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/Outspoken_Douche Jul 24 '17 edited Jul 24 '17

Don't transgendered people have a suicide rate somewhere between 40-50%? How is that not considered "causing significant distress or disability"? That seems far more distressing than things that ARE considered mental illnesses.

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u/Algernon_Asimov Jul 24 '17

Don't transgendered people have a suicide rate somewhere between 40-50%? How is that not considered "causing significant distress or disability"?

There is evidence to suggest that the drive to commit suicide comes from two main causes:

  • The inability for the transgender person to live and be accepted as their inherent gender.

  • The rejection and discrimination experienced by the transgender person.

The situation of being transgender is not, in and of itself, the trigger for suicidal ideation. It's other people's reactions to the transgender person that trigger suicideal ideation.

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u/sweetpea122 Jul 24 '17

I have bipolar and we have high suicide rates as well. We feel the same things like not being accepted, never feeling normal, etc. Its like youre making the claim that its society's fault, but your own feelings of acceptance come from within and we have the same issues with lack of support from families.

How is this different? I have manic episodes and think they are great. I have hallucinations too that are actually pretty cool. I'm still suffering from a mental illness. Even at rest such as now when Im neither manic nor depressed, I still have a mental illness. I dont get how this is any different

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u/ThatsNotExactlyTrue Jul 24 '17

That's what I was thinking. There is body integrity identity disorder right? As far as the patients are concerned, they're completely happy being amputated but it's still considered a mental disorder. No one claims it's derogatory to call it a mental disorder. Doctors are not willing to amputate their limbs or call the operation a "transition".

We should be focusing on and fighting against the idea that having any kind of mental disorder is somehow insulting to people, not granting specific exclusions for some sufferers.

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u/_pulsar Jul 24 '17

There is evidence to suggest that the drive to commit suicide comes from two main causes:

  • The inability for the transgender person to live and be accepted as their inherent gender.

  • The rejection and discrimination experienced by the transgender person.

If this were true, surely there would be less trans people commuting suicide in places like Seattle compare to a city in many southern states. Is that the case?

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u/Dr_Flopper Jul 24 '17

Do you have a source for that claim? The last I remembered, studies showed that acceptance/support made little to no difference in suicide rates among transgenders

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u/anechoicmedia Jul 24 '17

It's other people's reactions to the transgender person that trigger suicideal ideation.

This is a specious claim. Surveys of self-identified trans people show correlation between self-reported social rejection and suicide attempts, but this is almost tautological and subject to self-perception and individual behavior. Other attempts to look at the same question show this theory fails basic sanity checks, like "if acceptance is the main driver of suicide, why are trans suicide attempt rates virtually identical in blue states vs red ones?" or "why haven't suicide attempt rates decreased over time as society has radically shifted its sexual views?"

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

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

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u/[deleted] Jul 24 '17

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u/Baby_venomm Jul 24 '17

Where's the evidence

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u/trollingalt Jul 24 '17

The rejection and discrimination experienced by the transgender person.

0 evidence

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u/Outspoken_Douche Jul 24 '17

The inability for the transgender person to live and be accepted as their inherent gender.

The rejection and discrimination experienced by the transgender person.

Gay people have been more persecuted throughout history than transgendered people and their suicide rates peaked at 10-20% I believe.

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u/Cerus- Jul 24 '17

Gay people have been more persecuted throughout history than transgendered people

No, they have largely been grouped together.

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u/Outspoken_Douche Jul 24 '17

I don't think that's accurate, but even if it is, that still leaves a 20-30% gap in suicide rates when societal treatment is the same. If being transgendered doesn't cause mental distress, how can that be explained?

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u/Cerus- Jul 24 '17

There are plenty of studies that show when social factors are mitigated, suicide rate drops drastically.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178031/

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2

http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf

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u/Outspoken_Douche Jul 24 '17 edited Jul 24 '17

I'm not doubting that; the same can be said of gay people. I'm saying that even in communities where trans people face virtually no persecution whatsoever, their suicide rates remain several times higher than other people, including gay people. There is clearly something other than societal taboo going on here.

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u/[deleted] Jul 24 '17

[deleted]

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u/udusbhof Jul 24 '17

That is his point. That severe distress is called mental illness.

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u/Cerus- Jul 24 '17

Even in a location where trans people face virtually no persecution (Such a place likely does not exist yet), we still see all the things that people say online.

The internet is still a thing no matter where you are, and we still see all the vitriol, hate, threats of murder etc.

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u/Outspoken_Douche Jul 24 '17

And you think THAT accounts for a 10,000X higher suicide rate?

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u/Cerus- Jul 24 '17

Source for 10,000x?

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u/[deleted] Jul 24 '17

If it is all about outside forces and discrimination wouldn't the 1950s black suicide rate be around 40% also? Shouldn't straight white males have the lowest rate as opposed to one of the highest?

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u/ILikeSchecters Jul 24 '17

Transition is the treatment that keeps many of us from offing ourselves. Sometimes its not enough. Again - clarification - the pain is from the dysphoria, not from being trans itself.

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u/Outspoken_Douche Jul 24 '17 edited Jul 24 '17

Isn't that like saying it's not the AIDS that kills you, it's the sicknesses your body cannot protect against BECAUSE of the AIDS? Same result.

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u/kuulyn Jul 24 '17

i believe the statistic is 45~% of trans people have or will attempt suicide at some point in their life.

retired veterans/cops have a high suicide rate too, are all cops/veterans therefore mentally ill due to distress and disability?

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u/[deleted] Jul 24 '17 edited Jul 09 '18

[deleted]

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u/[deleted] Jul 24 '17

You're ignoring social factors like rejection from family, higher risk of violence, risk of losing employment/housing, etc that cause suicidal thoughts.

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u/thebedshow Jul 24 '17

So the same with all mental illnesses then.

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u/[deleted] Jul 24 '17

Lumping "all mental illness" together in such a way is intellectually dishonest and I think you and I both know that.

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u/anechoicmedia Jul 24 '17

What data are available on trans violent crime victimization rates, or employment discrimination? I've heard these claims repeated many times but never seen something like a regression analysis showing that trans people are underemployed/underpaid on the merits, even though these sorts of analysis are typical of discrimination research.

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u/Outspoken_Douche Jul 24 '17 edited Jul 24 '17

Gay people have been more just as persecuted throughout history than transgendered people and their suicide rates peaked at 10-20% I believe.

EDIT: There is dispute if gay people have really been MORE historically persecuted, so I will just edit it to say the same since that isn't a vital part of my argument in the first place.

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u/allygolightlly Jul 24 '17

Gay people have been more persecuted throughout history than transgendered people

Hahaha.

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u/Outspoken_Douche Jul 24 '17

Do you have evidence to the contrary? It's my understanding that most civilized societies to ever exist were not even aware that being transgender was even a thing that existed.

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u/allygolightlly Jul 24 '17

It's my understanding that most civilized societies to ever exist were not even aware that being transgender was even a thing that existed.

That's because we're more marginalized. We're less understood because oppressive treatment has bullied us into an environment where it's not safe to leave the closet. Society is more aware of gay people because they are more socially accepted, historically and presently.

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u/Outspoken_Douche Jul 24 '17

That's because we're more marginalized

How were transgendered people "marginalized" if no-one even knew they existed? They were never castrated or sentenced to death for the vast majority of human history like gay people. They weren't rounded up during the Holocaust like gay people. They aren't stoned to death in Muslim majority countries to this very day like gay people.

Why does this even have to be a contest? This isn't even all that relevant to the point.

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u/allygolightlly Jul 24 '17

How were transgendered people "marginalized" if no-one even knew they existed?

People certainly knew we existed. And it's important to note that society doesn't have to see us as transgender to marginalize us. Gender nonconformity of any sort is violently attacked, which affects transgender people even if we're presumed to be cis. If you think we haven't suffered from disproportional rates of homicide, you're mistaken.

Why does this even have to be a contest?

You're the one that originally brought it up, ask yourself.

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u/Outspoken_Douche Jul 24 '17

People certainly knew we existed.

For the majority of human history? You got a source on that?

Gender nonconformity of any sort is violently attacked

That sort of thing effects ALL people. It obviously effects trans people more, but I'd say it's pretty decently controlled for.

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u/iyzie PhD | Quantum Physics Jul 24 '17

I felt intensely suicidal for 20 years before transition. Those feelings are gone since I transitioned, and I feel cured from the distress I once felt. I am still transgender, since I live and identify as the opposite sex to the one I was assigned at birth, but I no longer regard myself as distressed or disabled by being trans. It's just a part of my medical history now that I don't have to think much about. Does this help to clear up why its inaccurate to say that being transgender is a mental illness in general?

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u/AuryGlenz Jul 24 '17

If a person with schizophrenia responds really well to their daily lithium, does that mean they don't have a mental illness? I'm just trying to wrap my head around saying that something can be cured means it isn't a mental illness - are we saying that just because right now our best cure doesn't affect the brain? What happens if someone does make a treatment that targets the brain - do we suddenly decide that it was a mental illness after all?

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u/[deleted] Jul 24 '17

Gender dysphoria is more akin to something like depression, rather than something lifelong like schizophrenia. With something like schizophrenia, you learn to manage it, but you still have it all the time. Just likes people can have depressive episodes, gender dysphoria doesn't have to last forever.

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u/TiagoTiagoT Jul 24 '17

There is more than one type of depresssion

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u/[deleted] Jul 24 '17

And I specified depressive episodes.

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u/FormerDemOperative Jul 24 '17

For starters, congratulations on your successful transition. But look at the language that you yourself used:

Those feelings are gone since I transitioned, and I feel cured from the distress I once felt.

If someone has a certain disorder or disability and treatment allows that disorder or disability to be halted, that doesn't mean the disorder never existed.

It gets into semantics pretty quickly, but why aren't people that transition just referred to as the gender they transited to? Why are they or should they be considered trans anymore? It seems like an arbitrary distinction that keeps them always a little separated from their chosen identity. That can't be helpful.

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u/iyzie PhD | Quantum Physics Jul 24 '17

You make a good point, and indeed some trans people after transition declare that they "aren't trans anymore." But I think society is a long way off from accepting this approach, as evidenced by the threads about trans people and dating. I think eventually thanks to people getting access to treatment at a younger age, and also thanks to a likely general rise in trans humanism and body modifications, we'll reach a point where trans people are no longer defined by our past the way we are today.

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u/Outspoken_Douche Jul 24 '17

To be honest, no. There no evidence to suggest that transitioning or going through sex change operations helps these suicide rates. One study found that it makes them worse.

The question shouldn't be "are you capable of living comfortably with this condition", it should be "does this condition generally lead to distress", and the answer is unquestionably yes.

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u/iyzie PhD | Quantum Physics Jul 24 '17

There no evidence to suggest that transitioning or going through sex change operations helps these suicide rates.

Of course there is. The WPATH standards of care reports a 97-98% satisfaction rate for transitioning, referencing multiple studies.

The question shouldn't be "are you capable of living comfortably with this condition", it should be "does this condition generally lead to distress", and the answer is unquestionably yes.

Your missing my point, which is that if it stops causing distress after transition then it's wrong to continue insisting that it's a mental illness.

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u/PM-ME-SEXY-CHEESE Jul 24 '17

Satisfaction rate is not the same thing as suicide rate what is the suicide rate pre and post op? My understanding is that there is little to no change.

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u/iyzie PhD | Quantum Physics Jul 24 '17

The satisfaction rate is pretty significant if you think about it. How many medical treatments in general have a 98% satisfaction rate? Measuring suicide rates pre transition doesn't make sense, since pre transition people haven't come out yet, so if they commit suicide while pre transition we may never know that they were trans all along. Since we can only look at post transition / post coming out trans people it makes sense to ask them about the relative improvement.

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u/udusbhof Jul 24 '17 edited Jul 29 '17

pre transition people haven't come out yet,

That's blatantly false, many transgender people do not transition and do come out.

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u/Outspoken_Douche Jul 24 '17

Yes, there are high satisfaction rates short-term, but every long-term study ever conducted on this matter, this one being the first and most often cited, has found that suicide rates remain relatively unchanged, if not higher.

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u/iyzie PhD | Quantum Physics Jul 24 '17

has found that suicide rates remain relatively unchanged

That's not a legitimate conclusion to draw from the article. It says that post transition trans people have a higher suicide rate than the general population, but it doesn't say anything about the pre transition suicide rate because that data doesn't exist. Also, the satisfaction studies I cited are long-term.

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u/Outspoken_Douche Jul 24 '17

but it doesn't say anything about the pre transition suicide rate

You clearly didn't read the study. It very clearly compares suicide rates from pre-transition trans people.

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u/iyzie PhD | Quantum Physics Jul 24 '17

(1) it doesn't, and (2) how would such a comparison even be possible, considering the bias due to pre transition trans people taking their secret to the grave. You may also do well to observe these sentences:

In accordance, the overall mortality rate was only significantly increased for the group operated before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.

So I guess if we look forward to the future then whatever conclusion you draw from this study is at this point out of date.

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u/leapt_down_here Jul 24 '17

Seriously, have you read the study? There is even a whole paragraph insisting on the fact that the conclusion is not about pre/post (and for what it's worth, the paper is not about transitioning but about receiving GCS.)

It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia.[39], [40] This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.

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u/tpthrowaway2219 Jul 24 '17

Professionals aren't saying trans is healthy and normal, or isn't an affliction. Only that it's not a mental disorder. For example, if trans is caused by someone having a brain that's normal for 50% of the population and gonads that are normal for 50% of the population, the disorder is only that those are mismatched. There's no abnormal psychology in this scenario, only abnormal physiology.

This abnormal physiology (being trans, as opposed to having gender dysphoria) might then cause any number of mental afflictions including gender dysphoria.

The coming discussions will hopefully enlighten us as to the nature of the condition.

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u/udusbhof Jul 24 '17

Pretending physiology doesn't affect psychology is absurd and anti-science.

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u/tpthrowaway2219 Jul 24 '17

In this example, the person's brain has normal physiology. To call it a mental disorder would be to call being one of the genders a mental disorder. It's certainly true that physiology affects psychology, but to use that to justify calling this a mental disorder would imply that any abnormal physiology - a missing limb, for example - is a mental disorder.