Talk:Gender dysphoria in children/Archive 3

Archive 1

Archive 2

Archive 3

Reorganizing page slightly

TheTranarchist said they were reorganizing the page slightly. They put so much old information at a top level in the article. WP:MEDMOS advises placing history late in the article, so I put TheTranarchist's information late.

Others might want to investigate "Notable proponents of the view that a trans 'outcome' should be discouraged have included Richard Green, John Money, George Rekers, Ole Ivar Lovaas, Kenneth Zucker and Susan Bradley." There is some discussion at Talk:Kenneth Zucker about him rejecting some of the claims made against him. Try for WP:NEUTRAL where proper, everyone. SangdXurWan (talk). I have really red hair. 05:53, 10 May 2022 (UTC)

I agree with this. I have just had to revert TheTranarchist titling a section conversion therapy. That is completely non-neutral, for the reasons you say. Not to mention that this was not considered conversion therapy. The relative newness of such a view as conversion therapy was discussed at the conversion therapy talk page. Stathin (talk) 18:47, 14 June 2022 (UTC)

Charges of conversion therapy are covered in the society and culture section, in a neutral way, although some might argue that it heavily favors those arguing against Zucker et al. It's better than calling the older practices conversion therapy in WP:WIKIVOICE. WP:WIKIVOICE talks about opinions and facts. The argument that Zucker et al. performed conversion therapy is an opinion. Stathin (talk) 19:27, 14 June 2022 (UTC)

The mainstream view, held by all relevant professional bodies, is that therapy intended to change a person's gender identity is, in fact, conversion therapy. The position, in the 21st century, that it is anything else is marginal at best. Newimpartial (talk) 20:03, 14 June 2022 (UTC)

And now I've reverted. Stathin is entirely correct that calling this conversion therapy doesn't adhere to WP:WIKIVOICE. We don't present opinionated, hot button things such as this as fact. It's also why it's not done in Zucker's article without his response. For many social topic articles, whether's it's abortion or gender identity, we don't do this. Even material at the rapid-onset gender dysphoria controversy article adheres to not presenting opinions about it in Wikipedia's voice. SangdXurWan (talk). I have really red hair. 00:31, 15 June 2022 (UTC)

The discussion at Talk:Kenneth Zucker about his views on this includes material rejecting the claim that he and those who worked with him performed conversion therapy. Zucker's approach doesn't appear to have been "let's change this person's gender identity". SangdXurWan (talk). I have really red hair. 00:41, 15 June 2022 (UTC)

Could you please quote the section within this that you all believe is not adhering to WP:WIKIVOICE? I've read it multiple times now and do not see what you all are seeing. Sideswipe9th (talk) 00:47, 15 June 2022 (UTC)

I have reverted it back. SangdXurWan, I don't think you are understanding what WIKIVOICE is about. The revised text does not assert in wikivoice that certain practices are conversion therapy, it attributes the statement to a list of organizations, saying that they consider attempts to change a person's gender identity to be conversion therapy (emphasis added). Nor is there any statement in Wikivoice taking Zucker to task for his therapeutic practices - there are two, attributed statements that represent mainline contemporary evaluations of his work. And DUE, rather than your feelings about hot button things, determines the inclusion (or not) of Zucker's own explanations in Wikipedia articles. I have not seen any evidence, based on reliable, secondary sources, that would make it appropriate to include them. Newimpartial (talk) 00:55, 15 June 2022 (UTC)

Do either of you know the difference between fact and opinion? That is WP:WIKIVOICE in a nutshell. The heading alone is calling the practices conversion therapy. The heading is stating it as conversion therapy in wikivoice. And I've seen that headings have been considered in wikivoice violations on Wikipedia. Then the text says, in wikivoice, that past attempts at therapeutic intervention often included conversion therapy, and lumps Zucker in there. Newimpartial has twisted protocol once again. Look at how they twisted WP:MEDRS, even when told by a medical editor how things work. They lecture about feelings when that appears to be the only way they know how to edit. Let's see you call Zucker a conversion therapist in wikivoice in his Wikipedia article and see how that works out. Then maybe you'll understand WIKIVOICE. Stathin (talk) 16:11, 15 June 2022 (UTC)

Not the heading alone, the statements and positions of m major modern health organizations. Wikivoice doesn't mean agrees with you, it means it agrees with scientific consensus. When we're done squabbling this article, I see no issue updating Zucker's too. TheTranarchist ⚧ Ⓐ (talk) 16:16, 15 June 2022 (UTC)

I await you trying to call that man a conversion therapist in his Wikipedia article. Stathin (talk) 19:44, 15 June 2022 (UTC)

Stathin, you confuse me when you revert changes to article text that have almost nothing to do with the use of wikivoice (with the one very small exception of the heading, "conversion therapy") and then, when your edits are contested, you change the topic to raise questions of attribution and wikivoice (re: Zucker) that were not altered in the edits you were reverting.

The current paragraph in which Zucker's practices are discussed reads as follows:

Past attempts at therapeutic intervention often included conversion therapy, viewing gender non-comformity as a problem to be fixed rather than natural variation. In addition, gender identity, gender expression, and sexual orientation were often conflated as problems to be corrected and replaced with the "correct" gendered behavior. Noting that many transgender and homosexual adults reported gender-nonconformity in childhood, clinicians at the time viewed early childhood intervention as a way to prevent a later LGBT identification. Notable proponents of the view that a trans "outcome" should be discouraged have included Richard Green, John Money, George Rekers, Ole Ivar Lovaas, Kenneth Zucker and Susan Bradley.

It is true that this paragraph does use wikivoice, but I don't see anything here but well-sourced statements of fact. And the only one that relates to Zucker names him among (n)otable proponents of the view that a trans "outcome" should be discouraged. This certainly does not have the character of a BLP violation, and I am not aware of any RS that contest his inclusion among proponents of this view. If it is contested, then by all means the prose could be adjusted to reflect the reliable sourcing. But that is not a pretext for reverting other content, nor is it justification for you to cast aspersions (though I must admit that twisted protocol would have been a good name for an early industrial band), make irrelevant "whataboutist" comments, and generally engage in playground behaviour that is out of scope for an article Talk page. Newimpartial (talk) 16:52, 15 June 2022 (UTC)

Love the word whataboutist? I guess we all have our favorite words. But it makes no sense when you use it. Stathin (talk) 19:44, 15 June 2022 (UTC)

Zuckers' approach has been, according to what is in the article currently,

to "encourage the child to identify with their assigned sex"

to "encourage same-sex friendships"

"setting limits on the child's cross-gender behavior" (note conversion therapy is also defined as trying to police "deviant" gender expression of any kind)

to "state that children with GD tend to come from families where cross-gender role behavior was not explicitly discouraged."

All of these are based off his reports from 1997 and 2002, and the field of trans medicine has moved on since then.

Also, when criticized for conversion therapy, he made the stellar defense of calling it

"the work of a journalist whose views shouldn't be put into the same camp as those of scientists like Richard Green or himself." (Richard Green was a conversion therapist for the record)

Not to mention, as stated in Kenneth Zucker, he has stated:

"We recommend that one goal be to help the child feel more secure about his or her actual gender, another to deal with the child's emotional difficulties, and a third to help with problems in the family. It's helpful to have parents set limits on things like cross-dressing, which many parents have not done before coming to us."

What about this approach is not conversion therapy? And to be clear, conversion therapy as defined by the least the majority of major health organizations, the linked article goes into more detail than the already sizeable chunk on conversion therapy here. TheTranarchist ⚧ Ⓐ (talk) 02:48, 15 June 2022 (UTC)

Opinions. A wait-and-see approach, or trying to relieve gender dysphoria by seeing if the child can be comfortable in their assigned sex, because of the research they had on prepubebescents mostly desisting, is not conversion therapy in the sense of trying to change the child's gender identity. It's trying to figure out what that child's gender identity is and whether it's true. When most cases have shown children are likelier to desist, then accepting that the child is trans is neglectful. Puberty blockers for treatment of gender dysphoria also take a wait-and-see approach. When Zucker says he's fine with the child socially transitioning after a wait-and-see approach, he can hardly be called a conversion therapist in the way you're trying to make him out to be. I take back what I said about you being level-headed. Since day, one you have added a conversion therapy POV in dubious ways. If you do this at the Zucker article, let's see how WP:BLP holds up. Stathin (talk) 16:11, 15 June 2022 (UTC)

Opinions is a funny way of saying quoting a person and comparing their statements to the positions of major modern health organizations.

Also, there are many other discussions of this throughout WP, but high desistance is not a fact but a misinterpretation of the data that is known to be so.

Quick question about my "conversion therapy POV", what false statements have I made? "Day one", I was challenged for trying to say transgender conversion therapy exists at all, not for faulty evidence. You haven't had to go through the fun stuff he describes as just "wait and see". It's also the position of the APA that "wait-and-see" is not neutral FYI.

In regards to my latest edit/reversion, I accidentally pressed enter while typing. The edit summary would have been: reverting the position of the Endocrine Society to a past one, misrepresenting what the medical community considers conversion therapy, countering style/format changes to keep older medical diagnosis criteria in there, and denying the existence of MEDR studies on the topic at hand is not "neutral". TheTranarchist ⚧ Ⓐ (talk) 16:25, 15 June 2022 (UTC)

For your edification, conversion therapy as described by APA and the SAMHSA as "efforts to change an individual's sexual orientation, gender identity, or gender expression—is a practice that is not supported by credible evidence and has been disavowed by behavioral health experts and associations. Conversion therapy perpetuates outdated views of gender roles and identities as well as the negative stereotype that being a sexual or gender minority or identifying as LGBTQ is an abnormal aspect of human development. Most importantly, it may put young people at risk of serious harm."

According to the APA, "Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses. Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth"

According to WPATH: "Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical."

Did Zucker not explicitly say he set limits in a child's gender expression ("It's helpful to have parents set limits on things like cross-dressing")? That is a yes or no question.

You are the one here who is not "level-headed", and is pushing misinformation. As a trans girl who's seen too many people go through what you're describing as fine and not conversion therapy, and as someone who actually relies on current sources and definitions which you seem to have an aversion to including, frankly your POV is laughable if not for its real world dangerous effects. TheTranarchist ⚧ Ⓐ (talk) 16:37, 15 June 2022 (UTC)

"Conversion therapy" in the heading is WP:WIKIVOICE. And having Zucker in a paragraph about conversion therapy is obviously implying that he performed conversion therapy. Wikivoice doesn't mean agrees with you. Take note, I agree. And I didn't mean to remove any updates to the diagnosis criteria. I only meant to remove your POV of calling practices conversion therapy when they were based on desistance rates, the DSM criteria at the time, and trying to apply appropriate standards of care. Your argument that "high desistance is not a fact but a misinterpretation of the data that is known to be so" is only an assertion at this point with the research that exists. I notice that you admit to that here. The desistance rates may not be as high as reported, but more research is needed for the true prevalence. Not one primary study.

Where do reviews call Zucker's practices "conversion therapy"? I don't see it in reviews. I see more neutral outlooks than what you describe. "Gender nonconforming youth: current perspectives" is a 2017 review that mentions Zucker and analyzes what it calls "the traditional model of gender development". It says "Underlying the treatment was the intent of warding off a homosexual outcome for young effeminate boys" and "it should be mentioned that this model is still practiced today, referred to by some as the reparative model.", but one of the things among many that it says about the newer model is, "In this contemporary model of gender development, added to the three dimensions of nature, nurture, and culture is the fourth dimension: time. Each child alters their gender web as they weave together nature, nurture, and culture, 'over time'. In other words, gender is neither fixed by age 6, as in the traditional model, nor static throughout all stages of child and adult development, thus explaining how an individual at age 40 or 50 could come to the realization that the gender they had identified as being is no longer a good fit."

Of note, it also says of the "live in your own skin" model, "As mentioned earlier, this model was developed by Drs Susan Bradley and Ken Zucker at the Center for Alcoholism and Mental Health gender clinic in Toronto.16 The treatment goal of facilitating a young child accepting the gender identity matching the sex assigned to that child at birth, based on the supposition that younger children, in contrast to older youth, have a malleable gender brain, is tied to a medical–social rationale. Specifically, being transgender is a harder way to live one’s life, both because of social stigma and potential requested hormonal treatments and surgeries to align a youth’s body with their transgender identity. Given the perceived plasticity of the young child’s gender brain, best practice would be to introduce interventions to help a child accept the sex assigned to them at birth as their gender identity, with no harm done and indeed added benefit to their psychological and social well-being." They describe things differently than you do.

You also say, "It's also the position of the APA that 'wait-and-see' is not neutral FYI." The review says, "The 'watchful waiting' model was designed by the members of the interdisciplinary team at the Amsterdam Center of Expertise on Gender Dysphoria, VU University Medical Center, under the leadership of Dr Peggy Cohen-Kettenis. Borrowing from the medical use of GnRH agonists for children exhibiting precocious puberty, the Netherlands team is responsible for introducing the use of puberty blockers for gender purposes, to put a pause on pubertal growth and allow more time for a youth to explore their gender and consolidate their adolescent gender identity, with the future possibility of cross-sex hormone therapy to align their bodies with their affirmed gender identity. In contrast to the live in your own skin approach, a young child’s demonstration of gender nonconformity, be it in identity, expressions, or both, is not to be manipulated in any way, but observed over time. If a child’s cross-gender identifications and affirmations are persistent over time, interventions are made available for a child to consolidate a transgender identity, once it is assessed, through therapeutic intervention and psychometric assessment, as in the best interests of the child. ... No attempts are made to alter a child’s gender identity or expressions; yet it is postulated in this model that it would be better to hold off until puberty on any social transitions of a child from one gender to another, and instead give them safe spaces to fully express their gender as they prefer before facilitating any full gender transitions.. ... The third model of care, the gender affirmative model, is closely aligned with the watchful waiting model but in opposition to the live in your own skin model." It also describes things differently than you do on this, and reflects my comment on puberty blockers.

More: "The watchful waiting model is a highly respected model of care worldwide, offering careful and cautious procedures; but it has run into a snag: many contemporary families in the Netherlands are not content to hold their children back from social transitions until puberty, and have, through both local and international support networks of parents and professionals, proceeded to facilitate their children’s social transitions without awaiting clinical approval or waiting until puberty arrives. Parents do this not because they dismiss professional care, but because evidence is accruing that young children thrive when given permission to live in the gender that is most authentic,27,28 and are at risk for symptomatic behaviors if prevented from doing so. At the same time, the watchful waiting model is effective in its thorough attention and assessment of the child over time, integrating the services of mental health and medical professionals. ... The gender affirmative model is questioned by some on the basis of the lack of evidence-based data that indicates that young children can reliably communicate and have self-knowledge of a transgender identity or benefit from a social transition. There is also concern that the model of listening to the children puts too much weight on a child’s self-report."

Newimpartial criticized Jdbrook in the weak support section and at WP:MED, but it looks like some of the criticism is unwarranted. Stathin (talk) 19:44, 15 June 2022 (UTC)

This last paragraph is a perfect example of Whataboutism, since it directs the discussion entirely away from the topic (in this case, away from any of the topics actually being discussed) and towards some poorly articulated "dead cats". Newimpartial (talk) 20:10, 15 June 2022 (UTC)

That last paragraph is very relevant, considering what Jdbrook argued. I've never seen your interpretation of whataboutism until you. At least you changed that "conversion therapy" heading. Stathin (talk) 20:40, 15 June 2022 (UTC)

I haven't seen Jdbrook make any arguments, on this page or elsewhere, that would be relevant to this section. Perhaps you could enlighten me. Newimpartial (talk) 21:04, 15 June 2022 (UTC)

1) Here is a peer-reviewed critiques of the high desistance myth: https://doi.apa.org/doiLanding?doi=10.1037%2Fsgd0000504. Here are the original authors of the high desistance review ackowledging they didn't track gender identity, but referrals to clinics. https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1468292

2) Here is a sources where Zucker's practices are compared to conversion therapy: https://www.tandfonline.com/doi/abs/10.1080/19361653.2019.1665610,

3) In regards to "Specifically, being transgender is a harder way to live one’s life, both because of social stigma and potential requested hormonal treatments and surgeries to align a youth’s body with their transgender identity. Given the perceived plasticity of the young child’s gender brain, best practice would be to introduce interventions to help a child accept the sex assigned to them at birth as their gender identity":"

3.1) the current medical consensus is that gender identity is biologically rooted, not a choice.

3.2) I suppose you would also be completely fine with the statement "Being homosexual is a harder way to live one’s life, both because of social stigma and potential discrimination in receiving healthcare. Given the perceived plasticity of the young child’s sexual brain, best practice would be to introduce interventions to help a child accept the sexual orientation assigned to them at birth as their sexual orientation." For the record, the approximate phrase "it's not conversion therapy since life is hard for trans people and we'll treat them when they're older" is nothing new, I refer you to the history section of this article and page conversion therapy.

4) The affirmative model does not mean tell any gender-noncomforming kid they're trans, it means accept them without judgement without trying to convince them they're anything." No attempts are made to alter a child’s gender identity or expressions" is contrary to Zucker's own quote. From your own quote, "evidence is accruing that young children thrive when given permission to live in the gender that is most authentic,27,28 and are at risk for symptomatic behaviors if prevented from doing so." Here is an article where the main factor separating the wait-and-see from affirmative model is laid out to be disallowing social transition before puberty: https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12833 It's also interesting how you quote the APA's 2017 review to try and get around their 2020 position statement.

4) As stated and you keep avoiding. 1) Is the definition of conversion therapy as I stated (attempting to change gender identity or expression)? 2) Did Zucker not encourage parents to set limits on gender expression? TheTranarchist ⚧ Ⓐ (talk) 20:40, 15 June 2022 (UTC)

TheTranarchist, I don't know the full context of "the perceived plasticity of the young child's gender brain" in terms of this topic, but neuroplasticity is a biologically-rooted topic and the Wikipedia article for it says that the developing brain exhibits a higher degree of plasticity than the adult brain. "Choice" wasn't mentioned in the text Stathin quoted.

Re: "quote the APA's 2017 review to try and get around their 2020 position statement", I don't think that's what they were doing. FYI, though, WP:MEDORG has a section on guidelines, position statements, and reviews. SangdXurWan (talk). I have really red hair. 03:27, 16 June 2022 (UTC)

Prevalence section

This section should only be about the prevalence of those with gender dysphoria. The prevalence of trans or gender-diverse children is a different topic. Crossroads already removed the different topic from the section. But TheTranarchist has attempted to add more information about trans kids to the section. I reverted this. Stathin (talk) 18:58, 14 June 2022 (UTC)

Gender dysphoria is a convenient half-truth the medical system has rather than an existing condition. It is the term for a trans person's desire to transition which prioritizes the distress caused by not being able to as the issue at hand, as opposed to terms like euphoria which center the joy and authenticity transition allows us to express. While not all trans people have dysphoria and vice versa, that's because it's a poorly formulated concept that's been changed over the decades. Under the current medical system, any trans person who wants to transition requires a diagnosis of gender dysphoria. The current diagnosis requires only a self-identification as trans/desire to transition. As such, when discussing how many children have "gender dysphoria", ie don't feel comfortable in their assigned gender at birth and want to transition, how on earth isn't how many kids say they're trans a valid datapoint?

Not to mention, I updated it after Crossroads undid my initial edit. The initial figures referred to gender-noncomforming children, that is true, the one I added and you reverted referred explicitly to transgender youth. TheTranarchist ⚧ Ⓐ (talk) 21:27, 14 June 2022 (UTC)

The prevalence of children with gender dysphoria still is not the same population as children who actively identify as transgender. We have to be even more careful about this because of the shifting data on this topic and questions about what percentage of prepubescent children with gender dysphoria desisit or persist. SangdXurWan (talk). I have really red hair. 00:49, 15 June 2022 (UTC)

What evidence do you accept as reliable on this topic? Newimpartial (talk) 01:00, 15 June 2022 (UTC)

What we need are MEDRS review(s) that are specifically on numbers of children with gender dysphoria. Crossroads ^-talk- 05:04, 15 June 2022 (UTC)

Is there a source for "people with gender dysphoria" does not refer to trans people? How does "gender dysphoria", distress with one's assigned sex at birth and a desire to transition, not reflect trans people? If "gender dysphoria" is defined as "A strong desire to be of the other gender or an insistence that one is the other gender", which trans youth exactly don't fall under that umbrella?

As stated earlier, and in the article concerning it for that matter, gender dysphoria is a medical diagnosis which its proponents say exists to justify a trans person's desire to transition medically. The idea "distress" is the end all be all of the trans experience is deeply misguided. If considering homosexuality as an example, would you argue that there is a objective meaningful difference between statistics on how many people identify as gay vs how many have been diagnosed with homosexuality, ie "medically" recognized as "desiring to have romantic relations with the same gender and distress when expected to do the opposite"? So when considering the medical term for "wanting to live as one gender and feeling distress over being unable to do so", why exactly can't we use the statistics on the number who are trans as relevant?

Also, the studies referenced included reports on youth <= 19 who were asked "Do you think you are transgender? This is a girl who feels like she should have been a boy, or a boy who feels like he should have been a girl (e.g., Trans, Queen, Fa’faffine, Whakawahine, Tangataira Tane, Genderqueer)". Given how a common statement by any side researching trans healthcare is we need more studies that aren't completely focused on clinics and small populations, multiple surveys across thousands of kids at different schools seems like a fairly good statistical look into the question of many of how many people are trans, ie don't feel comfortable in their assigned gender at birth.

If you can provide some better statistics on this, please by all means do. But please don't act like a systematic review fully MEDR compliant doesn't cut the mustard because it doesn't pathologize and medicalize trans people enough. For the record, the review used studies using the term "gender dysphoria" and the official diagnosis. All studies selected for the publication did so because they "1) appeared in press in 2009 or later; 2) were published in English; 3) used a clear definition of TGD status; 4) calculated proportions of TGD people based on a well-defined population denominator; and 5) were peer-reviewed." TheTranarchist ⚧ Ⓐ (talk) 06:56, 15 June 2022 (UTC)

Earlier, you say, "While not all trans people have dysphoria and vice versa, that's because it's a poorly formulated concept that's been changed over the decades." Then you ask if there is a source for saying "people with gender dysphoria" does not refer to trans people. You also include the question: How does "gender dysphoria", distress with one's assigned sex at birth and a desire to transition, not reflect trans people? Well, sure there's a source. There's many. You can't not know that. National Health Service has a report saying, "A diagnosis of gender dysphoria in childhood is rare. Most children who seem confused about their gender identity when young will not continue to feel the same way beyond puberty. Role playing is not unusual in young children."

But that's the crux, isn't it? A lot of sources, even if relying on "myth" data, report that children with gender dysphoria will no longer have it before or at some time during puberty. In the case that we think of "children who seem confused about their gender identity" to be broader than those with gender dysphoria, the National Health Service uses that wording under a title termed "Signs of gender dysphoria in children" regardless. The material on desistance is about some prepubertal children who were diagnosed with gender dysphoria and then not having gender dysphoria and not actually being transgender. Do you think differently about it because the older criteria for gender dysphoria was partly "wrong"? All children diagnosed with gender dysphoria today are transgender? Also, you endorse "gender dysphoria is just about trans people", and the altered criteria, but then say the idea that distress "is the end all be all of the trans experience is deeply misguided" while an article from the American Psychiatric Association says, "In order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning"? SangdXurWan (talk). I have really red hair. 03:39, 16 June 2022 (UTC)

Continued reorganization

Foe those averse to following the thread of wdit summaries, I have again followed up on some of TheTranarchist's structural changes by making more modest changes of my own: in this case, moving material from "Management" to "History" so that contemporary management tools are in managwmrnt and the whole historic arc of deprecated approaches is in "History" (including the decisions that deprecated them). I believe this change serves the interests of our readers. Newimpartial (talk) 00:28, 16 June 2022 (UTC)

Realise I'm re-opening a can of worms here per the above sections, but the History section really really badly needs some subsections to break up the content. There's also something odd about how that section flows linguistically, possibly with some repetition, though I can't quite tell if you're finished with your rejig yet. Sideswipe9th (talk) 00:40, 16 June 2022 (UTC)

I did some basic work on verb tenses, but I'm fine for others to continue now. I just wanted to rough out a basic division of content between sections: there is certainly more to be done. Newimpartial (talk) 00:49, 16 June 2022 (UTC)

The new setup isn't too bad, but the history section does look exhaustive. SangdXurWan (talk). I have really red hair. 03:48, 16 June 2022 (UTC)

Recent sources

Recent investigative reports by Reuters, The BMJ and others may be useful for article improvement, especially the societal aspects. --Animalparty! (talk) 21:21, 25 February 2023 (UTC)

• Block, Jennifer (23 February 2023). "Gender dysphoria in young people is rising—and so is professional disagreement". The BMJ. doi:10.1136/bmj.p382.
• Respaut, Robin; Terhune, Chad (October 6, 2022). "Number of transgender children seeking treatment surges in U.S." Reuters.
• Conlin, Michelle; Respaut, Robin; Terhune, Chad (November 18, 2022). "A gender imbalance emerges among trans teens seeking treatment". Reuters.
• Rigby, Jennifer; Respaut, Robin; Terhune, Chad (December 15, 2022). "England's trans teens, lost in limbo, face mounting barriers to care". Reuters.
• Ovadia, Daniela (February 15, 2023). "Puberty Blockers for Gender Dysphoria Controversial in Italy". Medscape.
• Sapir, Leo (21 February 2023). "Finland Takes Another Look at Youth Gender Medicine". Tablet Magazine.

Undue weight to conversion therapy in the lede and in the history section

Conversion therapy, or the "theraputic approach", as it was called, is not a safe or effective treatment for gender dysphoria. Including in the lede gives it undue weight, so I recommend we remove it per WP:NPOV.

Also, while there might be value in having a section on the history of gender dysphoria in children, if the entire section is going to be on conversion therapy, we should just call the section that. I saw that there was some unresolved prior discussion on this, so to avoid an edit war-by-proxy, I'm bringing it up here again instead of boldly editing.

And also I'm including this here too because it's about this topic so any edits should be coordinated, there seems to be a page structure issue in the Society and culture section -it seems that this was either supposed to be a heading 3 under History, or for some reason the entire section is dedicated to what one person seems to think on the issue, which again raises undue weight concerns. I recommend restructuring or removing that section. Egefeyzi (talk) 01:46, 3 March 2023 (UTC)

Seeing no objections for a while, I'm boldly editing the page Egefeyzi (talk) 19:29, 21 March 2023 (UTC)

Hrm. The previous version probably gave it undue weight (and especially had too much WP:PROFRINGE stuff defending it) but I do think it might be worth at least a brief mention in the lead, at least to note that it is broadly rejected. --Aquillion (talk) 06:13, 22 March 2023 (UTC)

Are all therapeutic approaches tantamount to conversion therapy? 81.79.156.133 (talk) 13:05, 14 April 2023 (UTC)

References

Internal Inconsistencies / Dishonest Framing in "Persistence"

Apologies for any missteps, infrequent editor and first-time commenter.

I've seen the "Persistence" body used in full or part on another page before, and while I can't recall it precisely, prolific editor @Crossroads raised multiple valid objections and then the page was still changed to match this topic body after seeming consensus against it. Seeing it here again, I felt compelled to leave a comment, but I recognized @TheTranarchist from their exchanges with Crossroads, and I'm not looking to start any fights. I understand the policy of assumption of good faith, but I hope that given the issue I am raising, it is acceptable to politely share my impression of the edit wars and relevant actors. Although I suppose from reading her about me, she is happily combative, which I know is necessary at times. I leave the above "their" in place as a show of good faith: I went to read your page after I decided to tag you and Crossroads, I learned your pronouns in the process, and - as anyone should - I instantly began to use them.

To preface everything, I think it is important to acknowledge the implicit validity in transitioning and trans people in general. And, unrelated, it is relevant to this topic that sensitivity around the evidenced reality that many youth (group in question) have for years demonstrated the possibility (and, as cited in text, propensity) to desist in their feelings of gender incongruence / dysphoria / etc.

The "Persistence" body proceeds as follows:

1. An out of context (with the rest of the body) quote suggesting gender is "stable" by age four.

2. A paragraph-opening sentence, quoted verbatim: "If gender dysphoria persists during puberty, it is very likely permanent." - note this already calls into question the first paragraph; clearly, if one's gender and feelings around and from it continues to change even around puberty, trying to set up a belief in a "stable sense of...gender" "by age four" is unreasonable.

3. Following 2. (same paragraph), the verbiage changes from "during puberty" to "through puberty", continuing the trend of revolving goalposts. Otherwise, the content here is of good quality, and I recognize and affirm the "intensity" and "are" versus "wish" points.

4. The next massive (separate problem) paragraph is most obvious through proportions, aside from the overt "(since debunked)" at the very start. Ignoring the disparate quality of the lower citations and single-author opinion pieces, this paragraph is 460 characters (including 8 citations) speaking to a few of the studies showing a high desistence rate followed by 1926 characters (including 4 citations, ~10% of the above) of unquoted apparent original research with only end-of-paragraph citations.

5. The next (final) paragraph is insultingly poor. Not only is it a bland rehash of the prior paragraph with original claims of "biased research" "disproving the results of the prior studies", the two citations are single-author borderline opinion pieces, and the one that is closest to credible is a "literature review", stylized at the start of the paragraph as a "systematic review of research."

I cannot be invested enough to fight this battle myself, and I think it would be ethically dubious to directly place text into the wiki as someone active in the field, but I implore the understandably-dedicated, understandably-polarized (subject of polarization, by the many opponents of trans rights) editors to reevaluate your own biases. Gender dysphoria is variable and multifactorial, to say the least. Acknowledging that neither invalidates nor undermines trans people or trans identities, and intellectual dishonesty not only hurts the greater cause and dissemination of knowledge, it is causing youth to bypass that critical self-understanding of "are" versus "wish" (referencing point 3, above). "If you, a youth, experience dysphoria, you are trans" - unqualified - is not true, and you must not lead people to that belief. "If you, a youth, experience a desire to be the opposite sex/gender, you are best served by transitioning" - unqualified - is not true, and you must not lead people to that belief. Sacrificing integrity to put on a stronger front for the public eye will backfire, and it is not a good way to be. Sadly, that is the state of a number of the ideological topics of this decade. It has become propaganda on both sides. 49.186.63.35 (talk) 09:35, 26 April 2023 (UTC)

You could start by chopping about 90% of that wall of text per WP:TLDR. Dronebogus (talk) 12:22, 26 April 2023 (UTC)

Much of it seems to be analyzing the content in the article, which obviously takes some length. What, if any, changes are merited I'll have to come back to. Crossroads ^-talk- 23:23, 28 April 2023 (UTC)

Yeah I'll have to agree the massive edit was not my best work, the article still has ways to go. The version before this one had major NPOV issues, but after stepping away from the article for a while and reading what you wrote, I agree it's still not great. I'll respond to your concerns piece by piece:

All the credible sources I've found seem to indicate that there is no propensity of youth to have their gender dysphoria resolve on its own without transitioning. To the contrary, it seems to get much worse very quickly. (See the sources in the article.) Can you cite credible and recent secondary/tertiary sources that disagree with that? I couldn't find any.

The persistence section was a mess of severely outdated information and that and a few other sections were focusing on a single researcher and their studies, which obviously raise major WP:NPOV and WP:PROFRINGE concerns. There was a paragraph or so at the very bottom talking about how the research was discredited. This, however, buries the ending in the details and makes it look like the studies are credible to a reader skimming the article. I tried to not blank the whole section but instead point out that the studies in question were not credible. In hindsight, bringing up a study just to debunk it is not good practice so I probably should have deleted that whole bit to avoid WP:FALSEBALANCE.

Regarding inconsistent use of language, feel free to fix copy editing mistakes without bringing them up here.

With regards to the final paragraph, I'm just going to ask you to read up on the current medical consensus regarding gender dysphoria and remind you that Wikipedia is not a forum, nor is it a platform for advocacy. No matter what your opinions on what we should be pushing children to do, our job here is to provide unbiased information from a neutral point of view. With all due respect, giving undue weight to a fringe point of view just because you want to achieve a certain social effect is not appropriate on Wikipedia.

So overall, I think we should edit the persistence section to remove the very long description of debunked studies (which is now an obvious conclusion but oh well lol) and instead focus on the up to date information from the APA/CPA/etc. Egefeyzi (talk) 06:13, 10 May 2023 (UTC)

Yeah, I don't think we should be bringing WP:FRINGE theories into these pages unless there is some strong reason that readers need to be aware of them. Since these are medical topics, we should generally follow the best mainstream sources, ideally from systematic reviews, etc., rather than trying to throw in every idea that has ever come up, and creating a sense of WP:FALSEBALANCE. Especially when the sources represent old theories that never gained mainstream acceptance. Hist9600 (talk) 16:30, 10 May 2023 (UTC)

Seems like there's a consensus to remove that part of the section, edited the article. Also cleaned up some direct quotes to improve flow. Egefeyzi (talk) 22:51, 3 June 2023 (UTC)

Without having looked at the article recently, and only having skimmed your comment for now, I think there are some good points and this section is likely in need of improvement. Hopefully I'll have time to take a look into it once I get home this evening. Equivamp - talk 10:34, 10 May 2023 (UTC)

Dubious sources on long term effects of puberty blockers

Of the three sources listed for the claim "Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited." one is a newspaper article, another disagrees with that claim, and the third one from "Annals of Pediatric Endocrinology & Metabolism" is misquoted. It explains that research is limited specifically for the use of puberty blockers on trans youth and that controlled studies aren't common because they are considered unpractical and unethical.

What the author is explaining here is that it's very difficult to see the effects of puberty blockers on trans youth by using the usual double blind placebo controlled studies, because they're already the standard of care. Giving a group of patients placebo instead of the actual standard of care would be unethical, so these studies aren't contucted in the usual manner, and not frequently. When they are, longitudinal studies are conducted instead. The limited data we have seems to indicate the somewhat obvious conclusion of puberty blockers being helpful at preventing trans children from having their gender dysphoria worsened.

Also it's important to know that puberty blockers have been used for a very long time to treat precocious puberty.

Overall, I don't like the sources cited for that claim, they don't support it. We should either find better sources or remove the claim entirely. Egefeyzi (talk) 23:30, 3 June 2023 (UTC)

I agree better sources should be found, but the claim is not completely unsupported. Specifically, I think reliable sources positively affirming the contrary should be provided if the research of long-term effects is not 'limited'. The Reuters article contains "Puberty blockers and sex hormones do not have U.S. Food and Drug Administration (FDA) approval for children’s gender care. No clinical trials have established their safety for such off-label use," which is clear enough in itself. --TadejM ^{my talk} 19:04, 27 June 2023 (UTC)-

If a source such as a newspaper article does not meet the criteria for WP:MEDRS, it probably is not reliable for establishing anything important for this subject. See in particular: WP:MEDPOP. Hist9600 (talk) 19:22, 27 June 2023 (UTC)

In my opinion, this goes along with "As the quality of press coverage of medicine ranges from excellent to irresponsible, use common sense, and see how well the source fits the verifiability policy and general reliable sources guidelines." Specifically, there are two crucial claims that are easy to verify. --TadejM ^{my talk} 19:34, 27 June 2023 (UTC)

I believe the interpretation of the Reuters article regarding the lack of FDA approval is a classic example of a statement that is (presumably) true but does provide any information about the question at hand, in this case, whether puberty blockers are safe for trans youth. Lack of FDA approval due to lack of clinical trials itself is clearly not the same as "it is unsafe" or "nothing is known about its safety".

I agree with Hist9600 and Egefeyzi that we clearly need sources that meet WP:MEDRS. For example, doi:10.1111/camh.12437 is a recent review already cited in the article and concludes that "[a]lthough large long-term studies with diverse and multicultural populations have not been done, the evidence to date supports the finding of few serious adverse outcomes and several potential positive outcomes."--TempusTacet (talk) 19:55, 27 June 2023 (UTC)

If it was a matter of citing well-known easily-verifiable facts, then it might not be an issue. But since this is a controversial topic, and people should be able to verify any and all details, I don't find one or two sentences in a news article to be sufficient. Better sources should be used that summarize the latest findings. From WP:MEDRS: Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies. Hist9600 (talk) 19:57, 27 June 2023 (UTC)

Ok, but the question at hand is not whether they are safe but whether the research is limited as this is what the statement in the article claims. The provided source corroborates the opinion of Reuters in this regard: "long-term studies with diverse and multicultural populations have not been done". --TadejM ^{my talk} 20:01, 27 June 2023 (UTC)

Yes. There is not necessarily a contradiction but WP:MEDRS-compatible sources should take precedence & the phrasing in the article should not imply that a lack of studies means that there is a lack of safety or a significant level of uncertainty regarding safety.--TempusTacet (talk) 20:11, 27 June 2023 (UTC)

Exactly, pharma companies don't reapply for FDA approval for a new area their medications can be used in is discovered. It's an extremely expensive process that they have no reason to repeat when they're already allowed to sell the medication in the US.

We do already know GnRH agonists safely and effectively block puberty, since they've been used for precocious puberty for ages now (see article for details/sources.) Any studies in their use for GD would focus on effectiveness in psychiatric concerns, not safety. Egefeyzi (talk) 23:12, 28 June 2023 (UTC)

As long-term research is lacking, the question of the long-term safety of puberty blockers, particularly regarding bone health and psychosocial health, remains open.[1] There may also be unknown long-term adverse effects. As stated: "Lack of information about long-term effects of GnRHa use was not considered an important problem by interviewed adolescents with gender dysphoria in the study by Vrouenraets, Fredriks, Hannema, Cohen-Kettenis, and de Vries (2016), but is seen as a major problem by many professionals (Vrouenraets et al., 2015)." [2] --TadejM ^{my talk} 17:38, 30 June 2023 (UTC)

I would argue that psychosocial health is not a safety concern but rather a question of treatment effectiveness. I still think that the review by Rew et al. doi:10.1111/camh.12437 (published in 2021) is a good, recent source that comes to more concrete conclusions than doi:10.1111/apa.1679 who are mostly concerned with methodological problems. I didn't have the time yet to compare the two in detail but I'd assume a significant overlap in the studies considered in the two analyses. I also came across doi:10.1111/camh.12533, which is a commentary on the 2021 Rew et al. paper sponsored by the "Society for Evidence-Based Gender Medicine" that one could consider the anti-PB voice in the debate. Puberty_blocker#Medical_uses contains a relatively comprehensive review of the recent literature that one could draw from and/or link to.

In general I believe that the discussion around long-term safety is a bit of a red herring. Considering the poor mental health outcomes in children with GD concerns over effects on bone density are surely valid but small in comparison to eg Combined_oral_contraceptive_pill#Side_effects.--TempusTacet (talk) 21:11, 30 June 2023 (UTC)

I would disagree with you and recent research confirms my earlier stance.[3][4][5] --TadejM ^{my talk} 14:51, 6 March 2024 (UTC)

I agree with your point, but I think more importantly, discussions of the evidence base of puberty blockers belongs on the puberty blocker page. This page is already too long and I would support removing this section. HenrikHolen (talk) 19:46, 29 September 2024 (UTC)

References