If you go to the same school, you are more likely to be from the same social and circumstantial strata, which may be a bigger factor in openness to diagnosis and development of mental issues.
Yes, and people who have a certain mental architecture tend to associate with others who have similar brains. ADHDers tend to have friends with ADHD at least partly because they are more forgiving of some of the challenges of having ADHD.
This study is junk. There is no dataset or study design that is feasible for untangling the complexities of "like minds attract" to allow for an examination of the memetic spread of psychiatric disorders.
I can corroborate this, with an oddly well timed recent event.
In school I had a large friend group, none of us were diagnosed (publicly) with anything. We spent a few years together and then all scattered across the country and did not particularly keep good contact.
Cut to a decade and a half later, I'm attending a good friend's wedding back in my home town at the beginning of this month. I was diagnosed very late with autism back in 2019, then at the celebrations I discover the vast majority of my friends have had their own either autism or ADHD diagnoses since we last saw one another. Our crew ended up somewhere like a 3/4 or a 4/5 with a diagnosis, from a group larger than 30.
If we were included in the study's population, would the authors have declared that we "transmitted" these conditions to one another?
Yeah this is an error people make about transgender people all the time. Parents say "my child started hanging out with a bunch of trans people and then they told me they are trans, but they never told me anything about this before so I think they became trans because of those people" and it's like, no the child was attracted to the group of trans people because something about that group resonated with the child, and having spent some time seeing their perspective they felt that transition would better resolve some internal tension they may never have understood or had words to express. Being friends with trans people didn't make the child trans, it just showed them a new perspective they had been seeking when they decided to become friends with those people.
Similarly, people with various mental health conditions may have some attraction to others in the same boat, as they can find mutual understanding, learn coping skills, and vent about the other people who don't understand.
You could just as easily say mountain biking is socially transmitted because all these mountain bikers are hanging out together.
> and having spent some time seeing their perspective they felt that transition would better resolve some internal tension
Thing is though, that during puberty there is a huge amount of internal tension as one's body goes through significant developmental changes. Especially for girls as they start to be sexualised by men. The idea that transition can be used to escape this makes for a tempting second option, and if there are peers who also think that way, it can be very encouraging.
We know that the number of detransitioners is on the rise, and their stories are very often along those lines. They became obsessively drawn to the idea of transitioning, often through social media and peers, and later, when they had the insights of adulthood and the obsession had faded, regretted what they'd done.
The problem is that transition isn't actually a change to the opposite sex, it just creates a poor facsimile at best, and the medical pathway of blocking puberty and taking cross-sex hormones causes irreversible harms to one's body. Loss of sexual function is a big problem. And of course, teenage girls who undergo mastectomy to affirm their idea that they should be boys, can't get those body parts back.
> We know that the number of detransitioners is on the rise, and their stories are very often along those lines
For some extra context on this comment "on the rise" still constitutes an absolute minority of those who transition, I believe somewhere between 5% and 8% -- and the most common reason given for detransition is due to lack of support, coercion or pressure from family and friends rather than transition regret.
"Of those who had detransitioned, 82.5% reported at least one external driving factor. Frequently endorsed external factors included pressure from family and societal stigma."
Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health
doi: 10.1089/lgbt.2020.0437
This article is useful because it explicitly mentions people often misconstrue detransition for regret, when that as a cause for detransition is considered uncommon compared to external pressure.
The reasons given for detransition vary by survey. In these two papers, lack of support was a minor reason amongst those surveyed:
Vandenbussche, E. (2021). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. Journal of Homosexuality, 69(9), 1602–1620. https://doi.org/10.1080/00918369.2021.1919479
> The most common reported reason for detransitioning was realized that my gender dysphoria was related to other issues (70%). The second one was health concerns (62%), followed by transition did not help my dysphoria (50%), found alternatives to deal with my dysphoria (45%), unhappy with the social changes (44%), and change in political views (43%). At the very bottom of the list are: lack of support from social surroundings (13%), financial concerns (12%) and discrimination (10%).
Littman L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of sexual behavior, 50(8), 3353–3369. https://doi.org/10.1007/s10508-021-02163-w
> The most frequently endorsed reason for detransitioning was that the respondent’s personal definition of male and female changed and they became comfortable identifying with their natal sex (60.0%). Other commonly endorsed reasons were concerns about potential medical complications (49.0%); transition did not improve their mental health (42.0%); dissatisfaction with the physical results of transition (40.0%); and discovering that something specific like trauma or a mental health condition caused their gender dysphoria (38.0%). External pressures to detransition such as experiencing discrimination (23.0%) or worrying about paying for treatments (17.0%) were less common.
One major problem in fully understanding this phenomenon is that there is currently inadequate follow-up by gender clinics to collect data on detransitioners.
As the Cass Review notes:
> 15.50 Estimates of the percentage of individuals who embark on a medical pathway and subsequently have regrets or detransition are hard to determine from GDC clinic data alone.
> There are several reasons for this:
> - those who do detransition may not choose to return to the gender clinic and are hence lost to follow-up
> - the Review has heard from a number of clinicians working in adult gender services that the time to detransition ranges from 5-10 years, so follow-up intervals on studies on medical treatment are too short to capture this
> - the inflection point for the increase in presentations to gender services for children and young people was 2014, so even studies with longer follow-up intervals will not capture the outcomes of this more recent cohort.
The Review also noted the problem of clinics not adequately sharing the data they do have:
> 15.55 An audit was undertaken at The Tavistock and Portman GDC on the characteristics of individuals who had detransitioned. Most papers on detransition are based on community samples, and questionnaire reports, but this was a case series of 40 patients who had all been examined by a psychiatrist.
> 15.56 Findings from the audit were discussed with the Review. The time for people to choose to detransition was 5-10 years (average 7 years). Common presenting features and risk factors such as high levels of adverse childhood experiences, alexithymia (inability to recognise and express their emotions) and problems with interoception (making sense of what is going on in their bodies) were identified in the audit, and this audit would be informative for clinicians assessing young people with a view to starting masculinising/feminising hormones. The Review asked to have access to this audit in order to understand some of the qualitative findings, but the trust did not agree to this.
There is a gulf between the quality of the sources we're looking at here and I want to highlight it so it's not hidden behind links.
My supplied source in the GP comment is an n=27,715 cross sectional survey supplied to any adult who has transitioned in the past, it's not detransition specific and it's sort of like a trans census taken yearly.
Your first source is an n=237 online survey on a detransition specific website which did make any effort to verify if any of the poll answerers were trans at any point.
Your second source is an n=100 anonymous poll posted on social media. This could well have been a strawpoll on twitter.
The main discrepancy is that these have different survey populations.
Turban's study is based on an survey (which was also conducted online) of people who, for the most part, currently identify as trans, of which some had temporarily detransitioned in the past. Whereas Littman's and Vandenbussche's studies only surveyed detransitioners who no longer identify as trans.
What these suggest in aggregate is that these populations generally have quite different reasons for detransitioning.
The study I linked has 2200 detransitioners, an order of magnitude above the ~240 or the 100 you've referenced.
What the studies kind of suggest more is that if you pull your sample from somewhere like a detransition website you're likely to get a biased result which doesn't map to the sentiment of the larger population.
It's a carefully considered, in-depth and thorough evidence-based review of clinical policy from an independent expert group, led by an eminent paediatrician with decades of experience.
I'm baffled as to why you've decided it's an "unscientific hatchet job". Would you like to explain your reasoning?
Because they set an unrealistic bar by excluding all research which wasn't double blind, in the knowledge that there's barely any research you can perform on trans youth with that criteria that an ethics board will allow and there's barely any research anyone would attempt — because your blind is immediately nullified by the obvious continuing signs of puberty, or the obvious continuing signs of body produced hormones.
By doing this they have excluded the vast majority of the extant research, leaving what's essentially the most biased remaining sample.
Now add in the government of the UK's current attack angle on trans people, and Cass herself exclusively operating with anti-trans groups on social media.
> Dr Cass was asked about particular claims spread online about her review - one that "98% of the evidence" was ignored or dismissed by her, and one that she would only include gold-standard "double-blind randomised control" trials in the review.
> She said the 98% claim was "completely incorrect".
> A total of 103 scientific papers were analysed by her review, with 2% considered high quality, and 98% not.
> "There were quite a number of studies that were considered to be moderate quality, and those were all included in the analysis," she said.
> "So nearly 60% of the studies were actually included in what's called the synthesis."
> And on the "double-blind" claim - where patients are randomly assigned to a treatment or placebo group, getting either medicine or nothing - she said "obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them".
> "But that of itself is not an issue because there are many other areas where that would apply," she said.
> "If you were doing a trial, say, of acupuncture, people would know exactly what treatment that they were getting."
You can of course confirm this yourself by reading the report and the systematic reviews commissioned to inform it, rather than listening to social media bullshitters.
Please try harder not to succumb to the strawman fallacy, you're arguing a point I didn't make.
The base truth is that the Cass review excluded a large portion of the research based on evidenciary standards which are higher than we'd apply otherwise.
Citing her Q&A with the Kite Trust is great but that doesn't undo the fact that she designed her review to exclude trans people as much as possible. There were zero trans clinicians, trans academics or even trans users of healthcare services included in any part of the study.
Within her purview for study quality she decided to include the work of a known transphobe who was caught out in 2018 posting essentially hate screeds on an anonymous twitter account[1] -- why was his work included but not a >> SINGLE << trans person could sit in on the review?
> You can of course confirm this yourself by reading the report and the systematic reviews commissioned to inform it, rather than listening to social media bullshitters.
And now I see why you decided to spin up a fresh account for this. I'm done, I don't believe in debate with people who mistake debate for online shitfling. Have a good one.
I'm directly addressing your claims, not arguing a point you didn't make.
You said:
> Because they set an unrealistic bar by excluding all research which wasn't double blind,
To which I replied with a BBC News article quoting Cass, which refutes this falsehood. While noting that you could also confirm this yourself by actually reading the publications you're so misinformed about.
The problem is that you'd rather listen to liars like Erin Reed and Alejandra Caraballo, who have apparently made it their mission to sow as much disinformation about the Review as they possibly can, and those who amplify their mendacious nonsense.
I mean, all you've been doing in this thread is further spreading their lies, and then doubling down when proven wrong. Are you really so in the thrall of these prevaricators?
Uninterested in a sockpuppet's views, sorry. If you're serious come back on your main and we'll discuss without all the creative attempts you've made to answer sentence A while ignoring sentence B.
You've know you've been called out on your bullshit and are attempting to deflect. That's fine, you can do that if you want. But there's really no point in continuing any sort of exchange with you on this, because it's very clear that you'd rather spread lies than discuss facts.
I don't think that your explanation leads to the conclusion that these things are not socially transmitted.
Mountain biking as a sport would not be possible for the average person without the community. Sure, someone could be, and had to be, "the first" MTBer, make knobbly tires, build a suspension, go without a trail, etc, but that sort of spontaneous "new sport discovery" process is not going to happen at anything like the rate that people are attracted (via social transmission!) to the existing sport with everything in place.
The question seems to be whether being transgender, or being a mountain biker, is something that can exist purely in the mind, in the absence of the ability to realise it.
In some ways it feels like an unanswerable question because normal gender roles are socially transmitted anyway, so we can't even say whether "being a man" exists in isolation.
> The question seems to be whether being transgender, or being a mountain biker, is something that can exist purely in the mind, in the absence of the ability to realise it.
Agreed. And we don't generally refer to mountain bikers like that, but we do for trans people. Equalizing the analogy, it would be "person who would enjoy mountain biking" and "person who would enjoy gender transition". I think this framing makes it easier to see as something that could already exist within a person.
Of course the truth is that whether someone would enjoy mountain biking or whether someone would enjoy transition is related to both social factors and pre-existing personality traits.
The real problem comes when we stigmatize people for having these traits or for deciding to do something about it.
I agree with what you are saying up until the last part because "traits" as a general term are not all positive.
As an example, we stigmatize, and should stigmatize, the behaviours of those who are attracted to minors, and that stigma likely does reduce the social transmission of those behaviours.
The question I think comes down to essentially whether one considers the results of acting on gender dysphoria to be "bad".
If it is bad, then the question then becomes, is it a net benefit to stigmatize transitioning - i.e. do the benefits in reducing overall gender dysphoria outweigh the costs to those who would have it regardless of social factors.
For me it seems to have some pretty significant downsides. Loss of fertility, permanent hormone replacement, surgeries, trouble dating and being accepted in society, never really "passing" unless you do it very early on, etc.
If it's the only choice for a given individual e.g. they'd feel terminally depressed otherwise, then sure, they should be able to do it. I wouldn't really call it good though, it seems like the best worst option.
Of course, if the stigma has no effect on rates of gender dysphoria then none of this makes sense because there is then no benefit in dissuading people from transitioning.
Well, I’m trans. Loss of fertility is mixed. Probably I could stop hormones for six months and still conceive. I might do that in the next few years but of course that would be disruptive.
I’m not going to have any surgeries, but those that do seem to be happy for it so that doesn’t seem to be a down side.
Trouble dating doesn’t fit for me. My dating life is massively better, in large part because I finally feel good in my skin and now how to look sexy.
I don’t make any attempt to “pass”. I’m a non-binary transfemme. My gender expression is all over the place. I’m just happier with hormones and the clothes I like. It’s more about not trying to be a “man” and just doing whatever, including hormones in my case. All the problems with passing come from places where society doesn’t accept trans people, and expects everyone to fit in to rigid gender roles. That’s not a problem with trans people that’s a problem with society, and in many places people have realized that it doesn’t matter if someone is wearing a dress and has facial hair, or whatever doesn’t fit normal gender roles. On analysis it obviously doesn’t matter, but some places need to catch up. In the San Francisco Bay Area, no one gives a shit. From the earliest most awkward moments of my transition, no one ever seemed to care and no one ever said anything.
And my life is so much better. I feel better. I feel sexier and more confident, and my dating life has exploded. Sex is so much better without heteronormative expectations. I got so tired of that sex life, and now I feel so may possibilities.
So yeah, when you understand the facts, stigma is anti-social behavior and acceptance is the best response.
I wish you all of the best in your life, but what you are describing sounds like a colossal pain in the arse to me.
I think that we are speaking at cross ends, as you are comparing life before and after transition, whereas I am comparing the lack of perceived need to transition vs the perceived need to transition.
That is to say, it seems clearly better to not be dysphoric in the first place, if that can be achieved. Especially considering what you describe!
I mean the fact that it doesn’t sound nice just means it not for you! That’s the whole point about being trans is that it’s an individual decision and most people won’t want to bother.
Also I never had dysphoria. Still I had been on this path for a long time, and after thinking about it for two years I decided to start hormones a few years ago. I’m so happy I did!
And sure, lots of people have dysphoria and it would be better if they didn’t. A great way to relieve dysphoria is to transition! That is literally the medically recommended treatment for gender transition. That or in mild cases therapy, and time.
But I transitioned because it seemed quite powerfully like something I wanted to try, and having done it I realized why I had been so interested, so adjacent to it for so long. Because it was right for me.
You’re clinging to a semantic distinction that is meaningless to me. I’m happy and I feel good, and your desire to simplify the meaning of gender transformation in to little boxes you can understand has no bearing on me or my life.
Counter point is that I’m an adult who started transition at 36, and I really wish I’d known this was an option when I was younger. I knew trans people existed, but only as the butt of jokes. I wish I had understood this to be a real choice when I was younger.
Who here has independently arrived at the conclusion that they must don the toga virilis[1] between the ages of 14 and 16? It's a difficult position to be in.
