Philosophy Discussion Forums | A Humans-Only Club for Open-Minded Discussion & Debate

[Pattern-chaser]

But if one undergoes sex re-assignment surgery, in normally involves lifelong hormone therapy and regular follow ups with healthcare professionals. If you've had a re-constructed vagina, it needs ongoing dilation to maintain it. Depending on the specific surgery and retained organs, you may need follow ups with a urologist or gynaecologist for routine cancer screenings and other potential health problems arising from the process itself. Regular check ups with a GP is a must.

In the examples I know of — and I already mentioned, they are few — all of what you write is untrue. Except the need for hormone tablets. They are required for life, as you suggest. Just as I (and millions of others) need to take medications regularly. But such regular prescriptions do not usually (or often) require the personal attention of a doctor.

If what you say is true then it sounds like negligence to me.

Well it would, wouldn't it? Because that is what you want to believe. Your bias is clear for all to see, but it does tend to make it more difficult for you to appreciate a point that is not wholly in line with your own beliefs.

[Fried Egg]

If you are any long term prescription, you should be periodically re-assessed by your GP or a specialist. Even people who are healthy should be periodically screened for cancers. But if you are receiving such radical treatments as these (with so little known about their long term effects), all the more reason for regular follow ups and check ups. If you are receiving cross sex hormones after you have had surgery to remove the organs that produce your natural sex hormones, I would count it as negligent if such patients weren't followed up and monitored periodically.

That seems like a reasonable, common sense position to me. If you had presented me with compelling arguments that I couldn't refute, or evidence I couldn't deny, and yet I still clung to my position; that would be bias. However, it is precisely the reverse. You admit that there is a lack of evidence for such treatments and yet cling to supporting their prescription because of your ideological bias.

As I have said, I don't believe it is the lack of opportunity to monitor and gather data about people who have received treatments. It is has been shown (in many cases) to be a lack of inclination to do this.

[Sy Borg]

If people don't report back, you can probably assume success.

Is this your suggestion for how doctoring as a whole should operate ?

Or are you showing your willingness to make exceptions to any general rule, in cases where people's Important Feelings are involved ?

Or are you saying that this sort of therapy isn't really medical at all, and therefore generalisations about the practice of medicine don't apply ?

It seems that, if a post-op trans fails to report back afterwards about their surgery, then they should be horse-whipped and sent to work in the salt mines. What else are you going to do? Freeze their funds? Refuse future medical treatment? Prison?

It seems to me that you prefer mass dysfunction and suicides of innocent people struggling with an extremely difficult situation to offering them flawed, messy solutions that we don't fully understand.

[Fried Egg]

It seems that, if a post-op trans fails to report back afterwards about their surgery, then they should be horse-whipped and sent to work in the salt mines. What else are you going to do? Freeze their funds? Refuse future medical treatment? Prison?

If nothing else, you could stop their prescription for cross sex hormones until they check back in.

However, checking in of former patients is not the problem, it is the lack of inclination to collect the data. You never actually become a former patient because the treatments never completely end. In everything I've read on sex re-assignment surgeries, they are not one off operations, but require regular post op check ups and monitoring to look out for the many potential side effects and to ensure that cross sex hormones are prescribed at the right level (which may need to change over time).

[Pattern-chaser]

If you are any long term prescription, you should be periodically re-assessed by your GP or a specialist. Even people who are healthy should be periodically screened for cancers. But if you are receiving such radical treatments as these (with so little known about their long term effects), all the more reason for regular follow ups and check ups. If you are receiving cross sex hormones after you have had surgery to remove the organs that produce your natural sex hormones, I would count it as negligent if such patients weren't followed up and monitored periodically.

That seems like a reasonable, common sense position to me. If you had presented me with compelling arguments that I couldn't refute, or evidence I couldn't deny, and yet I still clung to my position; that would be bias. However, it is precisely the reverse. You admit that there is a lack of evidence for such treatments and yet cling to supporting their prescription because of your ideological bias.

As I have said, I don't believe it is the lack of opportunity to monitor and gather data about people who have received treatments. It is has been shown (in many cases) to be a lack of inclination to do this.

This (unnecessarily) confirms your bias, while describing conduct that is appropriate to many or most of us; maybe even to all of us. I can't see that it progresses our conversation, does it?

[Pattern-chaser]

If nothing else, you could stop their prescription for cross sex hormones until they check back in.

If punishment is what you're about, I can't agree. Whatever condition someone might have, I don't think punishing them for it is a helpful approach.

I have enough trouble with attitudes like these in RL, as my disabilities are invisible, so they are ignored. It is assumed, because there is no visible evidence of my disabilities, that I'm putting it on, and could (if I chose) set it aside and behave 'normally' if I wanted to. It doesn't help me, and it wouldn't help someone who is transitioning either. IMO.

[Fried Egg]

If nothing else, you could stop their prescription for cross sex hormones until they check back in.

If punishment is what you're about, I can't agree. Whatever condition someone might have, I don't think punishing them for it is a helpful approach.

It's not about punishment. When you prescribe someone something, you need to monitor to see if the dosage needs to increase or decrease (or maybe even stop altogether). It's not about punishment.

But it's such a non issue that you and Sy-Borg are intent on drumming up because I don't understand why most people would not willingly follow up with post-op treatments which result in on going medications who's level depends on how one reacts to both the initial operation and the subsequent medications.

And if the doctors aren't monitoring the patients, or are but aren't collecting data in order to better formulate evidence for the treatment of future patients, simply aren't doing their job properly.

This (unnecessarily) confirms your bias...

Bias in favour of what? Evidence based medicine? Well, guilty as charged! Perhaps you can reciprocate with your own honesty and admit your bias for ideology based medicine?

[Sy Borg]

It seems that, if a post-op trans fails to report back afterwards about their surgery, then they should be horse-whipped and sent to work in the salt mines. What else are you going to do? Freeze their funds? Refuse future medical treatment? Prison?

If nothing else, you could stop their prescription for cross sex hormones until they check back in.

Could you? What about the lawsuits when post op transpeople who don't dare jeopardise their anonymity develop osteoporosis due to lack of hormones?

However, checking in of former patients is not the problem, it is the lack of inclination to collect the data. You never actually become a former patient because the treatments never completely end. In everything I've read on sex re-assignment surgeries, they are not one off operations, but require regular post op check ups and monitoring to look out for the many potential side effects and to ensure that cross sex hormones are prescribed at the right level (which may need to change over time).

That might last some years but it's not going to be for life. It seems to me that almost everything I read from and about transpeople is coming from people who have not had the surgery, and those who have been "done" had it not so long ago. You don't hear much from people who changed over last century.

It seems to me that if people are disappearing into general society, it's mission accomplished.

[Pattern-chaser]

Bias in favour of what? Evidence based medicine? Well, guilty as charged! Perhaps you can reciprocate with your own honesty and admit your bias for ideology based medicine?

In favour of nothing. Bias against trans people and their needs.

I am grateful to our healers for their efforts, and if I have a bias, it's in favour of that which works, evidence or not. I am pragmatic here, supporting any form of healing care that patients want or need.

[Fried Egg]

Bias in favour of what? Evidence based medicine? Well, guilty as charged! Perhaps you can reciprocate with your own honesty and admit your bias for ideology based medicine?

In favour of nothing. Bias against trans people and their needs.

I am grateful to our healers for their efforts, and if I have a bias, it's in favour of that which works, evidence or not. I am pragmatic here, supporting any form of healing care that patients want or need.

To this, I will say just two things:

1) What people need is not necessarily the same as what they want.

2) It is only through evidence that we find out what works and what doesn't. It is ideologues, not pragmatists, that are prepared to go against (or ignore the lack of) evidence.

It seems to me that if people are disappearing into general society, it's mission accomplished.

As long as that's what's genuinely happening and not simply negligent medical professionals and clinics not bothering to follow up.

Although it seems to me that this is surely what happens with all successful medical treatments; they don't hear back from their former patients once it's all over. But that doesn't mean you can't establish evidence for medical practices. Before any treatments become routinely prescribed, you would expect proper trials to take place, right? I don't see what makes gender re-assignment surgery (including puberty blockers and cross sex hormones) any different from other medical practices.

[Sy Borg]

It seems to me that if people are disappearing into general society, it's mission accomplished.

As long as that's what's genuinely happening and not simply negligent medical professionals and clinics not bothering to follow up.

Although it seems to me that this is surely what happens with all successful medical treatments; they don't hear back from their former patients once it's all over. But that doesn't mean you can't establish evidence for medical practices. Before any treatments become routinely prescribed, you would expect proper trials to take place, right? I don't see what makes gender re-assignment surgery (including puberty blockers and cross sex hormones) any different from other medical practices.

You can only establish as much evidence as you can, not all of the evidence.

What makes sex change surgery different is that candidates have to be assessed by psychiatrists for two years beforehand. I think they have to live in role during that time to see how viable a sex change will be. No idea what the situation is with hormones but I think there needs to be huge caution around the prescribing of puberty blockers.

I also think that some of these strange mothers who are raising their boys as girls, against the boy's wishes, need to be punished and their abuse stopped.

[Pattern-chaser]

1) What people need is not necessarily the same as what they want.

And yet they know what they want, while others tell them what they need. If the two differ, who is it who will decide what I really want ... sorry, need? You?

2) It is only through evidence that we find out what works and what doesn't. It is ideologues, not pragmatists, that are prepared to go against (or ignore the lack of) evidence.

Oh, going *against* existing valid evidence is very different from deciding in the absence of evidence. But if we waited for evidence before we decided anything, we'd never decide anything.

Your words are dogmatic and absolute. They say there is only one valid point of view, and it's yours. Not so.

[Pattern-chaser]

I also think that some of these strange mothers who are raising their boys as girls, against the boy's wishes, need to be punished and their abuse stopped.

If we search the whole planet, I'm sure we would find one or two such people. But it is very far from common, and may unsettle the discussion with thoughts of perversion and abuse. For sure, the latter need to be opposed and stopped, but it's a teeny-tiny problem, thrown into a much larger problem-pool, I think. Let's leave it aside for now, on the understanding that we all agree with what you have stated here?

[Fried Egg]

1) What people need is not necessarily the same as what they want.

And yet they know what they want, while others tell them what they need. If the two differ, who is it who will decide what I really want ... sorry, need? You?

Well, as it happens, I'm inclined to agree with you when it comes to adults. They can take the responsibility of such a decision and live with the consequences. But when it comes to children; no.

I'm actually quite encouraged by the new plans being proposed by the NHS, in response to the Cass Review, to introduce a more holistic approach to diagnosis for children who are referred to gender clinics. The plans, which are to go through consultation, are to screen patients for neurodevelopmental conditions (such as autism). They will also evaluate each child’s mental health, their relationship with their family and their sexual development, including whether they are experiencing same-sex attraction.

It's a clear move away from the "gender affirming" approach that has hither to held sway but hopefully it should lead to a reduction in children being mis-diagnosed with gender dysphoria and ensure that they get the most appropriate care for their needs.

Oh, going *against* existing valid evidence is very different from deciding in the absence of evidence. But if we waited for evidence before we decided anything, we'd never decide anything.

When "anything" includes chopping off healthy body parts (or other irrevocable damage to a healthy body), I say it's best to wait for the evidence.

However, as I said, when it comes to adults; if they want to take the risk that's up to them.

[Pattern-chaser]

Well, as it happens, I'm inclined to agree with you when it comes to adults. They can take the responsibility of such a decision and live with the consequences. But when it comes to children; no.

Then how can parents do their jobs? They are there, among other things, to take decisions for their children, decisions the children aren't ready to make for themselves, yet. So if you won't allow parents to decide, how will it work? Will all important decisions be referred to a court, or must all significant decisions just wait until the child reaches adulthood and maturity?