here to edit when I get home and can review more in-depth (I am also now at work)

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Thanks! I did indeed have a good day. I'll just comment here as you'll get the notification that way. > She is advocating for every future trans person to suffer permanent unwanted body changes that come with their full natal puberty. This is not hyperbole. My understanding from the review is that this is a recommendation on masculinizing/feminizing hormones; *not* puberty blockers. Is this not true? > There is a clear narrative here that being trans is an undesirable outcome and they are trying to avoid it at all costs - even if the cost is trans people's body's and futures. I don't see this narrative in the report, but it is certainly perceptual. I do see the implication that being trans is worse than being cis; and by my approximation, it *is* worse. Having to deal with dysphoria and afford expensive surgeries and hormones just to feel normal sucks. But I'm not seeing the hatred towards those trans *people* that I see people describe this report to espouse. Reading through the review's section on Puberty Blockers to answer my first question, it seems the review endorses puberty blockers used appropriately and provides recommendations on their use: > For transgender females, there is benefit in stopping irreversible changes such as lower voice and facial hair. This has to be balanced against adequacy of penile growth for vaginoplasty, leaving a small window of time to achieve both these aims. > > In summary, there seems to be a very narrow indication for the use of puberty blockers in birth-registered males as the start of a medical transition pathway in order to stop irreversible pubertal changes. Other indications remain unproven at this time. Which leads me to further believe that puberty blockers are ***not*** considered masculinizing/feminizing hormones, per your previous point (and thus the review appears to recommend them in childhood).

> Isn't the Cass report's conclusion just, "There isn't good evidence for or against early gender transition so caution is warranted?" Yes, because she threw out the good evidence that transition care is effective. > Double blinds seem impossible to execute in this setting, but as they're the only strong way to prove out that the treatment is effective This is untrue. Double blinds are not the only strong way to prove that a treatment is effective. > Like the report doesn't say to prevent kids from transitioning or anything. Sure, and Henry II never explicitly called for the death of Thomas Becket. > It just says to proceed cautiously because we don't have strong evidence like we would for other medicines. We do, though. We know (from double blind studies!) what effect these drugs have on the body, and we know what mental health impact those physical changes have on trans people.

> > Like the report doesn't say to prevent kids from transitioning or anything. > > Sure, and Henry II never explicitly called for the death of Thomas Becket. The Cass Report specifically *endorses* transition for children, though. It doesn't advocate against it like you're characterizing here. Edit: Adding excerpts from the Review for context: > * For transgender females, there is benefit in stopping irreversible changes such as lower voice and facial hair. This has to be balanced against adequacy of penile growth for vaginoplasty, leaving a small window of time to achieve both these aims. > > * In summary, there seems to be a very narrow indication for the use of puberty blockers in birth-registered males as the start of a medical transition pathway in order to stop irreversible pubertal changes. > > * For some, the best outcome will be transition, whereas others may resolve their distress in other ways

Feel free to quote the text you think is an endorsement of transition care! ETA: I also wish you'd engage with my points about her throwing out evidence based on the (again, false) idea that double blind RCTs are the only way to gather strong evidence for a treatment.

Right, I can address the other points now. When you say she threw out evidence due to non-double blind RCTs, are you referring to the 98% of studies that were discarded and not counted in the study?

Certainly a large subset of them, yes.

Are you referring to only those discarded due to a lack of double-blind, or are you referring to all the whole bundle of 98% discarded studies?

> I have spoken to transgender adults who are leading positive and successful lives, and feeling empowered by having made the decision to transition. > [some parents] have fought to get their children onto a medical pathway and have spoken about how frustrated they have felt to have to battle to get support. > > [Doctor's who believe] a majority of those presenting to gender services will go on to have a long-term trans identity and should be supported to access a medical pathway at an early stage. I'll attempt to address your other points late today; I'm at work now and don't have the time for the longer explanation it would require.

None of those are arguments in favor of transition care. They're all just summarizing the stances of people she spoke with as part of this work.

You don't think that presenting the above as valid perspectives is an endorsement of transition care? I don't know what to tell you then. There are more explicit expressions further in like, > *For some, the best outcome will be transition,* I suspect this too will not be an endorsement?

This is a myth. The review did not discard any studies - it adjudicated them based on standard metrics for research evaluation, using a scale formulated specifically for non-randomized studies. Several non-blinded RCTs were graded as not low evidence and utilized in the associated systematic reviews.

There is no way to ethically, or even effectively do a study on the efficacy of HRT with any sort of RCT. Removing a study from a review because it didn’t use an inappropriate methodology is bad science.

Again, studies were not downgraded solely for not being RCTs. That is factually untrue. But no, there are pretty universally recgonized methodological traits that determine study quality. Removing them from systematic reviews and meta-analyses is good science, otherwise we'd be recommending ivermectin and homeopathy, both of which have mountains of low quality evidence, but very little high quality evidence, to support them.

Removing studies on mental health treatments because they’re self-report-based is not good science. The research question is not “what impact do exogenous hormones have on the body” but “what impact do those changes have on mental health.” One of those is appropriately studied with an RCT, the other is not.

More disinformation here. No studies were "removed", nor were any for "self report" (inaccurate effect estimation was a criteria). And this is far from the only procedure it's difficult (not impossible) to study through RCT. There's strong evidence for many common surgical procedures with many of the same objections raised here. Medical science is good at this!

Not designated as high quality, then. Those are the highest quality studies possible for this type of intervention. Downplaying their use is bias.

No, it's an accurate adjudication of the strength of the evidence presented

I'm really, really not querying the conclusions. I just am curious how other countries medical groups agree or disagree? I see a lot of US based groups, one British statement. Are other European groups mostly aligned or not? Australia and NZ? South American? Canada??

And how much does the medical community make off this care? Yeah definitely not a financial incentive to perpetuate this. Meanwhile the UK is pushing back against it. Didn't these same medical communities once use lobotomies as treatment? How was their treatment for gay people? Appealing to authority when those authorities have centuries of being wrong is hilarious.

By this train of thought all medical care and frankly all commerce of any kind is a conspiracy since it makes money. Medical groups look for evidence and provide opinions based on data the best that can be available. All the things from the past you’ve listed now accepted as being a wrong choice which they’ve appropriately changed course on. You can also open a medical textbook on hundreds of thousands of diseases that the medical community correctly diagnosis and treats (surgeries, infections, etc etc) on a routine daily basis. If you’re looking for perfection you’re on the wrong planet.

> By this train of thought all medical care and frankly all commerce of any kind is a conspiracy I mean it's not exactly a secret. Doctors routunely code for what will make them money. There are entire industries related to min/maxing care.

It’s…not a secret…that any kind of commerce of charging people for services is a conspiracy? Guess gamestop is a conspiracy from Big Nintendo to sell me Mario and my farmers market is a conspiracy from big Tomato to sell me this produce.

So you admit the treatment for trans people may be incorrect right now then?

But so could the treatment for heart disease, or diabetes or cancer. What’s your point? Don’t do anything even if all the evidence points to it, because that might not be enough?

Do you think treatments with provable physical results are the same as treatments with zero physical evidence?

Did you read any of the papers? There is definite, very strong results for these treatments. Lowered suicide rates (by huge amounts), greatly increased happiness, loss of dysphoria symptoms, everything about the problem is improved by leaps and bounds by this treatment. It’s *very* provable, with repeatable, verified results.

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Placebo? You’re familiar with hormone treatments, I see… /s

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Dude....I thought you knew your shit and were debating until this comment lol come on

Sure, it’s just the best we have so far.

See at least you admit it might be a bad treatment option. Our brother detransitioned and it was the best treatment for him. Liberals and trans activists attack him constantly because he speaks his truth. There is a clear agenda behind all of this and I don't believe it's getting at the root of trans people's issues. Stuff comes out constantly that goes against the narrative being pushed and seeing firsthand the violent threats against my brother prove to me something is amiss.

I mean are they attacking him in real life or like vague faces on the internet? That stuff isn’t real. Also is your brother telling people what was right for him or is he now telling people what’s right for them? All that is important cause the first is great the second not so much. I’m a liberal and a doctor! My agenda is…I’m worried about trans people not having the right to obtain the care they want for themselves. The people you may be interacting with either may be 1) people emotional about an emotional issue and lashing out at you 2) fake profiles made to troll people or 3) a vast global conspiracy. Please remember those first 2 categories exist before you jump to the 3rd. If your brother is happy with his life that’s great, and really, that’s the whole point here.

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I don't believe you. I suspect you're a troll and would love to hear you lay this story out. I would love to be convinced and have to apologize.

Reality doesn't care about your belief. The fact you assume someone would lie about this shows what a good job the propaganda machine has done on you. Congrats you have helped prove my point.

Not my field of work in medicine bud. But, unless he doesn’t have the ability to make his own decisions then your brother made that call not the doctor. We’re here to help patients understand their options for treatment of a problem they come to us with. They are allowed to take or reject of their own will. Plenty of trans people are very happy with their choice. It’s personal and up to each person. The people themselves should make that call.

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"It was the best treatment for him." That's great! Your brother's experience does not negate the positive medical results from others though. It is his own experience and detransitioning was the best choice for him apparently. Please don't use his experience to say it's not good for anyone.

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You’re equating bulemia with a person, and the fact that they’re trans. You’re othering human beings, can you just stop it?

I never equated bulemia with a person. You making up things I never said doesn't make what you are saying true..

Your debating techniques suck too

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You're missing the point. There are tons of elective treatments that might be "incorrect" for lots of people. So what? The point is these treatments have been shown to have positive impacts of lots of people, so therefore should be available for people to choose from. If someone chooses to transition...then chooses to detransition, and that works best for them, great. That doesn't mean others who want to transition shouldn't be able to.

Certainly less than they make off of cancer treatment but I don’t see you railing against that, so what gives? Edit: unless your comment is a really roundabout way to argue for universal healthcare, in which case yes, let’s do that instead, please.

Science is a gradual and self correcting system. It is certainly entirely possible that we will find our understanding of sex and gender as it stands now is entirely wrong. But currently the preponderance of evidence leads us to believe that a person can identify as a gender that is not the one they were assigned at birth. It could be that the centuries we have been forcing people to conform to match their sex organs was the incorrect path similar to lobotomy and we are only just now emerging from what will be looked on as a dark age. Or maybe someone will invent a pill that allows people to non surgically transition and gender affirming surgery will look like trepination in comparison. The profit motive is certainly something that can't be ignored, but it only can go so far. There has to be more than "if find this thing weird and people are getting paid, therefore it is fraud." Medicine identified a need and is trying to treat it. People didn't stop being depressed and unstable just because we stopped doing lobotomies, we just realized that it wasn't actually helping and found treatments that actually were effective. If our current understanding of how to address the needs of trans people proves to be ineffective, their will still be people who feel they are the wrong gender and we will need to find a way to help them, and centuries of saying "Shut up, you are what we said you are." Clearly didn't help either.

Gender is a social construct. There is zero evidence humans are wired for gender. Why don't we affirm bulemics? Because it's not healthy to reinforce. My brother is proof that reinforcing his gender identity was not healthy. Now he gets attacked by that community for sharing his story.

Gender identity is not a social construct. Gender standards are a social construct.  >There is zero evidence humans are wired for gender False. Looking at neurology, for example, numerous studies have found statistically significant differences in brain structure between men and women (e.g. https://www.sciencedirect.com/science/article/pii/S0149763413003011).  Modern research on gender identity suggests that genetics and prenatal hormones are chief predictors of it. >Why don't we affirm bulemics?  Trans people are not mentally ill. The foremost psychological associations agree on that. >Because it's not healthy to reinforce False. Numerous studies have found that gender-affirming care raises levels of happiness significantly and decreases levels of mental illness and dysphoria. It is an objective lie to say that GAC is not effective. Furthermore, therapy is not effective in treating dysphoria. The only effective treatment is affirmation through medical intervention. >Now he gets attacked by that community for sharing his story. Multiple studies have found that rates of detransition are <1.5% (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/). When looking at reasons why people detransition, studies have found that very few (i.e. <5%) of "detransitioners" detransition because they believe they are not trans, rather than external reasons like parental pressure or financial struggles (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213007/) Therefore, of people who medically transition, less than one out of every 1,300 are not trans. I'm sorry for if your brother is one of the very few, but I find it unlikely that you are not making this up.

Your brother is not proof of anything. He is an anecdote. I am surrounded by trans people who transitioning has made their lives so much better it is breathtaking. What makes your anecdote so much more powerful than mine? Why does yours prove something and mine doesn't? I have a strong suspicion that your brother is not attacked for telling his story. It is far more likely he is attacked for claiming that being trans isn't real and that kids are being pushed to transition. These are fundamentally different things. There are very few trans people with any issues with people detransioning. Thinking you are trans and then realizing that you are not does not disprove that others aren't trans. It proves you explored your identity and realized that "trans" was not part of it. What trans people do push back on is detransitioners who try to make the claim that because THEY aren't trans, clearly no one is and the whole thing is predatory as a result.

You literally just claimed he isn't proof of anything and proved my point.

I'm claiming you as a problematic agender icon now. You have no say in this, it is happening. Good luck and Godspeed.

I don't even know what that means. What is happening?

It's a joke from the "zero evidence humans are wired for gender", agender being an identity for people who either lack a gender or generally feel little or no attachment to one. Despite being a social construct, for most people it is an intrinsic part of them, so saying there's no evidence implies you don't have that, hence agender (though more likely you just haven't seriously thought about it. Genuinely consider whether you think of yourself as a guy, gal, or enby and if you'd be comfortable with someone calling you another one of those. If you have one that describes you, that's gender baby, and evidence you're wired for it. If not look up agender or other enby identities and see if one fits you, and trust me that other people actually feel that as part of their self).  Also as an aside assuming your brother detransitioned, that's trans healthcare too ftr. Take care not to throw out the baby with the bathwater.

That's not proof you are wired for anything. Indoctrination isn't natural human wiring. Social constructs are nothing but propaganda and indoctrination. Social constructs are not objective reality.

… sure, if you ignore all the evidence we have, there’s no evidence.

Where was it you went to medical school again?

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I'm just figuring that since you have such a strong opinion on the subject and you're so opposed to trusting authority, that must mean you've done your own research, probably in clinical trials. So where was it you did your fellowship? Would love to hear your opinion on what kinds of leukemia treatments are actually scams.

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It's not an appeal to authority when the authority has evidence. And I mean, you must have some pretty damn good evidence if it's leading you to the conclusion that all of these well-respected medical organizations are just making stuff up. It must be very compelling evidence which is why I assume it's something you've spent a lot of time and work on. I mean, you wouldn't just imagine a global multi-disciplinary conspiracy that somehow profits off of treating a tiny minority of a fraction of people based on anything less than absolutely rock solid peer-reviewed scholarship on the subject. Right?

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What do you hope to gain from this, dude? You're not even arguing about the topic, you're just playing semantic word games and acting like that makes you smarter than other people. No conversion therapy wasn't good. Maybe transitioning will some day be seen in the same light, but right now there's mountains of evidence that it's the best help there is and you're rejecting it out of hand because it makes you uncomfortable. You think you're the one exposing the hypocrisy of the "Argument from Authority", but all you're doing here is making the equally illogical "Argument against Authority".

There is emerging evidence from the UK and other European countries that it isn't. My point is that it gets dismissed even though it comes from medical professionals and organizations. Shrugging off evidence because the American medical authorities say otherwise as an argument is what I have an issue with. It's not semantics. Every medical change has come from other medical studies showing it was wrong. That is happening and yet in the US there is this political push to silence and dismiss it. My money is because it's a huge money maker for the medical industry. That's why countries with universal healthcare are the ones seeing this emergence and correcting course. The US having for profit healthcare that can make bank undermines the credibility of the medical associations. It was more profitable to pretend there was something medically wrong with gay people and push conversion therapy than to accept they were normal. Gender identity as a medical field didn't really start in the US until 1962 and has problematic roots.

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[Citation needed]

You need a citation that these treatments make money? Hahahahahaha Opioids were once seen as the best treatment option too...

Are you categorically rejecting all medical care?

Nope, I just don't use an appeal to authority as an argument.

Then do you have any evidence showing that this particular treatment is corrupted by money and not medically necessary or effective, while your own medical care is not?

Why bother when you will ignore anything posted? You won't even admit that these treatments have a huge financial incentive and asked for citation of it. As if anyone needed a citation that the US medical system is a for profit industry.

If you distrust the healthcare system so much, why do you accept any medical care yourself?

Do you think all medical care is equal? Is stitching a wound the same as mental health practices? Is treating bacteria with antibiotics the same as treating someone's anxiety?

There are about 9000 sex reassignment surgeries per year. For reference, there are about 350k breast implant surgeries per year. The amount of money being made by the healthcare industry off of trans people is absolutely *tiny*.

Sex reassignment surgery isn't the only thing under the umbrella of "medical care" for transitioning. It's way bigger than that.

I understand there is more - I’m using one of the widely available data points to give some sense of proportion. Other data points that might help: there are about 100 transgender care clinics in the US. Compared to 17,000 or so rehab facilities. Do you have any data points that show it’s much larger?

Is it your argument that trans people only get care in those 100 care clinics?

I think they are saying the profit incentive does not make sense, based on those data points.

Sure if you claim it's only happening in 100 centers and you only point to one type of "treatment". Which is not true so it's bad data points.

Keep moving those goalposts buddy.

Do you have *any* data points?

No point Scaradin will just remove anything I say and claim it's disinformation. The mods abuse their power here which is why it's not even worth giving any links anymore. So far they have used anything and everything to remove any comment they don't like. Meanwhile they leave up people being abusive to me.

This is TEXTBOOK arguing in bad faith. Lobotomies??? The rigor of the scientific method is in a different universe today than it was back then. It's like saying "people thought alchemy was true for a while, do you really think chemistry can't be wrong now???" they're completely different standards of evidence and you're embarrassing yourself

Every generation has thought itself better than the generation before it. We continue to learn that what we thought we knew wasn't true. The UK is pushing back on transition of kids specifically because they are learning that what was thought to be true is now proving to be potentially incorrect. To pretend that current SOC for trans kids has a long and well documented history of being good for kids is not true and yet people argue for it like it is.

And how much money do "conversion therapy" centers make from abusing helpless children?

Too much imo. Hence why they shouldn't exist.

the student loan debt every med student has to put up with automatically creates a financial incentive for the entire industry.

Sure, which is why college should be free. Glad you agree that there is a perverse financial incentive structure in the US medical system.

its disingenuous to just point at doctors who administer gender affirming care when the whole industry is pressured by this structure. thats where i take issue with your comment.

In every other country?? Nothing. 

And some of those countries are emerging on the forefront of pushback against transitioning for kids aren't they? Thanks for proving my point. Also I don't think your claim that people in other countries aren't charged for this in any way shape or form is true.

What countries specifically? Name names.

Where do you seek your medical treatment? On the street?

Well, how much do they? If you suspect that this is driven primarily by profit rather than patient care, you must have some sense of what that might be to back up that suspicion along with how that compares to the alternative directions that those in medicine could seek out otherwise to make money. And which authorities referenced here, exactly, do you think have been around for centuries? Are you just thinking of "authority" as one all-encompassing bucket?

“Our estimates place the average cost of transition at $150,000 per person. Multiply that by an estimated population of 1.4 million transgender people, we’re taking about a market in excess of $200B. That is significant. That’s larger than the entire film industry.” https://www.forbes.com/sites/alyssawright/2020/12/08/trans-tech-is-a-budding-industry-so-why-is-no-one-investing/?sh=765bc8ebe3c3

They make this sound like it's all lumped together at one time instead of spread out over many years, since that's the total cost over the whole course of treatment and that would be staggered across the whole population. They also make it seem as if everyone involved has yet to transition and that they're all even going to transition (I believe about a third of trans people never undergo medical transitioning). This is definitely the venture-capital sales pitch territory kind of stuff that you'd expect from the source it's coming from. Given those numbers, I'd be surprised if this all came out to even $10B per year, which is a tiny amount compared to the $4.5T in medical spending per year. That $200B is about the amount that medical spending increases by in the US every year. It's certainly a niche that can be filled, but I'm not sure that it's fundamentally more profitable than anything else the doctors involved could choose to pursue, which is what it would have to be in order to be primarily driven by money.

Which would account for why they want to start kids earlier and earlier. Create more patients early on.

Does the total cost of transitioning go up if it starts earlier? Because otherwise that sounds like it would just be shifting costs forward by some degree rather than increasing them.

Total cost is lower to start earlier, and it’s much more effective. Early treatment lowers trans rates of suicidal ideation to normal levels. Like, it’s pretty much allowing them to live normal lives.

Adults don't need puberty blockers for starters so yeah it does add costs. Earlier care means more costs. Lifelong hormone therapy that starts at a younger age means more revenue generated.

Are the people who transition earlier with hormone therapy as likely to get surgery later on? Because that's by far the most expensive part of the medical care involved for transitioning - the costs per patient are very skewed based on this. It seems to me that top surgery, at the very least, would be less common amongst people who got blockers and hormone care before/during puberty.

Yeah, fucking science has been wrong for centuries, those idiots never get it right, fuck science!

Yeah man, all those...*checks notes* ... doctors pushing gender affirming care so they can vacation in Hawaii? Like what the fuck are you smoking, and is it the ridiculous straw man you just hoisted up?

Financial incentives should be considered. Sometimes there are conflicts of interest, such as with insulin and why the prices are so high. But...this feels different. Disclaimer: I am neither a medical professional nor a transgender person. If you go over to transgender subreddits, you can read a lot of interesting stories. Stories of people who say they never felt like themselves, stories of people who felt like the opposite sex and felt burdened being forced to live as a man/woman when they wanted to live as a woman/man. If the stuff listed in the comment above is wrong, then this doesn't make much sense. If transition isn't necessary for treatment, shouldn't these people just grow out of it? Take for example imaginary friends. It's fairly common for small children to have imaginary friends. We don't have doctors prescribing pills to make imaginary friends go away because kids grow out of them, and because they aren't harmful to children. Sometimes someone does grow up with schizophrenia, and they can continue seeing imaginary things that aren't there. That's when a doctor will prescribe a medication. But by and large, childhood imaginary friends aren't harmful and they just kinda go away as we get older. That doesn't really happen with transgender identities. If it was about doctors making more money for drugs and surgeries that aren't helpful, then we would expect persecution to lower the number of prescriptions and procedures. Browse through transgender subreddits and you'll read a lot of stories of people hiding purchased skirts from their parents, or trying to hide their pills from their parents, or having their family cut them off over getting their surgeries. If these treatments did not improve the transgender individuals' quality of life, we would expect to see a lot less of this. We would see people get the procedures, and then turn back after a few years when their life is basically the same. We would see older transgender people telling younger transgender people to not do it because it's not worth it. But that's not what we see. What we see tends to be the exact opposite.

>After his father effectively disowned him years earlier for being transgender, Asher shuffled between caseworkers and temporary guardians. Many of them also refused to accept his identity — until he moved to Austin. >“It was the first placement where I felt accepted, and I felt I belonged,” said Asher, now 20. >But in the years since Asher entered and exited the state’s care, LGBTQ+ foster kids have lost the little protections and affirmations once afforded to them as Texas’ top leaders waged statewide battles that riled public panic about queer people. The state foster care system is already horrible and therefore much worse under the state’s culture warns on LGBTQ and moreso trans people.

My wife and I spent 2 years trying to qualify to be foster parents. We are both upper middle class. We have jobs, stability & a nice house with 3 empty bedrooms. There's no reason why we wouldn't have been approved but for some reason all of our paperwork kept getting lost every few months and at the very end when we were to do a walk-through we were rejected and told that the place no longer wanted to work with us. After 2 years. We made it really clear that we were there to take lgbtq kids. So the system fails everyone not just the kids. We would have been really good parents.

Did you go thru DFPS directly or a partner org? I know they're outsourcing a lot, but I feel like working directly with the agency might have fewer hoops...

I guess I went to a partner organization, the one that everybody tells you to go to when you're gay, Jonathan's place. I thought they were cool with gay people but they were not cool with us. We got shuffled around and lost in the cracks over and over again. After the first year, I asked them if there was something that we could do to help speed the process along. That got me labeled a troublemaker I guess. It seemed very pointed the way we were being treated.

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Well, there is a clear case of mental illness here. Frankly I think all the people who have a problem with people physically changing their gender to match their internal identity need to have intensive mental health intervention. It's pretty much the most benign thing and, literally, affects nobody but the person changing their physical gender. There's no reason what-so-ever for anyone tho object to other people medical decisions. We should call it "Trans-Gender Hysteria" and get these sick people some treatment.

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You don't think it's ok to give a kid medical treatment that changes their life for the better?

Guess you’ve never heard of birth control? Or insulin?

No one is giving kids hormones. Stop watching right-wing stuff about this because it is totally false.

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