It's chilling watching the latest political powers openly declare that trans people are not who they are inside and must never be allowed to become what they are inside, while eliminating legal recognition and protection and criminalizing life-saving transition healthcare. I find myself retreating into dissociation because to feel the horrors is more than I can bear.
The glass-is-half-full take is that no states have prohibited gender affirming care for adults. All the present bans in the U.S. only proscribe treatments for minors. But one would be forgiven for not knowing this because it's not how it's reported.
Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.[1] Which is not nothing considering how many were so quick to ban abortion.
Also, it's not just the U.S.; plenty of "liberal" Western European countries have reversed course on care for minors. Even the Netherlands, the origin of the WPATH protocol, has pulled back on the reigns for minors, though they haven't yet instituted any prohibitions.
IMO, the trans advocacy rhetoric that equivocated hurdles to gender affirming care for minors as murder backfired. The fact there seems little motivation to limit treatment for adults suggests substantial openness to the issue among even conservative populations. And there are many in the LGTBQ community, include trans community, who share similar sentiments, at least regarding the rhetoric.
[1] Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.
The problem with adult-only transition is that it dooms trans people (at least, those who go on HRT) to go through two puberties, which has visible physical effects that then have to be undone or worked around (breast growth, facial hair, deeper voice, etc.). The ideal for most people is that you'd just go through one.
The issue with this framing is that it ignores blockers' influence on desistence rates. Without blockers, 60-90% of kids presenting with gender dysphoria desist in cross sex gender identity by adulthood. But when put on blockers, nearly 100% continue living as the cross sex gender.
Even with a suppressed puberty, being transgender is extremely hard with high rates of depression and suicide. Any responsible analysis of the aggregate benefits of prescribing blockers needs to factor in the rates of desistence with and without blockers, but proponents of blockers almost always try to frame this discussion as though all kids with gender dysphoria persist in a cross sex gender. And indeed many try to claim that desistence is a "myth", despite most research into the topic.
This is why I hate online "debates". Because over and over people will repeat the same stuff that have been debunked thousands of times before.
The DSM criteria for gender dysphoria aren't particularly useful when you are diagnosing kids that play with dolls despite not expressing a trans identity or wish to switch sexes by themselves.
In addition to that, when you are dealing with a conversion therapist it is only natural to depress, but this doesn't mean that it's healthy for you eeither mentally or physically. This is something that was forced onto me as well.
Finally, you seem to be considering transitioning to be inherently something that should be avoided, otherwise why would less kids desisting be considered a negative?
The same criteria used to approve patients for puberty blockers were used in the study. Heck, the author of the study helped write the DSM criteria for gender dysphoria. This is not at all "debunked", as much as activists try to insist that it is
Transition is indeed something that should be avoided if a patient can become comfortable in a same sex gender identity, because even with a suppressed puberty trans people have negative health outcomes across a variety of measures. To say that transition is best avoided if possible isn't a moral judgment against trans people, it's an accurate statement about the disparities in health outcomes.
This is a simplistic model, but imagine trans people have 10% risk of suicide if they don't get blockers, 5% if they do, and cis people have 1%. If I have a cohort of 10 patients with gender dysphoria 8 will desist and 2 will persist without prescribing blockers. And if you do prescribe blockers all of them will persist and transition. The former achieves the optimal health outcomes for the group as a whole. Again this is hugely simplistic, as suicide is not the only healthcare outcome we care about, but it illustrates that desistence rates are relevant to measuring whether blockers improve overall health outcomes.
Of course ideally we'd be able to know which patients will and won't persist. Psychologists attempted to do this for decades, but were never able to reliably predict which patients would and would not persist. People like to point to the extremely low rates of desistence among people prescribed puberty blockers as proof that psychiatrist are predicting correctly. But of course it's also consistent with blockers serving as a determining factor in persistence, and not merely offering "time to think".
The fact that you think 90% desistence is credible discredits you.
Most people who pass by a bus stop don't get on a bus, but if they stop and wait at a bus stop then the probability they soon get on a bus is above 90%. Do you think standing at a bus stop caused them to get on a bus?
First of all, thank you for being upfront about the fact that your rejection of these studies is not based on their methodology, but because your don't like their results.
It's more like I have two different buses. When kids get on bus A, ~80% of them arrive at destination X and 20% at destination Y. When kids bet on bus B, 2% of them arrive at destination X and 98% of them arrive at destination Y. It sure looks like bus B isn't merely affording the kids "time to think" but is in fact altering their destination, does it not?
The patients in the study are diagnosed with the same criteria for gender dysphoria in the DSM. Heck, the author in the study I linked wrote the criteria for gender dysphoria in the latest iteration of DSM. I'm always puzzled by people who insist that the study was including patients that weren't actually experiencing gender dysphoria.
It's less that I "don't like" the results and more that the results are completely unrealistic. Trans people tend to make friend groups with other trans people, and I trust that they would notice if on average 90% of their friends stopped being trans.
I don't get your bus analogy. Surely the people who get on bus B which goes to destination Y do so because they want to get to destination Y? The act of getting on the bus doesn't cause them to want to go its destination.
It's not the child picking the bus. The choice of whether a medical professional chooses to affirm a patient or take a neutral, observational stance is a choice made by the medical professional, not the patient.
And how does that choice seem to affect the outcome? When gender dysphoric children are met with a neutral model of care that primarily seeks to observe the child, about 4 in 5 desist by young adulthood. When they're affirmed, and especially if put on chemical treatment to suppress puberty, 98% or more persist with a trans identity. Even with a suppressed puberty, transgender people experience worse health outcomes than cis people across a variety of measure. To say that the former approach is a better healthcare outcome in aggregate is not a denigration of trans people but a recognition of the challenges they face. To justify affirmation, the improvement has to be demonstrated not only against an adult transition, but also against the population that desist and live life as cis people.
The studies presented above took a sample of the patients that visited a a clinic that voiced distress of their gender over the span of a period of time - the majority of them meeting the criteria for gender dysphoria in the DSM - and tracked which of them desisted or persisted in expressing a non-cis gender identity decades or more after the fact (average time from first visit to last follow up was 13 years). The lowest rate of desistance was 70%, 3 out of the 4 were above 80%.
To call the results of a study "unrealistic" indicates that one already knows a "realistic" result would be. This is essentially admitting to bias approach to the data: if it doesn't conform to your predetermined "real" result, and your criticism is solely based on that and not any methods in the study. By comparison, the studies that show extremely low rates of desistance are either studies with kids on blockers, or they are not cohort studies. E.g. studies recruiting respondents from the internet is vastly more susceptible to reporting bias than taking the group of patients visiting a gender clinic over the course of a year.
If you want to actually post and discuss a study finding high rates of persistence under a neutral model of care, I'd be very interested in reading. But my approach towards deciding what a realistic result is leans more heavily towards published research than anecdotal claims.
> Without blockers, 60-90% of kids presenting with gender dysphoria desist in cross sex gender identity by adulthood. But when put on blockers, nearly 100% continue living as the cross sex gender.
You say "most research" shows this. From which source(s) do you draw these claims? If I recall correctly there were a lot of methodological issues with drawing this type of conclusion from those studies.
The desistence rate for this study was 87%. Most other studies fall in the range of >70%
> At the time of follow-up, using different metrics (e.g., clinical interview, maternal report, dimensional measurement of gender dysphoria, a DSM diagnosis of GID, etc.), these studies provided information on the percentage of boys who continued to have gender dysphoria (herein termed “persisters”) and the percentage of boys who did not (herein termed “desisters”).2 Of the 53 boys culled from the relatively small sample size studies (Bakwin, Davenport, Kosky, Lebovitz, Money and Russo, Zuger), the percentage classified as persisters was 9.4% (age range at follow-up, 13–30 years). In Green (47), the percentage of persisters was 2% (total n = 44; Mean age at follow-up, 19 years; range, 14–24); in Wallien and Cohen-Kettenis (52), the percentage of persisters was 20.3% (total n = 59; Mean age at follow-up, 19.4 years; range, 16–28); and in Steensma et al. (51), the percentage of persisters was 29.1% (total n = 79; Mean age at follow-up, 16.1 years; range, 15–19). Across all studies, the percentage of persisters was 17.4% (total N = 235), with a range from 0 to 29.1%.3
You can find studies that find a very low rate of desistence, in the single digits. But those are among children that were put on puberty blockers.
Those studies were mostly from the 80s-2000s when things were really different. Kids were often referred just for being gender nonconforming (like boys playing with dolls), not necessarily having serious gender dysphoria. Plus the treatment back then was often trying to make kids more "gender typical" - which obviously might push some kids toward appearing to "desist" even if they still had gender issues.
Many of the kids in those studies didn't even meet what we'd now consider the criteria for gender dysphoria. So saying "80% of trans kids desist" might be more like "80% of gender nonconforming kids don't turn out to be trans" - which is pretty different.
The majority of the sample met the criteria for gender dysphoria as listed in the DSM. Gender non-conforming behavior is just one criterion, multiple of which need to be met to categorized as gender dysphoric. This is the same set of criteria that a medical professional would use to approve a patient for puberty blockers.
The predominant approach back then was not to suppress incongruent gender identity. The approach was to take a neutral stance and neither foster not suppress the patient's gender identity, called "watchful waiting".
> The predominant approach back then was not to suppress incongruent gender identity. The approach was to take a neutral stance and neither foster not suppress the patient's gender identity, called "watchful waiting".
The clinic involved in this study actively was known for conversion therapy. Zenneth Zucker is one of the authors and is famous for it.
The head of the child and adolescent gender identity clinic at Toronto’s Centre for Addiction and Mental Health, Dr. Kenneth Zucker, has made a career promising the parents of intersexed and transgender children that he can make them “normal”. His method, called reparative therapy, in which children are pushed into assigned gender roles and discouraged from behaving or dressing in a way that’s counter to their ‘assigned’ sex, was once standard practice, but in recent years, has been increasingly scrutinized. A 2003 report in the Journal of the American Academy of Child and Adolescent Psychiatry called his techniques “something disturbingly close to reparative therapy for homosexuals,” and author Phyllis Burke has questioned the idea that transgendered children should be treated as mentally ill, saying, “The diagnosis of GID in children, as supported by Zucker and [his colleague J. Michael Bailey] Bradley, is simply child abuse.”
I imagine a conversion therapy clinic would issue a study that their conversion therapy works. I wonder how long those kids stayed "desisted" or if they were just pressured into the closet again only to transition later in life.
Kenneth Zucker won over half a million dollars in a defamation lawsuit over these false claims. Your own link covers his successful defamation lawsuit, but you seem to have ignored this:
> After his dismissal, Zucker sued CAMH for defamation and wrongful dismissal.[3] In October 18, CAMH settled with Zucker for $586,000 in damages, legal fees, and interest and released an apology for the report falsely stating he called a patient a "hairy little vermin".[3][46] CAMH removed the report from its website and apologized, and replaced it with a summary of the report which has not survived a move to its new website.
Is it intellectually honest to post CAMH's accusations against Zucker, but neglect to mention that they were sued, paid out a settlement, apologized, and removed this report?
And again, what about the other three studies that all saw desistance rates over 70%? Even if you want to ignore Zucker's results on the grounds that he practiced "conversion therapy" (despite winning his defamation case...) it's not the only study conducted on desistance rates absent puberty blockers.
> I wonder how long those kids stayed "desisted" or if they were just pressured into the closet again only to transition later in life.
You don't need to wonder, just read the study: they followed up with patients over a decade later. By comparison, much of the research attempting to study the benefits of puberty blockers only follow up 1 or 2 years later, yet few seem to point out that this is a small duration of time in the context of a child's entire future adult life.
I'm sorry, I don't want to spend my whole friday evening getting into this.
For me, the topic is personal because I was one of those young transgirls who was forced to go through male puberty. I transitioned the moment I was 18. I'm in my thirties now and still trans and still a woman. There's aspects of my body that are still permanently altered by the fact that I was forced to go through male puberty. I still resent the adults in my life, particularly the psychiatrist who strung me a long for years while I had to go through body horror. I would have done literally anything for hormone blockers back then.
I'm sure this is personal for you too. That's why you spend so much effort replying. Maybe we can see common ground? Neither of us want children to be forced to go through the wrong puberty.
A child put on blockers that would have desisted absent hormonal intervention is also a child that goes through the "wrong puberty". Chances are a good number of your psychiatrist's patients that became comfortable in their same sex gender, who would have been put on blockers and set on a track towards transition if your psychiatrist took a permissive approach towards hormonal intervention. Any responsible cost-benefit analysis of blockers has to weigh the effect it has on persistence rates.
And the cohort studies among gender dysphoria patients that don't receive blockers do show a majority desistence. This isn't just Zucker's practice finding majority rates of desistence. And your personal stake is still no justification to repeat defamatory statements about him.
Yeah but if you're a trans woman for instance, there are benefits to going through some male puberty. You understand men better. You understand yourself better, to know that's not what you want. Also you never go through a puberty in exactly the same way as a cis woman. A lot of the effects are reversible, especially if you start at 18, since I don't think maleness fully develops until at least age 25. Treating people under 18 is a politically losing issue. When policies around it changed, that tipped the scales from the public ignoring trans women or seeing them as victims, towards many members of the public seeing them as monsters who are out to get their children. It's illegal in 27 states and the White House calls it child mutilation. Can you imagine what a burden it must be to live in a world where many ignorant individuals hold such a perception of you, due to no fault of your own, but rather physical characteristics about yourself you can't change?
> Treating people under 18 is a politically losing issue.
Treating people as 'a politically losing issue' is weird to me. There are certainly some nuances to <18 transgender care, but that statement doesn't address any of them and just suggests we embrace political cowardice.
> When policies around it changed, that tipped the scales from the public ignoring trans women or seeing them as victims, towards many members of the public seeing them as monsters who are out to get their children.
This is worse. It wasn't because politics around it changed, it was because republicans (upset that they could no longer target gay people), reused the same crappy arguments against trans people, and then wrapped it in a pedophilic flag.
The change in policy is just effective propaganda making people concerned that random doctors are allowing their children to get sex change operations without consent, when that isn't how ANY of this works. Children <18 can socially transition, get puberty blockers, and MAYBE get hormone treatment. WITH parent consent.
The fact that the media and comments like yours continues to pretend its a reasonable 'discussion' perpetuates the nonsense.
We? Political cowardice? Have you considered that trans people might just want to live their lives, and not be force-teamed into your war? Trans has been a thing since the 1950s and that whole time flew under society's radar, happy minding their own business and not be noticed, until around 2020 when your war started.
Trans has been a thing since a whole lot longer than that.
Discussions like this often end up at WW2 and that's not what I'm saying here, but Germany in the 1920s was essentially the Gay/Trans hub of the world until it wasn't: https://www.netflix.com/title/81331646.
But even that's not the beginning of 'trans'.
The reason trans isn't 'flying under the radar', isn't because trans people got too proud. Its because one political party decided to shine the magnifying glass to turn trans into a political issue.
Have you considered that trans people just want to live their lives? As we all know, transitioning, social, hormonal, reduces incidence of suicide. This also applies to under 18 individuals. Should such options and approaches suddenly be revoked and discontinued, it will naturally follow that some will die who otherwise would not have.
How many do consider reasonable to sacrifice in the name of political expedience?
Back in the days when there were gatekeepers, doctors would actually refuse to treat you for gender dysphoria if you were suicidal. Because suicidal people aren't thinking clearly enough to be making such an important choice, and their actions could be seen as abusing the treatment as a means of self-harm. I think people also make that argument because they feel they need to be manipulative so that others will let them do what they want to do. If the world were more enlightened, we wouldn't have such issues.
Trans women until VERY recently were forced to go into prostitution and were excluded by the wider society. Trans people were not force teamed into any war, or rather, this is partially right, they were forcefully forced to pick a team by the side that aims to take away their bodily rights, protections, and mark them as undesirables again.
As a person born in a country on the very same trajectory Trump is pushing US into now, let me share some insights written in our blood with you. In my country, there were people who thought like you, thinking you can give them an inch and that they will be satisfied by it. But the truth is they always need more to keep the fire of hate going. First, they will take the <18 care because it was the point with weakest support. Next, when that is done, the weakest point becomes your legal identity. Then, your legal care at all. Then other lgbtqi+ groups. There is this poem about "first they came for _", this is a great illustration of it in action. It ends with transgender people pushed into conversion therapy or exile, like in my country. You should really look into how life for us was like in "1950s" and up to now, because if you don't fight for this happy life you want to live they will just take it without asking you, like they did throughout the history. The only answer to authoritarianism is to make sure there are no weak points to attack, stand united and you have a path to win. You can learn from our mistakes, or you can learn from yours. The choice is up to you.
Based on my perception of where US is now in terms of government, where its going and how seriously people are taking what is happening, I don't plan on going anywhere near it today or in the ~10 years to come. That is an optimistic timeline where trumpism is eventually stomped, btw. If you think it matters what individual states legislate when the entire country's government is being transformed into authoritarianism before your eyes, you are well on your way into pessimist timeline.
Odd that the idea of a child making permanent life changing decisions about their body hasn't been mentioned, you're so convinced you're right about all this.
> Also you never go through a puberty in exactly the same way as a cis woman. A lot of the effects are reversible, especially if you start at 18, since I don't think maleness fully develops until at least age 25. Treating people under 18 is a politically losing issue.
Imagine trying to make the same argument about forcing cis women to go through male liberty to "understand men better". It's ridiculous.
Further, studies show that the main predictor of bone structure is whether you started HRT before or after the beginning of puberty, and that outcomes get worse the more it progresses. At 18 you still get some change, but you really need to either block puberty or start HRT before it for optimal outcomes.
And if you don't want to give HRT to trans children, at least get them on puberty blockers. There's pretty much zero evidence suggesting they do anything worse than temporary and reversible reductions in bone density.
The first rule of medicine is to do no harm. It's an ethically grey area to intervene with something the body is doing naturally that isn't putting the person's life at risk. The technology available today for gender transition is crude compared to what will be available in the future. I know intersex people who are pretty unhappy because medical professionals chose the wrong intervention in childhood. Only adults of sufficient mental faculties who are under the care of a doctor should be making these tradeoffs. That's how trans worked for ~70 years before recent political activism forced the medical industry to loosen its standards.
Puberty blockers are routinely prescribed for other indications, and there are countless other treatments with more risks that are prescribed to children every day.
As a trans woman who has talked with many other trans women, the majority, including me would prefer not having gone through male puberty at all. The benefits do not outweigh the gender dysphoria. We would love to go through puberty the exact same way as a cis woman, but it's not like we don't realize HRT and current methods have room for improvement.
The effects are only partially reversible, and only after tens or hundreds of thousands of dollars in surgeries, hair removal, voice training, other treatments.
I understand it's a politically losing issue now, but I believe it's due to misinformation, outrage porn, and unfair application of rigor, from mostly the anti-trans side but even allies and trans folk themselves sometimes. To that end I hope this does not feel like an attack - let me know if you have any questions that you think my perspective would help.
Look forward to the future. Superintelligence will invent better treatments for trans people. However there's not going to be any better treatments if trans becomes illegal due to the backlash caused by folks agitating for the use of the comparatively crude treatments available today on children. Trump has setup a legal regime for annihilating everyone in the medical community who's been providing trans care. You better hope there are still people around who are willing to help when the dust settles from all this political fighting.
> Treating people under 18 is a politically losing issue.
This is the key point, imho.
In the transgender rights discourse no margin for error is admitted, but there is like in any other human field (of course).
There have been several cases of people being given a "gender disphoria" blanket diagnosis (eg: the case of Chlementine Breen[1]), which later caused issues. And of course some of those people are transitioning back and started doing activism against the trans rights movement.
It's weird that minors are not allowed to do something trivial as drinking a beer or driving a car yet they're allowed to take on irreversible changes (sometimes involving surgery) to their bodies.
This is hurtful to all people involved, and until this point is not understood, the attrition will continue.
[1]: that case is a textbook example of "no margin error admitted" because in order for their voice to be heard they had to resort to talking to the extreme opposite political side.
> The convenience of a hypothetical cis peerson is worth more than the lives of 100 trans people it seems.
Complete nonsense. The ratio is generally the inverse: there are 100 cis people and 1 trans person. Those are just the numbers, otherwise trans people wouldn't be a considered a minority.
Actually you're the one arguing that the convenience of one trans person is worth more than the life of 100 cis people.
This is true, but also, going through the wrong puberty and being forced to live as the wrong gender afterwards is also an inherently traumatic experience, even if it would be possible to fully reverse the mutilation caused by the first puberty.
Is mutilation the right term here?
Mutilation is altering the physical appearance.
Puberty by default follows what the body was designed to do, it seems confusing calling it mutilation: I couldn't tell if surgery is involved or this is just talking about the natural process of going through puberty
It's clear that earlier intervention with gender affirming care leads to better outcomes. There are fewer suicides when people start getting care earlier. This means puberty blockers early, and HRT in late teenage years. Are we just ignoring that?
The Cass review, most notably, pointed out that the research supporting these claims are extremely weak. In particular there have only been two randomized controlled trials studying blockers in minors, and neither of them saw improvements over the control group. To date, the UK, Finland, Sweden, Italy. Norway, and Denmark have stopped prescribing puberty blockers to minors with gender dysphoria.
Don't get me wrong, trans issues do need more study, but this is also an example of isolated demand for rigor. Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
In addition, trans healthcare in Sweden has historically been behind the US. Trans people were forcibly sterilized up until 2013, and trans healthcare underfunded. In Finland the sterilization was required until 2023!
The Cass review was not, in fact, rejected by most reputable medical institutions. Unless, if course, your criteria for "reputable medical institution" includes support for puberty blockers and hormones treatment in minors.
The UK, Italy, Denmark, and Sweden all stopped prescribing puberty blockers to gender dysphoric children following the Cass review. Other countries, like Finland, has stopped earlier. It's not possible to continue insisting that this is settled science, when much of the developed world has broken with the US's approach towards gender care in minors.
> Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
Such as? Furthermore, there were RCTs conducted studying the effects of puberty blockers. They didn't decrease gender dysphoria.
Also, put the evidence (or lack thereof) in the context of the certainty and urgency that proponents of gender medicalization were conveying: People were claiming that gender dysphoric children were going to kill themselves if they don't get blockers. Doctors like Joanna Olson-Kennedy repeatedly claimed that parents had the choice of a dead son or alive daughter, a statement parroted by politicians.
This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers [1]. And now she's trying to argue that no benefit is actually a good result because the patients would have fared even worse absent blockers. But of course, without a control group there's no substance to that claim.
> This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers
> "“They’re in really good shape when they come in, and they’re in really good shape after two years,”"
So a treatment that causes a change to not happen does not cause those who are doing well to do even better? Is this the evidence that's supposed to make me want to ban a widely-accepted medical treatment?
Correct. A treatment that causes no change in well-being, and has negative side effects on bone density, mental development, and more, is not a net positive treatment. This isn't even touching on the effect puberty blockers have on persistence rates. The justification for puberty blockers is that they lead to better outcomes, and the research doesn't show that.
Even stronger evidence for stopping the prescription of blockers are the randomized control trials conducted in Finland and the UK. The patients who received blockers fared no better that those that did not. Without a control group, there's no way to prove or disprove Olson-Kennedy's claim that the patient would have fared worse absent blockers. But the few studies on blockers that did have a control group found no improvement over the control.
And you're wrong that these treatments are widely accepted. In about half of the US they're already banned. In Europe, the UK, Finland, Sweden, Italy, Norway, and Denmark have all stopped prescribing puberty blockers. It is no longer correct to call this treatment widely accepted.
> Page 116: "... the consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric GD patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer."
If you could cite these randomized controlled trials, that would be great.
In how many US states were pediatric gender treatments suspended or phased out by medical bodies because doctors examined the evidence and determined that the treatments were not beneficial? That's what I would expect if the treatments really didn't work. From what I know, this isn't the case for any of the bans. The bans are all laws passed by state legislatures, especially conservative ones, and aren't meaningful evidence of anything except conservative lawmakers' political incentives.
You didn't link to a randomized controlled trial. You linked to a meta review. This is just reading and summarizing past research publications, not a RCT.
To date, no American study has been conducted that randomly assigned patients into groups put on blockers or not. That's the best way to study the effects of blockers: Have psychiatrists identify a group of 100 people that they think should be put on blockers. Flip a coin to assign 50 of those patients into a control group that doesn't receive blocker and the other 50 do. And then monitor their lifetime outcomes.
This is how the Finnish 2019 study functioned, and they found no improvement over the control group (and the country stopped providing blockers a year later). American gender medicine researches argue that it's unethical to conduct an RCT and deprive have the patient sample access to life-saving care. But of course, they don't know that this care is beneficial - let alone "life-saving" - until they actually compare the outcomes against a control group.
It's unfortunate that the rollbacks in America had to come from politicians instead of an internal process from the medical establishment. But ultimately, North American gender medicine has thus far refused to conduct effective research into the efficacy of medicalized youth gender care like their European colleagues. Politicians, and the public, have recognized this.
If proponents of medicalized youth gender care want to try and justify that this treatment is necessary, they ought to actually do randomized controlled trials. If we have cohorts of children expressing the same levels of discomfort with their gender, and the randomly-assigned treatment group sees better outcomes than the control group, that is a much stronger piece of evidence than only having a treatment group and baselessly claiming that the control group would have fared worse.
If I'm reading that first study correctly, "Ideation" and "Ideation with plan" are lower but "Ideation with plan and attempt" is higher and "Attempt resulting in inpatient care" is almost twice as high.
Neither the discussion nor the conclusion mention this, so maybe I'm misinterpreting something?
The results for attempts are underpowered and they acknowledge this (note the p-values too), but not for ideation. From the discussion:
> We did not detect a difference in the odds of lifetime or past-year suicide attempts or attempts resulting in hospitalization. It is possible that we were underpowered to detect these differences given that suicide attempt items were less frequently endorsed than suicidal ideation items (Table 3). Given this study’s retrospective self-report survey design, we were unable to capture information regarding completed suicides, which may have also reduced the number of suicide attempts we were able to account for. Given that suicidal ideation alone is a known predictor of future suicide attempts and deaths from suicide, the current results warrant particular concern.
Yeah but the whole point so far has been to pass laws under the guise of "protecting children" because that was easy to justify politically. Now that SCOTUS has green-lit denying healthcare on the basis of assigned gender at birth, the gates are wide open.
> Now that SCOTUS has green-lit denying healthcare on the basis of assigned gender at birth, the gates are wide open.
Yes, we're at a juncture. But my point is I don't think bans for adult care are inevitable, nor that strict prohibitions for minors need be permanent. If trans advocates and their supports took a breather and figured out how to reframe things, the backslide (such as it is) could be arrested and even reversed. But that will require, at a minimum, taking back the microphone from the most radical "advocates". And probably to depoliticize it. The issue has become highly politically polarized, but that's a relatively recent thing. I was gobsmacked by the generally tame and sympathetic conservative response to Caitlyn Jenner among conservatives 10 years ago. The turn was avoidable and, arguably, reversible.
“Denying healthcare on the basis of assigned gender at birth” seems like a deliberately loaded way to state this. Isn’t it more accurate to say it’s a blanket denial of a certain type of treatment to all minors?
Much of the majority and most of the dissenting opinions in the recent SCOTUS case are exactly about that--is it sex discrimination?: https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf All the opinions are worth a read. The best arguments for both sides are there. Though, I thought all the best arguments on both sides kind of sucked; it's just a very difficult issue. Transgender questions lay to waste 100 years of sex and gender discourse on both the right and left.
Thanks for sharing. SCOTUS basically said the same thing I was trying to point out in my comment: it’s not discriminating based on sex, but rather on age and “medical purpose”.
I agree with your assessment, and I am suspicious of anyone (on either side) who claims that there is an obvious “correct” answer to this issue.
I think where it's ambiguous, it should be left to the parents to decide. Parents can already decline life-saving treatment on their child in the US due to their moral beliefs. Why not let parents also decide if they want to let a 16 yo have hormone treatments. It surely can't be more serious than declining blood transfusion.
This is, of course, the voice of sanity. Unfortunately it's not encoded into our legal system in these terms. On the other hand, if your religion explicitly requires that everyone "art theretofore honest with thy sentiment of masculinity or womanhood" (dress it up in colorful language, ideally quoted from old books with ambiguous authorship) you might have something you can sell to the Supreme Court.
Personally I think it's less accurate to rephrase medical treatment as "a certain treatment". It's also false to say all minors, since cisgender minors are still approved to receive puberty blockers (and are regularly prescribed them for various reasons).
It's the same medicine from the same medical professionals and the only difference is your gender identity.
According to the Supreme Court, the difference is the “medical purpose” of the treatments. Presumably trans-identifying individuals can get the treatments if they meet the same criteria as cis-identifying ones (e.g. premature puberty). If they treated the sexes differently (e.g. those born male can get hormones for gender dysphoria, and those born female can’t) then it would be clear-cut discrimination.
First off, I fully understand that discriminating on gender identity isn't the same thing as discrimination based on sex however they are both discrimination.
Even if you were to convince me of this legal fiction that gender identity has nothing to do with idemitiy and is in fact just a medical condition the Supreme Court doesn't care to treat, I still would call it a life threatening attack.
If the Supreme Court denied chemotherapy for cancer patients, it'd be perfectly justified to call it life threatening denial of care. The fact that it's available for cancer patients with other diseases that are treatable via chemotherapy is irrelevant.
The elephant in the room here is why is the Supreme Court even concerned with how prescription drugs are used? I'm sure are justices are very smart - but they're not doctors. And they're certainly not my doctor or your doctor or every single child's doctor.
It should be up to a doctor to decide if a prescription makes sense for a particular patients symptoms and diagnosis. The Supreme Court should not concern itself otherwise.
At least with Roe v Wade there's an argument to be made about it involving a second hypothetical person. But this? This is strictly between patients, their medical care, and their parents.
The Supreme Court is only involved because a state passed a law banning these treatments, and someone brought a case against the state saying the law is unconstitutional. Deciding which laws are unconstitutional is like the main purpose of the Supreme Court.
But I guess what you’re saying is why is the state passing these laws, which is a fair enough question. The Supreme Court says they are allowed to, and they are the authority on which laws are allowed, so I expect the states will keep doing this sort of thing until the voters tell them not to.
Plato did try to warn us that democracy was a terrible idea.
There's a very big difference between giving a child undergoing precocious puberty blockers until they're 11, and giving a child blockers with the goal of preventing them from every undergoing a same-sex puberty. The latter has a whole host of risks, including infertility and inability to orgasm. To say that the only difference is gender identity is not even remotely honest.
I'm pretty sure they're still allowing puberty blockers for premature puberty, inducing puberty in cis teens, and surgically and medically forcing intersex people into a binary sex without consent.
No, because puberty blockers can be assigned to children (in fact, children are the only applicable group here). They just can't be assigned to children specifically because they are transgender. Similarly, mastectomies are available treatment for teens... they just can't be used as a treatment for teens assigned female at birth.
Allowing mastectomies for male-born but not female-born individuals seems like pretty clear-cut gender discrimination. (Not as murky as the hormone issue, at least.) Has that one hit the Supreme Court yet?
Florida and Missouri have been working on it, to some success. Florida's laws have decreased access by requiring in-person appointments with doctors instead of telehealth or nurse practitioners, which has eliminated access for 80% of transgender adults [1]. Missouri has banned Medicaid funding for transgender care for adults. [2]
At the national level, The One Big Beautiful Bill Act as passed by the House cuts all federal funding for transgender care for adults via Medicaid [3], though that's still pending what the Senate does.
the "there's a hole in the glass" take is that this is just where they start, it's easier to argue it shouldn't be possible for children to get adequate care (for some reason) than for adults.
I think that trans people, being the ones with firsthand experience of dysphoria and misgendering, and being a disadvantaged minority (https://www.mckinsey.com/featured-insights/sustainable-inclu...) threatened by right-wing rhetoric, should be the ones to speak for what is right for them ("nothing about us without us"), individually and as a group.
> The glass-is-half-full take is that no states have prohibited gender affirming care for adults.
Given that a number have prohibited it from being paid for by the state Medicaid program for adults when it previously was, that is, maybe, a glass quarter full take. (There is also the issue that wrong-gender puberty is a particularly significant suicide risk factor for trans youth, so restricting gender affirming care for youth is a particularly strong assault on trans lives.)
And even then, its not strictly true, as while most states with restrictions that have passed have only restricted care to minors, Nebraska did so for persons under the age of 19, which includes some adults.
> Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.
They have not only sought to do so, they have actually done so (as mentioned above). They have not yet implemented broad prohibitions (except Nebraska's for adults under 19), but "limit" and "broad prohibition" are not the same thing, and mere limitations can have the same practical effect as broad prohibitions, as many states demonstrated by making it nearly a practical impossibility to provide (and therefore access) abortion services, even before the Supreme Court overturned Roe; conservative states are following the same playbook with gender-affirming care.
> Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.
No, legally-imposed waiting periods for adult (or even youth) gender affirming care were not present (and still are not present) in the most liberal states. That's a very strange thing to invent to minimize the restrictions being imposed by conservative states.
If you are equating the fact that it can take time, for some services beyond HRT, to save up money and/or jump through whatever hoops are established by your insurance, and find and schedule time with the required provider(s) with legislatively imposed waiting periods and other access restrictions, that's incredibly dishonest (for one thing, the legislative restrictions don't overlap the other ones, they add on top, and, by making it more difficult for providers to operate and thereby reducing the number of providers, make the other issues worse as well.)
From the point of view of a conservative and non us citizen, you have a good life there compared to the rest of the world.
Technically, most countries don’t allow people to be openly gay. In some countries, being gay even privately means you get beaten to death or your head chopped off.
Needless to say that transgender people are not even taken into consideration.
If I was gay or transgender, god knows I would rather be in the USA or maybe north Europe than any other country and especially not Africa, Arabia, South America.
So to recap, you're saying, "don't worry about what's going on in the US right now, because you still have it better than most of the world"
Just because something could be worse does not mean that 1. It's nothing to be concerned about 2. That we shouldn't take steps to improve the situation.
Things can always be worse, so this "logic" is always applicable. It's a vacuous argument. Even if you lived in the country with the worst homo/transphobia in the world, you could tell the person, "well, at least your alive."
Moreover, there's nothing constructive about this line of thinking. If people actually lived by this logic, we would live in a static world, because "it could be worse."
It should be noted that the two don't necessarily go hand in hand the way you'd expect. E.g. in Iran, homosexuality is a crime that can be punishable by death depending on circumstances, but sex reassignment surgery is legal (and, indeed, can be de facto mandated in cases of anything perceived as gender dysphoria).
Indeed, I’m surprised to see it’s possible in Iran.
> The Legal Medicine Organization performs a number of tests, including at least six months of individual and group therapy sessions, interviews with family members, physical examinations, hormone tests, and chromosomal tests, in a process known as "filtering". Filtering is the separation of homosexuals, who are deemed "deviant", from transsexuals, who are deemed "curable" by undergoing surgery
Also, after further research, Iran is the only Muslim country in the Persian Gulf region that gives trans citizens the right to have their gender identity recognized by the law.
I don’t understand how such a country can be so open on trans right, but it’s really an exception in the world.
Just for clarity, we'd rather have your own words than words processed through an LLM. (I'm not saying you used an LLM—just explaining the principle. LLMs are amazing but we don't want HN conversations to be mediated by them.)
Non-native English speakers are not only welcome on HN, we're in awe of how good their English is. Most of us only wish we had any French, German, Hindi, etc. at all. So please feel free to write as you write, in your own voice.
I suppose it does work for interpreted languages (you just need to define what is success and what is failure), but for AFL the evaluation might be too far away from the actual branching that it would be less effective, possibly critically so. Additionall in fuzzing the bottleneck is running the programs, millions of times (though maybe not billions). So the slower your function is, the slower the fuzzing will be.
I think though the same approach could be used with interpreters, and I expect it would be easier to do there. E.g. for Python there is this, but I haven't tried it: https://github.com/jwilk/python-afl
Indeed, this is exactly the type of subtle case you'd worry about when porting. Fuzzing would be unlikely to discover a bug that only occurs on giant inputs or needs a special configuration of lists.
In practice I think it works out okay because most of the time the LLM has written correct code, and when it doesn't it's introduced a dumb bug that's quickly fixed.
Of course, if the LLM introduces subtle bugs, that's even harder to deal with...
> most of the time the LLM has written correct code [...dumb bugs]
What domain do you work in?
I hope I'm just misusing the tool, but I don't think so (math+ML+AI background, able to make LLMs perform in other domains, able to make LLMs sing and dance for certain coding tasks, have seen other people struggle in the same ways I do trying to use LLMs for most coding tasks, haven't seen evidence of anyone doing better yet). On almost any problem where I'd be faster letting an LLM attempt it rather than just banging out a solution myself, it only comes close to being correct with intensive, lengthy prompting -- after much more effort than just typing the right thing in the first place. When it's wrong, the bugs often take more work to spot than to just write the right thing since you have to carefully scrutinize each line anyway while simultaneously reverse engineering the rationale for each decision (the API is structured and named such that you expect pagination to be handled automatically, but that's actually an additional requirement the caller must handle, leading to incomplete reads which look correct in prod ... till they aren't; when moving code from point A to point B it removes a critical safety check but the git diff is next to useless and you have to hand-review that sort of tedium and have to actually analyze every line instead of trusting the author when they say that a certain passage is a copy-paste job; it can't automatically pick up on the local style (even when explicitly prompted as to that style's purpose) and requires a hand-curated set of examples to figure out what a given comptime template should actually be doing, violating all sorts of invariants in the generated code, like running blocking syscalls inside an event loop implementation but using APIs which make doing so _look_ innocuous).
I've shipped a lot of (curated, modified) LLM code to prod, but I haven't yet seen a single model or wrapper around such models capable of generating nearly-correct code "most" of the time.
I don't doubt that's what you've actually observed though, so I'm passionately curious where the disconnect lies.
I might have phrased this unclearly, I meant specifically for the case of translating one symbol at a time from C to Rust. I certainly won't claim I've figured out any magic that makes the coding agents consistent!
Here you've got the advantage that you're repeating the same task over and over, so you can tweak your prompt as you go, and you've got the "spec" in the form of the C code there, so I think there's less to go wrong. It still did break things sometimes, but the fuzzing often caught it.
It does require careful prompting. In my first attempt Claude decided that some fields in the middle of an FFI struct weren't necessary. You can imagine the joy of trying to debug how a random pointer was changing to null after calling into a Rust routine that didn't even touch it. It was around then I knew the naive approach wasn't going to work.
In general I've found the agents to be a mixed bag, but overall positive if I use them in the right way. I find it works best for me if I used the agent as a sounding board to write down what I want to do anyway. I then have it write some tests for what should happen, and then I see how far it can go. If it's not doing something useful, I abort and just write things myself.
It does change your development flow a bit for sure. For instance, it's so much more important to concrete test cases to force the agent to get it right; as you mention, otherwise it's easy for it do something subtly broken.
For instance, I switched to tree-sitter from the clang API to do symbol parsing, and Claude wrote effectively all of it; in this case it was certainly much faster than writing it myself, even if I needed to poke it once or twice. This is sort of a perfect task for it though: I roughly knew what symbols should come out and in what order, so it was easy to validate the LLM was going in the right direction.
I've certainly had them go the other way, reporting back that "I removed all of the failing parts of the test, and thus the tests are passing, boss" more times than I'd like. I suspect the constrained environment again helped here, there's less wiggle room for the LLM to misinterpret the situation.
> Fuzzing would be unlikely to discover a bug that only occurs on giant inputs or needs a special configuration of lists.
I have a concern about peoples' over confidence in fuzz testing.
It's a great tool, sure, but all it is is something that selects (and tries) inputs at random from the set of all possible inputs that can be generated for the API.
For a strongly typed system that means randomly selecting ints from all the possible ints for an API that only accepts ints.
If the API accepts any group of bytes possible, fuzz testing is going to randomly generate groups of bytes to try.
The only advantage this has over other forms of testing is that it's not constrained by people thinking "Oh these are the likely inputs to deal with"
This is not quite true, what you are describing is "dumb" fuzzing. Modern fuzzers are coverage guided and will search for and devote more effort to inputs which trigger new branches / paths.
My working model is that WebP images are generally a lossy copy of a PNG or a generation-loss transcoding of a JPG image. I know that lossless WebP technically exists but nobody uses it when they're trying to save bandwidth at the cost of the user.
Do any monitors use the I2C multi-peripheral feature to allow both DDC communication and an I2C EEPROM to exist at different addresses on the same bus? Or is it cheaper to integrate functionality into a controller chip? (Though DP tunnels EDID over the aux bus, and (I assume) doesn't use an EEPROM to begin with.)
The specification is explicitly designed to allow for it, but I honestly doubt it is very popular - if used at all.
There are two main issues here. The first is that the standard EDID EEPROM is very limited in size, and a lot of monitors need more space. VESA solved this by adding a dummy "segment selector" register, located on a separate I2C address. This makes it incompatible with off-the-shelf I2C EEPROM chips, so you'd need some kind of custom EDID-specific EEPROM chip anyways.
The second issue is that most monitors have multiple input ports. A regular EEPROM chip can only be hooked up to a single port (I2C itself supports it, but the spec forbids it), so you'd need one EEPROM chip per port. That gets expensive quite quickly.
If you're already implementing DDC/CI via some kind of microcontroller, why not have it deal with EDID as well? Heck, you could even give the microcontroller a separate connection to an EEPROM to make it easier to program! The EDID part is absolutely trivial, I bet you could implement it in two dozen instructions without even trying very hard. No reason to make it even harder for yourself by keeping it separate.
A friend had to reflash a monitor (Acer K222HQL) with a corrupted EDID over the HDMI port. I confirmed that it has three input ports (VGA, DVI, and HDMI) each with their own EEPROM chip next to the port (the friend had to lift a pin on the HDMI EEPROM to successfully reflash it; she should've connected it to ground but didn't). I found a manual online (https://global-download.acer.com/GDFiles/Document/User%20Man...) saying that the monitor supports DDC, implying it does do the multi-peripheral I2C trick.
I have another broken monitor's mainboard where the VGA and DVI's EDID pins go through 100 ohm resistors to {unpopulated 8-pin footprints, as well as the main chip}. I think this means the design considered saving EDID on dedicated EEPROM chips, but ended up integrating the data on the display receiver instead.
Attaching the write-protect pin to +V is literally free in the PCB design process; IMO not doing so is a design error or decision (though IDK how much thought was placed into allowing users to rewrite the monitor identification).
I have (too much) experience in EDID editing. My suggestions:
- AW EDID Editor as you mentioned.
- CRU is a Windows-only tool, and will modify the EDID files it dumps from monitors (removing serial/etc. descriptors to make room for detailed resolutions), but will work. It does not run under Wine.
- 010 Hex Editor has an EDID template.
- On Linux you can install wxEDID from Flatpak (IIRC the distribution packages would crash in WxWidgets). I don't think it can create sections though.
- v4l-utils has edid-decode (which can be used as a git diff textconv tool), though this does not help you encode EDID files.
I found that HDMI EDIDs have a CEA extension block while DP EDIDs have a DisplayID extension block. I haven't done any work in multi-page EDIDs with over 256 bytes (and don't know what EEPROM chip you'd use to emulate them, nor the protocol or APIs to read and write them).
