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Comment by silveroriole | Hacker News Reader

Would you support a woman having breast reduction surgery, or would you say “sorry your body doesn’t match your mind; get therapy”?

I suppose you can argue the tissue here is not “healthy” because it’s causing physical distress for the woman, but the same seems to apply to a trans person. Distress is never ‘just’ mental, it has physical effects on the body (and vice versa - pain is ‘just’ mental). The decision of what’s healthy doesn’t seem so simple to me.

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The argument you are making would hold up better if there was evidence that post-op trans people have dramatically lower suicidal thoughts, but multiple studies have shown suicidal thoughts is virtually unchanged after operation.

Now the argument becomes something like 'a body part of yours is causing mental distress, let's cut it off even though there's zero evidence it'll help'. Seems very flimsy and predatory to me.

As for breast reduction, there's actually evidence that large breasts can cause physical problems in women, so it seems reasonable to allow that along with the evidence that women with large breasts experience a better quality of life after surgery (absolutely not the case for trans people removing body parts).

"The overall mortality for sex-reassigned persons was higher during follow-up"

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

There’s no therapy that helps, at least as far as I know. At best you could learn coping mechanisms, but I don’t think anyone has ever been successfully convinced out of trans-ness by therapy, similar to how gay conversion therapy didn’t actually work. So we’d be left with telling trans people “there is no treatment at all, go deal with it somehow.” Anecdotal of course, but there are a fair number of trans people on social media who seem happy with their surgery - why deny them that because someone else is convinced that according to statistics it shouldn’t have made them any happier?

Desistance, i.e. "being convinced out of transness" is perfectly common, as mentioned in the article. I'm not aware of any studies on how therapy can affect this, but even if the therapy was merely helping the patient cope with their dysphoria for a period before exploring other options, that seems a far cry from saying "just deal with it".

The OP article is raising the claim that most of the (recent young) people probably aren't 'trans' at all, but there's a one-way affirmation pipeline backed by no science whatsoever.

> there are a fair number of trans people on social media who seem happy with their surgery

Are the people that are unhappy embraced by the community, or are they deplatformed? Are they happy with the surgery itself, or that they're now 100% part of a community of some kind?

Once someone has surgery, do they in their mind feel completely the new gender, and go about their lives as such, or are they now some elevated status within the trans community itself?

I don't have a problem with how people decide to live their lives, and while I'm generally against unnecessary surgery, adults are free to do what they want. I am against quack science and unethical behavior that might be exploiting the mentally unwell and even just confused children. I also am against using the power of the state to levy the quack science in the case of custody battles.

What exactly are your qualifications? How much of the scientific literature have you read?

> “The overall mortality for sex-reassigned persons was higher during follow-up“

Higher than population average. Do you have any evidence that it is higher than people who are denied treatment?

The surgery is objectively a failure if it doesn't lower suicide rates.

It's objectively isn't if it lowers suicide rates relative to pre-transition level. It does not necessarily need to lower rates to population average to be effective

This is not true. Even if your claim about the paper is true (which it isn't), there are other metrics to care about:

- suicidal ideation, which is bad in and of itself

- anxiety, e.g. social anxiety

- depression

Besides, the study does not account for the fact that until 2013, Sweden forced people to have surgery to get updated IDs. If a trans person does not want to have a particular surgery and yet is forced to have it, you can imagine why that would cause a great deal of suffering. That isn't gender-affirming care, that's forced sterilization (which is a human rights violation with a sordid history).

The idea that gender-affirming care doesn't have a large evidence base behind it is preposerous. See e.g. https://medicine.yale.edu/lgbtqi/research/gender-affirming-c...:

> As evidence for the proposition that “[t]here is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention,” the AG Opinion cites a 2011 Swedish study by Dhejne et al. that, the AG Opinion claims, “monitored transitioned individuals for 30 years [and] found high rates of post-transition suicide and significantly elevated all-cause mortality, including increased death rates from cardiovascular disease and cancer, although causality could not be established.”49 In fact, the 2011 study by Dhejne is badly out-of-date and does not support the AG Opinion’s claim.

> The Dhejne study compared post-gender-affirmation transgender individuals with cisgender individuals from the general population, as opposed to transgender individuals who did not receive gender-affirming care. Therefore, as the study’s author explicitly cautions in the body of the text, it is impossible to conclude from this data that gender-affirming procedures were a causative factor in suicidality among transgender individuals.50 Rather, the study shows only that transgender adults were more likely to experience suicidal ideation/attempts and risky behavior when compared to the general population in Sweden between 1973 and 2003. Further, the Dhejne study is not generalizable to a modern American population or to adolescents. During the study period, Swedish law required that individuals seeking gender-affirming surgery be sterilized. The presence of this law alone might account for the higher risk of suicide attempts and risky behavior in the transgender population compared to the cisgender population at the time.51

> but multiple studies have shown suicidal thoughts is virtually unchanged after operation.

This was literally the first result when I googled "post op trans suicidal thoughts study" (n > 27k)

https://jamanetwork.com/journals/jamasurgery/article-abstrac...

So, seems like there is indeed evidence?

The 2015 US Transgender Survey cited in your link was commissioned by the National Center for Transgender Equality (an organization that was founded by a transgender activist).

The study was performed online and links were posted exclusively in transgender support forums.

Your standards for "evidence" reach the heights of biased activist SurveyMonkey CSVs? I'm convinced!

the study was intending to measure the rate of suicidal thoughts among transgender people.

Seems like a great way to get a lot of datapoints is to use a transgender forum. Seems like a great way to measure suicidal thoughts is to ask "do you have suicidal thoughts"

So seems like a great approach to gather a lot of evidence for the question at hand?

Seems like you just don't like the evidence because it doesn't reach the rather bigoted conclusion you want it to

I think its worth noting that the authors of the same study conclude:

> Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.

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