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Comment by taraharris | Hacker News Reader

When you're an adult and you can't afford surgery with skilled surgeons, you get shunned by the less accepting parts of society, which leads directly to increased morbidity.

When you suppress treatment before adulthood -> higher surgical costs.

When you don't treat it at all -> quiet suicide, causes get buried in the statistics.

I lived through all of these things. It was an impossible childhood. I lived with this in total secrecy and agony until my early 40s. I'm 45 now, and I've had all my surgeries. I know what hundreds of thousands of dollars buying the best care can bring. None of that is available in Finland, where this study was done.

(I had the luxury of making my peace with my father before he passed.)

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The study involves a large number of people over approximately a quarter century, and its methodology is very robust. I don’t believe it’s an argument against recognition and kindness towards gender minorities, either intended or de facto.

It also focuses specifically on young cohorts so there are no people who loved in the closet for half of their lives. The range of medical transitioning described is by no means limited to surgery, and I don’t believe that therapy and hormones work differently in Finland compared to the rest of the world.

The primary takeaway here is that our understanding of gender and how to alter it is very poor and so treatment outcomes are often poor. That’s a call to more research and more efficacy, not calling trans people names and shunning them.

I understand why you’re defensive, it isn’t an unreasonable stance, but please do read the study at least.

It's telling that there isn't a single mention of surgery in the study or the interview.

Facial feminization surgery (FFS) exists but is extremely rare in Finland. After puberty, hormones alone can't change bone and cartilage structure, nor can they make vocalization congruent. Only surgery can do that.

Comparing what life was like before I had FFS+VFS, and I remember the way people treated me. After puberty locked in my bones, expecting life to be easy with hormone therapy alone simply wasn't realistic socially. Most people were incredibly judgemental. Life is a lot easier when people can't instantly spot you as something they see as abnormal.

I think you have a point, and of course no one study is going to be perfect. At the same time though one of the major strengths of this study is that it looked at large numbers of both MtF and FtM patients, and the results seem consistent, with both MtF and FtM sharing similar outcomes. If FFS was the key variable that was being ignored then you'd expect to see a stark difference between those populations.

The mean ages of participants also trended young, mostly still in their teens, which means that quite a few of the participants were receiving treatment before or during early puberty.

> see as abnormal

I see a lot of "abnormal" things daily, but only the results of people's own decisions attract attention.

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