South Carolina legislature proposes bill that bans informed consent for HRT, among other things

[John Dule]

Here's this which I'd already posted.

And more importantly the question of whether gender dysphoria technically counts as a "medical condition" in the world this argument is a pointless question. The important thing is how to help people with it. Adults generally can be trusted to make the decision on whether transition is right for them themselves(I would think this is a pretty natural conclusion for someone who's ideology is generally focused on letting people make their own decisions and live on their terms. And yeah, most won't regret it https://www.gendergp.com/detransition-facts/)
And for kids, desistence isn't common either. https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/Gender-Identity-5-Years-After-Social-Transition?autologincheck=redirected
And I'll say that you can't accurately assess people for this without an environment where the patients can speak openly about their doubts without fearing it'll cut them off from medical treatments they'll likely need. I have a lot of disorganized thoughts on this, but I need to be finished with this post.

Bolded for emphasis

And I'm going to repeat that whether gender dysphoria technically counts as a "medical condition"(whatever that means in this context) is not an important question. The important thing is what procedures and methods of treatment work the best for people with it.

I'd also argue that whether to transition is more a life choice than a medical question. The doctors role is more in what specific methods, doses, etc to use.

How is it "not important" to classify gender dysphoria as a medical condition or not? I hear people talking about "trans health care" all the time. If gender dysphoria isn't a medical condition, then what exactly does "trans health care" mean?

I'm trying to think of a precedent in the medical community for self-diagnosis as the only prerequisite for treatment, but I can't come up with one. Can you think of any?

[Since I'm the mad scientist proclaimed by myself]

How is it "not important" to classify gender dysphoria as a medical condition or not? I hear people talking about "trans health care" all the time. If gender dysphoria isn't a medical condition, then what exactly does "trans health care" mean?

Honestly, that argument is mostly there because you're kind of acting like gender dysphoria counting as a "medical condition" implies a lot of specific things about how it should be treated that it really doesn't. Poor way to argue on my part.

I'm trying to think of a precedent in the medical community for self-diagnosis as the only prerequisite for treatment, but I can't come up with one. Can you think of any?

The evidence and expert opinion support informed consent for adult transition care. That's the simple reality of this issue. How other issues are treated doesn't matter. What fits with abstract ideas, concepts, and principals isn't really important to this debate. I'd say gender dysphoria and being trans isn't really comparable to most issues the medical community deals with. Most issues aren't really so tied up in both identity and body image/comfort like transness.

[John Dule]

How is it "not important" to classify gender dysphoria as a medical condition or not? I hear people talking about "trans health care" all the time. If gender dysphoria isn't a medical condition, then what exactly does "trans health care" mean?

Honestly, that argument is mostly there because you're kind of acting like gender dysphoria counting as a "medical condition" implies a lot of specific things about how it should be treated that it really doesn't. Poor way to argue on my part.

I'm trying to think of a precedent in the medical community for self-diagnosis as the only prerequisite for treatment, but I can't come up with one. Can you think of any?

The evidence and expert opinion support informed consent for adult transition care. That's the simple reality of this issue. How other issues are treated doesn't matter. What fits with abstract ideas, concepts, and principals isn't really important to this debate. I'd say gender dysphoria and being trans isn't really comparable to most issues the medical community deals with. Most issues aren't really so tied up in both identity and body image/comfort like transness.

Well, the "medical condition" appellation certainly becomes important when people seek care in prison, through their insurer, or via state-sponsored health plans. It would also be relevant in the law (does seeking care for gender dysphoria constitute a "statement for the purpose of medical diagnosis or treatment?"). Are you arguing that these things don't matter, or that the classification of gender dysphoria as a mental illness wouldn't affect them? Because neither of those things are true. This would affect the lives of trans people every day.

"How other issues are treated doesn't matter?" Sorry, but I cannot accept that answer. Whatever you want to call gender dysphoria-- a mental illness, a mental "condition," etc-- you are going to have to categorize it somehow. This is not some unique occurrence that must be treated differently from all other medical conditions. There is no basis for that distinction.

[Since I'm the mad scientist proclaimed by myself]

How is it "not important" to classify gender dysphoria as a medical condition or not? I hear people talking about "trans health care" all the time. If gender dysphoria isn't a medical condition, then what exactly does "trans health care" mean?

Honestly, that argument is mostly there because you're kind of acting like gender dysphoria counting as a "medical condition" implies a lot of specific things about how it should be treated that it really doesn't. Poor way to argue on my part.

I'm trying to think of a precedent in the medical community for self-diagnosis as the only prerequisite for treatment, but I can't come up with one. Can you think of any?

The evidence and expert opinion support informed consent for adult transition care. That's the simple reality of this issue. How other issues are treated doesn't matter. What fits with abstract ideas, concepts, and principals isn't really important to this debate. I'd say gender dysphoria and being trans isn't really comparable to most issues the medical community deals with. Most issues aren't really so tied up in both identity and body image/comfort like transness.

Well, the "medical condition" appellation certainly becomes important when people seek care in prison, through their insurer, or via state-sponsored health plans. It would also be relevant in the law (does seeking care for gender dysphoria constitute a "statement for the purpose of medical diagnosis or treatment?"). Are you arguing that these things don't matter, or that the classification of gender dysphoria as a mental illness wouldn't affect them? Because neither of those things are true. This would affect the lives of trans people every day.
"How other issues are treated doesn't matter?" Sorry, but I cannot accept that answer. Whatever you want to call gender dysphoria-- a mental illness, a mental "condition," etc-- you are going to have to categorize it somehow. This is not some unique occurrence that must be treated differently from all other medical conditions. There is no basis for that distinction.

The evidence and expert opinion support informed consent for adult transition care.

I see you've completely ignored this. This is the core of the issue. Are you going to play games with words and dance around the issues or are you going to actually engage with my point?(y'know, like you were wanting me to do earlier?)

[John Dule]

How is it "not important" to classify gender dysphoria as a medical condition or not? I hear people talking about "trans health care" all the time. If gender dysphoria isn't a medical condition, then what exactly does "trans health care" mean?

Honestly, that argument is mostly there because you're kind of acting like gender dysphoria counting as a "medical condition" implies a lot of specific things about how it should be treated that it really doesn't. Poor way to argue on my part.

I'm trying to think of a precedent in the medical community for self-diagnosis as the only prerequisite for treatment, but I can't come up with one. Can you think of any?

The evidence and expert opinion support informed consent for adult transition care. That's the simple reality of this issue. How other issues are treated doesn't matter. What fits with abstract ideas, concepts, and principals isn't really important to this debate. I'd say gender dysphoria and being trans isn't really comparable to most issues the medical community deals with. Most issues aren't really so tied up in both identity and body image/comfort like transness.

Well, the "medical condition" appellation certainly becomes important when people seek care in prison, through their insurer, or via state-sponsored health plans. It would also be relevant in the law (does seeking care for gender dysphoria constitute a "statement for the purpose of medical diagnosis or treatment?"). Are you arguing that these things don't matter, or that the classification of gender dysphoria as a mental illness wouldn't affect them? Because neither of those things are true. This would affect the lives of trans people every day.
"How other issues are treated doesn't matter?" Sorry, but I cannot accept that answer. Whatever you want to call gender dysphoria-- a mental illness, a mental "condition," etc-- you are going to have to categorize it somehow. This is not some unique occurrence that must be treated differently from all other medical conditions. There is no basis for that distinction.

The evidence and expert opinion support informed consent for adult transition care.

I see you've completely ignored this. This is the core of the issue. Are you going to play games with words and dance around the issues or are you going to actually engage with my point?(y'know, like you were wanting me to do earlier?)

It's hard to respond when I'm not entirely sure which experts you're referring to. Definitely not the World Professional Association for Transgender Health, which has always maintained some level of need for mental health evaluation before accessing gender-affirming treatments. Sure, there are groups that advocate for informed consent, but you're acting as if there's some kind of scientific consensus on this on the same level as, say, climate change. There isn't.

[Since I'm the mad scientist proclaimed by myself]

How is it "not important" to classify gender dysphoria as a medical condition or not? I hear people talking about "trans health care" all the time. If gender dysphoria isn't a medical condition, then what exactly does "trans health care" mean?

Honestly, that argument is mostly there because you're kind of acting like gender dysphoria counting as a "medical condition" implies a lot of specific things about how it should be treated that it really doesn't. Poor way to argue on my part.

I'm trying to think of a precedent in the medical community for self-diagnosis as the only prerequisite for treatment, but I can't come up with one. Can you think of any?

The evidence and expert opinion support informed consent for adult transition care. That's the simple reality of this issue. How other issues are treated doesn't matter. What fits with abstract ideas, concepts, and principals isn't really important to this debate. I'd say gender dysphoria and being trans isn't really comparable to most issues the medical community deals with. Most issues aren't really so tied up in both identity and body image/comfort like transness.

Well, the "medical condition" appellation certainly becomes important when people seek care in prison, through their insurer, or via state-sponsored health plans. It would also be relevant in the law (does seeking care for gender dysphoria constitute a "statement for the purpose of medical diagnosis or treatment?"). Are you arguing that these things don't matter, or that the classification of gender dysphoria as a mental illness wouldn't affect them? Because neither of those things are true. This would affect the lives of trans people every day.
"How other issues are treated doesn't matter?" Sorry, but I cannot accept that answer. Whatever you want to call gender dysphoria-- a mental illness, a mental "condition," etc-- you are going to have to categorize it somehow. This is not some unique occurrence that must be treated differently from all other medical conditions. There is no basis for that distinction.

The evidence and expert opinion support informed consent for adult transition care.

I see you've completely ignored this. This is the core of the issue. Are you going to play games with words and dance around the issues or are you going to actually engage with my point?(y'know, like you were wanting me to do earlier?)

It's hard to respond when I'm not entirely sure which experts you're referring to. Definitely not the World Professional Association for Transgender Health, which has always maintained some level of need for mental health evaluation before accessing gender-affirming treatments. Sure, there are groups that advocate for informed consent, but you're acting as if there's some kind of scientific consensus on this on the same level as, say, climate change. There isn't.

Okay, I was misinformed on expert consensus. Desistence rates are low when it comes to transition. Including desistence rates among children during social transition. https://www.technologyreview.com/2022/08/18/1057135/transgender-contagion-gender-dysphoria/

We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years.

Generally, kids who are confident in their transness are correct. I don't see why older and more mature adults would be less so. I would think that someone like you, who's ideology is ostensibly based around letting people make their own decisions and take their own path, would see no problem with letting adults live as who they wish to be. If people are allowed to smoke and do drugs(things which are unambiguously harmful) without psychologist approval, why should hormone therapy, a treatment for making your body more like how you want it to be, be different.

And about of your complaint about "gender activists" "having it both ways" in terms of "medical condition or not", I'm going to question the assumption that it has to be one way over the other. To simplify a bit, transition is like cosmetic surgery in that its designed to make you feel better about your body, but it's very different from cosmetic surgery in terms of the level of benefit(often needed to be happy vs often makes life worse). So basically, it is cosmetic medical treatment that's more necessary for trans people to live a good healthy life than a decent chunk of medical treatments. So I'd say its logical and correct for transition to "have it both ways" seeing as it has aspects of both.

[John Dule]

Generally, kids who are confident in their transness are correct. I don't see why older and more mature adults would be less so. I would think that someone like you, who's ideology is ostensibly based around letting people make their own decisions and take their own path, would see no problem with letting adults live as who they wish to be. If people are allowed to smoke and do drugs (things which are unambiguously harmful) without psychologist approval, why should hormone therapy, a treatment for making your body more like how you want it to be, be different.

I'm not arguing for either side here. I don't care if gender dysphoria is classified as a mental illness or not. All I'm saying is that there should be some degree of consistency. If you're going to talk about "trans health care," then you should accept the implications of that term.

I'm always in favor of consenting adults making their own choices. The one area in which liberal self-determination runs into choppy waters, however, is the subject of mental illness. Should people with severe mental problems be allowed to make their own decisions no matter what? Almost everyone would draw a line somewhere (aside from Laki, who seems to think that it's A-OK to let depressed people choose medically-induced suicide). That limit should not, in my mind, prevent trans people from transitioning-- but if gender dysphoria is a mental illness, it does at least trigger the need to analyze it from that standpoint.

And about of your complaint about "gender activists" "having it both ways" in terms of "medical condition or not", I'm going to question the assumption that it has to be one way over the other. To simplify a bit, transition is like cosmetic surgery in that its designed to make you feel better about your body, but it's very different from cosmetic surgery in terms of the level of benefit (often needed to be happy vs often makes life worse). So basically, it is cosmetic medical treatment that's more necessary for trans people to live a good healthy life than a decent chunk of medical treatments. So I'd say its logical and correct for transition to "have it both ways" seeing as it has aspects of both.

This is a good argument, but I'm not sure I'm understanding the bolded portion. Why would gender reassignment hormones/surgery be less likely to lead to poor outcomes than other types of cosmetic surgery?

[Since I'm the mad scientist proclaimed by myself]

I'm not arguing for either side here. I don't care if gender dysphoria is classified as a mental illness or not. All I'm saying is that there should be some degree of consistency. If you're going to talk about "trans health care," then you should accept the implications of that term.

I'm always in favor of consenting adults making their own choices. The one area in which liberal self-determination runs into choppy waters, however, is the subject of mental illness. Should people with severe mental problems be allowed to make their own decisions no matter what? Almost everyone would draw a line somewhere (aside from Laki, who seems to think that it's A-OK to let depressed people choose medically-induced suicide). That limit should not, in my mind, prevent trans people from transitioning-- but if gender dysphoria is a mental illness, it does at least trigger the need to analyze it from that standpoint.

From my perspective as someone who lives through this, my gender feels more like an innate unchangable characteristic of my identity than my mental illnesses, which are more like things that happen to me or emotions gone awry. It's extremely hard to explain how it feels, which is probably a big part of why trans issues are as controversial as they are.

This is a good argument, but I'm not sure I'm understanding the bolded portion. Why would gender reassignment hormones/surgery be less likely to lead to poor outcomes than other types of cosmetic surgery?

Gender affirming care has much lower regret rates than cosmetic surgeries.(a quick google finds a poll where 65% of people in a UK survey of people who obtained cosmetic surgery regretted it. I don't know how good that survey is, but its something, while SRS has like a 1% regret rate according to this study https://journals.lww.com/prsgo/fulltext/2021/03000/regret_after_gender_affirmation_surgery__a.22.aspx 1% according to this). And I think I've linked to studies showing a low general detransition/desistence rate for trans healthcare earlier in this thread.

I guess the reason for this is that gender dysphoria is different than general body image issues. It's more like your body is sick and twisted into something awful than being ugly.

[Del Tachi]

This issue is actually way simpler than a lot of you are making it out to be, and the issue was really clarified by this post below:

Informed consent does involve doctors doing the actual prescribing. As Peebs said, it involves the doctor informing the patient of HRT's effects and letting them decide if they want it.

This is the same type of informed consent that happens when doctors prescribe diabetes, hypertension or any other kind of medication.  There is no legal requirement that diabetes medication only be prescribed to diagnosed patients, and many drugs are prescribed quite regularly and non-controversially for off-label uses.  Inventing such a requirement only for trans patients wanting to access HRT is onerous and unfair.  It is also quite weird to think about the government having the right to access people's medical diagnoses/history for this reason.

And the flip-side of informed consent is that no doctor is ever required to prescribe a medication or even discuss a potential line of treatment with a patient, even if they do have a diagnosed condition that would warrant it.  If a trans person with no previous medical history shows up to a GP asking for hormones, the doctor is allowed to (and most would!) not write the script. 

The problem is with rogue, activist doctors who are willing to prescribe SRS/HRT to young people or those who have not been fully evaluated for their condition.  The solution is not to make such treatment statutorily illegal, but to use the already-given power of state medical boards to curtail doctors with bad practice. 

[patzer]

The science overwhelmingly shows gender affirming care has serious benefits in the vast majority of cases, and that desistance is uncommon. https://www.gendergp.com/detransition-facts. Your case is very unusual. Things like it do happen, but they aren't the norm, and the barriers required to protect you

It’s worth mentioning the serious flaws in studies that show things like that. For starters, anyone who considered medical intervention, was unable to get it, then decided against it, won’t be included. Many people unhappy with some results of medical intervention simply won’t trust doctors to report back to and thus their voices aren’t heard. And finally, of course, the only long term studies on satisfaction with medical transition would be done on the much smaller body of people who did it decades ago, not the number of people transitioning now as a trend.

We’re now seeing more and more people come open about dissatisfaction with medical transition, and I expect awareness will increase in the coming years.

I'm also going to zero in on this. HRT isn't about "expressing yourself", its about changing parts of your body that cause you discomfort into a form that feels right. And as the link above shows, most people who transition would not call it a myth.

It’s common for people to feel discomfort with their body, especially when growing up. That’s a natural consequence of puberty and its implications.

But for young people nowadays, instead of being helped by therapy to care for their body, they’re instead victims of the viewpoint that surgery will “fix” them and any such self hatred. The combination of trans identity being the new trendy youth thing and the way it can feel like an “escape” for people... the consequences are obvious.

I think it’s really sad things have ended up like this, because the increase in availability of gender diversity and nonconformity nowadays is absolutely a good thing. It just desperately  needs to be decoupled from harmful medical procedures.

Do you have any actual evidence for these claims other than TERF talking points and assuming everyone else is like you?

Here's a scientific study showing that 30% of young people who take transition related HRT end up stopping: https://doi.org/10.1210/clinem/dgac251

Not a massive number of course but still very significant and I feel like it will increase in time.

As for proof of the other things, what do you want? The surgeon who advertises access to medically unnecessary mastectomies on tiktok? The fact the number of people who transition has shot up massively in the last few years (because there's a lot of evidence for that)?

The study I linked to shows a higher rate of cessation of HRT Among natal females, which makes sense given the number of transitioners there has shot up so much in the last few years and the way it's easy for teenagers to see it as an escape route from misogyny.

You can't just dismiss all evidence as "terf talking points" because the trans community has the whole if you're not with us you're against us attitude.