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Culture War Roundup for the week of November 7, 2022

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Is WPATH influential?

To a moderate extent, yes. They're not binding, and some jurisdictions actually prohibit some of their policies, but a lot of US-sphere medical practices will take it as the starting point, and the extent it exists as an organization with standards makes matters more billable. Some of that's probably the dog being wagged by its tail -- pre-2010-era trans stuff did reflect a lot of contradictory and not very well-considered rules (eg, requiring three months life experience before cross-hormone therapy basically required a lot of really bad attempts at passing in public) -- but it's hard to distinguish.

Are these guys influential within WPATH?

Hard to tell. Simply being a member of WPATH isn't that constrained; there's something like 4k members in the US, it's 225 USD/year (with discounts for low-income countries) and open to a wide variety of 'professionals' for voting membership, so that doesn't really much. On the other hand, Johnson is cited as an author in the draft SoCv8 (though, AFAICT not past SoCs), and Johnson, Wassersug both have research cited in the SoC.

((Willette isn't listed on the current membership directory or obviously cited on the research lists; the big connection here to WPATH seems to be a link to older research or public talks, but this could be the multiple author problem.))

It could be that they've played a longer-term role behind the scenes, or it could be that WPATH decision-makers already had the answer they wanted and just pointed to the first extant member who'd published anything adjacent to their target. I think part of the Red Tribe objection assumes at least in part the former (ie, that the casual treatment of therapies for trans-women are motivated in part by liking the side effects), but I don't think the latter would a high point even by the low standards of social science.

Is their behavior objectionable, and if so why?

I dunno. The fetish content is creepy, but 'people with a kink fantasize about legal acceptance of the kink' going into fantasies about a mandate isn't exactly unusual; if anything, it's bog-standard among free use and exhibitionists, and not unheard of elsewhere. On its own, I don't think it's terribly strong evidence favoring actually implementing such things, so much as it's something that the authors both desire and want to avoid the mental hoops of taking responsibility for desiring. Hypnosis kink and (among women) 'abduction' kink plays a pretty similar role, and there's even some pretty bog-standard gay furries who use a variant because they've got hangups about 'choosing' to be gay.

((That said, there's only a handful of furries that take to eunich/nullo/neutrois levels, and afaik none of them as trans-adjacent. Maybe Chris Goodwin?))

But it does raise serious questions about the strength of their research, especially given the relative lack of other researchers going after the same community (and... not exactly paranoid concerns that they've played a role in what other research that does exist). Weirdly fetishistic Q/A stories don't necessarily invalidate the same author doing conventional research, but I think there are serious data science problems with running one of these forums and using it as a data source, and that's if the author did actually disclose it.

If it is objectionable, has the system produced a reasonable response?

I don't think so, and perhaps worse, I'm not sure it can. I think the minimum for Red Tribe trust would involve some sort of moderately skeptical analysis of this stuff being taken seriously in public spaces, but there's not really a way for that to exist right now; academic research isn't going to publish (and probably shouldn't publish!) a 'hey, these guys are creepy weirdos with bad understandings of physical side effects to their interests', but more broadly no one sane's going to spend twenty years of their life on the matter on the off-chance that it becomes higher-profile.

((and I include myself as 'not sane' here))

But on the other hand, I'm not sure that the Red Tribe interest is in a reasonable response. WhiningCoil's self-described framework for this post below is that "These people want to mutilate and sterilize children." That's true in the strictest sense, but it's also The Worst Argument In the World, where expanded it becomes "These people (three of a dozen experts, plus the thousands of unaffiliated and unassociated doctors and shrinks doing the work) want to mutilate and sterilize (voluntarily) children (14-18-year-olds, which we do a variety of other not-exactly-great surgeries on)", in the same way that advocates for these policies are committing the same non-central fallacy when they compare the surgeries here to orchi or prostate removal for cancer treatment.

I'd expect that both WhiningCoil and the authors here would take similarly distinct positions on the availability of endometrial ablation as an option for sixteen-year-old women with extremely severe periods and no interest in reproduction (and actually doctors do!), even though the matter is clearly separate from trans stuff and from the sexual interests here, or even any externally visible modification.

On the gripping hand, there's a fun philosophical question about whether 20%+ of the voting population can be taxiomatically unreasonably on both the right and left, but the pragmatic side you kinda need a solution.

If the system has not produced a reasonable response, what's the appropriate way to talk about this here?

Dunno. I'd expect it would be helpful to focus more on the object level by WhiningCoil rather than repeating the vaguries, and to actually do some of his own homework for ChrisPratt, but that's kinda on the margins. I think ChrisPratt's pretty outright focused on the literal and central examples of sexual abuse of children, while WhiningCoil's concerns are far broader.

Plastic surgery (and other controversial elective surgeries like liposuction or bariatric surgery) exist, but they're controversial enough that they're not really good examples even if social conservatives don't really go after them with the same strength that they do (directly) sexual/sexuality stuff. Non-trans hysterectomy and endometrial ablation are similarly politically complicated, though in ways that don't break down into simple Red Tribe/Blue Tribe splits. And there are other 'cosmetic' plastic surgeries that are still pretty well-established for young patients that I wouldn't put into this category, like cleft lip repair.

But for a really outside-the-box example that isn't controversial because everyone accepts it, the current standard of care for all non-Becker's birthmarks over 20 cm, and for most other 'hairy' non-Becker's birthmarks over 2 cm, includes surgical removal or laser 'surgery' (basically high-power light therapy). This had a historic cause, since there's a small subclass of that may have an elevated chance of cancer, and historically for any birthmark in this class it was practical to remove, a meaningful biopsy was almost as invasive as the full surgery to remove it and nearby tissue.

We could now evaluate these in higher levels of fidelity without having to cut out large portions of tissue, so we could reduce the number of total surgeries being performed on minors. But the birthmarks do genuinely look pretty ugly, and they're very common targets for stigma and self-image problems, and surgery performed at younger ages tends to have better recovery and less obvious scarring than surgeries on older people (or, in the case of haemangiomas, can have less visually obvious scarring than what occurs as the haemangiomas naturally shrink and fade with age).

There seems a somewhat similar class of matters for some dental surgeries, where the results are aesthetically pleasing and have some ease-of-care benefits, but have complicated tradeoffs for health directly. I know less about that field, though.

So shines a good deed in a weary world.

On its own, I don't think it's terribly strong evidence favoring actually implementing such things, so much as it's something that the authors both desire and want to avoid the mental hoops of taking responsibility for desiring.

this... this is insightful. It connects to a whole lot of patterns I see in a lot of much more conventional lowbrow material; fanfic, pulp stories, web fiction and so on. Sort of a desire to offload moral responsibility to one's circumstances and surroundings. Most interesting.

I think part of the Red Tribe objection assumes at least in part the former (ie, that the casual treatment of therapies for trans-women are motivated in part by liking the side effects), but I don't think the latter would a high point even by the low standards of social science.

I think there's a bit more to it.

Reds think that a significant percentage of Trans people are actually engaging in a sexual fetish, not a mental state or some sort of deeply rooted gender identity. Certainly a lot of highly noticeable behavior by specific trans people seems difficult to explain in any other way. This is vehemently denied by Blues, whose counter-arguments start with Chinese cardiologists.

Reds think that Blues are in denial about the fetish aspect of the trans movement, along with a lot of other, similar aspects (tactical transness and pedophilia, to name two); the Red model says that Blues understand on some level that such behavior looks absolutely horrible to Normies, and they also understand that policing such behavior would mean conceding 90% of what Reds are fighting for on the issue. At a minimum, it would mean gatekeeping and skepticism about claims of transness, and the conflict between the two results in concealing the issue and attacking anyone who brings it up.

This is an example of people in the movement being pretty clearly in it for the fetish, in a way that should definately have resulted in some sort of social safeguards being activated. The absence of such social safeguards is evidence for the general Red argument: Blues cannot be trusted to think critically or act responsibly where this issue is concerned, because their social biases overrule what should be basic, axiomatic values. Their social immune system doesn't work, in short, and so social contagion runs rampant, necessitating quarantine.

Blues have a different view, of course, but as you say, we kinda need a solution.