If a person can be transgendered, shouldn't that mean people can also be "transracial" or "transage"?

[alhoon]

The argument that transsexuality can be a fashion for many. This was also said about homosexuality years ago. "What do I do to look cool, do I start vaping or change my sex? I will change my sex, without a doubt my parents and everyone around me will find it great and without a doubt I can find some really stupid psychologist to help me with this!!"

You don't take transsexuality seriously, I think that's already clear.

I haven't been able to see the article you link to (cookies and ###) but I understand that you can find cases of psychologists and parents doing stupid things. If you find ten cases, or twenty, they will be a really tiny proportion of all the cases in which the system works.

For some, it is fashion. The reason much fewer people take it up than vaping is that the world still works. However, for some it is not fashion but a decision. A decision that in most cases in my opinion is the wrong decision.
Before you answer "Then if you feel stressed over being a man, don't transition!" is not a real answer either; these are teenagers we're talking about and they will make foolish decisions. There are better ways to treat gender dysphoria than what is practically cosmetic changes to look like the other sex. As I said, only few, borderline cases should result in surgery.

[mishkin]

Edit: You don't take it seriously if you say things like "for some it's a fashion" and if you assume that these are decisions that (stupid) teenagers* make unilaterally. For my part, I believe that nothing useful can come out of our conversation or exchange of posts, thank you and until another time.

*the teenagers I have seen talking about their transition process were extremely mature.

[alhoon]

https://jamanetwork.com/journals/jam...stract/2813212

Now, that article presents stuff I disagree with and I am pretty sure the authors are biased. BUT... since that is a decent journal the bias of the authors is probably not that big to change the outcome: people that receive surgery to change their gender don't regret it very often.

[Lord Thesaurian]

The bias of the authors isn’t the issue. The selection bias of self reported survey data is. There’s little or no evidence sex reassignment surgery improves mental health outcomes, and longer term research shows people who undergo sex reassignment surgery are more likely to die by suicide, to attempt suicide, and to be hospitalized for psychiatric problems.

[Muizer]

longer term research shows people who undergo sex reassignment surgery are more likely to die by suicide, to attempt suicide

..... than non-transgender people. In other words, sex reassignment does not completely eliminate the elevated risk of suicide in transgenders. What point are you trying to make with this? Not to administer treatments unless the disease is eliminated completely in all cases?

[Lord Thesaurian]

..... than non-transgender people. In other words, sex reassignment does not completely eliminate the elevated risk of suicide in transgenders. What point are you trying to make with this? Not to administer treatments unless the disease is eliminated completely in all cases?

The authors alhoon cited position their study as a counterpoint to bans on sex reassignment procedures for minors, specifically claiming a lack of self-reported regret during post surgery follow ups rebuts the premise of those legislative efforts. The study is paywalled, but there are many like it using similar methodology and motivations. The lack of proven mental health benefits and far higher incidence of suicide and psychiatric hospitalization shows that Barbee et al’s findings are a poor proxy for the alleged benefits or safety the authors credit to these procedures.

[Muizer]

The lack of proven mental health benefits and far higher incidence of suicide and psychiatric hospitalization

Just pointing out the study you quoted does not establish these things.

[Lord Thesaurian]

Just pointing out the study you quoted does not establish these things.

They do, and I’ll go ahead and quote the relevant bits for anyone genuinely concerned.

The study population was identified by the linkage of several Swedish national registers, which contained a total of 13.8 million unique individuals.

The treatment for transsexualism includes removal of body hair, vocal training, and cross-sex hormonal treatment aimed at making the person's body as congruent with the opposite sex as possible to alleviate the gender dysphoria. Sex reassignment also involves the surgical removal of body parts to make external sexual characteristics resemble those of the opposite sex, so called sex reassignment/confirmation surgery (SRS). This is a unique intervention not only in psychiatry but in all of medicine.

The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9)

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

This is striking, because the other, more recent study I cited looking at the same data initially claimed sex change surgery reduced the likelihood of receiving mental health treatment, despite acknowledging the same trends noted above.

This total population prospective study included all individuals living in Sweden on December 31, 2014, as identified in the Swedish Total Population Register. Using de-identified personal identification numbers (a unique number assigned to all Swedish residents), we linked sociodemographic information with National Patient Register information on health care usage between January 1, 2005, and December 31, 2015, and Prescribed Drug Register information on prescribed and purchased medication between July 1, 2005, and December 31, 2015.

Overall, our results show that transgender individuals, here defined as those with a diagnosis of gender incongruence, are about six times as likely as the general population to have had a health care visit for any mood or anxiety disorder, between three and four times as likely to have received prescriptions for antidepressant or anxiolytic medication, and more than six times as likely to have been hospitalized after a suicide attempt. Time since initiating gender-affirming hormone treatment was not associated with these mental health treatment outcomes, whereas time since receiving gender-affirming surgery was significantly associated with a decrease in mental health treatment

In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.

The authors then corrected those claims based on a review of the same data, acknowledging there was no such evidence.

Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.

https://ajp.psychiatryonline.org/doi...1778correction

So, two separate analyses of some the largest available datasets over a decade or more concur with what I said about higher suicide attempts and psychiatric hospitalization. The more recent one further clarifies there’s a lack of evidence surgery improves mental health outcomes. These conclusions conflict with those of studies using self reported post op survey data to claim improved mental health/a lack of regret following sex reassignments procedures. The stark contrast highlights the pitfalls of selection bias inherent to studies like the one alhoon posted. These flawed conclusions are used to justify sex reassignment procedures on minors, so it’s important to put them in context.

[Muizer]

Let's first establish then that the studies definitely do not say that the statistics suggest higher suicide rates or increased mental health issues after treatment. I need to stress that , because your careless wording could definitely be interpreted that way.

These higher rates are in comparison to the general population. In other words it should be phrased as "treatment does not lower suicide rates or mental health issues to the level of the wider population".

The rectification compares trans people who do undergo treatment vs the ones who do not. While this may be a better comparison it is still not a good one, unless one assumes those who elected for treatment are a random sample from one population.

I'd say that given the treatment involved it is at least likely to assume those who get it are more strongly motivated by expected mental health benefits.

In other words, the 'one population' assumption is very suspect: we cannot assume their 'starting' mental health was the same.

The only experiment that could give clarity would be to select a group of people who want treatment and then randomly give it to some of them and not others.

As that would be highly unethical it's not surprising such an experiment wasn't conducted.

[Lord Thesaurian]

Let's first establish then that the studies definitely do not say that the statistics suggest higher suicide rates or increased mental health issues after treatment. I need to stress that , because your careless wording could definitely be interpreted that way.

These higher rates are in comparison to the general population. In other words it should be phrased as "treatment does not lower suicide rates or mental health issues to the level of the wider population".

The rectification compares trans people who do undergo treatment vs the ones who do not. While this may be a better comparison it is still not a good one, unless one assumes those who elected for treatment are a random sample from one population.

I'd say that given the treatment involved it is at least likely to assume those who get it are more strongly motivated by expected mental health benefits.

In other words, the 'one population' assumption is very suspect: we cannot assume their 'starting' mental health was the same.

It’s worth mentioning the other study attempted to control for “starting” mental health by adjusting for immigration status and psychiatric history. The relevance of comparing transsexuals who have surgery to general population controls is that the result conflicts with the notion that reported satisfaction post surgery is an effective proxy for mental health outcomes. The conclusion that even the most intensive treatments in the most accommodating environments at best fail to improve mental health outcomes for people seeking them is hardly an indictment of their restriction. Neither is the belief that orders of magnitude higher than average suicidal behavior, mortality and psychiatric hospitalization years after treatment would have been even higher without it.

The only experiment that could give clarity would be to select a group of people who want treatment and then randomly give it to some of them and not others.

Supposing this were the case, I think it would constitute an effective counter on its own to claims that restrictions are unjustified. A debate around the ethics of hormonal and surgical experimentation on minors would be a world apart from the current one in the US measured by how motivated the subjects of those experiments can be or how widely the latter can be proliferated.

[Muizer]

The relevance of comparing transsexuals who have surgery to general population controls is that the result conflicts with the notion that reported satisfaction post surgery is an effective proxy for mental health outcomes.

As I said, the studies neither prove nor disprove that mental health outcomes improve after treatment, because no studies with the proper control group have been carried out.

The conclusion that even the most intensive treatments in the most accommodating environments at best fail to improve mental health outcomes for people seeking them is hardly an indictment of their restriction.

But this reverses the burden of proof does it not? If no adverse effects have been demonstrated, should people not be free to choose what they want for themselves?

A debate around the ethics of hormonal and surgical experimentation on minors would be a world apart from the current one in the US measured by how motivated the subjects of those experiments can be or how widely the latter can be proliferated.

Sorry don't understand this sentence

[Lord Thesaurian]

As I said, the studies neither prove nor disprove that mental health outcomes improve after treatment, because no studies with the proper control group have been carried out.

But this reverses the burden of proof does it not? If no adverse effects have been demonstrated, should people not be free to choose what they want for themselves?

Sorry don't understand this sentence

As I said, a lack of any acceptable evidence would be an argument in favor of restriction on its own. Restricting experimental medical treatments on minors for lack of supporting evidence is as normal a burden of proof as I can think of. Where’d you get the idea there are no adverse effects of these treatments? Recipients have high rates of suicide and psychiatric hospitalization in common and there’s no proof they benefit from them. Concerns have prompted restrictions across the developed world. Post op satisfaction is hardly a rebuttal.