As your friendly neighborhood transhumanist liberal, I think "trust the science" is mostly a great heuristic.
So here's my attempt to trust the science/evidence trans issues. Obviously coming out and transitioning is very scary and very strongly suggests trans people experience something very real, intense and specific and I trust the reviews that gender-affirming care can help.
However, it seems some (!) people can experience gender dysphoria without being best described as simply trans or non-binary (GPT). This includes episodes of dysphoria related to hormone changes during pregnancy and menstruation. Similarly, dysphoria correlates with higher frequency of schizophrenia (Rajkumar, cited in ACX) and in some cases, it can be reduced by treating schizophrenia. Lastly, birth-sex-supporting hormones seem to help cis-people who experience body-dysmorphic disorder - an obsessive rumination about (sometimes invisible/imagined) flaws of your body. A thread on SSC Reddit contains two comments that claim sex-aligned behavior helped them reduce dysphoria one claiming this can worsen it. Kelsey P. suggested experimenting with hormones based on her experience with medication-induced dysphoria.
I think this is particularly important for the hormonal treatment of dysphoria in adolescents, where the evidence for gender-affirming care seems mixed. I agree with Scott Alexander that there's no point in obsessing over the meaning of "true men/women" and that both trans- and cis-gender are partially culture-bound constructs - the only relevant question is what actually helps people feel better. But I also have to partially agree with J. K. Rowling that children are not "born trans" - although I would add they are also not born cis or heterosexual - children are simply not born with all sexual instincts fully formed and active, just like all (?) other animals. See also the fascinating Bem's theory of attraction development and Scott's fun post on paraphilias and AI alignment.
Given all this, I was shocked that when I ran GPT Deep Research (links to a translation to English) I wasn't able to find a single study that would evaluate the use of birth-sex-affirming hormones to decrease dysphoria.
I'd expect to find these sort of studies in the UN or UK reports that recommend banning "conversion therapy" for gender identity. Unfortunately, they only cite the (unsuccessful) studies on homosexual conversion therapy, psychotherapeutic or "spiritual" interventions. One commonly cited review study from 1999 concluded psychotherapy does not help to change a "crystallized cross-gender identity". The 2021 UK government review found no newer studies on the topic. This is still relevant, as it suggests that for most people with gender dysphoria, the sort of advice from SSC Reddit above about behavioral experimentation will not work. However, I think the bar for banning a therapeutic method should be higher than "there's no evidence that a similar-sounding thing doesn't work for (perhaps) the vast majority of population".
However, after some debate with GPT, we were able to find one super relevant mention! It comes from the pioneer of gender-affirming care, Harry Benjamin's book The Transsexual Phenomenon, where he says:
This may be the occasion to mention the fact that, in about one quarter of my patients, androgen in the form of testosterone injections had been administered at some time in the past, the doctor evidently hoping to cure the transsexualism and the effeminacy of the patient through masculinization. Alas, it is the wrong treatment.
The conflict is aggravated when the body becomes hairy and the libido increases without, of course, changing its direction. Androgen is to my mind contraindicated in male transsexualism. In hypogonadal young boys, an attempt may be made to help the maturing process through injections of the gonadotropic hormone of the pituitary (APL). Hoping to influence nature in this direction, I continued in a few cases weekly injections Of 500 to 2000 units for several months, but saw no influence on the transsexual drive.
I take this as a strong indication that this obvious approach seems to have been commonly tried in the past and indeed, generally found ineffective. This is very reassuring! In the second paragraph, he's not 100% explicit that the boys were transsexual (rather than merely hypogonadal) but the later mention of "no influence on the transsexual drive" makes it overwhelmingly likely.
However, of course, the observation from the first paragraph regarding a sample of "people who decided to see a second doctor after unsuccessful hormone treatment in the 1960's" cannot be generalized to all cases, perhaps particularly people with mild/still "non-crystalized" dysphoria. As I mentioned, transsexuality is clearly based in very real feelings and so, most of the modern increase in transsexual identification is best explained as mere destigmatization of feelings that have always been around. However, I think there might be a "borderline" population, such as people with mild dysphoria or body dysmorphia and schizotypal traits that might not had fully developed a transsexual identification in the past.
Perhaps paradoxically, the development of non-binary and gender-fluid identifications might reduce the potential cultural harm for this borderline population. When men are able to reveal their feminine sides (e.g. Harry Styles) and women able to reveal their masculine sides without losing their masculinity or feminity, maybe people can address this "borderline dysphoria" psychologically, rather than surgically. Perhaps this second wave might explain some of the recent (2022-2024; roughly 50%??) decrease in both trans and NB identification?
So here's my tentative model: The fact that GPT was able to find Benjamin's book only thanks to TransReads uploading it makes me update towards "there probably is a lot of older studies that found that birth-sex-affirming therapy is ineffective for almost all gender dysphoria, but it's weird old-times sexological studies with null results that were not digitized, even though their findings are passed on through the sexological discourse".
However, it still makes me feel crazy that I couldn't even find an established word for the birth-sex-affirming therapy, or a single study other than the 2-paragraph mention above - yet these interventions are already getting banned and impossible to discuss in "polite society".
So this post is intended as a question: Does anyone know about any other relevant studies/indications? Thanks!
As your friendly neighborhood transhumanist liberal, I think "trust the science" is mostly a great heuristic.
So here's my attempt to trust the science/evidence trans issues. Obviously coming out and transitioning is very scary and very strongly suggests trans people experience something very real, intense and specific and I trust the reviews that gender-affirming care can help.
However, it seems some (!) people can experience gender dysphoria without being best described as simply trans or non-binary (GPT). This includes episodes of dysphoria related to hormone changes during pregnancy and menstruation. Similarly, dysphoria correlates with higher frequency of schizophrenia (Rajkumar, cited in ACX) and in some cases, it can be reduced by treating schizophrenia. Lastly, birth-sex-supporting hormones seem to help cis-people who experience body-dysmorphic disorder - an obsessive rumination about (sometimes invisible/imagined) flaws of your body. A thread on SSC Reddit contains two comments that claim sex-aligned behavior helped them reduce dysphoria one claiming this can worsen it. Kelsey P. suggested experimenting with hormones based on her experience with medication-induced dysphoria.
I think this is particularly important for the hormonal treatment of dysphoria in adolescents, where the evidence for gender-affirming care seems mixed. I agree with Scott Alexander that there's no point in obsessing over the meaning of "true men/women" and that both trans- and cis-gender are partially culture-bound constructs - the only relevant question is what actually helps people feel better. But I also have to partially agree with J. K. Rowling that children are not "born trans" - although I would add they are also not born cis or heterosexual - children are simply not born with all sexual instincts fully formed and active, just like all (?) other animals. See also the fascinating Bem's theory of attraction development and Scott's fun post on paraphilias and AI alignment.
Given all this, I was shocked that when I ran GPT Deep Research (links to a translation to English) I wasn't able to find a single study that would evaluate the use of birth-sex-affirming hormones to decrease dysphoria.
I'd expect to find these sort of studies in the UN or UK reports that recommend banning "conversion therapy" for gender identity. Unfortunately, they only cite the (unsuccessful) studies on homosexual conversion therapy, psychotherapeutic or "spiritual" interventions. One commonly cited review study from 1999 concluded psychotherapy does not help to change a "crystallized cross-gender identity". The 2021 UK government review found no newer studies on the topic. This is still relevant, as it suggests that for most people with gender dysphoria, the sort of advice from SSC Reddit above about behavioral experimentation will not work. However, I think the bar for banning a therapeutic method should be higher than "there's no evidence that a similar-sounding thing doesn't work for (perhaps) the vast majority of population".
However, after some debate with GPT, we were able to find one super relevant mention! It comes from the pioneer of gender-affirming care, Harry Benjamin's book The Transsexual Phenomenon, where he says:
I take this as a strong indication that this obvious approach seems to have been commonly tried in the past and indeed, generally found ineffective. This is very reassuring! In the second paragraph, he's not 100% explicit that the boys were transsexual (rather than merely hypogonadal) but the later mention of "no influence on the transsexual drive" makes it overwhelmingly likely.
However, of course, the observation from the first paragraph regarding a sample of "people who decided to see a second doctor after unsuccessful hormone treatment in the 1960's" cannot be generalized to all cases, perhaps particularly people with mild/still "non-crystalized" dysphoria. As I mentioned, transsexuality is clearly based in very real feelings and so, most of the modern increase in transsexual identification is best explained as mere destigmatization of feelings that have always been around. However, I think there might be a "borderline" population, such as people with mild dysphoria or body dysmorphia and schizotypal traits that might not had fully developed a transsexual identification in the past.
Perhaps paradoxically, the development of non-binary and gender-fluid identifications might reduce the potential cultural harm for this borderline population. When men are able to reveal their feminine sides (e.g. Harry Styles) and women able to reveal their masculine sides without losing their masculinity or feminity, maybe people can address this "borderline dysphoria" psychologically, rather than surgically. Perhaps this second wave might explain some of the recent (2022-2024; roughly 50%??) decrease in both trans and NB identification?
So here's my tentative model: The fact that GPT was able to find Benjamin's book only thanks to TransReads uploading it makes me update towards "there probably is a lot of older studies that found that birth-sex-affirming therapy is ineffective for almost all gender dysphoria, but it's weird old-times sexological studies with null results that were not digitized, even though their findings are passed on through the sexological discourse".
However, it still makes me feel crazy that I couldn't even find an established word for the birth-sex-affirming therapy, or a single study other than the 2-paragraph mention above - yet these interventions are already getting banned and impossible to discuss in "polite society".
So this post is intended as a question: Does anyone know about any other relevant studies/indications? Thanks!