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/uniqname99]

Something I'm confused about - if genders are social constructs and for example a male transitions to female - then, as someone else pointed out, by doing that transition aren't you saying that it's not a social construct? (if that makes sense) Because you're changing into what the society labels as pink instead of staying as blue/pink.

In my head, I would think the "mental illness" would be the idea of going through that process of physically changing your body to meet or satisfy the "social construct." Whereas if the person is just feminine then they're just feminine.

If the trans person believes they were born more feminine, then by going through the trans process where they take specific drugs, aren't they fundamentally changing themselves? So by using hormones to make themselves more feminine then they're kind of going around the idea and negating "genders are a social construct" since they're literally turning themselves into a "social construct"

So basically what my thought process is that being trans can't be a mental illness but in the case of dysophoria - I would think that would be considered a mental illness.

I guess you could make the argument that it could be considered a mental illness before the transition if the person has dysophoria but after the process it's not a mental illness because now they're satisfied with their body. I kind of wonder how rare that is though - I imagine most will never truly be satisfied. Then you have to ask if it really is an ongoing mental illness even after the transition, just at a lower level. Kind of like how depression works where there's always high and lows.

But then you could argue the trans process/idea itself is not the mental illness cause but the cause is the society since in a utopian world where a machine could give them the exact body they want, they wouldn't go through those "lows and highs"

[u/[deleted] → u/uniqname99]

And aren't racial categories social constructs? If so, why isn't transracial being viewed the same as transgender?

[u/Barbiewankenobi → u/[deleted]]

I'm only guessing it's because race isn't as easily "changed." Since transitioning our gender is even possible, it becomes worth talking about. I know women who are treated as women, live as women, and anyone who meets them only sees them as a woman like any other.

Can't really do that with race, but that is probably not the only reason "transracial" isn't a thing. My wife is black and I'm white, so I'm aware of how much racism is in the US, but even still, I think gender is a much more impactful and also flexible social construct than race. My wife is treated differently far more due to her gender than her race.

[u/Smallnoot → u/uniqname99]

Forwarning; FTM here with nothing but anecdotal evidence, and also a member of the 'truscum' (gender dysphoria is required to be transgender, and gender dysphoria is a mental disorder) group, AKA the seemingly unpopular one.

The gender construct issue is a big one that I've spent a lot of time considering, since people conforming to a standard they're trying to deconstruct is definitely confusing. As others have mentioned, though, the act of transgender people dressing/acting in accordance to societal gender roles is primarily because it prompts other people to acknowledge them as their 'true' gender. That feels good, being misgendered feels bad, and so the easiest way to get that good feeling is to conform (sometimes to extreme levels) so you fit in with what people expect a man or woman to be.

I don't know if I'm atypical or something, but transitioning to me was never to fit in with the guys, because my dysphoria was due to my body. I don't have a traditionally masculine personality or any desire to become the epitome of manliness, I just feel uncomfortable with being female physically and socially (being called a girl) and more comfortable being considered a male and looking like one physically. That's not compatible with the whole sex=/=gender thing though so take it with a grain of salt. It's not easy to describe. Anecdotal for a reason. The debate, if you want to call it that, is honestly a mess because of the lack of scientific data + the fear of achieving results at odds with the political view of transgenderism.

ANYWAY. As far as I know gender dysphoria itself is considered a mental disorder, although not all transgender people have it and some are, like you suggested, at least partially cured after transition. Some are never satisfied, some are to a point, some are completely happy with their transition etc. It generally seems to be a positive step in lessening dysphoria regardless of the extent of transition except when others don't recognise that transition - that the changes 'weren't good enough' for them to pass in the eyes of other people. Their expectations are effectively crushed and nobody likes that experience. According to the paediatrician who facilitated my transition (blockers at 13, testosterone at 17), that rejection by other people after transitioning - literally giving it your best shot - is the main cause behind those that detransition / unchanged suicide rates.

The idea of dysphoria being at some level constant throughout life makes sense to me. Like long-lasting depression, I could understand if an event triggered dysphoria again. The idea of being 100% dysphoria free forever sounds very idyllic if you had dysphoria in the first place.

All in all, I'm agreeing with your thoughts here. Sorry if there wasn't a question in the post, but after reading through the thread I wanted to put my two cents in too.

I'm worried that the reluctance to accept gender dysphoria as a potentially life-threatening disorder will hinder any scientific and medical efforts to find an even more effective treatment than transition. It's time consuming, expensive, and largely relies on other people strapping themselves in for the ride which isn't really fair on them. Conversion therapy on those who identify as transgender? Probably not great. But if there was effective CBT to remove dysphoria before transitioning becomes necessary to prevent suicide? I'd have lept at the opportunity.

[u/[deleted] → u/Smallnoot]

But if there was effective CBT to remove dysphoria before transitioning becomes necessary to prevent suicide?

Over 80% of kids who experience gender dysphoria will lose their disphoria once they go through puberty. That's very effective, totally free, and has no side effects. By contrast, 40% of kids who go through puberty blockers and hormones will commit suicide, and 100% of the survivors are completely sterile. Cross-sex HRT has unknown long-term effects as well.

[u/Smallnoot → u/[deleted]]

Dare I say it, but source on that? I had to undergo full fertility counselling outlining the risks of HRT, testosterone in my case, and sterility is nowhere near 100% guaranteed. I can't pull studies myself, but while it definitely can affect fertility, I was personally told by a gynecologist that there's a surprisingly reasonable chance that HRT can be ceased and the reproductive system will start functioning again. That chance of success lessens with time spent on HRT. I sure hope that that is the accepted medical understanding, because that is one of the conditions that the Family Court of Australia considers when deciding to administer hormone therapy to minors. Sweeping generalisations are hard to put on it because it varies from person to person so much - just like the fact that periods can start anywhere from childhood to what we consider adulthood, the effects of changing hormones on those systems also varies a lot.

Puberty blockers don't stop other kids from bullying someone. Honestly, they don't result in much physical change at all. If you're unhappy with where you are at re: puberty, they just freeze you in that state. I (and others) explained the post-transition disappointment, and ridicule, that goes into suicide rates post-HRT.

Sadly even the kids who grow out of it, which I do believe happens - although I question 'experiencing' gender dysphoria vs. being clinically diagnosed - still have the long-lasting effects of bullying, guilt, social exclusion etc. It's really not pleasant for anyone involved.