> it should not be sold as "the treatment" but as "we don't have anything better for now, we are working on it, if you can't wait, you can do it"

Isn’t this true of all treatments? It’s the best we’ve got. It seems to work. It has downsides. We’re looking for better options.

We start with the least invasive option. But we don’t stop midway because something better might one day turn up.

Not really - we now create stable identities from what is essentially a form of mental illness. We no longer say that someone suffers from "body dysmorphia", instead we say that they were "assigned the wrong body at birth". It's similar to those deaf parents of deaf children who are against giving them a cochlear implant lest they lose their "deaf culture".

> we are now creating stable identities from what is essentially a form of mental illness

Defining mental illness is imprecise. We’ve gotten it horribly wrong before, from diagnosing intelligent women as hysterics to gay men and women as deviants. We also have a long, failed history of well-meant prohibition.

If we’re seeing preliminary evidence that a surgery makes miserable people happy, I say we follow the lead without prejudice. Maybe we find these peoples’ bodies are picking up on precancerous signs? (Airball.) Probably, we don’t. But my peers’ botox has visibly reduced their faces’ expressiveness; is that mental illness?

Out of all of our emotions, I trust my sense of social disgust least. The world in which it evolved is no more. If I can’t find reason beyond discomfort to question someone’s decisions about themselves, I broadly tend towards letting them be.

(Side note: appreciate the discussion.)

All things you write - looks like you getting you data from conservative media. "assigned the wrong body at birth" - even in trans community considered huge simplification and wrong narrative. It's used only to explain the feeling to people who knows nothing about the issue.

Gender dysphoria - yes, people suffer form it. Transition is the way to lower this suffering. That's the 'cochlear implant' equivalent from your example.

> looks like you getting you data from conservative media

Not OP. But this seems unfair. Not only does the language surround trans persons vary from decade to decade, city to city, it’s also—understandably—guarded.

Someone far from knowing “nothing about the issue,” and moreover, wishes to learn more, could innocuously use language that is offensive in some circles but tolerated—even encouraged—in others.

I am sorry, but no, that's not coming from the conservative media.

See for example "sex assigned at birth" https://service-manual.nhs.uk/content/inclusive-content/sex-... as an example from a mainstream medical institution, the British National Health Service.

And transition is not "the cochlear implant", the implant would be "an implant that makes you not dysphoric". Transition is "learning how to live as a deaf person".

That NHS data collection recommendation says nothing about "wrong body", though. They're trying to elicit accurate information about something potentially medically relevant (assigned biological sex). Their concern is that if you ask a trans person simply "male or female" you'll get an answer that either reflects the gender someone is living in, or the sex on their birth certificate. The former is useless if you're trying to assess the risk of chromosomal disorders, the latter if you're trying to work out how to politely address them.

> "learning how to live as a deaf person"

This is what repression looks like. Before coming out, while you try to live as you assigned gender - that's living as a deaf person, pretty literally as derealization and depersonalization are kind of 'deafining'. As with deaf kid - you fix the body, not the mind, so with gender dysphoria you fix the body first.

Maybe it's just me, but fixing identities scares me much more than fixing the body. There was studies in which trans people were asked if they would want to be consent with their assigned sex (i.e. trans woman to be happy as a man) - most don't. After transition almost none would agree to change it for 'no dysphoria, assigned sex at birth'. 'Fixing' such people sounds like a very cruel and scary idea.

But sometimes deafness is the result of defects in the structure of the ear and sometimes it's the result of defects in the auditory nerve, or other structures in the brain.

In some instances we provide a prosthetic that overcomes the defects of the ear, like a traditional hearing aid, or surgery that corrects those defects, and in others we augment the person with a cochlear implant that bypasses the issue with the nerve. We don't yet have the ability to directly modify the brain with surgery or implants for deafness but I'm sure that we would if we could.

It's interesting that we're talking about deafness because there are many instances of deaf people with heredity causes for their deafness opposed to testing their children with new, effective treatments like cochlear implants because they view it as impinging on their deaf culture.

I think that there are many parallels between this and the developing trans culture which will result in trans people being resistant to more effective, less invasive treatments to cure them of their affliction.

Why do certain maladies develop strong identity politics while others don't? There isn't a diabetic identity, or a halitosis community, so why these ones?

I guess my problem with your view of 'transness' is that you view it as illness or dysfunction. And it's not that. Turning transwoman to a man is equivalent of turning man to opposite gender in a bad case of gynecomastia. That's not the mind that is a problem, I hope you understand my point.

Dysphoria goes deeper than just bodily dysmorphia, it's about how you see yourself, not only your body. So changing my mind to make me something I'm not (a man) sounds like a horror - some kind of upgraded lobotomy. That's much more invasive than any surgery. And it's not about culture, it's about understanding that people identities is not a part that you can/should fix.

And speaking about data and science, there is pretty clear evidence that trans people who receive proper care (hormones) and accepted by society live normal happy life as the rest of the people.

Well... it is an illness and dysfunction.

That's why people are treated by medical experts for it.

We're merely discussing the best form of treatment.

> We now create stable identities from what is essentially a form of mental illness.

Yes. And? A stable identity is preferable for the sufferers. Can you explain the problem with that?

The problem with that is the same as we would get if we decided that the way to treat anorexia is by allowing the patients to starve themselves to death. They would die thin and happy, but I don't think many people would agree with it being the "preferred solution to that problem".

You're comparing apples and oranges though. We know that anorexia can generally be treated with cognitive therapy and help restore people to a healthy and comfortable body weight. Those same treatments fail when applied to people with BIID. And they way they cause harm is different as well, since failing to treat anorexia results in starvation. While refusing to treat BIID results in people taking dangerous risks to amputate themselves.

I don't see much of an actual solution to these issues in your arguments other than some hand waving about politics as some sort of root cause.

I fail to see the parallel. Anorexia as "starving themselves to death" is not a stable identity, it is an identity in decline with ongoing suffering and temporary highs.

Should taking of legs be the first treatment option? No.

Should people get therapy, medication and other treatment? Yes.

Should those treatments be refined and improved, sufferers of BIID experimented on to improve treatments? Yes.

If society is unable to come up with a treatment that works for years should society deny sufferers this radical treatment forever? No. That is imposing the majority world view on a minority when the difference in world view poses no harm. Yes, society would need to address potential cognito hazards/memes and make sure there are no people doing this for economic incentives or other mental illnesses for which treatments exists.

If society would let people get the treatment, that would not be capitulation. That would be acknowledging that while society has interest in being able to treat that, that interest can not forever outweigh the benefits the radical operation has for the sufferer. Capitulation would be if society stops trying to find a treatment besides radical operation and handed operations out without scrutiny.

How does one distinguish between a stable identity and an identity in decline?

One way to do that would be to look at outcomes of patients who have received the therapy to see if they feel their needs are met, like this study did.

> it should not be sold as "the treatment" but as "we don't have anything better for now, we are working on it, if you can't wait, you can do it"

It's not sold as the treatment.

And to your comparison to trans folks, top and bottom surgery is not easy to access (and getting harder by the day!). Talk to any trans person and ask them all the things they needed to do and go through to prove to their doctors that they're trans enough. Besides there not being another option, gender affirming surgery works! The patients are largely satisfied with their outcomes! Why do we need to complicate this with suggesting how they should feel or think?

But moreover, who the fuck cares? I had gynocomastea surgery (after years of bodybuilding) and all I had to do was sign a form. Women can elect to get breast augmentation with no evaluation. Why should a trans person have to prove that they deserve a cosmetic surgery that anyone else can get—so long as the outcome is gender conforming? I can get anything I want tattooed on my face today, but someone else can't get their chest flattened for months because...some lab coats don't think they deserve it enough?