Lawyerly law stuff that's interesting


#482

Right, but there are signs the more complicated treatments are simply ineffective or harmful. See this, from the Guardian, citing researchers: https://www.theguardian.com/society/2004/jul/30/health.mentalhealth

Quoting:

With so much uncertainty, I think it makes sense to err on the side of not comparing people who are skeptics of these treatments as bigots or 'gay conversion 2.0" crowd. I think more emphasis should be placed on counseling.

Like I said, there’s so little long-term data about the effectiveness of some of the treatments (like surgery), that it’s hard to say if there’s a “more effective” treatment. There can be so many other mental health concerns going on at once, that sometimes what appears to be a person who would benefit from hormone therapy or surgery, may not in fact be one.

Sure, but if it causes depression – for example, by enhancing social isolation, or leading to feelings of doubt – that’s not a great outcome, right? Sort of like solving a leg injury by giving someone persistent heart attacks.


#483

Are you saying that there isn’t an incredible amount of counseling before any actual treatment is done? If you are, you are wrong. Thus you have no clue.


#484

All treatments have a risk of a bad outcome, and patients experience adverse events every day. As a society, we have chosen to inform patients of potential benefits and adverse events, and then allow them to make an informed decision.

In the case of sex reassignment, available evidence points to an overall decreased risk of depression. So it is not rational to avoid sex reassignment solely over fears of depression.


#485

There’s not enough in some cases, judging by how badly some of these procedures are going.

Didn’t the study I linked earlier show that the rates of depression remain incredibly high compared to the general population? And another study showed high risks of regret about the procedure? I think the long-term data are inconclusive at best.


#486

That is what you would expect regardless of whether the treatment improves risk of depression.

There are also high rates of regret after getting a tattoo.
Or getting married. Regret is not a diagnosis.

Anyway, it’s clear that sex reassignment is not the right choice for you, just as getting a tattoo is not the right choice for me. But if someone else understands the risk and is willing to proceed, then it is their right to do so.

Of course you find the data inconclusive, you barely looked at them.


#487

Thinking that in a decade or two, this will be moot. Thinking Gender transformation procedures may be as common as Plastic surgery someday. I’ve just read too much SF which touches on the topic, and given how the science/technology is evolving, this is likely to be much more fleshed out as to the dangers, and I think there are definite commercial applications to it eventually.


#488

Actually, I was referring to this line in what I linked:

No idea why you are being so hostile to the idea that the jury’s still out on this.

Yep, although I’d be curious if rates of depression are astronomical afterwards too.

Could be for sure.


#489

To be clear, ARIF was not actually conducting research, but rather was reviewing research done by others. But when you did into their investigations, you find some things that explain the findings. Here’s a write-up about ARIFs work.

It points out that ARIF discounted a large number of studies, because the studies did not meet ARIFs requirements. But the problem is, the nature of the issue makes doing things like double blind studies impossible.

But the reality is that there many studies, and they generally sure that SRS has been results for these patients.


#490

I am not hostile. I simply doubt that you have spent much time investigating the issue, and therefore it comes as no surprise that your opinion is muddy.

For instance, that quote comes from a Guardian pop science article that refers to an article by Chris Hyde. The article was not peer reviewed.

  • Did you bother to look up the original article from Chris Hyde et al, or evaluate his methods?

  • Did you know he also said “the research published generally states that the effects are beneficial”?

  • Did you know that the paper was written in 2004? As a reminder, Bush was in office then. Things have changed a lot since then, especially for the transgender community.

  • Did you know that Chris Hyde only looked at seven articles before concluding that “there is insufficient evidence”? The most recent paper he looked at was written in 1993. As a reminder, that was in Bill Clinton’s first term.

Dozens of papers have been published since that review article, and if you ever do read that article you will first be warned that even the publisher considers it outdated.

Yet here you are, citing data that are 20 years out of date to support your belief that we “lack evidence.”

The truth is that you’re not really interested in reviewing evidence, only in finding support for your preconceptions.


#491

Yeah of course, there’s the attack on my motivations. Please stop with that. The study I cited earlier, from the NIH, is neither out of date, nor particularly helpful for your position that the data is settled:


#492

Can you reword the last sentence? I don’t quite understand it. But it seems you are saying that it is hard to find a lot of great research on the topic with useful controls.


#493

Sorry, or should read something like:
They generally show that SRS has been beneficial for those patients.


#494

I read the article, and it does seem encouraging and is a great takedown of the Guardian’s piece, although as the author points out, I think more research in the area into long-term effects is advisable-- Would you agree?


#495

The study you cited earlier is evidence that gender reassignment does not solve every problem. And again, that is a straw man. Nobody claims that gender reassignment is a panacea. It only needs to better than the alternatives.

More research is advisable in a lot of areas, including cancer, heart disease, and stroke. But “more research is advisable” does not mean “treatment is not recommended.”


#496

How often are permanent, irreversible operations performed for a hybrid physical/ mental condition (gender dysphoria) without a lot of good evidence on the long-term effects? I don’t think the comparison works. We simply don’t know for sure it’s “better than the alternatives” yet.


#497

So you believe that transgender people are merely suffering from a psychological illness.


#498

By definition, those with gender dysphoria are suffering from a condition that involves both physical and mental elements:


#499

But you believe that they can be cured of a psychological defect, and thus, be turned back into “normal” people, thereby removing any need to undergo a sexual reassignment surgery, since they will be happy with their biological gender.


#500

In some, but certainly not all cases, that could be the case (although I object to the terms you used, e.g. normal). The current practice is to engage in a very very rigorous psychological assessment before any doctor considers hormone therapy or surgery, with the goal of curing the problem before more advanced procedures are needed. Do you object to that? Is the hesitancy to acknowledge this down to the stigmatization of mental illness?

Step one for any doctor would be to see, where do these thoughts of gender dysphoria come from? Are they the result of trauma, or have they existed since birth, etc? The doctor could successfully address the dysphoria without further procedures in some, but not all cases. In other cases, hormone therapy and surgery are necessary, but not all the time.


#501

You don’t know, because you haven’t really looked into it. And I’m not impugning your motives, I’m simply pointing out that your argument is fundamentally based on incredulity.

There have been a lot more papers published since 2004 on the topic, and they support a beneficial role for gender reassignment therapy. You should read them.

The literature surrounding this subject is at least as compelling as that surrounding other irreversible procedures, such as laparoscopy-assisted distal gastrectomy.

Finally, the distinction between “hybrid physical/mental condition” and other conditions is as worthwhile as the distinction between “hybrid neuro/cutaneous condition” and other conditions. Which is to say, it’s a pretty useless distinction for those of us who aren’t trying to stigmatize large groups of patients.

Step for one for any doctor is to go to medical school and learn the modern practice.

Seriously dude. Did a psychiatrist show up at your workplace and tell you how to do your job?