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As a transgender woman myself, I have been witness to many in my community reduce some recreational drug use with HRT. I think it's unlikely that estrogen literally causes euphoria, but gender euphoria is real, lasting happiness. When you compare to the health effects of letting someone waste away on recreational drugs to dull dysphoria, it paints a visceral picture of transition as healthcare.

nyanpasu64
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.
wahern
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.
Manuel_D
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.

seethedeaduu
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?

Manuel_D
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".

a_shovel
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?

viamiraia
> 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.

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?
hemogloben
> 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.

Llamamoe
> 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.

viamiraia
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.

calico96
Those of us transitioning with hormones willingly go through puberty twice.

Damn the social consequences, it's who we are. If transitioning were available as a minor it would greatly reduce suffering.

seethedeaduu
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.
Fire-Dragon-DoL
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
amanaplanacanal
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?
Manuel_D
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.
viamiraia
The Cass review has been widely rejected by reputable medical associations. In addition, reviews of the Cass review have found several flaws and instances of bias: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186...

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!

Redoubts
There’s no evidence for any of those statements
ghushn3
Here's a study that shows evidence that puberty blockers reduce lifelong suicidal ideation: https://pmc.ncbi.nlm.nih.gov/articles/PMC7073269/

Here's a study showing evidence that gender dysphoria treatment in children improves well-being and mental health: https://pubmed.ncbi.nlm.nih.gov/25201798/

There's loads more.

NewJazz
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.
wahern
> 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.

titanomachy
“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?
wahern
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.
DoctorOW OP
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.

nyanpasu64
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.
KittenInABox
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.
TJSomething
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.

[1] https://apnews.com/article/florida-transgender-health-care-a...

[2] https://www.pbs.org/newshour/health/missouri-governor-signs-...

[3] https://www.politifact.com/article/2025/jun/02/medicaid-bill...

Grimblewald
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.
nyanpasu64
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.
dragonwriter
> 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.)

aucisson_masque
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.

xiande04
Ah, the old "it could be worse" fallacy.

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."

nyanpasu64
On top of that, legislatures, courts, and right-wing agitators are pushing to repeatedly worsen living conditions for trans people.
int_19h
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).
aucisson_masque
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.

dsadfjasdf
there's no science on souls. which is what you are basically talking about
karcass
I lost interest in psychedelics after transitioning.
somsak2
trading one drug for another?
Everyone has estrogen, half the population is estrogen dominant. It's a normal human hormone, not a recreational drug.
Zardoz84
I have a friend that sometimes described having good trips when she got a strong dose of hormones.

I wonder how I would feel when I begin with hrt.

deadbabe
Is gender dysphoria thus caused by the body craving testosterone or estrogen hormones, when it doesn’t have?
kelseyfrog
That's one way to think of it, but the root of it (imho) is a mismatch between ones internal sense of inalienable gender identity and the embodiment of that identity physically - think clothing, bodily form, social perception, etc.

It might be difficult to imagine how those two things are separable if one has lived their whole life with them in congruence. If perhaps, you close your eyes and concentrate on your being, there is a part of you that feels that your sense of manness of womanness is part of who you are? What would you do if you retained that sense, and woke up in the body of the opposite sex and were expected to behave in congruence with that contrary to your internal sense of self? It can be a bit like that.

deadbabe
I think that is the best way to think about it. Because if not, then gender dysphoria sounds mostly like it’s just about fashion.

I wouldn’t want to wake up and be a man, but not for any reasons that are biological. I work in a male dominated field, and most of my interactions are with men, I like the things I can do and get away with, where a man would not have the same experience. The male experience sounds lonely, tough, and a lot of your success seems to just depend on chance and grit. My life has some bad parts, but it’s softer and more comfortable. Would I have dysphoria as a man? I don’t know, to me it sounds like it’d be something closer to envy, but maybe that’s just dysphoria by another name. Maybe that’s the root cause of why so many men lash out at women.

DoctorOW OP
I haven't studied gender dysphoria but I've been diagnosed with it. In my experience, it's an incongruence between your idea of yourself and your perceptible form. In some ways it could be argued your body is "craving" it but not in the same way it may crave a specific nutrient. Instead, you're sort of surprised and often upset by the way that you are.
tasuki
Would you say it is similar to how some people with no legs want to have legs? Or fat people who want to be skinny?
DoctorOW OP
I guess it's kind of similar to how people without legs feel. I've heard that people without legs sometimes have "phantom legs". While they're consciously aware they're missing legs, their brain is still wired to have them. Similarly, my brain is wired for a female body.

Every trans person's experience is different, I know that the "wrong body" terminology doesn't apply to everyone.

deadbabe
What about more like a poor person wishing they were rich?
deadbabe
How do you cope?
DoctorOW OP
Honestly I truly believe that I will reach a point where my body feels like mine. The changes with HRT do a whole hell of a lot to minimize dysphoria in my experience. I also live with, work with, and am friends with people who genuinely see me as the way I see myself, as a woman. You can tell from the way people interact with you, how they see you. Being perceived as a woman fits with my perception of myself.
tasuki
> Honestly I truly believe that I will reach a point where my body feels like mine.

There are two ways to achieve that: changing the body, and changing the mind.

(I'm not claiming one to be easier than the other, but I've noticed most people have a strong preference for changing their body rather than changing their mind)

DoctorOW OP
I believe you have to do both. On the rest of my comment I tried to convey that in addition to changing my body, my female mindset is a key part of expressing my gender identity.
a_shovel
This is something I've been thinking too (though it seems clear to me it's only one factor out of many). I've heard at least two anecdotes from trans women I follow on social media that led me to this theory. One was prescribed estrogen doses too infrequently, and the other had lost access to medication, and they both started feeling like total crap when they went off estrogen, without any associated perceptible changes to their bodies.
4gotunameagain (dead)
antithesizer
Amen

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