All right, as I am having a small spell of insomnia, I got the time to address the replies given to me in a
relatively timely manner instead of taking weeks like it happened last time.
I'll move around the order in which the replies were given. I'll do it in the interest of the logical of progression of answering topics, as I build my own reasoning. I'm pointing this out just in case this feels weird.
So, let's do this:
Hello. My name is Aleks, they/them. I have been a nonbinary person since 2018 (i.e, over five years). I am just getting my proper medical transition underway, even though there's been some rocky periods getting it through. I live in Bulgaria, so I have a somewhat different-ish perspective on things albeit I'm clearly following the "Discourse". I used to be a regular in the old Ask a Trans Person thread, and I was unaware a second one popped up - it was one of the few threads on OT I regularly replied to.
I will confess that while I am more than happy to answer any questions asked out of genuine curiosity and good faith, it's a little bit disheartening to see such a bizarre comparison between euthanasia (which has been used to engage in taking out 'undesirable' or poorer sort in recent years) and GRS (a procedure with a less than <5% regret rate, which would put it at a lower regret rate than medically emergent operations, such as knee replacement surgery). But it's not just that - as others have stated it clearly, trans people are already under fairly restrictive control over GRS & HRT (why else would DIY be so widespread?) by the medical establishment & governments. For an example, in Bulgaria, in order to 'legally' go on HRT, one would have to go through the courts to prove that they are, in fact, transgender and they want to undergo this treatment. Is this enough of an "anchor"?
It's the usual "we just have concerns" irt to accessing gender affirming care, that only ever seems to be applied to trans people seeking it
I get cis people being ignorant of the process, it can be complicated and difficult to grasp even as a trans person, but to then advocate for restrictions based upon your own ignorance of the system and the already existing barriers?
I find it very difficult to separate that from what i see as being functionally the same as further restricting access to gender affirming care. It's the same tactic that anti trans advocates use, specifically the one's trying to hide the fact that they're motivated by their animus of trans people
I'll address mainly Aleks here, but also Cloud_Strife as his following quote above was, basically, support of the same idea.
And, speaking of disheartening...
So, my argument is
literally "of course the person's opinion is important and should be taken in account", but "a board of doctors should also be consulted in order to minimize the possibility of harm"... and your reading of this is: "
he is likening transition with attempts of genocide".
Really? That is your takeout from this?
My only response to this is: we have first to reach
language consensus before anything of use can come out of this. And in this interest, here is the
wikipedia article on the concept of euthanasia.
You will notice that the basic concept of euthanasia is "
the practice of intentionally ending life to eliminate pain and suffering".
You will also notice, in the session of the article regarding the euthanasia program of the Nazi party,
that the term was coopted to function as euphemism for genocide, not because it is what euthanasia means, but because people doing terrible acts like to mask them with softer terms. The nazis loved to torture words and concepts beyond recognition; after all, their own name meant "socialism" when it was as further away from socialism as you can possibly be; Nietzche's "Übermensch" became a proxy for racism; "lebensraum" was claimed in lieu of expansionist agression.
To the point of interest to this thread; for you to extract, from both the text and the context of my post, that this
perversion of euthanasia, instead of what the term actually means, is what I was talking about; well, the leap of logic you needed there is
pretty spectacular. Or do you do think those genocidal attempts at the past were worried with the subjects' informed consent, and also had plenty boards of doctors trying to minimize the chance of their mass killings causing unwanted harm?
I'll try to read your reaction to my post in the best light possible and assume that you are so used to
antagonism when dealing with that topic that you see it where there isn't, even to that, well,
burlesque extreme; that this conclusion was in good faith, no matter how unwarranted. However, maybe - just maybe - debate threads aren't the best place for that atitude.
After this, here is a little statement of intentions:
This thread is an open invitation to debate and conversation. The kind of debate and conversation that interests me are the ones in which
topics are difficult; that deal with moral friction, and that are uncomfortable for those proposing that they have pertinent knowledge and the ability to enlighten the rest of us. Perhaps you expected a thread that is sanitized with only questions there are, well - not
easy, because I don't think anything involving this is easy - but that aren't taxiing from your end. Things like "how did your family and friends adjust"; "how hard was it to get the medical support you need"; that sort of think - they are even interesting (I always read when a topic I'm unfamiliar with pops up), but these are issues of affirmation that I, particularly, would only consume passively.
If that is the thread you
all want, that's fine. I'll just withdraw from this conversation. Let me know.
I'll point this out, though:
should this thread be exactly the opposite of what it is; if this was an open invitation form an MD that takes part in the evaluation and decision for greenlighting the transition, I'd be hitting
him with whatever challenging topics I could think of. From the top of my head: 1) Under what criteria can you justifiably deny someone who conclusively declares the interest in transition? 2) Is it morally OK to demand a period of trial if there is suffering in the continuation of the current condition? 3) How can you guard the protocol/guideline for the decision against biased cultural standards? 4) If a board of doctors deny a transition, and your own opinion is that it is warranted, wouldn't it be your moral obligation under the Hippocratic oath to perform it anyway? 5) Is it adequate to even consider this kind of procedure elective, if it is necessary for the person to externalize their true selfs?
Unfortunately, as far as I know, we have no doctors here that I can send these questions to. If any
are here, please do identify, or even better,
open that thread..
So, there it is. I like to deal with
issues that present difficulty to the ones answering it, in serious threads with demanding topics. If that is not your cup of tea, feel free to ignore me. However, should you decide to still engage with my own line of questioning - and I have nothing against it if you do - please go easy on the accusations of supporting crimes against humanity. It's not good netiquette.
I'm going to try to be as respectful as possible here... so bear with me, but I'm also going to be honest and blunt:
I don't know man, trans people itt are saying that barriers to unfettered surgical transitioning already exist, not even taking into account the financial requirement or the ability to get time off to recover.
People routinely get surgeries, ones that can be just as dangerous and taxing on the individuals body, so i don't understand why you've decided that trans specific ones are the ones that you need to be concerned with when it comes to regret, not least because other forms of surgery carry higher levels of regret, specifically from cus people.
Maybe medically transitioning provokes unconscious, uncomfortable reaction in you, if that is the case, which i genuinely believe is possible for a lot of cis people, then you need to ask yourself why gender affirming care for trans people causes this sort of reaction and if it's indicative of any sort of underlying discomfort with transitioning in general.
If it is, you need to interrogate those feelings, because from personal experience, these can often go hand in hand, it's something i still struggle with and i bet if you ask any other trans person they'll also bring up their battles with internal transphobia and how it shapes their attitudes towards medically transitioning.
I want to stress this point; having those feelings doesn't make you an intrinsically bad person, it's how you deal with it that does; any advocation to further restriction to transitioning kind of gets my back up and it signals to me that that the person advocating for it, no matter the degree, hasn't done the homework on why trans people seek out these options to begin with.
There is a fair bit of
projecting in this, and it is also very unwarranted. You don't know me
at all, except for what I decided to share here, and I said, at least twice, and now I'm saying it again: "if it makes you happy, more power to you".
I'll talk a bit about what I'm getting, from this thread, regarding the relation between the trans community and the power over them held by doctors, but I'll do it in my replies to Johannak and Igloodame, because I feel what they contributed to the topic is a better trigger to my own interaction. Feel free to go there, if you want.
Why are cis people who have issues with gender affirming care specifically targetting trans people's access, who are a small minority compared to the majority of gender affirming care which is predominantly used by cis people?
Really makes you think.
Are you ok with people medically transitioning @FredLC?
If it makes you happy, again - fourth time now - more power to you.
And more, if you could perform it in yourself
on your own, many of my arguments here would be inapplicable.
As, for obvious reasons, this is not something that an untrained person could ever perform, let alone on themselves, and the assistance of a class of professionals is required, for a procedure that c
an be potentially harmful (even if the safeguards currently in place are making sure that it happens rarely),
I'm sorry, but simply put your needs are not the only ones that should be taken in account.
There being consensus between the trans person and the doctors involved, that such is the best course of action as recommended by the best science available in order to minimize suffering and maximize happiness,
by all means, transition away!
I'm not partial against you. But I'm not partial for you either.
We're losing access to basic healthcare, anyone advocates for a rethink on what little healthcare there is, is going to be viewed with suspicion at best.
Cis people might disagree with this stance, but we are the ones having our healthcare removed or gatekept on the basis of being trans, not them and i don't have much patience for those that want to play this jesse singal-like game of advocating for the cessation of our healthcare whilst pretending they aren't doing exactly that when confronted with the consequences of what their beliefs would look like put into action
Well. Here my only question is:
where did I suggested reduction of your healthcare? Please do point it out. Preferably with quotes!
I dunno man, the medical consensus is that the affirmative approach is the best way to approach trans healthcare because it minimises harm to the most people. Doctors got that answer for you. People keep telling you that this is the consensus even from institutions that have traditionally been the cornerstone of abusive gatekeeping practices that harmed us so much.
Why do people keep asking "is this ethical?" when medical associations that have already applied and failed with every other approach tell you that yes, indeed, trusting the patient is the best approach to treatment.
As a footnote, I think knee replacement surgeries have 20 to 100 times higher regret rates (6-30%) than gender affirming surgeries (0.3%). So, you know, details.
Nobody is getting these surgeries out of the blue.
This is something curious I noticed on this thread. It contains a weird combination of flaunting the safety of the procedure under the safeguards in place, and a very encouraging success rate, and at the same time, a discontent on the same system as too restrict, and a source of gatekeeping, preventing people who need it to get, to the point that they try to prepare themselves to answer not truthfully, but the keepers want to hear, in order to beat the excessive restrictions.
This is a not as clear a contradiction as I make it sound in the first paragraph, because the "medical establishment" isn't a singular entity, but a system that can also act internally contradictorily. So it is entirely possible that both things are true at the same time.
Still, these are opposing pressures. What is kind of worrying. If the system has such an
exemplary success rate, why are people trying to beat it? Could it be because it also blocks instances when the transition
should not happen? Couldn't it cause a deterioration of that success?
I don't think your argument about knee replacement is particularly good. I would need to talk with a doctor to determine the precise definition of elective surgery (if a situation is not life-threatening, but is source of unbearable pain/discomfort hinders functions, is it even elective? I already hinted in my list of questions that maybe even gender affirmation should not be, depending on how it is defined, what might have implications in the right of health assistance) but if one surgery has
very questionable success rates compared to the other,
maybe the solution is to increase the oversight of the bad one instead of decreasing the one of the successful.
Have you considered this as a possible approach to the issue? Because I have.
Granting equality does not equal giving what you want. These are two different exercises.
I don't disagree, but I'd also add that it doesn't have to be tragic.
Agree 100%. That it is tragic is entirely a cultural thing that needs not to be. There is nothing
intrinsic in it.
If it were a recognized condition that had decades of research behind it indicating that giving people fins made their lives better, I'd say give those people fins.
Agree again. That said, this is more convergence than concession. The scenario you describe (there is technical consensus and experience affirming the validity) fixes my point of contemption.
Maybe you'd like to take a crack in the issue that came up, of whether euphoria is equivalent to dysphoria as in being a detrimental condition that needs medical attentiont, and it's relation to the Hippocratic oath?
Perhaps a bit of background will help. When I was growing up, I learned from somewhere that in order for a 'transsexual' to get "the surgery" or really any sort of hormones or treatment at all, they had to live as their correct gender in all ways for two years, at which point the "doctor board" (I have no idea who it actually was, the individual surgeon or someone else) would decide whether it was truly warranted or not, and part of their decisionmaking was whether the person would be heterosexual in their correct gender, and for trans women whether they'd be pretty (or passable) or not. Even in this century that was still the case. So excessive 'lead times' and decisionmaking by medical authorities using really screwed up guidelines, "gatekeeping" being the umbrella term, is a very sensitive area for me personally and I think for trans folk generally especially older ones.
No one (that I'm aware of) is suggesting zero medical screening for HRT or appropriate surgeries, and as I noted there's currently no country where it is offered with zero screening. "Informed Consent" is the standard for HRT in the US, and the effects of HRT are for the first month or so completely reversible if one stops doing HRT. There are plenty of countries where gender affirming medical care is not available at all, and more countries where the gatekeeping is still almost insuperable -
the UK comes to mind and indeed some US states are trying to re-implement deliberately excessive gatekeeping 'so the poor confused trans folk (or folks that think they're trans) don't get taken advantage of by woke society or the medical-industrial complex' - or at least that's what they claim. They're 'doing it for our own good', despite the American Medical Association, American Psychiatric Association*, and other major health orgs saying these treatments are appropriate. So the objection that you're raising seems immaterial to me, unless you're recommending that there's currently insufficient medical screening/gatekeeping, in which case I strenuously disagree.
And, Sophie and others have already pointed out that trans folks getting gatekept or prevented from getting these appropriate procedures is *also* a problem, and so excessive or overly strict screening is itself as dangerous if not moreso than excessively allowing people getting these procedures that truly shouldn't. So 'being too careful' is at least as bad as not being careful enough.
Does that help any?
*I find it extremely telling that the American Psychiatric Association states that psychotherapy is not an effective treatment for gender dysphoria. Surely they know better than all the laypeople who say we just need counseling rather than hormones and surgery?
So, a fair bit of my establishment axions for answering you are laid bare already, so excuse me if I repeat myself. Excuse me if I repeat myself.
I'm picking up a bit of contradiction in the praise of the system when you guys point out how successful it is and at the same time complaints about how exaggeratedly restrictive of a system it is, and thus, a self serving bias in
praising it but only when convenient (not by you, let me be fair here). Also, if I am honest, there obviously is a fair bit of hostility against my critical commentary (how dare you question such a great success rate you insecure cigender "genocidal?" gatekeeper you). Those are factors that
diminish the ability of this debate to persuade a change of heart, because they go to the credibility of the opinions laid.
To be perfectly honest again, even if this thread were the epitome of sensible debate, I still would not change my mind, in the topic of the adequacy of the system, under the universal principle of
hearing both sides. I'd love to hear what someone involved in the screening process would have to say about the issues you raised. Intellectual honesty demands that I reserve judgement on that front.
I also said that I take the Hippocratic oath very seriously. I am not a doctor, but I took an oath myself, and I am keenly aware of how seriously I take it). So, really, I
don't think a doctor should be demanded to perform a procedure,
anyone, unless he is sure (under the best science avaiable) it is the path to minimize harm
. And unlike most medical procedures, gender affirmation involves the deliberate alteration of body parts and their functions, a characteristic that makes it unique as most other ones aim to
restore those as close as possible to the original state. This is a qualitative difference between the two things.
W
hile I absolutely do agree you have rights and your needs should be met, I acknowledge you are not the only part of that equation
. Boards of revision, frustrating as they could be, serve that function.
BUT - returning to my original point of disagreeing with arbitrary power - It is
absolutely possible that something presented under the guise of an impartial revisional board could be nothing but a traditionalist gatekeeper that aims to block access to people who need it or, less maliciously, at least interprets the necessity of transition way too restrictively.
That is a universal issue of seats of power, actually - as a Lawyer, I have frequently to contend with magisters and courts that receives the label and respect of the impartial judge yet are
anything but.
To tell the truth, under the context of revisional boards to transgender access to affirming surgery,
I'd consider, irrespectively of my reserved judgement on the efficacy of the current system, that it would be wise that those boards are composed observing representation - preferably with transgender doctors, absent those at least with members of the LGBT community - but with the technical expertise to also address the science involved, as means to counter possible conservative bias. And don't get me wrong, conservative ones as well, with the same technical expertise requisite. The entire spectrum of opinions and pressures. In fact,
I'd support legislation that demands such representation. If there is one topic in which Trans people should hold positions of official, sanctioned power, undeniably it is that one.
There is no perfect answer to the political question that is "
legitimate exercise of power". Abuses will always exist, and these are indeed frustrating. If you guys figure out a solution better than this one, let me know. I'll be sure to pass up to the courts.
Though this answer what was your actual point, there is one last thing I'd like to lay out here, and though, again, it is not something that you, specifically, committed, I feel your post accidentally gave me a perfect trigger - which is the excerpt: "
so the poor confused trans folk (or folks that think they're trans) don't get taken advantage of by woke society or the medical-industrial complex".
Your point there, though incidental to your larger topic that I already answered, is that much of the distrust directed to the current medical system derives from a
condescending atitude, treating trans people as incapable of their own self-determination. I feel a lot of the hostility directed towards me has the same root; a weariness with such treatment, betrayed by sentences like Cloud_Strife's "
It's the usual "we just have concerns" irt to accessing gender affirming care, that only ever seems to be applied to trans people seeking it".
However, a
very significant, impactful, part of my whole contribution to this thread have been "I hold the need to respect the oath of doing no harm of doctors in high standing, to the point that I find it acceptable that some frustration is acceptable in defense of it.
What leads me to ask? Am I condescending the "poor confused doctors (or board reviewers) so they don't get taken advantage of by woke society or transgender special interest group"?
Again, this is certainly not directed at
you Igloodame, and actually, not even at Cloud_Strife (who articulated it more clearly but was not unique
). This is a last attempt at burying that atitude once and for all by exposing the last issue that I saw in which the treatment was unbalanced and the representation of my opinions skewed, and permit that debate, of even difficult topics, proceed unhindered.
I hope it works. Only time will tell.
Regards
.
