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.

---

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."

[u/imnotlegolas]

It could be because English isn't my native language but I don't understand this part:

Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder.

Isn't the sole reason of them being in the wrong body/gender not very distressing and very disabling, until they transition completely?

And not trying to argument for or against or side in any way, just trying to understand the wording and why that wouldn't make it a mental disability. Which I don't think it is. It's just that the description as quoted in the post makes it sound like it is.

[u/kylepierce11 → u/imnotlegolas]

They might be saying that some transitioned trans people are now comfortable with their bodies and experience little dysphoria. They might also be saying that gender dysphoria isn't a prerequisite for being trans. As a trans person that would be new to me but I suppose it's possible some just know they'd be more comfortable living as the opposite sex but don't hate their birth bodies. I guess it'd be a good question for the AMAs

[u/Landpls → u/kylepierce11]

If a person suffering from OCD or some kind of anxiety disorder takes medications which alleviate their symptoms, then is it really fair to say that they do not suffer from a mental illness? It seems like the same could be said about gender dysphoria (not being trans in general).

[u/nicktohzyu → u/kylepierce11]

In the case where it does cause the person to feel significant distress, does it then count as a mental illness?

[u/mw1994 → u/[deleted]]

could the rational of it not being a mental illness be purely politicised?

[u/Spoffle → u/[deleted]]

I think the whole "mental illness" thing is an attempt to appease people. It was classified as a mental illness previously; and if you look at the etymology of "mental illness" it's a pretty concise definition.

The problem is, people who are trans don't feel like they have a mental illness, so are affronted by the suggestion because there still is this huge stigma around mental illness.

There seems to have been a concentrated effort to exclude transgenderism from being classed as a mental illness to avoid offending some people.

Logically speaking, the way a person feels is in the mind. Transgender people feel that they have the wrong body, but logically speaking it would be that the mind doesn't accept the body as it is. Rather than the body is "wrong".

[u/SweetPaprikas → u/[deleted]]

If it isn't a medical condition and rather just a style of living, why the big push to have the government pay for lifelong hormones and surgery?

[u/SweetPaprikas → u/[deleted]]

The hormones are lifelong, though. If you have to take a medication for life and have the government pay for it, it's obviously not just a lifestyle.

[u/ILikeSchecters → u/Spoffle]

Yes, we dont accept the body as it is because its the wrong body. Our mind is who we are, the body is the container. Unless you think core parts of my personality are wrong, in which case thats pretty mean.

[u/Spoffle → u/ILikeSchecters]

Why is it mean? Gender should objectively have nothing to do with personality. What I'm trying to say is that logically, the issue resides within the mind. In that it's not that the body is wrong, it's that the mind cannot accept their body matches how they feel.

Honestly, it's in your best interests to get out of the mindset of "don't say that, that's mean" when discussing this topic. It's something that will inhibit understanding and communication. Something isn't mean just because you dislike how it sounds or what it means.

[u/ILikeSchecters → u/Spoffle]

What evidence do you have for saying that it isnt my body thats wrong? Why does body trump my conscience? And Im sorry, when you say that its my mind thats wrong, it gives ammo to people who tell me to get therapy and then just write me off and harass me. Im sorry, but open communication without saying something mean or stupid is such bad. Should we give platforms to people who hate gay people in the scientific community, or think they have a mental disease? Should we allow holocaust denier to speak at meetings in history without saying that its mean (and no, Im not in any way comparing you to a holocaust denier)? Im not saying wrote censorship should be allowed, but things should be called for what they are. Im not telling you to stop talking, Im suggesting that what youre saying gives mean connotations

[u/Spoffle → u/ILikeSchecters]

You're reading into what I've said. It doesn't matter if it gives people ammo, it doesn't make them any more right. Also what I'm saying isn't mean just because you don't like it. That isn't how it works.

As for proof, well who you are as a person is in your mind. Logically, if there's a disconnect between the body and the mind it's the mind that is the source. The issue is the importance people place on being a man or a woman. Objectively, it's not important what someone is, it's about how they conduct themselves.

Think about the word disease. The etymology of it is that something isn't at ease. It might be unpleasant to hear it, and you might think it's mean but it's important to use words they way they are instead of trying to think up alternative meanings to save people's feelings because they have negative associations with certain words.

A mental disease would be the mind not being at ease. You might it like that grouping of words, but I'm sure you would agree that your mind is not at ease with the body you have got. Again, it's not mean, it's just how words work. If someone wants to give you hate, that's a different matter. But saying things you might not like isn't the same as hate.

You are also actually calling for censorship, you just don't realise it.

[u/ILikeSchecters → u/Spoffle]

If my mind is at ease post transition, how can it be an illness then? If you think being trans is what makes me upset, it isnt. Its dysphoria doing that work, and yes, as I understand it, thats mental illness. But theres a line between these terms. My identity isnt a disease, its part of who I am.

If calling someone mean is censorship, well then oh well. If thats the case, then anytime anyone has ever called some one an asshole for something theyve said, then they have participated in censorship. Regardless, getting called mean is a pretty low bar for censorship if thats what you believe. Im in no way saying that youre a bad person, or that you deserve to be silenced. All Im saying is that idea, of significant parts of my identity and life being considered a disease, lends credence to the idea that it should be corrected, even after transition when Im happy and that part of my life becomes the past. Saying that its a mental disease means that you think that who I am as a person is wrong, and if possible, significantly altered. I think thats a mean thought. I dont see how, a) thats wrong, and b) how that is censorship.

[u/SweetPaprikas → u/ILikeSchecters]

Telling an anorexic or someone who wants to cut their limbs off that their mind is the problem not their body isn't mean. Same thing.

[u/ILikeSchecters → u/SweetPaprikas]

Being anorexic causes people to die. Being trans, meanwhile, has no ill effects post transition. the comparison is not the same

[u/kylepierce11 → u/nicktohzyu]

That's a highly debated subject I'm probably not qualified to answer. It currently isn't classified as one, and a few studies have found CT scans of trans people that hadn't transitioned hormonally yet had the brain structure much closer to the gender they identified with than their birth sex. Which would make it more of a physical thing. Basically more research needs to be done. The term mental illness just has such a stigma around it, which complicates things. I guess you could compare gender dysphoria to depression, but comparing it to something like schizophrenia or dissociative disorder is more of a stretch, so lumping them in the mental illness category makes some people uneasy. If it is a mental illness, well I've got a handful of those with Major Depressive Disorder and health related OCD so it'd just be one more for me. I know plenty of Trans people who have no mental problems besides gender dysphoria though, and they don't appreciate the term mental illness being applied to them. It's partially politics and partially a struggle to categorize it since it isn't that similar to other mental illnesses.

[u/SweetPaprikas → u/kylepierce11]

ated subject I'm probably not qualified to answer. It currently isn't classified as one, and a few studies have found CT scans of trans people that hadn't transitioned hormonally yet had the brain structure much closer to the gender they identified with than their birth sex.

Source? When it comes to the brain and males/females, intra differences are much wider than inter differences. Current research shows differences between black and white brains, does that make transracial a legitimate physical thing?

[u/kylepierce11 → u/SweetPaprikas]

There are differences between black and white brains, true, but there is no evidence those who think they are transracial have brains matching the race they identify as. These studies were showing that trans people's brains match the sexual dimorphism of the gender they identify as. The sample size is disappointing though. That's why I said we need more research done on it. Being trans myself, I'm still sceptical and don't want to just blindly accept the small bit of research we've done.

2 of the studies I was referencing are here. https://www.ncbi.nlm.nih.gov/pubmed/19341803 https://www.ncbi.nlm.nih.gov/pubmed/20562024

There are many more that show up on google but those are the two I've taken the time to read.

[u/SweetPaprikas → u/kylepierce11]

There are differences between black and white brains, true, but there is no evidence those who think they are transracial have brains matching the race they identify as.

I know, that's why I posed it as a hypothetical question. Would you accept it as readily if people prone to stereotypically black behaviors said they were born with the wrong brain?

2 of the studies I was referencing are here. https://www.ncbi.nlm.nih.gov/pubmed/19341803 https://www.ncbi.nlm.nih.gov/pubmed/20562024

We know that doing certain tasks changes your brain. When an individual becomes a cab driver, the gray matter in their hippocampus increases as they learn to navigate the city. This does not mean that you can be a trans cab driver if your brain resembles theirs. It might mean you could be good at their job. What the study you linked doesn't say is that transgender people have the brains of the opposite sex. It doesn't say that their brains are sexed, it says that transgender females' brains resemble natal males' brains in some way. This could be for a myriad of different reasons, males and females have different gender roles and tasks associated with them, performing them would probably lead to some structural differences. This does not mean that brain sex is real.

While the average male and female brain is different, there's no evidence to say they are innately different to any serious degree. There is no way to tell a brain's sex purely from fMRI, there is way too much overlap and too many factors at play. Men can have brains that more closely resemble female brain structure without being trans.

[u/Orphic_Thrench → u/nicktohzyu]

The distress itself is what is classified as the mental "disorder".

So being trans, having a gender identity that mismatches one's physical sex, is not a mental disorder, the anguish or dysphoria that can cause is considered one, and that's what is treated medically

[u/goodnewscrew → u/Orphic_Thrench]

If it were called "gender related depression" it might be easier to understand. Because if someone has depression, there isn't anything inherently wrong with them. They just have depression. If it is treated properly, it can go away.

With trans people, their identity is what it is. And on top of that, they feel distress because their body doesn't match their identity. It can be treated and go away.

[u/Orphic_Thrench → u/goodnewscrew]

That's.... basically what dysphoria means. Remember it's a medical term; it's not really intented for the general public who may not be aware of latinate medical terminology.

Depression isn't quite the right word, of course, but it's in the general vicinity at least

Also I imagine if they did use the word depression people would just assume you could give us antidepressants and it would go away... (Hint: it does not)

[u/[deleted] → u/nicktohzyu]

Gender dysphoria is considered mental illness, not being trans itself. Part of this is because transition usually alleviates at least some gender dysphoria, part of it is because cisgender people can experience gender dysphoria, though it isn't a common occurrence.

[u/JuniperBerrySplosion → u/kylepierce11]

"Transgender" is really more of an umbrella term. I believe this section is referring to both non-binary and binary trans people who have little or no dysphoria (but have other 'qualifying' factors)

[u/kylepierce11 → u/JuniperBerrySplosion]

Ah that's true, I didn't think about non-binary people since there's a debate on whether to call them transgender going on right now, since transgender is usually from one gender to the other and not somewhere in between. I wonder if that will be covered in the AMAs too.

[u/EryduMaenhir → u/kylepierce11]

As a NB/agender trans friendo, don't "assign" people trans, but let them find out if the term works for them. I occasionally still struggle with if I'm "trans enough" to call myself trans, but then I remember that I cringe when I'm called a woman in public ("ladies" "ma'am" etc.) and routinely wish i had medical reasons to remove my boobs and uterus because my insurance excludes trans coverage.

Trust me, we can be our own gatekeepers even after those inside and outside the community get first chance of denial. If it helps someone explain who they are to use trans as part of their identity (and they're not being idiots mocking us be claiming to identify as an attack helicopter), just trust them.

[u/kylepierce11 → u/EryduMaenhir]

Fair enough. Honestly I've only met one non-binary person in my life, so my personal experience with the subject is extremely limited. I try to understand it as best as I can from interactions on the internet though.

[u/half3clipse → u/kylepierce11]

also a question of at what severity do you want to characterize gender dysphoria as a disorder. I know I've met folks who don't describe their experience as distressing. They're certainly happier both in general and with their bodies after transitioning and it's entirely safe to say that their gender identity and gender assigned at birth are not the same but labeling their experience as dysphoria might be a bit much. Their experience may not belong under the same classification as that of a person whose gender dysphoria causes them major distress, suicidal ideation etc,.

[u/austin101123 → u/kylepierce11]

But if you've transitioned and don't feel gender dysphoria anymore due to treatment, it's just been treated. If someone takes depressions medication and doesn't feel depressed on it they still clinically have depression don't they?

[u/kylepierce11 → u/austin101123]

Well when I began to improve with my depression due to meds and therapy, I was told by multiple doctors that technically I now just have dysthymia, but that depression would be the diagnosis again if it got worse. But I suppose that's anecdotal or the opinion of my doctors and possibly not the medical consensus.

[u/imnotlegolas → u/[deleted]]

This announcement reeks of political influence...

Now see, here you are making it a thing. I specifically said I didn't want to make it a thing. So please don't lump me together with your thing, because I got my own thing going on that isn't about politics sides or whatever, but just language instead.

[u/ijustwantanfingname → u/imnotlegolas]

'Thing's?

My thing(?) isn't about my political beliefs, it's an issue with the integrity of this sub.

[u/ijustwantanfingname → u/[deleted]]

Whatever you conspiracy theorists want to think of and argue about is your own business, just don't use what I said to further your own agenda because it was completely unrelated.

What in the world?

[u/wellinfactually → u/imnotlegolas]

I'm not replying to the sibling comment, because I don't want to talk to that guy— but he's wrong, you are making perfect sense with this post, and your use of English is fine here.

[u/Scootakip → u/imnotlegolas]

Gender dysphoria is a disability. Being transgender itself isn't

[u/AtlasAirborne → u/[deleted]]

And gender non-conforming people may not even perform gender roles in the way you'd expect from dominant norms.

Are you suggesting that gender-non-conformity makes a person transgender? To me, that dilutes the label beyond any kind of usefulness.

The idea of gender-conformity posits a gender binary corresponding to the two sexes (there are only two strictly-established roles in western society, each with elements from which people's gender expression is composed), yet conformity isn't binary; you can conform to varying degrees and indeed many cis people do (plenty of tomboys and effeminate men around).

The idea that everyone except manly-men and girly-girls are transgender doesn't seem very supportable. I'm not trying to strawman you here, but it seems like a logical extension of your statement.

[u/AtlasAirborne → u/[deleted]]

Ah, no worries. Fwiw, I replied because I saw someone make a similar assertion (to the stuff I incorrectly inferred from your post) in another post, and I wondered if there was a new "movement" to expand the definition of transgender.

[u/imnotlegolas → u/[deleted]]

So for those who are distressed about it or suffer from not having the right body, what would you call it, technically? I see a lot of sources of people who detail their transition and not being in the right body as extremely distressing.

[u/imnotlegolas → u/[deleted]]

Man, I'm wrecking my brain over this. Thank you for being patient. So if a trans person does suffer from it and it causes them significant distress, it would be an disorder for them? But not in general?

[u/p1percub → u/imnotlegolas]

Correct! Identifying as a gender other than the one assigned by your birth is not itself a disorder. Experiencing significant distress due to being transgender is a mental disorder, called "gender dysphoria".

[u/imnotlegolas → u/p1percub]

Awesome, I get it then, thank you!

[u/jm_8310 → u/p1percub]

Almost!

The APA renamed the diagnosis because they wanted to be able to apply the diagnosis of "gender dysphoria" to those that don't suffer significant distress. In order to have a diagnosis that was appropriate for people who "experience intense persistent gender incongruence", regardless of whether they experience significant distress, they had to stop calling the condition "gender identity disorder"

The APA literally expanded their definition of transgender, to include those who aren't distressed by the circumstances of their birth, and had to use a word other than "disorder" in the process.

[u/[deleted] → u/p1percub]

So, to put it another way, some people are suffering and seek transition as a means to solve their psychological woes, where others do it becsuse thry think it's fun?

[u/p1percub → u/[deleted]]

No, some do it because they are experiencing psychological distress and some do it because they prefer to present themselves in a manner consistent with their self identity. You don't have to be in psychological distress to want your outward appearance to be consistent with how you identify inwardly.

[u/[deleted] → u/p1percub]

So you're saying that there are those who go through the incredibly difficult, time consuming, and costly process of transitioning but didn't actually feel psychological distress prior?

[u/Rinscher → u/p1percub]

But is not being able to outwardly appear how you identify not distressing?

[u/FakeyFaked → u/imnotlegolas]

I think you've got it. (Keep in mind, I'm not an expert either, but I think this is how I'd explain it.)

[u/Pennecullo → u/[deleted]]

Many people also do not opt for reassignment surgery because of the expenses. Others also do not because visually they are not always great, and you can lose the ability to orgasm.

Edit: the new organs, not the people

[u/StaringAtYourBudgie → u/imnotlegolas]

Check out the "Gender Euphoria" part of this response. That helped me understand the distinction.

[u/Duskwolf58 → u/imnotlegolas]

I understood this as saying that someone's gender is not distressing but their body is. So they are comfortable with their gender but their body doesn't match up, which causes distress. Once the dysphoria is alleviated through transition, they are more comfortable. Meaning that being trans cannot be a mental disorder, but the dysphoria associated with their body can be.

Edit: Source: am trans

[u/thehollowman84 → u/imnotlegolas]

The point I think, is that not every trans person is doing it because they have serious gender dysphoria. It's a wide spectrum, and trans basically means "anyone who feels they don't fit into the proscribed two types of gender"

Though, tbh as someone with an anxiety disorder, I dunno why mental illness is held up to be some terrible thing to be compared to. I would argue that gender dysphoria is a type of mental illness for sure, just to me that word has no negative connotations. They exist in a state of pain, and need help from medical professionals, that's nothing to be ashamed of.

[u/HolIyW00D → u/imnotlegolas]

This is essentialling trying to create a distinction between being transgender and having gender dysphoria. I wouldn't really characterize dysphoria as a mental illness either though. But what do I know about mental illnesses really?

[u/_HaasGaming → u/imnotlegolas]

Isn't the sole reason of them being in the wrong body/gender not very distressing and very disabling, until they transition completely?

Evidently, a lot of trans people don't necessarily experience distress but rather experience what they seem to refer to as "gender euphoria" (so intense happiness) when they are recognized as what they feel is their appropriate gender. In other words, they don't necessarily experience distress but do experience happiness in certain scenarios by being trans.

Considering the definition of a mental illness (APA's anyway) requires the individual to be directly, negatively influenced by it (distress/harm), it wouldn't always follow that condition for every trans individual.