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I agree "mutilation" is a little tendentious, but only a little. You are removing healthy body parts, which in almost all other circumstances is mutilation. I also note that you do admit that minors are getting top surgery, so I wouldn't say hormones are the only focus for minors. Not to mention that hormone replacement can leave minors sterilized and sometimes unable to orgasm for the rest of their lives, or cause osteoporosis-type symptoms, so I wouldn't exactly consider it a minor intervention even if no surgeries were being done.
A lot of our disagreements probably come down to empirical questions. How many kids would simply get over their transgender phase and never experience the "hell" of being in a body they hate if they weren't "affirmed"? For how many people does gender transition actually lead to long term mental health gains? How many people will regret being put on hormones or going through surgery as minors? How many people would go through the "hell" of being stuck in the "wrong body" in the absence of trans activists constantly telling them about transgenderism? These seem like very relevant questions to how we should approach this issue.
There is growing evidence that associates being transgender with a cluster of physical disorders linked to a genetic abnormality on chromosome 6p21. An enormous proportion of transgender patients have nearly all of the below conditions:
Hypermobility/Ehler-danlos syndrome
impaired thyroid functionality
gastrointestinal issues of varying severity
autism
adhd
dysautonomia/postural orthopedic tachycardia syndrome
in natal females, congenital adrenal hyperplasia, and PCOS
some more random markers like acidic urine
Transgender healthcare specialist Dr Powers*, who noticed the above list and corroborated it with other doctors, also managed to successful treat teenage female dysphoric patients with a completely different approach: prescribing them anti androgens. The earlier, the higher the chance of the dysphoria being “cured”. Unfortunately he has not had much luck with natal male patients and the hypothesis is that it could be due to androgen exposure in the womb.
In the light of the above, a hypothesis based on endocrine disruption instead of cultural contagion makes more sense as an explainer of gender dysphoria. Perhaps elevated micro plastics in the environment, or perhaps chemical in the water turning people gay, I don’t know.
But the “wait until they’re adults to do anything” approach for dysphoric teens is clearly not optimal, especially when you have patients that fit so neatly in a cluster, and have some for who transition is not necessary if the endocrine abnormality is treated early enough.
Now the medical treatment needs to be optimised for the best outcomes, sure, but currently the detransitioners are a small minority (2-5%), with most of them detransitioning because of social reasons and not due to desistance of dysphoria, and many retransitioning later. You are thus suggesting throwing 95% of the trans population on the bus to protect 5%.
*Dr Powers is also known for reversing sterility in transgender patients and also enabling normal genital development in younger patients by the use of topical HRT.
I respect Dr. Powers, but one clinician noticing that he has a lot of patients with certain comorbidities and doing informal surveys on the internet with his fanbase is not high quality evidence.
One possibility is he's too good at his job, he's one of the few endocrinologists who actually run hormonal assays on his patients before prescribing them new hormones. He always does a mental health referral before doing anything else. In other words, he's ethical. It is entirely possible that he and his band of clinicians using the "Dr. Powers'" method have already weeded out the tucutes from their patient list and are only looking at a smaller subset of the transgender phenomena - those with actual hormonal issues and would have a problem regardless of the culture. Not every underweight person has anorexia!
I am 100% supportive of trans-identifying teens having a hormonal assessment and then prescribed methods of making their hormonal profile more closely fit with their sex assigned at birth. Medicine should be focused on restoring health and biological functioning when possible. I would love if the battle over trans-identified individuals took place over polluting corporations, identifying all the endocrine disruptors and removing them from our environment.
I do want to note that opponents of transitioning have also noticed the correlation with ADHD and Autism, and have taken it as evidence that it is a social contagion (we would expect these groups to be more susceptible to feelings of not fitting in with peers, body dysphoria, etc.)
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Yeah, I think, especially with the rise of what I think are more transitioners due to cultural contagion, that the 2-5% detransition number is quite likely a severe undercount (and as far as I know, some of the low detransition numbers were collected from studies that had serious flaws).
The empirical landscape here is really complicated, both because it's a relatively new phenomenon and because the political stakes are so high for any given study that it can be hard to trust the results/interpretation from either side. So I don't think either of us will be able to convince the other by throwing studies/etc. at each other. I will mention that some European countries are pulling back from the affirming care model as more evidence comes out that the mental health gains claimed for transitioning are less certain than was claimed. See, e.g., here.
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