#health outcomes for patients struggling with gender dysphoria”

[fromedennn]

writing my short politics analysis paper for my public health class on idaho house bill 71, which makes it a felony to provide gender affirming care for minors, and … these people are literally trying to use science as their source in this ??? and then they go and say that offering these interventions violate the Hippocratic oath . what the fuck

[laundryandtaxes]

When the whole thing is said and done, I hope that what comes out of the medical scandal of pediatric transition is an understanding not just of the fact that it's important not to let ideology guide practice such that real physicians tell outright lies, ideological abstractions, and/or functionally religious beliefs (that one may have been born in the wrong body, or that one may have the wrong variety of brain in their body, or that one could possibly be "harmed" by going through one's natural puberty in and of itself, etc) to patients who are literally too young to distinguish between lies and truth, but also an understanding that what happened here on the whole with the medical approach to gender dysphoria was a total abdication of duty to provide least invasive practices first, total refusal to provide justification for the practice of selling extreme body modification to people who are at least often obsessively convinced that something is wrong with their body when medicine doesn't do this regularly for any other patients with body distress, total failure of safeguarding practices in a patient group very likely to contain vulnerable and otherwise emotionally distressed patients, and most of all a refusal to even try to address the mental health concerns of a group of people that these physicians just decided on no basis (there are no large studies comparing overall outcomes with transition treated as an actual variable, wherein some people are given one treatment, others none, others another treatment, underlying this practice) were too ill to respond to all of the practices we have already accepted as approaches to psychological distress.

This is at the heart of why ROGD has so many people freaked out- sure, those people who show signs of extreme gender nonconformity in childhood, who grow more distressed than normal at the onset of puberty because it means a loss of the androgyny that protects so much of child gender nonconformity, who are likely to grow into crossdressing homosexual or bisexual adults, who are more likely than other people to struggle with obsessive and compulsive tendencies, who are more likely to struggle to connect with other people socially, I'm sure they require surgical and hormonal body modification in order to live happy and healthy lives, but I am quite sure that no such treatment is right for my sweet, outgoing, heterosexual daughter who until 6 months ago was never very gender nonconforming. People like her deserve extra safeguarding so that the only treatment medicine ever even attempted at scale for this psychological problem is reserved for the people who truly cannot be integrated into society any other way. It is really quite deeply offensive that, because very gender nonconforming people are less valued, we got none of the normal safeguarding or study or approach to treatment that people who approach doctors with broken bones or other physical problems receive. Of course there is always some very real chance that we just happened upon the "right" treatment, but for one thing we don't know that because we simply never tried anything less invasive the way one normally does in medicine (let alone actual comparative studies different potential treatment options) and for another it's currently being sold to people using ideological abstractions or functionally religious concepts that have no basis in reality like the concept of being born in the wrong body. Those are both problems no matter how long medicine is allowed to continue ignoring them, which by the way will not be forever. If medicine cannot reign itself in, if it cannot police itself, then the only actors left to reign it in are all much more susceptible to their own forms of ideological capture than medicine was, such as state legislatures, which is bad for everyone in the same way that state intervention in doctor/patient decisions is almost always bad for everyone.

[sirfrogsworth]

So I followed Sabine Hossenfelder a few weeks ago thinking, "Here is a cool science lady" and then out of nowhere she releases a video on trans people where she is all, "Trans people are crazy and I'm normal!" and then dubiously interprets trans studies for 20 minutes. Then, while claiming she is the levelheaded centrist only seeking objective scientific facts, she references Jesse Signal, a bad faith anti-trans "journalist", as a scientific source.

I also hate this notion that the only metric for the success of gender affirming care is a decrease in depression, anxiety, and suicidal thoughts. Those are certainly goals. But...I mean, life is tough out here even if you aren't transgender. You can feel you've had a positive outcome with your transition and still struggle with mental health. I think that is clear by the low regret rate. And even when people are able to tackle their gender dysphoria via transition, we cannot discount the effects of poor societal acceptance. Not to mention the cruel legislative onslaught currently underway.

It's like, "Yay! I'm finally who I'm meant to be!"

But also, "Ack, these transphobic dipshits are trying to kill me!"

No other treatment is held to the standard of creating shiny happy people at a 100% success rate.

And yes, drugs sometimes have side effects. All drugs. Even over-the-counter drugs like Tylenol. There is no medical treatment without risks. And if we banned every treatment that had the possibility of a bad outcome, we would have literally no medications at all. She was very serious about all the bad things that can happen with blockers and hormone therapy but didn't mention how uncommon those risks are. She didn't mention that bone density is closely monitored. And the risk of heart trouble she mentioned was for older patients getting treatment for prostate issues.

Which makes me wonder why in the world she did not at least consult an actual trans person? Or even a doctor that provides gender affirming care? She just googled everything and interpreted the data with her physics brain and didn't even think to run her interpretations by people with actual expertise.

I'm not even sure a purely scientific analysis of trans issues is possible due to so many variables not being quantifiable. You can't just toss out the politics and focus on the science. The politics are a huge part of transgender existence right now.

And I don't even know what to say about her giving credence to the "social contagion" theory. Her only evidence was a theory concocted by a single person. No studies. No peer review. When I was in high school, none of us knew anything about being queer aside from the existence of gay people. We'd never even heard the words transgender or nonbinary. And even my friends who were gay didn't even consider that as a possibility until they went to college. There just wasn't any information available to teenagers. All they knew was that something was different and they had no resources to help them figure out what that different feeling was.

Teens are not being infected by a social contagion, they just have better access to information. They can also find more support and acceptance in online communities. Not to mention any competent gender affirming care program will do extensive evaluations to rule out things like peer pressure or someone seeking attention. Contrary to conservative belief, they don't just throw hormones and puberty blockers at everyone during their first appointment.

She quickly discounted the left handed analogy because some gender affirming treatments have lasting effects. Which didn't make much sense to me. All that analogy is meant to explain is that teens are more comfortable with queer introspection and feel less pressure to repress said queerness. The huge increase in queer teens matches almost perfectly with the dawn of the information age.

She also said that biological sex is "simple" (it is not) and then handwaved the existence of intersex people as "rare." First, I think the number of intersex folks is undercounted, but also, they are just as prevalent as people with red hair. When there are 8 billion people on the planet, even small percentages add up to a lot of people.

It was just a mess of a video.

I am disappointed in what I thought was a cool science lady.

[spiritualdirections]

England's National Health Service to stop offering gender transitions to adolescents

Britain's NHS has accepted the recommendations by Dr. Hilary Cass and her team of researchers, after a four-year study, which showed that the "gender affirming care" for adolescents with gender dysphoria was not working and should be replaced by normal psychological therapies.

Here's a summary:

"The concept of 'gender-affirming care' – the notion that the doctors must accept children’s declarations of identity at face value and must assist them in gender change as early as possible– actually originated in the United States, and only then spread internationally. 

"The Cass Report provides a scathing assessment of the gender-affirming approach in general, and the gender-clinic model of care, which operationalized this approach of on-demand provision of gender-reassignment interventions, in particular. Going forward, England will treat gender dysphoric youth <18 using standard psychological and psychotherapeutic approaches, with very few young people receiving endocrine gender reassignment interventions (gender-transition surgeries for <18s have never been allowed in England). Further, the review noted that the group of young adults 18-25 is subject to many of the same concerns as the <18s, and recommended that the new regional “hubs” being set up to help gender dysphoric youth be expanded to include patients up to 25 years old.

"NHS England (NHSE) welcomed the Cass Report's recommendations and expressed a firm commitment to implement the recommended changes. However, NHSE went one major step further, announcing that they will be initiating a Cass-style review into the adult gender dysphoria clinics (GDCs) in England. NHSE had already decided to bring forward to 2024 its periodic review of the adult 'service specifications,' which set out what clinical services adult clinics provide; as a consequence of Cass’ recommendations, they are additionally launching a much broader review of the entire adult gender clinic system. This was in part due to the concerns raised by the Cass review that a vulnerable group of 17-25-year-olds (who can access adult GDCs) represents fundamentally the same group of youth as the <18s, and needs similar protections from non-evidence-based practices. Further, whistleblower complaints from adult clinics corroborated concerns that vulnerable adults were not receiving proper evidence-based care. The refusal by all but one adult gender clinic to cooperate in the outcome analysis for the 9,000 patients as part of the Cass review likely contributed to NHSE’s determination to investigate the adult service. Adult gender dysphoria clinics see patients aged 17 and upwards, and NHSE has written to require them to halt appointments with 17-year-olds.

"In summary, the care for <18s in England will no longer be based on the 'gender-affirming' model of care but instead will treat youth with gender distress similarly to how it treats youth with other developmental struggles. Further, with the announcement of the adult gender clinic review, England starts a new chapter in the history of gender medicine, with a new focus on vulnerable gender-dysphoric young adults. 

"Many more developments are expected from England in the coming months. To what extent the UK changes will impact the West’s approach to helping young gender-dysphoric individuals remains to be seen. In SEGM’s view, the impact will likely be significant, even if delayed, as other countries contend with England’s findings and their implications for evidence-based clinical practice."

Read the original report here: https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf

Read the National Health Service's response here: https://www.england.nhs.uk/2024/04/nhs-england-responds-to-the-publication-of-the-independent-review-of-gender-identity-services-for-children-and-young-people/

Source:

https://segm.org/Final-Cass-Report-2024-NHS-Response-Summary

[detransdamnation]

tumblr ; com/iwantagreenmug/699146751096078336/ Hey pal If you have the disposition to read the full guidance linked in the end, would you give your thoughts on this?? like does it feel as an improvement to you or does it seem ominous and too good to be true?

Hey, Anon. Thank you for your patience in my getting back to you. Here are some of my (critical) thoughts on this:

On gender incongruence/dysphoria:

The decision to rally with the DSM-V on dysphoria is, dare I say, a huge mistake. The necessary criterion for children to be diagnosed include (but are not limited to) “cross-dressing,” playing with gender roles and/or pretending to be the opposite sex in play, and preferring toys and games typically associated with the opposite gender. How the fuck can you preach that “gender incongruence does not necessarily lead to transition” while basing your treatment off of criterion that assigns gender to fantasy play and inanimate objects? This is the exact line of thinking that leads so many children to develop dysphoria in the first place. Gender-nonconformity is not a diagnosis. Get your heads out of your asses, NHS.

The NHS has articulated two main outcome measures of treatment: clinically significant distress and social functioning.

I struggle to articulate how I feel about this.

What I think the guidelines may be failing to consider here is that a very large part of dysphoria is an unstable sense of self that does not usually reflect objective reality. A medically-transitioned person could experience little to no clinically-significant distress and function perfectly well in social situations, yet still have objectively worse mental and physical health compared to pre-transition measures. I was one of those people; in fact, my dysphoria and social-functioning were both better in many ways when I was still medically-transitioning. Would I be considered a “success story” under this protocol, even though I’m obviously not?

I don’t want to downplay the good of this revision. Honestly, I’m just happy that there is finally a set measure that patients will be evaluated by. At the same time, I think something is missing here. Ironically, I actually believe that treatment of dysphoria needs to be less about the dysphoria itself because it’s way too unstable of a condition to tell you anything about how you are really responding to treatment (in my experience and in my opinion). The protocol claims to be employing an interpersonal team henceforth, so here is my suggestion: Add a third outcome measure that evaluates overall health and well-being, both mental and physical. If physical health and well-being declines after transition, the treatment is a fail. If mental health and well-being declines after transition, the treatment is a fail. This would be regardless of social-functioning, distress or lack thereof, or any sort of improvement in dysphoria. Even the most severe cases of dysphoria can be managed, if not treated—but no case of dysphoria can be addressed if the “treatment” is objectively harming the patient.

And speaking of treatment, a final note:

On "higher-risk" cases:

To grant an exception to “higher-risk” cases who “understand the implications of treatment” is such a slippery slope. Anyone can be of “high risk” if we want them to be. Everyone thinks that they are able to “consent” to life-altering treatment. We have literally already seen this in the gender-affirmative protocol. Give desperate people an inch, they will try to go a mile, and no matter how carefully curated your team, there will always be a chance that this will be exploited. Call it a moral bias, but as it stands right now, I do not consider this much of an improvement. That is my honest opinion.

I have some other reservations but this should cover the bulk of them. I wouldn’t say that these proposals are “ominous.” Too good to be true? Maybe. Only time will tell. It should go without saying that I think this protocol is a huge step-up from the gender-affirmative one—but even the best protocols can have the worst outcomes if they are executed poorly. I am willing to bite my tongue when it comes to the bumps that I see and I hold cautiously optimistic hope that they will smooth out once (if?) this is implemented.

[and-then-there-were-n0ne]

On May 14th, 2021, The Lancet published an editorial titled “A flawed agenda for trans youth”. This contains a number of weak or flawed arguments and rhetorical framing that I believe are far below the quality one might reasonably expect from a publication as prestigious as The Lancet.

On April 6, 2021, amid a flood of new bills to curb the rights of transgender and gender diverse (trans) youth in the USA, Arkansas became the first state to prohibit doctors from providing youth (<18 years) with gender-affirming treatment: puberty blockers, hormone therapy, and gender-affirming surgery.

From the outset, the focus is on the political and legal situation in the US, which of course is not reflective of the global picture. Seen from the UK, our legislative, medical and political landscape are markedly different, but that has not stopped this article being shared approvingly by UK-based lobbyists such as Stonewall’s Nancy Kelley.

Here we see that editorials such as this are not merely narrowly focused on the specifics - and ethics - of care of vulnerable youth, but actually in service of wider political lobbying. This is evident from the language and framing of the whole editorial:

However, what the bills seek to protect appears to be traditional gender norms, using a vulnerable group in a protracted culture war. The bills' socially conservative advocates create fear by focusing on emotive issues, honing the same messaging around protecting women and children that was used in earlier campaigns against abortion and same-sex marriage. As clinicians, it is important to use evidence to debunk the false claims being made.

The author castigates “social conservatives”, and links opposition to euphemistically titled “gender-affirmative care” as akin to anti-abortion or anti-gay marriage.

This is a binary framing that bears no real relation to the actual breadth of opinion and concern out there. For sure, many social conservatives are in opposition on those grounds - but there is a failure to recognise and account for the positions of the many people who come from an entirely different position. People who embrace and encourage gender nonconformity, who fought for gay marriage, and who now see current attitudes as a regressive approach to behavioural stereotypes that are harming predominantly gay and lesbian youth.

Disproportionate emphasis is given to young people's inability to provide medical consent, a moot point given that—like any medical care—parental consent is required.

This is not a moot point. A parent does not have unlimited power to subject a child to elective medical treatment. Indeed, this is the entire crux of the matter: is the treatment necessary? Does the potential benefit outweigh the potential harm? Is a child capable of understanding what they are consenting to?

This is why so much of this is framed in life-or-death terms - because absent some imminent threat, there is no justification for subjecting a child to experimental treatment in the first place.

Supplanting parents with the law for this decision presumes that a parent living alongside their child cannot grasp what is best for them, despite often witnessing many years of struggle.

And yet, parents abuse their own children, and sometimes the duty of the state is to intervene in the best interests of the child. This is a legitimate conflict - simplistically pretending it doesn’t exist, or that a balance is not needed to be struck, denigrates the debate.

Driving this consent narrative is the anxiety evoked by focusing on the minority who regret transition (estimated as 1% of adults who had gender-affirming surgery as adolescents).

This cites a recent meta-analysis of 27 articles, going back to the 80s. As such, I think it has the following weaknesses for making this specific claim:

It covers decades of adult transitioners. Adults are not directly comparable to children because there is wide variation in the persistence of dysphoria past adolescence (as high as 88% in a recent study). This is a key point of contention with early intervention, because this would indicate a nearly 9-in-10 chance of unnecessarily and permanently medicating a child. If regret samples are only drawn from the pool of those who persist into adulthood, then of course regret measures will be lower.

It covers surgical outcomes only. This again does not apply to children maybe given puberty blockers and hormone treatments.

Patients lost to followup or who (for whatever reason) do not proceed to surgery are often not accounted for - and by the above metric these could easily be patients who presented for treatment, before desisting, something much more likely with younger patients. For example, the meta-analysis cites the following paper as having a cohort of 132, only 2 of whom express regret. But actually, the paper starts with 546, which becomes 201 participants, only 136 of whom proceed to surgery, 4 of which are lost to followup. This is a very different picture, with 75% of the recruited sample an unknown quantity - and it is those lost to contact, or refusing to participate, or who simply drop out that are most likely to contain those with regret.

Whatever else, I don’t think that regret rates of adult surgical transition are a useful proxy for regret rates of children who have been affirmed as the opposite sex from a young age and proceed through puberty blockers to cross-sex hormones. I think these are entirely different groups, and using the best-case success rate of one to downplay concerns about the other is disingenuous.

However, in any situation when medical treatment will alter a person's identity, no one can know whether post-treatment regret will occur; therefore what matters ethically is whether an individual has a good enough reason for wanting treatment. Regardless of law makers' stance on identifying with a gender other than one's birth-assigned sex, the autonomy for this decision lies with young people and their parents.

Autonomy, but also clear and informed consent. A child who simplistically believes they are in the wrong body, who may be struggling with internalised homophobia - or homophobic parents - and comorbid mental health issues. Who has been told by people they trust that blockers and other interventions are necessary, and that they will simply go through the “correct” puberty for their “identity”, is being told lies. Phrasing such as “birth-assigned sex” is part of that lie - for sex is determined at conception, and cannot be changed. The association of the word “gender” with “sex” is part of that lie. How can anybody meaningfully consent when surrounded by such imprecise language? Why are children encouraged to change their sex characteristics to express their “gender identity”? What does any of this even mean? When even the Lancet publishes misleading data about rates of regret, or the reversibility and side effects of blockers (see below), how can a child understand this complicated and contradictory picture and offer informed consent?

More fear is stoked by rhetoric about a malevolent threat to children. Social conservatives in the USA, UK, and Australia frame gender-affirming care as child abuse and medical experimentation. This stance wilfully ignores decades of use of and research about puberty blockers and hormone therapy: a collective enterprise of evidence-based medicine culminating in guidelines from medicalassociations such as the Endocrine Society and American Academy of Pediatrics. Puberty blockers are falsely claimed to cause infertility and to be irreversible, despite no substantiated evidence.

Again, the editorial frames opposition as “socially conservative” - and completely ignores the social progressives who are expressing concern. This is simply not a narrative that fits the polarised binary of US liberal/conservative politics. In fact - especially in the UK - opposition is largely left wing, from those who don’t believe that gender nonconformity is something that should be medicalised, and who are worried at the prevalence of gay and lesbian youth in the cohort of children now being referred for paediatric transition.

It is telling also that the study offered to rebut the claims about infertility or irreversibility of blockers is not applicable. The cited paper is a study of the effects of blockers as a treatment for several conditions, but the author here cites the outcome when treating precocious puberty, ie in the instances where a young child is given blockers to halt early pubertal development for a short period, and then allow the remainder of normal adolescence to continue as much as possible.

This is not at all applicable to the treatment of children who go on to cross-sex hormones. These children never experience natural puberty. Blockers in this instance do not delay, they prevent it entirely, and substitute with synthetic hormones to encourage the development of opposite sex characteristics. This is a wholly different treatment pathway, and yes, blockers cause infertility and in some cases complete loss of sexual function, as well as other long term issues.

And the paper itself confirms this:

I believe The Lancet are wholly wrong to present this position with such certainty, and that by making claims that are contradicted by the given citation they fatally undermine this claim.

The dominance of the infertility narrative, usually focused on child-bearing ability, perhaps reveals more about conservatives' commitment to women's role as child-bearers.

Again, this does a huge disservice to the actual debate. The focus is on such things as fertility and sexual function because these are the very things children are incapable of consenting to lose. A child cannot know if they will never want to have a child of their own. A child too young to experience an orgasm cannot consent to never experiencing one.

Puberty blockers are framed as pushing children into taking hormones, whereas the time they provide allows for conversations with health providers and parents on different options. Gender transition involves many decisions over a long time, and those who take hormones do so because they are trans. Contrary to claims of a new phenomenon, trans youth have always existed; historians show they have sought trans medicine since it became possible: the 1930s in the USA.

The concern is that affirming the social sexual transition of a child too young to understand what sex is, is fixating on a fantasy identity that then becomes a medical one, again before a child is too young to know the implications. This is something borne out by the difference in desistance rates between children left to resolve their gender identity in adolescence (ie, allowing non-conforming boys and girls to simply be authentically nonconforming boys and girls) which are up to 88%, and the <1% desistance rate seen with the affirmation approach at the Tavistock. If the intervention itself is fixating and medicalising an otherwise fluid identity, is that really in the interests of the child? And again, this was found in the Keira Bell case - blockers are not in practice “a pause” for “time to think”, rather an early intervention to avoid the development of secondary sexual characteristics and lay the ground for inevitable cross-sex hormones.

Focusing on potential harms ignores the fact that wellbeing is broader than physical health alone. The harms to wellbeing posed by prohibiting care are huge. Being a marginalised group (<2% of US youth), trans youth already experience the stress of discrimination and stigmatisation. They have high rates of depression, anxiety, and suicide: almost double the rates of suicide ideation of their cis peers. As Laura Baams discusses in her Comment, puberty blockers reduce suicidality.

Except as the published work by the Tavistock shows, this is not true. Blockers don’t improve mental health outcomes at all, and indeed the focus on avoiding the development of secondary sex characteristics may even be creating distress.

Additionally, such studies of mental health and suicidality are skewed both by sex differences and confounding comorbidities. Notably, girls are more likely to suffer poor mental health than boys, especially lesbian and bisexual girls. There are large numbers of co-presenting conditions, like eating disorders and self-harm - and it is specifically among girls that we are seeing a large rise in identifying as trans or non-binary.

The author says they have poor mental health because of discrimination and stigmatisation. However, another hypothesis might be that children are identifying as trans as a response to homophobia (as has been reported at the Tavistock), or - in the case of girls - as an escape from a highly sexualised culture of objectification, or experiencing social contagion in friendship groups as has been shown with eating disorders and self-harm in the past. Do they have poor mental health because they are trans, or do they identify as such in response to poor mental health and other social factors?

Separating out whether identifying as trans is a cause of or a response to such things is difficult, but statements like the above are reductive and simplistic. The author leaves no room for such alternative interpretations of the same evidence, which again falls into the whole polarised culture-war framing of the article. Such alternatives invariably are not given weight in pieces like this because they do not fit that narrative.

Removing these treatments is to deny life.

And here is the crux of it - the emotional blackmail. The only thing that could possibly justify the risk of unnecessarily sterilising children is the threat of death.

Moreover, whereas the bills focus on medical treatments, the care trans youth receive is far wider in scope. Those seeking care typically also see social workers and psychiatrists, and much of health providers' work involves listening, talking, and setting up support in their families, schools, and communities. Health providers also discuss with them the idea that gender is something we “do” in social practice and can take many forms.

I struggle to see what the point of this paragraph is. If wider care and therapy are not under threat, why mention them? If the focus of legislation is on medical interventions, then talking about other forms of care is irrelevant. If people are arguing for less medical intervention and more of these wider social measures, then what is the author taking issue with?

Indeed, some choose social transition without medical treatment, and it is useful to remember that the notion of gender dysphoria perpetuates the historical pathologisation of gender diversity. Challenging the current social construction of male–female will undoubtedly ease trans youths' lives, reducing the pressure of rigid definitions. But alongside these social aspects is a pressing need for medical care.

This is pure doublespeak. What is more pathologising of gender diversity than the medication of children who display it, to “fix” their bodies so that they match their expression?

It is precisely the opposition to the pathologisation of gender nonconformity that is at the heart of many progressive objections to the current treatment regime.

We would agree that encouraging children to express themselves however they like is the aim - but we argue that telling them that they need to somehow “correct” their bodies in order to do this is a regressive step. You cannot literally change sex, and telling young children that you can, or connecting such things to stereotypical dress and behaviour and ephemeral feelings is so bizarre that I am still staggered as to how prevalent such a conservative idea is among supposed “progressives”.

Indeed, the idea that you can literally change your sex in this way also means that you can literally change your sexuality. With the right treatment, apparently a gay child becomes the straight one they truly were all along. Can the author really not see how some gay and lesbian people might be appalled by such measures? Might see such interventions as conversion therapy?

This editorial is partisan and polarising. It relies on limited or questionable evidence, does not consider the full range of contradictory evidence, and focuses on a narrow - and false - political framing of a complex and wide-ranging issue. It does nothing more than provide superficial legitimacy and ammunition to a particular political stance, rather than any sort of informative or open assessment of the evidence or genuine criticism.

As such, it is no different to 99% of what is written on this subject, but I do feel that The Lancet ought to aspire to more.

[transadvice]

Hi I think that I'm nb but I'm not sure? Sometimes I'm OK with my assigned gender and other times it hurts to be referred to as such. Also I don't like certain parts of my body but I'm not sure if that's internalized fatphobia or body dysphoria? I don't know if I'm actually nb or if I'm just trying to deal with other issues. Do you know anything I could do/look into to figure it out? What if I'm just pretending because some of my friends are trans? Sorry to bother you.

Not a bother at all! I couldn’t do this tumblr without askers like you!

“It hurts to be referred to as [my assigned gender]” is basically the definition of dysphoria. Whatever identity label you end up with, it certainly sounds like you have some gender dysphoria symptoms.

It’s possible to have social dysphoria (where you dislike referred to as your assigned gender) and not physical dysphoria (where you dislike certain parts of your body, notably secondary sex characteristics). It’s also possible to have both physical dysphoria and unrelated body discomfort. Some people struggle with accepting being fat AND have gender dysphoria. It can be hard to isolate the problems when they overlap, mask, or exacerbate each other.  We are often made to feel like gender must be the last thing we deal with; we need to look into all other options first. We must be 100% “of sound mind” (without mental illness) before we can decide to transition (which is almost impossible since dysphoria often CAUSES depression/anxiety). We must be in peak physical shape before we can begin changing our bodies. The medical and mental health establishments have been known to push this agenda, telling patients that we need to lose weight before we can have gender affirming surgeries, or that we need to conquer all our other traumas first before we can start thinking about gender. 

This is just not right! You do not have to deal with all your other issues first before you deal with your gender dysphoria. First of all, why? What’s so bad about being trans that we need to rule out every other option first? Second of all, gender is so foundational to our understanding of ourselves and the way we move in the world that fixing the gender dysphoria often makes other issues a lot easier to deal with. I can’t count the number of people I know who, once they transitioned, were a lot more at peace with their physical “flaws” and/or more able to work on them in a healthy way. It is HARD to get in shape when the shape you’re meant to aim for isn’t the one you actually want. 

Almost all trans/nonbinary people I have ever met have gone through a period of impostor syndrome, especially early in their questioning phase, wondering, “What if I’m just pretending?” It’s a trans MOOD. I’ve never met someone who was actually “just pretending.” (Wouldn’t you know if you were pretending? As long as you’re questioning in good faith, there is nothing wrong with questioning: the whole point of questioning is that you don’t know the outcome.) 

The fact that you have a bunch of trans friends is not concerning to me. It’s common for trans people to gravitate toward each other, even before we consciously know we’re trans (for years before I came out, it was a running joke/observation that all my exes came out as trans after dating me). When a person has a bunch of trans friends, then questions their own gender, what that says to me is that they were drawn to trans people because they recognize something familiar in them.

[sharistonecom]

Gender Reassignment Surgery – Transgender Procedures, the Facts.

One of the most controversial areas of cosmetic surgery that has arisen in the last decade is ‘Gender Reassignment Surgery’.  This is both of medical and political interest.  The emerging transgender movement and its position at the very forefront of ‘identity politics'  means that it is a very special and sensitive topic in cosmetic and reconstructive surgery.  It also requires a very specialised background to fully explain how the surgery works and what can be attained.

Sex reassignment surgery (SRS) is known by a variety of labels, including gender reassignment surgery (GRS), sex change surgery, sex affirmation procedures, and genital reconstruction surgery. These operations, which are known clinically as genitoplasty procedures, are done to surgically change the genitalia from one gender to another.

For the majority of patients undertaking SRS, the surgery is performed in order to match their physical gender with what they feel emotionally and intuitively is their correct gender. This syndrome, known as gender dysphoria or gender identity disorder, is infrequent but getting more widely diagnosed. You may also hear these individuals being referred to as “transgender.”.

Gender identity struggles usually begin in early childhood but descriptions of feeling like a man trapped inside a woman’s body, or vice versa, have been identified in and reported by people of all ages. A person living with this an internal conflict may develop anxiety and depression, and go on to be diagnosed with gender dysphoria, formally known as gender identity disorder

(GID). Gender dysphoria is a mental health condition that can arise when a person lives with ongoing feelings of being physically incongruous with his or her birth sex — and medical intervention may be beneficial. Identifying as transgender, itself, is considered by scientists to be, at least in part, biological and not a mental illness

Male to Female Transition. The procedures that change male genitalia to female genitalia include a penectomy (removal of penis) and orchiectomy (removal of the testes), which are typically followed by a vaginoplasty (creation of the vagina) or a feminizing genitoplasty (creation of female genitalia).

For those born male and transitioning to female, there may also be procedures that include breast implants, gluteoplasty to increase buttock volume, a procedure to minimize the appearance of the Adam’s apple, and possibly, feminizing hormones.

Facial feminisation surgery (FFS) is often done to soften the more masculine lines of the face.2 Each patient is unique and the procedures that are done are based on the individual need and budget, but facial feminization often includes softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. For some, a chondrolaryngoplasty, commonly known as a “tracheal shave,” can help reduce the prominence of the Adam’s apple.

Female to Male Transition. The procedure that changes female genitalia to male genitalia is a masculinising genitoplasty (creation of male genitalia). This procedure uses the tissue of the labia to create a penis.

The procedures that change the genitalia are rarely performed without other procedures, which may be extensive. For those born female, the change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy, a hysterectomy procedure, and perhaps additional cosmetic procedures intended to masculinise the appearance.

Transitioning is often two-fold: a social transition, such as new clothing, a new name and new pronouns; and a medical transition, with treatments such as hormone therapy and surgical procedures. Depending on the needs and wants of each individual, transitioning may include both social and medical transitions; just one of the two; or for those who eschew gender completely, neither.

But does GRS really work for everyone?

Medical evidence suggests that sex reassignment does not adequately address the psychosocial difficulties faced by people who identify as transgender. As Ryan Anderson points out in his book ‘When Harry Became Sally'  ‘even when the procedures are successful technically and cosmetically, and even in cultures that are relatively “trans-friendly,” transitioners still face poor outcomes’.

There are strong arguments on both side of the line and this is not really the place to debate them since the argument as to whether sex can be truly reassigned is an enormous political and cultural battlefield.   Experts like Dr Lawrence Meyer from Princeton is quite clear on the subject:

Cosmetic surgery and cross-sex hormones can’t change us into the opposite sex. They can affect appearances. But they can’t transform it. They can’t turn us from one sex into the other.  “Scientifically speaking, transgender men are not biological men and transgender women are not biological women. The claims to the contrary are not supported by a scintilla of scientific evidence,” explains Mayer.

The Global GRS Market

But what is certain is that there is a substantial demand from men and women who feel that their lives can be radically improved by trans-gender surgery  and the job of our site is to guide them to reliable surgeons around the world who have extensive experience in this kind of work.  We are also including a list of helpful organisations that will advise and guide you in your quest for the right answers.

The market is large and is trending ever upwards. Global Market Insights, Inc. has recently added a new report on sex reassignment surgery market which estimates the global market valuation for sex reassignment surgery will exceed US$ 1.5 billion by 2026. Rise in number of sex reassignment surgeries across the globe will be a major factor driving factor. The growth of market can be attributed to the increasing patient pool with an inclination towards changing sex from male to female as well as female to male. The number of such patients has increased nearly four times in the past years.

Destinations to Transition.

Germany dominated the European market and was valued at USD 15.9 million in 2019. The growth can be attributed to the development of lesbian, gay, bisexual and transgender (LGBT) rights in Germany. Also, improving healthcare facilities and presence of doctors, surgeons and clinics specialised in sex reassignment surgery will further boost the market growth over the forecast period. For instance, HELIOS Hospital Berlin-Zehlendorf provides female to male sex reassignment surgeries.

There are major facilities in the UK also driven by the LGBT movement.   The UK also has some excellent support groups such as.  FORGE  and  FTMMentors. Some of the other major players in the market include Some of the leading players in the sex reassignment surgery market share include Bupa Cromwell Hospital, Yeson Voice center, Chettawut Plastic Surgery Centre, Sava Perovic Foundation Surgery, Phuket International Aesthetic Centre (PIAC), Rumercosmetics, Transgender Surgery Institute of Southern California and Mount Sinai Centre for Transgender Medicine and Surgery (CTMS).  You can also browse through our general listings and you will find many clinics offering these types of surgery at varying price ranges.

Clinic ImageRatingClinic Name & Feature

Chettawut Plastic Surgery Center, Bangkok Thailand

This is a ‘goto’ clinic for Gender Reassignment Surgery (GRS). Dr. Chettawut Tulayaphanich is regarded…

Sava Perovic Foundation Surgery Belgrade Serbia

This clinic is dedicated to genitourinary surgical procedures and ia a European frontrunner in gender…

Phuket International Aesthetic Centre (PIAC) Thailand

This is a medical tourist’s dream location on the fabulous island of Phuket and a…

Rumer Cosmetic Surgery. Ardmore USA

Dr. Kathy Rumer is a leading aesthetic and reconstructive plastic surgeon with a private practice…

1. Chettawut Plastic Surgery Center, Bangkok Thailand

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This is a 'goto’ clinic for Gender Reassignment Surgery (GRS). Dr. Chettawut Tulayaphanich is regarded as one of the great surgeons in this controversial area of cosmetic surgery. With almost 3,000 cases in Sex reassignment surgery and Facial feminisation surgery with satisfactory outcomes. They even offer voice surgery to change a low pitch (Male voice) into a higher pitch pattern with natural voice quality. If you are looking for gender transition surgery this clinic will be high on your list

Address

1529/4 Onnut 31 Sukhumvit 77 Bangkok, Thailand 10250

Phone

+(669) 5650-3892

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Gender Reassignment Surgery

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2. Sava Perovic Foundation Surgery Belgrade Serbia

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This clinic is dedicated to genitourinary surgical procedures and ia a European frontrunner in gender reassignment surgery. They are are also highly geared to the medical tourism market with a deep understanding of the needs of the travelling patient. A visit to their website will show you the wide menu of reconstructive and transformative surgeries on offer. If you are searching for this type of surgery you will be reassured by their services.

Address

Sava Perovic Foundation Belgrade, Serbia

Phone

+1 (216) 220-4220

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Airport Pickup

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Gender Reassignment Surgery

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3. Phuket International Aesthetic Centre (PIAC) Thailand

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This is a medical tourist’s dream location on the fabulous island of Phuket and a renowned clinic to make a gender reassignment surgery. In addition to GRS they offer a comprehensive range of plastic surgery and cosmetic procedures all aimed at reshaping appearance and improving lifestyles, performed by internationally recognised plastic surgeons.

Address

Phuket Plastic Surgery Institute Bangkok Hospital Siriroj 44 Chalermprakiat Ror 9 Rd, Phuket 83000 Thailand

Phone

+ 0 76 361 888

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Procedures Offered

Breast Augmentation

Breast Reduction

Breast Lift

Blepharoplasty (eyelids)

Abdominoplasty. (tummy tuck)

Rhinoplasty (nose job)

Otoplasty (ear correction treatment)

Thigh and Buttock Lift

Rhytidectomy (Facelift)

Gynecomastia (male breast reduction)

Labiaplasty

Hymen Repair

Gender Reassignment Surgery

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4. Rumer Cosmetic Surgery. Ardmore USA

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Dr. Kathy Rumer is a leading aesthetic and reconstructive plastic surgeon with a private practice on Philadelphia’s Main Line. Board-certified in plastic surgery, Dr. Rumer’s practice offers state-of-the-art procedures, cutting edge product offerings, and innovative technologies that achieve the maximum results for her patients. This is a top place for gender reassignment surgery. Her reputation is unparalleled in the field so you can put her high on your list.

Address

105 ARDMORE AVE

ARDMORE, PA 19003

USA

Phone

+ 1(855) 782-5665

Checklist

Procedures Offered

Liposuction

Breast Augmentation

Breast Reduction

Breast Lift

Blepharoplasty (eyelids)

Abdominoplasty. (tummy tuck)

Rhinoplasty (nose job)

Non-surgical Nose Job

Forehead Lift

Otoplasty (ear correction treatment)

Thigh and Buttock Lift

Rhytidectomy (Facelift)

Gynecomastia (male breast reduction)

Labiaplasty

Hymen Repair

Gender Reassignment Surgery

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The post Gender Reassignment Surgery – Transgender Procedures, the Facts. appeared first on Best Cosmetic Surgeons.

source https://bestcosmeticsurgeons.com/gender-reassignment-surgery-transgender-procedures-the-facts/ source https://bestcosmeticsurgeons.tumblr.com/post/616827659929993216

[hcsmca]

Building healthy foundations for life

If we want to build a stronger foundation of health for tomorrow, we need to start with our children today. This year at TEDMED, the program will showcase Speakers who are are dedicated to supporting young people in shaping positive, healthy lifestyles. From helping children living in challenging environments to make healthier choices, to supporting transgender teens and their families with mental and physical health services, to providing young people with new tools to deal with the effects of race issues, these three TEDMED 2017 Speakers are empowering the next generation to navigate today’s complex health challenges and to take charge of their own health.

Physician Sandy Hassink has dedicated her career to helping children achieve a healthy weight. As President of the American Academy of Pediatrics (AAP) and Chair of the AAP Institute for Healthy Childhood Weight Advisory Board and Steering Committee, Sandy aims to ensure every child has access to a healthy and supportive environment, where nourishing food and opportunities for physical activity are readily available. Unfortunately, many Americans don’t live in communities that enable healthy behaviors. For instance, over 23 million Americans (including 6.5 million children) live more than one mile from a supermarket. With this type of statistic in mind, Sandy stresses the importance of understanding that the health decisions people make go beyond willpower or lack of knowledge, and she focuses instead on the ways a person’s neighborhood and physical surroundings ultimately affect their diet and activity choices. Furthermore, Sandy believes influencing healthy behavior is less about telling people what to eat or how to move and more about getting families and children involved in shaping their own healthy lifestyles. Bringing health closer to home has the potential to make long lasting positive impacts—as Sandy puts it, “good nutrition in childhood sets the stage for lifelong healthy eating.”

While childhood obesity is considered one of the nation’s largest health concerns, other important issues related to the health of young people have started receiving more attention in recent years. Gender dysphoria, or the distress that occurs when an individual does not identify with the sex and gender they were assigned at birth, affects an estimated one in 30,000 males and one in 100,000 females in the United States (though data is limited, and studies from other countries suggest this number may be higher). Yet when pediatric endocrinologist Ximena Lopez was first approached by parents looking for medical advice for their child, who was struggling with gender dysphoria, Ximena learned that the only experience her hospital had with transgender youth was in the psychiatric ward. Due to reasons such as discrimination, bullying, isolation, and lack of support, the prevalence of suicide attempts among transgender individuals is 41%—compared to 4.6% of the overall U.S. population. Ximena knew she had to do something to help. In 2014, Ximena founded the Children’s Gender Education and Care Interdisciplinary Support Program, or the GENECIS Program, at Children’s Health in Dallas, Texas, which has grown from five patients to 60. The multidisciplinary team at GENECIS works with patients on everything from medical interventions to mental health support. Ximena stresses that early intervention, treatment, and parental support are key ingredients to a successful outcome. “The parents feel like you’re saving their children,” she says, “and these patients feel like you’re saving them.”

Children and young people confront different types of health stressors every day. Race issues, often a taboo topic and not openly discussed, can be at the root of emotional stress for many young people. Howard C. Stevenson believes it is essential that everyone is given the tools and skills to openly talk about race and to express ourselves in a healthy way when faced with racially stressful situations. To foster these types of important conversations, Howard promotes racial literacy—“the ability to read, recast, and resolve racially stressful encounters”—in schools, families, and communities. At the Racial Empowerment Collaborative, where Howard is Executive Director, programs like EMBRace (Engaging, Managing, and Bonding through Race) are designed to help children and parents reduce and manage racial stress and trauma. Instead of internalizing the emotions connected with racially charged encounters, these programs empower young participants with the tools to successfully navigate difficult conflicts. Through the Collaborative, Howard is helping youth to reduce stress, build confidence, and to stand up for themselves in a productive and healthy way.

The Racial Empowerment Collaborative at Penn GSE.

Kids are the future. Yes, it’s a cliche, but it’s also the truth. These three thought leaders recognize the importance of equipping the next generation with the tools they’ll need to navigate important health decisions and empowering them with the knowledge to live healthy lives now and into adulthood.

The post Building healthy foundations for life appeared first on TEDMED Blog.

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New Post has been published on http://www.jaysennett.com/the-truth-about-why-transsexuals-hate-gender-identity-disorder/

The Truth About Why Transsexuals Hate Gender Identity Disorder

The real reason many transsexual and transgender people hate the DSM and GID?

We don’t want to be perceived as crazy.

I am NOT Craazzzyyy!!!

Transsexualism, to be treated legally by the medical establishment, needs a diagnosis. In my case, and most typically for most transsexuals, I think, therapists diagnosed me with gender identity disorder (GID).

GID is a psychological diagnosis, as is another diagnosis I have been given, transsexualism.

When I started hormones in 1996, GID enraged me. I didn’t have a psychological problem, people with bipolar disorder or schizophrenia had psychological disorders.

“There is nothing psychologically wrong with wanting to change my gender!”

I had a medical problem and believed my interests as a transsexual female to male would be best served by creating a medical diagnosis, i.e. an endocrine disorder, for example.

A medical diagnosis would surely be better than a psychological one. A medical diagnosis had little social and medical baggage, I thought.

Being lumped together with people with autism or bipolar disorder terrified me.

I wasn’t demented, deranged or unhinged.

A deep seated fear of Crazy bubbled up from somewhere within my socialization. All my middle-class fears about not fitting in and being different was like adding gasoline to a fire.

Not me, nope. Just an ordinary, taller-than-average female to male transsexual in great need of hormones.

The system of gender socialization created the problem, I railed. The problem lay with society, not my mental state or mental health.

A Funny Thing Happened on the Way to a Disability Rights Meeting

I possessed no ability to see the flaw in my logic.

If I believed a system of gender socialization created behaviors some people deemed normal and others not-normal, mightn’t that also be true for other psychological diagnosis?

No. I wasn’t crazy, just pursuing a right I believed belonged to every human being, the right to define and express gender as each person desires.

Then I became aware of disability activism and the neurodiversity movement, an approach to disability that sees neurological conditions as a result of variations in the human genome.

Wait. What?

Psychological disorders aren’t disorders at all unless considered by therapists, psychiatrists and the general public.

A person doesn’t need to be cured of their autism or tourette’s or bipolarity, neurological states that carry heavy social approbations, but accepted as part of the diverse human experience.

The striking similarities between this argument and transsexuals argument regarding unencumbered access to hormones free of social controls failed to impact me immediately.

I understood the arguments of the neurodiversity movement, and I’d like to be able to say today how I was struck smart instantly, but I would be lying if I said that.

In truth I bumped around my own internalized ableism.

Our society profoundly hates and loathes people with different-than-normal neurological conditions.

We joke about them, fear them, round them and murder them, corral them in institutions and betray them repeatedly with shock therapies, water treatments and all kinds of tortures more suited to an Inquisition chamber, not a modern medical establishment.

Oh, and if the person is also transsexual and taking hormones, we’ll be sure to take away their hormones, anytime we want.

Just because we can.

When the Corners Don’t Meet

When I learned medical authorities, particularly doctors, men and women sworn to do no harm, confiscated hormones from patients presenting with other issues/problems/concerns related to their neurological condition, my confusion began to lift.

Seizing hormones is a cruel punishment for a transsexual. How does taking them away from someone who feels suicidal make them feel less suicidal?

Around this same time a dear friend with an exceptionally strong form of bipolarity gave permission for several rounds of ECT or shock treatments. Doctors convinced this person of the efficacy of these treatments.

They ultimately went through several rounds, then stopped. We spoke not long after that.

“I’m sorry but there will be entire months, and maybe even years, of our relationship I won’t remember. I’ll probably never remember.”

Then this person said words that changed my life.

“You’re my memory keeper now.”

I couldn’t square this deal anymore.

What that FtM don’t to warrant a death sentence from people who are supposed to help? Or my dear, dear friend?

Why must we fix different neurological states?

When the objective goal is to make a person normal, perhaps we need to change normal.

At this point I had come full circle.

As a transsexual, I hated normal and realized disability and neurodiversity activists did as well.

One or Two Things I’ve Learned

My fear of being diagnosed with a psychological disorder is arbitrary and results from my wrong-headed beliefs.

Now I’ve learned psychiatric treatments often center around making a person productive, which I think codes out as “go earn the system some profits,” or unitary or stable, whatever that means.

Psychiatric treatments seek to make neurologically diverse people their kind of normal.

I can relate.

A therapist once asked me if I had ever tortured animals, all because I needed his professional okay to pursue top surgery.

The questions and tests and interviews facilitated by the diagnosis of gender identity disorder often seem more about the clinicians than me.

Now I’ve learned psychotherapeutic communities want control. They want to mold us into an image in which they see themselves. Whether or not we survive such extrusions, who cares? We’ll get a stamp of “normal” or we should die trying.

But the most important thing I’ve learned is that a diagnosis is a diagnosis.

Whether the diagnosis is medical or psychiatric, I must still navigate through a system of channels and locks controlled by people who may or may not have my interests in mind.

Medical diagnosis don’t offer better solutions. People with diagnosis of cerebral palsy, for example, or dystonia, can, and are, treated like children by clinicians.

I’ve learned that if you are a black man fighting against a system out to kill you, you’ll probably get diagnosed as schizophrenic.

I’ve learned what happens to a white woman fighting against the malaise of confined, middle-class womanhood.

Either way the cure – whether the diagnosis is schizophrenia or severe under stimulation – doesn’t address the problem, which is racism and misogyny.

Now I’ve learned few circumstances exist that warrant denying a person hormones because they have an additional neurological condition.

I’ve learned a person’s gender dysphoria  and another neurological state can follow parallel paths and never intersect. Most therapists I’ve known misunderstand this phenomena, believing that gender can’t be independent of any other diagnosis, even a medical one.

I find it difficult to believe psychiatry a value-neutral proposition. Too many therapists have feed me and my people loads of crap. I’ve had to eat my share of shit sandwiches when it comes to managing my transsexualism, but I’ve always chosen to eat them.

It’s different when someone is shoving it down your throat, while sitting on your chest with their hands around your throat, implying you are abnormal because you struggle to eat the sandwich.

When I really listened to disability activists, sitting with my prejudices and discomforts, I realized a diagnosis is a diagnosis.

Now I’ve learned a medical diagnosis doesn’t make things better for people. A diagnosis of cerebral palsy or dystonia can, and does result, in being treated by like a child by clinicians.

Mostly I’ve learned how desperate middle-class people are for everyone to fit it, get along and keep a low profile.

When I worked at a social work school, a new coworker once called me in a panic.

“A man is sitting in the common area, shouting and biting his fist.”

“He has Tourette’s syndrome,” I told her after walking past the man to her office.

“We know him,” I said.

She smiled, sort of.

The social norming of my employer told her she needed to accept him. He had a right to sit in the common area and shout and bite his fist.

“Oh. Okay.”

Her upbringing, however, suggested a different outcome.

Middle-class people prize quiet and social conformity.

Crazy is a very bad thing among the middle class. Your head is broke.

Now I realize my head is broke, too, when examined through the lens of extreme middle class blandness, gender conformity and the DSM.

Whether a little bit or a lot, a broke head is still broken. I needs  diagnosis to get fixed.

When I fear crazy and rail against gender identity disorder and makes claims that I’m not crazy, I’m not really doing anything to change a system I say I hate.

The problem isn’t people who are neurologically different from me. The problem is the system that wants me to believe they are the problem.

Let’s work on changing the system, a twisted, violent thing that really is broken.