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By far the largest externality of the trans movement, in my opinion, is not in any individual case, but the production of additional trans people. Dependency on external hormones, drastic surgeries, elevated suicide risks, worse mental health–even beyond my own negative aesthetic judgment and opinions of what human flourishing looks like, this looks like a horrendous thing to be causing any substantial increase in.
Regardless of what we do involving any single person, we should try to prevent this from increasing as a societal phenomenon—this is of course hard to do in the current state of affairs, where this is controversial.
Not least because it's verboten to consider whether trans people can "spread" being trans to others like a social contagion.
There's a couple reasons to believe this is the case. The proportion of trans people historically has been almost zero. There's two ways they try to explain this:
Cite various examples of historical trans people. But the problem is that these examples are not trans people in the sense of a person who thinks he's a woman in a man's body. These are always an effeminate man who couldn't perform the male gender role, so he was assigned a third gender role (this is almost always what the "third gender" or "two spirit" stuff means), or someone who pretended to be the opposite gender for strategic reasons (e.g. a woman pretending to be a man to join the army).
Say they were just not noticed, or, uncharitably, suppressed by cisheteronormativity. But this doesn't explain why there wasn't a lot of suicides from these transgender identities being suppressed or not affirmed.
Suicide wasn't really as accepted historically either, with Christianity threatening you with hell for it and all. And anyway, even if the entire 0,5% of trans people really have been committing suicide, would it really be traceable on the historical level? We didn't have big data back then.
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