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Dr. William J. Powers - Biological factors of gender dysphoria and transitioning

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Linde

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@ Allie, I don't know much about Australia and it's health care system, and the education standard of your physicians.  But I think anybody in the medical profession should be able to do continuous education, because everything is available online these days.  I changed the first endo, because he seemed to be so ar outside of the world that he could not even communicate with me, and he retired shortly after this.
I am working with my GP, who is an internist, on my general medical needs (most of the time I tell him what to prescribe).  I had another endo, who seemed to know a lot, but he acted like a major gatekeeper, and after I was at the Mayo Clinic, I told him to take a hike.  I don't know if you have something like Planned Parenthood on your side of the globe.  They are most of the time pretty qualified in treating trans people.

@ Donica, Power is on the same line with the endo department of the Mayo, they did some study and found that E pills taken sublingual, are still swallowed by almost 50% with the saliva in the mouth.  They are neutral about progesterone, and as several studies show (I think Margrit posted one from the UCFA here as a video), P is a hit and miss hormone for trans people.  It was a gigantic miss for me, because it caused my hair to fall out, and did nothing to my sleep or my boobs.  I took it for about 6 months, and the only result was hair loss.  So, don't expect wonders from it unless those wonders will actually happen!

I personally feel that the best way to feminize your body is to have an orchi to eliminate all T (except that bit from the renal glands), and take E in the form of injections in a concentration to achieve blood levels between 300 and 500.
an orchi is , of course, also ideally for tucking.  If there is not much left to tuck, nothing needs to be tucked.  I can wear any tight female swimsuit without the fear to sow up.  Some women have more flesh from their larger labias than I have left from my, now, mini penis (which hopefully will be gone pretty soon).


Hugs
Linde
 

OzGirl

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Linde said:
@ Allie, I don't know much about Australia and it's health care system, and the education standard of your physicians.  But I think anybody in the medical profession should be able to do continuous education, because everything is available online these days.  I changed the first endo, because he seemed to be so ar outside of the world that he could not even communicate with me, and he retired shortly after this.
I am working with my GP, who is an internist, on my general medical needs (most of the time I tell him what to prescribe).  I had another endo, who seemed to know a lot, but he acted like a major gatekeeper, and after I was at the Mayo Clinic, I told him to take a hike.  I don't know if you have something like Planned Parenthood on your side of the globe.  They are most of the time pretty qualified in treating trans people.

Hugs
Linde

Linde, Australia is reputed to have some of the best health care in the world, with leading research and practices in cardiac and cancer therapies, but on trans care we are sadly lacking, due to our small population. Add to this that I live in a regional area with no trans support, and I must go to another city to find help. I also find that, like every other vocation, there are good doctors and there are bad doctors. I dumped 3 male doctors treating me for a mystery illness as they would not listen to me, and found a young female doctor who was open to new ideas. She was the only one who would write me a referral to a gender therapist, something which saved my life. I also lost a lot of faith over my losing height. My doctors simply said it shouldn't happen in such a short period, and didn't even try to find an answer, then my Endo felt it might be osteoporosis. I argued that if I lost an inch to collapsing bones I would certainly feel it! This told me he really didn't know much more than he has studied at uni, but for the time being I am stuck with him and find myself again in the position of directing my own health care. I am disappointed that I have to wade through 'qualified' but incompetent medical practitioners to find someone competent.

Allie
 

pamelatransuk

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I sympathize completely Allie.

As you know I live in  well populated country UK of 67M inhabitants - I know this if just one fifth of population of US but still large - and transgender care is simply not funded by NHS such that many of us including me choose private. Whereas I am happy with my private therapy and HRT (although like you it had previously stalled), there a very few available surgeons for GRS in UK.

Also like you, I feel I am advising my NHSGP (from whom I obtain my medication and BTs on NHS) about transgender matters.

I have said several times on the other site that in UK the transgender subject has been in the public domain since around 2005 and frankly I think 15 years on, it is about time my country got its act together on transgender care!

Hugs

Pamela  xx

 

Lexxi

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Katie said:
[member=9]Lexxi[/member] , An endocrinologist is not a specialist in transgender healthcare. Dr. Powers became a specialist in transgender healthcare through practice and real world trial and error. There is no school for transgender healthcare, there is no diploma you can get that makes a specialist in transgender healthcare.

I really like the way you explained that [member=3]Katie[/member] ,

It would be really cool if some institute of higher learning came up with a degree program that fit that description though. Maybe Dr. Powers could teach it. ;D ;D ;D
 

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Hi Allie,
I'm really fortunate in that after a bit of a wait I got into treatment at the Northside Clinic in Fitzroy North, where there are a number of GPs and allied health professional with lots of experience in transgender issues. My prescriber is a GP but very experienced in transgender health.  But reading this thread I wondered if there might be better people in Geelong than those you've found so far then I remembered the AusPATH site which I checked, but only found a psychologist in Belmont and a psychiatrist in North Geelong.  However my psychologist is a fount of knowledge in relation to trans issues and other providers and I wounder if you've spoken to either of these local AusPATH members in relation to other sympathetic, or competent in trans medicine, professionals in your area. Hugs,
-Kenna
 

Marie62

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Dear All,

Wow, this thread is so full of information and has so many twists and turns on its only three pages that I really don't know where to start, but I do feel compelled to comment on a few concepts and ideas, so here we go ...

Male vs. female brain

@Michelle_P gave an excellent summary on the scientific basis and status quo in this on page 1 and - being all three, a clinical psychologist, a neuroscientist of many years and since 2000 the owner of companies (now only one) deeply involved in the development of methods and devices for imaging science - I do want to add that we must never forget that ...
a) to this day we do not know what exactly the BOLD (Blood Oxygen Level Dependent) responses we detect in fMRI really stand for! They are observations and with the underlying assumption that where there is more oxygen around cells, there must be more activity, we *assume* that what we see is neuronal activity, but we simply do not (even) know (that).
b) to be able to say that something is "cognitive" in such functional changes over time, one has to do cognitive (or whatever) testing and then, this test would have to be specific to "trans* cognition" or at least "female cognitition" and as a psychologist, I wonder what that might be. Remember, it is not about the generality of something being cogitive of sorts, it would have to be something that is so specifically trans* or female and vs. male that the variance shows up in the fMRI images and can be interpreted as being *response variance* and not *response uncertainty*. The actual concept is a bit more complicated, but the short message is that it would be really, really difficult to devise a cognitive test that - at the fMRI level - shows up trans*cognitive differences compared to either males or females, for that matter.
c) all data from MR, be it functional (fMRI) or structural (MRI) data, is correlational and not causal. You acquire data from as many subjects as you can, since any given individual tells you nothing conclusive, then do group statistics on this accumulated data and can or cannot determine that there are differences between groups that are statistically significant. However, this does not elevate these findings from correlational to causal and one can still only say that there are differences, but not why or to what effect. And this also goes for brain anatomical data. There may be (and there are) differences, but they follow the same path of reasoning and inherent restrictions as the fMRI/MRI data. To put it bluntly, even the gender dimorphic sites may in the end only explain the tendency to have smaller feet and noses. This is silly (and can be proven or falsified), but you get the point, there simply is nothing in these data that is causal beyond merely being correlational.

Therefore and in summary, it is plain wrong to label these things as the "female brain" and the "male brain", since it gives the - probably wrong - impression that the observed differences have something to do with femaleness vs. maleness and that the variability observed has to do with the spectrum from female to male. This *may* be the case, but it cannot be said beyond being correlational - at best.

Good doctors, bad doctors, specialists and taking charge ...

This is a really touchy and very complex topic and we all have to be very careful with our judgements of our professional health care providers. It is totally true that there are physicians out there who should not have become physicians in the first place, be it due to complacency and lack of will to learn, be it out of other and more "personal" issues with accepting others' views, etc.

However, one thing all of these physicians, the good ones, the bad ones and the specialists are ahead of nearly all of us in, is their being trained at a broader level to be able to know, see and react to that which is not the "trodden path" of a given illness or condition. What I mean by this is that if I, as a layperson read 10 books on appendectomies and then do 1000 of them, I might just become the expert on them, but this does not make me qualified for anything outside that box and any incident or freak side effect I see can throw me off - even after years of "practice" and 1000s of patients. I simply lack the broader underpinnings and understanding of what I am doing!

Physicians are human and they have a full day of work every day and therefore should, but simply cannot keep up with the rapid pace of science in all areas and especially not for something as fringe as transgender care. And, stupidly, the same goes for specialist doctors such as endos, only at a higher level and starting from a "higher ground". Therefore, if you feel frustration at your doctor not knowing "as much" about the topic as you do, then please remember that you are a layperson and that what you know, may not be true or even plausible from a well trained physician's perspective and that there is nothing to say that your physician should or even must have this very specific tidbit of information that seems so overwhelmingly conclusive to you. After all, it may only be so to you, since you found it, it was reiterated on by many others and then seems like common knowledge to you (and me). It may well be correct and worthwhile knowing, but even your specialist endo might not know it, so tell him/her and from his/her reactions you will see the other major point @Linde made further up, which is that nothing beats being able to form a "seeing eye to eye" patient <> doctor relationship.

So, and again in summary, my suggestion to all of us is to indeed take charge and try to learn and know as much about our very special condition and about novel ideas out there as possible and to then find the one doctor who will listen to us and shows interest in working with us on the matter.

De-medicalization and the psychologists ...

There seems to be a major misunderstanding here, since the drive to "de-medicalize" trans* as such does not exist. Instead, there has been a drive to de-pathologize the sexual disorders as they exist in DSM and ICD - for more than 30 years - and with intensive and driving support from exactly that, the clinical psychology field. ICD-11 and DSM-5 are another major step forward in this respect, since both for the very first time take anything to do with Trans* (among others) out of the subcategories defining illnesses and disorders and place them in new categories defining "conditions" that make people eligible to receive medical and psychological treatment - if and only if - they exist.

This is of the utmost importance because - in the end - it simply does not matter if I am Trans* and suffering from Gender Dysphoria due to prenatal DES exposure or to some obscure and magical "happening" later on, the point is that if I can be fit into, if I belong in the category of individuals described in DSM and ICD, then I can make a case with my insurance (or as is the case for socialized medicine as we have it e.g. in Germany and in UK) also to society that they ~have to~ pay for my treatment.

The role that true psychotherapy plays in this, specifically within the transition process, is dimished massively with ICD-11 and DSM-5 compared to their predecessors and many clinical psychologists and therapists moan at this, and I am very clear in my (negative) opinion on this move myself, but no colleagues I have talked to on this topic so far gave the impression that they were fearing for their standing or their income, it was always the fear that laying the responsibility to deal with earth shaking life changes and concomitant decisions in the hands of the "afflicted" without there being a need or at least a good prodding to get good professional help with whatever problems may and surely will arise out of this is plain wreckless!

So, to again summarize, let me say that it is excellent news that we, as trans*people are now finally and completey leaving the arena of the "mentally ill" with the current and - in some parts of the world such as Germany - upcoming diagnostic standards, but this does not mean that we are not perhaps suffering badly (look around this site for proof!) and it is therefore equally excellent news that both the ICD and the DSM provide for this by still having an essentially non-pathological section for our conditions that nonetheless makes us eligible to receive medical and psychotherapeutic treatment, should it prove to be necessary and helpful in avoiding secondary and more grave (true) psychopathologies or secondary somatic illnesses.

My five cents - actually looks more like 5 dollars - sorry for the length, it's the genes, I swear ... :eek:

Love,
Marie
 

OzGirl

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Marie, so many studies have come to similar conclusions in regard to the structure and functions of small parts of the brain, and these conclusions were similar whether the study was purely by dissection or by MRI. They all seem to conclude there is dimorphism in the brains, and that Trans brains more closely resemble brains of their identified gender. Granted, the differences are minuscule, and probably why most of these conclusions are very recent. Certainly most official bodies are taking this on board and changing their own definitions. The WHO changed their classifications, yet so many conservative bodies cling to outdated and discredited classifications. The AustralIan College of General Practitioners for instance is still classifying transgender as a psychological disorder based on a 1970's study by the Anglican Church.

The shift of classification from psychological to a medical condition has not been readily accepted by many, and I suspect there is some level of wanting to remain central to the diagnosis process. Many official bodies and insurance companies require a diagnosis of transgender by a psychologist, but we know, they don't really have the ability to do this. All they can do is eliminate other causes. In the future, it is likely that medical examination might be the defining diagnostic tools, and the official bodies and insurance companies will adopt this, though I know many trans people fear this development. Psychology will remain as a support to people dealing with being trans, but psychologists can't cure this condition.

In terms of competent medical services, when pressed, all of my doctors and psychologist admitted they had little knowledge of my condition, but they are willing to treat me. As I said earlier, I am disappointed that I need to do my own research and find myself in a position where I need to direct my care. I know there are some competent medical and psychological providers, but they seem to be in the minority. I feel this is because there are no courses to teach Transgender medicine and psychological treatment, so there is really nobody actually qualified to give such treatment. This is where people like Dr Powers gain such a reputation. He has an impressive record of treating patients, admittedly by an educated trial and error method, in which the error count is surprisingly low. His methods are based on success, and have been strongly adopted in full or part by other doctors, but his credibility in the academic field is almost nil. He would need to get another doctor to write his methods up into a paper to get any acceptance as he has been unable to gain membership of a recognised body. This is so sad, as the person with the most experience, and probably the most knowledge, will be ignored by the official bodies driving the acceptance of insurance companies, and the result of this is poorer care for trans people.

If 2% of people are transgender, that means there are 160 million of us on this planet. Given that more than half would not be able to get care for their condition, it still means around 50 million trans people looking for competent care, so why can't we get properly trained and qualified medical and psychological professionals? Of course the answer is that we are seen as too small a group to matter, especially as countries like the US work hard to understate numbers so they can avoid allocating funds proportionately.

Allie
 

Linde

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@ Allie, you know that I am sceptical about Powers, and his methods. As a medical researcher, I am weary that he uses his patient as experiments. We don't her about the failures (he may not have any, he may have gag clauses, or they are dead, who knows). Hormones are pretty powerful things, and they can kill people, if used wrong, they can look great in the early years, but can cause cancer or other problems later, we don't know. And that Powers is the best known for trans women, we don't know either, because we are just knowing about him through our internet forums. The endocrinologists I talked to, had never heard about him..
His academic credits are so low, because he is not eligible to become a member in the endocrine society! He does only a tiny bit of endocrinology. It would be the same as I would say I am the same in marine biology as you are, because I know how to swim a little!

I bet that institutions like the UCSF and similar, have seen more transgender people than he ever will, but will not advertise this as he does, because they are public institutions, while he has a private, for profit parxis.
Concerning advancement in medical research, the US, and probably Germany are still the leading countries. because you have the large med. companies in those countries, and they are willing to spend money on research. But they are only interested in getting a return on investment for their money. With the current political system and attitude against trans and LGBQ people that return is not realistic, and thus nobody is willing to sponsor much of the research. I have several patents that were never commercialised, because they did not promise the big buck in return, they might be canned forever.

I think, we will see only very marginal improvements of services rendered to us, until we do not have a system that recognizes us as jut normal umans, and not as some results of devilish undertakings!

Hugs
Linde
 

Marie62

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Hi Allie,

thank you for answering and I fully understand that what I wrote might seem quite negative or at least discouraging, but let me assure you that I am not. However, I do believe that is is totally necessary for all of us to not only know our sources, but to also understand them, both with respect to who says what and is how qualified to do so and with respect to what do they say and what does this mean. I know that to demand this of everyone around is unrealistic, since only endos and neuroscientists ~can~ be expert enough in specialist topics such as endo or neuroscience and this goes for all specialist topics. However, we all can understand the difference between basic concepts such as "correlation" vs. "causality" and this is central to any conclusions we can and may validly draw from the data we are being shown as "conclusive".

... so many studies have come to similar conclusions in regard to the structure and functions of small parts of the brain, and these conclusions were similar whether the study was purely by dissection or by MRI. They all seem to conclude there is dimorphism in the brains, and that Trans brains more closely resemble brains of their identified gender.

What you say above actually is a good example of why not only knowing but also keeping this difference in mind when drawing conclusions is so important. The core points of what you say above are that there are "many studies" that come to "similar conclusion" regarding differences in brain structure between males and females and that trans brains more closely resemble the identified gender. Ok, but what you imply with this statement is that "surely this will mean something somatic is causing transgender" (not quoting, just interpreting), but what you neglect is that these studies cannot possibly show any such causality due to their very nature.

Essentially what you describe is what is called "converging evidence" and one has to understand that all this is is a bunch of studies that all show with more or less (statistical) certainty, that there are *differences*, NO MORE, NO LESS! - This means that - so far - noone has any idea if this converging observation indexes anything meaningful at all - with respect to being transgender, that is - thus my above example with "smaller feet and noses". And very clearly noone at all can say if these differences are relevant to us becoming (phylo- or ontogenesis) or being (secondary sexual development) transgender.

Here, I again have to give it to @Michelle_P for using exactly the right cues in her page 1 post, where she pointed to some gender dimorphic sites being or not being plastic, meaning that changes during life span can plausibly be expected or not and this is one direction in which these purely correlational findings can and must be substantiated in further research. And she also pointed to the human connectome project, which is a world over effort to unravel the mysteries of the brains "gazillion" interconnections and querying data from that massive body of "evidence" might just show us something more interesting and beyond mere correlation at site level. However, even there it has to be said that delineating a sites fully blown connectivity is just like drawing lines between many connected sites where we typically only have correlational data for each of them. Darn, still no causality at the larger level, only an advantage in interpretation of "possible functionality" and besides, we have quite a ways to go also in this area - especially here, with this gender dimorphic "thing".

Certainly most official bodies are taking this on board and changing their own definitions. The WHO changed their classifications, yet so many conservative bodies cling to outdated and discredited classifications.

I am afraid that what you imply here is plain wrong. The WHO changed her (?) definition in accord with the recent changes in DSM-5 and ICD-11 and not in any way related to the studies you mention or their converging evidence. You can easily read up on this in the official WHO briefs on changes in transgender definition and let me add that ANY organization would be ill advised to change their stanza towards transgender definition or care based on such "converging evidence". For any serious organization to do so, there has to - at least - be some "conclusive evidence" where "conclusive" indicates that one can, may and should draw conclusions from a finding so clear in its cause<>effect relationships that calling this conclusive is permissible and that one can base actions upon it.

I think the actual question we should ask ourselves here is just what we are hoping for when we set our hopes on such data. What is it that having "proof" that I am somatically different and that this is the root cause for me being transgender would do for me? Would it help me justify being the way I am, would it help me to feel that I am not a "basket case", would it help me to get easier access to health care support? - I cannot say, but my feeling is that we should discuss THIS rather than how many studies were done and how converging the evidence was, if the meaning of that converging evidence remains entirely unclear.

Many official bodies and insurance companies require a diagnosis of transgender by a psychologist, but we know, they don't really have the ability to do this. All they can do is eliminate other causes. .... but psychologists can't cure this condition.

Again, this is a misunderstanding of what psychotherapy is charged with in this area and please see my post on the topic of "Gatekeeping in Psychotherapy" in another thread here at TR. All the psychotherapists are charged with doing is to - beyond reasonable doubt - establish that you - based on your self description - and your presentation during the sessions, belong to the group of persons meeting the criteria set by DSM-5 and/or ICD-11 for your "condition", e.g. "Gender incongruence" (HA60) in ICD-11. In both diagnostic systems, there are exclusion criteria, such as the existence of other paraphilic disorders or conditions and other severe psychopathologies, and in my post linked to above I outlined why this is so. The psychotherapist also has to establish whether the "Gender Dysphoria" so centrally required to qualify for indication can be substantiated.

All of this is, should and must be based on the self report of the client and on the "between the lines" observations of the psychotherapist and this is no different from any other diagnosis a psychotherapist makes. A schizophrenic patient presents with typical behavior and thinking patterns and the psychotherapist has to rely on the observable behavior and draw conclusions from the interaction with the patient to be able to make the diagnosis, since they have no window into the patients' brains and it wouldn't help to have one anyway, see above, so this is no different from the transgender diagnostic approach and method.

And no reasonable (i.e. intelligent) psychotherapist would ever be so daft as to try and cure transsexualism! This is plain impossible and anyone pretending they can most definitely is a quack! What they can do - and many of us are using their services for this - is to help us adjust to the dramatic changes in us, in our lifes and in our bodies during our transition and to alleviate suffering from all of this. However, even this "cure" is not at all "given" by the psychotherapist, it is effected by the clients themselves and the psychotherapists can only support and help the client along in a constructive, but mostly unobtrusive way.

Sorry to have to be so firm in my statements and please believe me that I do not want to be or appear confrontative, but we do have to face up to the facts - it simply does not help to set our hopes on opinions and beliefs instilled in us by people and organizations, many of whom might even have an "agenda" in giving us "sparsed out truth tidbits". - Know your sources as well as you possibly can and then go talk to your doctor ... :)

Love,
Marie
 

OzGirl

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Marie, my post was more about emerging technology, and the future of transgender care. This is why I started out referring to the findings from many researchers, and mostly Universities like Harvard and Oxford, rather than drug companies. I understand where the standards are currently placed, and there has been some small movement, but as more research is done these standards must yet evolve again.

We agree that psychotherapy plays a support role, but disagree on diagnosis. You explain how it is under current standards, but I am saying those standards don’t give us the care we need, and must change into the future. I might be somewhat biased on current care standards as the professionals I have so far dealt with have poor abilities while strictly adhering to the current standards.

As there isn’t a definitive diagnosis for our conditions currently and it relies upon the opinion of someone reading between the lines, and with no medical input, it seems incongruent with the only treatment which may cure being medical. We deserve more certainty in our diagnosis and treatment and this will only come from emerging research findings and specialist qualifications for our health professionals. In truth, I don’t think we are ready for specialist qualifications as there simply isn’t enough knowledge about our condition yet, and so for now we must muddle along with unqualified care and look to trailblazers to improve out outcomes.

Hugs,

Allie
 

Marie62

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Hi Allie,

thanks for not getting frustrated (openly, at least) at my insistence and let me say that I fully and wholeheartedly agree with just about everything you write above and that the little bit where I feel the urge to object still has to do with the uncertain „value“, the current research into any putative neurophysiological basis for transsexualism has, imho.

But even there I would simply agree that „further research is needed“ and that once and if robust and conclusive evidence is found, it will allow us to make well founded changes to trans health care standards. And then everything else such as diagnostics, etc. will follow suit and we will be looking at a completely new diagnostic and health care eco system for trans.

Even then, though, seeing a psych to check if one is mentally fit to withstand the stress of transition and is free from other psych disorders would be advisable, and in my books still should be a prerequisite to be allowed to transition, but this is then clearly not psychotherapy, since effecting changes to whatever condition there is, simply is neither intended nor being asked for.

But as of yet, we are not there, so let‘s not overshoot by calling things evidence that are not or by referring to brains as „female“ or „male“, if this poses the risk that people mis- or overinterpret such labels, since this is - at least currently - shaping wrong expectations. We are seeing this effect in our German forum right now, where a really heated debate on Powers and the meaning of ”neurophysiological proof“ got started an we are in fact finding it difficult to contain the bush fire. - And believe it or not, I am not even part of that debate ... 🤪

Hugs,,
Marie
 
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Linde

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Hi Allie,

thanks for not getting frustrated (openly, at least) at my insistence and let me say that I fully and wholeheartedly agree with just about everything you write above and that the little bit where I feel the urge to object still has to do with the uncertain „value“, the current research into any putative neurophysiological basis for transsexualism has, imho.

But even there I would simply agree that „further research is needed“ and that once and if robust and conclusive evidence is found, it will allow us to make well founded changes to trans health care standards. And then everything else such as diagnostics, etc. will follow suit and we will be looking at a completely new diagnostic and health care eco system for trans.

Even then, though, seeing a psych to check if one is mentally fit to withstand the stress of transition and is free from other psych disorders would be advisable, and in my books still should be a prerequisite to be allowed to transition, but this is then clearly not psychotherapy, since effecting changes to whatever condition there is, simply is neither intended nor being asked for.

But as of yet, we are not there, so let‘s not overshoot by calling things evidence that are not or by referring to brains as „female“ or „male“, if this poses the risk that people mis- or overinterpret such labels, since this is - at least currently - shaping wrong expectations. We are seeing this effect in our German forum right now, where a really heated debate on Powers and the meaning of ”neurophysiological proof“ got started an we are in fact finding it difficult to contain the bush fire. - And believe it or not, I am not even part of that debate ... 🤪

Hugs,,
Marie
OK, it
It's me with my pet peeve Powers over there!

Hugs
Linde
 

Marie62

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LINDE, darn you, all my efforts to make us look like two well chaperoned young ladies down the drain, shame on you ... :eek:
 

Michelle_P

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@Marie62, thanks for your clear explanations.

There is a strong desire among many to find definitive biological causes, driven on the rationale that this then renders being transgender as a medical issue, something outside of our conscious control and therefore not our fault, just the way we are. It’s very appealing, but as you and I have both mentioned, the information we have on the brain and on development establishes strong correlations, and not causation. Now, correlations often are waggling their eyebrows and telling us “Hey, look over there!”, but I suspect that the experiments that would establish causation would have some pretty severe ethical issues!

Knowing that this correlation does exist does strongly imply that treatment for persons in distress over being transgender are best addressed by making the person more comfortable in their body, rather than trying to treat being transgender as a psychological issue that can somehow be ‘cured’, the so-called conversion therapy route. The differences we observe are not the sort of things we can easily attribute to neural plasticity, our ability to learn, adapt, or adjust. We do know that the outcomes from treatment along the WPATH and other medical guidelines produces happier and better functioning humans than the conversion therapy route does!

I’’ve seen the desire for equity in human rights argued from the medical point of view, but honestly, tying a medicalized view of being transgender to human rights bothers me a little bit, as it implies that only those pursuing a medical transition are Impacted by being transgender. Not every transgender, gender nonconforming, or non-binary person may be able to or feel a need to enter into a medical transition.

I suggest that human rights should not be tied to a medical basis.

Each human life, cisgender or transgender, are and should be the prerogative of the individual, deserving of the law’s equal protection. It is very unlikely that people with a transgender identity simply choose their identity, unlike a freely chosen religious belief, yet the USA protects this choice of religion. A property as intrinsic to the individual as their gender identity, whether cisgender or transgender, is something at the core of the individual. The choices each individual makes about the expression of their gender, as a human being, whether cisgender or transgender, affect fundamental aspects of the individual’s identity at work, in school, and in the community, and are supported by our laws and policies.

It has been suggested in some circles that human rights equity for transgender persons somehow undermines women’s rights. Rights are not a pie, in which a larger slice for one person means smaller slices for others. Both transgender persons and women are entitled to human rights, the fundamental rights that belong to every person. Persons who are cisgender (that is, not transgender), or are transgender deserve to live, even flourish within their communities, with freedom to work, love, learn and play. Both cisgender and transgender persons should be able to build their lives at home, at work, and in public spaces without fear for their safety and survival.

Just my 2 cents worth...
 

OzGirl

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@Marie62, thanks for your clear explanations.


I’’ve seen the desire for equity in human rights argued from the medical point of view, but honestly, tying a medicalized view of being transgender to human rights bothers me a little bit, as it implies that only those pursuing a medical transition are Impacted by being transgender. Not every transgender, gender nonconforming, or non-binary person may be able to or feel a need to enter into a medical transition.

I suggest that human rights should not be tied to a medical basis.



Just my 2 cents worth...

Michelle, just for clarity, you are saying you aren't comfortable with only those undergoing medical transition being seen as transgender, but what about the prospect of a medical diagnosis in the future, where the subject still chooses their path? And I missed where human rights was mentioned before, so did you just introduce this aspect?

Hugs,

Allie
 

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Each human life, cisgender or transgender, are and should be the prerogative of the individual, deserving of the law’s equal protection. It is very unlikely that people with a transgender identity simply choose their identity, unlike a freely chosen religious belief, yet the USA protects this choice of religion. A property as intrinsic to the individual as their gender identity, whether cisgender or transgender, is something at the core of the individual. The choices each individual makes about the expression of their gender, as a human being, whether cisgender or transgender, affect fundamental aspects of the individual’s identity at work, in school, and in the community, and are supported by our laws and policies.
and
It has been suggested in some circles that human rights equity for transgender persons somehow undermines women’s rights. Rights are not a pie, in which a larger slice for one person means smaller slices for others. Both transgender persons and women are entitled to human rights, the fundamental rights that belong to every person. Persons who are cisgender (that is, not transgender), or are transgender deserve to live, even flourish within their communities, with freedom to work, love, learn and play. Both cisgender and transgender persons should be able to build their lives at home, at work, and in public spaces without fear for their safety and survival.
Well said Michelle!!!

On the broader topic, while it is entirely possible that there might be specific measurable differences between male and female brains that play a role in a person's gender identity, I tend to take the view that gender is something that is much bigger than simple biology. A person's gender just . . . IS. Even for people like me, who took ages to recognise it, my gender has been with me from the beginning, while others recognise it from an early age. For some, an important role of psychology or other professionals, is to help with the psychological and emotional impact of the evolution of a person's gender expression moving from one place on the spectrum towards another, or possibly for some, to not move much at all in spite of recognising a mis-match. Along with this, the medical profession plays a role in facilitating the physical expression of our gender through hormone therapy and/or surgery.

Drawing on my experience as a mental health social worker, I suspect that unlike me and many others here, there are some people who are uncertain about their gender, very likely as a result of their life experiences, who may present as, or claim to be, transgender. This uncertainty may be associated with physical and/or emotional abuse and/or neglect and these experiences can often have an effect on one's personality in a way that can become mal-adaptive. Such people may be cis or trans gender and often experience psychological distress in a way that may be similar to, but may not actually be, gender dysphoria. This is a psychological problem that may be amenable to treatment. It is the role of psychologists, psychiatrists or other relevant professionals to not only assess the fulfillment of criteria but to hear "between the lines" and identify if such psychological problems exist then offer and possibly provide treatment should the person agree. This is not "conversion therapy"! It is treatment of a psychological problem that may or may not reach the threshold of a Personality Disorder. As these problems are better managed, either as a result of treatment and/or of growing maturity with time, a person may gain a clearer understanding of their gender. I suspect that many of the people who choose to "de-transition" are in this situation.

Please note that I use "may" and "can" a lot! I don't want to suggest that this is a fixed route! It merely brings together a lot of what I have experienced in my mental health career with a growing, but still evolving, knowledge of what it is to be transgender. Also central to my experience is that people are so much more than just the combination of "nature" and "nurture"! I have often been astounded by a person's resilience, or occasionally their vulnerability, in the face of contrasting expectations. This experience of "moreness" adds to the comfort of my Christian faith!

-Kenna
 
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Marie62

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@Michelle_P - VERY well said and nice to see you look at this from a more humanist perspective! What you say is what this is ultimately about!

Just two final notes on the psychotherapy side of things ...

The idea of conversion therapy still does exist in a few small and radical groups, but it was officially abolished from the diagnostic standards way back in the late 60s with DSM-II, so this is now on the same level as “earth being flat”, etc. and thus more like the religious freedom you mention. In fact, groups that still advocate this typically *are* religiously motivated.

And secondly I think it is worth to again note that in order to qualify for transition, you are required to see a psychotherapist, but only for diagnosis, not for therapy!
 

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Michelle_P

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Michelle, just for clarity, you are saying you aren't comfortable with only those undergoing medical transition being seen as transgender, but what about the prospect of a medical diagnosis in the future, where the subject still chooses their path? And I missed where human rights was mentioned before, so did you just introduce this aspect?

Hugs,

Allie

Correct. There have been persons whose gender identity didn’t correlate with their birth genitals for far longer than there have been medical transition tools, yet we can often say that those were what we now call transgender persons.

There are persons living now whose gender identity doesn’t correlate with their birth genitals, but who cannot afford medical transition care. There are persons who cannot go through a medical transition due to medical reasons, and those who do not feel a need to do so, or who do not want to risk possible loss of function. They may still identify as transgender. A medical diagnosis may enable someone to obtain treatment, but it does not change who they are.

I mentioned the human rights aspect because in many discussions I find those most focused on medicalizing being transgender do so because they ultimately feel that the medical framing will allow them to justify equity in human rights. There are good and valid human rights arguments that can be made without medicalizing being transgender.
 
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Marie62

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It has been suggested in some circles that human rights equity for transgender persons somehow undermines women’s rights.
As I understand it, this is not so much about sharing a pie as it is about sharing an experience, where the argument is that we - as late comers to the female world - and as former members (no pun intended) of the oppressing gender, should have no right to claim “womens” rights, since we were not subjected to their life long suffering from male oppression.

In my opinion this is a point that can be made with at least some validity, as long as it hinges on “life long oppression” and not on biology as the TERF fraction would argue. And of course as long as we are talking about women’s rights, not human rights AS women.
 
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