Comment by gdavisson | Hacker News Reader

Comment by gdavisson | Hacker News Reader

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First, why do you consider it to be a problem in the mind, rather than the body? It seems to me that, fundamentally, gender dysphoria is a mismatch between the mind and the body. Declaring the body to be correct and the mind wrong seems arbitrary (as would declaring the mind to be right and the body wrong). It's not really a question of right and wrong, it's the mismatch that's the problem.

Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example).

Note that not all transgender people experience gender dysphoria. Some are fine with the bodies they were born with, and for them gender reassignment would be unnecessary and irrelevant.

Also, note that this is different from treatment for e.g. anorexia nervosa. If someone with anorexia loses weight, it doesn't help; they'll continue to see themselves as overweight. Treatment for anorexia has to focus on the patient's mind. Helping them lose weight would make their outcome worse, not better, which is why it's not done.

Scott Alexander gives an interesting analogy to a case from the mental hospital where he works here: https://slatestarcodex.com/2014/11/21/the-categories-were-ma.... A woman with OCD was constantly worrying that she'd left her hair dryer on, and was having to drive home 10-20 times a day to check whether it was really off, or was on and going to burn the house down. Nothing they'd tried worked, until someone suggested she take the hair dryer with her. That effectively solved the problem for her, because she could always just look over at the dryer, see that it was unplugged, and go about her business. But caused a huge controversy among the psychiatrists between those who thought "This Is Not How One Treats Obsessive Compulsive Disorder" vs those who just said "it worked".

I'm with the "do what works" crowd.

> why do you consider it to be a problem in the mind, rather than the body

One argument is that it's a category error to call gender wrong. Your ethnicity, gender and wealth of your parents etc. just is, it's the hand you are dealt with. You can be unhappy with it but it can't be "wrong" just like the country you are born in can't be "wrong".

If someone is distressed about the country they are born in to the point of suicide, we'd class it as a mental condition. Such a thought can be rational but it's the degree of distress that suggests disorder rather than a healthy preference/observation of one's situation. It does have a rather obvious "do what works" sticking plaster.

The concern with sticking plasters is if they end our curiosity about the underlying condition. If we normalise them such they are considered inviolable part of the culture, political sacred cows and the one true solution that cannot be questioned. I expect that hairdrier lady's OCD was not limited to just her hairdrier - the sticking plaster hopefully reduced acute disruption/distress that made more fundamental treatment tractable.

(FWIW, despite articulating this argument, I can argue against it. I don't hold any confident position in this culture war maelstrom of bigotry and questionable scientific/philosophical claims.)

> Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example).

There seems to be a prevalent problem in this area (and perhaps others too) to where the reporting on the "science" seems to be a lot more positive than the science itself. The original article alludes to this -- "stop questioning the science" like it's an open and shut case.

For that particular study, a more accurate headline would be: "In Our Pre-Registration We Expected To Find Improvements on Eight Measures but We Only Found Improvements on Two, Which Were Very Small, and Only For Natal Females."[1] It's not as snappy, but it's more accurate.

That complex and fairly ambiguous outcome gets summarised into an overall optimistic story by the press, which then in turn gets digested into "gender reassignment .. works", not just on HN but on forums all over the internet.

It's not just that study though -- whenever the field is looked at holistically the evidence for the effectiveness of these treatments is not strong.[2][3] and the evidence for such treatments on children (the subject of the article) is even weaker.

Ultimately I believe adults have the right to do as they wish with their own bodies, however when it comes to children we have to be guided by the highest standards of medicine and science.

[1] https://jessesingal.substack.com/p/the-new-highly-touted-stu... [2] https://www.cms.gov/medicare-coverage-database/view/ncacal-d... [3] https://www.cochrane.org/CD013138/TOBACCO_does-hormone-thera...

There is no empirical way to verify if someone is actually transgender. In fact, there really is no theoretical way that a person could even be transgender unless one accepts the idea of a non-material soul that is somehow gendered. Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are transgender and try to help them.

You are defining male and female that way. If you go by that definition, you can define a transgender person as someone who deeply thinks and feels they ought to be of the other gender. They are not 'mistaken' other than by your definition. If you ask them 'do you have a penis' or similar question, they will respond with your objective reality.

Yes, I believe transgender people exist if you define the condition as people who wish they were of the opposite sex or mistakenly think they are of the opposite sex. They definitely really have mental conditions that result in wishes and feelings related to sex and gender, but if they claim that they truly are of the opposite sex, they are mistaken.

Emperical measurement framing is a cognitive cul-de-sac. Drawing a parallel, there's no emperical way to determine someone's sexuality. Fifty years ago this argument was used to justify therapeutically changing people's sexuality. "If you're a man you're biologically attracted to women. It's biologically impossible to be homosexual." Today we have the same logic applied to people's gender. It's as invalid today as it was back then.

Of course there is an empirical way to determine someone’s sexuality. You can show someone different varieties of pornography and see which varieties make them sexually aroused. You can see sexual arousal happening in the brain with an MRI. You can also just simply observe someone’s sexual behavior.

I'm sorry, but that simply isn't true. Even if it were true, like all diagnostics, it would have a sensitivity and specificity, which of course brings us back full circle to the problem the author cannot escape.

You don't think it is possible to determine whether homosexual people actually exist???

When you said, "that simply isn't true," what exactly were you referring to?

Homosexuality is the condition of having a sexual preference for people of the same sex. We can easily observe that such people exist. Whether it is a disorder or not is a separate question.

When a man says, "I prefer to have sex with other men," we can easily check whether or not this is true. (Or do you think all gay men are just faking it?)

When a man says, "I am really a woman," he cannot point to anything empirical to back up his claim. To the extent that we can check this claim, we can easily determine that it is false.

Of course, a man can correctly say, "I wish I was a woman," "I think I would be happier if I had been born a woman," or "I really like dressing up like a woman," and all these claims can be true.

But when a man says, "I actually am a woman," we know this is false because we know what a woman is, and we know what a man is, and we know that they are distinct.

Sexuality cannot be directly measured; its consequences can however be observed. Gender, operating the same way cannot be directly measured, its consequences however can be observed.

Your argument suffers from assuming essentialism - the error of reifying your personal ontology. That's a misalignment between you on one side and facts, nature, science, and reality on the other.

But back to the sensitivity and specificity for the test you're describing, what are they?

You’re just wrong and determined, apparently. I just don’t know what to say to someone who doesn’t think it is possible to empirically verify that some people have a homosexual orientation.

An HN commenter like yourself who thinks this is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are right about this and try to help them.

I'm sorry that you are simply unable to change your mind. I hope you get the care you need.

> When a man says, "I am really a woman,"

They feel they are a woman.

You seem to be feeling something when discussing this topic. Please provide empirical evidence of whatever you are feeling right now.

That's just plain wrong. Mental properties in general (e.g. personality) are not easily measurable, but that doesn't mean they don't exist (or can't exist without a non-material soul), and I see no reason to think that an innate sense of gender would be any different.

In any case, while gender is not directly measurable, it does seem to correlate with some aspects of brain structure. A number of studies have shown that, at least in some respects, the brain anatomy of transgender people is more similar to that of cisgender people of the same gender than those of the same sex. It's clearly more complicated than trans people having one type of brain in the other type of body, but something sort of like that is going on. See https://www.scientificamerican.com/article/is-there-somethin... and the links at https://sitn.hms.harvard.edu/flash/2016/gender-lines-science....

But whatever the basis of transgender identities is, it's clear that something real is going on. Dismissing trans people as "simply mistaken" is, well, simply mistaken.

EDIT: I should probably point out that the idea of someone developing some male-type features and some female-type should not be particularly surprising. Sexual differentiation is complex and has a lot of moving parts that don't always operate completely in sync. For example, a genetic male with complete androgen insensitivity syndrome will generally develop male-type internal organs (i.e. testes) and female-style external anatomy (a vagina, generally female appearance, etc).

> Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition.

Hard disagree. Even with a strictly genetic interpretation there are more than just two sex-chromosomal configurations, but leaving that aside there are many of us who believe that gender, unlike biological sex, is a social construct. Saying "you must be a man because you were born XY" is roughly equivalent to saying "you must stay home and cook dinner because you were born XX".

Let's say we had the ability to genetically re-engineer people into whichever sex they wanted. Would you still be opposed to letting them do so because they were born a different sex? Would you deny genetic treatment of debilitating diseases because people were born with them?

> there are more than just two sex-chromosomal configurations

These are not additional sexes.

For example, a male with Klinefelter syndrome (XXY) is still male.

> Let's say we had the ability to genetically re-engineer people into whichever sex they wanted

We do not, nor anything even remotely close to that.

> These are not additional sexes. > For example, a male with Klinefelter syndrome (XXY) is still male.

Only by arbitrary definition of the abstraction we use. If we instead defined maleness as the ability to inseminate women and produce viable offspring they wouldn't count. If we defined it by having male genitalia then people with androgen insensitivity syndrome wouldn't count.

Male and Female are human terms we've chosen to categorize animals, but nature doesn't give a flying fuck about our definitions.

> We do not, nor anything even remotely close to that.

Obviously. This is called a 'hypothetical' or a 'thought experiment'. We use these to test the suitability of our mental frameworks of understanding. In this specific instance, I'm asking you to pretend this is true to see if your reasoning holds up, of if there is cognitive dissonance suggestive of a flawed model.

Sorry but no.

We're not living in computer game or virtual reality.

Technology still far from providing us freedom to change our bodies as we want.

It's not about even transgender operations - we can't achieve even smaller goals: to be more healthy, stronger, more beateaful, younger or more mature.

Nobody likes themselves in current state - you, me , my son, my parents, everybody.

Transgender operations should not be taken lightly because they are not transgender in reality.

The one who decided on such path should that it's something heroic in self-modification of such scale.

They'll pay a lot without any guarantee they will earn something.

I think that 100 clinics .. sorry, strong words: I think it's a crime.

Literally. Those "doctors" are not helping weak and unhappy, they're selling what they can't provide, they make people even more unhappy

> Declaring the body to be correct and the mind wrong seems arbitrary...

Hardly, our understanding of the human body is more experimentally valid and much more aesthetically developed than our understanding of the human mind. If there is some kind of 'mismatch' as you say and the body appears well regulated, then the medically responsible move is to defer to it.

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