Pronoun/Gender Wars Continue Apace

[Calm]

5 hours ago, Navidad said:

Having said that, I believe gender is very different. I believe gender lives in the soul (psychology). It is primarily a function of the mind, will, and feelings. Once again, I need to acknowledge the overlapping of the three. Exclusivity of each of the tripartite aspects of humanity exists, but overlap happens regularly. So, if gender lives (primarily) in the soul, then there are as many unlimited potentials for human gender distinctions as the soul (mind, will, and emotions) can create. I think that is endemic to humanity. Gender is as varied as any other "soul" trait.

I see this as a reasonable conclusion and my own conception is much like it.

Mapping this idea onto LDS beliefs….

Even if someone believes gender is eternal (and what does that even mean when the existence of the eternal self has gone from intelligence alone to the addition of a spirit and then the addition of a mortal body, which one day will be an immortal perfect body and likely keep progressing eternally rather than become static imo since progression has been its constant state from the beginning), I don’t understand why someone would assume the mortal expression of gender is equivalent to the perfected eternal version given how messed up the mortal expressions of our physical forms can be and how limited out spiritual expressions seem to be.  There are other aspects of the mind that are expressed that show significant limitations and possible damage even…extreme sociopathy for one example.  One just has to look at the variety of significant mental illness to recognize mortality does not allow us perfect expression of our eternal mental being any more than it does our physical and spiritual aspects.  Given this, why would anyone assume that the attribute of gender is somehow protected in mortality from such confusions?

If a charitable society makes adjustments to allow those with physical challenges to more fully participate in the community, to not miss out on activities and experiences they can accomplish with such accommodations and does that same for many other mental challenges, it makes sense to me that there should be adjustments when it comes to gender as well. What those need to be is certainly open to debate, I get that, because we have limited economic resources to apply to such.  A few wider parking spaces reserved nearer the activity costs little, but requiring ramps and elevators everywhere could amount to significant costs where the need isn’t that great (building codes requiring every two or more story home to include an elevator would be unreasonable since many will never have that need).  Makes sense to me that no to low cost adjustments when identified are accepted as immediate relief for those in need.  
 

Allowing those with physical challenges to get on and off the plane first because it will take longer for them to get settled or to make connections rather than requiring them to wait to be the last so as to avoid risk of injury in the crowd is another simple no cost except a bit of patience requirement.

Out of curiosity…Does anyone here believe handicapped parking shouldn’t be a standard part of our community accommodations because it might require a few more steps of those of us who don’t currently need that aid?  Is there some reason you feel you have an inherent right to park as close to a store as possible and it should be an individual’s choice whether or not to make that charitable adjustment for someone in need?  Do you perhaps believe it should always be first come first served no matter the risk to others?

Edited July 4 by Calm

[The Nehor]

6 hours ago, Navidad said:

My perspective has been and remains that humans are tripartite: body, soul, and spirit. The three often overlap and interrelate. As a young psychology professor in a conservative context, I frequently ran into those who denied the psychological, claiming that all human challenges were either spiritual (requiring a pastor) or physical (requiring a medical doctor). I still have wounds from those debates.

In my tripartite view, the body is the biology; the soul is the mind, will, and emotions (psychology); and the spirit (is the God-breathed part) unique to humans. These are overlapping circles where at the center all three interact. Neither is exclusive to the other two.  Related to this thread, I believe sex is fundamentally biologically (body) determined and is seen in humans along a normal distribution. The vast majority of folks are within 95% of the center, with 2.5% on either outer limit of the curve.  So I think 95% of humanity is biologically male or female, with at most 5% being outliers. I don't think that perspective is non- or anti-Biblical; its writers had no concept of normal distribution or the bell curve of human reality. So yes, God formed humanity as "male and female," but that does not rule out statistical outliers within the normal distribution found in the bell curve.  

Having said that, I believe gender is very different. I believe gender lives in the soul (psychology). It is primarily a function of the mind, will, and feelings. Once again, I need to acknowledge the overlapping of the three. Exclusivity of each of the tripartite aspects of humanity exists, but overlap happens regularly. So, if gender lives (primarily) in the soul, then there are as many unlimited potentials for human gender distinctions as the soul (mind, will, and emotions) can create. I think that is endemic to humanity. Gender is as varied as any other "soul" trait.

Therefore, I think that gender and sex are two unique and very different constructs. The personal, social, and perhaps even spiritual implications for that vary as widely as does humanity. I am reasonably sure it's not helpful to automatically label those variations as "sin," unless they are, well . . . sinful. That is another topic. As a director of counseling services at two Christian colleges, I am one who has encountered many "struggling with their gender" students. This certainly included "spiritually struggling" students, especially back in the 1960s and 1970s. Part of my work was with the struggler and part with the community. I failed more often with the latter than with the former. 

I don't know if any of this is important, but it is my experience and resulting perspective as a counselor in a quasi-fundamentalist/quasi-evangelical setting for numerous years. I simply offer it in that sense. 

A common saying is that there are as many genders and sexualities as there are people. The broad labels we use are a categorization tool and they are useful in a lot of contexts.

I am bisexual and that is a huge spectrum. You have those who are primarily interested in one gender with only limited attraction to the other gender or those who are attracted to a lot of the people of one gender and only a few of the other. Then there are those for whom the attractions are more equal. Then you have what kind of person you are attracted to on a physical level, what kinds of personalities you are attracted to, etc.

A lot of this also applies to monosexuals who have a wide diversity in what kinds of attraction they feel and how they view and experience gender.

[smac97]

On 7/4/2026 at 11:36 AM, The Nehor said:

Most gender affirming  surgeries done on minors are done on cisgender people. Gynecomastia is “surgical mutilation” and is often done on children, much more often on cisgender boys than anyone else. Are you calling for a ban on this procedure?

For my part, no, I am not calling for a blanket ban on all surgeries for minors.

Gynecomastia surgery is typically performed to correct a physical medical condition (excess breast tissue in boys, often caused by puberty, hormones, or medication). It is not the same as gender-affirming surgeries, which involve removing healthy organs (breasts, testicles, etc.) in an attempt to align the body with a perceived gender identity.  

Perhaps we are encountering a definitional issue.  "Gender affirming surgery" seems to refer to a category of medical procedures that does not include what you are referencing above.  See, e.g., here:

Quote

Gender-affirming surgery is an umbrella term for a series of surgical procedures that help transgender, non-binary, and gender non-confirming individuals alleviate their gender dysphoria and promote a sense of congruence between their physical body and gender identity. Not everyone needs surgery to affirm their gender. Below we outline the different types of gender affirmation surgeries that are documented in the World Professional Association for Transgender Health’s (WPATH) Standards of Care 8 (SOC8). 

I think most people, when they think of or reference "gender affirming" procedures, do not have Gynecomastia in mind.  They differentiate it in terms of designation ("Gynecomastia" v. Gender-Affirming “Top Surgery” (Double Mastectomy)), who the patient is (a biological male with excess breast tissue v. a biological female who "identifies" as male), what the purpose of the procedure is (to correct a physical abnormality / medical condition v. attempting to "affirm" the patient's "gender identity"), the medical basis for it (treating a diagnosable condition (hormonal, medication-induced, pubertal, etc. v. treating psychological distress (Gender Dysphoria), what the procedure entails (removing excess glandular tissue and fat v. removal of healthy female breast tissue), the longitudinal data supporting it, the irreversible impact of it (not affecting core sexual/reproductive function v. irreversible removal of healthy organs), and so on.

Gynecomastia surgery restores a more typical male chest appearance for a boy/man.

“Top surgery” removes healthy breasts from a girl to make her look more like a boy.

One is corrective of a physical deviation; the other is elective cosmetic/psychological intervention on a minor.

And then there are other "gender-affirming" procedures which are even more life-altering:

Quote

Quick links to options on this page: 

• Adam’s apple surgery
• Body contouring
• Facial surgery
• Genitoplasty
• Hysterectomy
• Nipple reinnervation
• Oophorectomy
• Orchiectomy
• Vocal surgery

Top surgery:

• Gender-affirming mastectomy
• Gender-affirming breast augmentation

Bottom surgery:

• Phalloplasty and metoidioplasty, including vagina-preserving options
• Vaginoplasty and vulvoplasty, including penile-preserving options
• Hysterectomy
• Genitoplasty
• Oophorectomy
• Orchiectomy

Bottom surgery options also include:

• Penectomy
• Scrotectomy
• Scrotoplasty
• Urethroplasty
• Vaginectomy

These are irreversible procedures, many of which involve infertility, sexual dysfunction, and regret — which is why several European countries (UK via the Cass Review, Sweden, Finland, Norway) have sharply restricted them for minors due to weak evidence of long-term benefit.

Adults can, generally, do what they please with their bodies (though I think there are ongoing questions about comorbidities, lack of informed consent, lack of longitudinal data, etc.), but I think many people do not support these procedures for minors where they are life-altering, sterilizing surgeries based on a contested ideological model, and when most gender dysphoric children historically desist with watchful waiting and therapy.

On 7/4/2026 at 11:36 AM, The Nehor said:

Also this is not radicalism for the sake of radicalism.  That is just “othering” people and ascribing a kind of hive mind mentality to transgender people who are depraved because they just want to be depraved. That is not how transgender people or people in general work. You don’t understand why transgender people seek surgical intervention because you don’t listen to their stories. You make up what to your mind are the most satanic or evil reasons why they would do something and assume it is true.

Is it possible, in your view, for people to "listen to their stories" and still come away with substantial concerns about these medical procedures, particularly when children/minors are involved?  I have previously posted this list of concerns:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Electively removing healthy body parts of minors. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Ideological/sociopolitical influences/pressures on medical care. 
• Social contagion risks. 
• Risk of financial devastation for the individual (and burden on society).

Even adults, who should enjoy presumptive autonomy regarding their own medical decisions, should still be evaluated for these factors.  Would you agree with that?

Thanks,

-Smac

[The Nehor]

2 hours ago, smac97 said:

For my part, no, I am not calling for a blanket ban on all surgeries for minors.

I said gender-affirming surgeries.

2 hours ago, smac97 said:

Gynecomastia surgery is typically performed to correct a physical medical condition (excess breast tissue in boys, often caused by puberty, hormones, or medication). It is not the same as gender-affirming surgeries, which involve removing healthy organs (breasts, testicles, etc.) in an attempt to align the body with a perceived gender identity.

Incorrect, the breast tissue removed when a trans man or a cis man have breast tissue removed is almost always removing healthy tissue so that the person can match a “perceived gender identity” 

2 hours ago, smac97 said:

  Perhaps we are encountering a definitional issue.  "Gender affirming surgery" seems to refer to a category of medical procedures that does not include what you are referencing above.  See, e.g., here:

That definition is incomplete because it comes from a clinic that specializes in procedures for transgender and other queer people.

2 hours ago, smac97 said:

I think most people, when they think of or reference "gender affirming" procedures, do not have Gynecomastia in mind.  They differentiate it in terms of designation ("Gynecomastia" v. Gender-Affirming “Top Surgery” (Double Mastectomy)), who the patient is (a biological male with excess breast tissue v. a biological female who "identifies" as male), what the purpose of the procedure is (to correct a physical abnormality / medical condition v. attempting to "affirm" the patient's "gender identity"), the medical basis for it (treating a diagnosable condition (hormonal, medication-induced, pubertal, etc. v. treating psychological distress (Gender Dysphoria), what the procedure entails (removing excess glandular tissue and fat v. removal of healthy female breast tissue), the longitudinal data supporting it, the irreversible impact of it (not affecting core sexual/reproductive function v. irreversible removal of healthy organs), and so on.

I don’t care what most people think. They have been fed propaganda and view the term as applying primarily to transgender people because propagandists like to simplify the concept to avoid ambiguity and to focus bigotry. I don’t see any need to cater to it.

2 hours ago, smac97 said:

Gynecomastia surgery restores a more typical male chest appearance for a boy/man.

And by some twisted rationale you are arguing that cosmetic surgery designed to make someone match their gender isn’t gender affirming?

I could probably stop here.

 

 

2 hours ago, smac97 said:

“Top surgery” removes healthy breasts from a girl to make her look more like a boy.

It is from boy to make him look more like a boy.

Also it is implants to help a girl look more like a girl.

2 hours ago, smac97 said:

One is corrective of a physical deviation; the other is elective cosmetic/psychological intervention on a minor.

No, they are both elective cosmetic/psychological interventions. There is usually no reason beyond cosmetic appearance and dysphoria to do gynecomastia. Dysphoria is psychological.

2 hours ago, smac97 said:

And then there are other "gender-affirming" procedures which are even more life-altering:

Which are rarely done on minors and virtually never on anyone under the age of 17 so this is more of a bodily autonomy issue so this really isn’t that relevant.

2 hours ago, smac97 said:

Adults can, generally, do what they please with their bodies (though I think there are ongoing questions about comorbidities, lack of informed consent, lack of longitudinal data, etc.), but I think many people do not support these procedures for minors where they are life-altering, sterilizing surgeries based on a contested ideological model, and when most gender dysphoric children historically desist with watchful waiting and therapy.

I am well aware you would ban these procedures for adults as well if you could.

Also, the “idealogical model” is not “contested” by experts. The overwhelming majority agree.

Also, the statistic you are trying to pull in that says dysphoria fades is not saying what you think it says but we have been over this before and you keep repeating this so there is no point in writing up the correction again as you will be back to trot it out again soon enough no matter what I say.

2 hours ago, smac97 said:

Is it possible, in your view, for people to "listen to their stories" and still come away with substantial concerns about these medical procedures, particularly when children/minors are involved?  I have previously posted this list of concerns:

If I believed the concern was genuinely motivated by questions of consent I would suggest that a discussion of what treatments minors should have access to and when would be something to figure out relying on the experience of experts to guid us.

I don’t believe this about you or pretty much anyone opposing them. The opposition is motivated by the ignorant regularly repeating falsehoods for idealogical reasons, not medical or psychological ones. What is the point of having a good faith discussion with people who aren’t operating in good faith?

2 hours ago, smac97 said:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Electively removing healthy body parts of minors. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Ideological/sociopolitical influences/pressures on medical care. 
• Social contagion risks. 
• Risk of financial devastation for the individual (and burden on society).

Even adults, who should enjoy presumptive autonomy regarding their own medical decisions, should still be evaluated for these factors.  Would you agree with that?

And you immediately prove my point that this is not about the children who make up a tiny minority of gender affirming surgeries and most of those minors are cis-gendered and you seem to find no problem with those ones despite them being equally “irreversible”. You want gender-affirming treatments to be difficult or impossible to access even for adults because you don’t like them. Not fo medical reasons.

I also love how you repeat the old “social contagion” pseudoscience again and talk about how they are somehow going to be a “burden on society”. What are you even talking about?

Gender-affirming treatments are all over the place and easily accessible for cis-gendered people. You have just arbitrarily decided that some are “corrections” and others are “irreversible” based on a disproven idealogical model. You want to throw out transgender people having access because a minority contest the model they operate under while your model is contested by the majority but should somehow be allowed to draw lines on when care is allowed?

Testosterone for cis-men and estrogen for cis-women are both gender-affirming treatments. I have a friend who is on estrogen blockers because he has more estrogen than women (cis and trans) are supposed to have. Hell, viagra and the other drugs along that line are gender-affirming treatments.

 

So no, you are wrong about what gender-affirming care means and trying to redefine terms is silly. You might be able to argue that transgender treatments are different if sex could be shown to be a strict binary but it isn’t. Even if it were nature declaring something to be the case isn’t a reason to say we can’t change it. No, the reason you oppose this is religious. You think it is an affront to God because God belatedly declared it to be wrong a few years ago despite transgender people existing for all of recorded history and transgender treatments of various kinds going back to ancient Egypt at least.

[california boy]

On 7/6/2026 at 5:21 PM, smac97 said:

For my part, no, I am not calling for a blanket ban on all surgeries for minors.

Gynecomastia surgery is typically performed to correct a physical medical condition (excess breast tissue in boys, often caused by puberty, hormones, or medication). It is not the same as gender-affirming surgeries, which involve removing healthy organs (breasts, testicles, etc.) in an attempt to align the body with a perceived gender identity.  

Perhaps we are encountering a definitional issue.  "Gender affirming surgery" seems to refer to a category of medical procedures that does not include what you are referencing above.  See, e.g., here:

I think most people, when they think of or reference "gender affirming" procedures, do not have Gynecomastia in mind.  They differentiate it in terms of designation ("Gynecomastia" v. Gender-Affirming “Top Surgery” (Double Mastectomy)), who the patient is (a biological male with excess breast tissue v. a biological female who "identifies" as male), what the purpose of the procedure is (to correct a physical abnormality / medical condition v. attempting to "affirm" the patient's "gender identity"), the medical basis for it (treating a diagnosable condition (hormonal, medication-induced, pubertal, etc. v. treating psychological distress (Gender Dysphoria), what the procedure entails (removing excess glandular tissue and fat v. removal of healthy female breast tissue), the longitudinal data supporting it, the irreversible impact of it (not affecting core sexual/reproductive function v. irreversible removal of healthy organs), and so on.

Gynecomastia surgery restores a more typical male chest appearance for a boy/man.

“Top surgery” removes healthy breasts from a girl to make her look more like a boy.

One is corrective of a physical deviation; the other is elective cosmetic/psychological intervention on a minor.

And then there are other "gender-affirming" procedures which are even more life-altering:

These are irreversible procedures, many of which involve infertility, sexual dysfunction, and regret — which is why several European countries (UK via the Cass Review, Sweden, Finland, Norway) have sharply restricted them for minors due to weak evidence of long-term benefit.

Adults can, generally, do what they please with their bodies (though I think there are ongoing questions about comorbidities, lack of informed consent, lack of longitudinal data, etc.), but I think many people do not support these procedures for minors where they are life-altering, sterilizing surgeries based on a contested ideological model, and when most gender dysphoric children historically desist with watchful waiting and therapy.

Is it possible, in your view, for people to "listen to their stories" and still come away with substantial concerns about these medical procedures, particularly when children/minors are involved?  I have previously posted this list of concerns:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Electively removing healthy body parts of minors. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Ideological/sociopolitical influences/pressures on medical care. 
• Social contagion risks. 
• Risk of financial devastation for the individual (and burden on society).

Even adults, who should enjoy presumptive autonomy regarding their own medical decisions, should still be evaluated for these factors.  Would you agree with that?

Thanks,

-Smac

I’m a little unclear. Are you against all gender affirming surgery or just against it for minors?

[smac97]

1 hour ago, california boy said:

Quote

Is it possible, in your view, for people to "listen to their stories" and still come away with substantial concerns about these medical procedures, particularly when children/minors are involved?  I have previously posted this list of concerns:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Electively removing healthy body parts of minors. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Ideological/sociopolitical influences/pressures on medical care. 
• Social contagion risks. 
• Risk of financial devastation for the individual (and burden on society).

Even adults, who should enjoy presumptive autonomy regarding their own medical decisions, should still be evaluated for these factors.  Would you agree with that?

I’m a little unclear. Are you against all gender affirming surgery or just against it for minors?

Under past, and somewhat ongoing, medical regimes, I am overwhelmingly against medical interventions for minors which are intended to address Gender Dysphoria.  This is largely due to the various factors in the above bullet list pertaining to and centering on minors.

I likewise have concerns about adults, and I think comorbidities, informed consent, etc. must be meaningfully addressed.  In the end, though, adults have greater autonomy.

I just came across an interesting article that lays out some concerns reflective of my own, and also lays out additional factors to consider:

On the disaster of transgender medicine

Quote

American doctors charged with caring for the vulnerable — and often troubled — young people who identify as transgender have catastrophically failed them.

Through an overzealous campaign to promote medicalized gender transitions for adolescents, they have permitted progressive identity politics to overwhelm common sense and caution.

Gradually, then all at once, they triggered a backlash — from cynical right-wing politicians who seized upon a new culture-war wedge issue, as well as justifiably concerned parents — that has toppled much of their medical field in the United States.

I agree that some advances in the trans movement, particularly "medicalized gender transitions for adolescents," have been politicized across the spectrum.  That is a big part of the problem.

Quote

Last year, the Supreme Court’s conservative supermajority effectively blessed state bans of gender-transition treatments for minors. And last month, the court affirmed state laws barring athletes born male from girls’ and women’s sports.

These rulings dovetailed with public opinion that has moved against the rigid demands of the transgender advocacy movement.

The linked article above is from Pew Research.  Very much worth a read.

Quote

But the battles over the explosion of transgender identification among adolescents have come at a devastating cost, especially for one tiny group of youths.

These people start expressing a cross-sex identity as young children and will likely hold a transgender identity for life. Absent medical transition, they may suffer from permanent gender-related distress. They have been known as the “true transsexuals,” destined to identify as the opposite sex throughout their lives.

They’ve been forgotten in this fight. They shouldn’t be.

This is an important point, and I want to better understand it.  I think recent years have exhibited a substantial "social contagion" component to this phenomenon:

• Demographic Shifts: Referrals to gender clinics have exploded (e.g., 4,000%+ in some places), with a reversal from mostly young boys to predominantly adolescent girls (often with no childhood history of dysphoria). This pattern coincides with widespread social media use and increased visibility of transgender identities.
• Peer Clustering: Littman’s study and others noted "cluster outbreaks" in friend groups, where multiple teens (sometimes a majority) identified as trans around the same time, far exceeding baseline prevalence.
• Social Media & Online Influence: Many parents have reported sudden onset teen emphasis on this issue after heavy Tumblr, TikTok, YouTube, or Reddit exposure to transition narratives. Social media can amplify identity exploration, provide echo chambers, and frame dysphoria as a solution to other distress (anxiety, depression, autism, trauma, bullying, same-sex attraction).
• Comorbidities: I have spoken about this a lot.  High rates of prior mental health issues, neurodiversity (e.g., autism), and social difficulties. Gender dysphoria may serve as a maladaptive coping mechanism for underlying problems, with transition presented online as a "cure."
• International Reviews: The Cass Review and similar European analyses acknowledged social influences and peer contagion as plausible contributors to the surge, noting weak evidence for medical interventions and recommending caution/therapy-first approaches. Several countries (Sweden, Finland, UK, Norway) restricted youth medical transitions partly for these reasons.
• Analogies: I have seen quite a few comparisons to past contagions like eating disorders, self-harm, or Tourette-like tics spread via social media. 

Regarding the concept of “true transsexuals,” I continue to struggle with it.  The author uses the term for the small, distinct subgroup of children who:

• Exhibit clear, consistent, insistent cross-sex identification from early childhood (not sudden adolescent onset).
• Likely have lifelong gender dysphoria without intervention.
• May suffer severe, persistent distress if not allowed to transition.

These are contrasted with the recent surge of mostly adolescent-onset cases (often influenced by peers/social media), which he sees as the core of the "disaster." He argues this tiny "true" group has been harmed or overlooked amid the broader backlash and politicization. The piece calls for better research and nuanced care that doesn't abandon them.

I struggle with "nuanced care" for these kids including puberty blockers, cross-sex hormones and surgical interventions.  These cases, though legitimate psychologically, are not reflective of biological/physiological reality.  A child who well and truly thinks (“consistent, insistent and persistent”) that he is a dog or a space alien certainly deserved compassion and attention, but not medical intervention to designed to make him have some sort of physiological approximation to looking like a dog or a space alien.  Indeed, even affirming his subjectve-but-clearly-delusional belief that he is a dog or space alien seems quite problematic for me.

The position I am trying to articulate here — compassion for genuine distress without endorsing or medically reinforcing a mismatch with biological reality — apparently aligns with a growing number of clinicians, researchers, and reviewers (e.g., the Cass Review in the UK, European reversals, and the recent HHS report). 

Gender dysphoria is real psychological distress. For a small subset of children ("consistent, insistent, persistent" from early childhood, as the article puts it), it can be profound and lifelong. Desistance rates are high overall (especially with watchful waiting + therapy), but some cases persist.  However, the subjective belief ("I am the opposite sex") does not alter objective sex (chromosomes, gametes, skeletal structure, etc.). Sex is binary and immutable in humans for reproduction. Interventions (blockers, hormones, surgery) do not change sex; they approximate secondary characteristics, often with sterility, sexual dysfunction, bone density loss, cardiovascular risks, and unknown long-term brain effects.

Treating this condition like other body/mind mismatches (such as anorexia — where we don't affirm starvation; or body integrity dysphoria — where we don't amputate healthy limbs) prioritizes psychological approaches first: exploratory therapy addressing comorbidities (autism, trauma, same-sex attraction, social contagion in adolescent-onset cases, family dynamics).

The dog / space alien analogy is a common reductio in the literature. If a child persistently believes they are another species or entity:

• We offer compassion, therapy, and support for the distress.
• We do not affirm the delusion as reality or pursue veterinary/cosmetic interventions to "match" it.
• Doing so would likely entrench the delusion rather than resolve underlying issues.

Critics of the "affirmative" model argue the same logic applies here: social/medical transition can lock in a pathway with high regret/detransition risks for some (especially rapid-onset adolescent cases), while foreclosing natural resolution. Persistent early-onset cases are rarer and deserve careful, individualized evaluation.  But even then, many experts now favor therapy over immediate medicalization due to weak evidence of net benefit.

So, what does "nuanced care" mean for this small subset of minors?  Apparently:

• Comprehensive mental health assessment (ruling out/exploring comorbidities).
• Therapy focused on distress tolerance and reality-testing, not immediate affirmation.
• Watchful waiting for most (high natural desistance in pre-pubertal kids).
• Very rare, highly restricted medical steps only after exhaustive evaluation, in clinical trials, for the most severe persistent cases.

My discomfort with blockers/hormones/surgery as "treatment" for a psychological condition is, it seems, shared by the Cass Review, multiple European health authorities, and the HHS evidence summary — they highlight poor evidence quality and significant risks. The surge in adolescent females (post-social media) particularly suggests social/contagion factors in many cases, not a sudden biological revelation.

In saying this I do not deny the suffering of genuinely dysphoric kids. Rather, this perspective questions whether chemically/surgically altering healthy bodies is the ethical or effective response, versus addressing the mind and environment. The data increasingly supports caution.

Back to the article:

Quote

Liberals and conservatives each deserve blame for approaching this complex issue with anything but the deft hand it required.

The left cooked up a civil rights movement that shut down dissent and made a litmus test of supporting radical, irreversible and often unethical medical interventions to troubled adolescents. The right responded with brute force.

Amid the rubble of this political collision are dashed hopes that researchers might determine how best to treat the gender-related distress some young people genuinely face. The existing research is of poor quality, which is especially concerning given the serious and unique risk of harm these medical interventions pose.

Several items in my bulleted list center on poor data.

Quote

But the American leaders in this medical field are too concerned with being seen as white-knight saviors of vulnerable youth to conduct rigorous research and to report it honestly and promptly if those findings show concerning results.

Partly in response to these blunders, conservatives have done everything they can to dismantle the nation’s research apparatus — and robbed the public of potential scientific findings that might better guide the care of young people who are often mentally ill and are frequently autistic as well.

But the pipeline of adolescents coming into a transgender identity hasn’t simply dried up. These distressed young people are headed for a blockade erected by statehouse Republicans and the Trump administration. And conservatives have offered them no solutions.

I'm not sure this is correct.  I think the following should be the foundation of all treatments (noted above) :

• Comprehensive mental health assessment (ruling out/exploring comorbidities).
• Therapy focused on distress tolerance and reality-testing, not immediate affirmation.
• Watchful waiting for most (high natural desistance in pre-pubertal kids).

The last bullet point is, I think, where there is the most contention:

• Very rare, highly restricted medical steps only after exhaustive evaluation, in clinical trials, for the most severe persistent cases.

I still struggle with the notion of "medical steps," but I'm willing to listen and pay attention to meaningful and clear and strong data.  I just don't think we are anywhere close to having that at present.  This point is addressed in the article:

Quote

The left’s contribution to this sociopolitical tragedy has remained underexamined, given the liberal bias of the legacy media. In a better world, media outlets would investigate and atone for their own failure to have covered this complex subject with the dispassionate circumspection it demands.

The current crisis had its origins in a clinic in the Netherlands.

In the 1990s, Dutch researchers launched a strict, cautious protocol to address the question that had long haunted adult transgender people: What if I could have gone through the opposite-sex puberty? The Dutch recruited a small cohort of youth who exhibited gender-related distress starting at a young age.

If these youth were “consistent, insistent and persistent” in their cross-sex identity, they could begin puberty blockers, later transition to cross-sex hormones and ultimately undergo gender-transition surgery. The study participants had to demonstrate stable mental health and have families supporting their transition.

The Dutch researchers’ findings, published in the early 2010s, were hardly grounded in high-quality science. They didn’t even have a control group. Still, they unleashed a new medical field — pediatric gender medicine — across the Western world.

Then American medical providers took this narrow protocol and went hog wild. They tossed aside rigorous psychosocial assessments and instead prioritized access. By 2018, it became Boston Children’s Hospital’s policy, for example, to provide minors seeking gender-transition drugs with only a two-hour appointment with a psychologist to determine whether to refer the child to a medication specialist.

"A two-hour appointment."  The mind reels.

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The nation’s first medical-malpractice trial waged by a detransitioner — a person who medically transitioned and then reverted to identifying as their birth sex — heard testimony in January from a 22-year-old plaintiff who, as a seriously unstable 16-year-old girl, underwent a gender-transition mastectomy after publicly identifying as transgender for less than a year.

Such practices should shock anyone who wishes the best for all children struggling not just with their gender but with identity confusion writ large during the daunting social media era.

The swift expansion of this new medical field coincided with the onset of what psychologist Jonathan Haidt has witheringly dubbed the “phone-based childhood.” Beginning around 2012, tweens and adolescents gained access to an algorithm-based virtual world in which to question and cultivate their senses of self.

As any parent who has had children in a progressive private school can attest, it was during this period that clusters of friends — biological girls in particular — suddenly started professing cross-sex identities.

I think the correlation noted here ("{t}he swift expansion of this new medical field coincided with the onset of ... the 'phone-based childhood'") has strong indicia of causation.

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But the leaders of pediatric gender medicine refused to consider whether adopting a transgender identity might sometimes be a socially-formed coping mechanism to deal with the anxieties wrought by Tumblr, Instagram and TikTok.

To such doctors, these were transgender children, bar none. And as the American Academy of Pediatrics wrote in a foundational, practically spiritual, and astonishingly flawed 2018 policy statement on the so-called gender-affirming care method, transgender kids know their gender as well as anyone.

We don't let minors get tattoos, or drink, or vote, etc., mostly under the rubric of minors not really being prepared for such things.  And yet "transgender kids know their gender" has been a rallying cry.

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Buttressed by that philosophy, a niche medical field designed for a tiny population of young people exploded. Scores of pediatric gender clinics opened their doors to aid transitions in kids not even old enough to drive.

Supply appeared to create its own demand.

By 2023, over 3 percent of teenagers reported identifying as transgender and over 1 in 250 natal girls were taking testosterone by age 17 in super-liberal Oregon. The World Professional Association for Transgender Health, or WPATH, an influential, quasi-activist-medical group, professed the following year that the majority of transgender adolescents should undergo medical transitions.

The leaders in this field, social-justice warriors to the core, rarely acknowledged that online trends could have encouraged this groundswell. In WPATH’s conferences, dissent or debate about this novel field remained shockingly absent, as I discovered from watching recordings I obtained of over 100 such conference sessions.

The imposed silence about this seismic cultural shift among adolescents extended to other scientists, concerned parents, journalists, and politicians.

Social contagion concerns.

Informed consent. 

Compromised assessments of the best interests of the child. 

Longitudinal studies essentially absent. 

Ideological/sociopolitical influences/pressures on medical care. 

These concerns come up over and over.

Quote

Dr. Lisa Littman, a researcher who sought to study what in 2018 she dubbed “rapid-onset gender dysphoria,” was shunned. Reporters like Jesse Singal who dared write even circumspectly about pediatric gender medicine were defamed and banished.

Parents could have child protective services called on them if they resisted their children’s demands for a medicalized gender transition. Democratic politicians were pilloried if, like Representative Seth Moulton of Massachusetts, they questioned how communities should respond to the proliferation of youth identifying as transgender in schools and sports.

Exerting thought control is not a healthy way for scientists and society alike to explore how best to care for troubled children.

I am very much on the periphery of this topic, and have only raised it occasionally on this board.  And I have been excoriated for doing so. We're apparently not allowed to even voice these concerns.  The censorious proclivities of the ideologues advancing this stuff are potent and wide-ranging.  

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Nor, often, is the blunt instrument of the law.

In the wake of gay marriage’s Supreme Court win in 2015, and amid rising support for gay rights, conservatives pivoted to leveraging transgender issues as a political wedge issue. Republicans saw pediatric gender medicine’s recklessness and were all too happy to express their horror at it with a show of authoritarian force. Starting in 2021, conservatives blanketed over half the states with bans of these practices, which the Supreme Court solidified in 2025.

Some youths will be saved from harmful and unnecessary medical interventions as a result — though many, primed by gender-medicine advocates to believe such treatments were vital to their health, will endure protracted suffering from the letdown.

A smaller group could pay an especially heavy price.

It is at least arguable that a select population of youths are best served by medically transitioning in early adolescence — namely, those “true transsexuals” who would have qualified under the original Dutch protocol.

I'd like to see data on this.  Frankly, if meaningful and reliable data were available, I think we would have seen it by now.  There have been huge incentives to find it, and yet it's not just here. 

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But few people in gender medicine are even trying to discern those children from others for whom the risks of medical intervention, including infertility and the loss of healthy body parts, dwarf likely benefits. Many leading voices in this field want to end assessments entirely. They believe that whatever a kid says should go, and that questioning such impulses is stigmatizing and harmful.

This leaves the average person to wonder: Have you ever met a teenager?

And more than that.  Medicine should be evidence-based.  As it is, this sector of medical care has been dominated by ideologues, politics and poor data.  

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Had pediatric gender medicine remained as cautious as the Dutch had first established it to be, it’s possible these medical practices would have kept operating quietly in the shadows. But the leaders in this movement egregiously overplayed their hands — and provided so much fodder for anxious parents and the field’s enemies on the right they effectively robbed the tiny minority of youth who truly might have benefitted from these interventions of a chance to receive them quietly in private.

That’s an American tragedy, and it’s still unfolding.

Interesting stuff.

Thanks,

-Smac

[Calm]

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Smac:  Gynecomastia surgery is typically performed to correct a physical medical condition (excess breast tissue in boys, often caused by puberty, hormones, or medication). It is not the same as gender-affirming surgeries, which involve removing healthy organs (breasts, testicles, etc.) in an attempt to align the body with a perceived gender identity.  

So you are okay with cutting off breast tissue for a commonly benign condition to relieve “embarrassment”, “anxiety”,and “psychosocial discomfort”?  Perfectly okay if it’s in the 30% of males who want to look more masculine even though it’s not a dangerous or particularly unhealthy physically wise condition (if you look at pictures of adolescents who have had surgeries, their breasts are typically relatively smaller than most women, so unlikely to affect posture much due weight, no need for bras.

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Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. 

https://pmc.ncbi.nlm.nih.gov/articles/PMC3987263/

Quote

Gynecomastia is defined as an enlargement of the male breast. It is often benign, and can be the source of significant embarrassment and psychological distress.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3706045/ (pictures include)

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Many males experience gynecomastia, or enlarged male breasts. While it’s not a dangerous condition, it can cause anxiety and low self-confidence in those with the condition

https://www.lecontoursurgery.com/blog/gynecomastia-vs-pseudogynecomastia-whats-the-difference/

Appears the vast majority of these surgeries are done for emotional health, not physical health according to every I am reading about it.

Are you okay with liposuction for those adolescents suffering from pseudogynecomastia when it’s biological males desiring to look more male as well?  The rate is unknown as it gets classified with gynecomastia (apparently unnecessary to separate the two even though cause is different).  Chat came up with solely liposuction*** masculinizing breast surgeries for biological males at 10-30% of all masculinizing male breast surgeries, so it looks like removal of healthy, if overweight breast tissue for boys is still done in significantly higher numbers than for removal of healthy breast tissue for biological females wanting to look more male.

***since it’s fat and not glandular tissue being removed, liposuction is the go to procedure for pseudogynecomastia.  Apparently rarely paid by insurance as typically purely cosmetic, unnecessary for physical health.

Edited July 10 by Calm

[smac97]

16 minutes ago, Calm said:

So you are okay with cutting off breast tissue for a commonly benign condition to relieve “embarrassment”, “anxiety”,and “psychosocial discomfort”?  Perfectly okay if it’s in the 30% of males who want to look more masculine even though it’s not a dangerous or particularly unhealthy physically wise condition (if you look at pictures of adolescents who have had surgeries, their breasts are typically relatively smaller than most women, so unlikely to affect posture much due weight, no need for bras.

I see the distinction differently.

Gynecomastia surgery corrects a physical abnormality — excess glandular breast tissue in males, often triggered by puberty, hormones, or medication. The goal is to restore a typical male chest contour, addressing a condition that deviates from normal male physiology. It’s corrective, like fixing a cleft palate or removing a benign tumor causing distress. The body is being aligned toward biological sex reality, not away from it.

In contrast, "gender-affirming" mastectomy in adolescent females (or "top surgery") removes healthy female breast tissue to approximate a male appearance based on a subjective identity. The breasts are not pathological; they are normal, healthy organs developing according to female biology. The intervention denies rather than affirms biological reality.

Both can relieve psychological distress, but that doesn’t make them equivalent. We don’t amputate healthy limbs for body integrity dysphoria, affirm anorexia by endorsing starvation, or surgically alter someone who believes they’re a different species. The ethical line is whether we’re treating a disorder of the mind by altering a healthy body in ways that are irreversible and carry known risks (infertility, sexual dysfunction, skeletal issues, potential regret).

I am not opposed to compassion or mental health support for gender dysphoria. But the evidence (Cass Review, European shifts, weak long-term data) increasingly questions whether rushing to remove healthy organs in minors is the right response — especially with the sharp rise in adolescent females and high rates of comorbidities like autism or trauma. Exploratory therapy to address root causes seems more prudent than immediate medicalization.

What do you see as the key difference (or non-difference) here?

16 minutes ago, Calm said:

https://pmc.ncbi.nlm.nih.gov/articles/PMC3987263/

https://pmc.ncbi.nlm.nih.gov/articles/PMC3706045/ (pictures include)

https://www.lecontoursurgery.com/blog/gynecomastia-vs-pseudogynecomastia-whats-the-difference/

Appears the vast majority of these surgeries are done for emotional health, not physical health according to every I am reading about it.
Are you okay with liposuction for those adolescents suffering from pseudogynecomastia when it’s biological males desiring to look more male as well?

I appreciate you sharing those links. I have looked into gynecomastia and pseudogynecomastia.

The key distinction remains: gynecomastia (and pseudogynecomastia) involves excess tissue in males that deviates from normal male physiology. Surgery removes abnormal or unwanted male breast tissue to restore a typical male chest contour. It’s corrective — aligning the body toward biological sex reality. Emotional distress is often a factor (as it is with many cosmetic or reconstructive procedures), but the underlying issue is a physical departure from the male norm.

In contrast, “gender-affirming” mastectomy in females removes healthy female breast tissue to create a male-appearing chest based on subjective identity. The breasts are not excess or abnormal; they are normal organs of female development. The surgery denies biological reality rather than correcting a deviation from it.

On liposuction for pseudogynecomastia in adolescent males: If it’s true pseudogynecomastia (mostly fat, often tied to obesity/puberty), I am more skeptical of routine surgery in minors for purely cosmetic/psychosocial reasons. But it’s still fundamentally different from removing healthy female breasts. One case addresses excess tissue in a male body; the other amputates normal tissue in a female body to affirm a perceived identity incongruent with biology.

Again, I am all for compassion and mental health support for body image distress in any minor. But we should be very cautious with irreversible surgeries on healthy minors. The evidence for benefits vs. harms in gender medicine (especially rapid-onset cases) is much weaker than for standard gynecomastia correction. Therapy exploring root causes seems preferable to jumping to the scalpel.

I am curious where you draw the line on medicalizing psychological distress in healthy bodies.

Thanks,

-Smac

[The Nehor]

1 hour ago, smac97 said:

I see the distinction differently.

Gynecomastia surgery corrects a physical abnormality — excess glandular breast tissue in males, often triggered by puberty, hormones, or medication. The goal is to restore a typical male chest contour, addressing a condition that deviates from normal male physiology. It’s corrective, like fixing a cleft palate or removing a benign tumor causing distress. The body is being aligned toward biological sex reality, not away from it.

In contrast, "gender-affirming" mastectomy in adolescent females (or "top surgery") removes healthy female breast tissue to approximate a male appearance based on a subjective identity. The breasts are not pathological; they are normal, healthy organs developing according to female biology. The intervention denies rather than affirms biological reality.

“Biological reality” is determined by the presence of hormones. We can change that. The reality is much more malleable than you want it to be.

1 hour ago, smac97 said:

Both can relieve psychological distress, but that doesn’t make them equivalent. We don’t amputate healthy limbs for body integrity dysphoria, affirm anorexia by endorsing starvation, or surgically alter someone who believes they’re a different species. The ethical line is whether we’re treating a disorder of the mind by altering a healthy body in ways that are irreversible and carry known risks (infertility, sexual dysfunction, skeletal issues, potential regret).

I don’t think you have a good grasp of the ethics behind all of this. You are putting the ethical line where your religion sets it, not based on medical ethics.

Also someone starving themselves doesn’t relieve the symptoms of anorexia. It doesn’t help with the problem. Gender affirming treatments DO help with body dysphoria. BIID is much more complicated than you are making it sound and some people who have an affiliation with another animal DO pursue elective cosmetic surgeries to alleviate their symptoms.

A lot of treatments are irreversible. You are drawing a really weird ethical line.

1 hour ago, smac97 said:

I am not opposed to compassion or mental health support for gender dysphoria. But the evidence (Cass Review, European shifts, weak long-term data) increasingly questions whether rushing to remove healthy organs in minors is the right response — especially with the sharp rise in adolescent females and high rates of comorbidities like autism or trauma. Exploratory therapy to address root causes seems more prudent than immediate medicalization.

So people who experience trauma or suffer from autism need to be infantilized and don’t deserve bodily autonomy? Yikes.

Exploratory therapy? LOL. Do you think this hasn’t been tried over and over again? If therapy could cure or heavily alleviate gender dysphoria the transphobes would be screaming this from the mountaintops. They don’t because it doesn’t work. Therapy helps with transitioning or determining the extent of a transition or whether the person wants to medically transition and lots of nuances and some therapy is sometimes required to get a prescription for hormones but it doesn’t help with the underlying issue.

You are suggesting people stop pursuing a treatment that works in favor of a treatment that doesn’t actually work and has been shown not to work. That is not compassion.

1 hour ago, smac97 said:

The key distinction remains: gynecomastia (and pseudogynecomastia) involves excess tissue in males that deviates from normal male physiology. Surgery removes abnormal or unwanted male breast tissue to restore a typical male chest contour. It’s corrective — aligning the body toward biological sex reality. Emotional distress is often a factor (as it is with many cosmetic or reconstructive procedures), but the underlying issue is a physical departure from the male norm.

In contrast, “gender-affirming” mastectomy in females removes healthy female breast tissue to create a male-appearing chest based on subjective identity. The breasts are not excess or abnormal; they are normal organs of female development. The surgery denies biological reality rather than correcting a deviation from it.

On liposuction for pseudogynecomastia in adolescent males: If it’s true pseudogynecomastia (mostly fat, often tied to obesity/puberty), I am more skeptical of routine surgery in minors for purely cosmetic/psychosocial reasons. But it’s still fundamentally different from removing healthy female breasts. One case addresses excess tissue in a male body; the other amputates normal tissue in a female body to affirm a perceived identity incongruent with biology.

You think it is icky and transgressive and sinful in one case and not in the other…despite scripture being silent about it. The distinction you are trying to make is an ad hoc justification for a religious conviction, not a serious distinction.

[Calm]

2 hours ago, smac97 said:

Gynecomastia surgery corrects a physical abnormality — excess glandular breast tissue in males, often triggered by puberty, hormones, or medication. The goal is to restore a typical male chest contour, addressing a condition that deviates from normal male physiology. It’s corrective, like fixing a cleft palate or removing a benign tumor causing distress. The body is being aligned toward biological sex reality, not away from it.

But there is typically no physical necessity for such surgery, only emotional distress.  

So it amounts to what emotional distress you believe is worth the risk of surgery for adolescents and what emotional distress isn’t…a pretty subjective measure, imo.

[smac97]

17 minutes ago, The Nehor said:

“Biological reality” is determined by the presence of hormones. We can change that. The reality is much more malleable than you want it to be.

Thank you for sharing your thoughts.

My understanding is that biological sex is not primarily determined by hormones. Hormones influence secondary characteristics (like breast development), but they don’t redefine the fundamental binary.  Rather, in biology, sex is defined by the type of gamete (reproductive cell) an organism’s body is organized to produce:

• Male: Small gametes (sperm).
• Female: Large gametes (eggs/ova).

There are only two sexes because there are only two gametes. This is the standard, unambiguous definition used in evolutionary biology, developmental biology, and genetics. No third gamete exists, so no third sex. Disorders of sexual development (intersex conditions) are variations within the binary, not evidence against it — they don’t produce a third gamete type.

Hormones (testosterone, estrogen, etc.) are important regulators, and we can alter their levels. But changing hormone profiles doesn’t change the underlying reproductive anatomy or gamete-producing design. A biological male (XY, testes designed for sperm) on estrogen still has a male reproductive system at the chromosomal and developmental level. The body isn’t “malleable” into the opposite sex; interventions create approximations of secondary traits, often with significant trade-offs (infertility, health risks).

Gynecomastia surgery removes excess tissue to align with normal male physiology. “Gender-affirming” mastectomy removes healthy female tissue to oppose normal female physiology. That’s the core difference.

17 minutes ago, The Nehor said:

Quote

Both can relieve psychological distress, but that doesn’t make them equivalent. We don’t amputate healthy limbs for body integrity dysphoria, affirm anorexia by endorsing starvation, or surgically alter someone who believes they’re a different species. The ethical line is whether we’re treating a disorder of the mind by altering a healthy body in ways that are irreversible and carry known risks (infertility, sexual dysfunction, skeletal issues, potential regret).

I don’t think you have a good grasp of the ethics behind all of this. You are putting the ethical line where your religion sets it, not based on medical ethics.

I appreciate you raising the ethics question, but I think you’re mischaracterizing where my line comes from.

My view is not rooted in religion setting an arbitrary boundary (moreover, I think the Church's doctrines, though fundamentally "religious" in nature, do not support the notion of "an arbitrary boundary," but rather boundaries that reflect reality, which corresponds to the designs of the Almighty). It comes from medical evidence, biological reality, and standard ethical principles in medicine: primum non nocere (“first, do no harm”), informed consent, and avoiding irreversible interventions on healthy tissue when less invasive options exist.

We as a society do not affirm anorexia by helping patients starve, amputate healthy limbs for body integrity dysphoria, or surgically alter people who identify as another species — even if it relieves distress. I think this is not in dispute.

The ethical line is whether we’re treating a mental health condition by permanently altering a healthy body in ways that introduce sterility, sexual dysfunction, bone density loss, cardiovascular risks, and uncertain long-term outcomes. Evidence reviews (Cass Review, European reversals, the recent HHS report) show the quality of evidence for “gender-affirming” surgeries/hormones in minors is remarkably weak, while harms are substantial.  I also think the ethical line is, or ought to be, drawn relative to the intended purpose of medical procedures which align physiology toward biological sex reality versus away from it.

My faith aligns with protecting kids from experimental medicalization, but the reasoning I have presented here stands on its own from the data, desistance rates, comorbidities, and regret/detransition patterns. If the evidence were stronger for net benefit and low risk, I would reassess.

Where do you draw the ethical line, and what data supports medicalizing healthy adolescent bodies for psychological distress in this specific case?

17 minutes ago, The Nehor said:

Also someone starving themselves doesn’t relieve the symptoms of anorexia.  It doesn’t help with the problem.

That’s exactly the point.  In anorexia, we do not affirm the distorted perception by helping the person starve or surgically alter their body to match the delusion. We treat the underlying psychological condition with therapy, nutritional rehabilitation, and support — even when the patient experiences intense distress and insists the thin ideal would “relieve” their symptoms.

The parallel with gender dysphoria is that we are often affirming a distorted perception of the body (by hormones and surgery on healthy tissue) rather than primarily addressing the psychological distress through therapy. Both involve body-image/identity issues where the “relief” from affirmation can be short-term and comes at the cost of entrenching the problem and introducing serious medical harms.

If the goal is genuine well-being, why would medical personnel treat one as a mental health issue requiring reality-based care and the other as something that justifies permanent medical alteration of a healthy body?

17 minutes ago, The Nehor said:

Gender affirming treatments DO help with body dysphoria. BIID is much more complicated than you are making it sound and some people who have an affiliation with another animal DO pursue elective cosmetic surgeries to alleviate their symptoms.

I agree that some people report short-term relief from gender-affirming treatments for body dysphoria — that’s not in dispute. The deeper questions are:

1. Net long-term benefit — Does it resolve the distress sustainably, or does it often mask comorbidities (autism, trauma, mental health issues) while introducing irreversible harms (sterility, sexual dysfunction, bone loss, cardiovascular risks, regret/detransition)? Evidence reviews like the Cass Review found the quality of studies claiming benefit to be very low, with weak follow-up data.
2. Ethical consistency — BIID (body integrity dysphoria) patients also report profound relief from amputation, and some “otherkin” or species dysphoric people seek extreme cosmetic alterations. We don’t generally affirm those by amputating healthy limbs or performing radical surgeries because the body is healthy and the distress is psychological. The principle is the same: treating a disorder of perception by mutilating a functional body is ethically fraught, especially in minors where desistance is common.

If the treatments were clearly safe, effective, and curative with strong evidence, this wouldn’t be so contested. The surge in adolescent females, high comorbidity rates, and European retreats from routine affirmation suggest caution is warranted over affirmation-as-first-line.

Where do you see the ethical stopping point for medically altering healthy bodies to match subjective identity?

17 minutes ago, The Nehor said:

A lot of treatments are irreversible. You are drawing a really weird ethical line.

Many medical treatments are irreversible — that’s why the ethical bar is high. We don’t perform them lightly on healthy tissue for psychological conditions.

Also, the line is not "weird."  Rather, it is standard medical ethics: primum non nocere (first, do no harm) and proportionality. We accept irreversible interventions in particularized circumstances:

• There’s a clear physical pathology (e.g., cancer, severe injury).
• Benefits demonstrably outweigh harms with strong evidence.
• Less invasive options have been exhausted.

Removing healthy breasts/testicles/penis in a minor (or adult) with gender dysphoria fails that test for many cases. The body parts are functionally healthy. Evidence for long-term mental health benefit is weak (per Cass Review and others), while harms (sterility, loss of sexual function, bone density issues, surgical complications, regret) are substantial and permanent. Comorbidities like autism, trauma, or social contagion are common, especially in rapid-onset adolescent cases.

Compare all this to to BIID (amputating healthy limbs), anorexia (endorsing starvation), or species dysphoria. We reject those despite reported distress relief because altering a healthy body to match a subjective perception is ethically problematic. The same principle applies here.

Again, if the data showed clear, sustained benefit with minimal risk, I would reassess. Right now, it doesn’t for most youth. That’s why European countries have sharply restricted these interventions.

What makes this case different enough to justify the exception?

17 minutes ago, The Nehor said:

So people who experience trauma or suffer from autism need to be infantilized and don’t deserve bodily autonomy? Yikes.

No — quite the opposite.

People with autism, trauma, or other comorbidities deserve the highest standard of care, not rushed medicalization that may entrench problems or create new ones (sterility, sexual dysfunction, surgical complications). Exploratory therapy and comprehensive assessment aren’t “infantilizing” — they are responsible medicine. We do this for other conditions with high comorbidity (e.g., eating disorders, self-harm, OCD) because adolescents’ brains are still developing, desistance rates can be high, and long-term data on these interventions is weak.

The Cass Review and European shifts highlighted exactly this: Many gender-distressed youth have co-occurring issues that should be addressed first. “Bodily autonomy” for minors doesn’t mean affirming every request for irreversible procedures on healthy organs. Parents and doctors have a duty to protect kids from decisions they may regret when older — especially when social contagion, peer influence, and mental health factors are prominent in the recent surge of adolescent females.

Supporting therapy-first isn’t denying autonomy or compassion. It’s prioritizing evidence-based care over ideology. Dismissing concerns as “yikes” doesn’t address the data on comorbidities or outcomes.

What evidence convinces you that immediate medicalization is the prudent path for these complex cases?

17 minutes ago, The Nehor said:

Exploratory therapy? LOL. Do you think this hasn’t been tried over and over again? If therapy could cure or heavily alleviate gender dysphoria the transphobes would be screaming this from the mountaintops. They don’t because it doesn’t work. Therapy helps with transitioning or determining the extent of a transition or whether the person wants to medically transition and lots of nuances and some therapy is sometimes required to get a prescription for hormones but it doesn’t help with the underlying issue.

You are suggesting people stop pursuing a treatment that works in favor of a treatment that doesn’t actually work and has been shown not to work. That is not compassion.

Exploratory therapy isn’t “LOL."  It is the approach increasingly recommended by systematic reviews because the affirmative model has weak evidence.

The Cass Review (UK, 2024) and similar European analyses found that routine therapy was often inadequate or bypassed under the affirmative model, with poor assessment of comorbidities (autism, trauma, same-sex attraction, social influence). Many clinics moved to “informed consent” or very brief evaluations. Long-term studies on medical transition show mixed or modest mental health benefits, persistent high suicide risk, and significant regret/detransition rates in some cohorts. 

We have not seen evidence supporting the supposed slam-dunk “it works” narrative.  Countries like Sweden, Finland, UK, and Norway didn’t shift to restrictions because therapy “doesn’t work” (or because of religious sentiments).  They did so because the evidence for puberty blockers/hormones/surgery in minors is low-quality, risks are substantial, and desistance is common with watchful waiting + therapy. The sharp rise in adolescent females (post-social media) particularly suggests many cases involve social/contagion factors or underlying issues therapy can address.

I’m not saying stop all medical transition forever. I’m saying don’t rush irreversible interventions on healthy minors when exploratory therapy, addressing root causes, and time often lead to better outcomes. That’s not anti-compassion — it’s evidence-based caution. The “transphobes screaming” line is a strawman; serious concerns come from clinicians, detransitioners, and reviews showing the affirmative approach failed many kids.

If the data robustly showed medicalization as clearly superior long-term, the European shifts would not have happened. What specific high-quality evidence convinces you it’s the best path for most youth?

17 minutes ago, The Nehor said:

You think it is icky and transgressive and sinful in one case and not in the other…despite scripture being silent about it. The distinction you are trying to make is an ad hoc justification for a religious conviction, not a serious distinction.

The distinction isn’t “icky/sinful vs. not” or an ad hoc religious invention. It’s grounded in clinical medicine and biology, which I have presented consistently.

Gynecomastia/pseudogynecomastia surgery corrects a physical deviation from normal male chest anatomy (excess glandular tissue or fat in a male body). The intervention restores typical male secondary sex characteristics. Emotional distress is a common reason for many reconstructive procedures — that doesn’t make the underlying issue subjective identity.

“Gender-affirming” mastectomy removes healthy, normal female breast tissue to oppose female physiology and approximate a male appearance based on felt identity. The tissue is not pathological; the body is functioning as designed for its sex. This is not corrective in the same way.

Scripture informs my broader worldview (including the sanctity of the body and sex as part of God’s design per the Proclamation on the Family), but the clinical distinction stands on its own: one aligns with biological reality, the other rejects it by altering healthy organs. That’s why European reviews (Cass, etc.) and medical ethics emphasize caution with the latter, especially in minors.

If the evidence showed equivalent outcomes and low risk for both, the comparison might hold. It doesn’t. Dismissing the biological line as mere religion avoids engaging with the data on desistance, comorbidities, and long-term harms.

What makes the two cases ethically equivalent in your view?

Thanks,

-Smac

[smac97]

9 minutes ago, Calm said:

But there is typically no physical necessity for such surgery, only emotional distress.  

So it amounts to what emotional distress you believe is worth the risk of surgery for adolescents and what emotional distress isn’t…a pretty subjective measure, imo.

Emotional distress is a factor in many surgeries (including gynecomastia), but it’s not the sole or defining criterion.  The key difference, then, is the underlying condition:

• Gynecomastia involves excess glandular tissue in a male body — a physical departure from normal male development (often hormonal/pubertal). Surgery removes abnormal tissue to restore typical male chest anatomy. It’s corrective, similar to other procedures addressing congenital or acquired deviations (cleft palate repair, gynecomastia is medically recognized for this reason).
• “Gender-affirming” mastectomy removes healthy, normal female breast tissue in a female body to align with a subjective identity. The breasts are not excess or pathological; they are standard female development. The intervention works against biological reality rather than restoring it.

Both can relieve distress, but one treats a deviation from sex-typical physiology while the other alters healthy sex-typical physiology. That’s an objective clinical distinction, not pure subjectivity. Medical ethics weighs risks/benefits differently when operating on healthy organs versus correcting abnormalities.

I’m open to nuance on adolescent gynecomastia (I noted skepticism for purely cosmetic pseudogynecomastia cases earlier). But equating the two ignores the biological grounding.

What makes removing healthy female breasts equivalent to correcting excess male breast tissue, in your view?

Thanks,

-Smac

[Calm]

2 hours ago, smac97 said:

high rates of comorbidities like autism or traum

Autism is not a disorder for most who have it, it is a different way of seeing and processing the world.  Treating autism as inherently unhealthy reminds me of when women were seen as incomplete or defective males or menopause a mental and physical disorder.  Dysfunctional forms of autism exist, of course, just as dysfunctional forms of masculinity in males can exist due to narcissistic or antisocial personality disorder.

[Calm]

13 minutes ago, smac97 said:

Gynecomastia involves excess glandular tissue in a male body — a physical departure from normal male development (often hormonal/pubertal). Surgery removes abnormal tissue to restore typical male chest anatomy. It’s corrective, similar to other procedures addressing congenital or acquired deviations (cleft palate repair, gynecomastia is medically recognized for this reason).

But it only needs to be “corrected” because of our culture’s standards of beauty, our judgment as to what is excess and what isn’t.  It doesn’t interfere with anything physically typically..  In other cultures when higher weights were a sign of prestige or strength, such appearances would have judged as normal and no need for correction.

Just because something isn’t “typical” doesn’t qualify it as needing to be corrected, otherwise a lot of our sports celebrities who are outliers when it comes to height, size, or strength would be viewed as needing correction rather than others wishing they had their build….which demonstrates the subjectiveness of judging something that doesn’t interfere with movement, etc as need to be corrected.

Even today, in some contexts such appearances are “normal”.

 

Edited July 10 by Calm

[Calm]

Btw, cleft palates are not a comparable condition as those do interfere with physical functionality.  A birthmark is a closer comparison or a mole.

Or let’s say having an extra finger as that has inherent dysfunction, but does not align with typical body type with excess tissue and bone.

Are you okay with chopping off a heathy sixth finger?  

Edited July 10 by Calm

[smac97]

36 minutes ago, Calm said:

Autism is not a disorder for most who have it, it is a different way of seeing and processing the world.  

Autism is a neurodevelopmental disorder (per DSM-5 and medical consensus), characterized by challenges in social communication, restricted interests, and repetitive behaviors. For many, it involves significant difficulties — sensory sensitivities, executive function issues, higher rates of anxiety/depression, and support needs that can range from mild to profound.

Yes, autistic people often have unique strengths (pattern recognition, focus, honesty, etc.) and see/process the world differently. That’s worth celebrating and accommodating. But calling it “not a disorder, just different” downplays the real struggles and comorbidities that many face. It’s both: a different neurotype and a condition that frequently impairs functioning in a neurotypical world.

We accommodate and support people with autism without pretending the challenges don’t exist — just as we do with other neurodevelopmental conditions. The same principle applies to gender dysphoria in autistic youth: high comorbidity rates deserve careful assessment and therapy, not rushed affirmation that may overlook root issues.

36 minutes ago, Calm said:

Treating autism as inherently unhealthy reminds me of when women were seen as incomplete or defective males or menopause a mental and physical disorder.  Dysfunctional forms of autism exist, of course, just as dysfunctional forms of masculinity in males can exist due to narcissistic or antisocial personality disorder.

Thank you for sharing your thoughts.  In my view, that analogy doesn’t hold.

Again, autism is a neurodevelopmental disorder involving measurable differences in brain structure/function, social communication challenges, sensory processing issues, and higher rates of comorbidities (anxiety, depression, epilepsy, GI problems). These can range from mild to severe and often impair functioning in a neurotypical world. Recognizing that isn’t misogyny or pathologizing normal variation.  Rather, it is clinical reality backed by genetics, neuroimaging, and decades of research. We accommodate strengths (focus, pattern recognition) while addressing deficits through therapy, education, and support.

Historical views of women as “defective males” or menopause as purely mental were wrong because they ignored objective biology and imposed cultural bias. Autism’s challenges are not imaginary or solely cultural.  Studies have shown high heritability, and interventions (behavioral therapy, occupational therapy, etc.) demonstrably help many.

Dysfunctional masculinity or personality disorders are separate issues of behavior/character, not equivalent to a neurodevelopmental condition present from early development. We treat the latter because it often involves genuine impairment, not to enforce conformity.

The same caution applies to gender dysphoria in autistic youth: high comorbidity rates warrant thorough assessment, not assuming affirmation is always the answer. Dismissing concerns as outdated prejudice avoids engaging with the data.

What specific evidence leads you to view autism as primarily “different, not disordered”?

Thanks,

-Smac

[smac97]

31 minutes ago, Calm said:

But it only needs to be “corrected” because of our culture’s standards of beauty, our judgment as to what is excess and what isn’t.  It doesn’t interfere with anything physically typically..  In other cultures when higher weights were a sign of prestige or strength, such appearances would have judged as normal and no need for correction.

Just because something isn’t “typical” doesn’t qualify it as needing to be corrected, otherwise a lot of our sports celebrities who are outliers when it comes to height, size, or strength would be viewed as needing correction rather than others wishing they had their build….which demonstrates the subjectiveness of judging something that doesn’t interfere with movement, etc as need to be corrected.

Even today, in some contexts such appearances are “normal”.

 

I acknowledge that cultural beauty standards influence many cosmetic decisions, but that doesn’t erase the clinical distinction for gynecomastia.

The surgery addresses a physical deviation from normal male chest anatomy — excess glandular breast tissue in a male body, often triggered by puberty/hormones. It’s not just “unwanted fat” or subjective aesthetics; it’s abnormal glandular development that deviates from typical male secondary sex characteristics. Medical guidelines recognize it as a condition warranting evaluation and potential correction, similar to other sex-atypical developments (e.g., certain cases of macromastia in females or precocious puberty).

Compare to your examples:

• Outlier height/strength in athletes is within normal male variation — extremes of the male bell curve, not a departure from male physiology.
• Gynecomastia is excess female-like tissue in a male body. Correcting it aligns the body toward typical male development, not an arbitrary beauty ideal.

In cultures prizing higher weight, obesity-related pseudogynecomastia might be less stigmatized, but the underlying glandular issue in true gynecomastia is still a biological anomaly. We don’t refuse cleft palate repair because some cultures might view it differently.

The parallel to gender medicine is that one corrects a deviation from sex-typical biology; the other removes healthy sex-typical tissue to oppose it. This is not mere subjectivity.  It is grounded in observable anatomy and reproductive biology.

Thanks,

-Smac

[smac97]

44 minutes ago, Calm said:

Btw, cleft palates are not a comparable condition as those do interfere with physical functionality.  A birthmark is a closer comparison or a mole.

Or let’s say having an extra finger as that has inherent dysfunction, but does not align with typical body type with excess tissue and bone.

Are you okay with chopping off a heathy sixth finger?  

A cleft palate is a good example of a structural deviation that often requires correction for both function and normal development. But even milder congenital variations illustrate the principle.

A sixth finger (polydactyly) is excess tissue/bone deviating from normal human anatomy. Surgery to remove it is common, even when it’s not severely dysfunctional, to restore typical hand structure, improve function and "cosmesis" (just learned that word recently), and avoid social/psychological issues. We treat it as a correctable anomaly, not something to affirm as a valid variation.

Gynecomastia is analogous: excess glandular tissue in a male chest is a deviation from normal male development. Surgery removes the abnormal tissue to restore typical male anatomy. It’s corrective.

By contrast, gender-affirming mastectomy removes healthy, normal female breast tissue to oppose female development based on identity. The tissue isn’t excess or anomalous — it’s standard for the sex. That’s the ethical and clinical difference: one aligns with biological sex reality; the other rejects it by altering healthy organs.

We don’t generally amputate healthy body parts to match a subjective perception (BIID, species dysphoria, etc.), even if distress is real. The same caution applies here, especially in minors.

The birthmark/mole comparison is weaker because those are usually superficial and don’t involve substantial glandular/structural change.

Would you support removing healthy breasts in a dysphoric adolescent female the same way we remove a sixth finger?

Thanks,

-Smac

Edited July 10 by smac97

[The Nehor]

1 hour ago, smac97 said:

Thank you for sharing your thoughts.

My understanding is that biological sex is not primarily determined by hormones. Hormones influence secondary characteristics (like breast development), but they don’t redefine the fundamental binary.  Rather, in biology, sex is defined by the type of gamete (reproductive cell) an organism’s body is organized to produce:

• Male: Small gametes (sperm).
• Female: Large gametes (eggs/ova).

There are only two sexes because there are only two gametes. This is the standard, unambiguous definition used in evolutionary biology, developmental biology, and genetics. No third gamete exists, so no third sex. Disorders of sexual development (intersex conditions) are variations within the binary, not evidence against it — they don’t produce a third gamete type.

Hormones (testosterone, estrogen, etc.) are important regulators, and we can alter their levels. But changing hormone profiles doesn’t change the underlying reproductive anatomy or gamete-producing design. A biological male (XY, testes designed for sperm) on estrogen still has a male reproductive system at the chromosomal and developmental level. The body isn’t “malleable” into the opposite sex; interventions create approximations of secondary traits, often with significant trade-offs (infertility, health risks).

Gynecomastia surgery removes excess tissue to align with normal male physiology. “Gender-affirming” mastectomy removes healthy female tissue to oppose normal female physiology. That’s the core difference.

Uhhh no, the reason you develop those gametes is due to hormones when young. Also it is probably only a matter of time before we can change that as well. So it is more of a skill issue.

Variations within a strict binary system means it is not a strict binary. You continue to deliberately ignore this.

1 hour ago, smac97 said:

I appreciate you raising the ethics question, but I think you’re mischaracterizing where my line comes from.

My view is not rooted in religion setting an arbitrary boundary (moreover, I think the Church's doctrines, though fundamentally "religious" in nature, do not support the notion of "an arbitrary boundary," but rather boundaries that reflect reality, which corresponds to the designs of the Almighty). It comes from medical evidence, biological reality, and standard ethical principles in medicine: primum non nocere (“first, do no harm”), informed consent, and avoiding irreversible interventions on healthy tissue when less invasive options exist.

We as a society do not affirm anorexia by helping patients starve, amputate healthy limbs for body integrity dysphoria, or surgically alter people who identify as another species — even if it relieves distress. I think this is not in dispute.

The ethical line is whether we’re treating a mental health condition by permanently altering a healthy body in ways that introduce sterility, sexual dysfunction, bone density loss, cardiovascular risks, and uncertain long-term outcomes. Evidence reviews (Cass Review, European reversals, the recent HHS report) show the quality of evidence for “gender-affirming” surgeries/hormones in minors is remarkably weak, while harms are substantial.  I also think the ethical line is, or ought to be, drawn relative to the intended purpose of medical procedures which align physiology toward biological sex reality versus away from it.

The difference is whether the treatment WORKS!!!!! The objective of medicine is to reduce suffering and increase human flourishing and all that. That is the question.

You are trying to make it about everything sticking to your idea of a sexual binary. The fact that someone is happier can be sacrificed to the idea of you holding on to a strict binary shows that your approach isn’t ethical.

1 hour ago, smac97 said:

My faith aligns with protecting kids from experimental medicalization, but the reasoning I have presented here stands on its own from the data, desistance rates, comorbidities, and regret/detransition patterns. If the evidence were stronger for net benefit and low risk, I would reassess.

Where do you draw the ethical line, and what data supports medicalizing healthy adolescent bodies for psychological distress in this specific case?

The increased quality of life is the data.

1 hour ago, smac97 said:

That’s exactly the point.  In anorexia, we do not affirm the distorted perception by helping the person starve or surgically alter their body to match the delusion. We treat the underlying psychological condition with therapy, nutritional rehabilitation, and support — even when the patient experiences intense distress and insists the thin ideal would “relieve” their symptoms.

Except that medical (and other forms of transitioning) does often relieve the symptoms. You continue to ignore this. That is the point. When it relieves the symptoms it means the treatment is working. Starvation doesn’t help with anorexia. Transitioning works very well in most cases. It helps. Talk therapy has minimal benefits. You want to get rid of the treatment that seems to be the most successful in favor of the one that doesn’t.

You are the joke in a lot of transgender memes that go along the lines of:

”Wow, I am happier now and more comfortable in my own skin. I hope this lasts forever.”

”But aren’t you worried this might be irreversible?”

1 hour ago, smac97 said:

The parallel with gender dysphoria is that we are often affirming a distorted perception of the body (by hormones and surgery on healthy tissue) rather than primarily addressing the psychological distress through therapy. Both involve body-image/identity issues where the “relief” from affirmation can be short-term and comes at the cost of entrenching the problem and introducing serious medical harms.

That is all nonsense. The relief is usually not short term and doesn’t introduce serious medical harms.

1 hour ago, smac97 said:

If the goal is genuine well-being, why would medical personnel treat one as a mental health issue requiring reality-based care and the other as something that justifies permanent medical alteration of a healthy body?

Reality-based care is the care that works the best at treating the symptoms. You just don’t think it is real. You aren’t basing this on data. It is a religious dogma that the Church came up with a few decades ago.

1 hour ago, smac97 said:

I agree that some people report short-term relief from gender-affirming treatments for body dysphoria — that’s not in dispute. The deeper questions are:

1. Net long-term benefit — Does it resolve the distress sustainably, or does it often mask comorbidities (autism, trauma, mental health issues) while introducing irreversible harms (sterility, sexual dysfunction, bone loss, cardiovascular risks, regret/detransition)? Evidence reviews like the Cass Review found the quality of studies claiming benefit to be very low, with weak follow-up data.

Yes, the distress is sustainably reduced. That is the overwhelming evidence. One heavily politicized review making recommendations on TERF island does not refute the consensus of the rest of the developed world.

1 hour ago, smac97 said:

1. Ethical consistency — BIID (body integrity dysphoria) patients also report profound relief from amputation, and some “otherkin” or species dysphoric people seek extreme cosmetic alterations. We don’t generally affirm those by amputating healthy limbs or performing radical surgeries because the body is healthy and the distress is psychological. The principle is the same: treating a disorder of perception by mutilating a functional body is ethically fraught, especially in minors where desistance is common.

Oh for the Love of Zeus. You are arguing we shouldn’t use an effective treatment because we don’t use the same treatment in analogous situations and that this is somehow based on ethics? What? Ethics in medicine isn’t scripture where there is some divine imperative we have to be consistent about. It is decided based on a cost/benefit analysis of potential benefits and harms.

1 hour ago, smac97 said:

If the treatments were clearly safe, effective, and curative with strong evidence, this wouldn’t be so contested. The surge in adolescent females, high comorbidity rates, and European retreats from routine affirmation suggest caution is warranted over affirmation-as-first-line.

It is contested because people hate transgender people. That is like arguing that segregation must be necessary because if getting rid of it was so good it wouldn’t be contested. Plus I have seen a lot of the stuff contesting it and it often comes down to nothing.

1 hour ago, smac97 said:

Where do you see the ethical stopping point for medically altering healthy bodies to match subjective identity?

I favor bodily autonomy in general. I also do not concede that identity is subjective. 

1 hour ago, smac97 said:

Many medical treatments are irreversible — that’s why the ethical bar is high. We don’t perform them lightly on healthy tissue for psychological conditions.

They aren’t performed lightly. The medicine behind it was built up slowly over decades. You are still trying to catch up because propagandists told you it was bad and you ignored it until they did.

1 hour ago, smac97 said:

Also, the line is not "weird."  Rather, it is standard medical ethics: primum non nocere (first, do no harm) and proportionality. We accept irreversible interventions in particularized circumstances:

• There’s a clear physical pathology (e.g., cancer, severe injury).
• Benefits demonstrably outweigh harms with strong evidence.
• Less invasive options have been exhausted.

Yep, meets that criteria.

1 hour ago, smac97 said:

Removing healthy breasts/testicles/penis in a minor (or adult) with gender dysphoria fails that test for many cases. The body parts are functionally healthy. Evidence for long-term mental health benefit is weak (per Cass Review and others), while harms (sterility, loss of sexual function, bone density issues, surgical complications, regret) are substantial and permanent. Comorbidities like autism, trauma, or social contagion are common, especially in rapid-onset adolescent cases.

Wrong.

Rapid onset cases are pseudoscience. Stop pretending you are discussing medicine and then drag in discredited theories with no evidential backing.

1 hour ago, smac97 said:

Compare all this to to BIID (amputating healthy limbs), anorexia (endorsing starvation), or species dysphoria. We reject those despite reported distress relief because altering a healthy body to match a subjective perception is ethically problematic. The same principle applies here.

Nope.

1 hour ago, smac97 said:

Again, if the data showed clear, sustained benefit with minimal risk, I would reassess. Right now, it doesn’t for most youth. That’s why European countries have sharply restricted these interventions.

What makes this case different enough to justify the exception?

No — quite the opposite.

 

1 hour ago, smac97 said:

People with autism, trauma, or other comorbidities deserve the highest standard of care, not rushed medicalization that may entrench problems or create new ones (sterility, sexual dysfunction, surgical complications). Exploratory therapy and comprehensive assessment aren’t “infantilizing” — they are responsible medicine. We do this for other conditions with high comorbidity (e.g., eating disorders, self-harm, OCD) because adolescents’ brains are still developing, desistance rates can be high, and long-term data on these interventions is weak.

It is not rushed medicalization. Again, that you just recently found out about this does not mean there isn’t data about it. And yes, you are infantilizing them.

And no, data on interventions is not weak no matter how regularly you hold to that evidenceless dogma.

1 hour ago, smac97 said:

The Cass Review and European shifts highlighted exactly this: Many gender-distressed youth have co-occurring issues that should be addressed first. “Bodily autonomy” for minors doesn’t mean affirming every request for irreversible procedures on healthy organs. Parents and doctors have a duty to protect kids from decisions they may regret when older — especially when social contagion, peer influence, and mental health factors are prominent in the recent surge of adolescent females.

So we can’t do anything until we can “cure” autism. Yeah, no, that is not how anything works. You are just looking for any roadblock that sounds plausible.

1 hour ago, smac97 said:

Supporting therapy-first isn’t denying autonomy or compassion. It’s prioritizing evidence-based care over ideology. Dismissing concerns as “yikes” doesn’t address the data on comorbidities or outcomes.

The evidence is that therapy DOES NOT provide more than a minimal benefit. Evidence-based care based on evidence that it doesn’t work.

Smac Medicine: Using Leeches Since 861!

1 hour ago, smac97 said:

What evidence convinces you that immediate medicalization is the prudent path for these complex cases?

Exploratory therapy isn’t “LOL."  It is the approach increasingly recommended by systematic reviews because the affirmative model has weak evidence.

Nope.

1 hour ago, smac97 said:

The Cass Review (UK, 2024) and similar European analyses found that routine therapy was often inadequate or bypassed under the affirmative model, with poor assessment of comorbidities (autism, trauma, same-sex attraction, social influence). Many clinics moved to “informed consent” or very brief evaluations. Long-term studies on medical transition show mixed or modest mental health benefits, persistent high suicide risk, and significant regret/detransition rates in some cohorts. 

We have not seen evidence supporting the supposed slam-dunk “it works” narrative.  Countries like Sweden, Finland, UK, and Norway didn’t shift to restrictions because therapy “doesn’t work” (or because of religious sentiments).  They did so because the evidence for puberty blockers/hormones/surgery in minors is low-quality, risks are substantial, and desistance is common with watchful waiting + therapy. The sharp rise in adolescent females (post-social media) particularly suggests many cases involve social/contagion factors or underlying issues therapy can address.

Wrong.

1 hour ago, smac97 said:

I’m not saying stop all medical transition forever. I’m saying don’t rush irreversible interventions on healthy minors when exploratory therapy, addressing root causes, and time often lead to better outcomes. That’s not anti-compassion — it’s evidence-based caution. The “transphobes screaming” line is a strawman; serious concerns come from clinicians, detransitioners, and reviews showing the affirmative approach failed many kids.

It is you meddling in things you don’t understand and showing a lack of compassion by doing so.

1 hour ago, smac97 said:

The distinction isn’t “icky/sinful vs. not” or an ad hoc religious invention. It’s grounded in clinical medicine and biology, which I have presented consistently.

You peddle pseudoscience and fringe theories. You are not good at this.

1 hour ago, smac97 said:

Gynecomastia/pseudogynecomastia surgery corrects a physical deviation from normal male chest anatomy (excess glandular tissue or fat in a male body). The intervention restores typical male secondary sex characteristics. Emotional distress is a common reason for many reconstructive procedures — that doesn’t make the underlying issue subjective identity.

That is exactly what it makes it. Otherwise why have the surgery. To conform to gender norms even though the person getting the surgery doesn’t care if they match those norms? That would be pretty horrific.

1 hour ago, smac97 said:

“Gender-affirming” mastectomy removes healthy, normal female breast tissue to oppose female physiology and approximate a male appearance based on felt identity. The tissue is not pathological; the body is functioning as designed for its sex. This is not corrective in the same way.

It is not corrective in a way your religious views allow.

1 hour ago, smac97 said:

Scripture informs my broader worldview (including the sanctity of the body and sex as part of God’s design per the Proclamation on the Family), but the clinical distinction stands on its own: one aligns with biological reality, the other rejects it by altering healthy organs. That’s why European reviews (Cass, etc.) and medical ethics emphasize caution with the latter, especially in minors.

Nope.

1 hour ago, smac97 said:

If the evidence showed equivalent outcomes and low risk for both, the comparison might hold. It doesn’t. Dismissing the biological line as mere religion avoids engaging with the data on desistance, comorbidities, and long-term harms.

It does actually. You have repeatedly insisted that there isn’t enough data on long-term harm (so sayeth the HOLY CASS REPORT). Now it is suddenly enough to draw conclusions from. You don’t have any consistent positions. You just throw everything at the wall in any combination you think might be plausible without any notion of consistency and just hope it sticks.

One moment data on long term effect are insufficient so we shouldn’t act. In another moment it shows consistent long term harm. Which is it? You want to argue that you are compassionate but you want to reject a treatment that improves quality of life for one that provides minimal or no benefit.

I’ve seen this before. During the days when conversion therapy for gay people consistently didn’t work but some groups wanted to keep trying because the alternative of accepting that it was largely immutable was abhorrent so instead of allowing them to exist and do their own thing they pushed for even more conversion therapy hoping it would eventually work or they could keep pretending it might because the alternative is unpleasant. The desperate attempts to find some fundamental and clear difference in race to justify segregation went down the same road with the endless repetition of pseudoscience and discredited theories to try to provide a rational basis for what was an emotionally driven distaste. That is the problem. You are defending an emotional position and not a rational one.

All of this has happened before….and it will all happen again.

[smac97]

1 hour ago, The Nehor said:

Uhhh no, the reason you develop those gametes is due to hormones when young. Also it is probably only a matter of time before we can change that as well. So it is more of a skill issue.

Variations within a strict binary system means it is not a strict binary. You continue to deliberately ignore this.

Thank you for sharing your thoughts.  A few further comments:

Hormones trigger and regulate gamete production, but they don’t create the underlying developmental pathway or redefine sex.

The binary is established at conception by genetics (XX vs. XY) and the SRY gene on the Y chromosome, which directs the undifferentiated gonad to become testes (leading to testosterone and sperm pathway) or ovaries (leading to eggs). Hormones are downstream effectors, not the root cause. Altering hormones later (cross-sex hormones) changes secondary traits and suppresses gamete production, but it does not rewire the body to produce the opposite gamete. A biological male on estrogen doesn’t produce eggs; a biological female on testosterone doesn’t produce sperm. That’s not a “skill issue” — it’s immutable reproductive biology.

Disorders of sexual development (DSDs/intersex) are variations or malfunctions within the binary, not a third sex. They don’t produce a third gamete type. No human reproductive system produces both functional sperm and eggs, or a novel gamete. That’s why biologists define sex by the binary gamete system: small (male) or large (female). Variations don’t erase the binary any more than birth defects erase the fact that humans are bipedal.

The core point stands: gynecomastia surgery corrects a deviation toward typical male physiology. Gender-affirming mastectomy alters healthy female physiology away from it. One is corrective; the other is not.

I am curious about your perspective on this point.  If sex is so malleable, why can’t medical transition produce functional opposite-sex gametes or reproductive capacity?

1 hour ago, The Nehor said:

The difference is whether the treatment WORKS!!!!! The objective of medicine is to reduce suffering and increase human flourishing and all that. That is the question.

You are trying to make it about everything sticking to your idea of a sexual binary. The fact that someone is happier can be sacrificed to the idea of you holding on to a strict binary shows that your approach isn’t ethical.

Reducing suffering and increasing flourishing is exactly the goal — which is why evidence matters so much.

If “gender-affirming” medical interventions reliably worked long-term with acceptable risks, that would be a strong argument. But the data (Cass Review, European health authorities, recent HHS evidence summary, and long-term studies) shows weak evidence of sustained mental health benefit, persistent elevated suicide risk, significant irreversible harms (sterility, sexual dysfunction, bone loss, cardiovascular issues), and growing reports of regret/detransition — especially in the rapid-onset adolescent cohort with high comorbidities.

"Whether the treatment works" is a pivotal concern.  That said, we do not evaluate treatments solely by short-term self-reported happiness. We weigh net outcomes, desistance rates, and whether we’re addressing root causes or entrenching a perception by altering healthy bodies. That’s why we don’t affirm anorexia with starvation, amputate healthy limbs for BIID, or perform other body-modifying procedures for psychological conditions despite reported relief. The ethical standard is “do no harm” plus strong evidence, not just subjective flourishing.

The binary isn’t my personal idea, it is observable reproductive biology (two gametes, two sexes). Interventions can approximate secondary traits, but they do not change that underlying reality. Prioritizing caution for minors isn’t sacrificing happiness to ideology; it’s protecting vulnerable kids from experimental paths with poor evidence. European countries reached the same conclusion based on the data, not theology.

If the long-term evidence robustly supported net benefit, I would reassess. Right now, it doesn’t for most youth. That’s the ethical heart of the disagreement.

1 hour ago, The Nehor said:

The increased quality of life is the data.

Increased quality of life is the goal, not the data.

Self-reported short-term satisfaction or “quality of life” improvements exist in some studies, but that’s not the same as robust, long-term evidence of net benefit. The Cass Review, European systematic reviews, and other analyses found the overall evidence base for puberty blockers, cross-sex hormones, and surgeries in minors to be remarkably weak — poor study quality, short follow-up, failure to account for comorbidities, and no good control groups. Suicide rates remain elevated post-transition, desistance is common (especially pre-pubertal), and regret/detransition data is underreported but growing.

We don’t accept “it makes them feel better short-term” as sufficient for other irreversible interventions on healthy bodies (e.g., BIID amputations, anorexia affirmation). The ethical threshold requires strong evidence that benefits outweigh harms long-term.

If you have high-quality, long-term studies showing clear, sustained reductions in suffering, improved functioning, and minimal regret for the current cohort of mostly adolescent females, I would genuinely like to see them. The existing data drove multiple European countries to restrict these interventions. That’s not ideology — it’s following the evidence.

Where specifically do you see the strong data for medicalizing healthy adolescent bodies?

Quote

Quote

That’s exactly the point.  In anorexia, we do not affirm the distorted perception by helping the person starve or surgically alter their body to match the delusion. We treat the underlying psychological condition with therapy, nutritional rehabilitation, and support — even when the patient experiences intense distress and insists the thin ideal would “relieve” their symptoms.

Except that medical (and other forms of transitioning) does often relieve the symptoms. You continue to ignore this. That is the point. When it relieves the symptoms it means the treatment is working. Starvation doesn’t help with anorexia. Transitioning works very well in most cases. It helps. Talk therapy has minimal benefits. You want to get rid of the treatment that seems to be the most successful in favor of the one that doesn’t.

You are the joke in a lot of transgender memes that go along the lines of:

”Wow, I am happier now and more comfortable in my own skin. I hope this lasts forever.”

”But aren’t you worried this might be irreversible?”

I’m not ignoring reported relief.  Some people do experience short-term improvement in dysphoria after transition. The issue is whether it’s sustained, net positive long-term, with acceptable risks. 

So far, the evidence for this is poor.  The Cass Review, European health authorities, and systematic reviews found the evidence for puberty blockers, hormones, and surgery in minors to be low-quality: short follow-ups, weak controls, failure to address comorbidities, and no clear proof of lasting mental health gains. Suicide rates often remain elevated, desistance is common (especially with therapy/watchful waiting), and regret/detransition is understudied but real. “Works very well in most cases” is not supported by the rigorous data.

We do not judge treatments by short-term self-report alone. Anorexia patients can feel temporary “relief” from restriction, but we don’t affirm it because long-term outcomes are disastrous. I submit that the same caution applies, or should apply, when irreversibly altering healthy bodies (sterility, sexual dysfunction, bone loss, surgical complications).

Exploratory therapy isn’t “minimal benefit,” it is the approach recommended precisely because it addresses root causes (trauma, autism, social contagion, mental health) rather than rushing to medicalization. Multiple countries shifted to this model after reviewing the evidence.

The meme framing assumes the premise (transition = happiness forever). The data shows it’s more complicated, especially for the recent surge in adolescent females. Prioritizing evidence over ideology ought not be mocked, as it is responsible medicine.

Again, if you have high-quality, long-term studies showing clear superiority of medical transition over therapy-first for this cohort, I’d like to see them.

1 hour ago, The Nehor said:

Quote

The parallel with gender dysphoria is that we are often affirming a distorted perception of the body (by hormones and surgery on healthy tissue) rather than primarily addressing the psychological distress through therapy. Both involve body-image/identity issues where the “relief” from affirmation can be short-term and comes at the cost of entrenching the problem and introducing serious medical harms.

That is all nonsense. The relief is usually not short term and doesn’t introduce serious medical harms.

What I am referencing is not "nonsense."  It is what systematic evidence reviews show.  The Cass Review (2024), Swedish, Finnish, and other European analyses concluded that the evidence for sustained long-term benefit from puberty blockers, cross-sex hormones, and surgeries in minors is weak to very low quality. Many studies have short follow-up, high loss to follow-up, poor controls, and fail to account for comorbidities. Suicide rates frequently remain elevated post-transition. Desistance is common with therapy and time, especially in pre-pubertal children. Regret and detransition, while understudied, are documented and appear higher than earlier claims suggested.

Serious medical harms are well-established: sterility, loss of sexual function/orgasm, bone density loss, cardiovascular risks, surgical complications (stenosis, fistula, need for lifelong dilation), and unknown effects on brain development. These are not trivial.

Short-term relief in dysphoria or body image is reported by some, but that doesn’t prove net long-term flourishing. The same pattern occurs in other conditions where affirmation entrenches the issue (anorexia, certain body dysmorphias).

This is why multiple countries have sharply restricted youth medical transitions in favor of therapy-first approaches. It’s not denial of relief for some — it’s recognizing that the evidence does not support routine medicalization, especially for the recent surge in adolescent females with high rates of mental health issues.  And these countries did not do so based on religious sentiment, but rather based on the evidence.

If you have robust, long-term studies showing clear, sustained benefits outweighing those harms for most cases, I’d genuinely like to see them. The existing data drove the policy shifts in Europe.

1 hour ago, The Nehor said:

Quote

If the goal is genuine well-being, why would medical personnel treat one as a mental health issue requiring reality-based care and the other as something that justifies permanent medical alteration of a healthy body?

Reality-based care is the care that works the best at treating the symptoms. You just don’t think it is real. You aren’t basing this on data. It is a religious dogma that the Church came up with a few decades ago.

I have repeatedly noted substantial shifts in both Europe and the U.S., the former of which obviously is not acting based on "a religious dogma that the Church came up with a few decades ago."

The Cass Review, European systematic reviews (Sweden, Finland, UK, Norway), and the recent HHS evidence summary all concluded that the quality of evidence for puberty blockers, cross-sex hormones, and surgeries in minors is very weak. These countries are shifting to a therapy-first, exploratory approaches and restricted routine medicalization — especially for the recent surge in adolescent females with high comorbidities (autism, trauma, mental health issues). This approach is following the evidence, not dogma.

The Church’s teachings on sex and the body predate modern gender medicine by millennia and align with observable biology (binary gametes, reproductive roles). But the clinical reasoning stands independently.  We don’t generally treat psychological distress by permanently altering healthy organs when less invasive options exist. That principle applies whether the distress is gender-related, anorexia, BIID, or species dysphoria.

If the high-quality, long-term data robustly showed medical transition as clearly superior for most youth, the European reversals wouldn’t have happened. Where specifically do you see the strong evidence that justifies routine permanent alteration of healthy adolescent bodies?

1 hour ago, The Nehor said:

Yes, the distress is sustainably reduced. That is the overwhelming evidence. One heavily politicized review making recommendations on TERF island does not refute the consensus of the rest of the developed world.

The Cass Review is not a “politicized TERF island” outlier — it is one of the most comprehensive independent systematic reviews ever conducted on this topic. It examined hundreds of studies and concluded the evidence for puberty blockers, hormones, and surgery in minors is of poor quality, with weak long-term data on benefits and significant risks.  Multiple other developed countries reached similar conclusions based on their own evidence reviews:

• Sweden, Finland, Norway, UK — all sharply restricted youth medical transitions in favor of therapy-first approaches.
• The WPATH Files and leaks from major gender clinics revealed internal doubts about the evidence and rushed care.
• Long-term studies (e.g., Swedish and Dutch cohorts) show elevated suicide rates post-transition, high comorbidity, and incomplete resolution of mental health issues.

If the “overwhelming evidence” showed clear, sustainable benefit with low regret, those countries wouldn’t have reversed course (and you would be presenting that evidence).  These things are not happening. Short-term relief in dysphoria is reported, but that doesn’t equal long-term flourishing or outweigh the irreversible harms (sterility, sexual dysfunction, bone density loss, etc.).

The consensus you mention was largely driven by advocacy-influenced guidelines (WPATH, Endocrine Society). The shift in Europe came from looking at the actual data more rigorously. That’s how science should work.

If you have specific high-quality, long-term studies showing sustained net benefit for the current cohort of mostly adolescent females, I’d genuinely like to see them.

1 hour ago, The Nehor said:

Oh for the Love of Zeus. You are arguing we shouldn’t use an effective treatment because we don’t use the same treatment in analogous situations and that this is somehow based on ethics? What? Ethics in medicine isn’t scripture where there is some divine imperative we have to be consistent about. It is decided based on a cost/benefit analysis of potential benefits and harms.

Cost/benefit analysis is central to medical ethics — which is exactly why the evidence matters so much.

If “gender-affirming” interventions showed clear, sustained net benefit with low regret and manageable harms, that would justify them. But systematic reviews (Cass Review, Swedish, Finnish, and others) found the evidence quality low to very low: weak long-term data, high loss to follow-up, failure to address comorbidities, and no good controls. Harms are substantial and irreversible (sterility, sexual dysfunction, bone loss, cardiovascular risks, surgical complications). Suicide rates often remain elevated. Desistance is common with therapy and time, especially in pre-pubertal kids. That’s a poor cost/benefit profile for routine use on healthy minors.

Consistency with similar conditions (BIID, anorexia, species dysphoria) is not “scripture,” but is rather a basic safeguard against confirmation bias. We don’t amputate healthy limbs for BIID despite reported relief, or affirm starvation for anorexia, because the body is healthy and the distress is psychological. The principle is the same here: we should be extremely cautious about permanently altering healthy adolescent bodies for a condition with high comorbidity and weak evidence.

European countries applied exactly this cost/benefit lens and restricted these treatments.  These countries are not being influenced by the particularized teachings of the Church.  They are following the data.

If you have high-quality, long-term studies showing strong net benefit for the current cohort (mostly adolescent females with comorbidities), I’d like to see them. The existing evidence drove the policy shifts.

1 hour ago, The Nehor said:

Quote

If the treatments were clearly safe, effective, and curative with strong evidence, this wouldn’t be so contested. The surge in adolescent females, high comorbidity rates, and European retreats from routine affirmation suggest caution is warranted over affirmation-as-first-line.

It is contested because people hate transgender people. That is like arguing that segregation must be necessary because if getting rid of it was so good it wouldn’t be contested. Plus I have seen a lot of the stuff contesting it and it often comes down to nothing.

Opposition isn’t driven by “hate for transgender people.” It’s driven by legitimate concerns about weak evidence, risks to minors, and the medicalization of healthy bodies.

The surge in adolescent females (a demographic shift unlike anything in prior history), very high rates of comorbidities (autism, trauma, mental health issues), social contagion factors, and desistance rates make this different from prior cases. European countries (UK via Cass Review, Sweden, Finland, Norway) didn’t restrict youth transitions because they “hate trans people” — they did so after systematic evidence reviews found the data for puberty blockers, hormones, and surgery in minors to be low-quality, with uncertain benefits and known harms (sterility, sexual dysfunction, bone loss, etc.).  Europe as been the epicenter for medicalized approaches to Gender Dysphoria, and their approach is clearly secular/clinical, not religious, so developments there should matter.

Your segregation analogy doesn’t fit. Segregation was overturned with overwhelming evidence of harm and no medical controversy. Here, multiple independent reviews (not fringe sources) raised serious questions about safety and efficacy for children. That’s why the debate exists.

Dismissing concerns as “hate” or “nothing” avoids engaging with the actual data: Cass, WPATH Files, detransitioner testimonies, and the policy reversals in Europe. If the evidence were as strong as claimed, those countries wouldn’t have changed course.

What specific high-quality, long-term studies convince you that routine medicalization is the right first-line approach for most of today’s youth cohort?

1 hour ago, The Nehor said:

Quote

Where do you see the ethical stopping point for medically altering healthy bodies to match subjective identity?

I favor bodily autonomy in general.

So do I, but that was not my question.  Do you see any ethical "stopping point" at all?

1 hour ago, The Nehor said:

I also do not concede that identity is subjective. 

Well, that's an interesting perspective.  Could you elaborate?

1 hour ago, The Nehor said:

Quote

Many medical treatments are irreversible — that’s why the ethical bar is high. We don’t perform them lightly on healthy tissue for psychological conditions.

They aren’t performed lightly. The medicine behind it was built up slowly over decades.

I am curious why you think so much of Europe has radially altered course on this.

1 hour ago, The Nehor said:

Quote

Also, the line is not "weird."  Rather, it is standard medical ethics: primum non nocere (first, do no harm) and proportionality. We accept irreversible interventions in particularized circumstances:

• There’s a clear physical pathology (e.g., cancer, severe injury).
• Benefits demonstrably outweigh harms with strong evidence.
• Less invasive options have been exhausted.

Yep, meets that criteria.

It does not meet the criteria for most cases.  There is no clear physical pathology in the breasts, genitals, or endocrine system of gender-dysphoric minors — the organs are healthy and functioning as designed for their sex. The distress is psychological.

Evidence reviews (Cass, European systematic analyses, HHS) show the quality of data for long-term benefit is low, while harms (sterility, sexual dysfunction, bone loss, cardiovascular risks) are substantial and irreversible. Less invasive options (exploratory therapy addressing comorbidities) are often bypassed.

That’s why multiple countries restricted these interventions. The ethical bar for operating on healthy adolescent bodies is (and should be) high.

1 hour ago, The Nehor said:

Wrong.

Rapid onset cases are pseudoscience. Stop pretending you are discussing medicine and then drag in discredited theories with no evidential backing.

Rapid-onset gender dysphoria (ROGD) is not pseudoscience. It’s a descriptive term for the well-documented epidemiological shift: a sharp increase in adolescent-onset cases (especially natal females) with little or no childhood history, often in clusters, after heavy social media exposure, and with high rates of comorbidities (autism, trauma, mental health issues).

This pattern was noted in clinical practice and parental reports, then studied (Littman 2018 and follow-ups). The Cass Review and European evidence summaries explicitly acknowledged social influence and peer contagion as plausible contributors to the surge. That’s why those countries moved away from routine affirmation toward therapy-first models.

Dismissing it as “discredited” doesn’t erase the data: the demographic flip, explosion in referrals (thousands of percent in some clinics), friendship-group clustering, and the timing with social media. These are observable facts needing explanation. “Social contagion” is a neutral hypothesis for part of the increase — not a claim that all trans identities are fake.

The medicine here is contested precisely because the evidence for medicalization in this new cohort is weak. That’s not ideology — it’s what systematic reviews found.

1 hour ago, The Nehor said:

Quote

I’m not saying stop all medical transition forever. I’m saying don’t rush irreversible interventions on healthy minors when exploratory therapy, addressing root causes, and time often lead to better outcomes. That’s not anti-compassion — it’s evidence-based caution. The “transphobes screaming” line is a strawman; serious concerns come from clinicians, detransitioners, and reviews showing the affirmative approach failed many kids.

It is you meddling in things you don’t understand and showing a lack of compassion by doing so.

I am not meddling.  I am engaging with the actual evidence and clinical reality.

The Cass Review, European systematic reviews, detransitioner testimonies, and whistleblowers from gender clinics all raised serious concerns about rushed affirmation, weak long-term data, comorbidities, and harms to minors. Those aren’t fringe opinions; they drove policy changes in the UK, Sweden, Finland, Norway, and elsewhere toward therapy-first approaches.

Caring about protecting kids from experimental medicalization on healthy bodies (especially with high desistance rates and comorbidities like autism and trauma) is not a lack of compassion. It is caution grounded in the data. Dismissing those concerns as “meddling” or “incomprehension” avoids the substance.  Genuine compassion means following the best available evidence, not ideology.

If the long-term outcomes were clearly positive with minimal risk, the European retreats would not have happened.

1 hour ago, The Nehor said:

Quote

People with autism, trauma, or other comorbidities deserve the highest standard of care, not rushed medicalization that may entrench problems or create new ones (sterility, sexual dysfunction, surgical complications). Exploratory therapy and comprehensive assessment aren’t “infantilizing” — they are responsible medicine. We do this for other conditions with high comorbidity (e.g., eating disorders, self-harm, OCD) because adolescents’ brains are still developing, desistance rates can be high, and long-term data on these interventions is weak.

It is not rushed medicalization. Again, that you just recently found out about this does not mean there isn’t data about it. And yes, you are infantilizing them.

From the previously-cited article:

Quote

Then American medical providers took this narrow protocol and went hog wild. They tossed aside rigorous psychosocial assessments and instead prioritized access. By 2018, it became Boston Children’s Hospital’s policy, for example, to provide minors seeking gender-transition drugs with only a two-hour appointment with a psychologist to determine whether to refer the child to a medication specialist.

Two hours seems rushed.

1 hour ago, The Nehor said:

And no, data on interventions is not weak no matter how regularly you hold to that evidenceless dogma.

I would be happy to consider the data you are referencing here.

1 hour ago, The Nehor said:

Quote

Supporting therapy-first isn’t denying autonomy or compassion. It’s prioritizing evidence-based care over ideology. Dismissing concerns as “yikes” doesn’t address the data on comorbidities or outcomes.

The evidence is that therapy DOES NOT provide more than a minimal benefit. 

Again, I am happy to consider whatever data it is you have which you feel supports your position.

I don't think you have such data, though, as you would have posted it by now.  

Thanks,

-Smac

[The Nehor]

2 hours ago, smac97 said:

Thank you for sharing your thoughts.  A few further comments:

Hormones trigger and regulate gamete production, but they don’t create the underlying developmental pathway or redefine sex.

The binary is established at conception by genetics (XX vs. XY) and the SRY gene on the Y chromosome, which directs the undifferentiated gonad to become testes (leading to testosterone and sperm pathway) or ovaries (leading to eggs). Hormones are downstream effectors, not the root cause. Altering hormones later (cross-sex hormones) changes secondary traits and suppresses gamete production, but it does not rewire the body to produce the opposite gamete. A biological male on estrogen doesn’t produce eggs; a biological female on testosterone doesn’t produce sperm. That’s not a “skill issue” — it’s immutable reproductive biology.

Disorders of sexual development (DSDs/intersex) are variations or malfunctions within the binary, not a third sex. They don’t produce a third gamete type. No human reproductive system produces both functional sperm and eggs, or a novel gamete. That’s why biologists define sex by the binary gamete system: small (male) or large (female). Variations don’t erase the binary any more than birth defects erase the fact that humans are bipedal.

The core point stands: gynecomastia surgery corrects a deviation toward typical male physiology. Gender-affirming mastectomy alters healthy female physiology away from it. One is corrective; the other is not.

I am curious about your perspective on this point.  If sex is so malleable, why can’t medical transition produce functional opposite-sex gametes or reproductive capacity?

Give it a few more decades. We might have been there or at least be much closer by now if the Nazis hadn’t destroyed most transgender research as one of their first acts in power.

2 hours ago, smac97 said:

Reducing suffering and increasing flourishing is exactly the goal — which is why evidence matters so much.

If “gender-affirming” medical interventions reliably worked long-term with acceptable risks, that would be a strong argument. But the data (Cass Review, European health authorities, recent HHS evidence summary, and long-term studies) shows weak evidence of sustained mental health benefit, persistent elevated suicide risk, significant irreversible harms (sterility, sexual dysfunction, bone loss, cardiovascular issues), and growing reports of regret/detransition — especially in the rapid-onset adolescent cohort with high comorbidities.

"Whether the treatment works" is a pivotal concern.  That said, we do not evaluate treatments solely by short-term self-reported happiness. We weigh net outcomes, desistance rates, and whether we’re addressing root causes or entrenching a perception by altering healthy bodies. That’s why we don’t affirm anorexia with starvation, amputate healthy limbs for BIID, or perform other body-modifying procedures for psychological conditions despite reported relief. The ethical standard is “do no harm” plus strong evidence, not just subjective flourishing.

The binary isn’t my personal idea, it is observable reproductive biology (two gametes, two sexes). Interventions can approximate secondary traits, but they do not change that underlying reality. Prioritizing caution for minors isn’t sacrificing happiness to ideology; it’s protecting vulnerable kids from experimental paths with poor evidence. European countries reached the same conclusion based on the data, not theology.

If the long-term evidence robustly supported net benefit, I would reassess. Right now, it doesn’t for most youth. That’s the ethical heart of the disagreement.

You are just wrong about the evidence.

2 hours ago, smac97 said:

Increased quality of life is the goal, not the data.

Self-reported short-term satisfaction or “quality of life” improvements exist in some studies, but that’s not the same as robust, long-term evidence of net benefit. The Cass Review, European systematic reviews, and other analyses found the overall evidence base for puberty blockers, cross-sex hormones, and surgeries in minors to be remarkably weak — poor study quality, short follow-up, failure to account for comorbidities, and no good control groups. Suicide rates remain elevated post-transition, desistance is common (especially pre-pubertal), and regret/detransition data is underreported but growing.

We don’t accept “it makes them feel better short-term” as sufficient for other irreversible interventions on healthy bodies (e.g., BIID amputations, anorexia affirmation). The ethical threshold requires strong evidence that benefits outweigh harms long-term.

If you have high-quality, long-term studies showing clear, sustained reductions in suffering, improved functioning, and minimal regret for the current cohort of mostly adolescent females, I would genuinely like to see them. The existing data drove multiple European countries to restrict these interventions. That’s not ideology — it’s following the evidence.

No you wouldn’t. You would dismiss it or pull a quote from the Cass Report and declare victory. I am operating on an abundance of evidence. You have to cherry-pick. But fine, her is a 40 year follow-up study:

https://pubmed.ncbi.nlm.nih.gov/36149983/

Sweden reportedly made some conclusions based on this study which had to issue a correction:

https://segm.org/ajp_correction_2020

And have a systematic review of all peer-reviewed studies in English to pull out a larger picture:

https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

I could post dozens more if I thought it would help but a simple Google search would get you a lot of the same data.

2 hours ago, smac97 said:

Where specifically do you see the strong data for medicalizing healthy adolescent bodies?

 

2 hours ago, smac97 said:

I’m not ignoring reported relief.  Some people do experience short-term improvement in dysphoria after transition. The issue is whether it’s sustained, net positive long-term, with acceptable risks. 

And the data shows that it is.

2 hours ago, smac97 said:

So far, the evidence for this is poor.  The Cass Review, European health authorities, and systematic reviews found the evidence for puberty blockers, hormones, and surgery in minors to be low-quality: short follow-ups, weak controls, failure to address comorbidities, and no clear proof of lasting mental health gains. Suicide rates often remain elevated, desistance is common (especially with therapy/watchful waiting), and regret/detransition is understudied but real. “Works very well in most cases” is not supported by the rigorous data.

Wrong. Just wrong. Totally wrong. A simple Google search would verify that. Even most AI is smart enough to answer that.

2 hours ago, smac97 said:

We do not judge treatments by short-term self-report alone. Anorexia patients can feel temporary “relief” from restriction, but we don’t affirm it because long-term outcomes are disastrous. I submit that the same caution applies, or should apply, when irreversibly altering healthy bodies (sterility, sexual dysfunction, bone loss, surgical complications).

You don’t judge them by any standard of evidence. You have just decided it has a negative effect.

2 hours ago, smac97 said:

Exploratory therapy isn’t “minimal benefit,” it is the approach recommended precisely because it addresses root causes (trauma, autism, social contagion, mental health) rather than rushing to medicalization. Multiple countries shifted to this model after reviewing the evidence.

None of those are known to be a cause of gender dysphoria. You’re just making things up.

To what model? What are you even talking about? What nations have abandoned medical transition entirely in favor of talk therapy? You are taking mostly minor changes in how some nations deal with pediatric cases and generalizing to an absurd degree.

2 hours ago, smac97 said:

The meme framing assumes the premise (transition = happiness forever). The data shows it’s more complicated, especially for the recent surge in adolescent females. Prioritizing evidence over ideology ought not be mocked, as it is responsible medicine.

Again, if you have high-quality, long-term studies showing clear superiority of medical transition over therapy-first for this cohort, I’d like to see them.

I posted a bunch above. You can find more with a simple Google search. Go nuts.

2 hours ago, smac97 said:

What I am referencing is not "nonsense."  It is what systematic evidence reviews show.  The Cass Review (2024), Swedish, Finnish, and other European analyses concluded that the evidence for sustained long-term benefit from puberty blockers, cross-sex hormones, and surgeries in minors is weak to very low quality. Many studies have short follow-up, high loss to follow-up, poor controls, and fail to account for comorbidities. Suicide rates frequently remain elevated post-transition. Desistance is common with therapy and time, especially in pre-pubertal children. Regret and detransition, while understudied, are documented and appear higher than earlier claims suggested.

Serious medical harms are well-established: sterility, loss of sexual function/orgasm, bone density loss, cardiovascular risks, surgical complications (stenosis, fistula, need for lifelong dilation), and unknown effects on brain development. These are not trivial.

Short-term relief in dysphoria or body image is reported by some, but that doesn’t prove net long-term flourishing. The same pattern occurs in other conditions where affirmation entrenches the issue (anorexia, certain body dysmorphias).

This is why multiple countries have sharply restricted youth medical transitions in favor of therapy-first approaches. It’s not denial of relief for some — it’s recognizing that the evidence does not support routine medicalization, especially for the recent surge in adolescent females with high rates of mental health issues.  And these countries did not do so based on religious sentiment, but rather based on the evidence.

If you have robust, long-term studies showing clear, sustained benefits outweighing those harms for most cases, I’d genuinely like to see them. The existing data drove the policy shifts in Europe.

Fine, look at the studies.

2 hours ago, smac97 said:

I have repeatedly noted substantial shifts in both Europe and the U.S., the former of which obviously is not acting based on "a religious dogma that the Church came up with a few decades ago."

The Cass Review, European systematic reviews (Sweden, Finland, UK, Norway), and the recent HHS evidence summary all concluded that the quality of evidence for puberty blockers, cross-sex hormones, and surgeries in minors is very weak. These countries are shifting to a therapy-first, exploratory approaches and restricted routine medicalization — especially for the recent surge in adolescent females with high comorbidities (autism, trauma, mental health issues). This approach is following the evidence, not dogma.

No, they didn’t and you asserting it isn’t making it so.

2 hours ago, smac97 said:

The Church’s teachings on sex and the body predate modern gender medicine by millennia and align with observable biology (binary gametes, reproductive roles). But the clinical reasoning stands independently.  We don’t generally treat psychological distress by permanently altering healthy organs when less invasive options exist. That principle applies whether the distress is gender-related, anorexia, BIID, or species dysphoria.

No.

2 hours ago, smac97 said:

If the high-quality, long-term data robustly showed medical transition as clearly superior for most youth, the European reversals wouldn’t have happened. Where specifically do you see the strong evidence that justifies routine permanent alteration of healthy adolescent bodies?

Why is it that changes you like are automatically free of political bias while those you disagree with are monstrous perversions of the system? It is almost as if you make that decision based entirely on whether it agrees with you.

2 hours ago, smac97 said:

The Cass Review is not a “politicized TERF island” outlier — it is one of the most comprehensive independent systematic reviews ever conducted on this topic. It examined hundreds of studies and concluded the evidence for puberty blockers, hormones, and surgery in minors is of poor quality, with weak long-term data on benefits and significant risks.  Multiple other developed countries reached similar conclusions based on their own evidence reviews:

• Sweden, Finland, Norway, UK — all sharply restricted youth medical transitions in favor of therapy-first approaches.
• The WPATH Files and leaks from major gender clinics revealed internal doubts about the evidence and rushed care.
• Long-term studies (e.g., Swedish and Dutch cohorts) show elevated suicide rates post-transition, high comorbidity, and incomplete resolution of mental health issues.

If the “overwhelming evidence” showed clear, sustainable benefit with low regret, those countries wouldn’t have reversed course (and you would be presenting that evidence).  These things are not happening. Short-term relief in dysphoria is reported, but that doesn’t equal long-term flourishing or outweigh the irreversible harms (sterility, sexual dysfunction, bone density loss, etc.).

Repeating the same thing over and over is so pathetic.

2 hours ago, smac97 said:

The consensus you mention was largely driven by advocacy-influenced guidelines (WPATH, Endocrine Society). The shift in Europe came from looking at the actual data more rigorously. That’s how science should work.

Nope.

2 hours ago, smac97 said:

If you have specific high-quality, long-term studies showing sustained net benefit for the current cohort of mostly adolescent females, I’d genuinely like to see them.

But not enough to Google them?

2 hours ago, smac97 said:

Cost/benefit analysis is central to medical ethics — which is exactly why the evidence matters so much.

If “gender-affirming” interventions showed clear, sustained net benefit with low regret and manageable harms, that would justify them. But systematic reviews (Cass Review, Swedish, Finnish, and others) found the evidence quality low to very low: weak long-term data, high loss to follow-up, failure to address comorbidities, and no good controls. Harms are substantial and irreversible (sterility, sexual dysfunction, bone loss, cardiovascular risks, surgical complications). Suicide rates often remain elevated. Desistance is common with therapy and time, especially in pre-pubertal kids. That’s a poor cost/benefit profile for routine use on healthy minors.

Consistency with similar conditions (BIID, anorexia, species dysphoria) is not “scripture,” but is rather a basic safeguard against confirmation bias. We don’t amputate healthy limbs for BIID despite reported relief, or affirm starvation for anorexia, because the body is healthy and the distress is psychological. The principle is the same here: we should be extremely cautious about permanently altering healthy adolescent bodies for a condition with high comorbidity and weak evidence.

European countries applied exactly this cost/benefit lens and restricted these treatments.  These countries are not being influenced by the particularized teachings of the Church.  They are following the data.

If you have high-quality, long-term studies showing strong net benefit for the current cohort (mostly adolescent females with comorbidities), I’d like to see them. The existing evidence drove the policy shifts.

Vain repetitions.

2 hours ago, smac97 said:

Opposition isn’t driven by “hate for transgender people.” It’s driven by legitimate concerns about weak evidence, risks to minors, and the medicalization of healthy bodies.

The surge in adolescent females (a demographic shift unlike anything in prior history), very high rates of comorbidities (autism, trauma, mental health issues), social contagion factors, and desistance rates make this different from prior cases. European countries (UK via Cass Review, Sweden, Finland, Norway) didn’t restrict youth transitions because they “hate trans people” — they did so after systematic evidence reviews found the data for puberty blockers, hormones, and surgery in minors to be low-quality, with uncertain benefits and known harms (sterility, sexual dysfunction, bone loss, etc.).  Europe as been the epicenter for medicalized approaches to Gender Dysphoria, and their approach is clearly secular/clinical, not religious, so developments there should matter.

I am not saying most transphobia is religiously motivated in Europe. I said your transphobia is religiously motivated. I don’t think in general it is religiously motivated. I think people are just uncomfortable with transgender people so they find justifications to back up their bigotry. For some that will be religion.

2 hours ago, smac97 said:

Your segregation analogy doesn’t fit. Segregation was overturned with overwhelming evidence of harm and no medical controversy. Here, multiple independent reviews (not fringe sources) raised serious questions about safety and efficacy for children. That’s why the debate exists.

You are absolutely and utterly wrong. Segregation was rooted in biology and trying to find a fundamental difference in races to justify its existence. The reason segregation began to fall legally was not primarily due to any moral advances. Part of it was that judges couldn’t find a key element to definitively differentiate between white and black people. When the binary was found wanting to thread that divide it became unenforceable. Another part was legislation and a lot of that legislation came because the Civil Right Movement was making life intolerable for the segregationist and (more importantly) costing the elite a lot of money.

2 hours ago, smac97 said:

2 hours ago, smac97 said:

So do I, but that was not my question.  Do you see any ethical "stopping point" at all?

Well, that's an interesting perspective.  Could you elaborate?

I am curious why you think so much of Europe has radially altered course on this.

It does not meet the criteria for most cases.  There is no clear physical pathology in the breasts, genitals, or endocrine system of gender-dysphoric minors — the organs are healthy and functioning as designed for their sex. The distress is psychological.

Evidence reviews (Cass, European systematic analyses, HHS) show the quality of data for long-term benefit is low, while harms (sterility, sexual dysfunction, bone loss, cardiovascular risks) are substantial and irreversible. Less invasive options (exploratory therapy addressing comorbidities) are often bypassed.

You are a broken record.

2 hours ago, smac97 said:

That’s why multiple countries restricted these interventions. The ethical bar for operating on healthy adolescent bodies is (and should be) high.

Rapid-onset gender dysphoria (ROGD) is not pseudoscience. It’s a descriptive term for the well-documented epidemiological shift: a sharp increase in adolescent-onset cases (especially natal females) with little or no childhood history, often in clusters, after heavy social media exposure, and with high rates of comorbidities (autism, trauma, mental health issues).

ROGD is junk science. It is a non-clinical diagnosis. It is not supported by evidence.

Here is a good article examining why it is unproven, where it came from, why the initial data that led to the hypothesis doesn’t work as evidence (which I have shared with you multiple times but you ignore it):

https://pmc.ncbi.nlm.nih.gov/articles/PMC11876199/

2 hours ago, smac97 said:

This pattern was noted in clinical practice and parental reports, then studied (Littman 2018 and follow-ups). The Cass Review and European evidence summaries explicitly acknowledged social influence and peer contagion as plausible contributors to the surge. That’s why those countries moved away from routine affirmation toward therapy-first models.

Dismissing it as “discredited” doesn’t erase the data: the demographic flip, explosion in referrals (thousands of percent in some clinics), friendship-group clustering, and the timing with social media. These are observable facts needing explanation. “Social contagion” is a neutral hypothesis for part of the increase — not a claim that all trans identities are fake.

The medicine here is contested precisely because the evidence for medicalization in this new cohort is weak. That’s not ideology — it’s what systematic reviews found.

I am not meddling.  I am engaging with the actual evidence and clinical reality.

The Cass Review, European systematic reviews, detransitioner testimonies, and whistleblowers from gender clinics all raised serious concerns about rushed affirmation, weak long-term data, comorbidities, and harms to minors. Those aren’t fringe opinions; they drove policy changes in the UK, Sweden, Finland, Norway, and elsewhere toward therapy-first approaches.

Caring about protecting kids from experimental medicalization on healthy bodies (especially with high desistance rates and comorbidities like autism and trauma) is not a lack of compassion. It is caution grounded in the data. Dismissing those concerns as “meddling” or “incomprehension” avoids the substance.  Genuine compassion means following the best available evidence, not ideology.

If the long-term outcomes were clearly positive with minimal risk, the European retreats would not have happened.

From the previously-cited article:

Two hours seems rushed.

I would be happy to consider the data you are referencing here.

Again, I am happy to consider whatever data it is you have which you feel supports your position.

I don't think you have such data, though, as you would have posted it by now.  

And a bunch more repetition of the same things over and over again because you do the line by line thing instead of discussing things holistically.

So………boring.

[longview]

22 hours ago, The Nehor said:

Give it a few more decades. We might have been there or at least be much closer by now if the Nazis hadn’t destroyed most transgender research as one of their first acts in power.

This is just foaming-in-the-mouth bizarre. Please CFR the historical evidence.

[The Nehor]

34 minutes ago, longview said:

This is just foaming-in-the-mouth bizarre. Please CFR the historical evidence.

History is bizarre. 

https://en.wikipedia.org/wiki/Institut_für_Sexualwissenschaft

https://blog.sciencemuseum.org.uk/magnus-hirschfeld-and-the-institute-for-sexual-science/

During the Weimar Republic this institute was studying gender and sexuality. They had a good working relationship with the Berlin police to help transgender people avoid legal harassment for “crossdressing” with medical certificates. They pioneered and adapted some basic gender-affirming treatments and surgeries (not the first such treatments, they go back to at least ancient Egypt). They had quite a few surgical techniques, treatments, and provided estrogen. Testosterone wasn’t synthesized until 1935 so wasn’t available but they did provide ftm treatments and surgeries.

The Nazis came to power in January 1933. Nazis attacked the institute in May. They burned the entire library that month. Some of the work was disseminated but a lot of it was lost. The Nazis started with vulnerable groups that almost no one would go to bat for. Plus the guy running it was a Jew. That makes it easier. Once you decide someone’s rights are actually privileges it is easy to move that line so that more and more people don’t deserve rights. Scattering that institute and destroying most of its research pushed back research on gender by decades.

All of this has happened before……

The Nazis came for the Jewish doctors, the trangender people, the gays, and the queers first because they judged (correctly) that almost no one would speak for them. Then they moved on to other groups.

 

Remember kids, it is always morally correct to punch a fascist.

 

Edit: One other thought. I think another reason the Nazis were so quick to hit the institute is that as fascism is primarily an emotional reaction to the Enlightenment and (classical) Liberalism its enemies and justifications are not rationally arrived at. Fascism is historically a philosophy for mediocre men who feel anxious or inferior about meeting the standards of masculinity and feel they have failed in some way. It tries to tell them that their failure is due to some other (Jews, Gays, immigrants, black people, some version of the deep state, etc.) Then it tries to tell these men they are great.

Since homosexuality is usually on the list of enemies and exalting men is part of the supposed goal you end up with a very homophobic but also deeply homoerotic political movement. This meant getting rid of any people associated with any kind of queerness was a top priority. If you are going to exalt men as uber-men and shoot for hypermasculinity it is easy to look very gay and being gay is bad. When you publish this you don’t want anyone to think anything queer is going on:

And when Rohm is training men like this:

It is homoerotic and homosocial all the way down. Women were there primarily there to create more men. Heterosexual activity is encouraged but homosocial relationships make the nation strong. Being friendly with women is often weakness.

You can see this in MAGA propaganda and rallies and right-wing influencers peddling.

Here is Tucker Carlson reaching out to men with anxiety about not measuring up with a few additions.Just watching the first few minutes should make it obvious what I am talking about.

This eyecandy is on a level with Heated Rivalry.

The same obsession with physical fitness the Nazis had repackaged. You get this with Pete Hegseth’s pathetic address to the military commanders about how important physical fitness is in the military as if it is the great strength of the US military. It is not. The US military’s superpower is its unparalleled logistical skills and decentralized command structure that works amazingly well in conventional conflicts but the current leader is worried more about how many pushups everyone can do. That is classic ‘illusion of strength’ propaganda. It is the kind of stuff Putin and other strongman leaders use.

Oh, and to be clear pretty much everything Tucker says in that video is ahistorical garbage.

If you prefer a more fun and hilarious version here you go. Note that no clips were added that are not in the real thing.

Oh, and that ridiculous device in the preview. Tucker sells those as a way to stimulate the testicles to produce more testoseterone. They aren’t even subtle about appealing to male insecurity.

 

Wow, I went on a for a while there. In short, punch fascists. Testicle tanning will not make you manly and I need to take a cold shower. To get rid of the fashy ideas. Get your mind out of the gutter.

Edited Sunday at 01:46 AM by The Nehor

[Calm]

2 hours ago, The Nehor said:

If you prefer a more fun and hilarious version here you go. Note that no clips were added that are not in the real thing.

 

I was honestly wondering if the first one was satire.  

[The Nehor]

9 hours ago, Calm said:

I was honestly wondering if the first one was satire.  

In any sane world it would be.