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That's fascinating to me.
On one hand, I definitely think that things like prison sexuality, bacha bazi and ancient Greece prove the idea that sexual behavior is partially a product of societal conditioning and material conditions. But I don't know how much that implies actual differences in people's underlying dispositions towards sex. If the story society tells is one where homosexuality is a moral failing, does this make a bunch of closeted gay guys, does it cause would-be bisexuals to bury their feeling so deep that they never act on them? Or can it actually affect a person's sexuality at the margins?
If there's been an increase of self-identified LGB people over the last 40 years, I think it's probably best explained by increasing societal acceptance, and perhaps some malingering from people claiming to be "bi" for social credit. However, I admit I don't know what to think of the T side of things. I suspect that the existence of HRT and other medical interventions does make the options look more attractive, but it's hard to say what that means in practice. More people in the modern world also get boob jobs, but that doesn't necessarily mean that people wouldn't have been getting boob jobs through out all of human history if they had been available. They just happened to not be medically possible, so people used different methods like corsets and weird dresses to artificially create more feminine figures.
The T side of things is what I have issues with. Who you sleep with is none of my business. Even if you come to regret it, you can move on with your life mostly without consequences. On the other hand medical transitioning, including puberty blockers, wrecks your body even if you don't regret it. The justification for it is that it's better than living with dysphoria, but if people are transitioning mostly because it's being promoted, we're doing them great harm by waving them through the pipeline, and not questioning them.
My understanding is that HRT was available for decades before the massive post 2010 spike, so I don't think we can use that to explain what we're seeing.
One thing to keep in mind is that we're not living in times where medical transition is merely possible, it's also heavily promoted, and skepticism of it is demonized.
You can't compare this to what's going on with trans issues nowadays. If a dude wants to wear a corset, or a woman wants to wear shoulder pads, more power to them. If you're going to sell them a medical procedure that will make them a patient for the rest of their lives, in the hopes of solving their psychological issues, that's a completely different thing. Not to mention all the slogans like "trans women are women" that everyone else is also supposed get on board of.
HRT was available, but not readily available: the standards of care were a little... stupid.
I think the pendulum's swung too far the other direction, but until 2011, the WPATH SoC required three months "life experience" before physicians were supposed to allow HRT. There was probably an underlying steelman that was making sure people were able and remained interested after doing anything outside of a closed room, but Common Knowledge -- and the legal name change requirement especially -- held to the mid-00s that this meant either cocooning yourself in a very LGBT-specific community or doing a very bad drag impersonation while at your work and normal social life for three to six months, minimum.
I think we'd still have seen a pretty significant boost just by getting rid of that, though I'd expect still less than today. In run, I'd caution a lot of what we're seeing in reporting is probably a conflation of many different categories that you may not be expecting. There are still some medical concerns for butch lesbian / femme nonbinary trans * (low and irregular T doses are probably less likely to lead to ovarian cancer, and still be reason enough for concern), but they're not that far from the corset ones (eg, high heel and chest-binding can actually be dangerous... in rare cases).
I might be missing something, but this doesn't strike me as particularly restrictive? HRT doesn't magically make you pass, so one way or the other you might end up in this situation. Isn't it better to find out if you're cut out for it before you start messing around with your body?
If we can revert that 3600% increase by telling kids to try on a dress for 6 months, maybe we should do that?
No, this is based on referrals to the Tavistock GIDS, not a survey of zoomer tumblrinas.
EDIT: Which, now that I think about it also addresses your previous point. The loosening of the guidelines for HRT has no impact here, since this is just the first step of your family doctor sending you to the gender clinic. You only get HRT after that,
My impression is that medical concerns abound. Increased risk of cancer, diabetes, osteoporosis, inability to orgasm if you block puberty too early... Even adult detransitioners say they feel they were mislead about the medical consequences of it all, and we're talking about pushing kids through the pipeline...
HRT doesn't make you pass, but the expected workflow where you were supposed to socially transition by throwing on a dress (or, to a lesser extent, bind your chest) alone didn't make passing likely for most people. The more approachable compromise was supposed to be more along the lines of crossdressing socially simultaneous with initial counseling and diagnosis, beginning HRT, and then showing as an increasingly androgynous "wrong" gender at work or unfriendly environments until they were more confident in passing, then legal transition and (optionally) surgical interventions.
((Though this didn't survive contact with the Culture War and the general paradox of forum-shopping.))
There was a lot less contemporaneous objection to the three months "counseling experience (eg, dressing and acting as the other gender in controlled or friendly environments)", and I do think that would be a lot more appropriate than 'whenever the doctor or patient slams the button'.
I think it's a good policy, but it wasn't really the effect of the "real-life experience" test, in the same way that a lot of other things don't actually follow their names in this sphere. Dealing with a legal name change that doesn't match your social presentation well isn't a particularly good emulation of what the end result -- or even most intermediate behaviors otherwise -- would have been. I think the best argument for it was a hazing, and there's some benefits to making starting difficult, but it's a different and far more controversial argument.
Yeah, that's fair: if you're specifically talking about just them, they do seem to be a bit of a mill compared to even other gender therapy-specialized places, especially for younger patients. I do think some people have a tendency to treat all gender stuff into one lump category that isn't getting day-one puberty blockers or HRT in /~99.8% of cases, but if you're not doing that the criticism isn't applicable.
I definitely think there's enough papering over side effects to leave serious concerns about any patient's ability to give genuine informed consent, both on the surgical and pharmaceutical intervention sides, especially for longer duration of puberty blockers. Some of that's doctors not keeping up in an experimental field, which happens a lot and often in worse ways -- my 'favorite' example is the weird TNF alpha blocker interaction that might cause a pretty horrible wasting cancer that a lot of doctors in that specific field still don't recognize almost a decade later -- but it's harder to excuse in a more well-networked area.
That said, (unless you're talking about specifically Tavistock-level clinics) I do think there's a tendency to mush together too many (sometimes even incompatible) approaches together and give a list of every possible side effect of each. Eg, estrogen therapy probably tie to diabetes but probably not osteoporosis, and vice versa for testosterone therapy.
Two points: First, I want to restate this is just counting referrals. The amount of times someone goes to the doctor saying "hey doc, my kid says they're the other gender", and the doctor sends them to Tavistock. How the clinic processes them is another matter, in theory they could send them all away saying they don't meet the criteria for the diagnosis. It's possible that if they're a mill, that encourages more people to come to them, but I don't know if we can assume it's a direct causation.
Second, no I'm not talking about just Tavistock. They're a convenient source because they cover the whole country, and have good book keeping that they have to share with the public, getting comprehensive data like that from the US would be a lot more complicated. Also from the size and structure of the country, I'll be happy to concede there's a much larger variance in approaches in the US, so probably there are also many clinics there that are unreasonably restrictive. With all that said, my position is that in the West we have a systemic problem with promoting transition as a cure for all problems for a certain type of person, and waving them through the pipeline without much questioning.
Until recently, I think we had a similar view on the topic: gender dysphoria is a real thing, living with is a horrible experience, and the best way we came up to help people who suffer from it is transition. That's absolutely fine, as long we put a lot of effort into ensuring that is actually the best way forward for the person, and I've seen a few too many pictures of adolescent girls showing off their double mastectomies to believe that this is what we're doing. Combined with my anecdotal experience of a friends daughter being nudged to HRT at the age of 13 without exploring any other potential causes of her problems (this isn't day one HRT, but she's 13, for the love of god), combined with the recent happenings at WPATH, or the messaging in the media, or the various pro-Trans laws being passed the West... I think it's time to slam the breaks hard.
Or are we actually still on the same page? You mentioned swinging too far in the other direction, are you just afraid the swing back is going to be too hard as well? I understand the fear, but I don't know what we can do about it. We could probably work out a reasonable compromise very quickly between the two of us, but literally no one will listen to us.
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I'm a trans woman and I agree. Coming out is going to be weird, and you're going to have an awkward period there no matter what. A lot of advice stresses that HRT is less than 50% of passing anyway (well, going MtF. Might be more FtM with beard and voice breaking and the ability to wear jeans without getting weird looks). A legal name change does seem a bit excessive though.
If you're hoping to transition without any awkwardness, inconvenience, or disruption to your life, the Standards of Care were hardly the biggest issue.
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