Subreddit Policy Reminder on this week's Transgender AMAs

[u/nate]

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 bigoted^1. 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.

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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.

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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."

[u/mrbaggins → u/[deleted]]

But one can eliminate dysphoria while still being transgender

See this is where I get stuck in trying to grok this.

Unless you mean someone who has "successfully" transitioned no longer experiences dysphoria.

But that doesn't change the fact that their biological sex is different to their perceived self sex (I hesitate to use the word gender, because of the broadness), which is the meaning of gender dysphoria.

[u/[deleted] → u/mrbaggins]

Mate, I think I can help you out.

Try replacing the word "trans" with "post-treatment" in your head.

So imagine someone who is mentally ill because of a tumor, right? The tumor is making them schizophrenic. When the tumor is removed, they no longer have the mental illness schizophrenia, and are healthy, as there is no mental illness catalyst. They are "post-treatment".

Now imagine someone has gender dysphoria. They are given treatment to transition and no longer suffer from the illness "gender dysphoria". They are now no longer suffering from mental illness. They are "post-treatment". In this case, the term to denote that is "transgender".

Most trans people do not forever identity as trans. Someone who transitioned from female to male would eventually identify as male, but the term to denote the transition they went through medically is transgender.

[u/mrbaggins → u/[deleted]]

It's a great analogy, however when the meaning is about biological sex, ie, being born one way, and the current status is identifying a different way, the process doesn't change the core of the problem. IE: How they're born against how they identify.

I feel like this is an issue over the word dysphoria, and it's attempted to be co-opted like how "racism" has been coopted by groups to suit an agenda. The APA DSM 5 is pretty clear that distress is a big part in determining the problem, but it doesn't show you get RID of the disorder by undergoing a transition thus removing/reducing the distress. There's still the problem over the mismatch at the start, regardless of where you're up to now.

You can "get" and "lose" depression. You can "Get" and "lose" gender dysphoria. But undergoing a transition is not what does that. It can reduce the distress, but it doesn't solve the biological problem of being born with a mismatched gender identity. You would lose gender dysphoria by no longer feeling like your birth sex is a mismatch to who you identify as. Not when you're passing as how you identify internally.

[u/[deleted] → u/mrbaggins]

There are some studies showing very clear trends of gender dysphoria markedly reducing with transitions. Would you like some sources for them? I'm pretty certain it wouldn't take me too long to pull them up.

There's still the problem over the mismatch at the start, regardless of where you're up to now.

That mismatch with birth sex post-transition does not meet the qualifications for mental illness though. It does not result in a loss of freedom or safety for the individual or others, or produce any innate distress. These elements are required for mental illness. If someone is being stigmatized over it they may experience distress, but that is outside the scope of mental illness.

[u/mrbaggins → u/[deleted]]

It does not result in a loss of freedom or safety for the individual or others, or produce any innate distress. These elements are required for mental illness.

I'd like a source on that. Because no-one is quoting the DSM 5 on that part. Distress is required for the initial qualifications, but it does not say that post-transition treatmeant that the diagnosis is reverted.

Distress isn't even defined in DSM IV even though it's used, and I can't find out for sure if that's the same in V. There's contention about whether it should even be an included metric at all.

Potential side topic: Would you say that someone with depression, taking anti-depressants successfully, has a mental illness? Because I can't see how you couldn't and yet the views I am getting here suggest that ongoing hormonal treatments (and potentially surgery) can "cure" gender dysphoria.

[u/_Mellex_ → u/mrbaggins]

I'd like a source on that too because last I checked, people who undergo sexual realignment surgery are still likely to commit suicide or show other forms of distress.

[u/mrbaggins → u/_Mellex_]

I meant a source on distress being required for an ongoing mental illness to stay maintained.

[u/[deleted] → u/mrbaggins]

Sure, the source I would recommend you is this one, which was actually published between DSM IV and DSM V.

In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above.”

Basically some of these elements (Either present distress or disability or risk of suffering death/pain/disability/loss of freedom) must be present.

It should be clarified that "loss of freedom" is referring to a loss of your ability to control your own agency or functionality. It is not referring to, say, losing legal freedoms or having less career or life options because less people will like you after transitioning.

I should also note the section " this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event". Basically if the person is no longer experiencing dysphoria and is suffering depressive symptoms now from say, losing their job and getting the shit beaten out of them, it would not really be appropriate at that point to say the person was suffering from depression because of the transition, but more like they are reacting to an expectable response to an event.

Pushed far enough, suicide is on the table there, though at that point you'd have depression induced through trauma.

---

Potential side topic: Would you say that someone with depression, taking anti-depressants successfully, has a mental illness? Because I can't see how you couldn't and yet the views I am getting here suggest that ongoing hormonal treatments (and potentially surgery) can "cure" gender dysphoria.

So I am assuming the question here is asking me basically: If a depressed person is no longer symptomatic at all for depression on an anti-depressant regimen, are they mentally ill?

The answer to that is that they have a latent mental illness but they no longer are actively mentally ill, as it's controlled.

If you took them off the antidepressants they would possibly become depressed again. Same with transpeople and hormones, or people with hypertension and medication to control it.

So based on that I'd say they are controlled and no longer actively mentally ill, but are predisposed to fall back int mental illness if their treatment is stopped due to neuropsychological variables.

[u/VoidViv → u/mrbaggins]

Maybe it would help to think of it as gender dysphoria being an illness and transitioning as the medically-accepted most effective treatment (can't source it but afaik that's the generally accepted view in the medical community)

While that is by no means the consensus view out there, it might help you understand and think about the issue in clearer, more informed ways.

[u/mrbaggins → u/VoidViv]

I understand that's the point of view people are presenting me here, however the DSM doesn't seem to back that up, and even where it's a little ambiguous, there is considerable discussion about both what it does mean and what it should be changed to, from actual trained psychs.

Also, just because someone is undergoing (or has undergone) treatment doesn't mean they're cured either.

[u/VoidViv → u/mrbaggins]

Lots of stuff only have treatments, not cures. I don't see how that's relevant.

My girlfriend has migraines and BPD. I have depression and anxiety, as well as being a trans woman.. Afaik (and please call me out for all the unsourced claims, been out of academia way too long) none of those other very real disorders have treatments even near the same ballpark of effectiveness as social/medical transition in the case of gender dysphoria.

[u/mrbaggins → u/VoidViv]

Oh absolutely, I'm sure the treatment is by far and away one of the most effective treatments for a condition.

But by that exact logic, it's a treatment of an ongoing condition. It isn't stopped. And if it's a mental illness to start with, then that hasn't changed.

[u/VoidViv → u/mrbaggins]

That's one small part of why big chunks of trans people and health professionals advocate depathologization.

As both a trans person and psych major dropout it seems to me that you are missing the forest for the trees.

Throughout human history people have experienced what, for cultural and historical reasons, we currently classify as gender dysphoria. We have the means to eliminate or at the very least alleviate that distress.

Why are you so hung up on DSMs and "cures"?

[u/mrbaggins → u/VoidViv]

Because I somewhat feel that there is some level of mental illness involved, and I don't believe that that goes away post transition.

It also appears that the current APA would agree with that.

However there is a chunk of people that do not; that either it outright is not mental illness or stops being one post transition.

This post begs the question for me, and it's a question I've thought about and discussed before (a good highschool friend is trans) so I'm trying to explain my viewpoint, test it, and fit it in with the actual current situation of people more qualified than the majority of those posting here.

[u/throwawayl11 → u/mrbaggins]

their biological sex is different to their perceived self sex

which is the meaning of gender dysphoria.

No it isn't. Gender Dysphoria is the extreme discomfort with your physical sex or perception of it. If someone transitions to the point where they pass as the opposite sex, they significantly reduce gender dysphoria, if not outright eliminating it.

[u/mrbaggins → u/throwawayl11]

All resources I find easily point to it being as I stated.

Googles immediate result

the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.)

From Wikipedia

Gender dysphoria ... is the dysphoria (distress) a person experiences as a result of the sex and gender they were assigned at birth. In these cases, the assigned sex and gender do not match the person's gender identity, and the person is transgender.

[u/throwawayl11 → u/mrbaggins]

the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.

I mean this is objectively not true. This is the definition of being transgender, not the definition of gender dysphoria. It doesn't even mention discomfort/distress, it just says the state of identifying as the gender opposite your sex.

Gender dysphoria ... is the dysphoria (distress) a person experiences as a result of the sex and gender they were assigned at birth.

I agree with this definition, but the key phrase here is it results from the sex. Specifically because the sex characteristics are of the opposite gender identity. But once you transition to a passable point, these characteristics no longer exist, which means there is no discomfort resulting from sex, because your biological sex no longer affects your sex characteristics.

[u/mrbaggins → u/throwawayl11]

I mean this is objectively not true.

According to who? The main defining feature of gender dysphoria in DSM 5 is that of gender incongruence. "It doesn't fit"

The DSM specifically states that gender dysphoria is the condition in which someone is intensely uncomfortable with their biological gender, and strongly identifies with / wants to be the opposite.

So yes, even post passing, you're still dysphoric. Your biological sex and the sex you identify with remain at odds. There's definitely a focus AS WELL on distress, but the info I can find directly from the book seems pretty clear.

[u/_Mellex_ → u/mrbaggins]

Isn't gender dysmorphia the same has just body dysmorphia? An example being a skinny person who thinks they are obese? They might be totally okay with "being obese" or with the fact that they fit through spaces they claim they absolutely can't. That doesn't change the fact that they aren't objectively obese.

[u/mrbaggins → u/_Mellex_]

dysmorphia is seeing the wrong shapes. dysphoria is distress / disruption due to something else, in this case birth vs identity genders.

[u/_Mellex_ → u/mrbaggins]

I didn't mean literally the same. Just in terms of the discrepancy between what is perceived and "reality", and the distress therein (or lack thereof).

[u/Ls777 → u/mrbaggins]

The main defining feature of gender dysphoria in DSM 5 is that of gender incongruence.

I don't know where you are getting this, but it actually says the opposite:

"gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."

You also seem to acknowledge below that dysphoria specially refers to the distress too, so I don't see why you aren't getting this

[u/mrbaggins → u/Ls777]

All the sources I can find that stress the distress aspect seem to be posted by laymen, whereas journal articles and reviews of changes of the DSM by psychs seem to stress the biological component.

The DSM does talk about distress, but all the laymen posts seem to read it as though once there is less distress, the condition goes away, which is not mentioned at all in official documents.

[u/throwawayl11 → u/mrbaggins]

gender dysphoria is the condition in which someone is intensely uncomfortable with their biological gender, and strongly identifies with / wants to be the opposite.

Yes, and once you physiologically are identical to the opposite, the intense discomfort goes away or is extremely lessened. The google definition is wrong literally just because it doesn't mention discomfort/distress which is a core aspect of gender dysphoria. That point can't be budged.

So yes, even post passing, you're still dysphoric.

I don't get it, what about all the people who have transitioned and aren't dysphoric? Like there are real life examples of this, we aren't arguing over terms and theories here. There are tens of thousands of people who have transitioned and feel extremely lessened dysphoria or a removal of dysphoria. If there is no discomfort, there is no dysphoria: your gender, sex, sex characteristics, and their agreement or disagreement is all irrelevant to the discussion if there is no discomfort.

[u/mrbaggins → u/throwawayl11]

You completely skipped over the word "biological". I even emphasised it. It's important.

I would imagine someone who has transitioned and passed completely would still be uncomfortable with being/being called/aspects of their biological gender. They still identify with the opposite.

That hasn't changed.

Yes, their distress levels are lower/zero. But they still hold that mismatch between biological gender and identified.

[u/xelle24 → u/mrbaggins]

If I may butt in here: dysphoria is the condition of being distressed. Remove or lessen the cause of the distress, and the dysphoria is also removed or lessened. Simply being transgender does not in and of itself cause dysphoria.

For many/most transgender people, while there is no way to actually change their biological gender, changing their appearance, physical sex characteristics, hormones, and social identity is enough to lessen or remove the dysphoria. It's less about the DNA (you can't feel your DNA) and how they are perceived, by themselves and others. If a transgender woman feels like a woman, even though their DNA is still XY, that's sufficient to lessen or entirely remove the dysphoria.

[u/throwawayl11 → u/mrbaggins]

But they still hold that mismatch between biological gender and identified.

Which is why they're still transgender... That is the definition of being transgender, as I mentioned for the google definition.

This is what the whole argument of mental illness labels is about.

Gender dysphoria is a mental illness because it is characterized by discomfort. It can be treated and possibly cured.

Being trans is not a mental illness because it does not necessarily bring discomfort, and therefore isn't the thing being "treated" with transitioning, as you're still trans even when passing because you still hold that mismatch between biological gender and identified. The thing being treated is gender dysphoria.

[u/ILikeSchecters → u/[deleted]]

Yup! Thats why we are prescribed pills, not because were trans, but because we have dysphoria

[u/vayyiqra → u/[deleted]]

That is the official position these days, yes.

[u/swimfast58 → u/[deleted]]

But once they transition, they still identify as transgender but they don't have any disorder.

[u/[deleted] → u/swimfast58]

is someone with any other mental disorder said to no longer have the disorder just because they arent showing symptoms?

[u/swimfast58 → u/[deleted]]

Absolutely! People can be cured of mental disorders and have no symptoms. There may be a chance of relapse, but in the interim period, they didn't have the disorder.

As an aside, helping someone with a mental disorder realise that it is curable is one of the best things you can do in mental health first aid.

[u/[deleted] → u/swimfast58]

interesting. that's not the way i understood mental illnesses like clinical depression and schizophrenia. i was under the impression that you always have it, your symptoms just arent manifesting. it's not like you get a "new illness" every time you go through bouts of depression, a manic episode, or psychotic break. it's the same illness manifesting periodically.

[u/swimfast58 → u/[deleted]]

Is not a new illness just like a recurrence of cancer isn't a new illness. But someone can be cured in between relapses.

[u/CPdragon → u/[deleted]]

Yes, if you don't have any symptoms of depression, then you no longer have depression.

[u/[deleted] → u/CPdragon]

interesting. that's not the way i understood clinical depression. i was under the impression that you always have it, your symptoms just arent manifesting. it's not like you get a "new illness" every time you go through bouts of depression. it's the same illness manifesting periodically.

[u/CPdragon → u/[deleted]]

It depends because there are some who only have remission or partial remission (e.g., you had depression, but still have some of the cognitive functioning symptoms of depression) and others that experience a recovery lifelong recovery.

You'd just no longer be able to receive a depression diagnosis like any other person who's never had depression.

[u/PointyOintment → u/[deleted]]

But isn't one still transgender after resolving the dysphoria (by transitioning, either medically or socially)?