Weltschmerz

Umbra | ♂️ | adult | trans | bi | transmed | aro/ace critical | nb critical | anti-MOGAI | anti-tumblr kin | pro-kink | anti-map | anyone can interact This is the blog where I have opinions but I'll probably also just post whatever.

[timewarpmlm-archive]

Gay men: hey yaoi is homophobic and consuming it is bad here’s like 300 reasons why

Every straight girl in earshot who “isn’t homophobic”:

[woke-transmed]

intersex isn’t inherently lgbt

[coincaster]

How hard is it to get this through people’s heads? Trans men are not women. If you are a woman you are not a trans man.

[coincaster]

I have to say, as a trans man, if a lesbian declared they were attracted to me and wanted to date me while still identifying as a lesbian I would be offended and assume they saw me as a woman.

“Trans men attracted to trans men can call themselves lesbians” is the shittiest hot take of the day. Trans men are men, being attracted to one means you’re attracted to a man. Being a trans man means you’re not a wlw because you are a man. Trans men are not women.

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[valkylander]

This isn’t just about gender dysphoria, this is about the idea that the diagnostic criteria for a condition are what the condition is. The criteria for diagnosing disorders change as our understanding of those disorders and of neuroscience in general expand. They change to include people who have the disorder but could not be diagnosed or to exclude people who don’t have it but would have been. The map is not the territory, and the diagnostic criteria are not the disorder.

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

Therefore (as your own example shows) the diagnostic criteria for gender dysphoria are not, by definition, what it is. The map is not the territory.

[coincaster]

It’s very difficult to debate you if you’re going to use your own experience as an example. I don’t know the details of your experience, nor can I verify that in any way. I can’t verify that the person who diagnosed you was following the DSM, I can’t say why you may have been excluded from diagnosis. 

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

Again, valid exclusions to diagnosis are trauma cases, peer pressure (including things like hating people of your assigned gender), or sudden onset symptoms that don’t persist for six months. Otherwise, the DSM covers how just about every tucute presents their symptoms.

[valkylander]

Buddy, I don’t have a diagnosis. I’ve been on HRT for a year thanks to the Informed Consent model (the only model under which everyone who needs treatment can receive it).

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

The fact is, not everyone who meets the diagnostic criteria has dysphoria. Not everyone who doesn’t doesn’t.

[coincaster]

Those people don’t meet the criteria because, as I said, there are things like trauma, peer pressure and sexism that exclude you from a diagnosis without further therapy. They’d fall under trauma exclusion.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

(I don’t know if HRT itself is life-threatening for women. For men it comes with all kinds of health risks, for women it comes with at least social health risks, so the point stands either way.)

[valkylander]

If there are circumstances, like trauma, peer pressure, and sexism, that invalidate the diagnostic criteria, the diagnostic criteria are not sufficient. They still meet the criteria, you’ve just added a corollary. Sufficient criteria wouldn’t have corollaries.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

Also, HRT isn’t life threatening. Worst case scenario I’d become infertile (literally a nonissue) and develop dysphoria. In which case, I would have stopped, because, again, I had no strong feelings about it. You’re acting like this is some super dangerous thing and not a thing I could just stop doing if it didn’t work out. The biggest risk to me was a waste of a day meeting the doctor and some money on pills. And, I guess, infertility, but again that’s a nonissue.

[coincaster]

Admittedly I’m just getting this from some internet research but it seems that trans women are more at risk for blood clots, gallbladder disease, osteoperosis, and a bunch of cancers and tumors.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Now that you’re no longer depressed, do you feel like you fit the criteria for gender dysphoria? Do you want to be and be seen as a woman now that the other condition is gone? If so it may be that there needs to be research done on how dysphoria presents in someone with the kind of emotional numbness you had. Comorbid conditions always tend to get complicated, and again that’s unfortunate but people are complicated.

[valkylander]

Yes. Now I meet the criteria.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

If you agree that a person can have dysphoria without meeting the criteria, and that a person can meet the criteria for reasons other than actually having dysphoria, then you agree your post was wrong.

[coincaster]

You being an anomaly due to a comorbid condition doesn’t change the fact that the current criteria is accurate for the vast, overwhelming majority of people, especially when you do meet the criteria with the emotional issues out of the way.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

Unfortunately, with the scientific understanding we currently have, some anomalies may fall through the cracks. Some patients are going to be difficult to treat. That absolutely needs to be mitigated as much as possible through more research and mental health professionals making good judgement calls, but science is limited and we can only try to do what’s best for everyone.

[valkylander]

However many people like me there are (and if you look, I think you’ll find more than you expect), the fact that we exist shows that the diagnostic criteria for a disorder are not the disorder itself.

I don’t know what my experiences would have been if my depression and depersonalization had been treated independent of my dysphoria. I don’t even know if such a thing is possible. I do know that I came to conclusion I wasn’t a man well before ever identifyng my dysphoria. The category “men” just wasn’t the right place to put myself.

Teaching people that you don’t need dysphoria to be trans doesn’t encourage people to take hormones or get surgeries they’ll regret. Teaching people that being trans requires medical transition does that. Delineating between transness and dysphoria helps this problem.

People have the right to do whatever they want to their own bodies, even if it’s something they’ll regret. Given the choice between false positives and false negatives, false positives are better. The worst a non-dysphoric person can do is put themselves in the same place a dysphoric person already is, including having the same treatment options available.

[coincaster]

“The category “men” just wasn’t the right place to put myself” sounds like the kind of dysphoria that presents without distress. That’s a disconnect. I really think whoever didn’t diagnose you was incompetent or just asked questions and ticked boxes without talking to you in depth over several sessions.

I’ve never said being trans requires medical transition. I said in one of the first posts in this conversation that it isn’t required, and I personally am not going through every possible surgery I could (in my case I just feel even the best results are unsatisfactory) so there’s obviously no reason I’d say everyone else has to.

My stance is that being trans requires dysphoria as defined by the DSM, which is something you have even if it wasn’t diagnosable because of a comorbid condition until after you started transitioning.

I understand the point that you’re trying to make by explaining it couldn’t be diagnosed, as far as any professional knew you didn’t have it. The thing is, you do have it, and I don’t have any reason to believe you didn’t have it before you transitioned despite a potentially botched diagnosis.

Adults already can do whatever they want with their bodies, that’s why we have informed consent. Teenagers can’t, but if they’re really determined then they’ll fall under a dysphoria diagnosis unless there’s something excluding them from that in which case it’s better they get therapy first. The system is working as intended, saving as many people from harming themselves as possible while still making it fairly easy to access treatment, the biggest hurdle being time if the patient isn’t already an adult.

I don’t feel that false positives are better than false negatives, but as I said it’s impossible to debate opinion. Maybe in the case of MTFs it’s less permanent, but I imagine people would be very unhappy if trans men had more gatekeeping to get through than trans women, so both need to be treated similarly. I have no opinion on whether trans women should have easier access to transition than trans men, but I know trans men are in immediate danger from transitioning and can’t just go back to the way things were by stopping treatment.

For the record, the same treatment options aren’t always available if someone goes as far as having surgeries they later regret, but as that isn’t really the core of what we’re talking about here I’m not going to go too far into that.

[valkylander]

Yes. I had a disconnect. Which is what being trans is. Nobody was incompetent, there was no way to connect my experiences to dysphoria under the current diagnostic criteria. And yes, I do have it, and I did have it. Because people can have dysphoria without meeting the diagnostic criteria.

It’s not that it’s comorbid, it’s that that’s how my dysphoria presents. Even now, when it flair’s up it does so as depression and depersonalization. I can just identify the cause now.

If a system working as intended prevents people like me from treating our dysphoria, you aren’t selling me on the system.

The fact that false positives are better than false negatives isn’t an opinion, it’s a conclusion based on utilitarian ethics and rights ethics (whether utilitarian or rights ethics is the best way to measure ethics is an opinion though). In terms of both maximizing utility and respecting personal freedom, false positives are better than false negatives, and informed consent is the only justifiable model of trans healthcare.

[coincaster]

A fact extrapolated from an opinion is still an opinion. Even if you’re basing your opinion on a system of ethics based on outcomes, you’re still forming an opinion on which outcome is worse. In my opinion, giving people dysphoria is worse than making people wait a while to transition. There is no moral high ground here for either of us, it’s an opinion.

Equally, your opinion on whether young people should be afforded the right to harm themselves in pursuit of happiness is also an opinion. Whether the right to bodily autonomy extends to children at all (I believe it does) or extends to people harming themselves (here I believe people need to be well informed, and I don’t believe children can consent to things that are harmful to them) has always been debated. It’s a grey area, there is no correct answer here, there’s no obvious correct moral stance.

Again, when talking about adults, informed consent exists so adults are not part of this part of the discussion. If an adult wants to transition without dysphoria and regrets it, that’s their choice.

Just from what you told me about how you felt before, the disconnect you felt from being called male, the fact that you were too depressed to feel anything strongly, the fact that you wanted to try transitioning (this is not something cis men generally consider a cure for depression), I would have suspected gender dysphoria and tried to explore that with you. I’m not a medical professional yet, and if I were I obviously wouldn’t be giving advice on tumblr, but whether you think so or not I really suspect your case wasn’t handled well.

[valkylander]

Making a person go through a puberty they don’t want is worse than letting a person go through a puberty they’ll regret. In both instances, a person undergoes permanent changes that give them dysphoria. Only difference is whether or not they chose it.

Not all adults have access to informed consent healthcare, and transmeds as a group are not making it any easier.

Yes, my case was handled poorly. It was also done according to the book. The book is wrong. Which is my point.

[coincaster]

I support puberty blockers for trans girls, as I said before testosterone does permanent damage, we can both agree on that. Blockers aren’t hormone replacement, blockers are also much less harmful aside from effects on bone density and muscle growth and give young amab people time to go through therapy and figure things out. The worst that happens is they end up short and have a harder time bulking up.

People not having access to informed consent doesn’t mean the system is inherently flawed in my opinion, it means there needs to be more access to informed consent clinics. I definitely understand that, when I turned 18 the closest informed consent clinic was hundreds of miles away and only dealt with trans women on top of that.

“According to the book” is debatable. No one is told to just ask the patient questions and accept their answers as gospel, there are plenty of things that would almost never be diagnosed if they did that. The DSM isn’t a checklist that you go over with the patient, if it were people could just go online and self dx everything with 100% accuracy. I know therapists do this because they’ve done it to me and it’s incredibly lazy and inaccurate. You had dysphoria, if they had asked the right questions they would have been able to help you identify that over time.

I feel like maybe we can both agree here that a large part of the problem is doctors being garbage or completely unavailable.

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[valkylander]

This isn’t just about gender dysphoria, this is about the idea that the diagnostic criteria for a condition are what the condition is. The criteria for diagnosing disorders change as our understanding of those disorders and of neuroscience in general expand. They change to include people who have the disorder but could not be diagnosed or to exclude people who don’t have it but would have been. The map is not the territory, and the diagnostic criteria are not the disorder.

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

Therefore (as your own example shows) the diagnostic criteria for gender dysphoria are not, by definition, what it is. The map is not the territory.

[coincaster]

It’s very difficult to debate you if you’re going to use your own experience as an example. I don’t know the details of your experience, nor can I verify that in any way. I can’t verify that the person who diagnosed you was following the DSM, I can’t say why you may have been excluded from diagnosis. 

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

Again, valid exclusions to diagnosis are trauma cases, peer pressure (including things like hating people of your assigned gender), or sudden onset symptoms that don’t persist for six months. Otherwise, the DSM covers how just about every tucute presents their symptoms.

[valkylander]

Buddy, I don’t have a diagnosis. I’ve been on HRT for a year thanks to the Informed Consent model (the only model under which everyone who needs treatment can receive it).

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

The fact is, not everyone who meets the diagnostic criteria has dysphoria. Not everyone who doesn’t doesn’t.

[coincaster]

Those people don’t meet the criteria because, as I said, there are things like trauma, peer pressure and sexism that exclude you from a diagnosis without further therapy. They’d fall under trauma exclusion.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

(I don’t know if HRT itself is life-threatening for women. For men it comes with all kinds of health risks, for women it comes with at least social health risks, so the point stands either way.)

[valkylander]

If there are circumstances, like trauma, peer pressure, and sexism, that invalidate the diagnostic criteria, the diagnostic criteria are not sufficient. They still meet the criteria, you’ve just added a corollary. Sufficient criteria wouldn’t have corollaries.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

Also, HRT isn’t life threatening. Worst case scenario I’d become infertile (literally a nonissue) and develop dysphoria. In which case, I would have stopped, because, again, I had no strong feelings about it. You’re acting like this is some super dangerous thing and not a thing I could just stop doing if it didn’t work out. The biggest risk to me was a waste of a day meeting the doctor and some money on pills. And, I guess, infertility, but again that’s a nonissue.

[coincaster]

Admittedly I’m just getting this from some internet research but it seems that trans women are more at risk for blood clots, gallbladder disease, osteoperosis, and a bunch of cancers and tumors.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Now that you’re no longer depressed, do you feel like you fit the criteria for gender dysphoria? Do you want to be and be seen as a woman now that the other condition is gone? If so it may be that there needs to be research done on how dysphoria presents in someone with the kind of emotional numbness you had. Comorbid conditions always tend to get complicated, and again that’s unfortunate but people are complicated.

[valkylander]

Yes. Now I meet the criteria.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

If you agree that a person can have dysphoria without meeting the criteria, and that a person can meet the criteria for reasons other than actually having dysphoria, then you agree your post was wrong.

[coincaster]

You being an anomaly due to a comorbid condition doesn’t change the fact that the current criteria is accurate for the vast, overwhelming majority of people, especially when you do meet the criteria with the emotional issues out of the way.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

Unfortunately, with the scientific understanding we currently have, some anomalies may fall through the cracks. Some patients are going to be difficult to treat. That absolutely needs to be mitigated as much as possible through more research and mental health professionals making good judgement calls, but science is limited and we can only try to do what’s best for everyone.

[valkylander]

However many people like me there are (and if you look, I think you’ll find more than you expect), the fact that we exist shows that the diagnostic criteria for a disorder are not the disorder itself.

I don’t know what my experiences would have been if my depression and depersonalization had been treated independent of my dysphoria. I don’t even know if such a thing is possible. I do know that I came to conclusion I wasn’t a man well before ever identifyng my dysphoria. The category “men” just wasn’t the right place to put myself.

Teaching people that you don’t need dysphoria to be trans doesn’t encourage people to take hormones or get surgeries they’ll regret. Teaching people that being trans requires medical transition does that. Delineating between transness and dysphoria helps this problem.

People have the right to do whatever they want to their own bodies, even if it’s something they’ll regret. Given the choice between false positives and false negatives, false positives are better. The worst a non-dysphoric person can do is put themselves in the same place a dysphoric person already is, including having the same treatment options available.

[coincaster]

“The category “men” just wasn’t the right place to put myself” sounds like the kind of dysphoria that presents without distress. That’s a disconnect. I really think whoever didn’t diagnose you was incompetent or just asked questions and ticked boxes without talking to you in depth over several sessions.

I’ve never said being trans requires medical transition. I said in one of the first posts in this conversation that it isn’t required, and I personally am not going through every possible surgery I could (in my case I just feel even the best results are unsatisfactory) so there’s obviously no reason I’d say everyone else has to.

My stance is that being trans requires dysphoria as defined by the DSM, which is something you have even if it wasn’t diagnosable because of a comorbid condition until after you started transitioning.

I understand the point that you’re trying to make by explaining it couldn’t be diagnosed, as far as any professional knew you didn’t have it. The thing is, you do have it, and I don’t have any reason to believe you didn’t have it before you transitioned despite a potentially botched diagnosis.

Adults already can do whatever they want with their bodies, that’s why we have informed consent. Teenagers can’t, but if they’re really determined then they’ll fall under a dysphoria diagnosis unless there’s something excluding them from that in which case it’s better they get therapy first. The system is working as intended, saving as many people from harming themselves as possible while still making it fairly easy to access treatment, the biggest hurdle being time if the patient isn’t already an adult.

I don’t feel that false positives are better than false negatives, but as I said it’s impossible to debate opinion. Maybe in the case of MTFs it’s less permanent, but I imagine people would be very unhappy if trans men had more gatekeeping to get through than trans women, so both need to be treated similarly. I have no opinion on whether trans women should have easier access to transition than trans men, but I know trans men are in immediate danger from transitioning and can’t just go back to the way things were by stopping treatment.

For the record, the same treatment options aren’t always available if someone goes as far as having surgeries they later regret, but as that isn’t really the core of what we’re talking about here I’m not going to go too far into that.

[valkylander]

Yes. I had a disconnect. Which is what being trans is. Nobody was incompetent, there was no way to connect my experiences to dysphoria under the current diagnostic criteria. And yes, I do have it, and I did have it. Because people can have dysphoria without meeting the diagnostic criteria.

It’s not that it’s comorbid, it’s that that’s how my dysphoria presents. Even now, when it flair’s up it does so as depression and depersonalization. I can just identify the cause now.

If a system working as intended prevents people like me from treating our dysphoria, you aren’t selling me on the system.

The fact that false positives are better than false negatives isn’t an opinion, it’s a conclusion based on utilitarian ethics and rights ethics (whether utilitarian or rights ethics is the best way to measure ethics is an opinion though). In terms of both maximizing utility and respecting personal freedom, false positives are better than false negatives, and informed consent is the only justifiable model of trans healthcare.

[coincaster]

A fact extrapolated from an opinion is still an opinion. Even if you’re basing your opinion on a system of ethics based on outcomes, you’re still forming an opinion on which outcome is worse. In my opinion, giving people dysphoria is worse than making people wait a while to transition. There is no moral high ground here for either of us, it’s an opinion.

Equally, your opinion on whether young people should be afforded the right to harm themselves in pursuit of happiness is also an opinion. Whether the right to bodily autonomy extends to children at all (I believe it does) or extends to people harming themselves (here I believe people need to be well informed, and I don’t believe children can consent to things that are harmful to them) has always been debated. It’s a grey area, there is no correct answer here, there’s no obvious correct moral stance.

Again, when talking about adults, informed consent exists so adults are not part of this part of the discussion. If an adult wants to transition without dysphoria and regrets it, that’s their choice.

Just from what you told me about how you felt before, the disconnect you felt from being called male, the fact that you were too depressed to feel anything strongly, the fact that you wanted to try transitioning (this is not something cis men generally consider a cure for depression), I would have suspected gender dysphoria and tried to explore that with you. I’m not a medical professional yet, and if I were I obviously wouldn’t be giving advice on tumblr, but whether you think so or not I really suspect your case wasn’t handled well.

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[valkylander]

This isn’t just about gender dysphoria, this is about the idea that the diagnostic criteria for a condition are what the condition is. The criteria for diagnosing disorders change as our understanding of those disorders and of neuroscience in general expand. They change to include people who have the disorder but could not be diagnosed or to exclude people who don’t have it but would have been. The map is not the territory, and the diagnostic criteria are not the disorder.

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

Therefore (as your own example shows) the diagnostic criteria for gender dysphoria are not, by definition, what it is. The map is not the territory.

[coincaster]

It’s very difficult to debate you if you’re going to use your own experience as an example. I don’t know the details of your experience, nor can I verify that in any way. I can’t verify that the person who diagnosed you was following the DSM, I can’t say why you may have been excluded from diagnosis. 

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

Again, valid exclusions to diagnosis are trauma cases, peer pressure (including things like hating people of your assigned gender), or sudden onset symptoms that don’t persist for six months. Otherwise, the DSM covers how just about every tucute presents their symptoms.

[valkylander]

Buddy, I don’t have a diagnosis. I’ve been on HRT for a year thanks to the Informed Consent model (the only model under which everyone who needs treatment can receive it).

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

The fact is, not everyone who meets the diagnostic criteria has dysphoria. Not everyone who doesn’t doesn’t.

[coincaster]

Those people don’t meet the criteria because, as I said, there are things like trauma, peer pressure and sexism that exclude you from a diagnosis without further therapy. They’d fall under trauma exclusion.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

(I don’t know if HRT itself is life-threatening for women. For men it comes with all kinds of health risks, for women it comes with at least social health risks, so the point stands either way.)

[valkylander]

If there are circumstances, like trauma, peer pressure, and sexism, that invalidate the diagnostic criteria, the diagnostic criteria are not sufficient. They still meet the criteria, you’ve just added a corollary. Sufficient criteria wouldn’t have corollaries.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

Also, HRT isn’t life threatening. Worst case scenario I’d become infertile (literally a nonissue) and develop dysphoria. In which case, I would have stopped, because, again, I had no strong feelings about it. You’re acting like this is some super dangerous thing and not a thing I could just stop doing if it didn’t work out. The biggest risk to me was a waste of a day meeting the doctor and some money on pills. And, I guess, infertility, but again that’s a nonissue.

[coincaster]

Admittedly I’m just getting this from some internet research but it seems that trans women are more at risk for blood clots, gallbladder disease, osteoperosis, and a bunch of cancers and tumors.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Now that you’re no longer depressed, do you feel like you fit the criteria for gender dysphoria? Do you want to be and be seen as a woman now that the other condition is gone? If so it may be that there needs to be research done on how dysphoria presents in someone with the kind of emotional numbness you had. Comorbid conditions always tend to get complicated, and again that’s unfortunate but people are complicated.

[valkylander]

Yes. Now I meet the criteria.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

If you agree that a person can have dysphoria without meeting the criteria, and that a person can meet the criteria for reasons other than actually having dysphoria, then you agree your post was wrong.

[coincaster]

You being an anomaly due to a comorbid condition doesn’t change the fact that the current criteria is accurate for the vast, overwhelming majority of people, especially when you do meet the criteria with the emotional issues out of the way.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

Unfortunately, with the scientific understanding we currently have, some anomalies may fall through the cracks. Some patients are going to be difficult to treat. That absolutely needs to be mitigated as much as possible through more research and mental health professionals making good judgement calls, but science is limited and we can only try to do what’s best for everyone.

[valkylander]

However many people like me there are (and if you look, I think you’ll find more than you expect), the fact that we exist shows that the diagnostic criteria for a disorder are not the disorder itself.

I don’t know what my experiences would have been if my depression and depersonalization had been treated independent of my dysphoria. I don’t even know if such a thing is possible. I do know that I came to conclusion I wasn’t a man well before ever identifyng my dysphoria. The category “men” just wasn’t the right place to put myself.

Teaching people that you don’t need dysphoria to be trans doesn’t encourage people to take hormones or get surgeries they’ll regret. Teaching people that being trans requires medical transition does that. Delineating between transness and dysphoria helps this problem.

People have the right to do whatever they want to their own bodies, even if it’s something they’ll regret. Given the choice between false positives and false negatives, false positives are better. The worst a non-dysphoric person can do is put themselves in the same place a dysphoric person already is, including having the same treatment options available.

[coincaster]

“The category “men” just wasn’t the right place to put myself” sounds like the kind of dysphoria that presents without distress. That’s a disconnect. I really think whoever didn’t diagnose you was incompetent or just asked questions and ticked boxes without talking to you in depth over several sessions.

I’ve never said being trans requires medical transition. I said in one of the first posts in this conversation that it isn’t required, and I personally am not going through every possible surgery I could (in my case I just feel even the best results are unsatisfactory) so there’s obviously no reason I’d say everyone else has to.

My stance is that being trans requires dysphoria as defined by the DSM, which is something you have even if it wasn’t diagnosable because of a comorbid condition until after you started transitioning.

I understand the point that you’re trying to make by explaining it couldn’t be diagnosed, as far as any professional knew you didn’t have it. The thing is, you do have it, and I don’t have any reason to believe you didn’t have it before you transitioned despite a potentially botched diagnosis.

Adults already can do whatever they want with their bodies, that’s why we have informed consent. Teenagers can’t, but if they’re really determined then they’ll fall under a dysphoria diagnosis unless there’s something excluding them from that in which case it’s better they get therapy first. The system is working as intended, saving as many people from harming themselves as possible while still making it fairly easy to access treatment, the biggest hurdle being time if the patient isn’t already an adult.

I don’t feel that false positives are better than false negatives, but as I said it’s impossible to debate opinion. Maybe in the case of MTFs it’s less permanent, but I imagine people would be very unhappy if trans men had more gatekeeping to get through than trans women, so both need to be treated similarly. I have no opinion on whether trans women should have easier access to transition than trans men, but I know trans men are in immediate danger from transitioning and can’t just go back to the way things were by stopping treatment.

For the record, the same treatment options aren’t always available if someone goes as far as having surgeries they later regret, but as that isn’t really the core of what we’re talking about here I’m not going to go too far into that.

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[valkylander]

This isn’t just about gender dysphoria, this is about the idea that the diagnostic criteria for a condition are what the condition is. The criteria for diagnosing disorders change as our understanding of those disorders and of neuroscience in general expand. They change to include people who have the disorder but could not be diagnosed or to exclude people who don’t have it but would have been. The map is not the territory, and the diagnostic criteria are not the disorder.

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

Therefore (as your own example shows) the diagnostic criteria for gender dysphoria are not, by definition, what it is. The map is not the territory.

[coincaster]

It’s very difficult to debate you if you’re going to use your own experience as an example. I don’t know the details of your experience, nor can I verify that in any way. I can’t verify that the person who diagnosed you was following the DSM, I can’t say why you may have been excluded from diagnosis. 

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

Again, valid exclusions to diagnosis are trauma cases, peer pressure (including things like hating people of your assigned gender), or sudden onset symptoms that don’t persist for six months. Otherwise, the DSM covers how just about every tucute presents their symptoms.

[valkylander]

Buddy, I don’t have a diagnosis. I’ve been on HRT for a year thanks to the Informed Consent model (the only model under which everyone who needs treatment can receive it).

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

The fact is, not everyone who meets the diagnostic criteria has dysphoria. Not everyone who doesn’t doesn’t.

[coincaster]

Those people don’t meet the criteria because, as I said, there are things like trauma, peer pressure and sexism that exclude you from a diagnosis without further therapy. They’d fall under trauma exclusion.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

(I don’t know if HRT itself is life-threatening for women. For men it comes with all kinds of health risks, for women it comes with at least social health risks, so the point stands either way.)

[valkylander]

If there are circumstances, like trauma, peer pressure, and sexism, that invalidate the diagnostic criteria, the diagnostic criteria are not sufficient. They still meet the criteria, you’ve just added a corollary. Sufficient criteria wouldn’t have corollaries.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

Also, HRT isn’t life threatening. Worst case scenario I’d become infertile (literally a nonissue) and develop dysphoria. In which case, I would have stopped, because, again, I had no strong feelings about it. You’re acting like this is some super dangerous thing and not a thing I could just stop doing if it didn’t work out. The biggest risk to me was a waste of a day meeting the doctor and some money on pills. And, I guess, infertility, but again that’s a nonissue.

[coincaster]

Admittedly I’m just getting this from some internet research but it seems that trans women are more at risk for blood clots, gallbladder disease, osteoperosis, and a bunch of cancers and tumors.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Now that you’re no longer depressed, do you feel like you fit the criteria for gender dysphoria? Do you want to be and be seen as a woman now that the other condition is gone? If so it may be that there needs to be research done on how dysphoria presents in someone with the kind of emotional numbness you had. Comorbid conditions always tend to get complicated, and again that’s unfortunate but people are complicated.

[valkylander]

Yes. Now I meet the criteria.

Here’s the thing: if we agree that more research needs to be done on how gender dysphoria presents in some cases because some dysphoric people aren’t able to meet the diagnostic criteria, then you’ve already agreed with my point. The diagnostic criteria for a disorder are not definitive of that disorder. The map is not the territory.

If you agree that a person can have dysphoria without meeting the criteria, and that a person can meet the criteria for reasons other than actually having dysphoria, then you agree your post was wrong.

[coincaster]

You being an anomaly due to a comorbid condition doesn’t change the fact that the current criteria is accurate for the vast, overwhelming majority of people, especially when you do meet the criteria with the emotional issues out of the way.

Do you think you would still be trans if your emotional issues had been treated successfully before you had been allowed to transition? Essentially, I’m wondering if you think you had dysphoria that wasn’t presenting due to the emotional numbness. I’m honestly just curious, this isn’t some kind of gotcha.

Unrelated to the original post, but teaching children and young adults that you don’t need dysphoria to be trans is still going to be harmful to them. It encourages the thinking that trauma, sexism, peer pressure, escapism etc are valid reasons to transition because they don’t need to actually feel like or want to be the other sex.

I honestly do not believe all or even most tucutes are anomalies.

Unfortunately, with the scientific understanding we currently have, some anomalies may fall through the cracks. Some patients are going to be difficult to treat. That absolutely needs to be mitigated as much as possible through more research and mental health professionals making good judgement calls, but science is limited and we can only try to do what’s best for everyone.

[elliot-in-progress]

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[valkylander]

This isn’t just about gender dysphoria, this is about the idea that the diagnostic criteria for a condition are what the condition is. The criteria for diagnosing disorders change as our understanding of those disorders and of neuroscience in general expand. They change to include people who have the disorder but could not be diagnosed or to exclude people who don’t have it but would have been. The map is not the territory, and the diagnostic criteria are not the disorder.

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

Therefore (as your own example shows) the diagnostic criteria for gender dysphoria are not, by definition, what it is. The map is not the territory.

[coincaster]

It’s very difficult to debate you if you’re going to use your own experience as an example. I don’t know the details of your experience, nor can I verify that in any way. I can’t verify that the person who diagnosed you was following the DSM, I can’t say why you may have been excluded from diagnosis. 

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

Again, valid exclusions to diagnosis are trauma cases, peer pressure (including things like hating people of your assigned gender), or sudden onset symptoms that don’t persist for six months. Otherwise, the DSM covers how just about every tucute presents their symptoms.

[valkylander]

Buddy, I don’t have a diagnosis. I’ve been on HRT for a year thanks to the Informed Consent model (the only model under which everyone who needs treatment can receive it).

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

The fact is, not everyone who meets the diagnostic criteria has dysphoria. Not everyone who doesn’t doesn’t.

[coincaster]

Those people don’t meet the criteria because, as I said, there are things like trauma, peer pressure and sexism that exclude you from a diagnosis without further therapy. They’d fall under trauma exclusion.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

(I don’t know if HRT itself is life-threatening for women. For men it comes with all kinds of health risks, for women it comes with at least social health risks, so the point stands either way.)

[valkylander]

If there are circumstances, like trauma, peer pressure, and sexism, that invalidate the diagnostic criteria, the diagnostic criteria are not sufficient. They still meet the criteria, you’ve just added a corollary. Sufficient criteria wouldn’t have corollaries.

I learned that other people whose depression was like mine got on HRT and felt better, and despite not having any strong desires one way or another, I’ve always kind of liked the idea of transition. So I figured I’d try hormones for a bit, see if I like them.

And they cured my depression.

Also, HRT isn’t life threatening. Worst case scenario I’d become infertile (literally a nonissue) and develop dysphoria. In which case, I would have stopped, because, again, I had no strong feelings about it. You’re acting like this is some super dangerous thing and not a thing I could just stop doing if it didn’t work out. The biggest risk to me was a waste of a day meeting the doctor and some money on pills. And, I guess, infertility, but again that’s a nonissue.

[coincaster]

Admittedly I’m just getting this from some internet research but it seems that trans women are more at risk for blood clots, gallbladder disease, osteoperosis, and a bunch of cancers and tumors.

I know trans men are in a pretty similar situation with increased risk for serious health conditions (blood clots, heart attack, etc), except we can also get organ atrophy and have internal organs become septic. It just happened recently to Buck Angel and he almost died. HRT is risky to dangerous depending on your anatomy.

Also, for afab people, HRT causes more pronounced permanent changes. I remember someone saying estrogen causes gentle changes while testosterone does damage that can’t be undone and that seems pretty accurate to me. Afab people who start HRT and get dysphoric are going to be stuck with some of the changes for life.

I point out the differences in a trans guy going on T from your experience because for you it may have been less dangerous/permanent but for others it might not be.

“Sufficient criteria wouldn’t have corollaries” is purely opinion and I can’t really argue opinion. Psychology is incredibly complicated, and ideally there would just be simple boxes to check but people aren’t that simple.

More research needs to be done on this, I can agree with that, but I still believe there needs to be medical gatekeeping because HRT is dangerous and kids and young adults keep demonstrating that they will harm themselves with this treatment if it’s freely available to everyone.

Now that you’re no longer depressed, do you feel like you fit the criteria for gender dysphoria? Do you want to be and be seen as a woman now that the other condition is gone? If so it may be that there needs to be research done on how dysphoria presents in someone with the kind of emotional numbness you had. Comorbid conditions always tend to get complicated, and again that’s unfortunate but people are complicated.

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[valkylander]

This isn’t just about gender dysphoria, this is about the idea that the diagnostic criteria for a condition are what the condition is. The criteria for diagnosing disorders change as our understanding of those disorders and of neuroscience in general expand. They change to include people who have the disorder but could not be diagnosed or to exclude people who don’t have it but would have been. The map is not the territory, and the diagnostic criteria are not the disorder.

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

Therefore (as your own example shows) the diagnostic criteria for gender dysphoria are not, by definition, what it is. The map is not the territory.

[coincaster]

It’s very difficult to debate you if you’re going to use your own experience as an example. I don’t know the details of your experience, nor can I verify that in any way. I can’t verify that the person who diagnosed you was following the DSM, I can’t say why you may have been excluded from diagnosis. 

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

Again, valid exclusions to diagnosis are trauma cases, peer pressure (including things like hating people of your assigned gender), or sudden onset symptoms that don’t persist for six months. Otherwise, the DSM covers how just about every tucute presents their symptoms.

[valkylander]

Buddy, I don’t have a diagnosis. I’ve been on HRT for a year thanks to the Informed Consent model (the only model under which everyone who needs treatment can receive it).

And I literally did not meet those criteria before starting HRT. I didn’t have a strong desire to be or be treated as another gender. I didn’t have a strong desire to anything. My dysphoria alienated me from my emotions to the point that I didn’t qualify for a dysphoria diagnosis.

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

^^Your example. These people meet the diagnostic criteria for Gender Dysphoria. They have a strong desire to be another gender and to be treated as another gender. Many of them have a desire to be rid of their secondary sexual characteristics.

The fact is, not everyone who meets the diagnostic criteria has dysphoria. Not everyone who doesn’t doesn’t.

[coincaster]

Those people don’t meet the criteria because, as I said, there are things like trauma, peer pressure and sexism that exclude you from a diagnosis without further therapy. They’d fall under trauma exclusion.

Why did you want to transition, risking all the awful things that can happen on HRT, if you didn’t have a strong desire to do so? You apparently had a strong enough desire to risk your health, and a strong enough desire to go on HRT under informed consent even after a doctor failed to diagnose you. 

Did you just decide “I guess I’ll undergo this life-threatening treatment that I don’t really feel I need” with no motivation at all? I really doubt that you did. Maybe your doctor wasn’t taking into account that a “strong desire” for you wouldn’t have presented the same as a strong desire would for someone with a healthy emotional range.

(I don’t know if HRT itself is life-threatening for women. For men it comes with all kinds of health risks, for women it comes with at least social health risks, so the point stands either way.)

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[valkylander]

This isn’t just about gender dysphoria, this is about the idea that the diagnostic criteria for a condition are what the condition is. The criteria for diagnosing disorders change as our understanding of those disorders and of neuroscience in general expand. They change to include people who have the disorder but could not be diagnosed or to exclude people who don’t have it but would have been. The map is not the territory, and the diagnostic criteria are not the disorder.

But let’s take a look at dysphoria anyway: Despite having dysphoria, I did not meet the diagnostic criteria. That doesn’t mean I didn’t have it, it means the diagnostic criteria are not sufficient to account for all dysphoric people.

Despite meeting the diagnostic criteria, the people in your example do not have gender dysphoria. That means the diagnostic criteria are not sufficient to exclude all non-dysphoric people.

Therefore (as your own example shows) the diagnostic criteria for gender dysphoria are not, by definition, what it is. The map is not the territory.

[coincaster]

It’s very difficult to debate you if you’re going to use your own experience as an example. I don’t know the details of your experience, nor can I verify that in any way. I can’t verify that the person who diagnosed you was following the DSM, I can’t say why you may have been excluded from diagnosis. 

When it comes to a single patient it could very well be human error on the doctor’s part for all I know, it could be bias, it could be a trauma exclusion. I don’t know your case. I’ve had a licensed medical doctor tell me I have a soul and have to go to church to keep it healthy, I’ve had another tell me I had to go to his church specifically to buy some holistic medicine that would cure autism and I’ve had a therapist who actually seemed angry when I told her I was trans and then proceeded to ignore it for weeks until I dropped her.

Doctors are people and sometimes doctors forgo science in favor of their own agenda. If your doctor didn’t properly diagnose you I’m sorry, you might want a second opinion.

Also, what people in my example supposedly don’t have dysphoria? What people are even in my example? I was paraphrasing the DSM when I listed symptoms, the symptoms I defined are straight from the DSM.

Do you wish to change your gender? Do you want to be seen/treated as the other gender? Have those feelings persisted for six months? You have dysphoria as defined by the DSM, as seen below:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

A strong desire to be rid of one’s primary and/or secondary sex characteristics

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender

A strong desire to be treated as the other gender

A strong conviction that one has the typical feelings and reactions of the other gender

Other than wanting to be the other gender and wanting to be validated as and treated like the other gender, how does anyone know they’re trans? What is trans other than wanting to be the other gender and wanting to be seen as the other gender?

The current definition of gender dysphoria is in line with what someone would be feeling to label themself trans. The current definition of gender dysphoria is required to be trans, because how and why would you be trans if you want to be and be seen and treated as you assigned gender?

The label they use for the disorder you have might change, yes, I went over this. As of right now, the label we use for someone who doesn’t identify as their assigned gender, wants to change it and have that change be validated by other people, and feels this way for at least six months, is gender dysphoria. If the label for that changes then the label changes, so what? If you no longer fit the diagnosis, if they make a more accurate map for trans people having less debilitating dysphoria, there will be two things that can define being trans. I don’t see why anyone would be resistant to this.

Again, valid exclusions to diagnosis are trauma cases, peer pressure (including things like hating people of your assigned gender), or sudden onset symptoms that don’t persist for six months. Otherwise, the DSM covers how just about every tucute presents their symptoms.

[coincaster]

Believe it or not, words have definitions and the diagnostic criteria for having a disorder is actually definitive of the disorder. I don’t know how to explain basic language to someone who doesn’t understand that.

[valkylander]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

[coincaster]

So, in your mind, what happens when those diagnostic criteria change? Did people who used to fit them have the disorder and now they don’t? Do people who only now fit the criteria start having the disorder when they didn’t before?

TW: ED mention

Diagnostic criteria don’t usually change so drastically that a person is going to go from having a disorder to not having one. If the criteria change that drastically it’s generally because the old symptoms fall into another category.

For instance, ADHD and ADD being merged into one diagnosis, or the same happening with Asperger’s and Autism Spectrum Disorder. No one who had those stopped having a disorder because the name changed, and treatment that helped was still valid treatment.

Another example is Binge Eating Disorder being added to the DSM in 2013. Before it was added to the DSM, people with the disorder were classified as Bullemic, and the treatment for that helped them somewhat, but they were put into their own more specialized category because their particular cluster of symptoms needed more specialized treatment.

I could write a lot about this, but honestly, you’re deflecting here whether you realize it or not. Gender dysphoria is an incredibly inclusive diagnosis as it is. If a person feels they don’t identify with their gender assigned at birth and has a desire to change it, they fit the criteria. Right now “gender dysphoria” is the label we use for people who need access to hormone replacement therapy and gender confirmation surgeries (note that I said access and not that it’s required).

If, in the future, the label is split into other labels that doesn’t change that you’re trans. It just means they decided the difference is vast enough to warrant a different approach between, say, gender dysphorics with severe distress and without. This does not mean they would stop you from transitioning, transition is already the treatment for your symptoms and that’s incredibly unlikely to change, it mostly means therapy may be approached differently and specific doctors would be able to specialize in one disorder over the other so there would be specialists trained to be better with your specific symptoms.

No doctor is ever going to suddenly tell you you’re not trans as long as you (at least) don’t identify with your gender assigned at birth and do want to change it. If eventually there’s a diagnosis other than gender dysphoria for those symptoms, then in that eventuality there will be two diagnostic labels for people who are trans.

What about people who fit a disorder’s diagnostic criteria but still don’t get diagnosed because the doctor finds a better explanation for what’s going on?

TW: slight mention of csa

I assume you’re talking about the case of people dissociating from their assigned gender because of (usually sexual) trauma, because that’s the only case right now where a doctor will avoid a diagnosis of gender dysphoria until after therapy. 

It’s becoming more and more clear that people who transition because, essentially, their assigned gender feels less safe than their prefered gender due to trauma are not happy after transitioning. If you look up detransitioners, the vast majority who detransition permanently are people who transitioned due to trauma (or peer pressure but I won’t get into that here) and got dysphoria from it because they didn’t identify with their body anymore.

Being (that’s their name if that’s not clear) is a good example of this if you want to look them up, they’re very open about their trauma and why they transitioned and detransitioned. 

If a doctor wants to explore a person’s trauma or just really talk things out before letting a person transition, it’s to protect them from permanently changing their body in a way that will cause them distress. Brains do a lot of harmful things to protect themselves, I say this as someone with a personality disorder (essentially someone who has a brain that’s stuck on doing harmful things to protect itself), and I say that without any judgement or malice. 

Brains aren’t always acting in your best interest, this is why we have specialists who can look at what’s going on and say “hey I’ve heard of brains doing this before, we better check this out further before you do the thing your brain thinks it wants to do, just in case that thing will actually hurt you”.

[coincaster]

As someone with a personality disorder, engaged to someone with a personality disorder, personality disorders are not fun and quirky and I wish kids on tumblr didn’t wish for them the way they do. It’s a struggle and no matter what tumblr tells you it won’t make you more interesting or give you a community the way you think it will. You’ll gain the right to post in the “actually [some PD]” tag and reblog relatable posts about being miserable and you’ll lose the ability to participate in society at your full potential. It’s not a fair trade, it’s not something that you’d be happy with as an adult when you stop caring about tumblr.

[coincaster]

jacksiestuff replied to your post “I wonder if all the self-diagnosed psychopaths and sociopaths on...”

Well imma probably go to a therapist when Im older cause I done some things that have scared my teachers and counselor. Theres alot of kids at my school who self diagnose themselves.

@jacksiestuff I urge you to go to a therapist as soon as you can manage. If your parents aren’t willing to take you it’s possible a school counselor (or just the nurse if you don’t have easy access to the counselor) or your primary care physician will be willing to advocate for you if you bring up concerns about your mental health to them.

ASPD very often presents with denial of any symptoms and avoidance of treatment, when it doesn’t are the times it can be treated successfully. If you see you have symptoms and want to be well, odds are you can achieve that. Furthermore, at your age (I’m making the obvious assumption that you’re under 25 and probably a minor) therapy now can save you from having to live with this disorder at all. 

ASPD is genetic, but it’s a genetic condition that usually requires an environmental activator, therapy can help essentially remove that activator from your life (or help you cope with it adequately) so there’s a good chance you can recover from conduct disorder if you have it before it’s too late for your brain to develop the way it should.

[coincaster]

This is just a right of passage on tumblr dot com now, I suppose.

[trenderish]

if youre nondysphoric youre cooler than every transmed combined

[punk-bitch-michael]

Remember everyone, Cis people are cooler than trans people!