Do transmen suffer from a form of autogynephilia or do they have 'genuine' gender dysphoria?

[GaIadriel]

Not looking to stir things up although I do appreciate this may be a controversial question.

I've read so much about how transwomen are often motivated by sexual perversions etc, and my kneejerk reaction is that it's certainly feasible. However, when I think about transmen it becomes a little bit more ambiguous.

I'm not sure I buy the argument that it's to 'escape from the pressures of being a female' as is often claimed because male hierarchy seems much more brutal and unforgiving to my eyes and seems to punish the 'weak' to a much greater extent.

When a female presents as male and uses male facilities (as many successfully do due to passing much more easily than most TW) what is their motivation for doing this?

I think this is much less true than it used to be. Especially with girls.

What makes you think that?

I think there are more populations represented now.

Among girls I am seeing fully half seem to be heterosexual. Proportionally that is high, but I would not want to say that most of these girls are lesbians, that gives the wrong impression imo. There seem to be more and more who are invested in the sexual element of being a "gay man."

I also think parents bringing quite young kids can be all over the place now. I wonder too if some have been interpreted as gay when they shouldn't have been - people often describe Jazz Jennings as a boy who would have been gay, in reality there is zero evidence of that given that he was 3 when socially transitioned and never had any sexual interest in anyone due to puberty blockers

And then makes xlso include quite a lot of AGP types. They used to merge publicly later in life, but the rise of gender ideology seems to mean they are now identifying that way even in the late teens.

Statistically, yes, I believe so. Men are more likely to be killed, men are more likely to be stabbed etc.

But in the scheme of things, those events are vanishingly rare. I've been punched in the face completely at random twice in the last 20 years. (Really weird coincidence, both times it was Friday 13th December!) And I'm unlucky compared to most men, most of my male friends have never been in a fight at all. Violence for men isn't a daily worry. It's random, it's abstract, it happens to other people, until it happens to you.

Violence against women on the other hand is all the fucking time. It may be lower level a lot of the time, but it's a constant worry. DD first got cat called at age 11 (and yes, I'm counting that as violence. It's behaviour designed to intimidate). DP has had her arse grabbed twice in the past year. Men generally don't have to worry about their partners physically hurting them. That the date their on is going to rape them, that the person they've trusted completely for decades is going to suddenly decide tonight's the night he's going to choke them during sex for shits and giggles.

And then there's the biases with statistics. Men deal with more serious violence because men put themselves in dangerous situations more. I got punched in the face the first time while walking home along a deserted street alone at 2am. How many women do that. Men are more likely to be stabbed in gang violence for the simple reason that men are more likely to be gang members.

And then you've got reporting biases. Men are more likely to report violence towards them because that violence has been done to them by a random. How much domestic abuse, how much rape goes unreported because the abuser is the woman's husband.

I realise I'm preaching to the choir with the above ( and also that this is a complete digression from the original point of the thread), so sorry for that. But no, the fear of violence just doesn't feature in mens lives in the way it does for women.

"I did not equate short-term or ‘mistaken’ cases with long-term cases. My point was and is heterogeneity: different people may arrive at a trans identity through different routes."

But the route indicates authenticity to the term. Like women seeking lesbian partners because of bad experiences with men not because they are exclusively same sex attracted. These women aren't lesbians & diminish the meaning of 'lesbian'.

"Judging from your response, I am given the impression that you’re attempting to preserve the pure category of ‘real trans’ people by excluding detransitioners and ‘transitory’ cases. But who decides who is really trans before medical intervention? By what test? Duration? Degree of dysphoria? Willingness to undergo hormones or surgery? Childhood persistence? Adult insistence? Neurological essence? Ironically, Aisha, the moment you try to answer this you will have abandoned the activist slogan-world and entered the very terrain of scrutiny you are currently condemning."

The fact their claim to being trans isn't based on gender identification rather escapism. That they may undergo transition doesn't change that.

Another thing: you say that detransitioners are very few in numbers - and even if that were true, it still does not make them irrelevant. Rare harms still matter in safeguarding, especially where minors are involved. Sterility, sexual function, mastectomies, endocrine disruptions, lifelong medical dependence are not trivial things.

They are irrelevant in terms of what defines a trans person which is gender identification not escapism.

Harms occurring as a result of misdiagnosis are common to all areas of health care & yet treatment isn't withdrawn because of it. Let's not forget The Cass report never banned gender affirming care but like all other European countries that have conducted reviews only restricted it to candidates who are more likely to maintain their trans identity long term which indicates its continuing utility.

In terms of serious side effects & costs, a good many other medications & treatments are known to produce such results & yet are continued to be made available because the trade off is considered of greater benefit with mental health considerations being one of them.

While some may be skeptical about mental health outcomes it can't be denied that 'passing' & social acceptance go hand in hand that has implications on an individuals well being. In fact one of the greatest risk factors for suicidality in the general population is social acceptance. When you combine that with other mental health/suicidality risk factors of family rejection, homelessness, addiction, mental health problems & unemployment which trans people often suffer from makes for them being potentially at an increased risk of suffering.

Lastly you object to pathologising, yet you immediately offer your own causal theory: ‘genetic & hormonal dispositions that drive personality inclinations’. That is also an explanatory model. It’s fine if you believe that some people are born with a predisposition towards sex-atypical behaviour and dysphoria (generously assuming that is what you mean and not ‘brain sex’ or ‘gendered souls’), but when making a claim that trans identity is caused by innate biology, then you are indeed making a causal claim and must accept scrutiny. And if causal scrutiny is bigotry, then you shouldn’t invoke biology as proof when convenient. It’s wanting the authority of science without the inconvenience of being examined by it.

It's scientifically uncontroversial that genetics & hormones influence gendered personality traits that by extension result in gendered inclinations/behaviours which are shared by both sexes. That there are average differences in how these gendered inclinations are distributed between the sexes doesn't implicate the impossibility of diversity. See: Butch females/effeminate males.

What's bigotry is dismissing the uncontroversial plausibility of normal biological influences by deferring automatically to social environmental influences or mental health disturbances.

"And as I mentioned in my previous post, not every trans-identified person agrees upon what makes one trans. Many genderist activists would decry the ‘innate biology / dysphoria’ requirement as bigoted and gatekeeping."

I'm not aware of any genuine trans people claiming their gender identification doesn't emanate from any thing other than a personal inclination. Can you elaborate on what this?

Many trans people know and understand that their gender identity doesn’t match their sex assigned at birth yet they don’t experience dysphoria so dysphoria isn't a defining characteristic of being trans. Not every trans man, trans woman, or non-binary person experiences emotional pain, discomfort, or other negative feelings deriving from the body in which they live & not everybody needs to take any steps to medically transition in order to express their gender identity and live as themselves.

We’re collectively being told to affirm affirm affirm, don’t question, make access to medicalisation easier, support and encourage and play along. What happens when you do all that, and the young woman in question eventually turns out to be one of the ‘transitory trans’ you’re describing. For years she socially transitioned, medicalised, made irreversible changes to her body. Do we just throw our hands up and say, ‘Well, guess she wasn’t REALLY trans after all’ and move on? Because we weren’t allowed to question or examine the why when it was happening in real time, only affirm, and now she has to deal with the consequences for the rest of her life. That is indescribably callous.

Like any other treatment, appropriate evaluations can & need to be made to avoid misdiagnosis as the Cass report recommended.

Like any other treatment, appropriate evaluations can & need to be made to avoid misdiagnosis as the Cass report recommended

I don’t think “appropriate evaluations” are possible anymore, not now that “trans” encompasses children and adolescents with so many mental health co-morbidities.

Remember that to be eligible for the original Dutch study - the only one that showed that the PB/cross sex hormone in children improved mental well-being in adults - participants needed to be entirely free of any other mental health disorders. They were also mainly boys.

So, so different from the anxious, dysregulated, socially isolated, often autistic, often traumatised cohort of trans identified teen girls now.

If you go back to diagnostic basics though, the only group who benefitted from early hormonal intervention were the otherwise well-adjusted and mentally well. Whereas now the opposite seems to be true, doesn’t it? Mentally unwell early teen girls quite often co-opt a trans identity as part of their overall, mentally unwell profile.

Some people may argue that they are mentally unwell because they are trans, but they just didn’t realise it yet 🙄 but, if that were the case, why don’t they feel more content with hormones? The original cohort did, yet, as per Cass, there’s no strong evidence that “gender-affirming care” improves well-being.

The Cass report has led to recommendations that CAMHS treat and stabilise trans-identified children before gender clinic referrals - presumably in an attempt to more closely align with the original Dutch cohort. However, there’s a world of difference between a medicated teen girl who says she’s trans and who also has GAD/OCD/ADHD, is home educated, spends hours on line and few friends and a mentally healthy teen who is well-adjusted, has friends, doing well at school and who has a good sense of self and whose only issue is being “trans”. In fact, I don’t think the latter group exist anymore.

"(some of them, such as the assertion that 90% of women have AGP so it's an invalid concept are so silly they're self refuting), but needless to say, I reject them."

More like it's not worth refuting a normal behaviour because you can't.

Around 2016/2017 I read an article by a psychiatrist who said that his anorexia patients had almost been completely changed to gender identity patients. He said that they were the exact same type of girl- high achieving neurodiverse perfectionists with anxiety disorders. His view was that these girls needed control in an uncontrollable world. Previously these girls had been controlling their food intake but now they were controlling their puberty through blockers and planned surgeries.

I would be really interested to know if further research has been done on the crossover between eating disorders and trans identities.

All of the trans identified girls I know fit the above description. I move in middle class circles. My social worker friend sees trans identified girls who are a different cohort- it’s a trauma response.

Funnily enough I observe the girls I know are always deeply uncomfortable when surrounded by groups of teenage boys. I don’t actually think they want to be boys. They just want to not be girls.

I don’t think “appropriate evaluations” are possible anymore, not now that “trans” encompasses children and adolescents with so many mental health co-morbidities.

That's like saying any medical evaluation can't be made if co morbidities exist which is patently untrue given assessing how multiple conditions interact is a standard, essential part of modern clinical practice.

Remember that to be eligible for the original Dutch study - the only one that showed that the PB/cross sex hormone in children improved mental well-being in adults - participants needed to be entirely free of any other mental health disorders. They were also mainly boys.

These older studies have been heavily criticised for being too small in numbers.

So, so different from the anxious, dysregulated, socially isolated, often autistic, often traumatised cohort of trans identified teen girls now.

Anxiety & social isolation are often a byproduct of 'not fitting in' or being socially rejected because of trans identity rather than cause it. Autism is associated to sensitivity & stubbornness so its also quite possible that individuals who are more self aware & less vulnerable to social pressure are more likely to publicly identify as trans. Its also important to note the social cost of coming out as a trans man is much less than that of a trans woman.

"If you go back to diagnostic basics though, the only group who benefitted from early hormonal intervention were the otherwise well-adjusted and mentally well. Whereas now the opposite seems to be true, doesn’t it? Mentally unwell early teen girls quite often co-opt a trans identity as part of their overall, mentally unwell profile."

There's no causal link between poor mental health & being trans. That gender affirming care doesn't improve mental health problems doesn't take into account its also been shown mental health doesn't deteriorate that is often the case without care which indicates preventive care. As mentioned upthread, 'passing' & social acceptance go hand in hand that's a necessary part of mental well being so to assume gender affirming care has no impact on well being is ludicrous.

"The Cass report has led to recommendations that CAMHS treat and stabilise trans-identified children before gender clinic referrals - presumably in an attempt to more closely align with the original Dutch cohort."

And yet Cass did not ban puberty blockers for trials…just like the rest of them.

Funnily enough I observe the girls I know are always deeply uncomfortable when surrounded by groups of teenage boys. I don’t actually think they want to be boys. They just want to not be girls

I agree. They want to be trans, like their friends.

As mentioned upthread, 'passing' & social acceptance go hand in hand that's a necessary part of mental well being so to assume gender affirming care has no impact on well being is ludicrous

But - it doesn’t, does it? That’s literally the point of Cass - as verified by the activist BMA group - “gender affirming care”, as you call it, doesn’t make people feel better or function better. This might not fit with the vibes you want but the Cass report showing that, thus far, evidence of any improvement was very weak has been a game-changer.

Cass herself seems to believe in “true trans”, personally I don’t any more. You do, which is fine.

But not weak enough to ban puberty blockers completely. The evidence being 'weak' works both ways with no conclusive evidence that gender affirming care doesn't help hence further research required…of which anti trans activists are attempting to prevent. The Cass report it would appear is only an authority when convenient.

It’s not about taking sides and it’s more nuanced than Cass is good vs bad. Her findings can be decoupled from her recommendations. All research summaries say “further research is required”, don’t they?

Cass was hugely important. The report demonstrated that trans-identified children’s well-being didn't definitively improve with hormonal manipulation and that almost all children in blockers progressed to CSH.

The latter means that tanner stage 2 children are (somehow) consenting to chemical castration and impaired sexual functioning.

Cass herself may believe that, buried in amongst the swathes of anxious, traumatised, autistic, abused children who now call themselves “trans” a few “true trans” kids exist. However, it’s unlikely that ethical approval for a PB blocker trail will now be granted, given that will sign off a treatment protocol where healthy children are sterilised as an expected outcome.

Who would be ok with that? There’s not public support, politically no one will want to be associated with sterilising children and morally I hope most people would feel uneasy.

https://yougov.com/en-gb/articles/51545-where-does-the-british-public-stand-on-transgender-rights-in-202425

The public are overwhelmingly opposed to puberty blockers and CSH for children. The halcyon days where the Tavistock gave them put like candy to children who said “I’m trans” (as per Time to Think) are over.

Children aren't sterilised on puberty blockers. And sighting political popularity for whether a medical treatment is appropriate should ring alarm bells for any body who understands the necessity of health care.

Cass was hugely important. The report demonstrated that trans-identified children’s well-being didn't definitively improve with hormonal manipulation

The Cass report limited research included that has been justifiably criticised as inconsistent. Including research that didn't support puberty blockers that had the same weakness as those that did. A lot of research was excluded sighting low numbers hence more research required not to mention clinical data.

and that almost all children in blockers progressed to CSH.
The latter means that tanner stage 2 children are (somehow) consenting to chemical castration and impaired sexual functioning.

That could well be a function of correct self selection & appropriate screening. To say that puberty blockers caused infertility is a stretch. Its like saying smoking a joint causes heroin addiction.

However, it’s unlikely that ethical approval for a PB blocker trail will now be granted, given that will sign off a treatment protocol where healthy children are sterilised as an expected outcome.

Side effects are often an outcome of treatment that are weighed against benefits. But I agree the trial maybe scuttled because of political interference. It is interesting that politicians in some countries are now the arbiters of medical treatments & not medical experts….& none seems to understand the dire implications of the death of expertise because of its political convenience. Its a dangerous precedent to say the least.

Oh well, other countries will just do the work.

97-98 percent of children on PBs progress to CSH. If PBs are commenced at Tanner stage 2 and are followed by CSH these children are sterilised.

This is not actually contested. Does it make you uncomfortable?

No. Because I understand the words 'trade off' in terms of a life time of serious mental health issues.

Doctors are charged with doing no harm. That includes not withholding treatment if on balance it produces a better health outcome.

You seem to imagine fertility is the be all & end all of healthy outcomes when its cold comfort for those who can't get out of bed because of debilitating mental health problems.

What does debilitating mental health problems have to do with teens who identify as trans?

The issue you don’t understand here is consent.

Children can’t consent to being a life-long patient - including lack of fertility and impaired sexual function - whilst in primary school and early high school (Tanner stage 2 starts at 8 for girls and 9 for boys).

There may have been a case to argue ethically if Cass showed spectacular improvement in well-being but all of the studies haven’t shown “a better health outcome”, as you call it.

Why are you so insistent that this hormonal manipulation that doesn't make children happier and more functional will make them happier? Vibes? Reddit?

"What does debilitating mental health problems have to do with teens who identify as trans?"

Because fitting in as in 'passing' goes hand in hand with social acceptance & by extension mental health well being. I'm sure you are aware that a trans woman who retains their male characteristics gets treated a lot worse that one who doesn't. And 'passing' is related to teens by virtue of the power they have over it that will have lifelong consequences on their mental health.

The issue you don’t understand here is consent.
Children can’t consent to being a life-long patient - including lack of fertility and impaired sexual function - whilst in primary school and early high school (Tanner stage 2 starts at 8 for girls and 9 for boys).

Parental consent to medical treatment of their children that's likely to have side effects is nothing new. In fact puberty blockers have long had parental consent for precocious puberty. And some mental health medications can cause lasting physical or behavioural effects in children.

The problem with the logic of withdrawing health care to trans children is it doesn't account for principles involved that need to be applied consistently.

There may have been a case to argue ethically if Cass showed spectacular improvement in well-being but all of the studies haven’t shown “a better health outcome”, as you call it.

No. Many studies were rejected on the premise of low numbers that points to utility requiring further research to prove. That some of the studies failed Cass' standards for admission of evidence doesn't prove there were no health outcomes. Clinical evidence also shows improvement but doesn't qualify as a smoking gun because of possible confounding variables. Its for these reason Cass was unable to discount the possibility of puberty blockers being helpful. And let's not forget puberty blockers just stop puberty they don't confer desired sex characteristics so to expect vast improvement isn't possible. What they can do is prevent the escalation of mental health distress which has been shown in research.

Why are you so insistent that this hormonal manipulation that doesn't make children happier and more functional will make them happier? Vibes? Reddit?

Many relevant globally highly accredited medical associations indicate they do. Remember principles matter. One can't defer to experts just when one feels like it & expect they will continue to maintain the authoritative power they deserve.
Why are you so insistent to enable arm chair experts assume their position?

Why are you so insistent to enable underground unregulated treatment which will be the outcome here just like it is in countries without abortion reproductive health care which have seen a huge spike in online purchases of termination drugs. If you think that can't happen with puberty blockers & hormones you are very mistaken.

Parental consent to medical treatment of their children that's likely to have side effects is nothing new. In fact puberty blockers have long had parental consent for precocious puberty

I was waiting for this. You know that there’s a difference between PBs used when puberty is occurring too early that are then stopped vs PBs that are used when puberty is supposed to occur?

The “easily reversible” trope that applies to the former can’t be assumed for the latter, esp after than Mayo study showing fibrosis and calcification of boys’ testicular tissue after a few years on blockers as “gender affirming care treatment”. It’s moot anyway, because 97-98% of children go on to take CSH and no one seems to follow up the ones who don’t. Reversible? Who knows?

What they can do is prevent the escalation of mental health distress which has been shown in research

You keep saying this, but you’re making it up.

Why are you so insistent to enable underground unregulated treatment which will be the outcome here just like it is in countries without abortion reproductive health care which have seen a huge spike in online purchases of termination drugs. If you think that can't happen with puberty blockers & hormones you are very mistaken

You’re scraping the barrel here.

Children aren't sterilised on puberty blockers.

Why would you make this claim when it is demonstrably true that children are sterilised by puberty blockers? Why persist with the lie that they aren’t? Even WPATH’s clinicians know that fertility is a massive problem and “it’s like talking to a wall” trying to have a discussion with teenagers about it.

It’s a blatant lie to say fertility isn’t affected. Why lie? Everyone knows it is.

Because fitting in as in 'passing' goes hand in hand with social acceptance & by extension mental health well being. I'm sure you are aware that a trans woman who retains their male characteristics gets treated a lot worse that one who doesn't.

Well that’s it, isn’t it? It’s always been about “passing”, the Dutch researchers admitted that was the primary aim. The notion that it lessens their risk of suicide was added later by activist clinicians because they knew doing so kids looked better was a hard sell.

Parental consent to medical treatment of their children that's likely to have side effects is nothing new. In fact puberty blockers have long had parental consent for precocious puberty. And some mental health medications can cause lasting physical or behavioural effects in children.

Parents consent to PBs for precocious puberty knowing their child will resume puberty at a suitable age to treat a different condition.

For gender reasons, parent consent their children to never resume puberty and the lifelong consequences of that.

Consent is not transferable. It doesn’t matter is parents, or children themselves for that matter, consent for one thing. That doesn’t mean they can consent automatically for other things. Each condition and each treatment carries a new requirement for appropriate consent.

Many relevant globally highly accredited medical associations indicate they do. Remember principles matter. One can't defer to experts just when one feels like it & expect they will continue to maintain the authoritative power they deserve.
Why are you so insistent to enable arm chair experts assume their position?

Yet many countries and organisations acknowledge there is no benefit. They have principles too.

Why are you so insistent to enable underground unregulated treatment which will be the outcome here just like it is in countries without abortion reproductive health care which have seen a huge spike in online purchases of termination drugs. If you think that can't happen with puberty blockers & hormones you are very mistaken.

This is just a load of nonsense. Children got by perfectly well without puberty blockers before this experiment took off 15-20 years ago, it’s a fad that will disappear.

I was waiting for this. You know that there’s a difference between PBs used when puberty is occurring too early that are then stopped vs PBs that are used when puberty is supposed to occur?

Yes but the context was parental consent for medical treatment with side effects.

The “easily reversible” trope that applies to the former can’t be assumed for the latter, esp after than Mayo study showing fibrosis and calcification of boys’ testicular tissue after a few years on blockers as “gender affirming care treatment”.

And heart attacks & strokes are potential side effects for many drugs that don't normally eventuate.

It’s moot anyway, because 97-98% of children go on to take CSH
As I said correct self selection & screening are more likely the reason.

and no one seems to follow up the ones who don’t. Reversible? Who knows?

That's why clinical trials matter.

What they can do is prevent the escalation of mental health distress which has been shown in research

You keep saying this, but you’re making it up.

"Psychological distress and self-harm are known to increase across early adolescence. Normative data show rising YSR total problems scores with age from age 11 to 16 years in non-clinical samples from a range of countries [29]. Self-harm rates in the general population in the UK and elsewhere increase markedly with age from early to mid-adolescence, being very low in 10 year olds and peaking around age 16–17 years [53–56]. Our finding that psychological function and self-harm did not change significantly during the study is consistent with two main alternative explanations. The first is that there was no change, and that GnRHa treatment brought no measurable benefit nor harm to psychological function in these young people with GD. This is consonant with the action of GnRHa, which only stops further pubertal development and does not change the body to be more congruent with a young person’s gender identity. The second possibility is that the lack of change in an outcome that normally worsens in early adolescence may reflect a beneficial change in trajectory for that outcome, i.e. that GnRHa treatment reduced this normative worsening of problems."

Conclusions
Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7853497/

"You’re scraping the barrel here." = over the target

Yes but the context was parental consent for medical treatment with side effects.

Consent is not transferable.

And heart attacks & strokes are potential side effects for many drugs that don't normally eventuate.

Funny you should say that, because trans people are more likely to die early because of heart attacks and strokes, as a result of CSH.

As I said correct self selection & screening are more likely the reason.

This old trope. So PBs aren’t a “pause” then, are they?

Either they’re a “pause” and barely anyone reverses them, or you know from the start you’re selecting the correct cohort who “need” CSH. Which is it? Because if you’re saying it’s the latter (which you are) you’re acknowledging that they need to be consented for the lifelong consequences of CSH after PBs. Like sterility. And infertility. And loss of sexual function.

That's why clinical trials matter.

So why hasn’t any gender clinic anywhere around the world done a clinical study on any of its patients into the true reversibility of PBs? Because they can’t. They’ve put them all on CSH and they don’t follow up detransitioners. They’re unethical.

And scraping the barrel is very apt to describe you posting the joke of “study” by the Tavistock which showed no improvement in mental health and a third actually got worse 🤡

There is no trade off, that's the point. So a serious trade off isn't justified. It doesn't show improved outcomes.