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There is no simple choice here, and any method is going to inevitably have both false positives and false negatives. I think there are a couple of good reasons to err on the side of more false negatives, though. One is the basic principle that's often summed up as "first, do no harm." This isn't some iron-clad rule even within the medical community, much less reality itself, but it's a general call for epistemic humility in medicine such that, unless we can be really really sure that some intervention won't be a net harm, we ought to allow human biology to take its course. The other reason is the base rates: the odds that any given child is trans is minuscule, likely less than 1%, from what I recall about the stats. Now, we aren't sure what the odds are, conditional on the child believing that they're trans, but it's not clear that that conditional shifts the odds significantly, much less that it shifts the odds to 50.00001%, which would be the threshold at which it would make sense to even consider any sort of irreversible interventions.
What I think any sort of people who are for use of puberty blockers in trans children ought to do at this point is to generate credible scientific knowledge on how to accurately determine if a child is trans, as well as create credible mechanisms by which children are properly filtered out. At a bare minimum, it would have to include metaphorically tarring and feathering anyone who would refuse to publicize research on this topic based on the fear that it would be politically inconvenient, as well as encouraging criticisms of any research from people who are ideologically opposed to them. It's only through building such a credible mechanism of accurately identifying trans children and minimizing false positives that I think society in general would be on board with the program. Even then, there will always be people who oppose it entirely on principle, much like, even in 2025, there are people who believe homosexuality is a sin or are against miscegenation. Those people ought to just be ignored and will simply lose their credibility over time if giving puberty blockers to kids proves itself to be fine.
It seems like this would require defining what it means to be trans... any suggestions?
Seems like you're begging the question here. If people think something is wrong in principle, then it won't be "fine" by their lights even if it doesn't cause secondary problems.
Personally, no. I agree that it'd be incumbent upon anyone who wants society to be accepting of giving puberty blockers to trans children in order to transition them to provide a definition of "trans" that society in general would accept. For the past couple decades, I think we've seen them push the idea of "really really feels like they're the opposite sex," along the same lines as homosexuality being defined as something like "really really feels like they're sexually attracted to the same sex," but that clearly hasn't stuck. Given that we're talking about actual medical intervention, the definition would probably have to be a lot more objective.
Sure, just like how homosexuals still aren't "fine" by the lights of plenty of people today. But, again, we can just ignore those people and win over the people who can be won over based on the (lack of) those secondary problems.
But the homosexual community is still struggling with the issue: Turns out they can't ignore those people and instead seem compelled to eradicate them from all public fora. And I think trans advocates are cut of this same cloth. Dissent and debate are lethal to these movements, seemingly, in very similar ways for very similar reasons. Some feelings are good for governing behaviors. Things like the feeling that touching a stovetop hurts is a very good way to avoid severe damage to your limbs. However, these more complex feelings are much more of a crapshoot. Love is notoriously ephemeral. Sexual attraction is less so, but letting attraction have a strong influence on your sexual acts is still a recipe for disaster.
This struggle seems like an entirely voluntary decision and the source of entirely self-inflicted suffering. Unfortunately, that's often not easy to pull someone out of. My hope is that enough people just walk away from this that the people who choose to inflict this unnecessary suffering on themselves (and others) are sufficiently few as not to be a major issue.
Funnily enough, your choice of the word "struggle" actually reminds me of another rather famous Struggle that also seemed entirely voluntary and led to a ton of self-inflicted unnecessary suffering both to himself and his compatriots. Hopefully it doesn't come to anything like that.
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Sounds like we agree on basically everything. Except I want to reserve the right to value things independently of whether they cause secondary problems. E.g. I'd fight to stop secretly torturing people even if the practice didn't cause secondary problems.
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