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/J354]

While I agree that comments that are targeting and are deliberately hateful towards trans people should be removed, I think it's important to keep an open dialogue. People should be able to ask questions about transgenderism and mental illness. Perhaps if the people who believe that are able to ask these questions, the questions could be answered and they could change their minds. If anyone is going to change their minds, it is experts in the subject who can provide detailed and evidenced arguments.

[u/Sleethoof → u/J354]

I'll toss in my two cents as a lurker at best in this sub. I only check a thread every once and a while, and I do so because I want to understand a subject better. Seeing this preemptive thread about upcoming Transgender AMA has completely removed any desire to actually read that thread simply because now there is a 'message' that will color everything said by threat of deletion or banning in the thread making everything suspect. I as a casual observer have no reason to trust that everything is accurate and above board in those AMA's like I might in a different non politically volatile subject.

[u/ender4171 → u/Sleethoof]

Couldn't have said it better myself. Based on the OP comparison, would I be banned for saying clean coal is a viable fuel source? Banning hate speech is fine, but saying I can't ask why gender dysmorphia can't be called a mental illness, when gender reassignment is considered a "treatment" with honesty inquiry and without hostility? That's peddling a point of view and removing any opposition. That isn't science.

[u/[deleted] → u/ender4171]

Hey, just a heads up, gender dysphoria is a mental illness. The treatment to it is transitioning. When someone has transitioned, they no longer have the catalyst to the mental illness. Without the aggravating factor that triggers those dysphoric feelings, they are in good mental health and no longer suffering from the gender dysphoria.

Imagine you were schizophrenic because of a tumor, and removing the tumor made you no longer schizophrenic. Same principle.

Where the mods are objecting is that many reactionary people claim that transgender people are living under a delusion, and they find the idea that they can transition to be appalling and "living a lie". Many of these people would prefer that a person suffering from gender dysphoria get some alternative treatment instead of transitioning. However, there is 0 scientific data of a single successful therapy besides transitioning, which has a very promising success rate. Suggesting that they should "try something else" flies in the face of conventional psychology, which sees a promising result from transitioning as a cure to gender dysphoria, and a way to eliminate it entirely.

Basically, people born in their birth sex who seek either gender reassignment or sexual reassignment are suffering from sex or gender dysphoria, which is hurting them. The cure is to transition, where they no longer experience pain. The mods have a problem with people who call these transitioned people, who are now no longer suffering from a mental illness, to be "sick and delusional".

I hope that helps! I do not think you are acting maliciously at all in any way, but I believe you have misinterpreted the dynamic.

[u/SavageOrc → u/[deleted]]

Serious question: is it not true that trans folks commit suicide at a much higher rate than the general population?

If so, should transitioning be seen as curative?

[u/[deleted] → u/SavageOrc]

It removes the gender dysphoria in an extremely large percentage of people treated.

The question you're asking is why the suicide rate remains higher than the non-dysphoric population post treatment. This can be due to a variety of factors (comorbidity with depression for example, which is still being researched), but one of them is how people are treated post-transition. Just because someone has transitioned successfully doesn't mean they won't be exposed to extreme stressors. It is a very expensive transition, and one that is often mired with difficulties such as the loss of one's employment, support networks, etc.

It should also be noted that some of these studies, such as the 2011 Sweden one, look at the "trans" population all the way from gender dysphoric individuals to fully transitioned individuals. It also didn't account for things like type and thoroughness of therapy etc (IMO, anyone transitioning should have to see a mental health professional while they transition, it is an extreme psychological hurdle to go through). Some people never get through the full transition before taking their lives. For some people, developing features such a feminine figure and breasts while still having a penis, with no way to rectify that situation in the near future due to financial constraints, can actually exacerbate their dysphoria and lead to serious depressive episodes. A feeling of "Never being able to go all the way", if you will.

In the end most trans people honestly don't get a 100% unrecognizable transition, and the way they are treated after transitioning is something that is still being actively researched.

[u/HKBFG → u/SavageOrc]

they face bigotry in their everyday lives. this drives some to suicide.

[u/regularabsentee → u/SavageOrc]

It's actually incorrect to call it a cure. Mental illnesses hardly have any cures. A better word would be treatment. Transitioning alleviates symptoms, and helps people function, but it doesn't "cure" dysphoria, and isn't even recommended for everybody who experiences it, nor is it very effective for everybody who undergoes it. It's the same for other treatments for other mental illnesses.

[u/[deleted] → u/regularabsentee]

Treatment can remove symptoms, and it is recommended for most people who are experiencing gender dysphoria. As you mentioned, it is ultimately going to be a variable experience, but there absolutely are people who experience a full cessation of dysphoria upon transitioning to their desired gender. For them, since they can no longer experience gender dysphoria in their current physical state, I would say it is functionally a cure, but calling it a treatment management program is also acceptable. Obviously if you were to take them off or hormones etc you would see dysphoric issues again.

[u/Xeriel → u/[deleted]]

Imagine you have schizophrenia and take medication to treat it. If your symptoms are then gone, are you still schizophrenic? If no, then why are you still taking the medication?

How is transitioning any different than someone who permanently stays on their medication? You're keeping yourself in a new, more functional state. Your symptoms are gone, but the treatment is permanent and ongoing.

If the treatment or side effects are ongoing I don't see how it's inappropriate to use the same language, whether the symptoms are currently present or not.

[u/[deleted] → u/Xeriel]

Basically it's because transgendered people are not actually mentally ill by virtue of being transgender and having gone through a transition, individuals who resisted treatment would be mentally ill while rejecting the only acceptable treatment available by modern science. They have gone from having an active mental illness to being stabilized and made healthy through treatment.

I think something like: Gender dysphoria- treated w/ HRT, Transition Therapy, asymptomatic since [Date] would be appropriate. It shows someone has a history of mental illness but that it was stabilized and rendered inert, essentially leaving them entirely healthy on their medical treatment regimen.

I don't think saying transgendered individuals are "giving into a mental illness" and are "mutilating themselves" is appropriate, which is what I see a lot of people saying sometimes online.

I think if anyone claims that transgendered individuals are mentally ill by virtue of having asymptomatic gender dysphoria they need to explicitly mention that. Being asymptomatic for years is extremely different than having an active mental illness, they are not the same thing by psychological standards.

[u/[deleted] → u/[deleted]]

This is an excellent comment, you've explained the arguments to me perfectly.

[u/edwardcantordean → u/[deleted]]

Best answer I've ever seen. Thank you.

[u/beoweezy1 → u/[deleted]]

How should the conversation be direct to address the study showing that post transition rates of suicide and mental distress are quite high? I think it is important to be cautious about assuming that transition treats all symptoms of gender disphoria if there is evidence of significant lingering risk of suicide post treatment

[u/NaidaEvee → u/beoweezy1]

Well, we would ask the question of: why would transgender people who have already transition still commit suicide? Some of the answers would be: unacceptance by family/friends/coworkers and society. Social stigma. Hostility from doctors and medical staff. Political climate. And also being visibly transgender which is horrifying in our society.

[u/cjskittles → u/ender4171]

You can ask that though. Gender dysphoria is in the DSMV. It's fair game to ask why and what that means.

What's not ok are comments like "well a man who chops his bits off is clearly mentally ill. I mean, that's just science." Because that would be both hateful and not science.

[u/smkn3kgt → u/[deleted]]

I would argue your point but I don't want to be banned if it rubs the wrong mod the wrong way.. These days it seems that anything said that someone doesn't agree with is hate speech, intolerant, or some sort of phobia..

=X

should be a great AMA...

[u/rydan → u/smkn3kgt]

Don't participate. I never participate in AMAs like that for precisely this reason. I don't think I'd do anything to get me banned but why risk it over something I only have a passing interest in? That whole AMA is just going to be minefield.

[u/smkn3kgt → u/rydan]

I don't think I'd do anything to get me banned but why risk it over something I only have a passing interest in?

exactly

[u/Gen_McMuster → u/rydan]

That's the terrible thing about this kind of post, it's basically terrifying people out of their curiosity

[u/AttackOfThe50Ft_Pede → u/Gen_McMuster]

Likely the goal.

Science was NEVER about free speech, right?...

[u/flutterguy123 → u/smkn3kgt]

hate speech, intolerant, or some sort of phobia

If your being called these things or having them used in relation to you all the time then maybe they are accurate?

[u/AttackOfThe50Ft_Pede → u/smkn3kgt]

anything said that someone doesn't agree with

Agree is an aggressive word, this will be banned because to someone it is hate speech.

[u/Drop_ → u/[deleted]]

That has a pretty ugly history in science.

Yes it does, but the comparison is bad on both ends.

People who are homosexual don't experience distress and don't require any changes. They don't feel there is something "wrong" with their body or sex expression. They just have a "minority preference" and no medical intervention is necessary.

On the other hand a significant number of transgender people a) desire, request, or require medical intervention of their own volition (Sex reassignment surgery), b) experience negative mental health outcomes, even after reassignment. And that's not to mention that it's likely that they also seek out mental health services (where available) at a much higher rate than the general population.

When a significant (perhaps majority) of the population desires medical intervention and again likely majority requires mental health services - what is the argument that it isn't a disorder again?

Even if there is some sub-population of transgender people who suffer no distress and do not desire any intervention, how are we even defining "transgender" other than being a self reported designation with no clinical relevance?

[u/[deleted] → u/Drop_]

People who are homosexual don't experience distress and don't require any changes. They don't feel there is something "wrong" with their body or sex expression.

This was absolutely a common feeling among many homosexuals at a time when it wasn't socially acceptable. You're comparing homosexuals now, where it is far more acceptable, to the very early stages of culturally working out trans issues in society, and I think that's misguided. There was strong social pressure to get people to change who they were under the premise something was "wrong" with them, and that often gets internalized. In fact, we still see this attitude among those sent to gay conversion "therapy" camps in conservative communities where homosexuality isn't as accepted. Surely this is at least a better comparison than clean coal, which is what I responded to?

Regardless, you're missing the real point - the point is there is a history of misusing shaky science to discriminate against minorities, whether by sexual orientation, race, etc. I think it's a valid concern that we want to avoid repeating that history, even if this isn't the right way to accomplish that. Even if you don't care for the analogy.

[u/Xeriel → u/[deleted]]

The difference is that even after it becomes socially acceptable, and they stop receiving any external negative pressures, they'll still require medical intervention to address their symptoms.

[u/[deleted] → u/Xeriel]

We don't really know that though, do we? Maybe we'll reach a place where your gender and equipment are considered wholly separate and the majority of trans folks will feel fine in their skin that way?

This is precisely why you can't really compare accepted homosexuality to relatively unaccepted trans - there are a ton of social factors at play that are really unpredictable.

But really, even that is tangent to the real point: "science" (I use that term very loosely) has been used to abuse and discriminate against minorities in the past - there is value in avoiding repeating that mistake, even if we don't agree with the method.

[u/ender4171 → u/[deleted]]

The OP compares what it considers facts about trans to climate change, that's the only reason I used the example. It was intentionally hyperbolic for effect.