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Comment by gcr | Hacker News Reader

I can understand this perspective. You're looking at it with healthy eyes.

But for fat people, the calculus looks different.

A decision to take semaglutides is a decision between the long-term negative effects of obesity *now*, or the possibility of long-term negative effects *later.*

Anecdotally, trans people have a similar calculus. Going unmedicated/unsupported brings significant mental health risk now[1], whereas going on hormone replacement may or may not cause complications much later in life (osteoperosis, hepotoxicity issues for some treatments, etc).

Either way, you gotta get to the "later in life" part before you can worry about the outlook there.

1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G

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Tangential, but

> 1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G

This paper also finds that 5% of cisgender male and 11% of cisgender female students (out of ~8k surveyed for each) attempted suicide in the past year. It's kind of strange, because the age <=18 suicide rate (of "completed" attempts) is much smaller, approximately 1 in 5,000 to 1 in 10,000 [1].

[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf, Figure 3

No, they're making a choice between the long-term negative effects of not losing weight naturally, vs the possibility of long-term negative effects of using artificial methods. This isn't polemic, as even things as basic as birth control and advil have negative long term effects.

I think we’re saying the same thing? The only difference is that I personally don’t believe that self-control is sufficient for everyone to lose weight. If you do believe that, then the risk estimates become much easier.

Some people cannot lose weight naturally. So the question stands: what is the least bad alternative?

Maybe it's harder, but I don't think anyone is immune to calorie restriction.

And yet, statistically, caloric restriction has one of the worst success rates in modern medicine.

Depending on which study you look at, up to 80% of people who attempt lifestyle modification end up gaining the weight right back.

So yes, it's theoretically possible for everyone under ideal circumstances, but in the real world most people don't succeed. We can argue over why that happens - but the statistics remain.

So again... given these abysmal odds, for the 80% of people who try and (repeatedly) fail at lifestyle modification, what is the least bad alternative?

I was curious and a bit skeptical that sex change operations materially affected suicide rates for trans people but available papers tended to find significant effect sizes of about 50% reduction

Did that study account for the socioeconomic status of the participants? Common sense suggests that people who can afford to undergo such surgeries would tend to be richer, more supported, and from better neighborhoods.

There's certainly room for more research here, but some of them do attempt to account for other socioeconomic factors.

It's worth noting that surgery isn't the only option. Hormone therapy has also shown to reduce suicide risk, which is more accessible across socioeconomic strata.

There's a meta-analysis here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10027312/

The data is poor quality. It's not like you can randomize who gets a sex change operation. And there are major issues with even knowing who to count when people can just decide they're not trans any more. All the research on this is riven with such unhandled problems.

The research is also highly motivated. A researcher who found that sex change operations were harmful would be targeted for endless harassment by gender activists, if they could get published at all.

The effect sizes here are huge and seemingly hold when controlling for the typical factors such as socioeconomic status. They appear to hold both across groups that did not seek treatment and those that did AND in follow up studies checking the rates of how feelings (e.g. ideation) evolve over time for each group. It’s ok to raise concerns about confounding variables but the hypotheses here for such a huge effect size seem limited.

The fact that people can decide they’re not trans is not particularly material. This is very uncommon.

The conspiracy that such research must be politically motivated is a contrived argument and also falsely paints a dichotomy of saying that it must either help or harm. My assumption before doing the research was that they would find no effect.

>The fact that people can decide they’re not trans is not particularly material. This is very uncommon.

You really lost us with this.

Many, MANY people dally with the idea of being trans and decide it's not for them. This is extremely common, and is probably the overwhelming majority outcome for all people who are ever trans-curious.

Show your research please.

> The research is also highly motivated. A researcher who found that sex change operations were harmful would be targeted for endless harassment by gender activists, if they could get published at all.

A researcher who found this would be feted by the conservative/evangelical wing of the US political spectrum. They would stand to make a ton of money in the book and personal appearance circuit.

How many universities are run by the conservative/evangelical wing of the US political spectrum?

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