Social Justice Transgender and gender identity discussion

[alasdairm]

Basically showing disrespect to the preferences of transgender people by refusing to refer to them by their preferences.

we had a meeting at work recently. among other things, i'm on our documentation team and the meeting was about using more inclusive and accessible language in various places: product help docs; communication with customers; internal communication; etc.

one of my coworkers said: "we just need to remind ourselves that it costs nothing to change the words we say, and it may mean everything to someone else."

it resonated with me.

alasdair

 

[SKL]

we had a meeting at work recently. among other things, i'm on our documentation team and the meeting was about using more inclusive and accessible language in various places: product help docs; communication with customers; internal communication; etc.

one of my coworkers said: "we just need to remind ourselves that it costs nothing to change the words we say, and it may mean everything to someone else."

it resonated with me.

alasdair

This is an appealing notion, but ultimately a platitude. "It costs nothing to change the words we say?" Sure, it's no particular effort to change the words we use, but in this case, I'm choosing my words rather deliberately to convey meaning that is lost if I use the "politically correct" ones. This is particularly a pernicious problem in situations like social research and in the medical field. In more ordinary social contexts, it might matter less.

And yet, psychiatrists pathologized them anyway. So that excuse is bullshit. There is no requirement because of that to have the insane models proposed by blanchard.

There is absolutely a requirement to have a model if you are going to intervene medically. The medical system is not and should not be a vending machine for patient preferences.

I'm not saying it entirely doesn't exist. I'm saying suggesting that if you're a transsexual, and happen to be attracted to women, that that's the explanation, is retarded. I simply do not believe that all transsexuals can be categorized on the basis of their sexual preferences as either attracted to themselves as women or homosexual men with internalized homophobia.

I think you're reading too much into the connection between "gynephilia" and "autogynephilia." An autogynephile (a natal male who sexually fetishizes the idea of being a woman) is not an autogynephile because he is trans-identified and gynephilic. (Yes, once again the terminology leaves something to be desired.) That's not the reason the category was developed. The category of autogynephilia was designed to accomadate an observed pattern of TiMs who exhibited similar fetishistic preoccupations, largely but not entirely identical with what the DSM-IV called Transvestic Fetishism (now Transvestic Disorder, which Blanchard published a paper about as a part of the lead up to the DSM-V.) Blanchard published his typology before either but apparently the DSM-III still had Transvestic Fetishism as a diagnosis with broadly similar criteria. To wit (cf. genderpsychology.org, this is the DSM-IV):

The paraphiliac focus of Transvestic Fetishism involves cross-dressing. Usually the male with Transvestic Fetishism keeps a collection of female clothes that he intermittently uses to cross-dress. While cross dressed, he usually masturbates, imagining himself to be both the male and the female object of his sexual fantasy. This disorder has been described only in heterosexual males. Transvestic Fetishism is to be diagnosed when cross-dressing occurs exclusively during the course of Gender Identity Disorder.

Transvestic phenomena range from occasional solitary wearing of female clothes to extensive involvement in a transvestic subculture. Some males wear a single item of women's apparel (e.g., underwear or hosiery) under their masculine attire. Other males with Transvestic Fetishism dress entirely as females and wear makeup. The degree to which the cross-dressed individual successfully appears to be a female varies, depending on mannerisms, body habitus, and cross-dressing skill.

When not cross-dressed, the male with Transvestic Fetishism is usually unremarkably masculine. Although his basic preference is heterosexual, he tends to have few sexual partners and may have engaged in occasional homosexual acts. An associated feature may be the presence of Sexual Masochism. The disorder typically begins with cross-dressing in childhood or early adolescence. In many cases, the cross-dressing is not done in public until adulthood. The initial experience may involve partial or total cross-dressing; partial cross-dressing often progresses to complete cross-dressing.

A favored article of clothing may become erotic in itself and may be used habitually, first in masturbation and later in intercourse. In some individuals, the motivation for cross-dressing may change over time, temporarily or permanently, with sexual arousal in response to the cross-dressing diminishing or disappearing. In such instances, the cross-dressing becomes an antidote to anxiety or depression or contributes to a sense of peace and calm.

In other individuals, gender dysphoria may emerge, especially under situational stress with or without symptoms of depression. For a small number of individuals, the gender dysphoria becomes a fixed part of the clinical picture and is accompanied by the desire to dress and live permanently as a female and to seek hormonal or surgical reassignment. Individuals with Transvestic Fetishism often seek treatment when gender dysphoria emerges. The subtype with Gender Dysphoria is provided to allow the clinician to note the presence of gender dysphoria as part of Tranvestic Fetishism.

The label (n.b. not diagnosis) of HSTS is, yes, exclusively for androphilic TiMs in Blanchard's original formulation, and that of AGP for gynephilic ones, but this is not the only or even the most striking difference. Notwithstanding this and the bold part above, these two types of individuals, drawing in broad strokes, have vastly divergent reasons for cross-sex identification and gender non-conforming behavior which aren't identical to their sexual orientations. In today's world which is more accepting of homosexuality and has less fixed gender roles, one can probably find gynephilic but effeminate TiMs who resemble the HSTS standard, and androphilic TiMs who have AGP characteristics. Sexual orientation isn't the most important part of the descriptive value of these labels.

Nonetheless, it stands to reason that a gynephilic male (generally) is more likely to develop a sexual interest in women's clothes (an ETLE, which is, in brief, the idea that this fetish escalates to the sexual preoccupation with wearing them and, in turn, with erotic self-identification with the feminine) than an androphilic male, who, for entirely different reasons, might develop a sexual interest in femininity qua the receptive role in intercourse with another male. These are necessarily broad strokes. Nobody's saying these are objective, strict, ontological categories. They merely describe patterns that Blanchard saw in his practice, and that can be seen today in the behavioral profiles of TiMs (which in an era of social media is a remarkably easy hypothesis to test. Really. I'm not joking when I say go and read trans reddit for a few hours.)

And insisting that transexuals are what they were born as and always will be is quite obviously offensive, unnecessary medically, disrespectful, and unproven.

And insisting that they are born as and can somehow become female is what, exactly? It's certainly the way they wish to be spoken of in terms of not causing offense. But it flies in the face of all reality and takes some real contortions in order to have it make sense at all. Now, referring to someone using their preferred name and pronouns is one thing, but starting to invent a whole ontology of gender is a very different one.

 

[cduggles]

starting to invent a whole ontology of gender is a very different one.

I disagree based on medical sociology and the concept of gender as a social construct rather than a biological one.

 

[SKL]

I disagree based on medical sociology and the concept of gender as a social construct rather than a biological one.

I can agree with gender as a social construct (something that you "perform") to an extent and to an extent only. Now, going beyond that, it is very different to say that males and females have different roles in society more or less thrust upon them at birth than it is to say that by virtue of self-identification, you can in some essentialistic way be the opposite to that which you were assigned. In a way, that's more essentialist than saying that gender isn't a social construct. That is the claim of the transgender ideology that I particularly contest. Saying "I am a woman because I identify [or feel, see myself, etc.] as such" is a very different thing than saying "I am a feminine man and that is OK." The former actually can and often does take a dark turn into rather misogynistic places (a metaphorical "woman suit") while the latter is relatively unencumbered by them. To speak to this, often you will find few people more concerned with gender roles than trans-identified people, who often develop a performative presentation which is almost a caricature of the social constructs surrounding the other sex. One often counters an AGP-fetishistic view of women that is actually extremely regressive.

Ill reply to the read of this post later I want a break after this.

Me too tbh.

It's a definition. One that doesn't have a solid all encompassing answer.

I think we've been here already in this thread so I don't think we need to continue this part of the discussion.

Also, there is absolutely NO need to have a crazy perverted model to treat transsexuals. You don't need a model at all.

You need to get your head out of your ass, let people do what they want, provided they're adults and comprehend the risks and are able to appreciate dangers to their health.

I don't necessarily have a problem with adults getting prescribed the hormones or even the surgeries they want. I hope by saying "adults" you're agreeing with me that children are another matter. Not anyone who walks in from the street should be able to access these interventions though as trans-identification is frequently comorbid with a variety of psychiatric conditions. Assessment is definitely needed. In Blanchard's heyday there were much more restrictive conditions (having to live as the opposite sex for an extended period of time, being at least relatively passable, and, generally speaking, being HSTS and not AGP.) Those days are long gone though and I'm not sure if that's entirely a good thing, but that's were we are, anyway.

Nonetheless, even if the model originated with the need to describe transsexuals presenting themselves for medical intervention, and we have left this by the wayside, it retains a lot of descriptive utility. I brought it up in the first place in terms of the discussions around the behavior of TiMs in female spaces, which is a set of situations that needs that descriptive utility. There are a lot of public-policy discussions about trans-identified people today, and to be able to speak about them a little more descriptively than "men dressed as women" on the one hand and "women stuck in men's bodies" on the other is pretty important.

 

[w01fg4ng]

14 occurrences of the word "fetish" on this page. FYI and yes I know it's totally not a fetish.

 

[SKL]

We had the conversation but you were never able to come up with a definition of male and female that doesn't end up with giant asterisks to make it work.

No, natal male and natal female are very obvious categories. My only "giant asterisk" was that Intersex doesn't mean anything in the conversation, which I think is entirely reasonable.

Also, they had to be passable.. Before they got help being passable? Wtf kinda retarded psychiatrist logic is that?

The idea, I guess, was that they didn't want to sort of "strand" anyone perpetually looking like an ugly dude in bad drag. I'm not saying this is a criterion I'd return to. That passing aesthetic judgment on your patients is kinda creepy is definitely not the least of my reasons why.

 

[Jabberwocky]

Let me just read that back to you, you're saying that some gay men are so bullied and discriminated against... That they decide the solution is... To be go around identifying as women?

Is that really what you're sincerely proposing to me?

That if you're gay in America you should transition because then you'll be more accepted..

I did not say bullied. But I have read some literature suggesting that some parents (Particularly fathers) in certain communities may find it easier to deal with ‘born in wrong body’ - a medical issue, than ‘is same-sex attracted’ - potentially a religious or moral issue.

 

[SKL]

Rofl. Dude. If your definition is "it's a male when they're born with a penis, and a female when they're born with a vagina.. Except for when that doesn't work".

Your definition blows.. Lol.

Same with "they're a male if they have xy sex chromosomes and female if they have xx, except when that doesn't work for any of a variety of reasons". That's not a good definition.

What exactly makes someone male or female "in reality". Give me a definition that doesn't include any instances of saying "except for these arbitrary exceptions because it doesn't work without them".

No, it's really remarkably simple if you aren't using extreme edge cases (intersex conditions, e.g. cases of male or female sex which are pathologically expressed due to very rare chromosomal conditions) to try to make a point in an argument that they have no bearing on whatsoever (trans-identification.) While a favorite tactic of the trans lobby, it's intellectually dishonest.

I thought we were taking a break though?

 

[SKL]

Intellectual dishonesty is ignoring the edge cases.

The edge cases are why such a definition doesn't work.

Soo, how does it actually break down in your mind with intersex people. Say they are genetically male yet born and brought up physically female, which are they, female or male?

The mistake is trying to apply these cases to transsexualism (except in the case you mention below which I'll get to.) They are categorically different. This is an imperfect analogy because race is not an objectively essential category in the same sense that sex is an objectively essential category (not at all), but nobody would consider a Black albino to be White, even though the "Black vs. White" racial dichotomy at least in America is fairly binary. Albinism and intersex conditions are both birth defects of a sort. They do not impact social categories which they may have a passing resemblance to.

I am rather sure we have reached loggerheads here though.

What about children who were born male and reassigned to female at birth? We used to do that a lot with children born with ambiguous genitals. If they go on to identify as female? Are they female? If they go on to reject their reassigned sex, are they male? We're they male all along? Which? And on what basis do you say which.

Now this is relevant to trans issues. In fact, a lot of the early work on "sex reassignment" surgeries actually had to do with this. John Money was and remains highly influential in the whole way we think and speak about trans issues. He got his start in that arena working with intersex patients. The tragic case of David Reimer resembles what you are talking about, although he was not intersex. Surgical errors during his circumcision lead to him having incomplete male genitalia. Dr. Money convinced his parents to allow him to surgically reconstruct a pseudo-vagina ("neovagina," which you can't really properly create in [if at all] a child let alone an infant--see the experience of Jazz Jennings) and also hormone therapy. (Perhaps of note, Reimer's parents were religious with conservative views of gender roles. This is not the same as the situation with homosexuals that I and @Atelier3 have noted, but it is food for thought.) Dr. Money also engaged in highly suspect (to say the least) "rehersals" of sexual activities with Reimer in the receptive role, also having him pose for sexualized photographs. The supposed purpose of this (which may have been outright pedophilia) was to encourage "female" sexual development. Dr. Money highly publicized the case as evidence that "gender identity" was not correlated to natal sex. Unfortunately David realized he was not female and then lead a troubled life culminating in his suicide. This is one case (although there have been similar) but is definitely worth referring to in the current debate around imposing "transition" on children.

In cases where medical "transition" is performed upon intersex infants successfully in intersex situations, which, n.b., will need repeated surgeries in life to be anything resembling success (and success of genital surgeries even on trans-identified adults doesn't look that great) there is still not a correlation with transsexualism. Even if you believe that children can form a stable trans-identity (while in fact they very often wish to "detransition" and revert to their natal sex after trans-identifying early) this is a different situation, but not ontologically: sex is still sex, even if "gender" is successfully performed starting at an early age. It's categorically different than transsexualism but does not change that fact. Some intersex individuals of ambiguous genitalia, whether intervened with or not at any early age, do identify as a gender opposite the one that they were born into.

This is very interesting and I'll admit I do not have an easy answer for it, although cases in which the child or even just their parents were aware of the intersex issues are more easily explained as environmental. An interesting set of cases would be those in which a chromosomally intersex individual who was completely convincing as one sex but in terms of their chromosomes was another, and who wound up experiencing gender dysphoria and then later it was discovered that they have an intersex condition, however, I'm not aware of any such cases. They are an interesting hypothetical though.

But once more, none of this is really the same as trans-identification which is based upon dysphoria or some nebulous concept of "gender identity." The intersex stuff is not evidence one way or another in the discussion, period. Sex is not a spectrum, it is a binary. "Gender identity," which is a term that I have issues with but is really the only one that is applicable to the situation of trans-identified persons, has been described as a spectrum. If you define gender as a spectrum between masculine and feminine "poles," then sure, but the category starts to lose it's utility quickly, and then starts to get into strange territory when people claim genders other than male or female, or no gender at all.

"Gender non-conformity" and "gender dysphoria" are definitely useful terms, though, when speaking about trans-identified as well as normal individuals. Less so intersex conditions which are a medical issue unrelated to either. To bring intersex issues into the trans debate is to conflate "sex" and "gender" which is something that the trans activists are usually opposed to, and as such is hypocritical. So too trans activists deploring "gender roles" and then luxuriating in them when identifying with the opposite sex, or, worse, suggesting that (say) a boy who likes to play princess is actually trans and not just GNC.

Bottom line, the intersex stuff is interesting but it's a red herring when it comes to transsexualism in adults and even children.

I'll admit I'm concerned you're gonna avoid this question entirely and come back again with "oh well all those cases that break my definitions don't count and they can be uhh.. Iunno. Whatever I guess". In which case I'm just gonna point it out for the intellectual dishonesty it is. There's nothing scientific or intellectually honest about a model w ere you just happily ignore part of reality that doesn't confirm with it as edge cases you don't wanna have to think about. My point here is that what makes someone male or female is clearly complicated and on a spectrum and it makes SOOO much more sense along with being profoundly less arrogant and offensive to just adhere to their identification.

Given how much I've written about it, it seems insanely complicated, and I open myself up to your accusation that I'm throwing a bunch of qualifications onto the issue of biological sex, but I'm really not. I outright like to discuss things, even tangentialities, in detail, but I can sum up what I'm saying simply: Biological sex is the presence or absence of a Y chromosome, period. Intersex conditions are just that, "conditions." GNC/GD issues are the ones at play in the trans debate, not biological sex issues.

You're probably right that some people identify as trans for reasons that can't truly be said to be that they just honestly feel they're the wrong sex. But pointing to their existence and acting like they make up the entire community of a large and diverse group of people is just doing what you've been doing above again, which is ignoring anything that doesn't fit into your model as an edge case.

If I am reading you right here, you're saying that the AGP/HSTS category is a problem because it excludes a category of trans-identified persons who express traits of neither and merely feel an essentialistic "gender identity" that is divergent to their natal sex, and you seem to be implying that this may be the majority. Based on my research, I disagree with that implication in particular.

I will admit that it is worth questioning, though, as you have repeatedly, whether it is right to question the motives of people to undergo intervention to "transition" their gender, or whether their "gender identity" had ought to be simply taken as a given based upon what they say. This is pretty much what is going on now in "informed consent" gender clinics. You go in, state that you trans-identify, undergo a rather non-rigorous assessment to make sure that you are not totally crazy and are able to understand the ramifications of the decision, and then you are prescribed hormones and at some point later, if you so desire (many or even most don't or simply can't) you are referred for surgery.

This is a model which appeals to libertarian sentiments and patient-driven ideas about medicine. There is something to be said for that. However, there is something to be said for the old model too which delves more into motivation and involves significantly more assessment as to whether the patient is compos mentis and prepared for what they are going to do. I am not necessarily in favor of returning to the days of standards as rigorous as those which Blanchard was working with in the 80s. But there has to be some kind of middle ground here. I'm not entirely sure what that is. This is not my area of expertise professionally, so I can't really comment there, something I'll readily admit. But regardless we do need some kind of standards and some kind of model by which we can better understand our patients and people who are in society at large.

However, given the transsexual/transgender phenomenon that is going on in society, we are very much in need of a descriptive model for what is going on. Blanchard's is good but it is not by any means holy writ set in stone. New research is very hard to do due to academic pressure. The research on ROGD which they are trying to shut down is very important stuff and has already contributed a lot to our ability to describe in at least somewhat objective terms what is going on with trans-identified individuals. Blanchard is quoted as saying that originally, and for a long time, he thought there was no such thing as "autoandrophilia" to correspond with "autogynephilia" but that now he might have been wrong about that.

THAT is what intellectual dishonesty is. Having a model you know can't actually describe everything and yet insisting, even to people's psychological harm, that it's true. It's.. Well I think that's actually pretty damn disgraceful. Not because it's intellectually dishonest, which it is, but because you bring harm to other people in doing it.

It is all a moving target. I guess you are saying that the only descriptive model we need is "gender identity," "women in men's bodies" and "TWAW/trans women are women." I disagree wholeheartedly. It's just not a model I believe in, because I don't accept the idea of an essentialist "gender identity." This I actually have in common (along with a number of things) with the "gender-critical feminists" (their term.) I do believe that gender is to a certain extent "performative" and "constructed." It is not an essential characteristic that boys play with a certain type of toys and girls play with another. It is not even essential that men are the leaders of a society: matriarchal societies exist, but they are rare (I believe there are fairly obvious biological reasons for this, but still, this points to the "social construction" of "gender" itself.) You can't have your cake and eat it too: gender cannot be simultaneously socially constructed and essentialistic. The "TWAW" narrative falls short here. Effeminate men and masculine women exist, and the majority of them are not trans-identified (but in our society today, many of them are being actively encouraged to be, especially the latter, cf. "Where Have All The Butches Gone?") Trans identity is something more than that. As to what it is, we are left with descriptive models as I have said.

If your belief will hurt other people, maybe I'm just a bleeding heart but I think you have a responsibility if you're gonna argue for it to really and properly think about it and make sure you're entirely confident about every element of your belief.

I'm quite confident. I also do not believe that any of this hurts anybody. I am not suggesting that anyone go out and beat or harass trans-identified individuals, something which has only recently begun to elicit sympathy and be considered a "hate crime." I'm not suggesting any kind of suppression of trans-identified people, either, although I am suggesting more of what they would call "gate-keeping," but this is for the sake of the many troubled individuals who undertake "transition" without full understanding of what will happen, or with the false idea that it is a "magic bullet" for their difficulties in life (the latter is something about which I'll have significantly more to say when the conversation turns to TiFs and ROGD.) I am not suggesting that trans-identified individuals should have fewer rights in society in any way, although I do believe that we cannot responsibly treat them as their self-identified gender in all situations in society or medicine. This should be obvious, but the current gender ideology sees it as a form of oppression.

In terms of mere discussion being hurtful, I am sure that many will consider some of what I say to be so. It is not meant to be, and should not be. Critical discussion of the "transgender" phenomenon is something that is essential for our society to have, especially given what is going on everywhere today. Before all of this exploded, discussions of things like HSTS vs AGP were pretty esoteric and relevant only to the few clinicians who were involved in that work, and issues like the use of cross-identified bathrooms were pretty much irrelevant to society at large as well. Now this is no longer so. The transgender movement wishes to make all critical discussion taboo. It should not be necessary to state how illiberal and dangerous to a free society this is. The particular problem here is this: the transgender movement is often compared to the gay rights movement. By and large, the latter just wanted to be left alone and to have a minimal number of accomodations made for them. Even the redefinition of marriage does not really effect heterosexuals. The transgender movement, though, has much more in common with the bizarre saga of the cake-bakers: many if not most "trans rights" issues do, inherently, effect other people and quite often rise to the extent of imposing gender ideology on others, sometimes even on a very physical level.

Not just as a health professional, but as a human being. Of course doing it as a mental health professional isn't just irresponsible id say it borders on ethical negligence.

What @alasdairm said about referring to people as they wish to be referred to comes in here. In a clinical setting, as well as a social one, it is polite and costs nothing (or close to it) to refer to someone by a chosen name or even by chosen pronoun. It is a bit thornier when talking about people in settings where accuracy is important, and--this always made me think--one rarely refers to another person by a third-person pronoun in that person's presence, which brings me to my next point regarding clinical situations. In psychiatry (and in medicine generally) clinicians deal with people who believe all sorts of things, ranging from people with different religious beliefs to people who are outright delusional (which, n.b., is a different phenomenon to trans-identifying, although people can have delusions of being the opposite sex while in a psychotic state which are not the same as trans-identification.) One has to make do and make certain accomodations. Generally one does not outright argue with a delusional patient nor does one get into theology with a patient with different religious opinions. In no way shape or form does this mean that one has to agree with the patient. Only to show them respect and decency. And in psychiatry in particular but also in medicine generally there are times in which opinions contrary to the patient's will be discussed among providers or entered into the patient's medical record.

I have not dealt with many trans-identified patients in my career mainly due to the nature of the patients that I work with. I am not currently working although I plan to return in the nearish future. Due to social developments and the fact I will very likely be working with a different population I expect to see more trans-identified patients. I have every intention of treating them with the utmost decency. There is no reason to argue politics or the ontology of sex and gender with them nor to, really, express any opinion whatsoever, positive or negative, of their situation. I have no problem with referring to them as they wish to be referred to, which is also the standard of professional care nowadays anyway. None of this abrogates my right to have critical personal and political opinions regarding the gender ideology and of current situations going on in society. One just keeps that separate from patient care. I honestly take offense at the implication that any of this would impact my professional standards. I have rather regularly cared for individuals such as child molesters and murderers, and have always done so professionally and compassionately and without letting any opinion or feeling of mine get in the way. Relative to that pretty much anything is a walk in the park. You learn not to make, or take, things personal.

This is why I refuse to give an opinion about trans people in sport until I actually know that they have an advantage (in the case of transgender women). Because saying they shouldn't be allowed is obviously going to be hurtful and I feel a responsibility to be sure my opinions would actually be correct.

I am not going to get into this can of worms to any great extent at this point other than to say it should be entirely obvious that a natal male has an advantage in sports due to things like bone density, etc. even in cases where free testosterone levels approach that of a natal female. The only reason you do not see TiMs dominating every category they are allowed to in female sport is because there simply are not enough TiMs to do it. I'm not saying that any natal male could beat talented natal females, but if both are serious, there is no question whatsoever (the US National Women's Soccer Team, the very height of their sport, have routinely lost to high-level teams of adolescent boys. That Billie Jean King, at 29, beat Bobby Riggs, at 55, at tennis was an utter aberration and Riggs is even strongly suspected of losing on purpose.)

The idea that excluding them from sport is "hurtful" and that this is enough to cause a serious discussion of this topic would have been considered utterly outlandish not long ago, and that alone should be food for thought. Including TiMs in female sport simply for "affirmation" or "inclusiveness" takes "TWAW" beyond parody (although there are arguably even more surreal situations, like TiMs trying to see gynecologists.)

Love you though.

 

[SKL]

OK that's a huge post and I'm about to get some sleep so I'll have to go over it later. I'll just quickly say this. It floors me that anyone even remotely involved or experienced with mental health would suggest that just because there's no physical violence that nobody is being hurt.

Words hurt. Words can be far more devastating than physical injury.

Yes, words hurt. Above I was not speaking about harassment or denigration of any kind. What I said was:

In terms of mere discussion being hurtful, I am sure that many will consider some of what I say to be so. It is not meant to be, and should not be. Critical discussion of the "transgender" phenomenon...

I am referring to "critical discussion of the transgender phenomenon" which is very much not about being hurtful. It can be about (as I go on to say) expressing opinions about these issues that people will not agree with. The objection can be made that I am expressing views (which I am) and passing judgment (which I'm not) about things that I have not experienced and that I don't have a right to do that. This is bogus. If mere description of certain facets of the transgender situation, and a bit of more-or-less neutral analysis of the same, offends, then I'm comfortable saying it's not my problem. As I mentioned above, I am not going to get into an argument with an actual trans-identified person (much less a patient of mine) about their own experience and identity.

I am not going to shout at anyone that that they are ugly and will never be a woman, or what have you. I'm not saying anything derogatory and I'm not advocating for bad things to be done to anyone. I'm simply taking a critical approach to the situatin in a rather abstract way, with particular regards to how that issue effects society and other people. But, "people will do what they do," as Nancy Pelosi said so eloquently. I do not care if adults cross-dress or even if they undertake medical "transition." It does not offend me. I do not intend to offend them. But the whole phenomenon (a) now is beginning to have serious effects on other people and society at large and (b) is interesting, sociologically and clinically.

And as for sex being a binary.... It's just not. I mean correct me if I'm wrong but I assume that if someone if born physically female but with a y chromesome where that chromesome is either damaged and didn't function properly or the persons body doesn't respond to androgen. I assume you accept that that persons female, no?

Female for what purpose? I'll try to reiterate this once more, and then I think we should really table this discussion. You are talking about a very specific type of intersex condition (one out of a broad category.) I am not terribly well-versed in intersex conditions. I think you are talking about complete androgen deficiency or something very like it. This (chromosomally male) individual does not have internal female organs, but the outer body is pretty much indistinguishable from a female (the vagina ends abruptly in a "pouch.") She (which I'll be OK saying) will be raised and socialized as female. The condition will typically even be missed at birth. By and large for most purposes and for all or nearly all social purposes (except, of course, reproduction) she will "be" female. Nonetheless, in a strictly technical sense, "she" has XY chromosomes and a developmental anomaly which has physical consequences for her (her internal anatomy is different and she will have elevated risks for certain conditions like testicular cancer. She has internal testicles instead of ovaries.)

If not I think I'll just leave this discussion cause as I said earlier I can't take people seriously if they deny even that.

But assuming you accept that, that means you accept that sex in fetal development is a process where a fetus, starting off physically female as all fetuses do, is masculinzed by male hormones.

How is that not a spectrum?

If a fetus starts physically female and gradually become male in fetal development, during which any number of things can go wrong, how can it possibly be a binary? That makes no sense.

You mention two cases where during fetal development changes happen, but the baby is born one sex or the other. Thus, not a spectrum. The two (rare) cases you mentioned involved a process but one which results in one or the other in a binary. Process does not mean spectrum. Very, very rare intersex conditions exist where sex is not obvious. I say "not obvious" because nonetheless every individual has a male or female sex. In these hypothetical cases, and in our case with CAIS, you are still identifying them as male or female. Not something in between. Whether using external criteria or chromosomal criteria, sex remains a binary and not a spectrum. The development of our XY woman above is still the interrupted and pathological development of a male.

Intersex conditions are indeed something that happens physiologically and sometimes we struggle to describe the individual in question. They certainly create some conundrums for their healthcare team (but not for people in bathrooms.) Sex is still a binary. Neither of us, I think, are qualified to delve into the minutiae of obscure birth defects effecting sexual characteristics, and while I find this discussion intruiging, I still don't see the relevance to the trans debate except to say "here is another situation where there is some ambiguity around sex/gender." Just because there is ambiguity in both cases doesn't mean the ambiguities are similar. There is no argument to be made from these intersex cases that has relevance to whether a developmentally normal natal man can "be" a woman.

While trans advocates like to say "women can have penises" and the like, this has nothing in common with people with CAIS who are externally female but have testicles. I can see the temptation to draw a parallel here with the CAIS case because "sex" and "gender" don't seem to match but I don't know how many times I can say this: these are categorically different conditions and to draw a parallel between them seems to me to be very offensive.

 

[SKL]

(edited to clarify some acronyms for other people reading this)

A delusion as I feel you must be well aware, is when someone's internal experience of reality is significantly disconnected from what is actually being seen by them. Such as someone believing people are spying on them for no good reason [...] Believing they're the wrong sex is NOT a delusion. They're fully capable of comprehending their situation, they understand what they want to do to resolve their issues. That's not delusional.

I'll have to ask you to read my post again, I actually very specifically said that gender identity disorder is not delusional in the traditional psychiatric sense. (However, psychotic patients can have delusions of being the other sex which resolve when the psychosis resolves. This is a different matter unless the patient in question winds up receiving some kind of "gender affirming care" which in this case is actually going to be harmful. This is a rare scenario that I mention only for the sake of completeness, but it is one that I have seen clinically. Obviously we did not try to enact any "transition" for the psychotic patient, but I worry about what would happen now.)

Incidentally, pimozide (Orap) is an old school antipsychotic which, for reasons totally unknown, is particularly effective in somatic delusions (delusions relating to the body, a very common one is that one's organs are rotting or being variously transformed.) Anecdotal evidence has been presented of Orap "curing" gender dysphoria, however the information is very shoddy as to what was actually going on with the patients in question (the study reads sort of like a case of autogynephilia (AGP) but the patient had other issues as well.) This is a no-go zone for research now for political reasons. I am not saying here that we should start giving trans-identified people Orap willy nilly but it might be worth a go in people who are actively troubled by these feelings and wish to be rid of them instead of wishing to enact them. I would love to see more research on the subject.

However, most people with gender identity issues do not show signs of psychosis or delusion as the term is generally used in psychiatry. They do tend to have comorbid personality issues which is a separate phenomenon. I mentioned narcissism before (trans-identified males (TiMs) tend towards it much more than TiFs) but borderline personality disorder, though, which is very common amongst people with gender issues (and more common in TiFs), and cluster "B" PDs generally, are characterized by disturbances in, and poor development and distinction of, personal identity (a good paper on this. n.b. cluster "B" personality disorders, especially in young women, is a population that I worked with very extensively during a certain period of my career, one that I have an enormous amount of sympathy for and one which I must resist the temptation to elaborate on. I will only say that the same population of young women I was working with now has high rates of turning TiF, which was something I practically never saw only a relatively short time ago. This should be extreme food for thought and I will pick up on this later as I have promised repeatedly. I have on almost exclusively about the natal males for a few pages now. The females will get their turn and if anything what I have to say there is more intense.)

n.b. The tendencies towards borderline vs narcissistic PD in trans-identified individuals is more in proportion to natal than to identified sex, if that is worth anything. Chalk it up to male and female socialization, or something more integral? Interesting question. A correlation between AGP and NPD seems almost tautological, though.

Why is it so hard to believe that the brain itself might really express sexual dimorphism in a way that the brain itself has a sex. Why is it so hard to believe that someone who thinks they're supposed to be female when they were born male or vice versa isn't just another type of intersex.

"Brain sex" is controversial to say the least. A recent interesting book is The Gendered Brain, which argues against intrinsic differences in the brains of the sexes and attributes observed differences to brain plasticity and environmental factors. Some studies have shown observable differences in scans of the brains of trans-identified individuals, and even that they resemble the opposite sex, but this begs the same chicken-and-egg type question, and the jury is still out on the intrinsic nature of any serious functional and organic differences between the brains of males and females anyway.

Studies have also shown that homosexual men have more "feminine" brains, and most research on the brains of trans-identified persons has been on MtF transsexuals of the "homosexual-transsexual/HSTS" androphilic type. Brain scans of gynephilic and AGP-type TiMs is lacking as are brain-scan studies of, I believe, any TiFs whatsoever there are a very few TiF brainscan studies, all on gynephilic FtMs. Most of the brain studies are on people who have undergone some kind of medical intervention, usually cross-sex hormones, for "transition," (which is why I'm careful with the terms I'm using here) so this further muddies the waters.

Highly recommended reading on the "culture–behavior–brain loop model" in trans-identified persons.

Positing a hypothetical "brain sex" as the reason why people develop trans-identification is an unnecessary "multiplication of entities" without good evidence. It's also an essentialistic view of gender and confounds gender presentation, gender identity, and biological sex in a sort of fundamentally unscientific slurry. Even if individuals with similar perceptions and behaviors have certain brain commonalities, this does not mean that the brain commonalities caused those feelings and behaviors as such and that there is some particular "thing" in the brain that causes those feelings and behaviors. This is over-reductionistic. Until firm evidence presents itself, and it will have to cross a number of difficult hurdles.

Until we really understand how the whole brain works, how is it anything less than an arrogant presumption to assume that's not possible?

Why assume that it is possible? By "it" I mean that there is a specific feature of the brain that "holds" and determines one's "gender identity" which sometimes for no discernable reason is incongruent with natal sex. I do not believe this exists and would require very good evidence to change my mind.

I agree with you that this probably doesn't describe a lot of transgender people (assuming this is in fact the case I mean) I agree that from what I've seen there probably is an element to which this is also a social trend. But that doesn't preclude it being a social trend in top of a real condition like I describe above.

Your whole arguments just have this huge vibe of arrogance to them. Insisting that you KNOW what gender is in spite of you constantly having to shew away exceptions to your belief system.

"Gender" vs "sex" is a slippery differentiation. I don't like the term "gender" to be honest. Nouns have gender. People have sexes. A more useful term, "gender performance" can be masculine or feminine, and can vary over time, and is not necessarily a correlate of natal sex. The slipperiness comes in when we give it a particularly fixed and essential ontological implication, "gender identity" apart from either "gender performance" or "sex." Identity does get complicated, though. You do get TiFs who identify as specifically feminine men, and the inverse (very anecdotally I'd say the "trans softboi" as they call it is more common than the "trans butch.")

I on the other hand do not know. I do not know if the brain has a gender and if it can be different to the rest of the body. But I do know that there are transsexuals out there that seem to be quite normal people other than that they feel they were born in the wrong body.

There are absolutely trans-identified persons who are fairly well-adjusted members of society. They are probably in the minority, but they are out there. I also will readily admit people who exist outside of the HSTS/AGP dichotomy or even who's trans-identity might be less contingent on androphilic vs gynephilic issues and more internal, a feeling of being "born in the wrong body" leading to gender dysphoria. A sort of longing to be the other sex and the belief that in doing so one will be more comfortably embodied and "at home."

This exists in both natal males and natal females. Often it can be described as being HSTS or AGP but sometimes it is a stretch at best. The terms HSTS and AGP were originally invented to talk about men only, so the shoe fits better there, but there are definitely gynephilic TiFs who could be called HSTS by simply inverting the definition, and similarly "autoandropheilia" seems to be a thing, possibly a recent development, definitely a social trend. Blanchard as I mentioned only recently came around to admitting it exists.

The psychology of TiFs is not as well studied as TiMs (it's hardly unusual, unfortunately, for males to get more attention: see signs of heart attack in females being underobserrved.) ROGD (rapid-onset gender dysphoria), a recently coined and controversial term, is more often seen in TiFs but is also seen in TiMs, where it has not gotten as much attention (here the females are the focus for once?) Because studying it is so politically charged we don't know as much as we could about it.

Regardless of interpretation and labels there do exist people who simply feel "embodied" in the wrong natal sex. I believe, who you are talking about and this is a population that both exists and deserves a lot of sympathy. What causes these feelings? I do not know. Nobody does. So as far as this goes, we're fairly agreed on a few things here. All we can do is try to describe what is going on and do what is best for these individuals and for society at large, and determine the appropriate proportions there (which is a thorny balancing act and one that showed up, albeit in different form, constantly with the types of psychiatric patients I've worked with.)

And yet... There's seemingly almost noone out there who seems to think tthey were born the wrong race or the wrong species.

You just haven't been to "that part" of the internet, clearly

Spoiler: meme

So why is the wrong gender so much more common? I think I'd be a fool not to at least consider that their feelings might represent exactly what they say they're feeling. Not when we don't know nearly enough to rule it out. And frankly. Even if they're wrong. And the brain has no gender. And it's simply that for some psychological reason or whatever they feel more comfortable as a different sex. So what? I don't see why that really matters and why I still shouldn't respect their wishes.

Here's the rub, I think. Whether we should respect their "wishes." You're right that it shouldn't really matter what the etiology of trans-identification is in terms of how we act towards the individuals concerned. All people deserve dignity and respect. Trans-related issues become a thornier problem when trans-identified persons demand "affirmation" beyond simple respect. This can be as simple as requesting people use different pronouns or get more complicated with issues around bathrooms and sports and everything else that is so frequently in the news today.

The demand for trans "affirmation" seeps into academia and the clinical world and seeks to restrict how we can talk about these issues. In LGBT circles, the demand for "affirmation" becomes pressure on natal female lesbians to have sex with TiMs. The cry of "affirmation" leads to encouragement by anonymous people online of young people, particularly GNC girls, to take cross-sex hormones with unclear long term effects and to undergo very serious and mutilating surgeries, presenting it as a sort of panacea for youthful alienation, in a cult-like manner. AGPs have been known to try to make visits to the gynceologist for "affirmation" 'that is at it's heart fetishistic. All these and even stranger things are going on out there and getting more and more prominent in society.

Dignity and respect for all, but things are getting extremely out of hand. A critical discourse is needed. Simply say "TWAW" and leaving it at that does everyone a disservice.

Alrighty this time bed first reply later.

Good morning. Hope it finds you well. Always fun having an antipodeal conversation, isn't it? Wreaks havoc on sleep, but "I cherish my intercontinental friendships." Hope you wont keep me up to late this time. Trans issues really do seem to bring it out in people, don't they? Thanks for putting up with my tangential writing style (and I hope other people read this and get something from it too.)

Funny thing is, well to me I mean, I don't really consider myself a trans advocate or a LGBT advocate. Id call myself a human advocate, and more specifically an advocate for people who seem to need an advocate. I believe in helping people. That's why I'm still on bluelight after all these years and still keep a presence on the recovery forums.

I have never worked in any job as an adult that wasn't about helping people and I spend a great portion of my off time doing the same with 12-step groups and stuff like that. I'm with you here. I like your formulation of an "advocate for people who seem to need an advocate." I've got my street credentials too, and I don't lack sympathy for the trans-identified who as I've said I have limited experience with clinically but who I've certainly encountered and tried to do my very best for.

But I also have sympathy for people who are negatively effected by the current trends, and this motivates my critical approach (which is syncretistic, incorporating some ideas from GC feminism and some other ideas from my academic/professional reading and just generally what I have learned researching the subject including spending a lot of time in both trans-positive and trans-critical spaces on the Internet.) My heart particularly breaks for the young people, especially young women, who are now in immense numbers making very permanent decisions that they will later regret. I haven't really begun to discuss this and it is difficult for me to even do so without getting a little upset.

 

[cduggles]

race is not an objectively essential category in the same sense that sex is an objectively essential category

Disagree. Example: medications can affect members of different races differently. What do you do when someone of mixed race shows up, which is common, unlike intersex individuals. What to do then?

One just keeps that separate from patient care.

One tries. Assumption of objectivity in patient care is a tad arrogant. And possibly leads one down the road of good intentions.

That Billie Jean King, at 29, beat Bobby Riggs, at 55, at tennis was an utter aberration and Riggs is even strongly suspected of losing on purpose.

Okay.

I still don't see the relevance to the trans debate

Intersex individuals are placed into a world where gender expectations are binary for babies and most children. How they are raised and how well that matches their own perception of sex and, particularly, gender is relevant to any discussion where gender is an issue.

"trans softboi"

You admit you have little contact with this community in your work, and it might behoove you to be careful about using terminology that is freely used by members of the community, but is not perhaps as appropriate for someone outside the community to use. Watch your language, in other words. Thanks.

 

[SKL]

Disagree. Example: medications can affect members of different races differently. What do you do when someone of mixed race shows up, which is common, unlike intersex individuals. What to do then?

This is true but leads to a bit of a tangent. In fairness I had said I was making an imperfect analogy. There are important differences, genetic differences, that can effect patient care. I think this actually strengthens my original analogy now that I think about it: an albino Black person still needs to have an adjustment made when calculating GFR. There is some analogy here to an androgen-insensitive person with external female anatomy still has (internal) testicles which are at elevated risk for cancer.

One tries. Assumption of objectivity in patient care is a tad arrogant. And possibly leads one down the road of good intentions.

It is good to get reminded of this from time to time.

Intersex individuals are placed into a world where gender expectations are binary for babies and most children. How they are raised and how well that matches their own perception of sex and, particularly, gender is relevant to any discussion where gender is an issue.

Intersex questions are very interesting. You are right, for example, it is of enormous consequence that the androgen-insensitive person I mentioned before receives female socialization from birth. What I'm trying to say, and I don't really want to go down this road again as I've written a lot of words about it, is that analogies between intersex persons and trans-identified persons are questionable (and as I've mentioned repeatedly seem to me to be offensive to the intersex.) There is simply not a biological analogy to make here and a phenomenological analogy is tenuous at best. The whole discussion between myself and @JessFR around intersex issues was around the question of binary male/female sex which I maintain is absolute even accounting for intersex cases as aberrations.

trans softboi

You admit you have little contact with this community in your work, and it might behoove you to be careful about using terminology that is freely used by members of the community, but is not perhaps as appropriate for someone outside the community to use.

I realize that these are sensitive issues and I don't intend any mockery here. Please note, and I should probably do a better job of making this clear in what I'm writing, that not everything I am saying here comes from clinical experience. I got into this a little bit at the very bottom of my last post: part of the base of knowledge I have here comes from doing a lot of research on this subject including spending time in relevant online communities, both gender-critical ones and trans-positive ones, observing from a necessarily etic standpoint. I should mention I make no pretense of this part of my "research" being scientific (unlike when I cite, well, actual research.) Perhaps I should make this more clear as well.

However, I'm not sure how I had ought to refer to this sort of thing other than with "endonyms?" I suppose I could have omitted the phrase entirely having already mentioned "TiFs identifying as feminine man" but I feel that using the term adds something important: connecting abstract and fairly clunky wording to the real world and actual people.

 

[cduggles]

@SKL For some reason I can’t quote you.

It’s cool that you have learned about the trans community from its members in an environment where they interact casually. I appreciate the added color that language from such an environment brings, but please use care with it. Some words are not really for use by an out group member in some settings.

 

[birdup.snaildown]

please use care

I think he did an extraordinary job. Certainly way better than I'm capable of... It's kind of impossible not to offend people these days.

I'm happy to admit that (personally) I don't understand the trans movement. I think people are a bit confused about gender these days. I've brought this up with some trans people I know and they were surprisingly accommodating. There were no hurt feelings.

I will always call people by their preferred pronouns assuming they aren't super confusing. It doesn't cost me anything to say he or she. I think zhe is a bit much, but that's somewhat of a rarity in the trans world. Most people who transition are happy with "normal" pronouns.

I don't think a trans woman is a woman. If you have XY chromosomes, you are a man. (Excluding intersex situations or whatever. You know what I mean.) That's my opinion. I'm not going to yell it from the rooftops. But, I also don't feel guilty for having that opinion.

I've met a lot of lovely, intelligent trans people. I read something a while back that indicated that gay/lesbian people tend to have higher IQs than straight people. Maybe it's not true, but (from my experience) it probably is. I think the same is true for trans people. I've had fascinating conversations with trans men and women. They are light years ahead of me in terms of deconstructing gender... so maybe I don't understand because I'm ignorant.

I've tried to understand. I just don't get it.

 

[birdup.snaildown]

Something occurred to me just now.

There are certain languages (like French) that gender objects... I wonder: can objects be trans/non-binary?

 

[cduggles]

And I definitely wouldn’t hold @SKL to such a high standard if he wasn’t so conversant in the vernacular of the community.
But I would mention it to anyone who used a word that it might not be as appropriate for a non trans individual to use.

 

[cduggles]

Something occurred to me just now.

There are certain languages (like French) that gender objects... I wonder: can objects be trans/non-binary?

That’s how das is used in German. It indicates a neutral noun.

 

[birdup.snaildown]

So there are feminine / masculine and neutral nouns in German?
Interesting. You learn something new every day.

anyone who used a word that it might not be as appropriate for a non trans individual to use.

I'm not big on words that can only be used by certain people.

 

[w01fg4ng]

Is it more shocking that German has three genders for nouns or that English inherently has none?