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Gender dysphoria and its similarities to more general body dysphoria
So consider the /r/loseit subreddit. There are a ton of people on there who hate their appearance and would like it to be different. Consider also the community of people who get plastic surgery.
Hating your body is a very universal human experience! An experience that sucks! The interesting thing here is how the different types of "hating your body" are perceived radically differently by wider society. As in:
(1) Consensus is that weight-based body dysphoria is reasonable and you should fix it by dieting. (It can also be fixed by medication-- semaglutide/tirzepatide, in particular-- but this has not achieved widespread social acceptance.) There is also a fat-acceptance movement, but this is niche and is discouraged by obesity being comorbid with a ton of medical issues.
(2) Consensus is that age-based and (more broadly) ugliness-based body dysphoria is something you should just get over instead of addressing directly. Plastic surgery exists, but it does not have widespread social acceptance, and it is socially acceptable to make fun of women whose plastic surgeries are bad enough to be noticeable.
The common line of "cosmetic surgery won't make you feel better about yourself" is contradicted by pretty clear evidence on average; a cursory google scholar search gets us https://academic.oup.com/asj/article/25/3/263/227685 , which claims the following:
(3) Gender dysphoria has, of course, gotten a huge amount of play in the media since addressing it optimally requires surgery and hormones in adolescence, when we mostly accept that people have not yet reached their full capacity for judgement. Plus, even in rich countries bio-engineering has not reached nearly the place it would need to in order to make neogenitalia function properly, or for "passing" to be easy for transitioners.
Is the current push for social acceptance of gender-based body modification something that will spread into other kinds of artificial body modification, such as plastic surgery for appearance or medications for weight loss?
I certainly hope so!
I think it's a good thing to compare transgenderism to body dysmorphia and have done so before but we should be careful as most mainstream trans advocates are very much not arguing in terms of merely aesthetic/feeling better about yourself. If the desire was merely to allow for men to bolt on some breasts and max out their femininity while still claiming to be fundamentally men(and vice versa for women) we'd have a very different debate.
Hey, there's a reason I'm drawing this comparison here rather than, say, /r/politics.
Though I dislike the characterization that "merely feeling better about yourself" is something frivolous and unimportant. I do agree with you that trans advocates would absolutely object to my characterization above, but I think this is basically just respectability politics; people can and should reshape their body as much as technology allows to suit their desired aesthetics.
The fact that trans advocates would be likely to find the parallel unflattering I think more speaks to societal puritanism around self-modifying your appearance than it does the parallel being inappropriate.
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These 3 things all have different causes of "not liking how you look," different proposed interventions, and different consequences for those interventions.
Being overweight is mostly the result of being exposed to and embracing an environment unlike the one we evolved in, with easy access to high-calorie foods and reduced need to engage in physical activity. It has a lot of negative medical consequences. It should be no surprise, nor considered unexpected, to not want to be in this state. The process of losing weight is mostly eating a more normal amount of calories and engaging in physical activity, which are both entirely "natural" (in the sense of reflecting the evolutionary environment) and which have positive medical consequences even aside from losing weight. I think calling this "dysphoria" in the same vein as obesity is equivocation and not useful in understanding what's going on.
Age-based appearance change is "natural" (expected, typical, whatever) and thus the only interventions available, other than partial mitigation by the same kind of healthy living mentioned above, rely on modern technology. There might be some negative effects of age which can be mitigated this way (like improving vision by tightening the skin around the eyes) but mostly cosmetic surgery to change appearance has little effect on physical health.
I don't know much about the history of gender dysphoria, but a description like "feeling like you're in the wrong sex body" indicates that something is going wrong. It's weird to use language "not working properly" in an evolutionary context, because evolution does not have purpose. However, if we can say that a complex brain does something which improves fitness, then the brain operating in this way is probably not doing that, like how a brain that hallucinates is not improving the fitness of the organism its in. There are ways to affect one's appearance (breast binding, hair, clothes, etc.) but sex-change surgery or manipulating hormones is very new, it's a pretty serious and irreversible intervention, and it certainly doesn't reliably solve all of the relevant issues (not even appearance, reliably).
Worth pointing out that diet and exercise alone have extremely poor intent-to-treat efficacy, generally between 2% and 4% of body weight as measured by most studies. For instance, see https://www.nature.com/articles/0803015 . Medication dramatically improves weight successfully lost (see also: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183)
I'm aware that the studies don't show huge effect sizes, but I'm also skeptical of their quality. For example "intention to treat" does not mean the subjects actually adjusted their diet and exercise as much as intended. That people are bad at following the interventions is certainly relevant information to have, but it doesn't mean that diet and exercise aren't relevant, just that people are bad at sticking to these sorts of changes.
Some other limitations to interpreting results like this:
The included studies range in duration from 10 to 52 weeks, average 33, and the meta-analysis reports an average of 13kg or 28 pounds lost with diet and exercise combined. In my mind, that's quite good. It's certainly much more than 4% of body weight. I don't expect these changes produce immediate results; most people who are obese have been slowly adding fat and weight for man years, and it takes time for them to become healthy.
Drop-out rate of included studies ranges from 15-25%.
Out of the included studies, 1 was male-only, 3 were female-only, and 2 had both. So 28 pounds is an even larger relative reduction.
You're definitely right that diet-and-exercise studies include a huge range of effect sizes. I'm not 100% certain how to interpret this; my suspicion is that there's a hidden intervention sliding scale between "doctor says to you, with gravitas, 'eat healthier'" and "nutritionist locks you in a box and hand-feeds you kale that they calorie-counted themselves." And meta-analyses do a poor job differentiating between these, including the one I linked.
I would expect that more dramatic effects combined with heavier fadeout of results is a natural indicator that a particular study is doing an unsustainably aggressive intervention; in the meta-analysis, it indicated that in both diet-only and diet-and-exercise groups everyone regained about half the weight after a year. Which still does leave 14 pounds, and that isn't anything to sneeze at.
You are also right that there are two ways of doing these studies-- "as prescribed" and "intent-to-treat", and as-prescribed results will always show much better effect sizes than intent-to-treat results. In a sense, intent-to-treat isn't measuring the results of the treatment as much as it is measuring the results of prescribing the treatment. And as-prescribed, diet and exercise will always be 100% effective at inducing any amount of weight loss almost by definition. Hard to beat that, really.
But on the other hand... I kinda figure that intent-to-treat is a fairer representation of real life? In the sense that in real life people don't have the option of getting locked in the nutritionist-box indefinitely. And if two treatments are both effective as-prescribed, but the first one has much worse intent-to-treat efficacy, I want the second treatment.
Sure, but that wasn't the point I was making. The point I was making is that obesity is caused, in the first place, by poor diet and lack of exercise.
Yeah, sorry, went on a bit of a tangent there. Anyway.
I feel a lot of skepticism about bad diet and exercise habits being the primary causal drivers of obesity, since on a personal level I know some people who struggle to lose weight in spite of vigorous and frequent exercise and a diet heavy in foods traditionally considered healthy.
I expect that genetics has a hell of a lot to do with whether somebody becomes fat or not, and that "well you probably have bad diet and exercise habits" is a close-to-hand explanation that is both extremely difficult to falsify and which satisfies our instincts toward the Just World Hypothesis. There might also be chemical contaminants involved.
There might be some sort of interaction between genes and environment, where some people are more susceptible to modern lifestyles causing obesity. But the obesity rate has increased rapidly across many countries, so whatever it is, is not wholly genetic.
(Not sure if you got the chemical contaminant hypothesis from Slime Mold Time Mold, but apparently a lot of their claims are not well supported.
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Pop culture's recent facination with gender-non-conforming males, namely "femboys" is particularly interesting. Based on my observations, most tend to be straight, gynephillic, sometimes bicurious young men who previously lacked a "goal body" that they wanted to achive. They're prehaps not traditionally masculine, have intelectual interests, and really do not aspire to the image of masculinity that society pushes: a dumb, uncaring, drunkard, heavyset dudebro who despises intelectualism and lacks emotional sensitivty. Thus they get fat and don't take care of themselves. Then along comes alternative depections of masculinty, you can be a lithe yet toned, slim bodied male with (debatable) good fashion sense. Not everyone actually has the discipline to actually get fit, of course, but enough people like the idea that's it's practially mainstream.
Also as far as the neogenitalia thing goes, FtMs will probably still want penises, but I highly suspect MtFs wanting vaginas will be a passing fad. Probably a really wierd prediction to make, but, although many men will likely want to become women, the future is absolutely phallocentric.
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My perception of what people think about this is somewhat different. While people tend to look down on plastic surgery, that's usually due to it being considered something you do if you're well off and/or obsessed with your appearance (so, typically associated with vanity rather than with wanting to not be ugly). Also, I think people very much encourage appearance modification like makeup for people who think they're ugly and that it is pretty much socially accepted.
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Plastic surgery has wide social acceptance, it just isn't something people talk about openly yet in America. Procedures are common for younger and younger customers. Brazil has recognized a Right to Beauty for decades, and hasn't collapsed on that score yet. It's incredibly common in Iran to gift a nose-job to a girl graduating high school. Bald celebrities barely exist (outside comedians and old men) anymore. My dad was shook when I pointed out to him that Terry Bradshaw and Howie Long hadn't aged a day since I was in middle school. People who don't pay attention just genuinely don't notice plastic surgery.
What counts as old? Vin Diesel at 55?
Shaved is a different category than balding.
Billy Chrystal in When Harry Met Sally, Kelsey Grammer in Frasier. Brady and Lebron being obvious non actor examples.
When I see a guy who has shaved their entire head bald and isn't, like, a skinhead or something like that, my automatic assumption is that they've started balding and have done the extremely typical move of just shaving it all off instead of having a bald spot. I wouldn't be surprised if that was the motivator for a fair few skinheads, as well.
That would be pretty funny if a skinhead based their whole life ideology on the haircut. Start with, well I need to shave it all off, and then take up all the other affectations to justify it.
Probably pretty true, but not really the point. Joe Buck still has a job, Lebron is the GOAT, Tom Brady is doing constant ads, Joe Biden is president, Elon Musk is idolized. Honestly, it's probably a rare American man who gets through a whole week without thinking about at least one of those men. Society accepts rich men getting plastic surgery.
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Not necessarily. People are good at compartmentalizing.
Has increased support for trans people translated into broader social support for transracial people?
To be fair, I think the only real hate for transracial people comes from the social-justice left; as far as I've heard nobody moderate to conservative has shown the slightest bit of interest. Admittedly this is also because the social-justice left is by far the segment of society most interested in any given person's race.
There's a reason the Rachel Dolezal transracial flareup happened to be around a college instructor! (Because if, say, the head of the National Rifle Association was transracial nobody would care even a little bit. Why would they?)
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I think the issue is often that people are trying to smuggle in reasons why their cosmetic surgery is more important than anyone else's.
We can talk about nickname hospitality, pronoun hospitality, and the basic freedom for adult people with the money to do so to pursue elective surgeries, but that isn't where the battleground really is. The issue is much more around things like: Should government healthcare pay for hormones, surgeries, etc.? Should kids be allowed to transition? How are trans people treated when it comes to sex-segregated spaces? Is the desire to transition innate, or are there reliable ways to steer a majority of would be transitioners towards acceptance of their bodies?
People will put forward a variety of evidence and arguments about each of these points, but I think this is the fundamental difference with the other forms of body dysphoria you compare it to.
If people were pushing for breast augmentation to be standard for teenage girls with body dysphoria, I think people would be just as up in arms about it. It is only because breast augmentation is usually paid out of pocket by an adult that can afford it that it's tolerated, even if there's a stigma associated with botched plastic surgery, or obvious "fake" looks.
There's a lot of birthmark removals done for teenagers, often early teenagers. I think the current standard of care is 'anything larger than a quarter', and middle school ages are pretty typical. There's a lot of overlap between the technologies behind laser hair removal and birthmark pulsed laser dye procedures, and those usually target six months to one year. Some of this is about cancer risk, but then a lot of the trans emphasis is about health risks (eg, hysterectomy is strongly recommended for trans men due to elevated ovarian cancer risk from hormone therapy and probably from puberty blockers). And most of the limits on traditional cosmetic surgery for teenagers are focused on parental consent.
I think there's something of a parallel from social conservative perspectives, but I think they're more separating things not on the basis of surgery or cosmetic surgery as a class, but more because of the invasiveness of the procedure, the higher (although still low in absolute numbers) chances of complications, and lower opinions about the efficacy or even relevance of the procedures (and lack of trust in publicly-presented numbers for the efficacy).
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I think you might be understating the social acceptance, or at least appeal, of cosmetic surgery.
Not that I’m an expert, but I’d say subtle surgery is tacitly accepted, but obvious or sloppy examples are gauche.
This is probably a class signaling thing where the level tolerated varies—see Jersey shore.
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Gender dysphoria, at least for me, is something that makes sense that it exists to a degree. I have compassion for people with it, and I think we should do what we can to best help them (within reason). My major concern about it, is something akin to what I think about body dysphoria....I'm worried about social pressure that might actually causes these various forms of dysphoria. And because of that, I'm not convinced that everybody with Gender dysphoria is best served by transitioning. Some people would be better served with understanding and dealing with those social and cultural pressures.
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Interesting point! I hope self_made_human has joined the site migration, would love to hear their thoughts on this.
How do you feel about body modification in ways that are distinctly non-human? Not necessarily talking about furry-type animal transmogrification, but more steampunk/cyborg style turning yourself into a car or something equally outlandish.
Not self_made but I'm in favour of non-human body modification, although only with seriously advanced technology. My idea of a good future is mass uploading people into star-faring battleships with an agreed upon distribution of the Solar system's resources and sunlight. Someone might get 1/200000 of Titan, others would get asteroids to mine and do what they want with them. There would be a relatively equal distribution of wealth and power between the richest and the poorest so people would have a chance to gang up against anyone seeking to conquer the worlds. Posthumanist libertarian confederation of citizens, basically what the US Founding Fathers desired but with more technology.
If you can turn someone into a car, then you can turn someone into a spaceship. The prerequisite, taking the brain out of the body, means you're about 90% of the way to the latter IMO.
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I don't really forsee this as becoming a thing any time soon. Sure, there will always been outlandish people that end up in vice news articles, but the human body remains the most versitile form in terms of ergonomics and utility.
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Most of my thoughts on this are driven by the practicalities of things we can do right now; I see no reason, assuming all technological restraints were lifted, that anyone shouldn't be able to do anything they want with their bodies.
Similarly, I feel like the only strong arguments against transitioning genders stem from the fact that our bio-engineering isn't up to snuff.
Although if we get to a decent level of bio-engineering, there'll still be debate over whether it is better to engineer your body to match up with how your brain works, or to engineer your brain to be comfortable with the body.
Maybe it won't matter so much then.
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It's not just that the engineering is up to snuff, it's that people think that it is, and want to force everyone else to act like it is.
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I honestly think outside of a small (mostly religious) minority, most people feel that way. The issue is mostly about societal acceptance of trans people and about what others think of them.
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Wheelers for instance. ...We have enough trouble maintaining a belief in shared humanity. I'm not sure widespread optimization for literal inhumanity of form would lead to anything good. We've chased that stuff in media because we enjoy novelty, but we enjoy novelty in controlled and carefully curated contexts.
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So this is a pretty common misconception when it comes to trans (and queer) people. Body dysmorphia often comes with being trans but it doesn't always. Plenty of people are trans without having or wanting any surgery at all.
Having surgery and hormones isn't the only thing thay helps trans people. It's about being socially accepted. They want to feel like they are respected and people aren't attacking them for just being who they are. Hormones and surgery can help with this because it helps some trans people fit in with what's socially expected for their gender identity. It's a different kind of social pressure from the ones anexoric people face.
I've gotten the impression from trans people I see on social media-- trans women, mostly-- that aesthetics are very important to them, and surgery and hormones help a lot with this. They want not only to be a woman, but also an attractive woman. And why wouldn't they? Attractiveness is an important quality-of-life determinant and I disapprove of pretending it's not.
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