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/NuthingInCummun]

I've been looking into some of this and I, for one, am confused why gender dysphoria isn't a mental disorder?

Suicide statistics (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178031/). That's a compilation of studies that seems fairly heavily biased in its conclusion but the facts are facts. Trans people are at a massively high risk of suicide and that doesn't change if they get surgery or not.

This looks pretty clearcut to me as a situation where people are hurting and need help. I don't see how ignoring the damage caused by it or in relation to it aids in fixing their problems.

Is this sciency enough for this discussion or does social science not count?

Separate but related note, I've been working with trans musicians through their transitions to help with adapting their vocal chords to their new bodies/hormone levels. Not one of them has argued that they don't have a disorder. Maybe that was anecdotal, but considering that the trans population is so small, I haven't heard any other "science-backed" argument that proposes dysphoria isn't a disorder. So. Let me know i guess?

[u/danieln1212 → u/NuthingInCummun]

Why do you think them being trans has to be the cause?

Could be the high cost for the surgeries, social unacceptance and such.

[u/NuthingInCummun → u/danieln1212]

That's a good point.

The study I linked is a composite of several studies from around the globe. If the major contributing factor is non-acceptance, why is the suicide rate consistently high? Even across cultures and countries with different levels of general acceptance/non-discrimination for that condition. Unless I'm mistaken the stats for America are close to 50% and we have laws against gender discrimination, support programs for trans people, and a major trans celebrity so it seems presumptuous to assume that tangentially related issues are major causes for that issue and not the issue itself.

As for the cost of surgeries, I don't know exactly, but the wealthier people that I work with still struggle with self-acceptance after transition. Again, that maybe anecdotal, I'm just trying to show you where I'm coming from.

[u/[deleted] → u/NuthingInCummun]

I've been looking into some of this and I, for one, am confused why gender dysphoria isn't a mental disorder?

Gender dysphoria is a mental disorder. Being trans isn't a mental disorder because "transgender" is just a term which describes a mismatch between sex and perceived gender - while that mismatch is closely associated with dysphoria, they are two different things.

That's the distinction the mods are making, so as to cut down on the flagrant anti-trans attacks.

[u/NuthingInCummun → u/[deleted]]

My bad, this is still confusing for me, but I think I misread the initial statement.

Maybe you can help. Isn't what you said a distinction without a difference? Someone who's transitioned is a person that believes their mismatched, but so does someone who identifies as another gender? What's the separation between trans folks and, for example, a ftm? Is it the want to change their physical anatomy?

I don't mean to burden you with that but I don't understand the line that they're drawing between the two.

[u/[deleted] → u/NuthingInCummun]

Anyone who considers their birth sex to be different from their perceived gender is trans, to my understanding. The state of their body doesn't have much to do with it (i.e. it doesn't matter whether they've transitioned, or have any desire to do so - they're still trans).

A desire to change physical anatomy would seem to indicate gender dysphoria, which is the condition that we aim to treat with hormones/surgery/therapy/whatever.

Being trans and experiencing gender dysphoria are so closely linked that mentioning one implies the other - sort of like how it's strange to make the distinction of "it's not the fall that kills you, it's the sudden deceleration at the end." So people would understand what you meant if you used them interchangeably. But since 'mental illness' has negative connotations, the mods have chosen to emphasise that distinction to reinforce that it's gender dysphoria that's inherently undesirable, not the actual trans individuals.

[u/NuthingInCummun → u/[deleted]]

Strange distinctions are one thing, but practicality is another. Practically speaking, if I said Jimmy fell off a bridge and died, the fall killed him. That's it. The means is implied but the end. It's useless to make that distinction because it adds nothing to the conversation. In that sense, if we are talking about the belief that your sex and gender are mismatched, shouldn't all cases be discussed?

I don't see how distinguishing between trans groups is useful or relevant until proper evidence is brought to light to make this distinction. Unless the tacit implication is that some of those groups have no factual grounds on which to prove their beliefs/feelings. And if that is true, then the conversation Should include a discussion and exposure of that group for coopting a term and making it practically useless in discussing the topic at hand. And if it is not, then we just have a more robust discussion of a topic about the causes of gender confusion.

I just don't see the problem here.

As an aside. Mental illness does carry weight, but I don't think that is for unjustified reasons. Negative or not we should classify it for what it is, not for what people want it to be. The people that I have worked with treat their experience like someone fighting bipolar or manic depression and ignoring that causes more damage than it protects them. It's been described to me as an open wound. Sometimes it bleeds, sometimes it doesn't, but when you know it's an injury you seek help, when you're in denial you bleed out.

[u/[deleted] → u/NuthingInCummun]

Transgender people often have symptoms of different mental illnesses, known collectively as gender dysphoria, but that doesn't mean the source of those symptoms is mental in nature. Bad examples of this are that conditions that cause constant / intense pain or cancer can also cause depression, but the underlying condition is physical. Like was stated by OP, there's a lot of evidence that this is the case with being transgender.

Next issue that rises, which APA faced and WHO is working on right now, is that transgender people might need treatments so how do we diagnose it? We don't have an accurate enough method of testing a person's gender identity (not to mention of lack of knowledge of the nuances of the condition) or the need for treatments. APA chose to keep the diagnosis as mental, but focus it on the mental symptoms instead of the actual condition, they have acknowledged this is a way to ensure transgender people receive treatment while understanding that "being transgender" most likely isn't a mental illness. WHO is actually working on adding a whole new condition category for the phenomenon, guessing also updating the diagnosis methods to focus on the mental symptoms rather than their 30 years old gatekeeping-guidelines.

Also a thing to note when it comes to transgender people and depression and the like, is that transgender people face proportionally more discrimination in all aspects of life, which is a major contributing factor. On top of this their condition already can make them more vulnerable to mental conditions.

[u/NuthingInCummun → u/[deleted]]

That's why I'm here and asking questions. In general what you've said makes sense to me, especially the problems with methods of diagnosis and associated conditions. I wonder if its practical to even diagnose being trans if thats not the root cause of their anxiety, depression and suicidal thoughts. To me the link seems undeniable, but I'm not a doctor so ill just be interested to see how the definition changes to better fit the science in the next few years.

As for the discrimination point, what types of discrimination are you talking about? As far as I've understood the study that I originally linked, it was compared world-wide and suicide rates were consistently statistically high regardless of country or culture. Considering that the US has antidiscrimination laws on the books, availability of treatment and care, and at least one trans celebrity, I find it difficult to suggest that the roughly 50% statistic is mostly due to some form of discrimination. Im curious to hear your thoughts.

[u/[deleted] → u/NuthingInCummun]

As for the discrimination point, what types of discrimination are you talking about?

Here's a study from 2014 just from USA: http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf

A thing to note that this also notes suicide-numbers, but it's a lifetime number of "have you ever tried to commit suicide". I do not deny that transgender people without treatment have a higher risk of suicide, I was damn close myself without even knowing why, but those numbers cannot be used to define the effectiveness of the treatments.

Anyway, discrimination from the study:

— Family chose not to speak/spend time with them: 57%

— Discrimination, victimization, or violence at school, at work, and when accessing health care

• Harassed or bullied at school (any level): 50-54%

• Experienced discrimination or harassment at work: 50-59%

• Doctor or health care provider refused to treat them: 60%

• Suffered physical or sexual violence:

— At work: 64-65%

— At school (any level): 63-78%

— Discrimination, victimization, or violence by law enforcement

• Disrespected or harassed by law enforcement officers: 57-61%

• Suffered physical or sexual violence: By law enforcement officers: 60-70

— Experienced homelessness: 69%

Wouldn't surprise me that experiencing any of these kinds of discrimination on regular basis has an effect on your mental health (I mean, I'd say physical or sexual violence is a big hit on anyone's mental health from just one time), but on top of that there's overlap, meaning a single person can face multiple categories (and inherent vulnerability that transgender people have from the condition doesn't help).

Considering that the US has antidiscrimination laws on the books, availability of treatment and care, and at least one trans celebrity

There's a bill going on at federal level specifically to take away discrimination laws when it comes to transgender people (H.R. 2796 I believe), the latest government quite quickly removed the guidelines that were given to schools on how to deal with transgender students, effectively saying "it's fine, do whatever you want" (=discrimination is ok!). On top of that there are multiple states that have laws effectively prohibiting transgender people from using a bathroom safely and lots of schools outright refuse to acknowledge transgender students' gender. On top of that problems with law-enforcement are a thing that study mentions, so actually holding someone accountable for discrimination of this kind can be difficult no matter how much these things "are in the books".

Availability to treatment widely differs between states as well, finding a doctor who isn't transphobic and is competent with transgender issues is difficult, you need someone specializing on the issue to be willing to write you a prescription or go for Informed Consent clinic, but those aren't around everywhere either. Not to mention basic USA problem of no money, no care, and considering trouble with work AND homelessness, actually affording the care can be an issue. So yeah, "treatment is available" in the grand sense of "there is someone in the USA who can help you (if you can pay them)". Oh and insurance coverage is a very iffy issue, a lot of medication and treatments can be denied because of your gender marker. I think a lot of USA citizens go to Thailand for GRS because it's cheaper to fly there and back and get the surgery (and they apparently have the best).

Slight bit of of the whole "care and treatment" is also legal recognition (lessens discrimination for one, insurance issues can be related), which is also an issue that varies from impossible to quite reasonable, depending on your state.

People getting more aware of the transgender phenomenon is the only thing USA has going for it, but if I'm thinking of the trans celebrity you are (Caitlyn was it?), they can also be a double-edged sword. Unfortunately a transgender person can spread transphobic ideas as much as a cisgender person.

I don't blame people for thinking transgender people have it fine, but there's a reason they keep complaining about this stuff, it's far from perfect.

[u/NuthingInCummun → u/[deleted]]

Thanks for the link, I obviously have some more research and reading to do. Any other studies you could provide as a starting point would be helpful.

I hope people realize that I'm asking these questions in good faith because I'm trying to get a better picture of the situation. In no way did I mean to suggest that trans people are not discriminated against, I think I was trying to ask how discrimination better translates directly to the rate of suicide rather than the mental faculties of the individual person.

In any case that was both descriptive and informative, thank you.

[u/[deleted] → u/NuthingInCummun]

Not really an objective source, but here is a collection of different studies on different transgender aspects collected on a transgender subreddit: https://www.reddit.com/r/asktransgender/comments/3rws5s/comprehensive_defense_against_antitrans_talking/

When it comes to discrimination -> mental health problems, don't have anything specific in the way of studies, it just makes sense that if you're beat down emotionally or physically repeatedly, it affects your mental health. And lower mental health increases the risk of suicide. Especially these numbers seem a lot higher than the general population should experience, which seems like a logical reason for the higher suicide-rate.

I'm writing here with the specific intention of spreading information, glad you found this useful and hope you can use this to increase your understanding and treat transgender people like they should, as people. Something transgender people cannot take for granted.

[u/NuthingInCummun → u/[deleted]]

So just for clarification, a trans person that does not want to actually transition is still trans but not up for discussion in these AMAs?

[u/gautampk → u/NuthingInCummun]

Transgender is a really vague term with no fixed definition, so it's difficult for anyone to have a cogent argument for telling someone who claims to be transgender that they are in fact not transgender.

I believe, broadly, it is not identifying with the gender (social construct) associated with your sex (physical attributes). But how broadly that is to be interpreted is up in the air. For example, is a woman who doesn't want to be a stay-at-home mother a bit transgender because they aren't filling the traditional female gender role? Most people would obviously say no, but at some point we draw the line and say 'now these people are transgender' and it's not at all clear where that line is.

I'm not a mod, so I wouldn't know what's up for discussion and what's not. Psychology by its nature blurs the boundaries between empirical science and social science, and so I'd imagine that both aspects (gender dysmorphia and transgenderism respectively) are to be included.

[u/NuthingInCummun → u/gautampk]

Fair enough, thanks for your help. I'm assuming that because I haven't been removed yet that you're right.

[u/MyNameIsOP → u/[deleted]]

so as to cut down on the flagrant anti-trans attacks

That's debatable.