Netherlands Puberty Blocker Review Comes to Opposite Conclusion, Dismisses Cass Review

Fair point!

We have no way of proving that god is real and we have no way of proving that gender identity is real. Both are real to those who believe they exist. To those that believe in them, several things are also true, including things that biological science says are impossible.

I'm aware you and I won't agree on the medicalisation of children who hold a belief that they have a gender identity that differs from their sex but can I ask where you would stand on other belief-centred medical interventions for children?

For example:

• religiously-led circumcision
• religiously-led FGM

We don't have robust medical evidence for the benefits of either of these. However, here are definitely lots of people who believe that there are benefits.

I googled what the documented harms of each would be. There are multiple complications with both, some severe, including death. This is also true of the documented harms of PBs. There was one death during the trial that led to the Dutch protocol being developed.

Should we run NHS trials on circumcision and FGM for a couple of years to test out the balance of benefit and risk? As children are too young to consent, their parents would need to do it and the children would need to assent to confirm that they understand the choice that they are making.

If a child wanted a foreskin or clitoris replacement at the end of the trial, this could be done. We have no way of knowing if this would be successful, but that's similar to the unknown with the PB trial where we have no idea if any potential brain damage will be reversed or whether the development windows that Sallie Baxendale describes will have closed permanently.

The beliefs behind circumcision and FGM are religious. The belief behind "gender affirming care" is philosophical.

Is a firmly held belief ever enough to justify trialling medical interventions to gather evidence on their efficacy and safety?

Edited for clarity.

Put bluntly, to me, Mary had sex with a man other than Joseph and managed to convince everyone that she hadn't

Surely the most obvious explanation is that she just had a sex with Joseph? ☺️🤪

@AimsAndObjectives yes, I think you're right that there are better tenets of Christian belief I could have picked. For me, the most non-sensical one is the idea that Jesus was conceived without sperm.

@Cairngormwildfire yes, I imagine many Christians believe that god started the process of the big bang.

Sunnibee has been posting lots of thoughts on what gender identity means and why it's reasonable to allow medicalisation as a means to support someone whose gender identity doesn't match their sex. There has been a lot of criticism from PPs about not really answering what gender identity is.

I think it's as impossible to argue what gender identity actually is as it would be for someone to make a clear case for Jesus being born without sperm.

Put bluntly, to me, Mary had sex with a man other than Joseph and managed to convince everyone that she hadn't. I think this because I know biology is real and I don't believe that god exists. However, I will never convince Christians that I'm right and they will never convince me that I'm not.

The same is true if someone holds a belief in gender identity. Given Sunnibee does hold one, I can see why it's a conundrum to know whether the cruelty is in giving the PBs or not giving them. To me, that's why we each ended up conceding to the other that there was nowhere else for that particular conversation to go. The most interesting moment for me came when we both agreed the most sensible thing to do was complete the data linkage study before undertaking any trial.

Seethlaw's position is different. Yes, there is a belief of some kind of inner self that is masculine, but the difference is in recognising that this may have come from without, e.g. a maternal influence, rather than it absolutely definitely having come from within.

Just as with variations in Christianity, when tenets of the belief colide with biological facts, each believer has to find their own lines between belief and observable, empirically provable reality.

With gender identity, believers who don't want to concede that it's possible that gender identity may not come from within are left with a choice of doubling-down on using tenets of the belief as the only way to be kind or coopting DSDs to "prove" some form of spectrum of sexes. The latter can be completely torn to shreds scientifically.

With Christianity, we're 2000 years too late to bring in paternity tests and CCTV footage of who Mary was hanging around with around the time when Jesus was conceived. Thankfully Christians stopped demanding everyone follow the tenets of their belief a long time ago and the NHS doesn't deliver healthcare based on any of it being real.

Edited for clarity.

Oooh, that looks really interesting! Thanks for the rec!

@Seethlaw if you haven't read it can I recommend this book?
Nothing about sex/ gender / dysphoria, but it's a real insight into the neuro-cognition of body awareness. The book argues that our experience of our own bodies is not simply a direct readout of the physical body. Rather, the brain actively constructs a "phantom" representation of our body ( body map). This representation is partly hard-wired but remains plastic, meaning it can sometimes be altered by changes in sensory input or experience.

except in phantom limb cases, the brain remembers a limb that used to exist and be attached to the body, which makes sense, while in my case, my brain wholesale made up a limb that never existed, and refuses to acknowledge the existence or position of bits that do exist, which is... a lot weirder

Actually I believe it can also happen in cases where people are born without limbs!

And also very telling in the context of this thread.

Clearly gender dysphoria doesn't extend to distress at missing the parts of the opposite sex's body one doesn't know about. Only the phyiscal differences one knows about cause distress,

Highlighting again that for all the talk of body map, both the map and possible distress because of it are products of the mind constructing meaning based on what it experiences.

Gender dysphoria is a mental distress entirely within and caused entirely by the (sub)concious mind and the associations that person subconciously projects onto body sex. It's not an unmediated experience.

I've said it often already- I think the trans fantasy falls into the same bucket as clairvoyance, shamanism, mediums, resurrection, underwater humans, gods and so on - a very obvious metaphor for the subconscious mind to seize on to explain/label a need or feeling.

Death, animals, fate, water, the opposite sex; all universal and familar but also ultimately barriers we can never cross. No wonder the human mind ascribes meaning and significance to them beyond their actual factual existence.

That's why it's funny. And also sad that someone should go to such lengths to get a simulacrum of female anatomy and either nobody's explained or IW has not understood what female anatomy actually is and the limits of what they can give a male person.

But surely that's physically impossible for any woman unless using a speculum and a tiny camera. I think Willoughby just doesn't understand what a cervix is, probably means 'vulva'...

Most Christians are under no obligation to believe Genesis is scientifically factual. They might have other non-scientific beliefs that they are required to profess and those would make a better analogy for you than cosmological theories.

If they also believe that the big bang was real, they will need to reject god as the creator of the universe

Missed the original post with this and a bit off topic, but why would believing in the big bang prevent you from believing it was instigated by God?

I'm definitely thinking of all Christians.

If you're a Christian who rejects creationism, of which there are many, you presumably choose which bits of Genesis are just a story. To some Christians the entire Bible is true.

I presume that most Christians believe Mary was a virgin and that Jesus rose from the dead... Setting aside artificial insemination on the former, both are biologically impossible of course.

Believing that Jesus was a man and the son of a deity is another good example of a belief that clashes with reality.

When belief conflicts with scientific facts it's very personal as to what people believe.

Mr Menno has an hilarious instructional video & song about India & his cervix.

@BonfireLady For some people, the existence of god explains it. If they also believe that the big bang was real, they will need to reject god as the creator of the universe

All that big bang theory, or any other mainstream cosmological theory, does is attempt to explain the way in which the universe evolves from its initial state. They cannot explain why there is an initial state. Even cyclical cosmological theories cannot explain why there is something rather than nothing. At times I have believed in a god and at times I haven't; it makes no impact on my scientific reasoning. Perhaps you are thinking of literal Creationists?

He not only thinks he has a cervix but wants to flaunt it on TV.

Yes.

I don’t understand how medical care can treat somebody on the basis that they have dysphoria, (disconnect between mind and material reality) but also be part of a movement that takes the ideological view that material reality is irrelevant.

’TWAW’ is where it all breaks down.

Using the word "gender" doesn't require a belief system. Using the phrase "gender identity" does.

"Phantom sex" sounds like a good description for anyone who genuinely experiences distressing dysphoria about their sexed body and finds that imagining it to be the opposite sex alleviates this in some way. It doesn't explain the fetishists' experience, but nor does gender dysphoria currently.

Did you get chance to read the blog I linked above? For me, having a societal understanding of the difference between a fetishist and someone genuinely experiencing phantom sex (or whatever we call it) is critical. Without that difference being clear, we're never going to help distressed children or adults. This relates to point 1 on your list of key questions: describing what the phenomen is. It needs decoupling from the fetish.

This then leads to your second numbered point. It's possible to acknowledge that the experience is real while still seeking to find and treat the underlying reasons that led to it. The success of this will largely come down to how wedded the person is to the belief that we all have a gender identity. If that's their start point, there may be no possibility of ever getting deep enough to understand what caused the distress because there will be a foundational understanding that it's a mismatch between a firmly held sense of gender identity and biological reality.

Regarding point 3, if someone believes we all have a gender identity, there is probably no way of ever establishing how separate these things are in their mind.

@Sunnibee
I'm not sure these two statements sit well together.

These people generally aren’t claiming to have the opposite anatomy. They’re perfectly aware of what their bodies are.

and

Gender is real in the sense that is it a real psychological-/ neuro cognitive experience . That "body map" in your brain and what it's telling you- that experence is real

Depends on whether India Willoughby understands what a cervix is. Also, is there any chance surgeons have learnt how to make and insert a plastic cervix?

Yep ...back the question that was never answered way back at the start of the thread:

Is "being trans" a feeling one is the opposite sex, despite being the sex one is?

Or is it actually, truly, in a not-yet-understood way, genuinely being the opposite sex, in a way that makes you genuinely more like the oppodite sex than your own actual sex?

And if the former, why does believing yourself to be something that you are not place an obligation on the rest of the world to pretend you are?

And if the latter, why is this "thing that no one can perceive and that is not sex" suddenly now the "real" definition of Man or Woman rather than the simple observable fact of sex?

And even if it somehow is reasonable that this "thing that is not sex" has to ne the yardstick for a man or a woman, why it is also necessary to pretend the thing that is sex doesn't matter and doesn't have consequences as well?

Are people in favour of children being given puberty blockers and made sterile and likely brain damaged because they believe it is the best way to relieve the distress of the dysphoria, or because they actually believe men and women are labels for our minds rather than our bodies?

And adding another - if it's simply to relieve distress, what happens next?

Are the people advocating PBs implicitly writing a blank cheque that the trans person will be accomodated as the oppodite sex in all things going forward and placing an obligation on society to cash it because otherwise BANG, back comes the dysphoria which we already established is so bad it justified blocking healthy psychological and sexual development? In a society that let that happen are we really going to be allowed to say "no" to the further demands that will undoubtably follow (and follow with the additional emotional blackmail of the damage already done)?

And if not, where does the actual boundary lie, after they already accepted so much?

I think we have good evidence that some people can take against various bits of their body in a way that they simultaneously know is "not so", and yet can't help doing because there is a quirk of some kind in whatever maps their body; and that it is sufficiently distressing in some cases to lead to extreme action in trying to alleviate it.

Where the anomaly (and the ideas) come in, is in treating such a state of mind about sex-related bits of the body differently from a similar state of mind about other bits of anatomy, eg arms and legs.

I wonder if it is because the existence of another sex gives the illusion of a viable alternative which isn't there in the other cases. Despite talk of being "differently abled", the stark truth is that someone without their legs, arms, eyes etc is disadvantaged compared with a human being who has the full set of kit. They aren't simply a different kind of human being and anyone desiring that situation is clearly in an unhealthy state of mind.

But if it's your sexed bits you don't like, because the opposite sex exists it's possible to imagine being a fully functional human being of a different kind and entertain the idea that you are "really" that other kind in some way. In other words, in the cases of sex-related characteristics, what is different is not the mis-mapping but the interpretation of what the mis-mapping signifies.

The situation is complicated by the fact that sex has become so socially loaded that people can also have all sorts of motives (conscious and unconscious) for wanting to abandon their natal sex, which have nothing to do with how their brain maps their body. (Escaping from misogyny is an obvious one.) There is less incentive to desire body alterations of other kinds.

Science addresses the how. Religion addresses the why.

@AimsAndObjectives this is a good example of what I mean by someone's own personal balance and acceptable level of cognitive dissonance.

As a non-believer in god, I have accepted that I have no answer whatsoever about why the universe happened, why we have consciousness and all that stuff.... other than "something started it all because it did". I'm quite happy with that being unknown and don't need religion to fill in the blanks for me. For some people, the existence of god explains it. If they also believe that the big bang was real, they will need to reject god as the creator of the universe but can presumably still have space for god as the creator of consciousness and the "souls" associated with this (i.e the part that is the mind, where it is separate from the body).

I feel similarly about the interactions of biology (e.g. testosterone-driven aggression and libido) and societal influence that might explain why we end up with sex-based stereotypes. I spent a lot of time learning why people thought of this as a gender identity, initially assuming that I had one too. I also learned some interesting aspects of feminist theory. The more I researched, the more I realised I didn't believe that everyone has a gender identity.... and that I'm totally ok with not knowing more about why we have a whole spectrum of societal behaviours that match or differ from sex-based stereotypes. I took my exploration of feminist theory as far as I had an interest, which I imagine to be a lot less than many posters on this board.

One thing I've noticed that I do find interesting is that some Christians get annoyed with me when I position their belief in god as just as real (or not) as someone else's belief that everyone has a gender identity. To me they are just as non-sensical as each other, but I know that plenty of people believe in either or both. Recognising this is why I don't use the word "delusional" to describe anyone's belief.

Everyone has their own appetite for seeking and getting answers on Life's Big Questions.

Again with the strawmen and distinctions without difference.

Apparently because the mind knows reality does not match the belief, it can't be a delusion.

But the delusion is not that the body isn't what it physically is, but that the mind is somehow wrong for the body. The delusion is the transgender identity, the persistent belief that a part of one's mind is incorrect for one's body. When of course any given mind is the product of one specific body. It may be unhappy but it cannot be "wrong", any more than a body can have the wrong shadow.

Also time for the regular reminder of the rubber hand experiment that shows the body map is not innate, but something actively produced by our mind based on our experiences, and as such it can be induced to "map" sonething we fool ouselves into believing in.

That "body map" in your brain and what it's telling you- that experence is real- whatever ideological beliefs you hold, that body map persists , and that it is what people refer to as "gender identity".

Then it's a complete misnomer, because it's got nothing to do with "gender" and everything to do with "sex". I have sex dysmorphia or something, not gender dysphoria.