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Culture War Roundup for the week of November 6, 2023

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What kind of medical treatment has other people than the patient as targets?

Any cosmetic surgery to correct a deformed but otherwise functional appearance?

You seem to believe PCOS to be a symptom of gender dysphoria while it could very well be that gender dysphoria is a symptom of PCOS, or a symptom of another underlying cause causing both dysphoria and PCOS.

I only said trans people often have those conditions, I didn't say anything about the causal chain. I agree that gender dysphoria could be a symptom of PCOS or another disorder. How else would treating the patient with antiandrogens work? If you read the post, the FtM patients had elevated testosterone levels, took medication to reduce those levels, and the gender dysphoria went away.

Source? They gave placebo hormones to transists and they compared results to transists with the real deal?

That's hard to do since hormones have obvious physical changes and you could tell easily you're in the placebo group. This is unfortunately only self reports from people that transition medically, but not socially (including some of the famous "detransitioners" on conservative media - a few said they detransitioned but admitted to still being on HRT).

It is possible to learn how to break away from negative thought patterns (for example: this part of my body is male and I need to see a surgeon, instead of: I love how male this part of my body is!)

It seems to me that you are not your gender dysphoria. If you are a person who is bad at math, then you can study hard and get a to a certain skill level where you can be confident solving some math problems.

It appears to me that if you are a person who is bad at seeing herself in her birth sex, then this is something they can practice and grow more confident in, instead of lobbing off body parts and playing with disguises for their whole life.

I tried this, I tried seeing a therapist, I tried living as a gay male. I tried everything I could not to transition because I disagreed with the leftist trans movement, for many many years. Yet a few months after I started HRT, my quality of life hugely improved, and I finally had a decent dating life. If anything, refusing to accept that I was trans and telling people I was a gay male - that was the lie.

You're telling me I should stop HRT and go back to that state of suffering - what for? I already did break away from a huge amount of the negative thought patterns, compared to before, and I have no desire to go back.

What would that even look like? How would you know what the opposite sex proprioception feels like? Even if you took cross-sex hormones and then feel that your skin feels different, how would you know that this is the same feeling that somebody of the other sex feels?

Sexual secondary characteristics are a thing - trans women have differently distributed body fat, develop breasts, softer skin (others have confirmed this), trans men get hairier, develop deeper voices, larger muscles and grow a small sort-of micropenis. Spatial and verbal abilities also change following HRT (this is where the infamous brain scan study of transwomen comes from). Proprioception in terms of those characteristics is real - I don't care that this is the same feeling that someone of the other sex has or not, it's different from the feeling I had before and externally matches the opposite sex, and that's good enough for me.

I don't see in which version of 'gender-affirming therapy' you would not be aware that you had your bones shaved etc.

The point is that other people see it too. A more interesting point would be, what if everyone wore these glasses and could alter how others saw them? Cosmetic surgery would be pointless in those circumstances, that I agree with.

They could be surgically-implanted as well.

The glasses wouldn't change how others treated me beyond the superficial - which pronouns and intonations absolutely are.

Rae: I'm glad that things worked out well for you, and I think that most people would be best served by treating transition more or less as you had: a last resort. I see it as a largely irreversible and major medical intervention that should be seen the same way we see things like spine surgery for herniated discs, or elective amputation, or other big, irreversible medical procedures. I'll also chime in as someone who's had mild to moderate gender dysphoria for a decade or more - from 9 or so till 19 - and decided against medical intervention: there's a spectrum of gender dysphoria or transness, and you're unfortunately at the far end of it. I wish medical science was better, to be honest.

Thanks!! The only thing I’d disagree with is that transition isn’t necessarily an irreversible all-or-nothing process. You can start by changing your presentation to something more feminine or masculine, transition socially, and even HRT is a very gradual process that leaves you with multiple months to decide and for MtF patients there’s one irreversible change and that’s breast growth, but they’ll rarely grow big enough that they would require double incision mastectomy should you detransition. FtM patients will get voice deepening, male pattern baldness, facial hair growth (although laser hair removal isn’t a big deal), and bottom growth, but it’s much easier for FtMs to socially transition than MtFs without hormones.

What made the gender dysphoria go away for you if I may ask? I was able to repress it for a while after adolescence, but it came back with a vengeance once the infamous “twink death” hit.

grow a small sort-of micropenis

Nope, that's the effect of testosterone on the clitoris. That's because both the clitoris and the penis develop, during gestation, from the same tissue:

The male and female human fetal external genitalia start out at the indifferent stage (8–9 weeks’ gestation) and grow differentially into a penis or clitoris, which are fully formed by 17–18 weeks gestation (wholemount ontogeny to 16-weeks gestation).

A micropenis is a different thing:

Micropenis is a medical term for a small but normally structured penis. Hormonal or genetic factors can cause this condition. Healthcare providers often note the condition during the newborn to early childhood period.

As long as no other health concerns are present, a micropenis can function normally. People with micropenis are still able to urinate (pee) and have erections.

To get a 'neo-penis' you need surgery.

Spatial and verbal abilities also change following HRT (this is where the infamous brain scan study of transwomen comes from).

There seems to be a lot of fascinating biology at work here:

In a new study published in Psychoneuroendocrinology, treatment of transgender individuals with cross-sex hormones is shown to result in changes in subcortical brain areas related to memory and emotion.

...After the treatment period, oestradiol levels were increased in MtF individuals, whereas levels of testosterone and progesterone were decreased. Conversely, in FtM individuals, levels of oestradiol and progesterone were decreased, whereas testosterone levels increased markedly. Analysis of brain structures revealed volume changes predominantly in MtF individuals, particularly in the hippocampus — a region involved in neurogenesis and neuronal plasticity. Specifically, oestradiol plus anti-androgen treatment reduced hippocampal volume in MtF individuals, which was accompanied by a global increase in ventricular structures. Moreover, reduced plasma levels of progesterone in MtF individuals correlated with reductions in grey matter structures in the right hippocampus and right caudate. Overall, the findings suggest that high doses of cross-sex hormones alter structures in the adult human brain.

That's from 2016, there's another study from 2021 which also records changes but it's murkier since both trans men and trans women had increases in certain area as contrasted with cis men and cis women:

Conclusion Long-term GHT seems to have a considerable impact on GMD and GMM in the brain of transgender individuals. Specific effects of either androgenizing or feminizing sex steroids must be taken into account in most regions, however, in selected structures both types of GHT affected GMD and GMM in the same way, pointing towards mechanisms that are induced by GHT irrespective of whether feminizing or androgenizing steroids are used. The combined approach in analyzing structural MRI data has the potential to shed light on changes of GM as reflected by both morphometric as well as microstructural analyses after GHT in a longitudinal design and in comparison to cisgender individuals. Nevertheless, larger sample sizes are needed to detect reliable associations between GM and potential MAO-A density changes induced by GHT.

A 2019 study suggests that there's a mosaic effect; male and female brains have differences, but also similarities, and you can't say that "this bit is specifically male, that bit specifically female"; brains of cis as well as trans individuals can have both male and female traits:

Cross-sectional studies One small cross-sectional study assessed the effects of at least 2 years of GAHT in 18 FTMs and 17 MTFs after gender-affirming surgery. Neuroanatomical differences in the brain were found to be region-specific between transgender individuals and their biological sex as well as their gender identity, suggesting localization of influence by sex hormones on brain structure [105]. More specifically, the mean neuroanatomical volume for the amygdala, putamen, and corpus callosum of MTFs was found to be significantly different from those of cisgender women, but not cisgender men (consistent with the natal sex of MTFs). FTMs, on the other hand, differed from cisgender women in the third ventricle and nucleus accumbens, which is consistent with their preferred gender, and differed from cisgender men in the medial temporal lobe structures and cerebellum. FTMs differed from both cismen and ciswomen in fusiform volume. These findings suggest that brain structures are not uniformly influenced by GAHT, and that while some structures become more like those of the preferred gender, others may not, or fall somewhere in the middle. This lends credence to the concept of the gender mosaic, which falls between the two rigidly defined binary gender identities.

The 2019 study is really good, a lot of details about how brains and brain structures differ in the sexes.

EDIT: Though this now makes me wonder, what if the solution is not "this child suffers dysphoria, they're trans, put them on puberty blockers" but "this child suffers dysphoria, this is a result of natal lack of/excess of hormones in utero, put them on extra doses of natal sex hormones"? That might be one reason why there are kids who go through puberty and then decide they're not trans; all they needed was for the 'proper' dosage of hormones to kick in and adjust their brain chemistry to their natal sex?

If you read the post, the FtM patients had elevated testosterone levels, took medication to reduce those levels, and the gender dysphoria went away

So women with a mental illness making them think that they are men took medication to reduce T levels (anti-androgens) and that helped them feel better about being women? Why aren't you taking anti-estrogens to cure your gender dysphoria then?

That's hard to do since hormones have obvious physical changes and you could tell easily you're in the placebo group. This is unfortunately only self reports from people that transition medically

Sounds like pretty bad science to me. They should have at least given cocaine to some of them and see who reports feeling better.

Yet a few months after I started HRT, my quality of life hugely improved, and I finally had a decent dating life.

Can you explain? The gay men that you were previously pursuing unsuccessfully finally took an interest in you after you grew your hair long and breasts? Or did you manage to attract a straight man who just can't wait to get married, 2 children and a white picket fence in the suburbs?

it's different from the feeling I had before and externally matches the opposite sex, and that's good enough for me.

Only because you have a point of reference to what the opposite sex is like. If you moved to a male-only monastery for life eventually you would have no idea what a woman behaves like. You could also get smart glasses that correct every dumb thing any woman say around you and you'd get the impression that women are rational, pragmatic people while men are the irrationally angry, ditzy sex.

The glasses wouldn't change how others treated me beyond the superficial - which pronouns and intonations absolutely are.

Well that's what the headphones are for.

I imagine they mean they are attracted to men, tried unsuccessfully to live as a gay man and did not like it for whatever reasons, then once presenting as a woman they were able to date straight men which is more satisfactory.

So women with a mental illness making them think that they are men took medication to reduce T levels (anti-androgens) and that helped them feel better about being women? Why aren't you taking anti-estrogens to cure your gender dysphoria then?

This is an incorrect view of gender dysphoria. Gender dysphoria isn't thinking you're the opposite sex, it's being uncomfortable about being the sex you are and feeling more comfortable if you adopt the characteristics of the opposite sex.

Sounds like pretty bad science to me. They should have at least given cocaine to some of them and see who reports feeling better.

Cocaine doesn't last for very long and the side effects/crash are very severe, but there's other stimulants out there! Given the high proportion of trans people that have ADHD, giving them one like Adderall or Ritalin might not be a bad idea.

Can you explain? The gay men that you were previously pursuing unsuccessfully finally took an interest in you after you grew your hair long and breasts? Or did you manage to attract a straight man who just can't wait to get married, 2 children and a white picket fence in the suburbs?

I dated and hooked up with plenty of gay men prior to transitioning. Gay men are actively uninterested in femininity and lost interest after I grew my hair long and such. I receive plenty of attention from bisexual/bicurious men - sexually speaking there's a ton of seemingly straight men that are very interested in trans women. I'm now in a long-term relationship with a bisexual man and we could certainly get married, adopt children (or go through surrogacy) and buy a house in a suburb. Ironically, I'm more comfortable now with having a family and the normal monogamous life that conservatives are a fan of, than I ever was before.

Only because you have a point of reference to what the opposite sex is like. If you moved to a male-only monastery for life eventually you would have no idea what a woman behaves like. You could also get smart glasses that correct every dumb thing any woman say around you and you'd get the impression that women are rational, pragmatic people while men are the irrationally angry, ditzy sex.

Why the thinly veiled misogyny? Your post has a fairly hostile, sarcastic tone in general. Is this a response informed from bad real life experiences with women and/or trans people?

Well that's what the headphones are for.

Not sure I understand this part?

it's being uncomfortable about being the sex you are and feeling more comfortable if you adopt the characteristics of the opposite sex.

Which are pretty nebulous as far as I know. There are plenty of flat-chested short-haired females out there but you needed long-hair and neo-breasts to feel better about yourself.

Either way you provided evidence suggesting that women with dysphoria should get anti-androgens to be cured, not cross-sex hormones (androgens).

What about you, have you tried supplementing androgens instead?

I dated and hooked up with plenty of gay men prior to transitioning. Gay men are actively uninterested in femininity and lost interest after I grew my hair long and such.

So you had no issue dating before growing your hair long? Plenty of straight men go with women with short hair as well.

I'm now in a long-term relationship with a bisexual man and we could certainly get married, adopt children (or go through surrogacy) and buy a house in a suburb. Ironically, I'm more comfortable now with having a family and the normal monogamous life that conservatives are a fan of, than I ever was before.

Idk about other conservatives but when I think "normal monogamous life" I'm not thinking about your situation. Also the guy you're dating, would he care if you told him to call you 'dude' instead of 'sweetie'?

Why the thinly veiled misogyny?

No misogyny, I'm merely suggesting an hypothetical device that would simulate every single social interaction in such a way that you could attribute certain dispositions to one sex while every single individual is actually completely identical in their behavior with no sexual dimorphism whatsoever.

Not sure I understand this part? The glasses wouldn't change how others treated me beyond the superficial - which pronouns and intonations absolutely are.

All I'm saying is that the glasses and headphones would come together to create the perfect 'I am a woman'-simulation, no matter what other people are actually saying.

Which are pretty nebulous as far as I know. There are plenty of flat-chested short-haired females out there but you needed long-hair and neo-breasts to feel better about yourself.

I don’t care that much about the hair or the breasts, but I need to compensate for my other male characteristics. There’s also other things like softer skin, facial fat deposition, hip/waist/bum fat, hairiness, which are changed by hormones.

The breasts are real, not implants, so the term “neo-breast” would be inaccurate.

Either way you provided evidence suggesting that women with dysphoria should get anti-androgens to be cured, not cross-sex hormones (androgens).

What about you, have you tried supplementing androgens instead?

Unfortunately the anti-androgen “cure” only worked for adolescent natal females, the earlier the better. I didn’t know about this during puberty, but there’s no evidence of supplementing androgen working in adolescent (or adult) natal males working - Dr Powers did try, and I recall some old studies but I can’t find them. B-12 and methylfolate supplementation has anecdotally worked in reducing dysphoria in adults but only by a small amount, not enough to cause someone to detransition.

In my case I had already very high androgen levels prior to transitioning with surprisingly little masculinisation, so I don’t know what would have helped.

Idk about other conservatives but when I think "normal monogamous life" I'm not thinking about your situation.

Compare my situation to the stereotypical gay man hooking up with a new partner every weekend, a queer polycule, or a straight incel addicted to porn? I want to get married, have kids and a home. Like ideally, I would go stealth, move to a suburb with my husband, and the neighbours would never know we’re not a normal monogamous couple with a normal life.

Also the guy you're dating, would he care if you told him to call you 'dude' instead of 'sweetie'?

“Dude” isn’t a term of endearment like “sweetie” is so he might be confused. If you mean, would it change our relationship if I asked him to call me my male pronouns? If that’s the only thing I changed, it would not, although it could be weird with my appearance (but he/him HRT femboys do exist). If I detransitioned, well, being bisexual he would still be attracted to me, but in a different way that makes me uncomfortable. In the past I did experience men and women being attracted to me for characteristics I hated, and it made me feel like I wanted to crawl out of my own skin.

All I'm saying is that the glasses and headphones would come together to create the perfect 'I am a woman'-simulation, no matter what other people are actually saying.

Wait, how?? If I didn’t transition and all I did was wear the headphones and glasses, people’s actions wouldn’t reflect them seeing me as a woman no matter how you edited their words. Like if I went to a bar, no straight man would actually want to take me home (and they might punch me if the AR system edited their words to mean sexual advances). I’d still be asked to lift heavy things, certain clothes wouldn’t fit or look right (and others might treat me worse as a result). I would still have male genitals and feel there them even if I didn’t see them, and the outline of my body wouldn’t match where I put my hands. Also if I applied makeup wouldn’t it look all wrong since it would edit my facial proportions?

but I need to compensate for my other male characteristics.

No you don't. There are plenty of out-of-shape women, with bad skin etc.

Compare my situation to the stereotypical gay man hooking up with a new partner every weekend, or a straight incel addicted to porn?

If I didn’t transition and all I did was wear the headphones and glasses, people’s actions wouldn’t reflect them seeing me as a woman no matter how you edited their words.

You don't have enough imagination.

Like if I went to a bar, no straight man would actually want to take me home (and they might punch me if the AR system edited their words to mean sexual advances).

The smart glasses would take you to the gay tranner bar full of gay men looking for other gay men wearing smart glasses.

I would still have male genitals and feel there them even if I didn’t see them, and the outline of my body wouldn’t match where I put my hands.

No because you'd be under the impression that all normal women have male genitalia as well.

Also if I applied makeup wouldn’t it look all wrong since it would edit my facial proportions?

Your face would look like it never needs makeup applied and even if you did apply makeup badly, it'd look great to you and you'd never hear anybody complain about it.

Tbh that sounds like a cool hook for a sci-fi dystopia story where the population is addicted to AR glasses that personalise reality to their own wants and desires. Basically one step below living in the Matrix.