Comment by mustache_kimono | Hacker News Reader

Comment by mustache_kimono | Hacker News Reader

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mustache_kimono

> And pretending that (in the United States of America of all places) teens can just walk up to their doctors super easily and get surgery done somehow.

You should see some of the background evidence on this. NY Times did a podcast series not long ago, which covered the controversy, called The Protocol: https://podcasts.apple.com/us/podcast/the-protocol/id1817731...

It was about how the so called Dutch Protocol re: gender affirming care first came to the US, and how long-ish psychological evaluation times were often truncated because of how far patients had to travel in the US. Then the lid flew off when such care moved to California.

> Singal is a fellow traveler to people who defend conversion therapy

Yikes. One doesn't usually expect people to use the actual language of McCarthy-ites.

> So who is Singal out there fighting for?

The kids? It's really not crazy to believe that the children, perhaps not given adequate care, could simply be wrong, or even socially influenced (like everything else in a teenager's life).

> He's going out there writing this kind of stuff so consistently that he's known for it. And I have a very hard time understanding who he is the voice for, except for people who are just against trans people existing in public society.

It's a new treatment and how it is practiced here in the US is the very Q he is examining. I'm not saying he's right, but I do feel better if there is someone with a critical eye looking at new treatment methods.

I am going to re-insist on the idea that parental consent is going to play a big role in practice in US healthcare practices, if only for financial reasons. I have very little patience for the idea that access is easy.

Perhaps there is a debate to be had on treatment protocols, but I generally feel like, for something that covers such a small segment of the population, the default is to err towards letting that debate happen in professional circles.

> I am going to re-insist on the idea that parental consent is going to play a big role in practice in US healthcare practices, if only for financial reasons.

Oh agreed. If, for no other reason, that is how the politics, even on the American Left, are now. A few years ago, people were talking about gender affirming care as a matter of right for the children. Singal, among others, changed that conversation.

> I have very little patience for the idea that access is easy.

Agreed, but I think you may have misconstrued Singal's point. He's not saying it's too easy, he's saying there is not enough preliminary psychiatric care like the treatment protocol dictated in the Netherlands.

> Perhaps there is a debate to be had on treatment protocols, but I generally feel like, for something that covers such a small segment of the population, the default is to err towards letting that debate happen in professional circles.

Um. Those professional circles like HN's professional circles need to be open to the air every now and then. Like -- what if we allowed Peter Thiel and his circle of founders, raised on Heinlein novels and sugary soda, to dictate tech policy in the US? Some people are just too weirdly close to a thing. We actually do need the wisdom that normies can offer.

Specifically, re: this topic, four European countries, who have a much more experience than Americans do with this care, have recently implemented more restrictive approaches to care. See: https://www.politico.com/news/2023/10/06/us-europe-transgend...

It should be a matter of right. My parents mutilated me as a child because they denied me healthcare. We should not allow parents to deny their children healthcare which leads to their permanent disfiguration. That's disgusting.

If you think it'd be wrong to force a cis kid to be trans, then it's also wrong to force a trans kid to be cis.

> It should be a matter of right.

I think that's a fine point to make, but I also think it's unlikely to be politically feasible, any time soon, in the US. You may have been perfectly capable of making this decision, but, in the most common case, most parents know that teenage brains driving almost adult bodies sometimes make really terrible decisions. And lots of us imagine we were much smarter than we actually were in adolescence. Moreover -- parents can be just as profoundly stupid.

I'd imagine a teenage Melanie Griffith would say she was perfectly capable of consenting to the very adult relationship she had with Don Johnson, and to which, I believe, her parents consented, as well. In retrospect, I'm not sure adult Melanie Griffith would feel the same. Or at the very least she may not allow her daughter to do the same.

Perhaps that's why we should willing to accept some guidance from things that at least can pretend to be objective -- science and journalism. Especially views critical of our priors and intuitions. And we definitely shouldn't seek to silence or de-platform anyone simply because they disagree.

Please -- vote the bastards out of office who don't take your problems seriously, but also please don't silence journalists for suggesting that there is more to this question than two simple American Left and Right narratives. Some of us need that kind of help to understand the world.

> We should not allow parents to deny their children healthcare which leads to their permanent disfiguration. That's disgusting.

So instead we need to enable parents to allow healthcare to disfigure their young kids when they predictably get influenced from social media and their peers?

How is it 'disgusting' to try to let someone live as they were born?

> How is it 'disgusting' to try to let someone live as they were born?

Welcome to the cleft palate surgical repair denialism club!

It's a medical matter. If medical officials broadly agree that having a prosthetic limb gives someone better quality of life than having no limb, then yes, we should disfigure the human body by attaching a prosthetic.

Medical officials fairly broadly agree that gender-affirming care improves the quality of life of patients, and so of course it should be allowed.

It's disgusting to try and use the law to force medical professionals to give sub-par care for no good reason.

> How is it 'disgusting' to try to let someone live as they were born?

I assume you're opposed to cosmetic dental braces for children? Even though just like gender-affirming care, they can lead to better self-perception and better outcomes (but 'disfigure' the child by making their teeth more aligned with stereotypical norms)

> Medical officials fairly broadly agree that gender-affirming care improves the quality of life of patients, and so of course it should be allowed.

This is not really true any more at this point in history. European countries have either backed away from pediatric gender affirming care, or they never allowed it in the first place. It's increasingly the case that the US and Canada are the outliers in the broader consensus that the evidence for the benefits of endocrine interventions in children is too weak to justify routine prescription.

> I assume you're opposed to cosmetic dental braces for children? Even though just like gender-affirming care, they can lead to better self-perception and better outcomes (but 'disfigure' the child by making their teeth more aligned with stereotypical norms)

Are we really going to try and draw an equivalence between cosmetic dental braces and permanently-altering hormones? A wire pulling a kid's teeth into places is not comparable to chemically castrating the kid for a few years and giving them opposite-sex hormones in their mid-teens. The measured benefits to the latter have to be way higher to justify that level of invasiveness and permanent change.

These kinds of blithe comparisons to the seriousness of gender-affirming care no small part of why trust on this issue has waned so fast.

> These kinds of blithe comparisons to the seriousness of gender-affirming care no small part of why trust on this issue has waned so fast.

No, let’s be real, this isn’t a dominant narrative in public discourse outside this thread. You’re irritated that you can’t simply assert a de novo principle of pediatric ethics that bans gender-affirming care without absurd collateral damage.

This isn't a de novo principle. It's pretty basic evidence based medicine: if a treatment has negative side effects, there needs to be significant evidence of positive outcomes to justify this treatment.

What "absurd collateral damage" have the UK, Sweden, Denmark, Finland, or Norway encountered when they banned endocrine interventions for treating gender dysphoric youth?

Talking with you is very difficult when you continue to conflate various claims and stances that are logically distinct.

OP said:

>>> How is it 'disgusting' to try to let someone live as they were born?

Asserting this as an ethical principle leads to absurdities. That’s all that occurred here.

> What "absurd collateral damage" have the UK, Sweden, Denmark, Finland, or Norway encountered when they banned endocrine interventions for treating gender dysphoric youth?

This is irrelevant to the point at hand (nobody here was discussing European medical policy), but this is not accurate. It’s strange, because you’ve correctly summarized what occurred elsewhere.

Let’s go review the situation at https://en.wikipedia.org/wiki/Puberty_blocker

> Danish guidelines published in 2023 recommend the use of puberty blockers on transgender patients at either Tanner stage two or three, as a means of buying time for patients to consider their gender more fully before making a decision.[119]

> In 2020, Finland revised its guidelines to prioritise psychotherapy over medical transition.[120] However, these guidelines are a recommendation, not a mandate.[121][122] The Council for Choices in Health Care allows the use of puberty blockers in transgender children after a case-by-case assessment if there are no medical contraindications.[123][124]

> In 2023, the Norwegian Healthcare Investigation Board, an independent non-governmental organization, issued a non-binding report finding "there is insufficient evidence for the use of puberty blockers and cross sex hormone treatments in young people" and recommending changing to a cautious approach.[148][149] The Norwegian Healthcare Investigation Board is not responsible for setting healthcare policy, and the Directorate, which is, has not implemented the recommendations, though they have said they are considering them.[148][146][125] Misinformation that Norway had banned gender affirming care proliferated on social media.[146]

Misinformation, by the way, that you continue to peddle in.

https://share.google/OfLzb9jqQywV1ZxOt

> While European health authorities aren’t instituting bans on treatment, currently minors in six European countries—Norway, U.K. Sweden, Denmark, France and Finland—can access puberty blockers and cross-sex hormones only if they meet strict eligibility requirements, usually in the context of a tightly controlled research setting. (Italics in the original)

Read through your quotes carefully:

> The Council for Choices in Health Care allows the use of puberty blockers in transgender children after a case-by-case assessment if there are no medical contraindications.

And how many of such cases were granted? This could be a de facto ban, if no such cases are granted.

> issued a non-binding report finding "there is insufficient evidence for the use of puberty blockers and cross sex hormone treatments in young people" and recommending changing to a cautious approach.

Again, how many new patients are being put on blockers after this recommendation?

You're trying to spin this false narrative that patients with gender dysphoria are still being prescribed puberty blockers as normal treatment for GD. This is not the case. Even though the legislatures in these countries haven't banned the treatment, effectively nobody is getting puberty blockers for childhood GD in these countries.

Actions speak louder than words. You can split hairs about how "recommending" the discontinuation of puberty blocks is not ban. But at the end of the day, what unambiguously true is that the vast majority of patients who are prescribed blockers in the US would not be prescribed blockers in these countries. If you have actual stats on the number of new patients prescribed blockers in these countries in 2025, by all means share it.

I read a study that said a majority of trans kids grow up to be gay if they don't take puberty blockers. I think it's wrong to force a gay kid to be trans.

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