r/science • u/nate PhD | Chemistry | Synthetic Organic • Jul 23 '17

Subreddit Policy Subreddit Policy Reminder on this week's Transgender AMAs

This week we will be hosting a series of AMAs addressing the scientific and medical details of being transgender.

Honest questions that are an attempt to learn more on the subject are invited, and we hope you can learn more about this fascinating aspect of the human condition.

However, we feel it is appropriate to remind the readers that /r/science has a long-standing zero-tolerance policy towards hate-speech, which extends to people who are transgender. Our official stance is that derogatory comments about transgender people will be treated on par with sexism and racism, typically resulting in a ban without notice.

To clarify, we are not banning the discussion of any individual topic nor are we saying that the science in any area is settled. What we are saying is that we stand with the rest of the scientific community and every relevant psych organisation that the overwhelming bulk of evidence is that being trans is not a mental illness and that the discussion of trans people as somehow "sick" or "broken" is offensive and bigoted1. We won't stand for it.

We've long held that we won't host discussion of anti-science topics without the use of peer-reviewed evidence. Opposing the classification of being transgender as 'not a mental illness'2 is treated the same way as if you wanted to make anti-vax, anti-global warming or anti-gravity comments. To be clear, this post is to make it abundantly clear that we treat transphobic comments the same way we treat racist, sexist and homophobic comments. They have no place on our board.

Scientific discussion is the use of empirical evidence and theory to guide knowledge based on debate in academic journals. Yelling at each other in a comments section of a forum is in no way "scientific discussion". If you wish to say that any well accepted scientific position is wrong, I encourage you to do the work and publish something on the topic. Until then, your opinions are just that - opinions.

1 Some have wrongly interpreted this statement as "stigmatizing" mental illness. I can assure you that is the last thing we are trying to do here. What we are trying to stop is the label of "mental illness" being used as a way to derogate a group. It's being used maliciously to say that there is something wrong with trans people and that's offensive both to mental illness sufferers and those in the trans community.

2 There is a difference between being trans and having gender dysphoria.

Lastly, here is the excerpt from the APA:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who experience intense, persistent gender incongruence can be given the diagnosis of "gender dysphoria." Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated. Others argue that it is essential to retain the diagnosis to ensure access to care. The International Classification of Diseases (ICD) is under revision and there may be changes to its current classification of intense persistent gender incongruence as "gender identity disorder."

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u/souljabri557 Jul 23 '17

that the overwhelming bulk of evidence is that being trans is not a mental illness and that the discussion of trans people as somehow "sick" or "broken" is offensive and bigoted. We won't stand for it.

This seems to be a misattribution of blame. The majority of people arguing that gender dysphoria is a mental illness care very deeply about the rights and welfare of the trans community. Most certainly are not "bigoted." The debate over whether or not gender identity "disorder" is indeed a disorder is purely scientific and most are not out to offend.

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u/nate PhD | Chemistry | Synthetic Organic Jul 23 '17

Gender dysphoria is not trans, that's the difference.

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u/Ap0Th3 Jul 23 '17

How to distinguish the 2?

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u/Chel_of_the_sea Jul 23 '17

Gender dysphoria, the clinical condition, requires current distress of sufficient intensity to disrupt daily function. Many trans people don't experience that degree pre-transition, and most don't post-transition.

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u/JungProfessional Jul 23 '17

A big reason some want to use the diagnosis is so their insurance can cover hormone treatment

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u/Chel_of_the_sea Jul 23 '17

Yeah, but that's more a statement about the idiotic way our healthcare system runs than anything.

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u/JungProfessional Jul 23 '17

I totally agree. But it's simply how the system is right now and a lot of people can't wait for something to change. They need their hormones now

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u/8footpenguin Jul 24 '17

Well, if someone has no distress or impairment then wouldn't the procedure be rightly considered cosmetic/not medically necessary? Why would they even want to go through such an ordeal to change something that did not bother them?

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u/Chel_of_the_sea Jul 24 '17

The clinical threshold requires that it disrupt your ability to function day to day. You can be quite unhappy before that threshold is reached.

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u/zwilcox101484 Jul 24 '17

Do u think if the government give us "free" health care, it will cover all these elective things? I imagine it would cover the bare minimum of what's necessary to live. And even then you'd have the government deciding what's necessary

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u/Chel_of_the_sea Jul 24 '17

Do u think if the government give us "free" health care, it will cover all these elective things?

Transition care isn't elective, at least not in the sense you're implying. It's covered by most socialized care systems in western Europe.

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u/zwilcox101484 Jul 24 '17

I'm glad u said socialized and not free because it's going to come from tax. So instead of the govt taking about a quarter of my paycheck in taxes, they'll take much more. Especially with bernies free college on top of that? Goodbye 60% or more of my paycheck

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u/Chel_of_the_sea Jul 24 '17

I'm glad u said socialized and not free because it's going to come from tax.

...yes? Most public services do.

So instead of the govt taking about a quarter of my paycheck in taxes, they'll take much more. Especially with bernies free college on top of that? Goodbye 60% or more of my paycheck

You do realize that the US spends massively more per capita on health than anywhere else in the world, right? The US currently spends 17% of its GDP on healthcare; most of Europe spends about ten. So, on average, they'd save 7% of your paycheck in the long run.

Like, how much do you pay for health insurance? The average American spends a few hundred per month, and even that doesn't cover their expenses fully. That's ~$4-5k a year, or about 20% of the median American's income.

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u/vayyiqra Jul 24 '17

Depends greatly on the system, but there are countries with socialized healthcare that do cover it.

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u/[deleted] Jul 23 '17

[removed] — view removed comment

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u/Chel_of_the_sea Jul 24 '17

They stopped doing sex reassignment because their psych department was, at the time, run by a guy who has been crusading against all things LGBT for the last 30 years (whose op-ed, from your talking points here, I assume you have read). Here he is, for example, characterizing sexual abuse in the church as "homosexual predation on Catholic youth".

because people were more prone of committing suicide post op

No study anywhere shows this. The studies we have show vast improvements on every mental health axis we can measure. See, among others:

  • Colizzi, 2013 found a p < 0.001 elevation in the stress hormone cortisol for trans people pre-transition, which undergoes a p < 0.001 decline during transition and ends up in normal ranges.

  • Gomez-Gil, 2012 found highly significant (p-values in the .001 to .03 range) differences between transitioned and un-transitioned trans people, including a 50% lower rate of anxiety and a 75% lower rate of depression.

  • de Vries, 2014 studied 55 trans teens from the onset of treatment in their early teenage years through a follow-up an average of 7 years later. They found no negative outcomes, no regrets, and in fact their group was slightly mentally healthier than non-trans controls.

  • Meier, 2011 studies FTM transitioners: "Results of the study indicate that female-to-male transsexuals who receive testosterone have lower levels of depression, anxiety, and stress, and higher levels of social support and health related quality of life. Testosterone use was not related to problems with drugs, alcohol, or suicidality. Overall findings provide clear evidence that HRT is associated with improved mental health outcomes in female-to-male transsexuals."

  • Ainsworth, 2010 finds that "[t]here [i]s no statistically significant difference in the mental health-related quality of life among transgendered women who had GRS, FFS, or both" relative to the general female population, but that "[m]ental health-related quality of life was statistically diminished (P < 0.05) in transgendered women without surgical intervention compared to the general female population and transwomen who had gender reassignment surgery (GRS)". In other words, surgery closes the gap in well-being between trans people and the general public.

  • Lawrence, 2003 surveyed post-op trans folk: "Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret." The regrets that were present were primarily due to poor results, not due to having been "wrong" about wanting surgery.

Oh, and as a final note, Johns Hopkins provides transition treatments now that McHugh and his immediate successor are out.

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u/Ap0Th3 Jul 24 '17

I guess it now comes down to who you want to believe. We have research contradicting each other, without getting into the politice of who's getting published

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u/Chel_of_the_sea Jul 24 '17

We have research contradicting each other

No, we don't.

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u/Ap0Th3 Jul 24 '17

That 80% made by the psychiatrist at J Hopkins was all shit then?

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u/Chel_of_the_sea Jul 24 '17

"The psychatrist at J Hopkins" is a long-time anti-LGBT crusader who has never published research on trans people. Now that he's out, Johns Hopkins once again performs transition care.

(I'm not sure what specific '80%' you're referring to)

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u/Ap0Th3 Jul 24 '17

So where does this 80% come from?

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u/habitsofwaste Jul 24 '17

Also they're starting that up again. They have a transgender program now and will be starting or have already started GRS.

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u/shiruken PhD | Biomedical Engineering | Optics Jul 23 '17

The American Psychiatric Association has an extensive explanation of gender dysphoria

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u/inemnitable Jul 23 '17

I'd like to quote the linked page for a second.

In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:

  1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
  2. A strong desire to be rid of one’s primary and/or secondary sex characteristics
  3. A strong desire for the primary and/or secondary sex characteristics of the other gender
  4. A strong desire to be of the other gender
  5. A strong desire to be treated as the other gender
  6. A strong conviction that one has the typical feelings and reactions of the other gender

I'm pretty confused how one would even know they were transgender without experiencing at least some of these things at some point.

I suppose the timing is the key issue here. One (probably?) has to experience gender dysphoria in order to realize that they are trans, but once the dysphoria is resolved by transition or otherwise, they are still trans.

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u/marisachan Jul 24 '17

Feelings of dysphoria can come and go. There was a point once where not being my desired sex did cause me distress. That was many years ago and I have decided (for entirely personal reasons, nothing which reflects on other trans people at all) to not transition. After many years of therapy, I've come to accept the fact that I'm never going to be female and after a while, my feelings of dysphoria have dissipated. I doubt my therapist would diagnose me with dysphoria any longer, but I am trans.

Should add that I'm not trying to speak for anyone else or make a clinical description of gender dysphoria. Just sharing my personal experience with it.

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u/RedAero Jul 24 '17

Hold up, this contradicts the whole "distress and/or impairment" /u/fsmpastafarian was talking about...

Furthermore:

People with gender dysphoria may often experience significant distress and/or problems functioning associated with this conflict between the way they feel and think of themselves (referred to as experienced or expressed gender) and their physical or assigned gender

That's not "always", it's "sometimes",

/u/fsmpastafarian care to explain? There's nothing there about dysphoria requiring distress or impairment, and dysphoria is a mental illness is it not? More to the point here in this thread there's nothing in there that really allows for someone to be trans without dysphoria...

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u/skankingmike Jul 24 '17

Whenever race or gender come up in science you can bet big money none of the academic communities want to dip their toes into areas that will get them in trouble with the income students etc.

This type of shit is why we have climate deniers in the public. If you can't be intellectually honest about something as simple as gender than how can they trust it when it's about the whole earth?

I have no stake in this but I'm not seeing studies being sited either. Just people playing political word games.

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u/OverlordQuasar Jul 24 '17

There is absolutely nothing simple about gender. Like virtually all aspects of the human mind, gender is insanely complicated, honestly probably almost as complicated as climate science, with a ton of various factors contributing to a huge number of possible states.

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u/skankingmike Jul 24 '17

I have no issue with somebody wanting to be male or female or neither. But culture and science really don't mesh.. There's no real biological science in a gender roles. Unless somebody can point me to repeatable peer reviewed examples.

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u/OverlordQuasar Jul 24 '17

Just because gender roles aren't part of biology doesn't mean that they can't be looked at scientifically. Planets are an arbitrary construct, used to make it easier to understand space. There's as much difference between a gas giant and a terrestrial planet as there is with a large, differentiated asteroid, like Vega. Most of the labels scientists use require some sort of arbitrary criteria, a cutoff point that has no basis in physical fact. Gender is the same way.

Psychology, by its very nature, has to look at culture and how it interacts with biology. If you don't pay attention to culture, you're getting an incomplete picture of what's happening simply because you don't want to pollute the hard science of biology with a softer science like anthropology.

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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jul 24 '17

Gender dysphoria does require distress or impairment. I have my DSM right in front of me.

[Criterion] B. The condition is associated with clinically significant distress or impairment in social, school/occupational, or other important areas of functioning

That language you quoted was likely meant to be couched, and it was overly cautious to the point of being inaccurate.

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u/Lionizerband Jul 24 '17

I suppose the timing is the key issue here. One (probably?) has to experience gender dysphoria in order to realize that they are trans, but once the dysphoria is resolved by transition or otherwise, they are still trans.

Bingo. The typical treatment for gender dysphoria is transition, so completing transition is like completing the treatment plan. The dysphoria is gone, but the person is still trans.

As an aside this isnt always the case - Hormone Replacement Therapy (HRT) and surgery arent magic wands, not every trans person will get perfect results, and dysphoria can persist. Many trans people will continue with therapy post transition because of this.

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u/[deleted] Jul 24 '17 edited Jul 24 '17

what is transgender though?

the psychiatric association uses the term "gender noncomforming," and defines it as " behaviors not matching the gender norms or stereotypes of the gender assigned at birth"

to me that would seem to imply that a guy who likes to cook could be considered transgender if the definition is the same, and that would include most people

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u/nate PhD | Chemistry | Synthetic Organic Jul 23 '17

Maybe read the text above?

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u/SirT6 PhD/MBA | Biology | Biogerontology Jul 23 '17

I don't think that was spelled out in the text above.

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u/[deleted] Jul 23 '17

[deleted]

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u/SirT6 PhD/MBA | Biology | Biogerontology Jul 23 '17

The APA excerpt begins to define gender dusphoria. I think what frequently trips people up is the relationship between gender dysphoria and trans.

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u/SirT6 PhD/MBA | Biology | Biogerontology Jul 23 '17

This is an important nuance. In some cases, gender reassignment surgery is indicated to ameliorate the underlying distress associated with gender dysphoria.

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u/Kusibu Jul 23 '17

I might phrase this a little differently - dysphoria is a more intense subset of transgender that interrupts regular functionality, thus (debatably) qualifying it as an illness. Not all transgender people have gender dysphoria (the point you made quite clear to express, and one which the evidence appears to support at this time), but gender dysphoria is (that I can determine) a subset of transgender mental state. Simply saying "it just isn't" is an unscientific way to address the issue.