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PaperclipPerfector  18d ago (text post)   32789 thread views

Culture War Roundup for the week of March 24, 2025

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around minors that have gone through the unethical transgender science grinder.

It's not a wonder you don't care about reforming the science to have evidence based results on if trans healthcare for minors has positive or negative results for patients if you've already made up your mind that it's unethical off other grounds.

Science should not be

Step 1: Have a view established off something else Step 2: Only accept evidence, research, and experts that agrees with the pre-established view and not the ones that disagree. Step 3: Declare the issue done with and stop further research.

Running these experiments is itself a violation of the ethics of human experimentation because, as detransitioners would be able to tell you, it can't be opted out of.

I think that there are plenty of medical interventions which can not be opted out after the fact.

A tonsillectomy can not be opted out after the fact, and yet it is regularly performed.

Generally, it is fine to study such interventions -- even randomized -- if you keep within the overton window of standard practices or have good reason to believe that your treatment will lead to a better outcome for patients. Nobody suggests rounding up kids and then randomly assigning them to the control or the puberty blocker / tonsillectomy group without any medical indication.

Also, a non-intervention can have just as severe consequences, and as a utilitarian, I do not believe that there is a fundamental moral difference between an act and an omission. Puberty blockers have permanent side effects, but so has going to puberty. In a world where the blockers exist, a doctor who withholds them is taking the responsibility for letting puberty happen -- just as a doctor who withholds antibiotics to let an infection kill a MAID patient is not very different from one who uses barbiturates instead.

Both puberty blockers and puberty have failure modes such as suicides. If and when they can be used to gain QALYs is an empirical question. Presumably, the path of expected best outcome depends a lot on the individual in question. A kid in 1980 whose reaction to growing breasts was to try to cut them off, and who attempted suicide over not being a boy might be different than a kid in 2025 who decided that they are non-binary after five others in their class already came out as non-cis.

I think that there are plenty of medical interventions which can not be opted out after the fact.

Sure. No one is saying you cannot do irreversible medical procedures, just that their effects have to be justified by the effects on the patient's health, and that the patient has to be aware of their irreversibility, and the effects. None of these conditions are met for puberty blockers. Their use was so far justified by their supposed reversibility, and sold as "buying time to think".

Generally, it is fine to study such interventions -- even randomized -- if you keep within the overton window of standard practices or have good reason to believe that your treatment will lead to a better outcome for patients.

I don't think "overton window" is a valid argument, it just means a bunch of people agreed it's a good idea. In my opinion they should have good reasons to think something is a good idea, so that leaves us only with the last criterion you cited, which currently is unfulfilled.

In a world where the blockers exist, a doctor who withholds them is taking the responsibility for letting puberty happen -- just as a doctor who withholds antibiotics to let an infection kill a MAID patient is not very different from one who uses barbiturates instead.

The difference here is that in the case of an infection, you're dealing with an unhealthy body, one that is veritably under assault by foreign organisms. In the case of puberty blockers you're intervening in a perfectly healthy body, hoping to achieve purely psychological benefits. I don't think we do that very often in medicine, especially for minors.

Both puberty blockers and puberty have failure modes such as suicides.

I don't think puberty causes suicide, and I'm pretty sure neither do puberty blockers for that matter.

If and when they can be used to gain QALYs is an empirical question

It was in this case as well, but somehow the doctor had his license suspended. None of the defenders of trans medicine were bothered, some even actively campaigned for it.

The same argument applies for signing up for experimental heart surgery.

Do we let people with a healthy heart sign up for experimental heart surgery?

The state of children transitioners is in my not so charitable opinion a giant Munchausen by proxy from the mothers being enabled by society. You don't get to consent to sex as a child, you shouldn't even have the concept of being the wrong gender/sex mix. If we could somehow blanket out from the children memeplex the concept of gender we could save them and ourselves so much grief.

You can't decide you should be a boy or a girl different from what you were born if you don't have the names for these concepts. At worst you could decide you're a tomboy or an effete guy.

Kids know what boys and girls are and the concept of boys becoming girls definitely occurs to them.

The state of children transitioners is in my not so charitable opinion a giant Munchausen by proxy from the mothers being enabled by society.

Some of them? Abso-fucking-lutely. Those mothers (and fathers, if there is a father in the mix) should be jumped on by CPS and charged with child abuse.

The problem is that there are kids with genuine problems, and parents genuinely trying to help them, and relying on medical professionals to guide them, and those professionals either being True Believers or terrified into 'if I oppose this I'll be charged with attempting conversion therapy which is illegal in this state' and going with the path of least resistance, which is to Affirm.

Some kids have mental health problems which need to be addressed. Some kids have problems with puberty (which is a confusing and often scary process) and need guidance around that. Some kids are genuinely trans, but how many and to what degree is what we are trying to figure out, as well as what is the best way to navigate that.

Unhappily it all gets thrown into the same basket, and the grifter adults take advantage of that.

The concept of changing genders is trivial to imagine without requiring people tell you about it, though?

If you're referring to the pseudosoul thing that Gender has become, fair enough. But children are capable-of going, "Hey, can boys turn into girls?" How disappointed / satisfied / excited / ambivalent any particular child would be to any particular response, IDK.

But yeah, the response to that question should not be "Ooh, come into this secret doctor's office and find out, and if your parents try to stop you, threaten to kill yourself."

This is a very stranger take. Children very much have a concept of being a boy or a girl, and are aware of grownups being men or women. Also, "minors" doesn't just mean hapless little six-year-olds who don't know about the birds and the bees. A fourteen or fifteen-year-old is a very different matter.

The state of children transitioners is in my not so charitable opinion a giant Munchausen by proxy from the mothers being enabled by society.

How do you square this with the erstwhile right-wing complaint that schools will encourage kids to transition while keeping it secret from their parents?

Munchausen by proxy doesn't have to come from the mother.

The "social transitioning" (ie teachers and staff hiding from the parents whats going on) is also an absolute shit show and a major own goal by the coalition of the ascendant.

Yeah, I think what he's talking about also happens, but is obviously not the whole picture.

Do people undergo experimental heart surgery because they don't like how their heart looks?

If there was an experimental heart surgery which changed the color of a patients heart from vaguely red to bright pink, I wouldn't support people doing it. I definitely wouldn't support impressionable teenagers who read about this on the internet doing it.

Oh, then you'll love the whole question of "people who want to be amputees" piggybacking off the trans movement, which in turn piggybacked off the gay rights movement. Welcome to the transableism community, and BIID (Body Integrity Identity Disorder).

One large reason this whole topic is a giant steaming mess is the over-reaction to "it's all personal autonomy, my body my choice, medical gatekeeping" push for absolute liberty on the part of the person seeking such radical changes. "It's not mental illness, it's my life!"

Except then that becomes the rationale for the craziness to seep in as well. If it's fine to seek radical surgery to change your body to fit with your mental model of what it should be like, why not people who feel deeply distressed by having an arm or a leg they want removed?

We need to get back to a common sense model, but unhappily nobody can agree what common sense looks like at this date. The success of having homosexuality removed as mental illness from the DSM meant that now all kinds of what can be described as 'alternate sexualities/orientations' cannot be called mental illness, and so the worst fringe cases get free rein. If we had the courage to say "no, this is insanity and not simply an unconventional lifestyle choice" we might cut the Gordian knot.

Your last paragraph doesn't follow from the rest of your post - indeed, it seems at odds with it. The transableism guys are claiming they deserve accommodation because their wacky desire is a mental condition isomorphic to gender dysphoria. The problem very much isn't that we've become unwilling to call these things mental illness! I say that neither should be classified as mental illness. Gender reassignment should be classified as elective plastic surgery, not treatment for an illness. This is what a principled stance for personal autonomy should yield, and cuts through all the bullshitting about suicide risks.

The model of transsexuals is exactly that. It’s medical, social and even political accommodation to a reality that exists only in a person’s brain. There is nothing physical about being a transsexual. If no biological or social intervention happens, a trans woman will develop into a man from the baby boy he was born as. A trans abled person is in exactly that position of wanting society and especially the medical establishment to not only accept them, but work to make the vision of themselves a reality in the real world.

My question is with so many of these issues — where and how do you stop the creeping of the concept into more related concepts? If we accept transgender, and force everyone to play along and force doctors to do surgery and insurance companies to cover it, why not trans-canines who want a tail, why not the trans-abled who want the doctor to cut off their legs? Why not allow for transracial people to live as their desired race?

I think a good working model of mental illness must naturally include deviation from observed reality, and the best option for treatment shouter accepting the reality that exists. I am not a Korean in a white American body. I can have all the surgery and act as Korean as I want. I’m still not Korean. And if I persist in that delusion then the problem lies between my ears, not with the reality that made me German American.

why not trans-canines who want a tail, why not the trans-abled who want the doctor to cut off their legs?

Why not indeed? I don't think you understood my position, which is happy with neither the mainstream trans or anti-trans positions. I'm a transhumanist, I have libertarian leanings on at least this particular issue, and I do in fact consider it a grown man's right to get an artificial tail if he wants, just as much as artificial breasts or a nose piercing. Or some sort of melanin injection that changes your skin color, if it existed. Bodily autonomy means bodily autonomy. I fully bite that bullet.

However, treating all these things as personal desires should also logically mean that we stop medicalizing them. I think it's disingenuous of the trans movement that they simultaneously go for the bodily-autonomy line, which I respect, and want to keep "gender dysphoria" classified as a mental illness. You really can't have both. Wanting-sex-reassigment-surgery should not be classified as a mental illness any more than wanting-a-tattoo-really-bad. (You could certainly find biological women with self-image issues who were suicidal before getting cosmetic plastic surgery, but that doesn't make the surgery a medical intervention then, just an expense she has decided on of her own free will in pursuit of her happiness. We shouldn't treat the matter any differently if it's a biological man who elects to get the same procedure.)

There is, of course, a separate conversation about whether someone who makes himself disabled on purpose should get the same unemployment benefits etc. as someone who lost an arm by accident. But if a millionaire wants to cripple himself at his own expense, and can demonstrate that he's making that choice of his own free will after careful consideration, rather than in a fit of psychosis - then I don't see why that should be a crime. Hella weird, but it's not my business.

The problem very much isn't that we've become unwilling to call these things mental illness! I say that neither should be classified as mental illness.

You have four healthy limbs. You feel really, really sad about that and believe you should only have three. Yes, that is mental illness, every bit as much as if you believed your neighbours were breaking into your house to smear shit on the kitchen walls.

You have healthy external and internal sexual characteristics. You feel really, really sad about that and want to undergo surgery to change what can be changed to those of the opposite sex. The only difference I see is that so far we have agreed to go along with the latter and not the former, as yet, though I wonder how long that distinction will hold. Somebody is going to do "limb reassignment surgery" (and apparently already has), there will be a movement and activism, there will be "studies show that after getting the amputation suicidality goes down and self-reported happiness goes up", there will be "what harm does it do? besides, it doesn't affect you anyway" and the rest of it.

Mental health is a part of medicine. The treatments we have in this area are less effective, less evidence-based, even controversial but part of current medicine nevertheless.

Some issues are clearly related to biologic disorders like autism or schizophrenia. Sometimes we are not even sure what it is.

You're a biological woman. You have healthy but pretty small breasts. You feel really, really sad about that and want to undergo surgery to make them larger. Is that mental illness?

I don't think desires should be pathologized, except in extremely rare cases. My belief is that legal adults should be able to get whatever elective surgery they damn well want, so long as they demonstrate informed, lasting consent. If it's kosher for a cis woman to get breast enhancements if she sees fit, I see no reason why the same right shouldn't apply to a biological male. Contrariwise, if we recognize that a woman who gets plastic surgery (or her ears carved to look pointy, or whatever non-gendered body modification) is just exercising her rights as a free individual, not responding to some all-important mental illness which it would obviously make her suicidal to deny - then the current classification of "gender dysphoria" as a mental illness becomes obviously nonsensical. It becomes a cheap and dirty hack to convince people to support transition, in minors and others, Because Psychiatrists Say So Suicide Risk Suicide Risk Suicide Risk Do You Want Their Deaths On Your Conscience. I think that is the great lie of the trans movement, and while I understand how they got there, I would like them to get rid of it and revert to a principled stance of "people can do what they want".

Is that mental illness?

If you think that in order to be attractive you need Giant Bazongas, and guys really do expect women to be waifs with Giant Bazongas or else they're not pretty enough, then maybe not strictly mental illness but something has gone wrong with social attitudes and expectations diverging wildly from reality. And people addicted to plastic surgery do exist, and I would have no problem calling that mental illness.

You feel really, really sad about that and want to undergo surgery to make them larger. Is that mental illness?

No real dog in the rest of this fight but I should point out that some of the plastic surgeons I've met believe that ANY desire for their services is fundamentally body dysmorphia (and therefore mental illness).

Even things as simple as nose jobs.

I really don't think that's enough for them. If it was just about body modification, then appeals to autonomy would be fine and a sensible position. But they want more than that. They want the right to do want they want, and make everyone else approve of it. They seek self validation from external sources and are sad at not getting it. Hence the moral blackmail.

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I'd be a tad bit concerned if my heart was, for example, a shade of blue. I'm not quite sure how I'd find out in the normal course of things, but it can happen, and represents a rather concerning situation.

Note that I'm objecting to the standards being used by the person I was replying to. I'm not a fan of gender reassignment surgery, or hormones, or putting on a dress.

I'm not a fan of gender reassignment surgery, or hormones, or putting on a dress.

I'm actually kind of surprised by that. As a transhumanist, I would've thought you were all in support of gender reassignment surgery (since it fits in nicely with the idea of breaking out of the limitations of the meat body one was born with). Can you expand on your thinking there?

You're in luck, because just a day or so ago I went into a lengthy explanation of why I'm not an advocate of gender reassignment surgery, and why transhumanism is as distinct from trans ideology as cats are from dogs:

https://www.themotte.org/post/1794/culture-war-roundup-for-the-week/311661?context=8#context

When I want to be a 6'9" muscular 420 IQ uber-mensch, I want that to be a fact about physical reality. There shouldn't be any dispute about that, no more than anyone wants to dispute the fact that I have black hair right now.

I do not think that putting on high heels and bribing my way into Mensa achieves my goal. I do not just want to turn around and say that because I identify as a posthuman deity, that I am one and you need to acknowledge that fact.

This explains why I have repeatedly pointed out that while I have no objection to trans people wanting to be the opposite sex, that they need to understand the limitations of current technology. I would have hoped that was obvious, why else would I pull terms like ersatz or facsimile out of my handy Thesaurus?

As one tanshumanist to another, my problem with this is that it seems like a very limited view of transhumanism. What I'm rooting for here is a future where I get to be some sort of shapeshifting consciousness which only occasionally reverts to humanoid form for old time's sake; not just "a 6'9" muscular 420 IQ uber-mensch". And if we get that, surely, surely you see that only joyless luddites would keep objecting to calling someone who's manifesting as a clearly-feminine angelic metaverse hologram "she", just because she doesn't have any biological female characteristics. (Because, you know, she wouldn't have any biological characteristics anymore.) Gendered language would only be based on presentation. And if Utopia involves calling people "she" even if they have no XX chromosomes if that's how they present themselves, it seems clearly morally correct to me that we should call a female-presenting person "she" even stuck as we are in flesh bodies that occasionally have spurious XY chromosomes.

I only used the example of a 6'9 genius for illustrative purposes (and it's an upgrade over my current build), I want to be a posthuman information entity running on a Matrioshka brain as much as you do. I'm pretty sure I've already said that.

And if we get that, surely, surely you see that only joyless luddites would keep objecting to calling someone who's manifesting as a clearly-feminine angelic metaverse hologram "she", just because she doesn't have any biological female characteristics. (Because, you know, she wouldn't have any biological characteristics anymore.) Gendered language would only be based on presentation. And if Utopia involves calling people "she" even if they have no XX chromosomes if that's how they present themselves, it seems clearly morally correct to me that we should call a female-presenting person "she" even stuck as we are in flesh bodies that occasionally have spurious XY chromosomes.

We're not yet at that posthuman state. People currently have certain physical and biological traits that they're unable to change even if they desperately want to change them. That's the whole thrust of my argument. Will I call someone "she" even they're not biologically female? Why not, it's not a big deal for me. Will I say that they're indistinguishable from a normal woman? No, because that's not true.

A large fraction of trans advocates make demands far more significant than merely calling people by different names or different pronouns. I personally don't care at all what toilets they use, or if they want to enter women's sports, but plenty of people do, and that's a far bigger ask.

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Trans women want to be called "she" because they would like to be biological women and forcing people to call them "she" is as close to that as they can get, barring operations. Your hypothetical hologram person doesn't want to be called "she" for this reason (because if they did, they would actually transform into a biological woman).

Gotcha. So it's not that you're opposed to those things per se, but that you're opposed to pretending like they are reaching the goal (when in fact they aren't).

That's a good summary. If there was a pill that magically turned you into the opposite gender, what business of mine is it if people take them or not? If there were people claiming to have that pill, convincing other people that worked, and resisting evidence to the contrary, then I'm against poor epistemics on principle, and I'm also a psychiatrist (in training).

https://www.themotte.org/post/1794/culture-war-roundup-for-the-week/311661?context=8#context

TL;DR we aren’t there yet, but once we are, he’s not going to complain.

I'd be a tad bit concerned if my heart was, for example, a shade of blue.

I'm lost in the analogy now. What?

I was being literal, sufficiently bad cyanotic heart disease can literally make your heart blue. You'd have more pressing concerns at that point other than the color.

Didn’t think about that! (That said I’ve not seen basically anything about early developmental disorders since medical school)

Would be rather odd for it to suddenly happen to an adult though

Depends on how generous you want to be with "late cyanosis", but my understanding is that something like an Ebstein's anomaly or PAPVAR can rarely present in adulthood with any asymptomatic childhood and adolescence.

That said I’ve not seen basically anything about early developmental disorders since medical school

Same dawg, same. Hoping none of that nonsense comes up in my line of work.

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I'm pretty sure he's referring to a heart attack, and I'm guessing the analogy refers to that "not liking how something looks" can reflect a more serious underlying cause than pure aesthetic distaste.

No one, and I mean absolutely no one, among trans activists believes there is an underlying issue with a trans person's endocrine system, genitals, or breasts. If for no other reason, then because it could be used for diagnosis and gatekeeping.

With all the caveats of our discussion a couple days back…I really don’t think this is true? If only because androgen insensitivities and intersex conditions make a really secure motte. They more or less defuse the “is it a choice/contagious?” step of the argument.

See also the confusion over whether Imane Khelif was an icon of trans resistance.

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I don't think that's true. The truscum/tucute divide exists, and it wouldn't surprise me if the former regained power in this new environment.

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I feel like there's a 'gonna die if you don't, gonna die if it doesn't work, not gonna die if it does' unstated exception to that particular tenet of the Nuremberg code.

Honestly, this is one of the situations where I say "fuck it"; the amount of trans surgeries from doing the RCT, assuming it finds that they're bad, will be lower than the amount from not doing it (in contrast to the usual case), so I'm not seeing the "do no harm" issue.

The bigger issue is that trans activists will attempt to defy you and transition the control group anyway. I don't see a way to get around that that isn't either "deploy the counterterrorism apparatus in full to prevent such attempts" or "ban transition as a whole in order to saturate the trans movement's covert-ops resources and draw them away from the trial". These are both pretty drastic actions, with significant PR costs even if you personally aren't bothered by using that level of force.

Honestly, this is one of the situations where I say "fuck it";

Yeah, I haven't settled on an opinion, but I feel you. There is currently some brouhaha about an NHS puberty blocker trial, with the anti-trans side arguing that it shouldn't be done because we already have the evidence (they also have other criticisms, but that tends to be the opener). A part of me feels like the political capital would be better spent saying "Oh, you want a trial? Fine, we'll do a trial, but we're doing this one properly", but I've been wrong on political tactics before (I was against blanket bans, until Alabama and Tennessee did them, and ACLU in their infinite wisdom decided to sue them, which allowed WPATH's internal docs to go into discovery).

The bigger issue is honestly the difficulty of actually running the trial successfully; trans activists have a lot of resources and will attempt to circumvent the prohibition on the control group transitioning (via paying for medical tourism, or if the parents are unwilling arranging for the kids to "self-extract"), at which point there's an obvious hole in your RCT due to either counting transitioned kids in the "untransitioned" group (when they're not) or not counting them (and removing the randomness).

When I was reading the papers on chemical castration, I think one of them said you can detect non-compliance with a blood test (though it may have been about taking counter-measures, instead of unauthorized taking of chemical castration / puberty blockers).

Oh, it's easy enough to tell if somebody's been taking hormones against your instructions. That just doesn't solve the problem.

  1. If you count defiant transitioners as part of your control group, it biases your study in favour of transition, because defiant transitioners amount to "transition with a bunch of extra annoyance" and as such are near-guaranteed to do worse than the transition group regardless of how good or bad transition is.

  2. If you kick defiant transitioners out of the control group, it biases your study against transition, because desisters will stop trying to defy you at some point, and as such success stories will make up a larger chunk of your control group than they would have if you'd successfully prevented the defiant transitioners from transitioning.

If the trans activists manage to subvert enough of your control group (which is pretty likely without the extreme measures I mentioned), these two effects will destroy the study's value; it will give the "do transitions!" answer with one set of rules and the "don't do transitions!" answer with the other. Whoops, looks like the clear liquid you poured on that fire was petrol instead of water.

Oh, and this is assuming that you picked outcome measures that don't allow for easy lying; it's not like people can't go on Twitter and yell "hey everybody, put down that you're ecstatic if you were in the transition group and suicidal if in the control group; it's for the sake of all the other transfolk". As Scott said, "sometimes people might just be actively working to corrupt your data".

Your overall point is correct, but:

If you count defiant transitioners as part of your control group, it biases your study in favour of transition, because defiant transitioners amount to "transition with a bunch of extra annoyance" and as such are near-guaranteed to do worse than the transition group regardless of how good or bad transition is.

That's not necessarily true: suppose transition, even with transition-with-extra-annoyance, always leads to strictly better outcomes. The control group will then have better outcomes if the defiant transitioners are counted than if they aren't, possibly on par with transitioners within margins of error depending on how many there are and how much the extra annoyance impacts outcomes.

This point aside, I also think any study of this sort would need extremely careful design to separate the effects of social transition vs the actual puberty blockers. I think you'd need two control groups: one where the kids socially transition but don't take puberty blockers, and one where they don't transition either way. And while it's very easy to tell if somebody's been taking unsanctioned hormones, it's rather harder to tell if they switched pronouns among friends, so you really couldn't run a study like that with participants who don't play fair.

That's not necessarily true: suppose transition, even with transition-with-extra-annoyance, always leads to strictly better outcomes. The control group will then have better outcomes if the defiant transitioners are counted than if they aren't, possibly on par with transitioners within margins of error depending on how many there are and how much the extra annoyance impacts outcomes.

By "biases in favour of transition" I mean "makes it more likely to put transition ahead". This cannot flip the study from "transition good" to "transition bad", but it can flip it from "transition bad" to "transition good".

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What if it's a surgery that doesn't solve a life-threatening problem, but holds the possibility of significantly improving quality of life? There are no end of heart conditions that won't kill you, but will make you miserable and make a normal life hard.

Why did we decide to stop (most) further study of lobotomies? The inventors of the procedure won a Nobel Prize for it! At some point it seems we decided that it wasn't actually worth it, as far as I can tell.

I think it's a hard question, honestly, even before the pediatric ethics complications. How do we decide what experiments are reasonable to run on people? Definitionally, sometimes experiments find negative outcomes, and if we never run such experiments, we never find ways to make things better. To me, at least, there needs to be some level of reasonable confidence on the theory for why a potentially-harmful, irreversible experiment would be likely to succeed, and clear consent to participate.

Medicine isn't my wheelhouse, but the repeated failure to turn what should be lots of test data into verifiable claims of strong evidence suggests that the evidence isn't as glowing as the rhetoric would require. Which colors me cynical about much of the whole movement, but that's just my opinion.

The main reason is that we invented neuroleptic drugs that worked. It's cheaper and easier to treat a raving, flagrantly psychotic schizophrenic with antipsychotics instead of surgery, and you don't have to cause nearly as much collateral damage.

At some point it seems we decided that it wasn't actually worth it, as far as I can tell.

They made violently mad lunatics docile. While risking destroying higher cognition, being dangerous surgery, and so on. The drugs sometimes suck donkey cock, but they're better than that. Lobotomies were also often used for people who weren't violent lunatics, just to make them easier to handle, which certainly didn't help their reputation.

These days, in rare cases, we perform surgeries like stereotactic cingulotomy, which is a far more targeted technique of cutting or destroying aberrant parts of the brain. Same theory as lobotomy, if you squint, but nowhere near as messy. Works okay, if nothing else does.

Medicine isn't my wheelhouse, but the repeated failure to turn what should be lots of test data into verifiable claims of strong evidence suggests that the evidence isn't as glowing as the rhetoric would require. Which colors me cynical about much of the whole movement, but that's just my opinion.

I happen to share that opinion, presuming you're talking about gender affirming/reassignment care.

To make the analogy work, the heart would have to be perfectly healthy, and the benefits of the surgery would have to be purely psychological*. "Oh no, your girlfriend broke up with you? You must be brokenhearted! Here, have a heart transplant!". This is about as much sense as gender affirming care makes.

*) If you want the analogy to be even more accurate, the surgery would have to have fairly massive, well-known, and acknowledged by everyone downsides, it's just that they are deemed to be a price worth paying for the psychological benefits.

Looking back, I didn't even mean it as an analogy. I sought to show that the standard he was advancing ruled out something considered benign or noble. It's the equivalent of someone pointing out that a No Parking prohibition on a street should make allowances for emergencies or an ambulance.

Hence that if you want to condemn such a procedure, you need different considerations. Which there are, which I haven't denied.

Posts get pretty bloated if you want to say something snappy but then also have to put in every single thing wrong with gender changing operations. I see this as a point where pretty much everyone knew what hydroacetylene was getting at, but more... analytical? minded people could want to demonstrate that that argument alone is bad. I suppose he should have written it better. I've always gotten annoyed at the "I know what you meant but let's argue out the phrasing" types.

I am fairly sure experimental heart surgery isn't conducted on children without their parent's informed consent, and a refusal to subject children to experimental heart surgery isn't a basis for taking children away from the parents.

That is an entirely different objection, and at least in the UK, doctors have the ability to override parental decisions if deemed in the best interest of parents, especially if the child agrees. And the definition of child here is 16 and below, no line in the sand, as long as the doctors think they're able to understand the risks and benefits.

In less politicized contexts, if not heart surgery, kids can be taken away if their parents are doing an egregiously bad job at handling their health.

This is all true, and for all the many failings of British governance, things seem to work fine here.

I make no comment on whether or not gender affirming care is something that should be treated in this manner, only that the previous standard suggested was poorly formed.

Indeed, in the UK we admit that capability to make informed decisions does not start at some arbitrary birthday but is more fluid and depends on maturity of a person. This is mostly about some minor treatments such as morning-after-pill or HPV vaccine which is for their own benefit. I expect that a healthcare professional would be more strict in cases when a minor is asking for treatment that has great potential of harm. Then it would go to the court and the court most likely would say that wanting a treatment that harms is the evidence that the person does not have the capability to make an informed decision or something like that :)

And your analogy for it being poorly formed was poor.

Most analogies are imperfect, few things are perfectly isomorphic to other things. I stand by mine as relevant and useful.

I'll bite that bullet - my opposition to gender transitioning prepubescent children does not hinge on science and I would not be convinced by studies that purported to show that it's actually very good for children. Many questions are good questions to apply the scientific method to and I don't think this is one of them.

Good news, with your attitude, you are not alone.

  • Jehova's Witnesses believe are opposed to blood transfusion for reasons which are orthogonal to the experimental method.
  • Many religions are opposed to most forms of sexuality and/or contraception without any evidence that it leads to bad outcomes.
  • Likewise, dietary restrictions.
  • Some people believe that various forms of genital mutilation are beneficial or required not as a matter of empirical evidence, but for inscrutable cultural reasons.

Of course, if you want to convince the grey tribe specifically, just stating that obviously blood is sacred or puberty blockers are evil or pigs should not be eaten is not going to convince anyone.

Edit: I wrote that taking "gender transitioning prepubescent children" as a straw man for puberty blockers, but on further reflection I think that I would even cover gender affirming surgery. Sure, I think that operating on the genitals of ten-year-olds is a terrible idea, but that is contingent on empirical observations about the state of medicine, and if our tech level was higher, I would be open to evidence that it is beneficial for kids to change their gender a few time, or that placing a brain in a robot body increases QALYs for that matter.

Let's borrow from Heidt for a second.

A man goes to the supermarket once a week and buys a chicken. But before cooking the chicken, he has sexual intercourse with it. Then he cooks it and eats it.

[...]

Julie and Mark, who are sister and brother, are traveling together in France. They are both on summer vacation from college. One night they are staying alone in a cabin near the beach. They decide that it would be interesting and fun if they tried making love. At the very least it would be a new experience for each of them. Julie is already taking birth control pills, but Mark uses a condom too, just to be safe. They both enjoy it, but they decide not to do it again. They keep that night as a special secret between them, which makes them feel even closer to each other.

As designed, harm has not occurred in these situations. Do you feel like the people (who indeed are numerous) who feel something morally reprehensible has occurred in both are engaged in silly superstition, or are you willing to concede that morality has more dimensions than the singular concern for harm reduction?

This is a sidebar from a debate on the medical merits of the Dutch protocol, but the idea that you can't object to such things on metaphysical grounds seems silly to me given the arguments in favor of transgenderism as a theory of GD are also on the level of metaphysics.

Presumably a chicken bought in a supermarket is already very dead. The only ethical question this raises for me is the buying of a chicken corpse produced for human consumption -- which would probably depend on if it is free range or factory farmed.

Likewise, plenty of people have sex in circumstances where a resulting baby would have plenty of genetic, developmental, or social disadvantages. Drug addictions, chemotherapy (?), parental genetic disadvantage, parents not invested in a relationship, parents who were exposed to ionizing radiation and so on. This is fine as long as they use appropriate contraceptives and ideally have a firm commitment not to bring any fetus to term, but often people are very negligent over these things. Granted, the disadvantage of a baby born from a union of first-degree relatives would be much larger than that of a baby from a random drunken hookup, but Julie and Mark are extra responsible with birth control, so I don't see an issue.

Let us try two more scenarios:

A and B are two adult males of sound mind who have sex. They were tested for STI before, use condoms and are not in other sexual relationships with anyone.

C is a 30 year old woman who works as an elementary school teacher. One Saturday, she goes to a shopping mall. She is wearing a blouse which shows a bit of cleavage and a skirt which goes to her knees, as well as some makeup. The shoes she wears leave her ankles clearly visible to the public, and she makes no effort to cover her hair. She is not accompanied by a male relative.

To quote you:

As designed, harm has not occurred in these situations. Do you feel like the people (who indeed are numerous) who feel something morally reprehensible has occurred in both are engaged in silly superstition, or are you willing to concede that morality has more dimensions than the singular concern for harm reduction?

I think it is hard to argue that billions of people recognize some moral truth when they react with disgust to your examples while also claiming that the billions of people who react with disgust to my examples are just engaging in silly superstition.

This is a sidebar from a debate on the medical merits of the Dutch protocol, but the idea that you can't object to such things on metaphysical grounds seems silly to me given the arguments in favor of transgenderism as a theory of GD are also on the level of metaphysics.

I firmly believe that we should see gender interventions only through the lenses of patient autonomy (which we generally deny minors, rightly or wrongly) and outcomes.

If someone argues "woo, gender is just a social construct, so it is fine to raise your XX child as a boy", I would be just as opposed to that.

I think it is hard to argue that billions of people recognize some moral truth when they react with disgust to your examples while also claiming that the billions of people who react with disgust to my examples are just engaging in silly superstition.

I happen to recognize the legitimacy of Abrahamism as the moral doctrine of at least three distinct human civilizations, so I don't find any difficulty there, both sodomy and dressing provocatively are "sins" in those places for reasons that are both practical and internally consistent.

If anything it's precisely my criticism that modern Western Liberal morality has become incapable of characterizing the issue with such behaviors at all which makes mitigating them totally impossible. And heralds the return of more barbaric solutions down the line, which I resent.

I firmly believe that we should see gender interventions only through the lenses of patient autonomy

I want to say that my Hoppean heart has no quarrel with that in practice so long as I don't have to get involved, but that's not advancing the discussion at all, and I do think that a moral standard that is solely based on consent is blind.

Mental illness is a millstone for the Liberal ethic because it is fundamentally irrational, so it destroys the base assumption that allows consent to ground judgement. People don't always want what's good for them, let alone what's right for them.

And you must recognize this because that is indeed why we deny children autonomy. Why then not do it for the mentally ill?

I could understand being afraid of people using "sluggish schizophrenia" and the like against political opponents, but insofar as one recognizes that delusions are a thing, you need to confront the fact that consent is an ill suited tool to attack this moral issue. Otherwise you end up assenting to people hacking their limbs off on whims, which is not right.

I happen to recognize the legitimacy of Abrahamism as the moral doctrine of at least three distinct human civilizations, so I don't find any difficulty there, both sodomy and dressing provocatively are "sins" in those places for reasons that are both practical and internally consistent.

This sounds like moral relativism to me: dress according to your religious community standards (whether it is a burka or just non-provocative western clothing), follow your community's sexual norms (whether you have three wives or one, and how old they have to be when you marry them), follow your religious communities dietary restrictions (especially regarding pigs, cows, humans, shellfish) and so on.

And you must recognize this because that is indeed why we deny children autonomy. Why then not do it for the mentally ill?

[...] insofar as one recognizes that delusions are a thing, you need to confront the fact that consent is an ill suited tool to attack this moral issue.

The fact of the matter is that humans did not evolve to be perfectly rational agents. As the sequences teach us, we are all loaded with our own biases. We treat the median adult as sane not because they are a rational actor whose map matches the territory who try to maximize some utility function, but merely because all the systems which did not engage in the polite fiction that people are sane have had much worse outcomes as the people who would take paternalistic charge of mankind are not sane themselves.

That being said, while I might deny that there are sane people, I will concede that some are way more insane than others. A demented person starving while wandering through the woods is likely lacking the coherence that we can apply the fiction of sanity, and we should institutionalize or MAID them per their living will.

Young people have two handicaps: first, their map is often even less accurate than that of adults simply because they lack experience, and second they are probably even more impulsive. As a crutch, societies have decided to lock certain autonomy behind age limits. This is manifestly unjust -- a tenth percentile 20 yo is likely less sane than a 80th percentile 10 yo, and yet the former can vote, consent to sex, enlist in the military, take on debt, immigrate to Saudi Arabia and so on. But until we find something better, age is a Chesterton's fence we should keep.

Still, I think that recognizing that our system is somewhat arbitrary and unfair, we should try to respect the choices of those whom we deny autonomy whenever their choices seem sane.

  • An 8 yo who wants to wear a red t-shirt instead of a blue one should get their wish, all things being equal.
  • A 10 yo who wants to get a facial tattoo should be denied -- presumably, there is a broad consensus among adults that they would have regretted getting such a tattoo at that age.
  • A 14 yo who wants to enter a relationship with a sugar daddy should likewise be denied, as there is a broad consensus that this will be harmful to their development.
  • A 14 yo who wants to quit school and live in the woods should be denied, but if they want to quit school to start a trade apprenticeship that is a different matter.

As a moral toy model, give the minor a minority of votes over their life and distribute the rest to adult society. At a very young age, they have little voting power, and only get autonomy to do stuff which a majority of society supports. At age 18 (or 21 or whatever), they gain majority, and have 51% of the votes, which means that they can do whatever they want, no matter how ill advised. Morally if not legally, it would make sense to have a continuous increase of their voting power in between these two points. Perhaps at age 17, they have 40% of the votes, so they get to do whatever at least 1/6th of the adults considers age-appropriate. Just because we don't give them full autonomy, we should not disregard their opinion entirely.

Likewise, mentally ill adults. Generally, I am against involuntary commitment of anyone who has not run afoul of the law (otherwise, sentence them normally, then give them the option to serve their time in a ward instead) unless it is very likely that they will die on the outside within a year. Plenty of people locked up in psych wards object to being locked up for entirely rational reasons orthogonal to any mental illness they might have.

I could understand being afraid of people using "sluggish schizophrenia" and the like against political opponents

I think there was recently some MAGA legislation trying to make Trump Derangement Syndrome and official medical diagnosis.

This sounds like moral relativism to me:

It is in that sense, I am not a universalist. I believe morality is meme evolved by and suited to a particular ethnocultural substrate.

merely because all the systems which did not engage in the polite fiction that people are sane have had much worse outcomes as the people who would take paternalistic charge of mankind are not sane themselves

I disagree that this is true and regard modern societies as much worse for human flourishing than their pre modern counterparts, despite recognizing the advantages of modernity.

Trump Derangement Syndrome

That's obviously crossing the line, but I'm tempted to still consider the idea given how demented I've seen people I know become from 2016 onwards. There's something to the idea that his smashing of post-Obama bourgeois certainties shattered the psyche of some people. Sam Harris never recovered from it.

The most intuitive explanation is that the feeling of disgust at the above scenarios is an evolutionarily useful heuristic against deviancy.

It's already known that most mental illnesses are varyingly comorbid, so it's not a stretch to conjecture that even benign sexual deviancy suggests more serious malfunction. Thus, the disgust response should be treated as an update torwards moral suspicion, but not full condemnation in of itself.

This is Heidt's opinion too as I recall.

But the point of the questions is to evidence the fact that some people are quite literally incapable of feeling that disgust response or connecting it to moral condemnation.

Then they end up writing books about the "authoritarian personality" thinking it can be eradicated as a mere cultural quirk, and always catastrophically fail because it's eugenic and human nature asserts the advantage.

Julie and Mark, who are sister and brother...

Replace this with "Julie and Mark went drunk driving. Nobody was hurt and they got home safely and sooner than they would have if they had to walk".

The fact that a dangerous activity sometimes works out doesn't make it a good idea. In order for this to prove what it's supposed to prove, the hypothetical would have to be "Julie and Mark committed incest, it all worked out, and they had good reason in advance to think it would work out". This hypothetical is impossible unless 1) it's a limited cultural practice that doesn't favor incest in general or 2) Julie and Mark are not human.

The point is precisely to show that care/harm doesn't take those two caveats into account.

Sufficiently sophisticated utilitarianism is indistinguishable from deontology. And vice versa.

Oh yay... another chance for me to share this gem of a paper.

Maybe it is the other way around – deontology is a veiled utilitarianism when precise evidence is hard to get or understand. :)

Which part of "and vice versa" was unclear?

"It is risky behavior that often, but not always, causes harm" is basically an objection about harm.

This is not so obvious with the incest example but it's very obvious about drunk driving. People don't have some independent moral aversion to drunk driving that is unrelated to the chance of harming someone. Harm need not happen 100% of the time for the objection to be properly characterized as harm-based.

Hey, look, you’ve rederived the categorical imperative.

As designed, harm has not occurred in these situations. Do you feel like the people (who indeed are numerous) who feel something morally reprehensible has occurred in both are engaged in silly superstition, or are you willing to concede that morality has more dimensions than the singular concern for harm reduction?

I always used to be confused why people considered this a gotcha or a particularly interesting question, cuz I thought it was obvious that there was absolutely no moral impropriety in either case, that only people who held on to silly superstitions would think otherwise, and I thought that this was basically the the position of most Democrats/liberals.

Now I understand that I was the weird/foolish one for actually believing people when they said that they were liberal.

It's still silly superstition, though.

Most humans are not WEIRD, you can call them what you like to cope with this reality, but that's not going to change because the Liberal ethic is unsustainable on its own.

Liberals used to understand this when they invented Liberalism.

Yes, those are also examples of positions that people hold that empirical evidence won't move them off of. Some of that may be because they don't think the evidence is compelling, but most of it is that these just aren't questions that are amenable to rigorous testing.

I think there are good non-empirical arguments for why transing children is a terrible idea (and people have made them in this thread) but I don't expect them to be compelling to strict utilitarians, particularly the utilitarians that are credulous about any institution that cloaks itself in the aesthetics of science. If my position depended on whether some shoddy, non-replicating study is consistent with it or not, I think that would be much thinner than reaching conclusions from considering the situation with the context of history and human nature.

My point was purely meta, I am absolutely fine with the argument "in the current political climate and given the replication crisis, it seems likely that the people who devote their lives to studying the outcome of gender interventions are more motivated by activism than by genuine scientific curiosity, and that a lot of them have already written the bottom line when the study starts. Then, they engage in cargo cult science to find the argument leading to their preferred conclusion. As the activists outnumber the scientists, they can use the mechanisms of peer review and grant-making to sideline authors with a lesser or opposite bias. Thus, all their studies are to considered unreliable and we should default to our priors regarding the benefits of gender interventions in minors."

I might have some disagreements with the argument (especially with its sibling being applied to climate science), but these would mostly boil down to object level questions about reality (including institutions) which are at least in principle fathomable by the scientific method.

It is the difference between Kelvin boldly stating:

I need scarcely say that the beginning and maintenance of life on earth is absolutely and infinitely beyond the range of sound speculation in dynamical science.

and a more modest:

Explaining life is currently very much beyond physics, and we lack a paradigm to even make progress on that question. It might be different in a hundred or a thousand years, or it might remain thus forever.

Good news, with your attitude, you are not alone.

Sure, because this includes most people. Pretty sure it even includes you (I dunno, would you teach your children to be transphobic if someone came up with some galaxy-brained study that it adds a few QALYs to their life?).

Of course, if you want to convince the grey tribe specifically, just stating that obviously blood is sacred or puberty blockers are evil.

Funnily enough, it's the pro trans side that fits better with the groups you mentioned. They have - by their own admission - no evidence that puberty blockers improve the outcomes for children / adolescents.

my opposition to gender transitioning prepubescent children does not hinge on science and I would not be convinced by studies that purported to show that it's actually very good for children

What is it based on?

Morality, presumably. Ought, not is.

We already have evidence based results for trans healthcare. That's why I brought up the Cass Review. Jesse Singal himself is good at actually looking at the studies themselves.

But I mean, yes, there are other reasons to oppose it, which have been brought up on this site many, many times, such as allowing children to consent to permanent side-effects like infertility from puberty blockers. Your three steps become a lot more understandable when it's about lobotomies and someone says "you've got all this positive research for this procedure, but you're still drilling people's fuckin' personalities out of their brains."

And there are other medical organizations and groups that reached a different finding. Clearly there's a disagreement and we need more high quality research to settle things. And if people are going to be doing something anyway, why not study them?

And there are other medical organizations and groups that reached a different finding.

Anyone you have in mind? As far as I can tell the organizations can be roughly divided into:

  • Ones who did do a systematic review and came to roughly the same conclusions
  • Ones who did not do one, and therefore can't really be said to have come to any conclusions
  • Ones who did do a systematic review, and decided to hide the results from the public, and made researchers sign a pledge of loyalty to only publish results that will be good for the transgender movement.

Clearly there's a disagreement and we need more high quality research to settle things

Can we at least agree that no one from the third group belongs anywhere near said research?

SEGFAULT. Replied to the wrong comment

I think you replied to the wrong comment (at least, I see you replying to yourself).

Thanks for the heads up!

I'm an American and I care, but I am assuming that like always, people will take what they want from Europe and sneer at the stuff they don't like. That goes for both sides. One side sneers at TERF Island but praises the public healthcare that it has (such as it is), one side praises the lockdown pullbacks and other Covid studies from Scandinavia but sneers at their high tax rate and large safety net. Seems like the good-science-enthusiasts have been getting Ws out of the area, though.

Edit: The comment got deleted. It asked something about whether Americans care about what happens in Europe, mentioning the Cass Report and the slow pullback of gender affirming care for minors across the continent.

It's not a wonder you don't care about reforming the science to have evidence based results on if trans healthcare for minors has positive or negative results for patients if you've already made up your mind that it's unethical off other grounds.

Do you think the science of treating autists with Lupron just needed reform, or is it better that it was axed?

Science should not be

Step 1: Have a view established off something else Step 2: Only accept evidence, research, and experts that agrees with the pre-established view and not the ones that disagree. Step 3: Declare the issue done with and stop further research.

Funny you say that, because this is exactly what trans medicine has been so far.

Has the buried systemic review from your second link been unearthed?

Never heard of it going public, but I didn't go looking either. Might take stab at it later.

It's not just one review they're sitting on, by the way, I don't remember the number, but I think it's about a dozen (or half-dozen? I seem to remember the word "dozen" appearing somewhere in the context).

@magic9mushroom, ah, there we go

C. WPATH Hindered Publication of Evidence Reviews.

Though the SOC-8 authors and their advocacy allies didn’t seem to have much use for them,132 the Johns Hopkins evidence review team “completed and submitted reports of reviews (dozens!) to WPATH” for SOC-8.133 The results were concerning. In August 2020, the head of the team, Dr. Robinson, wrote to the Agency for Healthcare Research and Quality at HHS about their research into “multiple types of interventions (surgical, hormone, voice therapy…).”134 She reported: “[W]e found little to no evidence about children and adolescents.”135 HHS wrote back: “Knowing that there is little/no evidence about children and adolescents is helpful.”136

All the references are to the Boe v. Marshall case from the second link (which also contains a direct link to the evidence from the case).

The "there we go" is in regard to the "dozen", not the buried reviews?

Correct, still didin't look if I'll find the reviews (and am leaning pessimistic, I'm guessing Alabama's AG who wrote that document would already have them, if they were uncoverable). Sorry if there was any confusion.

Do you think the science of treating autists with Lupron just needed reform, or is it better that it was axed?

Was there a bunch of consenting autistic people begging to be given lupron? I think there are different standards between "studies of medicine forced on someone without their permission" and "studies of medicine done with the consent of both child and parent"

Funny you say that, because this is exactly what trans medicine has been so far.

Ah I wasn't aware two wrongs made a right. I guess the Whataboutists had the best idea after all.

  • -10

Was there a bunch of consenting autistic people begging to be given lupron?

Since we're talking about children, they can't consent directly (and since we're talking autism, it's possible they could have been non-verbal anyway), so the relevant question would be about the parents. Yes, there were parents begging for it, that's why they went to a doctor offering it.

I think there are different standards between "studies of medicine forced on someone without their permission" and "studies of medicine done with the consent of both child and parent"

No one was forcing the parents, and if your entire objection rests on children "consenting", it's pretty trivial to manipulate them into wanting it (which is exactly what happened with trans care).

And if you're still not convinced I can give you more examples where the patients were begging for quack therapy, and it got shut down by the authorities. Burzynski's antineoplaston therapy, off the top of my head.

Ah I wasn't aware two wrongs made a right. I guess the Whataboutists had the best idea after all.

It's not whataboutism to want to defund corrupt research, and if you only criticize the defunders, you don't really believe it's "two wrongs".

A return to 2000s norms on this is hardly a wrong. The only reason we're here at all is due to about a decade of Overton window pushing. When these studies and techniques are the best they've got to offer on a fight they picked, it's a moral imperative to just kill it without even asking anymore.

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