Children and Puberty Blockers, Hormone Therapy, and Gender Reassignment Surgery

[Ajidica]

That seems vague enough to apply to any "you need to accept who you really are" thing tbh.

 

[Evie]

I turn 36 this year. When I was 16, I realized I was trans. I didn't have the term, and I didn't have the language to understand what I'd realized. My mind just *broke* when I had the thought, "I can't be woman." My coping mechanism was to try and kill myself right then and there, in my bedroom. Had someone not called my mom, I would not be part of the 0.6% of adults today who are trans.

Only reason I'm alive today is sheer spite. Death would have been so much easier at the time, but it would have been admitting defeat, and I wasn't going to do that, even if defeat looked inevitable.

 

[MontyJava]

Boys already have testosterone, so giving a boy more testosterone than they already have isn't going to alleviate the dysphoria;

I have heard this line of reasoning before, and I believe the idea behind it was that insufficient natural hormone production could be causing dysphoria, and by increasing that production you could fix the dysphoria to a degree. I have not read any studies either way on this.

Transgender and gender diverse (TGD) people have a gender identity that differs from societal expectations based on their sex assigned at birth. In the United States, ∼1.8% of adolescents and 0.6% of adults identify as transgender.1,2
so what are the causes of 3 fold decreased incidence?

Children's identities are, in general, in a higher degree of flux than adults'. Things just change as you age out and discover yourself and work through your youthful confusion.
The question for the survey cited is vague on how someone who is genderqueer/fluid should respond also (this is typical). I think it's far more accurate to consider only those who actively pursue HRT/surgery. Given what I suspect to be a wide spectrum of genderqueerness/transgenderness, that's sort of a "show don't tell" approach to demographics, and more reliable than self-reporting surveys, which are not the best form of scientific inquiry.
You're also asking children whose understanding of terms and medical/social issues is generally limited. Ask how many children are going to be doctors when they grow up, and compare that to the actual number of practitioners, the difference will be severe as well. Most don't realize the high levels of effort and commitment needed to become doctors, and ultimately accept being nurses or accountants instead... And they're happy enough as that, even if in a perfect world they'd be a doctor.
You also have the combined issues of repression in prior generations mixed with promotion in the younger generation. Time will tell how that balances out.

Here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841333/
The number of people who seek treatment suggest that male-to-female transsexualism has a prevalence of 6.8/100,000 and female-to-male transsexualism has a prevalence of 2.6/100,000 among adults.4,5 In the Netherlands, 0.6% of men and 0.2% of women (aged 15–70 years) reported incongruent gender identity and a desire to undergo sex reassignment (SR).6 Population surveys have suggested that about 0.5% of adults in the general population identify as transgender.5,7

The number of adolescents contacting specialized gender identity services has risen considerably over the past decade across Europe and North America.8,9 No conclusions regarding the prevalence of GD in general or of GD/transsexualism specifically can be drawn based on these increases. Studies using short (one to three item) self-reports of gender identity and its variance suggest that 0.17%–1.3% of adolescents and young adults identify as transgender.5,10 A school-based survey eliciting gender experiences with scales commonly used at gender identity services suggested that 1.3% of 16–19 year olds had potentially clinically significant gender dysphoria.

****
https://en.wikipedia.org/wiki/Transgender
estimated that 89,667 individuals included in the 2010 Census had changed to an opposite-gendered name, 21,833 of whom had also changed sex marker.[181] Prevalence in the States varied, from 1.4 to 10.6 per 100,000.

****
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823815/
Overall mP [meta-Prevalence] (95% CI) per 100,000 population was 9.2 (4.9, 13.6) for surgical or hormonal gender affirmation therapy and 6.8 (4.6–9.1) for transgender-related diagnoses. Among studies assessing self-reported transgender identity, the mP was 871 (95% 519, 1224); however this result was influenced by a single outlier study. After removal of that study, the mP changed to 355 (95% CI 144, 566). Significant heterogeneity was observed in most analyses.
​

You have something around 0.7% of children "identifying as transgender" (maybe as high as 1-2%), with only 0.0068% actually committing to medically it in the first study.
In the census, it's 0.01% as of 2010.
In the meta-study, it was about the same as the first.

With how promoted it is and accepted it is at least among other children these days, you would expect more than a 1000:1 ratio there if all ~0.7% or so were fully transgender. This leads me to believe the prevalence of true and non-fluid gender dysphoria is drastically lower than the 0.5-1.5% self-reported number pushed by advocates, even if it's ultimately higher than the 0.01% number.

That's what I've been trying to get at with my prior blog posts here: if you start expanding the scope beyond that 0.01% demographic, at what point does the harm from transitioning clueless children who end up being gendernormative more or less in adulthood outweigh the benefits of appropriate transitions?
We simply do not have clear data even on how many people are in either group yet, nevermind a full understanding of the psychology and neuroscience underlying it.
This is the definition of experimental and unclear medicine.
How loose do we want to play it going forward?

 

[emzie]

2010 is a very very long time ago in terms of trans awareness, health care access, acceptance, and legislation. The meta study includes papers as far back as 1968 (!!) and nothing more recent than 2014, which is still a very long time ago in terms of awareness, access, acceptance and legislation. Your sources might be some of the best actual data available, but that doesn't mean they're reliable.

 

[CKS]

I'm not sure that the number of people who seek treatment is a very accurate reflection of the number of people who are transgender. There seem to be a great many barriers to getting effective treatment - lack of money, lack of access to medical resources, lack of support from local healthcare providers, general awkwardness of finding out how to go about getting services and dealing with legalities, lack of support from family/friends/spouse, difficulty getting time off from work for medical appointments, etc. I'm sure that there are many others that I haven't thought of.

 

[IglooDame]

I have heard this line of reasoning before, and I believe the idea behind it was that insufficient natural hormone production could be causing dysphoria, and by increasing that production you could fix the dysphoria to a degree. I have not read any studies either way on this.

I've not either, but between all the anecdotes of prepuberty children experiencing gender dysphoria, and adults with normal hormone levels experiencing gender dysphoria, it seems pretty unlikely to me.

Children's identities are, in general, in a higher degree of flux than adults'. Things just change as you age out and discover yourself and work through your youthful confusion.

Do children work through autistic tendencies as well? Just curious.

How loose do we want to play it going forward?

Well, I'm part of the margin of error of those studies - I wouldn't have self-reported as transgender any earlier than 2019.

But the question seems to boil down to "how many children who are *really* transgender are we willing to let suffer potentially suicidal levels of anguish and depression in order to avoid an unknown but by current accounts relatively minimal health risk to 'confused' cis children with temporary use of puberty blockers", do I have that approximately right?

In Texas at the moment, the answer is "all of them".

And I think this will conclude my OT participation for a while, be well everyone.

 

[Evie]

Would ANY of the CFC trans folk be included in 2010 data?

 

[Berzerker]

its sad anyone would commit suicide... maybe trans folk are being tested like Job, or maybe the rest of us are being tested

I think it was a Plains tribe that considered trans people sacred, the duality of existence all wrapped up in one person

 

[choxorn]

Do children work through autistic tendencies as well? Just curious.

No. No we don't, at least not in the sense that MontyJava is referring to with kids "working through youthful confusion" on gender.

 

[Kaitzilla]

I disagree.

Texas Child Protection Services has already declared the surgery to be child abuse.
https://www.nbcnews.com/feature/nbc...firmation-surgery-minors-child-abuse-n1276687

Is there any thread to talk about that action?

What if they go further?

Texas just went further.

Texas Gov. Greg Abbott: gender-affirming care reported as child abuse (usatoday.com)

Texas governor orders state agency to treat gender-affirming care as child abuse

*bolded by me

Governor Greg Abbott
February 22, 2022

The Honorable Jaime Masters
Commissioner Texas Department of Family and Protective Services
701 West 51st Street
Austin, Texas 78751

Dear Commissioner Masters:

Consistent with our correspondence in August 2021, the Office of the Attorney General (OAG) has now confirmed in the enclosed opinion that a number of so-called “sex change” procedures constitute child abuse under existing Texas law.
Because the Texas Department of Family and Protective Services (DFPS) is responsible for protecting children from abuse, I hereby direct your agency to conduct a prompt and thorough investigation of any reported instances of these abusive procedures in the State of Texas.

As OAG Opinion No. KP-0401 makes clear, it is already against the law to subject Texas children to a wide variety of elective procedures for gender transitioning, including reassignment surgeries that can cause sterilization, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs or supraphysiologic doses of testosterone or estrogen.
See TEX. FAM. CODE § 261.001(1)(A)–(D) (defining “abuse”).
Texas law imposes reporting requirements upon all licensed professionals who have direct contact with children who may be subject to such abuse, including doctors, nurses, and teachers, and provides criminal penalties for failure to report such child abuse.
See id. §§ 261.101(b), 261.109(a-1).
There are similar reporting requirements and criminal penalties for members of the general public.
See id. §§ 261.101(a), 261.109(a).

Texas law also imposes a duty on DFPS to investigate the parents of a child who is subjected to these abusive gender-transitioning procedures, and on other state agencies to investigate licensed facilities where such procedures may occur.
See TEX. FAM. CODE § 261.301(a)–(b).
To protect Texas children from abuse, DFPS and all other state agencies must follow the law as explained in OAG Opinion No. KP-0401.

Sincerely,

Greg Abbott
Governor

 

[Evie]

A failed state unable to deliver basic utilities to its citizens yet very concerned about harassing minorities.

 

[Kyriakos]

Hm, this is tentatively tied (hormone or similar treatment), but what do (mtf) ts use for issues of body hair?
Since getting rid of body hair isn't strictly a ts focus ^_^

 

[Evie]

Okay, absolutely outdated choices of terminology aside...

Body hair growth, at least in my case, slowed pretty naturally with the hormones. A good old razor blade every once in a while on the legs is about the extent of it - so not unlike any other woman. Facial hair (which establishes itself much more strongly with puberty) is the though one, and that's pretty much a job for laser-and-electrolisys.

Yes, bombarding your face with a laser or electric current is about as fun as it sounds. Still better than the alternative (but if I could have blocked them from growing in the first place that would have been by far best).

 

[El_Machinae]

Texas just went further.

Texas Gov. Greg Abbott: gender-affirming care reported as child abuse (usatoday.com)



*bolded by me

I should really get a graph that correlates suicides with relative prevalence of Evangelicalism.

 

[Farm Boy]

its sad anyone would commit suicide... maybe trans folk are being tested like Job, or maybe the rest of us are being tested

I think it was a Plains tribe that considered trans people sacred, the duality of existence all wrapped up in one person

Job is not a test. You think it's a test, but Job is wrong. He learns this in the parable. The Book of Job is a promise from God.

 

[emzie]

Would ANY of the CFC trans folk be included in 2010 data?

None of us would be.

I considered pointing that out too, actually. Even with the 2014 cutoff, none of us would be counted. At least 4 of us have posted in this thread alone.

 

[MontyJava]

2010 is a very very long time ago....Your sources might be some of the best actual data available, but that doesn't mean they're reliable.

Certainly. I think my overarching point is we don't have the data, and the data we do have suggests a very mixed, confusing picture at present. As such, precaution is advised.

I'm not sure that the number of people who seek treatment is a very accurate reflection of the number of people who are transgender. There seem to be a great many barriers

Certainly. My point here was that the truth was likely somewhere in between 0.005% and 1%. Barriers to entry are one factor (also lack of truly effective treatment holds many back, I'm sure). On the other hand, you have self-reported studies with unclear terminology being applied to get to 1%+ territory. I don't know that barriers alone are going to explain a ~500:1 discrepancy here.

Do children work through autistic tendencies as well? Just curious.

Are the two conditions actually the same? Children work through sexual preference differences as they go through puberty. Lots of aspects of their personalities change over that ~10 year period. We have self-reporting studies showing a sharp divide between younger and older generations in how they identify. While much of that may be cultural differences, there may be underlying psychology as well. Do we know?

But the question seems to boil down to "how many children who are *really* transgender are we willing to let suffer potentially suicidal levels of anguish and depression in order to avoid an unknown but by current accounts relatively minimal health risk to 'confused' cis children with temporary use of puberty blockers", do I have that approximately right?
​

I am still waiting to see how much these therapies actually reduce suicide rates. It's been a point of contention here, and I've yet to see compelling evidence to show there's major long-term reductions. My point also is that this goes both ways, and expanding HRT/etc programs beyond their current scope (of 0.01% or so) may have equally suicidal outcomes for the likely much larger marginally trans community that ages and has to deal with detrans dysphoria later on.
I do not consider your hand-waving of detrans issues to be appropriate. Their anguish is no less severe than the "in the wrong body" issues suffered by trans people. Even with the current ~0.01% selectivity we have, we see a significant minority of detrans popping up.
Just because you personally are 100% trans does not mean everyone who self-identifies is as well. How many are full-trans, how many are just genderqueer or fluid, how many will shift from trans to another non-trans or quasi-trans identity as they age?

I'm also still waiting for actual hard science showing PBs are truly "just temporary" / "just a pill bro" in otherwise healthy adolescents, as well as HRTs longitudinally being just peachy. I have extreme skepticism that you can totally overhaul the endocrine system for life without issue, given how many issues people have from minor endocrine dysfunction (and it's got that whole cutting edge medicine thing going on too), but it takes decades to collect data on that, and we have such vanishingly small pre-current HRT test subjects to collect on.

 

[El_Machinae]

I do not consider your hand-waving of detrans issues to be appropriate. Their anguish is no less severe than the "in the wrong body" issues suffered by trans people.

I want to be careful that we're not mixing two issues.

"detrans" could either mean "resume life into the sex you were born with, despite the PB delay" or "all the effort required to undo all the previous efforts to hormone-into the new gender".

Those will definitely be different levels of anguish. The first seems (seems!) to be less anguish than the 2nd. But the 2nd will be a function of the number of people who transitioned and either did or did not wish they had.

 

[sophie]

It also flattens all detrans into „realized they weren’t trans,“ which is simply not the case. The vast majority who end up detransitioning (itself a small minority of the trans community) do so at least in some part because of an external pressure - because of social rejection from friends and family, or because of violence and harassment on the street, or because of the rampant housing and hiring discrimination directed against trans people, or because of the enormous costs and bureaucratic burdens associated with medical and legal transitioning, and many trans people who detransition will resume transitioning later in life.

It also commits the extremely common cis mistake of assuming trans = some combination of hormones and surgeries and detransitioning = undoing that

 

[Cloud_Strife]

The obsession with detrans people, who are often used as a cudgel with which anti trans groups like terfs/gender criticals and republicans use are a fig leaf for their real intentions of eliminating trans people and "transgenderism'

Its the entire reason that people like jesse dingal or abigail shrier, with their obsession with trans people and using detransitioning people as a justification for slowing down acceptance of trans people, are so dangerous.

Both are involved with anti trans individuals and groups