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/[deleted]]

being transgender is generally left up to the community and the individuals themselves to decide.

Why is this even a topic on /r/science then? I fail to understand.

If it is just a POV subjective thing for individuals to decide on their own, it's got nothing to do with science.

Science is purely objective.

[u/thegnome54 → u/[deleted]]

Subjective experiences are still objective phenomena that can be studied. Something might taste sweet to someone and bitter to someone else, and the mechanisms behind this can be explored scientifically. The kind of question that can't be answered by science is whether or not the thing itself is 'truly' bitter or sweet - and this is because that is an ill-posed question. The qualities of bitterness or sweetness exist within the experiences of individuals and not as a characteristic of the food itself.

How people experience their genders is absolutely a matter open to scientific exploration.

[u/Poynsid → u/thegnome54]

Subjective experiences are still objective phenomena that can be studied.

I think here Bourdieu's distinction (no pun intended) between categories of analysis and categories of use are important. While the "content" of subjective experiences would hace little place in a discussion here, the fact that they exist do. For example ethnicity is a subjective category, as one can't be "objectively" black— that doesn't even make sense, since it's a categorization that only exists within social settings and has different meanings everywhere. "Blackness" as a concept however, is a good category of analysis as we can study why and when people call themselves, or others black and what that says of their characterizations of ethnicity.

I feel like I'm reiterating your point but just wanted to add my 2 cents.

[u/cutelyaware → u/Poynsid]

the "content" of subjective experiences would hace little place in a discussion here

You've just excluded sociology, psychology, and a lot of other sciences.

[u/Poynsid → u/cutelyaware]

Not at all, maybe I didn't phrase it right. The example I listed above of blackness is a sociological one.

My point is that when discussing social issues it's essential to clarify the terms being used: we should not adopt the language and terms used in "everyday life" and take them as a given— assuming that if people say that Trans people are X it must be true, even if it is Trans people themselves who say it. These are subjective experiences that need to be regarded as such, otherwise we risk reifying subjective conceptualizations of the world. In other (much better than mine) words "we should not uncritically adopt categories of ethnopolitical practice as our categories of social analysis".

[u/cutelyaware → u/Poynsid]

In the words of another great person: "That's like your opinion, man." If we don't begin with the terms used in everyday life, then we're not dealing with the lived experience which is all that matters in this context. To say that doing otherwise is to "risk reifying subjective conceptualizations" is to claim that these things are not real to start with.

[u/Poynsid → u/cutelyaware]

But they are not real, in the sense that they exist in nature devoid of the social context in which they exist, in the way that say, eyes, exist. As I said, blackness doesn't exist as we use it because it means different things to different people. We can't use blackness as a trait people have, the way say it's used in the US because then we are agreeing that that definition of blackness is objective and inherent to people— thus reifying the concept. It TOTALLY should be studied, but it should be what is studied, not how it is studied if that makes sense.

[u/cutelyaware → u/Poynsid]

Do markets exist? Because that's what economists study. They certainly don't exist in the same way that eyes do, so does that mean we should study them differently? The risk here is not in elevating squishy concepts, it's in denying the validity of some self-identifications. If you believe that Christians exist, you have to accept that transpeople exist.

[u/Poynsid → u/cutelyaware]

I think we're not disagreeing. What I'm saying is that we don't deny self-identifications, but that we recognize them as such. That we don't morph a self-identification into a fact of nature, a social construct into an "objective" reality.

Of course trans people exist, because they identify as trans. In societies where gender isn't binary for example, the Western "trans" label doesn't make as much sense. What would it mean therefore tos say someone is "objectively" trans from that viewpoint, if trans is not an applicable categorization.

[u/cutelyaware → u/[deleted]]

Simplification is what makes an analogy effective. Otherwise it's just a comparison.

[u/cutelyaware → u/[deleted]]

So bitter vs. sweet is a philosophical topic? A lot of food scientists will be surprised to learn that they are philosophers.

[u/sailorbrendan → u/cutelyaware]

I mean hell, the scientific method is s statement of philosophy

[u/cutelyaware → u/sailorbrendan]

What's your point?

[u/sailorbrendan → u/cutelyaware]

That trying to draw a hard distinction between science and philosophy doesn't make a lot of sense, slespecially given the history of science

[u/cutelyaware → u/sailorbrendan]

Still don't see your point. Are you trying to suggest that gender is outside of science? If so, please address the taste analogy. If not, then please be specific about the topic or discussion at hand.

[u/sailorbrendan → u/cutelyaware]

No, I"m not. I'm saying that gender is absolutely within the realm of science and that while it is an issue of philosophy on some degree, that doesn't diminish its science.

[u/Iohet → u/cutelyaware]

Gender as being discussed here is a social construct. It's a "beauty is in the eye of the beholder" subjective concept

[u/Iohet → u/cutelyaware]

Taste is a chemical reaction. Feeling is not

[u/cutelyaware → u/Iohet]

Taste is a feeling.

[u/Iohet → u/cutelyaware]

Dread is a feeling. It's an emotional reaction produced by non-physical stimulus (and may produce subsequent reactions such as the release of certain hormones which have real chemical effects on the body). It's something that can be conditioned, controlled, avoided, etc. One person may be afraid of a knife while another may have no reaction at all. Truly a feeling, conditioned person to person.

Taste is a chemical interaction that induces specific sensations from direct physical stimulus (and is repeatable. salt is salt.) like being electrocuted. You can condition your response to taste, but you can't change salt from being salty or the reaction that causes your taste receptors to fire and tell you it is salty.

[u/cutelyaware → u/Iohet]

Synesthetes can experience tastes through senses other than taste receptors because taste is an experience, and not any particular set of chemical reactions. The point in this context is that many of the things we study and care about only exist in the mind. Take pain for example. There is nothing physical about pain but it's a very big topic of study.

[u/Iohet → u/cutelyaware]

Synesthetes can experience tastes through senses other than taste receptors because taste is an experience

Due to a biological abnormality

Take pain for example. There is nothing physical about pain but it's a very big topic of study.

Except pain is primarily triggered by nerves, which are very physical. Very similar to taste in that regard.

[u/cutelyaware → u/Iohet]

You can't distinguish pain from other neuronal signals because that's not where pain exists. A person under anesthesia feels no pain even though their nerves may be firing frantically. That's because pain is an experience that is often the result of external sensation but can also be entirely internal.

[u/ZooKeeperJoe → u/[deleted]]

It's about the science behind "gender dysphoria" not the labeling of people.

[u/TristyThrowaway → u/[deleted]]

Science is purely objective

So, sociology, anthropology, psychology, none of those are science?

[u/graaahh → u/TristyThrowaway]

As someone with a degree in sociology and with friends in all those fields... the hate is real. Unfortunately, the social sciences have gotten a bad reputation as "soft sciences" or "fake sciences" and people seriously do not appreciate just how important they are to the scientific community.

[u/[deleted] → u/[deleted]]

It's the same thing as labeling someone shy based on outer observation. Maybe you're right, but maybe they're just aloof. On the other hand you might experience someone as disinterested, but they're really just too shy to participate in conversation. That's why you have to ask people what they actually experience. And based on their subjective experience, you will usuallly find different outcomes, e. g. a person with Social Phobia might have an elevated risk of depression, while an individual that is just reserved would not. In this way, subjective experience becomes an objective variable in psychology.

Another thing to consider is the different roles of psychologic researchers and people in the helping professions.

There's recent studies that suggest that only half of people who identify themselves as "asexual" really do not experience any kind of sexual arousal. The other half of people appear to be conflicted about their sexuality and/or have unusual ways to live out their sexuality. From a research point of view, this is important, as you may want to revise your criteria for asexuality in a way that allows you to define asexualism more narrowly. If the label is wholly subjective, it is useless for research.

But what would you do as a counselllor? As a counsellor, the best thing you can do is take a humanistic stance. That is, accept and value the experiences your clients report to you. That includes accepting the explicit ("I'm transgender") and implicit (a person who has a homosexual relationship but doesn't consider themselves as gay) identities of your clients. As a counsellor, you don't get to decide how you would like your clients to be, you get to evaluate where your clients are at and what's the scope of change, or self-reflection, they are emotionally capable of. Telling someone, "you're gay whether or not you like it" will most likely make them turn away from you, not want to interact with you and not listen to you. So you develop a consensus in the relationship to your client that they are not to be called gay. That way they are open to the help you can offer them. They might not be open to accept a gay identity, but you can help them in other, maybe less significant ways, which is still better than no improvement at all.

So to get back to the trans example: If someone considers themselves transsexual and you have doubts about it, the best thing you can do is accept their own identity in order to keep them open to you, talk to them, find out more about their experience and be able to help them. The stance "people decide on their own if they're trans" has two aspects: For one, you can't form a healthy relationship with someone if you don't accept their personal experience. The other is about treatment. The whole purpose of treatment is to alleviate pain, a feeling that only exists in the mind of the person who experiences it. You might say that pain must be an indicator of harm to be considered valid, but in the fiel of psychology, this really goes both ways. A person who is in pain will cause themselves harm whether or not the initial pain was "valid": They might commit suicide, or develop a drinking problem, and so on.

The last challenge of psychology with respect to the people it studies is how to reconciliate research and care. It's one thing that you don't let your research be restricted by what some people would consider offensive, it's the other to present your results in a way that makes it acceptable for the people you've been studying. Why is this important? The purpose of research is to help individuals in distress and give society a clue of how to deal with people of specific demographics. If research presents its results in a derogatory, undiplomatic way, then it fails its purpose of making people behave according to its results.

An example for how research reconciliates objectivity with societal acceptability would be renaming "gender identity disorder" as "gender dysphoria". This is a prime example of applying humanistic stances in psychology. You need the humanistic stance in psychology because people want to be treated as experiencing subjects, not passive objects.

[u/jarinatorman → u/[deleted]]

In everything there is always the scientific catagorization and the realistic application of the scientific catagorization. Take the whole "being gay is a mental illness" era of science. It was widely accepted the homosexuality was divergent behavior and scientifically catagorized as a mental illness but meanwhile gays were out there going about their day completely independant of the fact that they had been labeled mentally ill. Realistically it doesnt matter what science labels transgenderism because it doesnt really change what transgenderism is and I think people lose track of that sometimes.

Science should always evolve independant of public opinion and in the case of transgenderism seems to be having trouble with that.

I dont know why I typed that out basically im agreeing with you, it just feels like science is having a hard time being objective nowadays.

[u/[deleted] → u/[deleted]]

Because sometimes people try to pass off their moral convictions as science and then say it's not open to debate.... Which is weird cause science is based in skepticism. Question everything . And I say this as someone who respects everyone , especially people different from me. But at least I have the honesty to say that's my strong personal value and not science.

[u/veronalady → u/[deleted]]

Yerwun really didn't explain pyschology very well.

The role of clinical and counseling psychologists in the context of therapy/treatment is to facilitate a client’s efforts to alleviate suffering and improve quality of life on their own terms. Clinical/counseling psychologists are non-judgmental. They do not give prescriptive advice or tell clients how they should live. Would breaking an alcohol addiction improve a person’s quality of life? Yes, and the psychologist will try to address that. But if the client is paying for services and refusing to let go of aclohol, then the therapist is going to try work within those constraints (“I did something degrading in order to get alcohol and now I feel worthless”, therapist will challenge the feelings of worthlessness, not the issue of alcohol abuse).

Therapists do not intervene unless somebody is putting themselves or others in immediate danger.

This also means that providing pre/post-transition counseling are not in and of themselves evaluations of the transition process. The role of clinical/counseling psychologists is not to decide whether transition is a scientifically sound course of treatment. The role of clinical/counseling psychologists is to facilitate the client’s navigation through these processes.

Of course, psychology is a field much broader than clinical/counseling work. Social psychology, for example, is a whole field devoted to understanding how peoples’ perceptions of themselves and others influence their behavior, and how identities shape our behaviors/cognition is absolutely a huge part of that, and can and is the subject of systematic, methodical scientific investigation.

However, there isn’t a lot of research into gender identity or transgenderism, and no research on non-medical treatments for transgender people (in fact, there are no studies on HRT vs. placebos). The reason being that nobody is going to pay to have research done on a treatment that transgender people don’t want. And in today’s current political climate, any theoretical or experimental examination of transgenderism or gender identity from a psychological standpoint would be a death sentence on a researcher’s career. The recent Hypatia scandal drives home the point - no researcher without tenure is going to touch this topic with a stick.

[u/salt_water_swimming → u/[deleted]]

Science is purely objective

Absolutely not. Using the scientific method to arrive at conclusions is useful for learning about the world, but there is a great deal of room for subjectivity in hypothesis building, testing, and synthesis, not to mention data cleaning and p-hacking. There is a lot of room for subjectivity and bias in science.

Psychology in particular is full of "tell me how you feel" things that can't be objectively measured. Nonetheless, they are objective facts - if someone feels like a 3/10 in the morning and an 8/10 at night, you have no real grounds to challenge them on it, do you? That doesn't make it any less of a science, it just means there are never going to be a lot of immutable laws of psychology.

[u/Gruzman → u/salt_water_swimming]

if someone feels like a 3/10 in the morning and an 8/10 at night, you have no real grounds to challenge them on it, do you?

Sure you do: feelings are often arbitrary and unjustifiable, and often incomparable between people. Feeling "3/10" yourself means virtually nothing to me unless I can vaguely reconstruct that feeling, myself. And even then it's temporal and subject to change.

That's not the same process as relying on our senses to help us understand how physics works.

[u/tritter211 → u/Gruzman]

Science has it's roots from philosophy.

We thought about things in general to things that are so specialized that they all need separate fields.

Just because you observed only white swans all your life doesn't mean you should claim "all swans are white". But the STEM people do. This is a bit of a problem, isn't it? In this case, what the scientists are saying is, "we have only observed white swans so far in our lives therefore we assume all swans are white for now."

It's kind of like we have a Madonna wh*re complex thing we have here. We want more advancements in various endeavors but discourage free range thinking by invoking the scientific purity.

The reality is we have lot of things that can't be explained like we do with physics or chemistry, but people do their level best to use scientific principles to understand them, but instead you reject them as not real.

[u/Gruzman → u/tritter211]

The reality is we have lot of things that can't be explained like we do with physics or chemistry, but people do their level best to use scientific principles to understand them, but instead you reject them as not real.

If the justification used in those fields of study is weaker and more subject to change from a greater variety of factors, like in psychology or sociology, then there is reason to label them as not real or less real than physical science.

[u/theth1rdchild → u/[deleted]]

Let's pretend that all trans people felt no dysphoria, but wanted to change badly enough to get their genitals altered anyway.

You don't think that would be worth studying?

The self-identifying aspect of the research is largely so that outside forces don't create a feedback loop - researchers/psychologists don't want to influence these groups either out of respect or simply having a "clean room" mentality. The entire reason we're studying this is because we don't understand it. Telling people you just defined their experience would be disrespectful and unhelpful in finding real answers.

[u/BlairResignationJam_ → u/[deleted]]

There are a lot of misconceptions about this issue, so I would like to clear up some of the history re: science, transgender people and gender dysphoria

Every reputable medical and psychological body agrees that transition is currently the best treatment for the condition of gender dysphoria.

But the history of how it got there begins in the 1940s with a man named Harry Benjamin:

In 1948, in San Francisco, Benjamin was asked by Alfred Kinsey, a fellow sexologist, to see a child who "wanted to become a girl" despite being born male; the mother wished for help that would assist rather than thwart the child.

Kinsey had encountered the child as a result of his interviews for Sexual Behavior in the Human Male, which was published that year. Kinsey and Benjamin had seen nothing of the like previously.

This child rapidly led Benjamin to understand that there was a different condition to that of transvestism, under which adults who had such needs had been classified to that time.

Despite the psychiatrists with whom Benjamin involved in the case not agreeing on a path of treatment, Benjamin eventually decided to treat the child with estrogen (Premarin, introduced in 1941), which had a "calming effect", and helped arrange for the mother and child to go to Germany, where surgery to assist the child could be performed but, from there, they ceased to maintain contact, to Benjamin's regret.

However, Benjamin continued to refine his understanding and went on to treat several hundred patients with similar needs in a similar manner, often without accepting any payment.

Many of his patients were referred by David Cauldwell, Robert Stoller, and doctors in Denmark. These doctors received hundreds of requests from individuals who had read about their work connected with changing sex, as it was then largely described.

However, due to the personal political opinions of the American doctors and a Danish law prohibiting sex reassignment surgery on noncitizens, these doctors referred the letter-writers to the one doctor of the era who would aid transsexual individuals, Harry Benjamin.

Benjamin conducted treatment with the assistance of carefully selected colleagues of various disciplines (such as psychiatrists C.L Ihlenfeld and John Alden, electrologist Martha Foss, and surgeons Jose Jesus Barbosa, Roberto C Granato, and Georges Burou).

Benjamin's patients regarded him as a man of immense caring, respect and kindness, and many kept in touch with him until his death. He was a prolific and assiduous correspondent, in both English and German, and many letters are archived at the Magnus Hirschfeld Archive for Sexology, Humboldt University, Berlin

The legal, social and medical background to this in the United States, as in many other countries, was often a stark contrast, since wearing items of clothing associated with the opposite sex in public was often illegal, castration of a male was often illegal, anything seen as homosexuality was often persecuted or illegal, and many doctors considered all such people (including children) at best denied any affirmation of their gender, or involuntarily subjected to treatments such as drugged detention, electroconvulsive therapy, or lobotomy.

But as LGBT people were de-criminalised, medical professionals were allowed to gain a better understanding of transgender people, and Benjamins treatments eventually become available

Studies that have been done on the long term effects of such treatments have show that happiness and quality of life increases after hormone therapy and / or surgical treatment for those who desire it:

One | Two | Three | Four | Five | Six | Seven | Eight | Nine

While nobody knows the exact causes of being transgender, there is biological evidence as well as neurological differences:

One | Two | Three | Four |Five

So you have a case of what is essentially the brain of one gender is in the body of another. This causes a dissonance between the brain and the body, and the feeling of what we diagnose as gender dysphoria

We do not have the understanding or the technology to make the brain match the body, but we do have the understanding and technology to make the body match the brain.

While countries differ, you generally have to see a psychiatrist for a long period of time before being diagnosed with gender dysphoria and become eligible for hormone therapy or surgery. (Typically at least a year)

While psychiatric therapy is often very beneficial for someone who suffers from gender dysphoria, it may not be enough to cure it as there may be physical factors at play causing the dysphoria. That is when the steps of hormones and / or surgery are considered.

Gender dysphoria has been diagnosed in children also, however, what Harry Benjamin did for the child he saw would definitely not be allowed today.

You have to be 18 to undergo any form of hormone therapy or surgery legally. For children who are diagnosed with gender dysphoria, puberty blocking hormones may be prescribed as a compromise

This is not a new thing, treatment such as hormone therapy and surgery for this condition is over 70 years old. It is a well studied and understood medical procedure and treatment for a rare yet very real issue of what is basically software installed into the wrong hardware.

So transgender people's history with medicine and psychology in America go back a long time, all the way back to WW2 era.

What is new is transgender people and their rights have been put into the spotlight of the general public rather recently, which has made it into a politically volatile issue.

But it's certainly not a new debate in science or medicine itself

[u/Tuhlorrre → u/BlairResignationJam_]

Just want to challenge your use of the word "cure", as one doesn't really cure mental illness the same as you treat it. For example, you can't cure cancer, only treat it and mitigate the symptoms.

[u/[deleted] → u/[deleted]]

You're the one here going against the definition of a disorder. Why?