South Dakota Legislature Plays Doctor to Transgender Children

[Jarhyn]

That's optimistic. Doctors have already done it. But more to the point, doctors already advocate mutilating the genitals of baby boys for no reason at all. Millions of boys have had their penises mutilated for no reason at all. And you think doctors won't perform genital surgery on children? They do it on babies right now for no reason at all.



You appear to believe that puberty blockers are harmless. There have been no long-term outcome studies on puberty blockers so the idea that they are harmless is not evidenced.

But they certainly don't have no consequences. Having a later-than-average puberty results in people being taller than they otherwise would have been. That's not obviously a positive or negative but it's not "nothing".

Blockers from the age of 12 to 16 are THE way to afford a child in consideration of HRT to have time to think it through, settle on a course, and not have to deal with unwanted permanent changes to their anatomy. Denying this as a course WILL result in 97% more surgical interventions.

I'm sorry you simply don't understand the maths involved. You really don't.

You also seem to believe the only thing I'm concerned about is the irreversibility of surgery. You've completely glossed over whether puberty blockers have harmful long-term outcomes.

They are not without risk, and the risks are mostly known: delaying puberty for too long increases risks of osteoporosis because of decreased bone density. This is certainly better than the ~6% morbidity rate following mastectomy.

If you think my maths are wrong, YOU can plug in the numbers and correct it. Don't forget to show your work for the class! That or accept the results.

The fact is, you are leaning on the same scare tactics marijuana opponents used "we don't have enough studies". But regardless, as Krypton mentioned we do have plenty of information on side effects of the medication in question. At any rate, the osteoporosis risk is mostly associated with long term delays in puberty, much longer term than the 2-4 years of blocking puberty that happens in these cases.

The risk of not doing anything is "growing up the boy with tits," needing expensive surgeries, and needing facial surgeries to remove secondary male bone growth. Those surgeries are not without risk either.

Unless you can establish that this course will result in MORE negative externality than the externalities of chest and facial reconstructions you don't really have a leg to stand on. My numbers show 97% reductions in negative externalities from allowing blockers.

You are focusing on minutiae of regret and unlikely consequence rather than the avoidance of much greater and more likely consequences of denying early treatment.

This is like screaming about the deficit and cutting PBS while making trillionndollar tax cuts for the rich and increasing military spending by 20%: the thing you bark about being dangerous or bad is between one and two orders of magnitude less concerning thannthebeffects of allowing the treatment.

 

[repoman]

Huh, was reading about puberty. Now it makes sense how most of the early puberty kids were short. Once the boobs or facial stubble developed there was not much more height increase.

 

[krypton iodine sulfur]

The fact is, you are leaning on the same scare tactics marijuana opponents used "we don't have enough studies". But regardless, as Krypton mentioned we do have plenty of information on side effects of the medication in question. At any rate, the osteoporosis risk is mostly associated with long term delays in puberty, much longer term than the 2-4 years of blocking puberty that happens in these cases.

The risk of not doing anything is "growing up the boy with tits," needing expensive surgeries, and needing facial surgeries to remove secondary male bone growth. Those surgeries are not without risk either.

Even for cisgender people, going through a normal puberty will increase the risk of certain cancers and other potentially harmful effects. We consider it normal because it happens without intervention, but when you start hrt, doctors have to mention some of these variables as potential risks and side effects. Any course of action (including inaction, in this case) results in changing your risk categories for various conditions.

And this is without even getting into areas you've touched on such as increasing need for certain surgeries a reduced efficacy of transition.

 

[Jarhyn]

The fact is, you are leaning on the same scare tactics marijuana opponents used "we don't have enough studies". But regardless, as Krypton mentioned we do have plenty of information on side effects of the medication in question. At any rate, the osteoporosis risk is mostly associated with long term delays in puberty, much longer term than the 2-4 years of blocking puberty that happens in these cases.

The risk of not doing anything is "growing up the boy with tits," needing expensive surgeries, and needing facial surgeries to remove secondary male bone growth. Those surgeries are not without risk either.

Even for cisgender people, going through a normal puberty will increase the risk of certain cancers and other potentially harmful effects. We consider it normal because it happens without intervention, but when you start hrt, doctors have to mention some of these variables as potential risks and side effects. Any course of action (including inaction, in this case) results in changing your risk categories for various conditions.

And this is without even getting into areas you've touched on such as increasing need for certain surgeries a reduced efficacy of transition.

Exactly. I would, in fact, support many provisions of the law stated in the OP: that people under the age of 18 be denied surgical interventions, and that people under the age of 16 be denied HRT.

My major complaint is the provisions on blockers, and the provisions against recognition of gender identity and transition: it damns children to permanent unwanted effects of their gonad puberty, and outs them to their peers. There is exactly one chance to get all that you want out of puberty. After that chance is missed, you are damned to surgical interventions that are themselves a damnation to imperfection.

This law turns what would be SOME absolutely reasonable provisions into a weapon against trans people: to out them, force them into unwanted body developments, and lock them in what is to them a living hell that can never entirely be escaped.

Most of my closest friends are trans, both my ex and my husband are trans. Maybe half of my entire friend pool at the moment is trans. None of them have any regrets over their transitions except regrets over steps that they either cannot take because of medical obstacles (one has a bad reaction to testosterone blockers), or financial obstacles (a few cannot afford mastectomy including my own husband).

I really do pity Metaphor for whatever unresolved issue translates into such angst over other people actually getting what they want out of puberty.

 

[krypton iodine sulfur]

Exactly. I would, in fact, support many provisions of the law stated in the OP: that people under the age of 18 be denied surgical interventions, and that people under the age of 16 be denied HRT.

I wouldn't. There isn't a blanket statement which can be made regarding timelines and age. It all comes down to the strength of the diagnosis. I knew much younger than 16, and as it turns out, I was correct. It wasn't random. My case was uncomplicated if we look at symptoms and remedy. Had treatment been available to me, there likely would have been no reason to deny me or surgery at ages younger than you specified. The problem is, how to do doctors safely differentiate my case from those where the potential for misdiagnosis is higher? It's especially difficult when we have to rely on self-reported symptoms. That's the barrier here. It isn't resolved with age limits.

In this case specifically, it certainly shouldn't be handled by legislators in such a ham-fisted and harmful way.

 

[Jarhyn]

Exactly. I would, in fact, support many provisions of the law stated in the OP: that people under the age of 18 be denied surgical interventions, and that people under the age of 16 be denied HRT.

I wouldn't. There isn't a blanket statement which can be made regarding timelines and age. It all comes down to the strength of the diagnosis. I knew much younger than 16, and as it turns out, I was correct. It wasn't random. My case was uncomplicated if we look at symptoms and remedy. Had treatment been available to me, there likely would have been no reason to deny me or surgery at ages younger than you specified. The problem is, how to do doctors safely differentiate my case from those where the potential for misdiagnosis is higher? It's especially difficult when we have to rely on self-reported symptoms. That's the barrier here. It isn't resolved with age limits.

In this case specifically, it certainly shouldn't be handled by legislators in such a ham-fisted and harmful way.

The age limits exist as a function of surety in what is otherwise a chaotic period of life and development.

I think that we should make sure all kids have an opportunity to be presented with an honest view of cultural and social expectations at an early age with respect to gender, and to make this presentation without any value judgements, and of the effects hormones can have on function.

This should happen before the age of 12, preferably in the days or weeks or months when the onset of puberty becomes observable.

Then, if someone expresses dissonance between their gonad puberty and their desired identity, they should start on blockers and spend a few years accepting this outcome because regardless of how sure you were, it is better to err on the side of caution. Then, when they turn 16, they can decide to stay the course and take HRT or have their normal puberty experience.

Having 2-4 years to process whether your gonad direction fits your identity direction is absolutely called for, regardless of how sure you feel when you are 12.

This path prevents a need for surgery in most cases, with the remaining surgical mitigations being necessary only for the tiny minority who regret their decision or the much larger segment who were denied self-determination because of the ignorance and failures of their parents, educators, and doctors which failed to prepare themnto make that decision.

 

[krypton iodine sulfur]

The age limits exist as a function of surety in what is otherwise a chaotic period of life and development.

Again, this isn't a useful consideration as a blanket rule. It isn't relevant to the awareness of one's gender identity in all cases.

Then, if someone expresses dissonance between their gonad puberty and their desired identity, they should start on blockers and spend a few years accepting this outcome because regardless of how sure you were, it is better to err on the side of caution. Then, when they turn 16, they can decide to stay the course and take HRT or have their normal puberty experience.

This standard for 'erring on the side of caution' is an inadequate substitute for better diagnostic criteria. The major complicating factors are ambiguous symptoms and the potential for conditions which may appear similar to gender dysphoria but may not actually be gender dysphoria. Only when this issue cannot be resolved should delays be standardized. That standard, however, should be a matter of best medical practices and not legislation. Best medical practices may very well change as treatment methods are refined over time.

Having 2-4 years to process whether your gonad direction fits your identity direction is absolutely called for, regardless of how sure you feel when you are 12.

Then all children should have puberty delayed to be safe, no? I was not less sure at twelve than my peers. I was just more closeted. The disparity in my situation and that of my peers is that I required medical intervention (which was not easily available to me in my youth). That meant requiring accurate and reliable diagnosis to know what course of action was suitable. In the case of my peers, the correlation between assigned gender, gender identity and sex characteristics is so strong that the statistical risk of allowing nature to take its course was well within acceptable limits. The chance of that course of action being correct exceeded 99%. But the issue was never the ability of a twelve-year-old to adequately understand their own gender identity and expression in order to go through puberty.

The delay is conditionally necessary, not absolutely necessary. That condition is, yet again, the ability to diagnose gender dysphoria, particularly in youth, accurately enough. That condition may prove resolvable, in which case the blanket age restriction is not useful. Where my gender identity is known with the same reliability of 12-year-olds ordinarily, I should go through the puberty commensurate with my gender identity to the extent medical science allows.

n.b. I am saying 12-year-olds as a generalization. The call to action is the onset of puberty, though precocious puberty presents its own unique challenges, admittedly.

 

[krypton iodine sulfur]

Then, if someone expresses dissonance between their gonad puberty and their desired identity, they should start on blockers and spend a few years accepting this outcome because regardless of how sure you were, it is better to err on the side of caution.

This statement rubs me the wrong way. I am not saying other people should be assessed based on how certain I was. Quite the opposite. I am saying there is individual variability, and treatment of the individual based on their needs rather than blanket assumptions is preferred when possible.

 

[Jarhyn]

Then, if someone expresses dissonance between their gonad puberty and their desired identity, they should start on blockers and spend a few years accepting this outcome because regardless of how sure you were, it is better to err on the side of caution.

This statement rubs me the wrong way. I am not saying other people should be assessed based on how certain I was. Quite the opposite. I am saying there is individual variability, and treatment of the individual based on their needs rather than blanket assumptions is preferred when possible.

The major issue here, between our positions, is edge cases. Here, you have to consider what regulations are meant to do, namely preventing negative outcomes. Few if any are harmed by taking things slow, particularly among those seeking transition (is that even an appropriate term when someone hasn't completed primary puberty?). There is general consensus that if someone doesn't feel discordant by the age of 12, especially given the opportunity to examine if they are discordant, then they probably will not. It is only in the case of those who DO experience discordance that some level of surety is needed because it is a big and fairly rare decision, especially for a child.

The consequences of going all in too early are much higher than going in after some period of evaluation. It is similar to the idea that one may not engage in contracts before the age of 18: many children are more than capable of understanding the ramifications of contracts before then, but we err on the side of caution because the consequences of being wrong are just too high. We treat sex similarly; I would far rather see someone be disappointed to have to wait a few years than open the door to ambiguity and allow attrocities to happen.

Individuals do vary, and not everyone is in the same position. It may be warranted to allow, behind some high gate, a waiver of such restrictions. But for most, the restrictions described are just not that burdensome; what is more important, as close to absolute certainty to confirm such impactful decisions, or merely catering to impatience?

 

[krypton iodine sulfur]

changed my mind on this post. this isn't worth the time or energy at this point in time for me.

 

[Loren Pechtel]

Even for cisgender people, going through a normal puberty will increase the risk of certain cancers and other potentially harmful effects. We consider it normal because it happens without intervention, but when you start hrt, doctors have to mention some of these variables as potential risks and side effects. Any course of action (including inaction, in this case) results in changing your risk categories for various conditions.

That reminds me of the bit the anti-choice crowd bleats repeatedly--that abortion increases the risk of breast cancer. Nope, it does nothing to one's risk of breast cancer, full term pregnancy lowers it.

 

[krypton iodine sulfur]

Died in the senate, it seems:

https://time.com/5781635/south-dakota-transgender-treatment-law/