Supreme Court's ruling practically wipes out free speech for sex writing online

The mode for treating trans kids is puberty blockers until they’re 18 and then they can choose their own treatment - but that pathway is being blocked by more and more laws and fear mongering about kids being transitioned against their will

We've always done so - popular opinion as reflected by the voters dictate that you aren't getting a prescription for arsenic (anymore? Or crack cocaine, for that matter.)

The government, for good or bad, regulates all healthcare, and that government is guided by its voters.

The majority of voters don't see this as a bigger problem than the issue they are currently voting on.

[Citation needed]

For a trans kid, going thru the wrong puberty is harmful. The best thing would be hormones at puberty. But given issues around informed consent, puberty blockers are a valid compromise.

Calling them harmful without considering the harm of the alternative is not honest.

“The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets” (DOI: 10.1016/j.jsxm.2018.01.016).

The word “many” is misleading – it’s less than 1 %. It’s not nothing, but it’s low.

This conception of the "wrong puberty" as something that needs to be blocked is as absurd as all that "born in the wrong body" ideological nonsense.

Most importantly, children can't meaningfully consent to having their sexual function permanently damaged.

When patients are given puberty blockers, desistence rates are miniscule, in the single digits. Proponents of hormonal intervention insist that this is proof that doctors are selecting kids that would persist in a cross sex gender absent blockers. But that's hard to reconcile with psychologists previous failures to predict persistence. While they're billed as giving "time to think", it's pretty much impossible to deny that blockers are causing patients who would have desisted in their cross sex gender identity if they went through their natal puberty.

It's not just conservative American States that are changing course on blockers for children: Finland, Sweden, the UK, Italy, Denmark, and Norway have all stopped prescription of blockers in children. Plenty of other countries never allowed it in the first place.

This isn't the desistence rate of children, this is the regret rate of adults who transition.

All the studies among gender dysphoric children who are not prescribed puberty blockers show desistence rates over 70%

There are studies that show very low desistence rates - many in the single digits. But those are studies among children that are given puberty blockers.

Why do you think you can’t experience the wrong one? Also, unless you are saying there is only one sex, how could there only be one puberty?

Given the definition of maturity is being fully grown, this comes across as an inherently unhelpful thing to ask. If we say “only once someone is fully grown they are able to determine if they experienced the incorrect puberty” then this makes it impossible to help children who are going to experience the incorrect puberty. Unless we have some way to determine a child is trans without any input from them, there becomes no way to help them.

https://apnews.com/article/uk-transgender-health-care-childr...

https://news.ycombinator.com/item?id=44546443

That began in 1906; it's hardly something we've "always done".

That is an extremely generous interpretation. I think you're giving way too much credit to the average person that uses that argument.

Also I really have to wonder how much of that desistance is giving up versus actually being satisfied.

If you ask trans people, "it's too late to live as my gender" is a common sentiment. You even see it in the gay community, where gay/bi people who come to acceptance of their sexualities late in life, feel like it's "too late" to live with that identity, and choose to continue to live and identify as straight people.

Hence the option for puberty blockers.

Turns out trans people will opt to go through the puberty that matches their gender if the opportunity arises, just as more people come out gay/bi/etc at an earlier age now that the opportunity arose.

Who are we to question God's natural order? If a 9 year old girl with precocious puberty is uncomfortable being oggled by old men, that's just fine because puberty can never be wrong.

Besides, she can't meaningfully consent to medically delaying puberty, anyway.

Same thing with gay people, as per your example. I'm sure some do remain closeted their entire lives. But plenty of them come out as gay later in life.

> Overall, 33% underwent transmasculine procedures and 67% transfemenine procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%–<1%) and 1% (CI <1%–2%), respectively.

That's less than the regret rate for life saving surgeries lol

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/

Plenty do, but the ones that don't give credence to the idea that forced closeting as a teenager makes it harder to follow your heart later. And that's in a situation where it doesn't get more difficult to come out later (if you're not married). Transitioning pre- and post- puberty is very different with current medical technology, so a lot more people will get "stuck".

> But plenty of them come out as gay later in life.

Some do, but statistics show that the majority don't. At some point it stops making sense to identify as a gay/bi person if you've been married for 20 years and have no intention of leaving. That ship has sailed, so to speak. The same thing happens with trans people for very practical and biological reasons post-puberty.

Here's what more reliable studies from the American Academy of Pediatrics, the largest professional group of pediatricians in the country, say[2]:

> Gender Identity 5 Years After Social Transition

> We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years.

[1] https://downloads.regulations.gov/ED-2022-OCR-0143-141953/at...

[2] https://publications.aap.org/pediatrics/article/150/2/e20210...

The study uses the DSM-III and DSM-IV criteria for gender incongruence disorder, or GID, now referred to as gender dysphoria. The sample ranges from 1989 to 2002 and those were the contemporary iterations of the DSM. The DSM-V wasn't published until 2013. At most the criteria is outdated by one decade, not "several decades". Furthermore, the author of the study would later write the criteria for gender dysphoria in the DSM-V. The criteria are not particularly different, and the author of the study I linked has stated in interviews that most of the sample would meet the criteria for gender dysphoria under the DSM-V (which, again, he wrote so this opinion should carry some weight). In short, the idea that if the psychologists had used the DSM-V the results would be substantially different is not likely.

And this isn't just one study that found low rates of persistence:

> In Green (47), the percentage of persisters was 2% (total n = 44; Mean age at follow-up, 19 years; range, 14–24); in Wallien and Cohen-Kettenis (52), the percentage of persisters was 20.3% (total n = 59; Mean age at follow-up, 19.4 years; range, 16–28); and in Steensma et al. (51), the percentage of persisters was 29.1% (total n = 79; Mean age at follow-up, 16.1 years; range, 15–19). Across all studies, the percentage of persisters was 17.4% (total N = 235), with a range from 0 to 29.1%.3

Are all these other studies finding low rates of persistence also tainted in some way?

The study you linked is among a group that were treated with an affirming model of care, where cross sex gender identity is actively encouraged, and a sizeable chunk of the sample were put on puberty blockers. This comports with what I have written: when gender dysphoric children are met with an affirming model of care and given gender affirming care, very few of them desist in their cross-sex gender identity. When they given a neutral, observational model of care not not prescribed puberty blockers, the majority of them desist. The study you linked just reinforces the former but does nothing to disprove the latter.

Look, if you want to debate your theory of contagious trans-ness, you should be open about that from the get-go.

What are you going on about "contagious trans-ness"? Gender dysphoria isn't spread by a bacterial or viral infection. I have no idea what you mean by "contagious". The second sentence reads like a total non-sequitur.

I feel like as a society we put trans people in a situation where it is controversial for them to transition as children, but also controversial for them to transition as adults. (The notion of a man in a dress no longer exists if the man never had male puberty, but not only is it controversial for such a boy to never have male puberty, we villainize the now-man's attempts to become a woman!) But then we say that outcomes for trans people are bad so them staying in the closet is good. Which is weird, because the cause of the bad outcomes is that there is no stage of their life where trans people can transition noncontroversially.

As someone else pointed out, the idea of gov deciding what our doctors can and cant give us is a VERY modern concept.

But your examples: arsnic & crack

1. Cocaine is legal for doctors to prescribe and use in specific circumstances. What is legally prohibited is recreational use. Most of the restrictions on use are due to the threat of addiction, not the threat of appropriate medical use.

2. Arsnic is similarly entirely legal for medical use. Restrictions are around putting it in FOOD because it’s POISON. Nobody is saying you can’t treat cancer with it, if it’s shown to be effective.

Your examples are not examples of the majority regulating medical care for individuals.

This is ideological nonsense.

Coulda said the same about homosexuality ~30 years ago. It’s a bad reason then, it’s a bad reason now.

Well, yeah. That's because it literally was a passing phase that the child experienced. That's why there's so many studies (some of them linked in this thread) showing that if you simply defer the decision until the minor is a major , the majority of gender dysphoria desists.

IOW, once the child has actually matured a little, their identity confusion goes away.

Deferring is the path of least harm; is it any wonder then that most of the people in the world, including highly secular countries, go that route?

Well there was never going to be a perfect solution, right? So a solution that results in the most number of satisfied adults is an okay goal.

(1) by transition i mean socially transition and go on puberty blockers if they want them.

There's a reason there's nearly 10x as many gay identifying people in recent generations compared to past, and you can't generalize it as being a "phase". The true rates are likely the same, but people who identify that way dip off as you go back generations.

You notice the same pattern with left-handedness and those who identify as left-handed over time.

Left handedness increased from about 5% to 12% over the span of more than 60 years: https://www.datawrapper.de/blog/history-of-left-handedness

By comparison rates of transgender identification among minors has increased by a factor of a hundred over the span of just 10 years: https://www.researchgate.net/figure/Rates-of-newly-recorded-...

We're talking about an increases that are multiple orders of magnitude greater, over a fraction of the time span.

Higher rates of suicidality: https://pmc.ncbi.nlm.nih.gov/articles/PMC7011156/

~4x the rate of depression: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

Even if these disparities are due to discrimination, those disparities still exist. We don't measure health outcomes based on what hypothetically would happen in an ideal world where people genuinely do not recognize or distinguish between the sexes. We measure health outcomes based on what happens in real world.

> Besides, she can't meaningfully consent to medically delaying puberty, anyway.

Yes, indeed she can't.

To take female puberty as an example, this is the growth and development of the uterus, ovaries, labia and breasts to reach their mature form and function. Most importantly, the menstrual cycle begins, making pregnancy possible.

If a boy has testosterone blocked and is given estrogen instead, he doesn't experience any of this, except perhaps some breast tissue growth and redistribution of fat. His penis and testicles will not develop further and he will probably remain sterile.

However, he doesn't have a female reproductive system, so this is not more similar to female puberty. What he's experiencing is stunted male development, a pharmaceutically-induced eunuch state.

There is no option for him to go through female puberty rather than male puberty, because he lacks the type of reproductive system that would make this possible. As female puberty is not an experience available to him, it makes no sense to describe male puberty as being the "wrong puberty" for him.

Likewise for girls and the impossibility of experiencing male puberty.

> You are counting kids with GNC behavior who never talked about transitioning themselves stopping said GNC behavior.

These children met the criteria for GID in the contemporary iteration of the DSM. The author of the study I linked would go on to write the criteria for gender dysphoria in the DSM-V. The idea that we'd see a substantially different rate of desistence if the DSM-V was used is not likely: the author of the study has stated that most of the children would have met the criteria for gender dysphoria under the DSM-V.

> You are also counting kids who end up repressing (some of which end up transitioning with worse outcomes years down the line)

The study followed up with patients for an average of over 10 years. Do you have any actual evidence that a significant portion of desisters in this study transitioned later in life? Or are you just stating this without evidence?

People have not offered a good explanation why these rates of desistence are false. They either insist that the criteria used was wrong, or baselessly claim that desisters are repressing a desire to transition.

I wonder how many left handed people were beaten into becoming right handed, and remained right handed. In a society where left handed people continue to be beaten, would these people be considered happily right handed since they continue to use their right hand? How would we be able to tell?

I wonder if we existed in a world where soft boys were beaten into becoming less emotional, who grow up to be unemotional men. In a society where adult men are beaten if they express softness, are these men considered happily unemotional? How would we be able to tell?

How do we tell if someone is cis when it is stigmatized to be trans or express gender dysphoria? Genuinely not sure, honestly.

This is why talking about what the outcomes would be in some hypothetical world is pointless. Doctors are striving to deliver the best outcomes in the real world, not the outcomes in some hypothetical world that doesn't actually exist and probably never will.

> yet also use the discrimination against trans people as a justification to discriminate against children exploring gender, i.e. trans children.

Children are free to explore their gender. Just not with powerful drugs that have lifelong effects. Refusing to prescribe puberty blockers to a child experiencing gender dysphoria isn't discrimination any more than it is to refuse to prescribe artificial testosterone to a boy that has normal levels of testosterone for his age. We "discriminate" against this boy that wants to explore hypermasculinity, too.

> I wonder if we existed in a world where soft boys were beaten into becoming less emotional, who grow up to be unemotional men. In a society where adult men are beaten if they express softness, are these men considered happily unemotional? How would we be able to tell?

You would measure their health outcomes: do the latter experience depression or other negative mental health conditions at different rates? Do they die by suicide at different rates? I haven't dug deeply into the effects of corporal punishment, but presumably it's discouraged because we've observed negative outcomes.

> How do we tell if someone is cis when it is stigmatized to be trans or express gender dysphoria? Genuinely not sure, honestly.

I'm not sure what you mean by "how do we tell if someone is cis". I think you mean something along the lines of "how do we tell which gender dysphoric children will or won't continue to experience dysphoria in their cis gender past natal puberty?" If that's the case then the answer is "we can't". Psychologists tried, for decades, and failed to predict the minority of patients that would persist in cross sex gender identity. We know that ~80% become comfortable in their cis gender after natural puberty. This is why it's hard to justify prescribing puberty blockers. Suppressing natal puberty will help someone pass better in a cross-sex gender, but the benefits of passing better need to be weighted against the probability that the child would live comfortably in their cis gender without dysphoria absent blockers.

Which is the better health outcome? 5 trans people who medically transitioned before puberty, or 4 cis people who live comfortably without dysphoria in their cis gender and 1 trans person who transitioned after natal puberty? Ideally we'd be able to predict the 1 patient that would persist, and transition them medically before puberty. But again, we don't have that ability. Thus, it's insufficient to justify prescription of puberty blockers by pointing to the one trans person who medically transitioned as an adult and say that they would have had a better live if they were able to transition medically before puberty. This is the big reason why advocates for puberty blockers tend to dislike discussion of persistent rates with versus without puberty blockers. It's fairly easy to justify them in the simplistic world where all gender dysphoric youth are guaranteed to persist. But factor in the persistence rates without blockers and it becomes vastly harder to make the case for them.

Learning about adverse side effects by talking about their experiences is LITERALLY what you’re advocating for a ban on. I’d say by any basic morality you’re not allowed to cite that as evidence if you want it banned.

Puberty blockers are a huge step. Not one taken lightly. Kids who are unsure, by and large don’t take that step.

I injured my wrist a few years back. Doctors offered me pt or surgery + pt. They clearly advised me that given the low severity of my injury, surgery would likely improve some things while causing other impacts. I declined the surgery.

This is how most medical choices are made. Doctor advises, patient listens and choses best option. For patients who are also minors - their parents are also involved. Every day a parent and child choose between consequences of the intervention and consequences of non intervention. The only difference with trans kids is apparently you and the gov want a say in the choice. It’s not your body, nor your kid. It’s none of your business.

You will say "but then you were not a desister" but I would be counted as one, just like the other kids in my position.

> Do you have any actual evidence that a significant portion of desisters in this study transitioned later in life?

I don't have enough funds to perform such a research, maybe there exists such a paper but I have not looked for it. In general trans topics are woefully underfunded. But I know enough people that ended up desisting either due to conversion therapy or due to shame and lack of support from their family, and transitioned years afterwards (5-15+ years) after living shitty and depressing empty lives pretending to be cis.

What's next, gene therapy because the embryo might want to be a different race when it grows up?

And how long until the current criteria is outdated?

> But I know enough people that ended up desisting either due to conversion therapy or due to shame and lack of support from their family, and transitioned years afterwards (5-15+ years) after living shitty and depressing empty lives pretending to be cis.

This is called "anecdote". As I said, the claim that a sizeable chunk of desisters transition later in life is being made without evidence.

And again, with a mean followup time of over 10 years, most of the people who transitioned 5-15 years later would be counted as persisters, not desisters.

Well, first off - we trust children to make life-altering decisions every day - sometimes without good access to info about potential downsides. A great example is sports. Many sports (ballet, football) can and do have life-long health and quality of life impacts. Minors can commit to those and yet there’s no widespread moral panic about it.

The thing is I actually do trust children to figure out what’s best for themselves. Children are impulsive, yes - they have poor in-the-moment judgement. But medical transition isn’t something that can be done impulsively. It takes years of consistent action, not minutes or hours.

In the UK, Canada, most of the rest of the world? Single payer public health systems mean trans healthcare isn’t more profitable than any other type of health care. Doctors have no profit incentive, as there are easier less controversial specialities that have larger patient bases and higher patient thru-put.

> This is called "anecdote"

When you are lacking proper research all you are going to get are anecdotes. Let's not put our heads in the sand.

> with a mean followup time of over 10 years, most of the people who transitioned 5-15 years later would be counted as persisters, not desisters.

10-15 years means that you are 25-30 if you came out at 15. At that point people often self-medicate with hrt and nobody ends up knowing. The mean age of 10 years is because they tracked younger children, if you came out at 7 its unlikely that you will transition at 17 with unsupportive parents, especially back then.

I am talking about d6e

Of course not. There is an assessment period. They are assessed for gender dysphoria, and if diagnosed they may be prescribed puberty blockers to treat their gender dysphoria. And what is the criteria for diagnosing a patient with gender dysphoria? Whether or not you think the criteria in the DSM are effective, at the end of the day these are the criteria that would be used to approve puberty blockers. If you think these criteria erroneously include kids who aren't "trans kids" then we're approving puberty blockers for patients who aren't "trans kids".

Of course a longer follow up time is strictly better, but it's not valid to simply fill in a gap in data with whatever better suits your worldview. If a study measuring rates of detransition follows up with patients for 10 years, then patients that detransition after 10 years would not be counted. Is it valid to point to a couple anecdotes of detransition, and then claim that the study's finding are false because there's loads of people who detransitioned after 10 years? Of course not. But that's the same flawed criticism you're making here.

Why the scarequotes? For the record I don't think I have used these two words together, but I obviously do think that kids can be trans just like anyone else, is that even debatable?

> don't get prescribed blockers

I am quoting here out of context but correct, there is no point in puberty blockers before the "natural" puberty.

> There is an assessment period. They are assessed for gender dysphoria, and if diagnosed they may be prescribed puberty blockers to treat their gender dysphoria

Sure, and we have been saying that these criteria are unscientific, inaccurate, and based on social stereotype.

> at the end of the day these are the criteria that would be used to approve puberty blockers

The difference being that teenagers who don't explicitly seek them because they don't consider themselves as trans are never considered for undergoing puberty blockers. All that study shows is what we have been saying all the time about the DSM.

> If you think these criteria erroneously include kids who aren't "trans kids" then we're approving puberty blockers for patients who aren't "trans kids".

No, because teenagers who don't consider themselves trans do not seek puberty blockers and are therefore never considered for them. The main distinguisher between trans and nontrans people is their self identification.

> Of course a longer follow up time is strictly better, but it's not valid to simply fill in a gap in data with whatever better suits your worldview. There certainly seems to be a pattern.

I don't think it's surprising or debatable that trans people who undergo conversion therapy or grow up in oppressive/conservative environments often end up repressing.

1. Expressed a cross-sex gender identity. They were trans kids, as you choose to term it.

2. Met the assessment criteria that would be used to approve a patient for blockers.

Yes, the desisters in the study would most likely be prescribed blockers if they went to a gender clinic that prioritized affirmation.

> The difference being that teenagers who don't explicitly seek them because they don't consider themselves as trans are never considered for undergoing puberty blockers

Again, these patients did express a cross-sex gender identity, or "consider themselves as trans" to use your language. If they never did, then they can't desist from a cross sex gender identity if they never expressed one in the first place.

> No, because teenagers who don't consider themselves trans do not seek puberty blockers and are therefore never considered for them. The main distinguisher between trans and nontrans people is their self identification.

To re-use your terminology, studies found that ~80% of the children who considered themselves trans stop considering themselves trans and become comfortable and no longer experience gender dysphoria in their cis gender after natal puberty. It seems like the root of the problem is the lack of understanding that the children in the study did "consider themselves trans", as you choose to put it.

If all you're going to do is continue to erroneously claim that the patients in this study weren't expressing a cross sex gender identity ("consider themselves trans"), or baselessly claim that the desisters are actually just repressing a trans identity then there's no value in continuing this.