Transitioning or therapy as the treatment for gender dysphoria

[FairHippopotama]

Most trans rights activists will tell you that all who claim to have gender dysphoria are valid in their feelings and the best treatment for gender dysphoria is always transitioning--both socially (e.g. pronouns, clothing) and medically (e.g. hormone therapy, mastectomy). These transitions should be accepted by society.

As far as I can tell, the typical gender-critical view is that while gender dysphoria may be a genuine condition, in all cases therapy or some such is a much preferred treatment to transitioning. Accepting transitioning is seen as requiring society to affirm certain falsehoods and harming women's interests. Am I right about this though? What are your thoughts?

Personally, I think the truth is slightly more moderate: gender dysphoria is a real condition, but should only be treated with transitioning in some cases--transitions which society should accept (but not be forced to do so). It depends on whether the cause is neurological and unchangeable (a sort of brain-body mismatch) or social and able to be treated with therapy (in my opinion).

Apologies if this is worded poorly and doesn't make sense.

Personally, I think the truth is slightly more moderate: gender dysphoria is a real condition, but should only be treated with transitioning in some cases--transitions which society should accept (but not be forced to do so). It depends on whether the cause is neurological and unchangeable (a sort of brain-body mismatch) or social and able to be treated with therapy (in my opinion).

I used to think something along these lines but then the more I have learned about the effects of medical "transition" the more horrified I have become.

Maybe psychotherapy doesn't work. But no-one has ever explained how sexual dysfunction, genital atrophy, sterility, incontinence, anorgasmia, necrosis, crushed ribs, premature menopause, and the many other reported physical consequences of medical transition are a happier outcome.

What is missing (IMO) on this thread, but has been discussed on others is the impact of puberty.

For many women any discomfort or bewilderment they may have had when younger about how they were treated because of being female become far worse during and after puberty.

Whether this is actually alienation from the changed body or the intensified pressure by family, advertising, whatever that the female body is quite often the initial response you get as a woman, as opposed to meeting someone for the first time who doesn't react to their femaleness.

Western society really needs to take more consideration for young people, many of whom have brains that are less mature than their body.

Rather than shoving the straight jacket of sexist stereotype it would be better that there were no expectations of conformity, that it is still seen as a period of childhood, of learning and change. Not the adultification that is pushed on them by the media, advertising and social media.

I agree. Personally I think gender reassignment surgery breaks the “do no harm” ethos of the medical profession.

it does an incredible amount of physical harm, which I don’t think is outweighed by any psychological benefits.

imo it’s no different to that dr who damaged his legs so they needed amputating, because he identified as an amputee.

cutting bits off people because “feelings” is not medically ethical, imo. Unless they can show all people who undergo gender reassignment are “cured” for life, it shouldn’t be done. Psychological treatment is a much better place to start.

My niece had a larger than average nose that made her feel very uncomfortable & unattractive to the point she was incredibly shy depressed & agoraphobic. She had a rhinoplasty at 23 & her confidence skyrocketed never looking back. She's now 42 & still living her best life. She could of course had years of therapy but who knows if that would have helped particularly because therapy doesn't always work. Therapy isn't always the all purpose answer irrespective of how 'morally righteous' it maybe 'that people should accept themselves as they are'.

Did she 'delude' herself into thinking she was ugly given socially accepted beauty standards? Maybe. But ultimately, what can't be denied is her solution for improving her mental health worked.

I think (AGP aside) it's often a trauma response rather than inate. That can be sexual assault or objectificarion or just the drip drip of never fitting in because of sexist norms or autism. I feel sorry for people who have internaliser it and think something is wrong with them.

The more kids I've seen latch on to it, the more I'm starting to think neither talking therapy or transitioning are the best approach, but actually being distracted, busy and fulfilled with other things is the best way past it.

Dysphoria isn't just disliking some aspect of yourself, it's losing all sense of proportion and being fixated on something that is irrelevant to everyone else. Take someone like Michael Jackson, how obsessed he must have been with his nose. How often have you wasted time analysing your nose shape this week - probably no time at all? The discussion around gender identity is currently focusing on the equivalent of whether his nose was right or wrong and not about whether he'd lost all sense of scale around it.

Therefore, I don't think taking at length about gender is necessarily the right approach, but therapy for underlying trauma might be. I think improving your relationship with your body, getting out more and meeting more varied people, getting some self esteem that isn't reliant on what other people think of you, getting off line... That's the right "treatment."

How would you have felt if she was unhappy because she felt her nose should actually be an elephant's trunk? Would you have recommended therapy? Or a surgeon to refashion her nose into a non-functional neo-trunk?

She got a better, to her, nose, nobody changes sex, and the mutilating surgeries can have some dreadful outcomes.
It's not comparable.

a nose job though is a relatively straightforward surgery with unlikely long term complications. Yes there’s always the risk of anaesthesia, infection etc, but generally most people will heal, retain sense of smell, be able to breath through their nose and function normally, as well as looking “normal”

gender reassignment is a much more complicated issue, with long term consequence on function and appearance. You can’t build a functioning penis and restocked, or clitoris, vagina and uterus. There is no surgery that will turn you from a functioning man into a functioning woman. the surgery itself means destroying normal body parts and function in order to make them look different.

if a nose job involves removing the nose and stitching on a new one, meaning you could no longer smell, or breathe through your nose, extensive scarring, having to pack it daily to keep the nostrils from healing together, it may be a much harder decision.

@BridgetYourFortyDaysAreUp @6ate9 See my previous posts about gender dysphoria with neurologicals cause vs non-neurological causes.

@Backtoschooloncemore I was referring there to the general idea of separating facilities by sex rather than by gender. Perhaps not legislating against trans people but their rights, at least the rights they tend to claim.

@BinturongsSmellOfPopcorn I think I have to concede the argument regardless of any of your points because a system that allows gender segregation over sex segration is easily abused by male predators. In my mind the system we had a decade ago where trans people that passed could use the facilities of their choice but where women would call out obviously male people seems to work best, but there's no way to return to that now because most people are aware of trans people now.

@Shortshriftandlethal Google Ngram Viewer shows that the term has been used back to the 1970s. Your explanation of Izzard's behaviour seems to make sense to me though.

@SwirlyGates The difference is that their dysphoria relates to something that is true (the disconnect between their sex and the sex their brain thinks of them as), whereas disorders like anorexia relate to things which aren't true.

What's wrong with calling trans-identified males 'women' or 'she'? There's no reason you can't separate gender from sex here.

Erroneously attempting to make a reasonable argument into an absurd one, by taking the argument to the extremes is a logical fallacy.

Trans people aren't transitioning into zoo animals any more than women getting enhanced breasts are transitioning into sex bots & that you feel this is an accurate assessment of the situation is perhaps more a function of your own perverse understanding of reality than an thing else.

Trans people aren't saying their gametes have changed so I don't know where you get that from & all surgeries have risks.

Medical interventions are often about trade offs. Lots of successful treatments have side effects & long term costs but patients weigh up those benefits & costs. Fertility is of no use when your mental health is severely compromised for many so its upto to the individual to decide what matters most to them not what others think should matter.

It's not really comparable since nose jobs are very minor compared to gender reassigment medicaitons and surgeries and they don't have the same range or likelihood of physically devastasting effects. Though even nose jobs can be devastating when they do go wrong.

And I sometimes wonder what happens when women have nose jobs and lead their best lives and meet their dream man... and have children whose noses take after their mother's. I wonder what the psychological effect is on these women and on their children.

Ouch, looks like I hit a nerve.

A nose job alters the size and shape of a nose. It is still a functioning nose after surgery.
A penis being re-fashioned into a 'neo-vagina', for example, is now a non-functioning and irretrievably damaged penis and will never be a vagina.
You are correct that no-one can change species. Just as no-one can change sex.

And fake breasts will never be the same as real ones. So what? If they are content with the outcome & it appears that they are given the satisfaction rates are 1% what's the big deal?

If stitching giant plastic bags of silicone to ones chest is perfectly acceptable & normalised I really don't see the difference particularly given breast enhancements aren't without problems like loss of sensitivity or challenges with cancer detection.

But its comparable depending upon the value an individual places upon their 'bits'. We aren't talking about your values here but someone else's don't forget.

I imagine big nose offspring are treated no different from any other offspring who happen to inherit 'undesirable traits' from their parents.

Patients only get to weigh up costs and benefits after doctors have already weighed up the costs and benefits and decided that a treatment is likely to be successful and beneficial. Otherwise patients don't get offered the treatment in the first place. It's only "up to the individual" after the doctors decide the treatment is within the scope of reasonable treatments for the problem.

You may hate your toes and think your toes don't matter, and you may think your toes are no use when your mental health is severely compromised. A doctor still isn't going to treat your mental health problems by cutting your perfectly normal toes off. No matter that you desperately want them removed. It's not about your priorities as an individual. It's about the doctors' judgment.

And medical interventions for transition are not "successful" in the usual sense of the word. They are only "successful" if you have a below the basement standard of what "success" means. They are terrible bodges.

"What's wrong with calling trans-identified males 'women' or 'she'? There's no reason you can't separate gender from sex here."

What do we call ourselves then? We are not the same, not in body nor in socialisation. Our experiences are not the same. How do we talk about our female only experiences, menstruation, birth, miscarriage, that feeling of being the only young woman and walking into a room full of men and wanting to disappear...
I am Latin, I was socialised to be an asset , to live a supporting role. Boys were taught they could be whatever they want.
All my life I had to deal with the fallout of that. A man grown in male privilege can not possibly comprehend what it really means - being a woman - and none of them want the discrimination, the mainsplaining, the "now let the men decide" side of things.
I absolutely refuse to give men the name we have that is ours.

I think you mean dissatisfaction rates.

We weren't talking about silicone implants, and I haven't commented on whether I consider them 'perfectly acceptable' or not. You have pivoted to that, from nose jobs, for some reason.

A nose job is not comparable to surgery for gender dysphoria, such as mastectomy and neo-phallus/neo-vagina construction.

You took an absurd argument and tried to make it in to a reasonable one, with your nose job story.

I never suggested doctors shouldn't be involved in the first place. That goes without saying surely.

Patient satisfaction & better mental health outcomes are key acceptable measures of of success that major medical organisations globally say that gender affirming care provides. Expertise matters.

Fertility is not the only trade off.

if only it were that simple. It’s a lifetime of managing a surgical site that doesn’t function like it should. Basic functions like urination, toileting. Hair growing and causing infection where hair shouldn’t grow. Pain, daily and constant.

it’s a surgery that leaves someone with a lifetime of management. More comparable to stomas maybe, yes it solves a problem, but would anyone choose a lifetime of stoma management if they really didn’t need to?

if mental health is “so severely compromised” then surely the treatment is for the mental health issues, not physical surgery.

Not all female bodies are the same; not all females are socialised the same.

Many females don't menstruate (whether due to a medical problem or age); many females never get pregnant and also therefore never miscarry. Is a woman really the sum of these? Is an infertile woman less of a woman?

A trans-identifying male can be socialised the same as a female if he transitions at a young age, and a TiM who passes will face the same sexism a female does. Is a woman really defined by the way she's socialised or treated by society?

@FairHippopotama The difference is that their dysphoria relates to something that is true (the disconnect between their sex and the sex their brain thinks of them as), whereas disorders like anorexia relate to things which aren't true.

But of course gender dysphoria relates to things that aren't true. Men aren't women, and women aren't men. Obviously

What's wrong with calling trans-identified males 'women' or 'she'? There's no reason you can't separate gender from sex here.

The words "women" and "she" are already taken. You can't have been on this board long if you don't see the problem with calling TiMs "woman" or "she". If TiMs are women, what does women-only toilets mean? What does women's sport mean? What is a women's refuge? If TiMs are "women", these places and resources would be open to "women + some men". We need a word that defines us and only us (and it's not bloody "cis women"). The same goes for "she". It's wrong, misleading, and difficult for many of us to use, especially those who don't like to lie - this includes, but is not exclusive to, autistic people.

You can separate gender from sex, but you need a new word for it. Go on, make one up and start a trend. Or, we could just call them TiMs and TiFs.

Again, a nose job is comparable depending on personal values. You seem to be avoiding this point.

After having my two children I thought about improving my breasts but for me personally, I find silicone implants a hideously creepy grotesque solution. That's just my subjective view that is clearly at odds with millions of women who consider such an intervention as like changing their fashion choices. I would have a face lift though, but many women are horrified by these. See? PERSONAL VALUES matter.

I suggest you read a biology textbook. Any will do. One at primary school level should be enough