Huge meta-study finds that transition helps trans people

[WAKAME]

whatweknow.inequality.cornell.edu/topics/lgbt-equality/%20what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people%20/

Some excerpts:

"We conducted a systematic literature review of all peer-reviewed articles published in English between 1991 and June 2017 that assess the effect of gender transition on transgender well-being."

"This search found a robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals. The literature also indicates that greater availability of medical and social support for gender transition contributes to better quality of life for those who identify as transgender."

"Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques."

"the health and well-being of transgender people can be harmed by stigmatizing and discriminatory treatment."

I've bumped it in FWR.

Neither of those studies compare pre-transition trans people with post-transition trans people so are not relevant to their study. You might like to see this interview with Cecilia Dhejne discussing the way people "misunderstand" her study here

While they, like all studies including the meta-study you posted, are too often taken out of context for a variety of reasons, if you're going to say 'transition helps trans people' then those studies are relevant. We can't just compare pre to post, we have to compare pre and post to the general population if we want, as too many say these days, that transition is a cure. Neither Dhejne nor the meta study seperate transition done with therapies to those done without because, as pointed out by Cornell, it would be unethical to encourage people to not use effective treatments. We'll only be able to look at such groups in hindsight.

At most, the Cornell study and the Dhejne study show a correlation between transition in dysphoric adults who choose and enabled to do so and improved well-being. None of it shows a causal link. The vast majority of dysphoric people don't transition and Cornell itself doesn't claim it as a cure or even best practice for those with gender dysphoria.

As Dhejne says in the link, there is a big noticeable differences in cohorts, those need to be recognized, treating things from 1991 to 2017 makes no sense when so much changed during that time on the topic at hand. Dhejne's study ended around when gender dysphoria moved from symptom to diagnosis, her better cohort went through medical evaulations and therapy and to transition would have been diagnosed not just with gender dysphoria. The concern is for those who came after, those with reduced if any evaluations or therapy, and we simply won't have good data on that yet. The concern is that things will have gone back to like Dhejne's worse cohort as there is evidence that there was more dodgy buying of hormones during the '70s and 'early 80s than later as more countries brought in better controls and proper access. As self medicating on hormones is having resurgence today and dysphoric people get less and less face time with professionals, it's likely the current cohort will differ from Dhejne's better cohort.

Also 56-73 studies isn't really 'huge'. Many meta-studies look at hundreds. This is a small-medium one. Making things bigger than they are doesn't make them look more important.

Dhejne's study ended around when gender dysphoria moved from symptom to diagnosis, her better cohort went through medical evaulations and therapy and to transition would have been diagnosed not just with gender dysphoria. The concern is for those who came after, those with reduced if any evaluations or therapy, and we simply won't have good data on that yet. The concern is that things will have gone back to like Dhejne's worse cohort as there is evidence that there was more dodgy buying of hormones during the '70s and 'early 80s than later as more countries brought in better controls and proper access. As self medicating on hormones is having resurgence today and dysphoric people get less and less face time with professionals, it's likely the current cohort will differ from Dhejne's better cohort

This is a really interesting point.

We can't just compare pre to post, we have to compare pre and post to the general population if we want, as too many say these days, that transition is a cure.
Well really, we should compare:
GNC individuals who think they might have gender dysphoria randomised into:
Arm 1 "Non-affirmation treatment" (general mental health treatment, advising against transition, educating on the prevalence of same sex attraction in GNC individuals, affirming same sex attraction where relevant)
Arm 2 "Affirmation mental health treatment" (general mental health treatment, advising on social transition and affirming social transition when chosen).
Arm 3 "Affirmation plus active cross sex hormones" (as arm 2 with active treatment cross sex hormones if still desired)
Arm 4 "Affirmation plus placebo" (as arm 2 but placebo, double blind if hormones still desired).
Arm 5 as arm 3 but offered surgery.

And outcomes for all individuals including measures that are objective (e.g. questionnaires where the person conducting the questionnaire and analysing the data never sees the patient).

But that would be totally unethical (except that we actually don't know the outcomes of a properly controlled study... so it wouldn't).

It is OK that some in some arms would move to another arm spontaneously because it would be an "intention to treat" design.

Oh sorry we would also need:

General young adult controls: who would go through Arm 1
Same sex attracted young adult controls: who would go through Arm 1.
(Ideally they would be randomised into Arm 1 and Arm 2 but again that would be unethical).

Apologies if it's been covered, but I'm glad the OP has posted this here, in FWR. I think it's disingenuous to have a go at them tbh.

If there was no context it would be irrelevant, sure.

But given the context of people not only talking about how trans rights affects women's rights but also actively campaigning on this, it certainly does help us protect women's rights to be aware of studies like this.

www.engage.england.nhs.uk/consultation/specialised-services-consultation/user_uploads/gendr-ident-policy.pdf

NHS Clinical commissioning document :

"Overall, there is only limited evidence to demonstrate the efficacy of hormonal therapy or gender reassignment surgery with regard to long-term complications or physical functional status"

@GibbertyFlibbert "So when you want to enter one of these mythical same-sex spaces how are you going to prove your right to be there to the door-keeper? Are you going to prove your sex? I doubt it. And if the door keeper asked for proof of sex I bet you would be terribly offended."

I would not be offended and i would be happy if we could have a fulproof way of proving our sex.

"I suspect you expect to be admitted based on your gender presentation?" I expect people can tell I am female and even if I dressed in male clothing I doubt I would fool anyway.

"And actually that is what you want." I want myself, my 80 something MIL and my teenage daughter (and all other females) to have toilets, changing rooms, medical overnight facilities etc which are based around sex, not gender, that is what I want. I accept the Gender recognition certificate and the fact that trans women with a GRC will also be in these spaces. I would still want rape services and medical services (like smear tests) and domestic abuse centres to be female sex only.

"Of maybe you would like to have to prove your sex - whatever that means - every time you want to swim or go to the gymn. What a terribly retrograde step that would be for feminism." No actually being able to have a way to show I am a natal female and that my rights should be respected would not be retrograde at all.

Increasingly, it is important for women and young girls to know they deserve single sex spaces and the rights of males should not take precedence over our won rights.

over our hard won rights

I wonder if the authors of this report did a long term follow up. I've read posts from Trans people who thought SRS would solve all their problems and when it didn't were more suicidal than before. I've also read a case where a TIM had SRS the surgery went wrong and now they are also suicidal. I bet those cases were not covered in this.

"No actually being able to have a way to show I am a natal female and that my rights should be respected would not be retrograde at all. "

How do you intend to do that?

@GibbertyFlibbert "How do you intend to do that?"

Well if I were sent to prison i expect they would know I was female so I'd expect that to be a female only environment. And when I was hospitalized I was on a female ward, so I guess they knew.

They are the big ones for me.

There is no one at the door to the ladies loo, at work, checking who is using it - so of course that is not relevant.

Every swimming pool I've used over the last couple of years (about 6) has been mixed and that's been OK.

I don't do professional sports but if I did I would hope they would have a way of knowing I was female.

But why do I need to defend my desire for female spaces when we know already some things in our society are segregated by sex?

Why does any male who identifies as a woman think they get the right to female only spaces? It makes no sense. If they are suffering from gender dysphoria and intend to actually 'transition' then why not go through the process for a GRC? Why demand the right to self id? I think it just weakens our perception of what it means to be trans.

This metastudy reviews many peer-reviewed studies but has this metastudy itself been peer-reviewed and published in a journal, and then critiqued by the wider scientific/medical community?

I think what’s often missed/misrepresented re this hyperfocus re toilets is that it’s primarily socially policed and self imposed.

I’m not so bothered about a small number of people within the trans group causing trouble in women’s toilets or committing crimes.

What I am bothered about is that if toilets are made unisex spaces then abusive men will not have any reason to stay outside when a woman seeks refuge from them and their behaviour. A toilet, rather than being a refuge will become a risk, women will not even be able to use the toilet to piss when in the company of an abusive man for fear he will follow her in she will be in a private space with him.

I believe the vast majority of women have sought refuge in the female toilets when experiencing a wide range of abusive or unwanted behaviour from men in public many times in their lives.

I think the fact that single sex toilets and this use of them is such a ubiquitous thing that most women have never really thought about the fact they are using them on many occasions for that function.

Of course there is nothing stopping a man from actually going in to the toilets if he is minded to, except himself and his assessment re the risks posed to him of doing that or his unconscious socialisation re them being places he is ‘not allowed’.

If they are gender ID segregated rather than unisex then the social enforcement/ideas depend on whether people in practice make determinations based on sex/gender ID and I worry here that actually in reality most people make determinations based on sex so to abusive men a trans woman is a reason they are also allowed in.

The only thing acting against this would then be homophobia/transphobia re not wanting to be associated with trans people who they are prejudiced against.

That social policing has been so powerful that abusive men have rarely entered women’s toilets in order to continue unwanted or abusive behaviour. They will bang on the door and shout but not take the step of entering.

Yes I agree. I don't want it normalised for males to be in female spaces.

Offred The hyper focus on loos bothers me also. I think the TRAs drive it because, of all of the normalised sex segregated provision, it is one that many people may feel less bothered by. Floor to ceiling cubicles etc. can lead lots of people to saying that mixed sex would be OK. I don't think there would be such buy in for hospital wards, prisons and changing rooms etc.

The bottom line is that single sex provision is not about gender or gender identity. Society needs to decide on which areas are OK to be mixed sex and which are better being single sex, and then this should be determined by sexed bodies. I don't think there would be any difficulty getting mass buy in to this idea.

Going back to loos, at the Tavistock (the leading GIDS service for children and young people), the loos are single sex except for one floor where there are gender neutral loos. This seems like the sensible way forward with loos. Individual organisations could decide on the balance of gender neutral and single sex, but they could cover all options. This would keep all but the TRAs happy I guess.

Floor to ceiling cubicles still leave women potentially in a private space with a male abuser/harrasser... this is more risky than being in public with a male abuser/harasser.

Men who abuse women do it because they are sexist. Transphobia and homophobia in these men often follow because for them those hatreds flow from sexism.

"noticed the thread from Wakame on transition studies. Women should know he's a well known troll from other boards"

It's "she" actually. "Troll" seems a little harsh - are you suggesting I should simply accept what you say about trans people in silence?

"My heart sank when I saw them posting here."

I'm sorry to hear that - I am only a trans woman with information. If I am wrong, then you needn't worry about me. If I am right, then it's an opportunity to learn :-)

"What's funny is reading when Wakame posts in the comments on Feminist Current articles. They take no prisoners."

As a reader of my comments on Feminist Current, then you will know that I try to be polite (although I am occasionally prone to both irony and mild sarcasm) and I try to back any claims I make with science and logic.

"Although, they are useful for peak transing folk."

Yes - no one on Feminist Current had reached peak trans until I arrived - before me, they were al extremely encouraging of trans people, especially trans women - happy to share toilets with us, always respectful of pronouns etc. Don't know where I went wrong really ;-)

Could possibly the ideology you are attempting to groom the nation with Wakame?

"We can't just compare pre to post, we have to compare pre and post to the general population if we want, as too many say these days, that transition is a cure."

You are free to do a study comparing post to cis. This particular study is not about that - it is about pre to post. "Cure" is not quite the word. I am post and I still have some gender dysphoria, but I went from desperately unhappy for many years, to being happier than I knew it was possible for a person to be. Sure, I get twinges of dysphoria from time to time but, to make an analogy, imagine if you used to suffer intense profound headaches every day for many years starting in your early childhood. They were so intense, you couldn't get on with a normal life - you just hid away, desperate for the pain to go away, crying yourself to sleep and wondering what the point of being alive was, then you tried a new therapy and your life is transformed. Now you still have occasional headaches, so you could say that you are not exactly "cured", but the headaches are mild - last a hour or so and don't impact on your day to day life or your general happiness.

"The vast majority of dysphoric people don't transition"

Do you have a citation for that? I would be interested to see it.

"As self medicating on hormones is having resurgence today and dysphoric people get less and less face time with professionals, it's likely the current cohort will differ from Dhejne's better cohort."

But we have the internet now, with lots of forums where people can learn what safe doses are and where to acquire genuine hormones. We will see where this is all heading in due course, though the Cornell study does go up to 2017.

"Also 56-73 studies isn't really 'huge'. Many meta-studies look at hundreds. This is a small-medium one."

It's by far the biggest done on this particular group. If you have a larger one, perhaps showing the opposite result, you are free to post it. If not, then I am sure you will agree that we can at least say that according to the best studies we have, transition has a positive effect on people suffering from gender dysphoria and we can therefore discount claims to the contrary unless those making the claims present evidence that supersedes the Cornell study.

We can't say that by comparing pre with post though. We can only say that by comparing a randomised group of transitioners to non-transitioners, as in my proposed study design above.
People who are in a mental health crisis can get better spontaneously. May have nothing to do with the treatment. This is why we carry out RCTs.

This metastudy reviews many peer-reviewed studies but has this metastudy itself been peer-reviewed and published in a journal, and then critiqued by the wider scientific/medical community?

I am not sure why it is being called a meta study. It is a collection of surveys and studies made over the years and has been posted here before as proof.
Trouble is when people looked at the "studies" they discovered they were not what they were purported to be. Some even demonstrated the opposite of what was being claimed in the popularization of the "studies".

It is very frustrating to deal with people who only care about winning their way and care nothing about the collateral damage they do along the way.
Transitioning away the Gays and Lesbians is an evil thing to do from a moral perspective.
Stripping women of their right to privacy and dignity is an evil thing to do from a moral perspective.
Demonizing women who say no to transitioning their toddlers is an evil thing to do from a moral perspective.

"Transitioning away the Gays and Lesbians is an evil thing to do from a moral perspective. "

A survey of roughly 3000 trans women showed that only 23% of them identified as heterosexual, with 31% as bisexual, 29% as lesbian, 7% as asexual, 7% as queer and 2% as "other" so by your own argument, transition increases the number of lesbians. But seriously, are you saying that trans women who are attracted to men should be forced to live as gay men?

"Stripping women of their right to privacy and dignity is an evil thing to do from a moral perspective. "

For that argument to work, you will first need to establish that trans women are not women.

"Demonizing women who say no to transitioning their toddlers is an evil thing to do from a moral perspective."

Refusing the most effective treatment for a recognised medical condition in children that causes depression, self-harm and suicidal ideation, is child abuse. If you know of a more effective treatment, please cite it along with evidence of its efficacy. In the meantime, you may find this recent study informative:

www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext

"Trouble is when people looked at the "studies" they discovered they were not what they were purported to be."

The only example so far cited (as far as I can see) seems to be a man on Twitter who says he isn't at all academically qualified, but still thinks all the studies are wrong. You will need something a little weightier to counter the Cornell study.