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Posted on 4/13/23 at 9:22 pm to Ross
quote:
Can you lay out for the O-T what the larger constellation of evidence might look like for a hypothetical patient?
Probably not in a way that is satisfactory for anyone, but I can try. I'm writing this off-the-cuff and am a little tired, so I'll try to address some theoretical aspects but I think I'm going to do a poor job of giving a description of the evidence in its totality at the moment.
Given my own background in molecular bio, my inclination is to give preference to genetic causes. That there are distinct differences between chromosomal sex, gonadal sex, and phenotypic sex and the fact that the embryological process is step-wise gives plenty of places where something can go haywire. For the category of DSDs which have distinct chromosomal causes, that makes it easier to categorize. I'm sure everyone knows someone with Klinefelter Syndrome, which is 47 XXY, and there is some possibility that something like 46 XY mosaicism might be underdiagnosed or missed, as those sex chromosome DSDs exist along a spectrum. The same is true of disorders of gonadal development which can lead to gonadal dysgenesis, ovotesticular DSD, etc..
The key feature to understand is that we've only really started to accurately describe disorders which are molecular in nature. Broadly, at the moment, they are categorized as disorders of androgen synthesis and androgen excess, which can have several other mini-categorizations. Many of these disorders can also exist on spectrums, such as androgen insensitivity. In addition, we've found several sites of possible estrogen dysregulation, which could explain for some of the variety in age and presentation of GD. Those newer sites of possible dysfunction also fit in with more or less older theories proposed for trans people, which included increased frequency of polycystic ovaries in FTM trans people and some anomaly with estrogen itself in MTF trans people.
There's a lot more I could write, but I'm doing a really poor job as it is. But we have to consider one thing, which is the effect of gonadal steroids on the brain. We know that there is a significant effect from studying the clinical population of people who have complete androgen insensitivity, as they will have the chromosomal sex of 46 XY, but will have characteristics of females. This shows the role that androgens have on masculinizing the brain, but it is going to be very difficult to categorize what levels of hormones are needed for masculinization, if that makes sense. Thus, you can have processes of sometimes incomplete masculinization, which can possibly explain some of the brain scan data. In addition, studies of people with congenital adrenal hyperplasia, another DSD, report more gynephilic sexual interests than normal females, suggest that pre-natal androgens could possibly influence sexual preferences too.
In addition to that, in 2015, we found that genes on pericentromeric chromosome 8 influenced the development of male sexual orientation, in addition to genes on chromosome Xq28, which points to multifactorial causes for differences in orientation and desired presentation.
The list of studies is so extensive in terms of suggesting a neuroendocrine etiology which isn't limited to one specific molecule that I can't privilege one presentation of GD over another because the former might have a DSD with it (as some of the current trans legislation does), as the presentations are not different in a meaningful way, and the possibility exists that there is a genetic cause or causes we haven't described.
I don't think I answered your question, but there is actually a lot more to say about the subject.
Posted on 4/13/23 at 9:25 pm to upgrayedd
quote:
I get that you're trying to approach this from a medical stance, but I think the social influence of this is 99% of the issue. I can't fathom how we've gone thousands of years as a species without this issue then a massive spike in the last decade.
There is that possibility, but other cultures have developed '3rd genders' which suggests that there is a distinct physiologic circumstance rather than something people are compelled into doing. There is even an evolutionary argument you could make for its existence, given its incidence and prevalence.
Posted on 4/13/23 at 9:36 pm to crazy4lsu
quote:
There is that possibility, but other cultures have developed '3rd genders' which suggests that there is a distinct physiologic circumstance rather than something people are compelled into doing. There is even an evolutionary argument you could make for its existence, given its incidence and prevalence.
I don't think using extremely obscure cultural anomalies is an effective way to explain its new foumd prevalence.
I also find it odd that an evolutionary explanation would pop up so quickly.
This seems to be pointing to a social contagion facilitated by desperate adults and a complicit medical industry
Posted on 4/13/23 at 9:50 pm to upgrayedd
quote:
I don't think using extremely obscure cultural anomalies is an effective way to explain its new foumd prevalence.
I don't consider them anomalies when they consistently appear in several distinct cultures.
quote:
I also find it odd that an evolutionary explanation would pop up so quickly.
I mean, the explanation would be the same for any disease which doesn't affect longevity but might affect sexual reproduction. If the mutations are random but occur consistently at rates above 1 in 200, it would survive selection pressures but still be relatively common.
quote:
This seems to be pointing to a social contagion facilitated by desperate adults and a complicit medical industry
I just don't buy that line of argument. I am very skeptical that anyone would choose to be transgender due to social pressure, just from my in-clinic experience. Those patients are signing themselves up for years of intensive therapy and care for social clout alone? That is exceedingly hard to believe.
Posted on 4/13/23 at 9:58 pm to crazy4lsu
quote:
I don't consider them anomalies when they consistently appear in several distinct cultures.
They're neither consistent not prevalent.
quote:
I mean, the explanation would be the same for any disease which doesn't affect longevity but might affect sexual reproduction. If the mutations are random but occur consistently at rates above 1 in 200, it would survive selection pressures but still be relatively common
That's a pretty weak theory.
quote:
I just don't buy that line of argument. I am very skeptical that anyone would choose to be transgender due to social pressure, just from my in-clinic experience. Those patients are signing themselves up for years of intensive therapy and care for social clout alone? That is exceedingly hard to believe.
We're talking about young, impressionable people glued to their phones and desperately in need of a attention and belonging. I've seen several stories of people who were also led to message boards via reddit where they were actively encouraged by adults to begin transitioning. These people are generally no different than the goth/emo kids and undoubtedly have the same mentality. Only this time, you can't take off the makeup and throw away your Hot Topic clothes.
Posted on 4/13/23 at 9:58 pm to crazy4lsu
quote:
I don't think I answered your question, but there is actually a lot more to say about the subject.
I unfortunately have to agree, and I’m not sure we’ve adequately decoupled developmental conditions that can lead to feminine or masculine predispositions from gender. This is why I asked you a fairly simple question to describe some factors you might find in a GD patient that would lead one to reasonably conclude that their gender does to align with their phenotypical/gonadal/chromosomal sex. You put forward brain imaging as one piece of evidence, I don't think many people would agree with you on that point.
I’m not entirely sure we even need gender as a construct to describe what we observe. Why would “biological male with feminine predispositions” and “biological female with male predispositions” not suffice, outside of intersex cases, given that feminine and masculine predispositions are in some instances entirely arbitrary cultural artifacts anyway. These predispositions can of course be traced back to some molecular and genetic cause. This was the cultural paradigm for the vast majority of my life and it was nothing if not functional and sensible.
Is that all the current functional definition is gender really is? Behavioral predispositions based on whatever the culture defines as masculine/feminine behavior?
This post was edited on 4/14/23 at 8:47 am
Posted on 4/13/23 at 10:04 pm to upgrayedd
quote:
That's a pretty weak theory.
That's just a description of why something with a genetic cause wouldn't be selected against.
quote:
We're talking about young, impressionable people glued to their phones and desperately in need of a attention and belonging. I've seen several stories of people who were also led to message boards via reddit where they were actively encouraged by adults to begin transitioning. These people are generally no different than the goth/emo kids and undoubtedly have the same mentality. Only this time, you can't take off the makeup and throw away your Hot Topic clothes.
But these people have to present to clinic at some point. Despite what is being said in the media, these drugs aren't being given out willy-nilly. It seems an incredibly taxing process to get a gender dysphoria diagnosis in order to go with a fad.
Posted on 4/13/23 at 10:13 pm to Ross
quote:
Why would “biological male with feminine predispositions” and “biological female with male predispositions” not suffice, outside of intersex cases, given that feminine and male predispositions are in some instances entirely cultural artifacts anyway.
That's a sociological question and would seem a vexing one. I can't speak to that other than preferences.
quote:
Is that all the current functional definition is gender really is? Behavioral predispositions based on whatever the culture defines as masculine/feminine behavior?
Well the specific definition of gender is outside my purview, as I can only describe relationships between chromosomal, gonadal, and phenotypic sex with ideas about gender. And as far as I know, this is a big problem in the psychological research. Who wants to study the development of childhood sexuality? From what I remember, we don't have an accurate description of the progression of childhood sexuality and the development of gender identity in a distinct way, as we do with childhood development broadly with all the associated theories. If I can summarize some of the studies referenced earlier more succinctly, many of them say that people who have been masculinized by androgens prefer masculine activities, and vice-versa. That's not really a robust description of the development of gender identity from a biologic or physiologic level, even though evidence suggests that the biologic aspect plays a major role.
Posted on 4/13/23 at 10:15 pm to saint tiger225
quote:
What's with the obsession of trans people here?
I guess its the same thing as obsessing over normalizing mental illness?
Blame the parents who normalize the stupid. Not the ones who see the insanity for exactly what it is right?
This post was edited on 4/13/23 at 10:18 pm
Posted on 4/13/23 at 10:20 pm to crazy4lsu
quote:
But these people have to present to clinic at some point. Despite what is being said in the media, these drugs aren't being given out willy-nilly. It seems an incredibly taxing process to get a gender dysphoria diagnosis in order to go with a fad.
You apparently showed how the medical field has justified the use of these drugs through the studies you showed. When these vulnerable kids have not only social trends, online encouragement, as well as complicit parents telling them this is not only the noble thing to do, but the only way to help them feel comfortable in their own bodies, it's no wonder that they go to these lengths. It doesn't appear that these procedures are being used as an absolute last resort but rather as an option in the tool kit.
Posted on 4/13/23 at 10:22 pm to crazy4lsu
well that’s sort of the crux of my issue with everything presented by you and in general on this subject
We talk about gender as though it’s simply an affinity to activities that society deems either masculine or feminine, but then there is a perverse sleight of hand done where many then argue that if your gender aligns in a certain direction, you ought to be treated by society as though your biological sex also aligns in this direction. See popular slogans such as “Trans women are women” which then prompted the very fair question in reply “what is a woman?”. I not only fail to see how this bridge passes scrutiny, I also fail to see how the use of hormone therapy to change the physiology of someone of a certain biological sex to be more aligned with the opposite sex based on their behavioral predispositions makes sense either.
It’s why I’m now asking about our definition of gender, because as these definitions get more and more conflated it becomes exceedingly difficult to convey meaning even with the simplest of concepts like “male” and “female”. You’ve talked about gonadal, chromosomal, and phenotypical presentations of sex and that is wonderfully precise language. If we had an equally precise definition of gender I think this entire conversation could be tied together with a much more satisfying ribbon, but as the concept is shrouded in vagaries it seems destined only to frustrate.
You’ve obviously outlined a series of conditions and factors that can potentially alter one’s predispositions in life, and if that’s how we define gender then so be it, but I don’t know if we’ve really gotten much further than that.
We talk about gender as though it’s simply an affinity to activities that society deems either masculine or feminine, but then there is a perverse sleight of hand done where many then argue that if your gender aligns in a certain direction, you ought to be treated by society as though your biological sex also aligns in this direction. See popular slogans such as “Trans women are women” which then prompted the very fair question in reply “what is a woman?”. I not only fail to see how this bridge passes scrutiny, I also fail to see how the use of hormone therapy to change the physiology of someone of a certain biological sex to be more aligned with the opposite sex based on their behavioral predispositions makes sense either.
It’s why I’m now asking about our definition of gender, because as these definitions get more and more conflated it becomes exceedingly difficult to convey meaning even with the simplest of concepts like “male” and “female”. You’ve talked about gonadal, chromosomal, and phenotypical presentations of sex and that is wonderfully precise language. If we had an equally precise definition of gender I think this entire conversation could be tied together with a much more satisfying ribbon, but as the concept is shrouded in vagaries it seems destined only to frustrate.
You’ve obviously outlined a series of conditions and factors that can potentially alter one’s predispositions in life, and if that’s how we define gender then so be it, but I don’t know if we’ve really gotten much further than that.
This post was edited on 4/13/23 at 10:32 pm
Posted on 4/13/23 at 10:26 pm to saint tiger225
quote:
But to say society is crumbling is fricking retarded.
The normalization of mental illness (lgbt) and promotion of it are indeed indicative of a failure of society. Not to mention the abandonment of Judeo-Christian values that made this country the dream destination it was. We are indeed regressing as a society, and it is because we have removed the most powerful tool of evolution. That being the failure of the weak. People often associate the phrase “survival of the strong” with evolution. But it is the culling of the herd that makes us better. We have completely removed that with entitlement programs.
quote:
There's been trans people forever. The only difference is now the left and the right are both obsessed with it, for some reason.
The left is obsessed with it for who knows what reason. The right is obsessed with it because it is yet another symbol of our society failing.
Posted on 4/13/23 at 10:34 pm to upgrayedd
quote:
You apparently showed how the medical field has justified the use of these drugs through the studies you showed. When these vulnerable kids have not only social trends, online encouragement, as well as complicit parents telling them this is not only the noble thing to do, but the only way to help them feel comfortable in their own bodies, it's no wonder that they go to these lengths. It doesn't appear that these procedures are being used as an absolute last resort but rather as an option in the tool kit.
Well, I can't speak to the totality of experience, but getting a GD diagnosis itself requires 6 of 8 clinical symptoms as well as clinically significant distress, with all the symptoms lasting 6 months. That was the robustness I referred to earlier, because it would seem next to impossible for a child to actually fake those symptoms for that time period, and also show some impairment in functioning. The time period and the generally stringent requirements make it seem very difficult to fake.
Posted on 4/13/23 at 10:49 pm to Ross
quote:
We talk about gender as though it’s simply an affinity to activities that society deems either masculine or feminine, but then there is a perverse sleight of hand done where many then argue that if your gender aligns in a certain direction, you ought to be treated by society as though your biological sex also aligns in this direction.
Well, I can only look at things as a medical condition. The labeling aspect in of itself isn't interesting to me except to defend patients who I feel have very complex, serious conditions. I do the same with respect to other mental illnesses, as it has become a sort of peeve of mine to assume that defining an illness as 'mental' somehow makes it imagined, when depression, anxiety, schizophrenia, etc., all have physiologic correlations.
quote:
I not only fail to see how this bridge passes scrutiny, I also fail to see how the use of hormone therapy to change the physiology of someone of a certain biological sex to be more aligned with the opposite sex based on their behavioral predispositions makes sense either.
Well, the reasoning here is that it was hoped that such a protocol would prevent suicide. At the one clinic where I was at, they presented data that suggested they saw an 80% reduction in suicidal ideation and other risk factors for suicide. The paper that clinic was going to publish might be in pre-print somewhere, but I think data from the Trevor Project and a few other studies showed something similar. The aim of using hormone therapy is to try to develop congruence inside the patient, as opposed to incongruence they feel when they present.
It does raise vexing questions in terms of the language we use, especially as we open that language up to the spectrum of possibilities. If gender doesn't exist, then why do we have the insistence on the concept of gender? Sex as it relates to male and females is useful for physiologic distinctions especially as they relate to reproduction, but if someone wants to exist outside that, why even the need to say 'trans-women are women' etc.
quote:
You’ve talked about gonadal, chromosomal, and phenotypical presentations of sex and that is wonderfully precise language. If we had an equally precise definition of gender I think this entire conversation could be tied together with a much more satisfying ribbon, but as the concept is shrouded in vagaries it seems destined only to frustrate.
It would be nice to develop a biologic concept of gender, but part of that identity is experiential, and though we have had no problem defining experiences into phases or stages with respect to other parts of human development, we struggle with anything that could be construed as sexual. That is clinically meaningful as well, because you have all sorts of paraphilias which aren't well-defined at all, so making clean and clear clinical delineations gets even harder at the edges, so to speak.
This post was edited on 4/14/23 at 6:23 am
Posted on 4/13/23 at 10:55 pm to crazy4lsu
quote:
Well, the reasoning here is that it was hoped that such a protocol would prevent suicide. At the one clinic where I was at, they presented data that suggested they saw an 80% reduction in suicidal ideation and other risk factors for suicide. The paper that clinic was going to publish might be in pre-print somewhere, but I think data from the Trevor Project and a few other studies showed something similar.
I’ve heard people contend the exact opposite with cited data with respect to suicide rates pre-transition and post-transition, so I’ll just say I’m fairly skeptical of this entire endeavor.
quote:
The aim of using hormone therapy is to try to develop congruence inside the patient, as opposed to incongruence they feel when they present.
I don’t feel we have appropriately defined what this incongruence is and how hormones could even possibly offer a mechanism to remedy it. Again, I feel this is conflating the ill-defined concept of gender, which is as of now loosely being defined as behavioral predispositions, and the well defined concept of phenotypical sex.
I think you lack a rational basis for stating these two things ought to be brought into congruence via hormone treatment. I’d think just teaching someone to be comfortable in their own skin seems to be a healthier approach.
quote:
It would be nice to develop a biologic concept of gender, but part of that identity is experiential
Well can you give me a functional definition that we can latch on to other than behavioral predispositions, because “identity” and "lived experience" just isn’t going to work for me nor should it work for anyone in this discussion. These are expressions that I find largely devoid of meaning.
As an anecdote, my wife was a college athlete and a genuine tomboy. For the first several years of her life said she hated that she was born a woman and wished she was a male. She didn’t take to traditionally feminine activities. It would have been an inaccurate assessment for anyone to claim she was actually a male in any capacity, yet I find definitions being loosely put forward that suggest exactly this, so clearing up the vagueness around this concept is pretty much required for me to go much further because I am confronted daily with an example that deeply frightens me when people start playing fast and loose with definitions. You are the one who introduced precision of language with medical jargon, I don’t see what the point of all that effort was if we just get lost on this point.
quote:
It does raise vexing questions in terms of the language we use, especially as we open that language up to the spectrum of possibilities. If gender doesn't exist, then why do we have the insistence on the concept of gender?
Well until we define what gender actually means, I don't know if it is fair to say we have an insistence.
I’ll reiterate my stance: I don’t think the entire concept of gender is needed or valuable in society. And until we define it adequately, I certainly don't see how one can justify hormonal treatments to bring an ill-defined concept into congruence with something real and observable like chromosomal/gonadal sex.
This post was edited on 4/14/23 at 8:53 am
Posted on 4/13/23 at 11:00 pm to crazy4lsu
quote:
The time period and the generally stringent requirements make it seem very difficult to fake.
Now I see you're talking about children, not sure what ages,
but I can tell you, certain personality disorders can and will fake this quite easily, and that's not to even mention other psychiatric illnesses that can lead an individual, particularly an adolescent, to latch onto GD as it is significantly growing in notoriety.
And I will say, the DSM now needs some revisions (that it won't get) regarding GD because of this. Six months isn't shite.
Clinically significant distress is subjective and there is a lack of a standardized research-backed evidence-based diagnostic evaluations and screening tools and understanding this you now begin to see the issue with a mere six-month time frame and then prescribing long-term treatment plans to children and, in particular, adolescents.
even if two psychiatrists sign off on it... Even today there are a lot of unscrupulous individuals out there handing out Benzos like candy... or "persuaded" into doing it by a cluster B patient.
Transgender / Gender Dysphoria is absolutely grossly overrepresented. What we see in the media today isn't GD. Throwing out the legitimate cases and the adolescents trying to find an identity, its 95% cluster B disorders using it as a pedestal to both dictate to and bully others, or for personal enrichment.
And never underestimate the damage they will do to themselves to get what they want.
My problem is the medical community, the AMA, the APA as well, seem all too happy to have found a lasting revenue source under the guise of 'patient safety' meanwhile, today's adolescents are pulled into what has become a cult of damaged, manipulative people.
This post was edited on 4/13/23 at 11:06 pm
Posted on 4/13/23 at 11:13 pm to USMCguy121
quote:
but I can tell you, certain personality disorders can and will fake this quite easily
For what end?
quote:
And I will say, the DSM now needs some revisions (that it won't get) regarding GD because of this. Six months isn't shite.
The patients who typically were referred to the pediatric endocrinology clinic had GD diagnoses for years at that point.
quote:
Clinically significant distress is subjective and there is a lack of a standardized research-backed evidence-based diagnostic evaluations and screening tools and understanding this you now begin to see the issue with a mere six-month time frame and then prescribing long-term treatment plans to children and, in particular, adolescents.
The DSM also states impairment in functioning, and that was more obvious than the nebulous 'clinically significant distress' but it was still referential and could be part of several other disorders. It was a long time before patients generally got puberty blockers either.
quote:
even if two psychiatrists sign off on it... Even today there are a lot of unscrupulous individuals out there handing out Benzos like candy... or "persuaded" into doing it by a cluster B patient.
Again, to what end?
quote:
Transgender / Gender Dysphoria is absolutely grossly overrepresented. What we see in the media today isn't GD. Throwing out the legitimate cases and the adolescents trying to find an identity, its 95% cluster B disorders using it as a pedestal to both dictate to and bully others, or for personal enrichment.
What cluster B disorders? Do you mean there is an overlap in symptomatology? And personal enrichment and/or bullying? That just isn't my experience with my friends who are trans.
This post was edited on 4/14/23 at 6:24 am
Posted on 4/13/23 at 11:20 pm to father2sons
quote:
This on interested me because he used to blast gender stuff all the time and make fun of it. Also, he had a wife and 2 kids. How do you go from that to deciding you’re a woman? Makes no sense
It makes all the sense in the world. It's an extreme, almost deranged form of repression.
Posted on 4/13/23 at 11:31 pm to crazy4lsu
Did Christina mutilate they genitals yet? If so, it probably looks like Beast burgers taste. Honestly the worst burger I've ever had. I don't know what they seasoned it with but it tasted like arse.
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