Transexuality as an illness?

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wumpus
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Re: Transexuality as an illness?

Postby wumpus » Sun Mar 16, 2014 7:07 pm UTC

Wonderbolt wrote:
wumpus wrote:Just out of curiosity, has anyone really looked into sexual development in in utero?

Presuming you're talking about sexual development of the brain, then yes, I've looked into it a bit.

Good. But my point was more in terms of the title "Transexuality as an illness?" and the assumption that any "treatment" that relied on post-puberty "patients" was probably not going to work.

Wonderbolt wrote:
wumpus wrote:My (likely out of date) understanding basically states that human brains (and the rest of the body for that matter) start out as female, but will turn male if hit with a burst of testosterone while a fetus (at presumably the right time). Additional changes happen at puberty when the male produces his own testosterone.

Have you looked up digit ratios (specifically, the ratio of 2nd and 4th digits)? Essentially, a smaller 2D:4D ratio is correlated to higher exposure to testosterone in utero. The second digit tends to be shorter for both males and females, but the difference in lengths is generally greater in males. A correlation has been found between digit ratio and male-to-female transsexualism.

My assumption was that simply establishing more or less normal hormone levels for the gender in question would likely avoid most common transexual situations. I suspect that no data is available now, and it would take roughly a generation to determine if that really is the case.

Wonderbolt wrote:
wumpus wrote:I can only hope that nobody tries to pick the gender before birth and then simply re-assign later if "wrong". From what I can tell, the technology is here long before the world's various cultures can deal with it.

I'm not sure what you're trying to say here. Can you elaborate?


Actually my original idea was that widespread "treatment" of such situations would be treating a rare condition with a "treatment" that would have a profoundly effect if the original gender determination was incorrect. I then worried that there would be enough places that would do so much to avoid "sissy boys" without a care of the effect on girls. The other idea was the proverbial "frustrated jock father" who wants a quarterback kid or a skating/dance/gymnastics mother with similar desires (who will get a kid oriented more or less in that direction regardless on how it helps the kid everywhere else in life). Hopefully my "sources*" dumbed the whole thing down enough that it takes way more than a testosterone patch to have these effects.

* basically brain explanations that handled this type of thing more as an aside than anything else.

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Re: Transexuality as an illness?

Postby Azrael001 » Wed Jun 25, 2014 10:03 pm UTC

I've spent literally 100% of my long absence from the fora researching the evidence for a neurological cause for transexuality (This is obviously a lie, but I have done a lot). From what I've seen it seems incredibly likely that being trans is a congenital neurological intersex condition. The wikipedia article is surprisingly good.

Brains are sexually dimorphic, some of the dimorphic parts of the brain are plastic, and will change from 'male shaped' (size, neuron type ratio or density etc) to 'female shaped' based on the presence of testosterone or estrogen(1). Some of the dimorphic parts are aplastic, and will remain 'male shaped' or 'female shaped' regardless of what hormones you are full of. In transexuals, the aplastic parts of the brain are generally found to be more in line with their claimed gender rather than their assigned gender.

Also of note:
nearly two thirds of non-transsexual males who have a penis surgically removed experience the sensation of a phantom penis, ... Perhaps more remarkably, two-thirds of FTM transsexuals reported the sensation of a phantom penis from childhood onwards, replete with phantom erections and other phenomena


This page has a decent selection of scientific papers that examine the subject further.
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mobiusstripsearch
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Re: Transexuality as an illness?

Postby mobiusstripsearch » Thu Jun 26, 2014 3:43 am UTC

Azrael wrote:
CorruptUser wrote:If the problem is that the gender doesn't match the person, it's physiological rather than psychological. But how do we determine if it's the body that should adapt to the mind or the mind to the body?

Does it matter?

The medical issue is in what treatments work. The ethical issue is in what treatments work for the patient.

For people with anorexia or Body Dysmorphic Disorder, while there are definitely neurological factors at play, it is psychological treatment (cognitive therapy) that works with the greatest success. Medication to treat the physiological? Not seeing much success right now. The therapy treats the disparity between subjective and objective by making the person aware of the difference -- aware that they're observations skew from others'. I would expect that one major reasons that gender dysmorphia can't be treated that way is that the person is already entirely aware that there's a difference between mind and body.


(Semantically, I'm not sure about calling this a matter of ethics. "Treatment" is neither as severe as (say) chemotherapy, nor as frivolous as plastic surgery, but lies somewhere nearer the latter because it's elective. It is not usually a live-or-die surgery. Are you referring to our society's ethics, or the ethics of us individuals?)

I think the question of working treatment is the most interesting one. I have a transgender friend who I would like to have a happy life (maybe we all do?). I'm still searching for the study cited here, but it's concerning that most treatments for the transgender (on aggregate) seem to not work.

Which shows how much we don't know about our own minds.
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Re: Transexuality as an illness?

Postby Brace » Thu Jun 26, 2014 4:20 am UTC

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mobiusstripsearch
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Re: Transexuality as an illness?

Postby mobiusstripsearch » Thu Jun 26, 2014 5:44 am UTC

By 'not working,' I didn't mean that patients' new genitalia didn't take like a failed hair transplant. I think it's a serious problem if someone spends thousands of dollars to change their sex and comes out just as depressed about their sex as before.
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Crissa
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Re: Transexuality as an illness?

Postby Crissa » Thu Jun 26, 2014 6:01 am UTC

Brace wrote:Your idea of evidence seems to consist of reading only the title of a news article.

There are people who, I dunno, actually talk to people with gender identity disorder. Who have taken their brains post mortem and sliced them into tiny parts. Who have taken trans people of many ages and run them through MRIs and Cat scanners to get images of their brains.

And those people say there really is something to it.

Even if there wasn't, if a problem can be treated by something as simple as taking on a new persona, and being respected, what skin is it off your nose?

Treatment for GID is an entire spectrum: Therapy, dress, mannerisms, hormonal intervention - from a tiny dose to a body-changing puberty dose; and the most severe, least common is actual genital surgery. There's an entire schedule of things to do before one gets there, to find where one is happy, it's called the 'Harry Benjamin Standards of Care'. Often misused - just like any treatment - and often maligned by those who got a misapplication of it. But it does exist.

There's an important reason for this diagnosis to exist in the DSM - the diagnostic manual for psychiatrists and psychologist - because that's the only way to diagnose it. We can't do scans on people's brains and find out what they're thinking, what parts are aplastic and which are not. And untreated, the disconnect of gender to body, kills.

Heck, Associative Vasovagal Reaction was only added to the DSM in 1994! That's the problem (long known) where by someone sees a hypodermic needle and passes out. So yeah, sometimes it takes a long time for something to get added, changed, or updated. That's how it is.

The thing to remember is that these are just diagnosis; the standards of care is something entirely different. (Physicians have the ICD, for instance, but it doesn't contain things they can't treat or diagnose medically.) The things are in the book because it has been noted that these things were a problem - and yes, being the wrong gender from your body is something that causes alot of stress. And one thing we do know is that we can't change the mind as well as we can the body!

mobiusstripsearch wrote:I'm still searching for the study cited here, but it's concerning that most treatments for the transgender (on aggregate) seem to not work.

The study was poorly designed; of course the know about the grand failures, because those are the people they find. And they have no control group, nor could they make a control group. There is no treatment that will make trans people be born the appropriate gender, be treated as such, especially since many of those genders aren't well tolerated in society. Medical treatment has a poor record with depression, and no impact upon discrimination.

-Crissa
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Re: Transexuality as an illness?

Postby Brace » Thu Jun 26, 2014 12:35 pm UTC

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Crissa
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Re: Transexuality as an illness?

Postby Crissa » Thu Jun 26, 2014 5:17 pm UTC

That's very...

Appropriate, Brace.

They don't have a baseline. I know of the peer group I counseled nearly 20 years ago, one got surgery, two were happy with pills, one dropped out (they had scammed for the paid training), one died to heroine (but two were addicted before counseling), one was killed by cops, one was killed in a car accident, and one committed suicide (all three were suicidal, but only one chose suicide). So how do you do any work on numbers like that?

Even moreso, those who have surgery often just ditch all contacts and closet up. Because they can, because life is filled with things far more important than worrying about a problem they once had. If they're successful, researchers never hear from them again.

And there really are researchers who are intent on 'disproving' or making up their own theory.

Anyhow, I don't generally post responding to someone specifically; my posts are supposed to be more aimed at anyone who may open the page.

-Crissa

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Re: Transexuality as an illness?

Postby Tyndmyr » Thu Jun 26, 2014 5:21 pm UTC

Brace wrote:
Body wrote:Its review warns that the results of many gender reassignment studies are unsound because researchers lost track of more than half of the participants. For example, in a five-year study of 727 post-operative transsexuals published last year, 495 people dropped out for unknown reasons.


No robust evidence =/= robust evidence against. The contents of the article don't line up with the title; they cast doubts on the methodological validity of the study, but not the validity of treatment. But worse than that, later...


This is an excellent point. Yeah, better data is great, and we always want it, but imperfect data is still more informative than no data. That shouldn't be a good reason to entirely discard the data... It'd be a good reason to consider another study if an obviously better one existed, but it's not a good reason to ignore data altogether.

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Re: Transexuality as an illness?

Postby mobiusstripsearch » Fri Jun 27, 2014 4:13 am UTC

Brace wrote:
No robust evidence =/= robust evidence against. The contents of the article don't line up with the title; they cast doubts on the methodological validity of the study, but not the validity of treatment. But worse than that, later...


That's a great point I agree with. But we're not looking at the study itself. If some of the studies this study studied did have valid data pools, then the title could be correct. Evidence against sum is not evidence against all.

If a fifth of patients regret changing sex, that means 80% didn't.


Which doesn't mean that they feel better either. Some patients could feel no regret and no benefit, or feel better but not better enough to make a huge difference.

80% is a pretty damn good success rate.


Yeah! But a 20% chance of feeling instead that you mutilated your genitals is worth noting.

The 18% suicide figure is meaningless without comparing to pre-transition transsexuals.


I agree entirely. A before-after comparison is really what I wanted, but I couldn't find one. (Maybe it's too sensitive a topic. The whole conversation depresses me.)

The source of the suicidal ideation is also unknown. My guess is that the main risk factors are social. If suicide reflected SRS regret, it would imply post-SRS patients had a higher rate of suicide than pre-SRS patients (not that this is the only thing that would imply this either). At the end of the article, a doctor says "A fifth of those who don't get treatment commit suicide". If it's literally a fifth, or even > 18%, then there's no evidence that SRS regret drives suicide. Another conspicuous possibility is that whoever wrote this article saw "18% transsexual suicide rate" and assumed it referred to post-op patients, and the two people are actually referring to the same statistic. I see this sort of blatant misreading/misunderstanding quite often, and it's hard to put down. People quote newspaper articles after googling the conclusion they want rather than reading and quoting primary sources, then these quotes become part of newspaper articles and other debates and on it goes *cough*.


(I don't think you're referring to me, but I want to emphasize that I definitely don't want suicide rates to be higher post-op. Or to be high. At all.)

I wasn't thrilled with this part of the body, and it's a shame that's what we have left to talk about. (I hate this trend of reporting studies without citing or linking them.) But the newspaper indicates that the study's abstract indicates "no robust scientific evidence that gender reassignment surgery is clinically effective."

I remembered vaguely reading somewhere that suicide rates were higher post-SRS than pre-SRS -- since I couldn't find it, I wanted the measliest cop-out: Maybe physically changing your sex doesn't work as well as we'd like. That article is riddled with mistakes. But I think it still shows that SRS is not completely reliable.

I don't have any ready statistics on the 'success rate' of plastic surgery, but I'd be concerned if more aesthetic faces didn't satisfy subjects. (I don't know of any cases where people regret plastic surgery except when they say "I should have stayed natural" or "I got a bad job". If someone was saying "I got everything I wanted and still don't like my physical appearance," I'd be very concerned. That's what I suspect happens to at least some of the 20% of Transsexuals who regret their surgery.)

The majority of transsexuals don't even get SRS due (generally) to financial constraints, so any general population wide suicide rate of known transsexuals would, all things being equal (or even things being less unequal than a pretty big disparity), reflect more heavily on the suicidal ideation of pre-SRS patients. It's known that 41% of living transsexuals have attempted suicide. With a table of suicide success rates and the estimate that transsexuals represent 0.5% of the population, a ballpark estimate shouldn't be too hard from there, but it's hard to gather actual data on the subject. Who can estimate how many mysterious suicides were trans people who never told anyone, or how many suicides weren't recognized as trans related? If your kid kills themselves, you might brush that sort of thing under the carpet even if you know.


Measuring problems like these always remind me of the Heisenberg Uncertainty Principle.
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Re: Transexuality as an illness?

Postby Tyndmyr » Fri Jun 27, 2014 12:28 pm UTC

mobiusstripsearch wrote:
80% is a pretty damn good success rate.


Yeah! But a 20% chance of feeling instead that you mutilated your genitals is worth noting.


Sure. But if they weren't happy with them beforehand, ehhh. Not sure the damage done outweighs the good. Doesn't seem likely.

Now, working to continuously improve, sure, everyone's for that. This is likely to mostly take the form of improved/more mental health care. It seems likely that other elements like depression may also be frequently present, and contribute to overall worse outcomes. The more complex the case, the more difficult care is, and the more likely someone is to fall through the cracks in some way.

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Re: Transexuality as an illness?

Postby Brace » Fri Jun 27, 2014 2:12 pm UTC

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Re: Transexuality as an illness?

Postby Crissa » Fri Jun 27, 2014 9:11 pm UTC

People who are seeking treatment are seeking in it lieu of suicide.

So the fact that they haven't died is a big success.

And as Brace said, this population already suffers a huge portion of social trauma, discrimination, and alienation. Many - and in the past nearly all - lost their families and all social support structures when they sought treatment. That sort of damage is going to leave a mark - a mark that no amount of treatment could cure. Some will eventually succumb to depression, some will not. What sort of time-period are they looking over?

And how does it compare to other cosmetic procedures? Cosmetic medicine has alot of regret involved, as most procedures are not permanent.

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Re: Transexuality as an illness?

Postby Shivahn » Fri Jun 27, 2014 10:34 pm UTC

SRS/GRS is hardly cosmetic. It is a pretty big functional change, and for a variety of other reasons doesn't fit in with actual cosmetic surgeries.

(I would say this is pedantic, but it is used to exclude care from insurance plans through arbitrary definition so I don't think it is pointlessly so.)

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Re: Transexuality as an illness?

Postby EMTP » Fri Jun 27, 2014 10:44 pm UTC

There is a broad body of research on sexual reassignment surgery which has found that it helps.

One can make the philosophical argument that it's like doing liposuction on anorexics, whittling down noses to make them less Jewish, etc., but the fact of the matter is, gender dysphoria is a physical reality, and no one has had much success with treating with purely psychological means.

Gender dysphoria is one of many "illnesses" that invite armchair philosophers and social critics to ask "But is it the person who has the problem or is it society that is wrong?" Practicing physicians do not enter into this question very much (not that it is not a valid or interesting question in its own right; I do not mean to disparage it). If the patient has a problem (whether its "really" their problem or not) and treatment helps, we'll tend to treat. You can't treat society. Someone with ADHD or Asperger's or gender dysphoria might not need treatment in a better world, but they still have to live, and finish school, and maintain working and personal relationships, and not kill themselves in this one. The bias of allopathic medicine is towards the welfare of the individual patient, which sometimes involves helping them better conform to society's expectations, if that is something they want.

I've worked with several doctors who perform this surgery -- not an unbiased sample, of course -- and they are unanimous in saying it helps. And as an aside, I doubt anyone in the US is getting rich treating these patients, because they usually have no insurance and no money.

This is a highly stressful condition for a myriad of reasons, including social stigma, and transsexuals have high rates of substance abuse, homelessness, unemployment and suicide. Surgery makes these problems better but does not resolve them completely -- they are still depressed and suicidal at a higher rate than the general population. But there is improvement.

Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5-15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. . . . In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.


http://www.ncbi.nlm.nih.gov/pubmed/19816764

None of the patients reported regret for having undergone the surgery. Sexual experience was considered to have improved by 83.3% of the patients, and became more frequent for 64.7% of the patients. For 83.3% of the patients, sex was considered to be pleasurable with the neovagina/neopenis. In addition, 64.7% reported that initiating and maintaining a relationship had become easier. The number of patients with a partner increased from 52.6% to 73.7%. Family relationships improved in 26.3% of the cases, whereas 73.7% of the patients did not report a difference. None of the patients reported worse relationships with family members after sex reassignment. In conclusion, the overall impact of sex reassignment surgery on this cohort of patients was positive.


http://www.ncbi.nlm.nih.gov/pubmed/17075731
No changes in levels of psychopathology and only modest gains overall in economic functioning and interpersonal relationships were found. Larger gains were made in sexual satisfaction and being accepted by family members. None of the 17 transsexuals had doubts about having had the surgery.


http://www.ncbi.nlm.nih.gov/pubmed/7361928

psychosocial status showed good improvement after surgery.


http://www.ncbi.nlm.nih.gov/pubmed/8928364
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Re: Transexuality as an illness?

Postby Crissa » Sun Jun 29, 2014 3:05 am UTC

Shivahn wrote:SRS/GRS is hardly cosmetic. It is a pretty big functional change, and for a variety of other reasons doesn't fit in with actual cosmetic surgeries.

(I would say this is pedantic, but it is used to exclude care from insurance plans through arbitrary definition so I don't think it is pointlessly so.)

It's pedantism that does no good: Rebuilding breasts after mastectomies or giving people functional lips after car accidents is also plastic surgery.

-Crissa

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Re: Transexuality as an illness?

Postby Brace » Sun Jun 29, 2014 3:39 am UTC

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Re: Transexuality as an illness?

Postby Shivahn » Sun Jun 29, 2014 5:48 am UTC

Crissa wrote:
Shivahn wrote:SRS/GRS is hardly cosmetic. It is a pretty big functional change, and for a variety of other reasons doesn't fit in with actual cosmetic surgeries.

(I would say this is pedantic, but it is used to exclude care from insurance plans through arbitrary definition so I don't think it is pointlessly so.)

It's pedantism that does no good: Rebuilding breasts after mastectomies or giving people functional lips after car accidents is also plastic surgery.

-Crissa

You initially called it cosmetic. Cosmetic surgery and plastic surgery are not quite synonymous, and insurance plans tend to exclude procedures they deem cosmetic.

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Re: Transexuality as an illness?

Postby Crissa » Sun Jun 29, 2014 5:43 pm UTC

Shivahn wrote:
Crissa wrote:
Shivahn wrote:SRS/GRS is hardly cosmetic. It is a pretty big functional change, and for a variety of other reasons doesn't fit in with actual cosmetic surgeries.

(I would say this is pedantic, but it is used to exclude care from insurance plans through arbitrary definition so I don't think it is pointlessly so.)

It's pedantism that does no good: Rebuilding breasts after mastectomies or giving people functional lips after car accidents is also plastic surgery.

-Crissa

You initially called it cosmetic. Cosmetic surgery and plastic surgery are not quite synonymous, and insurance plans tend to exclude procedures they deem cosmetic.

Like I said, it's pedantism without a point.

-Crissa

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Re: Transexuality as an illness?

Postby EMTP » Mon Jun 30, 2014 7:16 am UTC

Crissa wrote:
Like I said, it's pedantism without a point.

-Crissa


To say pedantry is pointless is redundant. Boom! #Metapedantry
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