Talk:Gender dysphoria in children/Archive 2

Archive 1

Archive 2

Archive 3

Why are all changes being reverted?

Hello FlyerReborn22,

First, thanks for your earlier welcome and pointing to resources.

Why are all of my changes being reverted? There is no clear challenge and many of the studies meet the medical standard. Some that are being used to replace them are old and single study, so confused. Would you please clarify? It would help to have a clear view of what is being disputed. I apologise for any ignorance; I am not a regular editor and have much to learn (but do wish to).

Thanks,

Cedarparrot. — Preceding unsigned comment added by Cedarparrot (talk • contribs)

Hey Cedarparrot, I'd like to also extend you a welcome to Wikipedia! Feel free to message me if you have any problems or questions.

I haven't looked at your changes thoroughly yet, but I did think some of them were good. The article currently does seem to be a little POV-pushy (or perhaps just out of date). It seems to be presenting a false balance between the fringe view that conversion therapy (or whatever you want to call it) is helpful for trans and gender-nonconforming children, and the current mainstream view that such therapy isn't helpful. I appreciate your attempt to help correct that imbalance.

However, some of your changes were less good, for example, you accidentally changed a direct quote (any wording in <blockquote> tags is likely a quote that shouldn't be modified.)

In any case, best to avoid a back-and-forth edit wars. (Please especially keep in mind the rule that you're not supposed to revert more than 3 times in a 24 hour period.) WanderingWanda (talk) 04:34, 27 September 2019 (UTC)

I can't speak for Flyer22 Reborn, but I reverted your reversion here because there are several problems mixed in, so I had to revert the whole thing. Also, because you were edit warring; generally you should follow WP:BRD.

(1) You drastically altered the meaning of the paragraph starting with, "Gender dysphoria in children is more heavily linked with adult homosexuality than adult transsexualism." It was based on two excellent sources according to WP:MEDRS. You then added content arguing against the conclusions of those sources, citing twice the "International Journal of Transgenderism, Volume 19, 2018 - Issue 2". Putting aside that this was improperly formatted, it fails to say what article said this. But looking at that issue, [1] I'm not seeing anything that could supersede the existing sources.

(2) You changed quotes (paragraphs where the diff says "blockquote").

(3) You brought back the inaccurate two-spirit material that CorbieVreccan had justly removed. [2]

(4) Edit warring = no.

I didn't examine all your changes, so there could be other issues; but I think the points I've made justify the revert.

Lastly, on talk pages, please sign with four tildes (~), that creates a proper signature with timestamp. -Crossroads- (talk) 04:57, 27 September 2019 (UTC)

Hi, Cedarparrot. In addition to what I stated when reverting you and on your talk page, Crossroads1 explained issues with your edits.

Crossroads1, thanks for taking the time to explain.

Any mention of "fringe" in the article will need a WP:MEDRS-compliant source unless it's an argument in the "Society and culture" section. But it might even be contested there.

With this edit (followup edits here, here, and here), I updated the article with WP:MEDRS-compliant sources and rearranged the layout per MOS:MED. I also made a few cuts. And like I noted in my edit summary, yes, the debate only fits in the "Society and culture" section, where requirement for WP:MEDRS-compliant sources is relaxed. It does not belong in the "Management" or "Treatment" section (whichever title one wants to use). I left a bit there about objection to treatment for changing one's gender identity in the "Management" section, but the vast majority of it is debate material; so I moved it to the "Society and culture" section. Also, not all therapeutic interventions for gender dysphoria in children involve aiming to alter a child's gender identity. The older approach does, but the newer approach is focused on creating a supportive and safe environment for the child to explore their gender identity and gender expression. And so I made that clear in the article. Flyer22 Reborn (talk) 15:58, 27 September 2019 (UTC)

With this edit, I re-added the "2017 Endocrine Society guidelines" aspect, but I quoted what it states for accuracy. As seen in the source, the organization still emphasizes/prefers age 16. Flyer22 Reborn (talk) 02:38, 29 September 2019 (UTC)

Management - Time for a restructure?

It stands out to me that sections titled things like "opposing", "other", and "alternative" contain "The consensus of the World Professional Association for Transgender Health". If the views described therein are now mainstream, sections should be retitled at least. We might also want to consider switching from away from a historical ordering in the Management section, to give more focus to current practices rather than history. CyreJ (talk) 10:48, 13 May 2020 (UTC)

This is what the section currently looks like. It seems you are suggesting to have the "Traditional therapeutic intervention approaches" section come after the "Opposing views and other therapeutic approaches" section, and this is because of the consensus of the World Professional Association for Transgender Health (WPATH). But the World Professional Association for Transgender Health isn't the only authoritative source on this topic. For this topic, we also obviously consider the DSM-5 and ICD-10/ICD-11. And we have to consider what the general literature, especially the secondary and tertiary aspect of sources, state. Before we relay anything as outdated, fringe, mainstream, or the majority view, we have to have WP:MEDRS-compliant sources stating that. We can't deem it so ourselves because of the consensus view from WPATH. I understand placing the more common approach first, but, in my opinion, the section does flow better addressing the traditional approach first and then the other therapeutic approaches since the latter section criticizes the traditional approach. We could change the "Opposing views and other therapeutic approaches" heading to simply "Other therapeutic approaches." We could also rename it something else (for example, a name that presents it as the current standard) if supported by WP:MEDRS-compliant sources. Or we could merge the content (both sections) under one heading and have that section detail what was previously the most common approach and what is now the most common approach, as long as such descriptions are supported by WP:MEDRS-compliant sources. But I'm not sure that setup would be best for readers. I still feel that the "Puberty blockers, hormone treatment, and surgery" subsection should come last, though. Flyer22 Frozen (talk) 22:12, 13 May 2020 (UTC)

I do not firmly suggest moving material based solely on the statement about WPATH - if I thought that was the case, I'd do it rather than starting talk page discussions. There may or may not be reason to change the structure of the section based on the state of literature at this time - I will attempt to survey sources when I have time and I suggested others consider it.

On looking at it again the Management section seems incomplete. A management section should certainly make clear to the reader what is currently the recommended (of medical sources and guidelines) and/or common current practice, and the information is not clearly included. My guess is that it will be neither the "traditional" approach outlined in the first section nor the complete rejection indicated by the second section but some intermediate approach. I completely agree that more material is needed, before deciding what to highlight as consensus. Is there some survey of current recommendations and practices out there?

On the minor point of the best ordering for readability I would favor putting the most relevant, current, and authoritative information first, with historical development and criticism later, at the cost of historical narrative flow. CyreJ (talk) 12:58, 15 May 2020 (UTC)

I appreciate you further explaining your views. As for what's out there, like some other topics, I'm thoroughly familiar with the literature on this topic and I'm not exactly seeing how the Management section is incomplete. It addresses all of the big points. If any necessary material is missing, I'm certainly open to it being included. Of course, more detail on what is there can be added. Sometimes a summary, although addressing all of the big points, doesn't provide as much detail as it should. So I'm certainly not stating that the section is perfect. Quoting a random psychiatrist and psychologist is not my idea of perfect. Per what I stated above, I obviously agree that "A management section should certainly make clear to the reader what is currently the recommended (of medical sources and guidelines) and/or common current practice." But like I stated, we need to go by what WP:MEDRS-compliant sources state on that. Yes, WPATH is a WP:MEDRS-compliant source, but it's one organization and its position is made clear in the section. I'm not aware of a survey of current recommendations and practices, but, like you, I can look at more of the literature. I also often have access to medical sources that others don't have access to.

With regard to article setup, and moving material based solely on the statement about WPATH, it's sometimes the case that editors feel that WPATH's statements on transgender issues trump all others. And I could see an editor querying about the matter on the talk page instead of making an edit that prioritizes WPATH. I see that you took my suggestion and shortened the "Opposing views and other therapeutic approaches" heading to "Other therapeutic approaches." In some people's view, the topic of puberty blockers, hormone treatment, and surgery are also therapeutic. So I could see a valid argument to merge the "puberty blockers, hormone treatment, and surgery" material with the "other therapeutic approaches" material. Still, the first two sections are about psychiatric/psychological approaches and the "puberty blockers, hormone treatment, and surgery" material is about the physical. So I still think it's best to keep the material about physical changes in its own section. We could alter the "Traditional therapeutic intervention approaches" heading to "Psychiatric" or "Psychological" and have all of the psychiatric/psychological content in the that section. The "Puberty blockers, hormone treatment, and surgery" section could simply be titled "Physical." We could also change "Traditional therapeutic intervention approaches" to "Traditional psychiatric approaches" or "Traditional psychological approaches", but then what would "Other therapeutic approaches" be titled? "Other psychiatric approaches" or "Other psychological approaches"? Out of these latest suggestions, going with a "Psychiatric" or "Psychological" heading and a "Physical" heading seems best to me.

And since I've spoken about going by what sources state when it comes to titling things, my choice of "traditional" maybe shouldn't be used. After changing the setup so that the psychiatric/psychological material is under a simple "Psychiatric" or "Psychological" heading, we'd then have to decide what to lead with in that section. If it's a matter of the traditional approaches still being practiced in some parts of the world, I still think it's best to lead with the traditional therapeutic intervention material. If it's a matter of the traditional approaches only being a past matter, then the Management section doesn't need to mention this route at all. It can be left to the "Society and culture" section (along with the criticism). I'm sticking with the "Management" heading per WP:MEDSECTIONS. With regard to the "History" section, I think it fits best as a subsection within "Society and culture"...like it currently is. Whatever alternative setup we go with for the Management section, I feel that it's ideal that we work it out on the talk page first. Flyer22 Frozen (talk) 00:36, 16 May 2020 (UTC)

Revisiting Improper Synthesis in Lede

I reiterate my request to change the sentence "Gender identity disorder in children is more heavily linked with adult homosexuality than adult transsexualism" to "Gender identity in children is strongly linked with both adult homosexuality and adult transsexualism" in the second paragraph of this article.

Interested Wikipedians may catch up on this issue, which was previously discussed in 2015, at Talk:Gender dysphoria in children/Archive 1#Improper Synthesis in Lead. I am initiating the dispute resolution process by requesting a third opinion. --April Arcus (talk) 23:04, 7 July 2020 (UTC)

April Arcus, that is not WP:Synthesis. It's just a topic sentence summary to preface the fact that several prospective studies indicate that the majority of children diagnosed with gender dysphoria cease to desire to be the other sex by puberty, with most growing up to identify as gay, lesbian, or bisexual. As the archived discussion you linked to shows, we've been over this. It's what the sources state (yes, explicitly state) or otherwise indicate by telling us that most of these prepubescent children (unlike the pubertal/adolescent children) with gender dysphoria are not transgender and are instead cisgender gay, lesbian or bisexual people.

Years ago, you complained about Green's studies. But like neuroscientist Simon LeVay states in his "Gay, Straight, and the Reason Why: The Science of Sexual Orientation book, page 91, "Several prospective studies, mostly less ambitious than Green's, have reached similar conclusions: Marked femininity in boys is a predictor of adult homosexuality. Perhaps counter to expectations, only a few feminine boys in these studies developed into transsexual adults. It should be borne in mind, however, that transsexuality is very much less common than homosexuality; thus, even if male-to-female transexuals have a history of marked childhood femininity -- and many do -- a small sample of feminine boys may not include any future transexuals." There are reviews with updated material, including further research, essentially stating the same thing or similarly. This 2010 "Lesbian, Gay, Bisexual, Trans and Queer Psychology: An Introduction" source, from Cambridge University Press, page 151, states, "Gender Identity Disorder (GID) of childhood is believed to be more strongly associated with homosexuality than with trans in adulthood (deVries et al., 2007)." That stated, the source does on go about assumptions. This 2016 updated version of "The Medical Basis of Psychiatry" source, from Springer Publishing, page 302, states, "It is important to note that the majority of children who present with gender dysphoria do not go on to be transgendered adults [...] Gender dysphoria in boys is more closely tied to later homosexuality than to the development of adult transsexualism." It's not just boys, though, the same applies to girls (though at different rates).

I would think you meant "Gender identity disorder in children" instead of "Gender identity in children" for your proposed sentence. Otherwise, it would appear that you are stating that having a gender identity is a weak thing with regard to cisgender, non-LGBT children. I doubt you have sources for that. And either way, we are using "gender dysphoria in children" and "an adult transgender identity" now. And what sources do you have for "strongly linked with adult transsexualism"? The literature shows and explicitly states differently.

I'm going to read the latest reviews on gender dysphoria in children, but I am not going to thoroughly debate the above with you again. Flyer22 Frozen (talk) 03:19, 8 July 2020 (UTC)

Response to third opinion request:

I have taken a third opinion request for this page and am currently reviewing the issues.Jack Frost (talk) 13:10, 8 July 2020 (UTC)

Sorry to butt in, I responded to the WP:3O request by reviewing the page and the various discussions. As a result I have removed the sentence under discussion, as being ill-expressed and, in view of the next sentence, redundant. I feel that the article is better without it. I hope this helps. I'll butt out now. Richard Keatinge (talk) 16:53, 8 July 2020 (UTC)

And reverted per what I stated above with academic sources. There is nothing at ill-expressed or redundant about it. It clearly lets readers know that gender dysphoria in children is more heavily linked with adult homosexuality than an adult transgender identity. It then goes on to explain why. Flyer22 Frozen (talk) 21:56, 8 July 2020 (UTC)

Further, the listing you butted in on, subsequently resulting in its removal from WP:Third opinion, is about "whether sources are sufficient to support a claim that gender dysphoria is 'more strongly' linked to adult homosexuality than to adult transsexualism." Per the sources I listed above (and others), the sources are obviously sufficient. Yet you didn't base your removal on the matter of WP:Verifiability and WP:Due weight. You based it on your personal opinion. And keep in mind that WP:Third opinion is supposed to simply be about offering a third opinion, not taking it upon yourself to remove the piece. Jack Frost should have been allowed to review the matter without interference. Either way, now I will source that line. Flyer22 Frozen (talk) 22:08, 8 July 2020 (UTC)

I crossed out part of my above post because Jack Frost had removed the WP:Third opinion listing before Richard Keatinge weighed in. He removed it due to the fact that he took on the listing. Anyway, I sourced this aspect in the lead, with an added emphasis on boys per the sources. I also expanded material on what is seen in that paragraph lower in the article. Followup edit here. Flyer22 Frozen (talk) 03:48, 9 July 2020 (UTC)

And a followup note is here. Flyer22 Frozen (talk) 03:55, 9 July 2020 (UTC)

I removed it based on the fact that it is a vague comment which expresses, badly, the much better formulation that immediately follows. In the present context, "more strongly linked" could mean a variety of things, and this vagueness may be relevant to the disagreement between yourself and April Arcus. The following bit makes clear exactly what it actually does mean. The bit I removed is redundant and its inclusion makes the article worse. The problem isn't sourcing, the problem is poor writing. Removing it makes the lede much clearer and saves you the trouble of sourcing it, thus freeing all of us to improve the encyclopedia in other ways. This became obvious to me as I looked at the issue, so I made the necessary edit. Jack Frost and indeed all other editors are of course still welcome to take part. Richard Keatinge (talk) 07:08, 9 July 2020 (UTC)

There is nothing at all vague about the first sentence of the second paragraph. And it is not redundant since transgender identity and gender dysphoria are not the same thing. It cleanly and clearly spells out a fact: Gender dysphoria in children is more heavily linked with adult homosexuality than an adult transgender identity, especially with regard to boys. It then gets into a bit of detail after that. Topic sentence stuff like this is common practice on Wikipedia. And with the "especially for boys" piece, the first sentence is even less redundant. Yeah, one would think that a person should be able to deduce that gender dysphoria in children is more heavily linked to adult homosexuality than to an adult transgender identity by reading "The majority of children" part. But history on this site with regard to not spelling things out for readers, especially on the topic of sexuality or gender, tells me otherwise. What is at the heart of the disagreement between myself and April Arcus is shown in the linked discussion from years ago. Flyer22 Frozen (talk) 07:46, 9 July 2020 (UTC)

It may take more than three opinions to solve this problem. Let's see who turns up to help. Richard Keatinge (talk) 07:55, 9 July 2020 (UTC)

In case anyone does turn up, the (or a) current issue is whether to include the comment "Gender dysphoria in children is more heavily linked with adult homosexuality than an adult transgender identity." This sentence could mean a variety of things. It actually means that most children with gender dysphoria become homosexual as adults, but most of them do not experience a transgender identity as adults; the next sentence says it clearly. "Heavily linked" could refer to something about the underlying psychological mechanisms, something about media comment, something about upbringing in families with a gay parent, even something about genetics - but it doesn't. It is a poor piece of writing, unsuitable for an encyclopedia and especially unsuitable for the lede, and the article is much better without it. Richard Keatinge (talk) 08:19, 9 July 2020 (UTC)

My apologies for the delay. I note there are now more than the two original parties, so please take this as me sticking my two penneth in, rather than as a response to the request for a Third Opinion. As I understand it, the current question is whether the sentence removed in this edit should be included in the lead. My view is that this sentence is well sourced; all three of the sources are reliable and directly support the statement. In terms of the lead, WP:MOSLEAD states, in part; The lead… gives the basics in a nutshell and cultivates interest in reading on... It should be written in a clear, accessible style with a neutral point of view. The sentence is interesting, adds context for the reader, and is covered further in the article; hence I think that its’ inclusion in the lead is not unreasonable. In terms of phrasing; the current wording is quite acceptable. Although I do empathise with Richard Keatinge's view that “…heavily linked…” seems a little vague, although this certainly should not preclude inclusion in its' current form (and I am stuffed if I can think of how to improve it right at the moment). In summary; (1) keep the sentence, (2) keep it in the lead, (3) consider a rephrase (although I do not believe by any stretch that this is a must). I hope that this is helpful. --Jack Frost (talk) 11:28, 9 July 2020 (UTC)

I'd also like to apologize to Jack Frost for cutting across the 3O process - I spent some time reviewing the issue, felt at the end that a simple edit should solve the problem, did it, then went over to 3O to take the case and only then noticed that you'd done so. One more comment before I take this page off my watchlist: the sentence at issue is already rephrased, much more clearly, in the very next sentence. If we have a consensus to keep it, that's fine, as you say it's sourced and there's no policy saying that we can't. But it is a poorly-phrased repetition of a much better sentence. Removing it still strikes me as the best way to improve the article. OK, I'll take this off my watchlist now. Richard Keatinge (talk) 12:13, 9 July 2020 (UTC)

Richard Keatinge, I do appreciate you trying to help. That stated, I don't think that anyone is going to ponder those other things you threw out there, especially with what follows that line. Not to mention that Wikipedia is not like other encyclopedias. Repeating the notion that the sentence is poor and unworthy of mention in an encyclopedia makes me think of the academics who use similar wording. It's like calling the academics' writing poor since a number of them do the same thing -- present the "gender dysphoria in children is more heavily linked to adult homosexuality than an adult transgender identity" aspect before or after stating that most prepubescent children with gender dysphoria cease wanting to be the other sex with the initiation of puberty and grow up to identify as gay or lesbian (or sometimes bisexual). Why would academics do this if it's a poor approach? Why does the aforementioned "The Medical Basis of Psychiatry" source tell us that "gender dysphoria in boys is more closely tied to later homosexuality than to the development of adult transsexualism" after telling us that the majority of children who present with gender dysphoria do not go on to be transgender as adults and research indicates that they will be same-sex attracted? Clearly, the part specifically about boys is not redundant. So that's why they state it. How do you suggest we relay the part about boys if that sentence is removed from the lead and lower in the article? As for "heavily linked", we could use "more closely tied to", like the "The Medical Basis of Psychiatry" source does, or is "more strongly correlated with." I also notice that "The Medical Basis of Psychiatry" source uses the word "development of", but we don't want to imply that a transgender person's identity is simply something they developed. And it's best to avoid use of the term "transsexualism", which some trans people consider offensive. "Transsexuality" is a little better and is currently used in our Causes of transsexuality title, but some trans people object to that term as well. So I went with "transgender identity." All in all, I will change "with" to "to." But I'm satisfied with the current wording and think that it's best. Flyer22 Frozen (talk) 21:45, 9 July 2020 (UTC)

Hey the link for source 9 is dead

Source is straight up a dead link. Can someone provide a link to a way back machine for that source or remove the source entirely. — Preceding unsigned comment added by CycoMa (talk • contribs) 04:30, 7 September 2020 (UTC)

The reference gives this archived link. Flyer22 Frozen (talk) 06:35, 7 September 2020 (UTC)

Prospective outcomes

@Flyer22 Frozen: How is my content about the persistence of gender dysphoria from childhood into adolescence not related to gender dysphoria in children, but somehow the entire rest of the "Prospective outcomes" section is? Understanding how often and why gender dysphoria persists from childhood through puberty (or doesn't persist) is a very important piece of information for parents trying to understand the condition, as it affects the decision whether or not to put children on puberty-blockers. The content I added is even sourced from a review article titled "Gender dysphoria in childhood" for Pete sake. I don't understand how you can argue it isn't relevant for the article. It follows quite logically from the preceding sentences, which are also about the persistence of childhood gender dysphoria (as that's the topic of the entire section). Kaldari (talk) 04:31, 2 December 2020 (UTC)

No need to ping me to a talk page I am obviously watching.

First thing's first: It makes no sense that you would remove the Gregor et al. piece about prevalence and then add this piece about prevalence. As seen with this edit I made, the prevalence material obviously fits together. And after this and this, it now unnecessarily has its own section.

As for this piece you added about "factors that are associated with gender dysphoria persisting beyond childhood"? Your text did not make it clear that it was about moving into adolescence. What you added applies to adolescence and adulthood. Furthermore, the topic of gender dysphoria in children extends to adolescence as well, as is clear by the "Puberty blockers, hormone treatment, and surgery" section. If you change the "factors that are associated with gender dysphoria persisting beyond childhood" text you added so that it is clearly speaking in terms of adolescence, I won't object to its addition. Feel free to re-add it. The line stating that "Prospective studies indicate that this is the case for 60 to 80% of those who have entered adolescence; puberty alleviates their gender dysphoria." that is already in the "Prospective outcomes" section is obviously there because it gives important context regarding "the majority of children diagnosed with gender dysphoria cease to desire to be the other sex by puberty, with most growing up to identify as gay, lesbian, or bisexual" aspect. It is obvious why the entire "Prospective outcomes" section is relevant to this article. As for the content you added being from a review? Yeah, I know. The source was already in the article. I'd read it months ago. Flyer22 Frozen (talk) 05:03, 2 December 2020 (UTC)

Actually, it was a re-read since I'd read it years ago. Flyer22 Frozen (talk) 05:09, 2 December 2020 (UTC)

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Requested Evidence

Tagging user:Crossroads

Since you requested evidence of this being professional consensus, here is such evidence, grouped by topic. I'll state in advance that because WPATH is in the process of rewriting their guidelines on trans health, with a planned release of this summer, I have excluded them for the time being. Let us begin:

Suicidality

American Medical Association:

"Studies also demonstrate dramatic reductions in suicide attempts, as well as decreased rates of depression and anxiety.3 Other studies show that a majority of patients report improved mental health and function after receipt of gender-affirming care." https://www.ama-assn.org/press-center/press-releases/ama-states-stop-interfering-health-care-transgender-children

American Association of Pediatrics:

"For young people who identify as transgender, studies show that gender-affirming care can reduce emotional distress, improve their sense of well-being and reduce the risk of suicide."

https://www.aap.org/en/news-room/news-releases/aap/2022/aap-texas-pediatric-society-oppose-actions-in-texas-threatening-health-of-transgender-youth/

American Psychiatric Association:

"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."

https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf

Stability of Childhood Gender Identity

American Association of Pediatrics:

"Accordingly, research substantiates that children who are prepubertal and assert an identity of TGD know their gender as clearly and as consistently as their developmentally equivalent peers who identify as cisgender and benefit from the same level of social acceptance"

https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for

"By age four: Most children have a stable sense of their gender identity."

https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Identity-and-Gender-Confusion-In-Children.aspx

American Psychological Association:

"WHEREAS many children and adolescents are aware of their diverse attractions and sexual behaviors, or of their identities by childhood and early adolescence"

"WHEREAS a person's gender identity develops in early childhood and some children and adolescents may not identify with their assigned sex at birth"

https://www.apa.org/pi/lgbt/resources/policy/gender-diverse-children

Medically Recommended Methods of Resolving Dysphoria

World Medical Association:

"Evidence suggests that treatment with sex hormones or surgical interventions can be beneficial to people with pronounced and long-lasting gender dysphoria who seek gender transition."

https://www.wma.net/policies-post/wma-statement-on-transgender-people/

Endocrine Society:

"Gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen that will suppress the body’s sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of sex steroids within the normal range for the person’s affirmed gender."

"We suggest that adolescents who meet diagnostic criteria for GD/gender incongruence, fulfill criteria for treatment, and are requesting treatment should initially undergo treatment to suppress pubertal development."

https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence#2

Pediatric Endocrine Society:

"Transitioning has been associated with positive health outcomes by reducing gender dysphoria."

https://pedsendo.org/patient-resource/transgender-care/

Need I go on? Because I have reams more of this stuff.

Snokalok (talk) 18:58, 13 June 2022 (UTC)

Tagging [[user:Stathin]] Too Snokalok (talk) 19:01, 13 June 2022 (UTC)

Tagging user:Stathin Hopefully that works this time.

user:Newimpartial

user:Sideswipe9th

user:TheTranarchist Snokalok (talk) 19:04, 13 June 2022 (UTC)

Just for the record, these are a decent representation of the sources I was referring to in my edit summaries and on Talk. As noted, however, it might be (procedurally) necessary to leave the section out until we can reach rough consensus on its content. Newimpartial (talk) 19:14, 13 June 2022 (UTC)

In accordance with the section on stability of identity, I think we should delete the "adult homosexual outcome" sections Snokalok (talk) 19:17, 13 June 2022 (UTC)

I think what TheTranarchist has done is good enough for now. It is in accordance with WP:DUE and stays true to the spirit of WP:MEDRS and what has been said at WP:MED about the research and how to report on it while respecting Wikipedia's policies. If we are to develop text further, I think we should do it on this talk page after forming consensus. Suggestions from TheTranarchist and Crossroads might yield decent results, as they seem quite level-headed on towing the line between reporting older and newer research. Others have mentioned the transition phase of the research and how to report on it in accordance with WP:MEDRS. Stathin (talk) 20:15, 13 June 2022 (UTC)

The fact is, the old research - and in particular, any thing citing Zucker - rely on thoroughly discredited studies that are against current field consensus. Thus, it doesn't matter if they're in a secondary source. The field has moved past their ideas, and there are high quality primaries available which support this new consensus. At this point, citing Zucker or reviews which base their conclusions on Zucker would be akin to citing Wakefield in an article about vaccines. It's medical misinformation. Snokalok (talk) 20:24, 13 June 2022 (UTC)

While I fully concur that Zucker's ideas are medical misinformation, my guiding philosophy on this is that the misinformation has been spread so far and wide it warrants mention since we need to factually present and discredit it. Ignoring them allows proponents to try claiming we're silencing them and covering the truth. Factually analyzing and critiquing them allows people to understand how they've been misapplied and leveraged. Of course, we should write about it in a NPOV way but that means clearly siding with science and transgender rights and presenting the discredited ideas as fringe as opposed to reversing it and giving them undue weight. TheTranarchist ⚧ Ⓐ (talk) 20:37, 13 June 2022 (UTC)

An understandable take, and I think in that case we should change the way they're introduced - by not putting them in the summary, and by clearly stating them as discredited misinformation instead of "prospective studies" or as just fact. Snokalok (talk) 20:38, 13 June 2022 (UTC)

For the record, TT, I agree with this approach. However, as long as editors continue to insist that "discredited" ideas are still, well, credited, I think it is sometimes better to say nothing than, for example, to include misinformation and then mitigate the "damage". Policy-minded editors then are forced to fight battles of attrition to retain the RS criticism within the article text, or to prevent less scrupulous editors from presenting old tertiary findings as statements of fact (both of which have been long-standing problems here and in the parent article). Newimpartial (talk) 20:43, 13 June 2022 (UTC)

Snokalok, I don't know if your pings were successful. A signature at first posting ensures successful pings, usually. You should probably ping everyone from the initial discussion about this above. While some have been at WP:MED, Mathglot, for example, hasn't commented since the initial discussion. As mentioned at WP:MED, we need strong sources for "consensus" and "discredited". SangdXurWan (talk). I have really red hair. 00:36, 14 June 2022 (UTC)

Yes, and another good comment from WP:MED: [3] It's not really Wikipedia's job to decide whether peer-reviewed review articles have pulled their data from discredited work. Also, MEDRS explicitly calls out Wikipedia editors' own "objections to the inclusion criteria" as something that we should not be relying on. If the research literature is wrong, then our goal is to be just as wrong as the research literature. Crossroads ^-talk- 04:27, 14 June 2022 (UTC)

Even that view should not be interpreted as supporting text that is more wrong than the research literature, which has been true of the section in question since it was added in mid-2020 (until this week). Newimpartial (talk)

Weak support for "the majority of children diagnosed with gender dysphoria cease to desire to be the other sex by puberty"

Hi there,

The leading trans youth researcher at Princeton, Kristina Olson, follows a prospective cohort of 300 self-identifying trans youth. She just published her most recent findings in the peer-reviewed journal Pediatrics here. Her main finding is that 94% of her cohort still identified as trans 5 years later.

This directly contradicts the title sentence in this topic.

Beyond that, the citations coming in support of that assertion in this page (2,3,4) are not citations of original research. The links lead to text books, which point to further papers that are not available in the links. Shouldn't such a strong assertion be supported by equally strong references?

Thoughts?

PS: I am new to Wikipedia editing, apologies if I'm missing a few etiquette points :-/ — Preceding unsigned comment added by Jbfrombkln (talk • contribs)

I skimmed through the article, and I would say go for it if you want to fix it yourself. I agree that it should have stronger references, but I didn't look too far into it. You would know more than I do right now about the citations. Additionally those text books would be outdated, they are from 2013 and 2014. Sign with ~~~~ to put in your signature, which will let others message you directly and put the date in. --Roundish ⋆tc) 20:21, 7 May 2022 (UTC)

A study vs. multiple reviews and sources a tier or two above WP:PRIMARY? Sorry, but Wikipedia doesn't endorse "citations of original research". It even has a WP:Original research policy. The norm for sourcing information like this is the WP:MEDRS page. This same information is in the transgender youth and detransition articles with newer sources supporting it and critical comments on it. A few of those sources are also in this article, along with the critical comments. SangdXurWan (talk). I have really red hair. 01:59, 8 May 2022 (UTC)

@Jbfrombkln: as SangdXurWan said, WP:PRIMARY and especially WP:MEDRS apply here. Do not use the one study you found, regardless whether it contradicts the lead or not. For in-depth discussion about this, you could ask at WT:MED. And welcome to Wikipedia! Mathglot (talk) 09:15, 8 May 2022 (UTC)

I think it is safe to assume that the high desistance rates from the earlier studies are not going to be replicated in the future, and that the studies currently ongoing, with much tighter definitions and more appropriate methodologies, will continue to see much lower desistance rates. We just need MEDRS review articles to publish this conclusion I just made before it can be included in wikivoice.

I would point out, though, Mathglot, that WP:MEDPRI does allow the inclusion of primary research in articles, and gives guidance on the same - If conclusions are worth mentioning (such as large randomized clinical trials with surprising results), they should be described appropriately as from a single study: - and then gives an example of how to attribute such findings. It seems to me that the much lower desistence rates being found in the high-quality studies currently ongoing in the US, Canada and elsewhere are very much analogous to large randomized clinical trials with surprising results and are therefore potentially DUE for attributed inclusion as MEDPRI allows. Newimpartial (talk) 10:59, 8 May 2022 (UTC)

I think it is safe to assume that the high desistance rates from the earlier studies are not going to be replicated in the future - no, assumptions either way are not safe. We want to wait for new WP:MEDRS secondary sources first - we cite reviews, we don't write them. This isn't the same thing as a large RCT either. Crossroads ^-talk- 20:19, 8 May 2022 (UTC)

I dunno @Crossroads:. Per the concurrent discussion at Talk:Detransition#"As gender-nonconforming children without gender dysphoria were included in studies", we do now have multiple papers showing a huge disparity between the older studies and the new. The older papers show a desistance rate between 61-98%, whereas all of the newer ones show it between 0.09-6.9%. This new paper by Olson does not seem out of the ordinary compared to other contemporary literature on this topic. Now while you are correct in saying that we don't write the reviews, I do believe we are now in the safe to assume that any upcoming reviews will make note of this huge disparity between the older and current literature.

Also in lieu of an upcoming review paper, @Newimpartial: is correct in that we can include papers, such as those by Olson, Davies et al*, Clarke & Spiliadis*, and Hall* here, as they do represent contemporary research and the reported rates are definitely noteworthy due to their significant departure from older literature on this topic.

*See Detransition#Occurrence for the citations. Sideswipe9th (talk) 19:05, 9 May 2022 (UTC)

It appears Jdbrook added much of the content about this at the detransition page. The editor also added related content to additional articles. They seem to have a good understanding of the research, and could probably be helpful here. I agree with others to do what WP:MEDRS says and to rely on reviews rather than the primary research findings. Thinnyshivers (talk) 19:39, 9 May 2022 (UTC)

Do you want to do what WP:MEDRS says or to rely on reviews rather than the primary research findings? MEDRS does not necessarily mandate us to ignore primary research findings. Newimpartial (talk) 19:45, 9 May 2022 (UTC)

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. Primary sources should generally not be used for medical content, as such sources often include unreliable or preliminary information; for example, early lab results which don't hold in later clinical trials." (The page's emphasis.)

If the reviews we have reported much lower desistance rates, and it was primary research reporting much higher desistance rates-what we have now-would you be pushing for us to add those primary research findings? Would you, Sideswipe9th? Thinnyshivers (talk) 01:20, 10 May 2022 (UTC)

If we had more recent, higher-quality primary studies showing much higher desistence rates, of course I would favor inclusion. I am a philosophical realist, and Wikipedia articles should reflect known reality. MEDRS gives specific advice on how to approproately incorporate the results of primary studies (notably through in-text attribution, which certain editors seem to find very difficult to do, for some reason). Newimpartial (talk) 03:24, 10 May 2022 (UTC)

@Thinnyshivers: hi--thanks for the ping.

The different studies are studying different interventions (and have a few other differences).

1.Many of the earlier studies with the 61%-98% desistance rates (and the later analysis of one of the larger groups, where subthreshold and threshold gender dysphoria were tracked separately) did watchful waiting (no social transition).

(Not all of the I think 10 studies included in the review had absolutely no social transition, see below.)

2. There are also studies of young people put on puberty blockers, where one finds that most of those kids persist (e.g., here and here).

3. This study is talking about 5 year outcomes after social transition, except that it also includes a bunch of kids with puberty blockers and hormones by the end. So it's a combination of social transition only outcomes and puberty blockers outcomes and hormones outcomes. Since the desistance rates are so low of the people who are tracked through the end, at least through the ages in this study, maybe it's not a big deal to separate them out, I have no idea. It's plausible some might desist as they get to the ages some of the other desistance studies tracked through, but one can't really say anything from this study one way or another. Also, to participate I think they already had to be socially transitioned for a while (1 1/2 years maybe), so those who stopped in that time frame weren't included.

In at least one of the studies in the review which found desistance rates between studies varying from 61%-98%, some of the kids were socially transitioned and it was seen that those were more likely to persist, but I am not sure if those were separated out clearly. There is discussion of a lot of this here.

So this study says nothing about what happens to kids who aren't socially transitioned, which is what many of the earlier studies looked at. It seems to say many kids who are socially transitioned stay that way for a while. It is unclear what the criteria were for inclusion, and I'm not sure about loss to follow up.

Again, in the different studies, different interventions are being studied (and for different time periods). 1-watchful waiting, mostly no social transition, 2- puberty blockers, 3- social transition, ~1/3 puberty blockers, ~1/3 hormones. The last two look like they tend to persist for the respective time frames, the first, to desist.

A recent review article that came out right before this study, but which seems prescient now, noted that one might need explicit informed consent to start social transition as a result:

Informed consent for social transition represents a gray area. Evidence suggests that social transition is associated with the persistence of gender dysphoria (Hembree et al., 2017; Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013). This suggests that social gender transition is a form of a psychological intervention with potential lasting effects (Zucker, 2020). While the causality has not been proven, the possibility of iatrogenesis and the resulting exposure to the risks of future medical and surgical gender dysphoria treatments, qualifies social gender transition for explicit, rather than implied, consent.

So it seems the study under discussion is saying something about how social transition affects the likelihood of desistance, not desistance in general.

Thanks. Jdbrook talk 00:45, 10 May 2022 (UTC)

Jdbrook, thank you. I hope you stick around to help. Your understanding of the research appears to be excellent. Thinnyshivers (talk) 01:20, 10 May 2022 (UTC)

User:Thinnyshivers, glad it was useful, I just happened to have read this article and the discussions about it right before you asked; this topic is really broad and complicated, it's usually hard to keep up with things at the level needed to edit these pages. Thanks for your contributions (and to everyone else, too). Jdbrook talk 01:40, 10 May 2022 (UTC)

To go back to this discussion thread, I note that Jdbrook seems prepared to ignore the guidelines or position statements from national or international expert bodies, which are fairly unequivocal in the low WEIGHT they place on the 20th century studies and review aricles based on them.

I also note that Jdbrook cites both Singh's terrible "recent" article with Zucker and controversial material from SEGM, while referring to superannuated Stephen Levine's most recent insertion into this debate as prescient - this is Stephen Levine who chaired the 1998 WPATH committee, producing the last version that endorsed the concept of "autogynephilia".

The sources preferred by Jdbrook, while they include certain articles published within the last ten years, are clearly selected in service of a certain (SEGM/Levine/Zucker) POV and do not represent the state of knowledge reflected in the current position statements of the relevant professional bodies, which are among the most authoritative sources per MEDRS. The recent studies of socially-transitioned trans youth, on the other hand, do align with the current state of knowledge per the content of the position statements (forming, indeed, part of their evidence base) and therefore merit inclusion according to the provisions in MEDRS concerning the findings of recent, high-quality studies. Newimpartial (talk) 14:03, 14 June 2022 (UTC)

I reverted Newimpartial's reinsertion of Snokalok's edit, per the discussion above. There isn't anything at WP:MEDRS that says to prefer primary sources over secondary sources in this way, especially when those same secondary sources are used to support things Snokalok agrees with while they excise them for things they disagree with. Additionally, the WP:MED discussion makes a point of saying that if information and criticism about these studies is to be covered anywhere, then it's this article. There's coverage on them at the detransition article, and they belong here more than they belong there. Complete failure to even mention this information in this article is not in accordance with WP:DUE. Stathin (talk) 22:53, 12 June 2022 (UTC)

I support your edit and comment. Also see this explanation from WP:MED. SangdXurWan (talk). I have really red hair. 00:11, 13 June 2022 (UTC)

Both of you seem to be ignoring that the current state of knowledge in this field is reflected in the MEDRS statements by the relevant professional bodies (which reflect the more recent scholarship), not by 15 year old review articles. Newimpartial (talk) 13:05, 13 June 2022 (UTC)

@Newimpartial I had just rewrote the body section in question but tried to push 7 minutes after you did and had a merge conflict. Personally, I think I organized it such a way it sticks to the facts and covers persistence and how it's been handled in a succinct informative way that doesn't give undue weight to desistance, but I'm open to it being moved to a more appropriate section. However, since persistence is such a contested issue, it might be best to address it in it's own section for people to reference. I'd appreciate your thoughts on this! TheTranarchist ⚧ Ⓐ (talk) 18:24, 13 June 2022 (UTC)

The way the discussion at WT:WikiProject Medicine is going - although it is focused on the parent article, not this one - I think we have to be procedural about this, and there seems to be most support to exclude the material on the debate until an acceptable version is arrived at on Talk. If your version isn't reverted, then I personally am fine to leave that in place as discussion continues, but if anyone does revert it, then I would strongly suggest that the whole section be removed from the article pending Talk page consensus.

In reviewing all of this today, I noticed that the whole section was added in mid-2020 (largely by one editor), and that it has in every version prior to this month contained statements in wikivoice that do not represent the balance of the MEDRS sources available even in 2020 - in particular, the section has overrelied on tertiary sources grounded in very old studies whole ignoring more recent statements from professional bodies that contradict these. If we can't have a policy-compliant section, the interests of our readers are better served by having no section at all. Newimpartial (talk) 18:38, 13 June 2022 (UTC)

You were told plain and simple at WP:MED about how Wikipedia/WP:MEDRS works. You've been reverted by multiple editors now. And there's reviews as late as 2016 to 2018 supporting the high desistance rates among prepubertal children. Stathin (talk) 19:02, 13 June 2022 (UTC)

The question you should be asking yourself is, is there consensus among high-quality MEDRS in favor of the statements in this section? If the answer to that question is "no", then we cannot include the status quo ante text in the article - the choices are to come up with text that reflects the recent, reliable sources, or to exclude the section. Unlike WP:MEDRS, WP:NPOV is an actual (core) policy - and correctly understood, MEDRS doesn't let editors present one side of a dispute within RS in wikivoice, either. Newimpartial (talk) 19:19, 13 June 2022 (UTC)

Instead of deleting text sourced to MEDRS secondary sources, in-text attribution should be added if other sources of similar WEIGHT disagree. Crossroads ^-talk- 04:19, 14 June 2022 (UTC)

Also, concerning this, nobody needs consensus to remove from the lead section, once challenged, material that is unsourced in the body of the article. You ought to self-revert. Newimpartial (talk) 19:40, 13 June 2022 (UTC)

The answers to the questions I ask mirror the one SangdXurWan linked to, and they support that you've gone about this all wrong. I reverted myself on my lead revert, but only because it's inferior to what was there. That information is sourced in the body. Now it needs to be summarized in the lead per MOS:LEAD. Stathin (talk) 19:56, 13 June 2022 (UTC)

The text you inserted in the lead was Gender dysphoria in prepubertal children is more heavily linked to adult homosexuality than to an adult transgender identity, especially with regard to boys. That isn't just unDUE; it isn't supported in the body at all. Newimpartial (talk) 20:02, 13 June 2022 (UTC)

That's not WP:UNDUE. And it's in the persistence section. The only difference is that it begins with "Prospective studies have reported that" there. Stathin (talk) 20:20, 13 June 2022 (UTC)

If you think it is not WP:UNDUE to isolate a finding that is included in the Article body only with attribution, and which is followed by a long paragraph of RS criticism of the relevant studies, and make the contested claim in the lead section in Wikivoice, then I don't think other editors should take your interpretation of WP:DUE very seriously. Newimpartial (talk) 20:27, 13 June 2022 (UTC)

Agreed Snokalok (talk) 20:34, 13 June 2022 (UTC)

And your interpretation of WP:DUE has been discredited multiple times at WP:MED. Stathin (talk) 20:54, 13 June 2022 (UTC)

While I hesitate to bite the newcomer especially having been bitten before, I think Stathin may be an SPA, since all their edits have centered on this article and talk page, and they were quoting WP Policy and seemed well acquainted with it right off the bat. I hope I'm wrong, but it would be neglectful not to raise that. TheTranarchist ⚧ Ⓐ (talk) 20:42, 13 June 2022 (UTC)

Do editors not typically start off with one article? And going into your history, you "were quoting WP Policy and seemed well acquainted with it right off the bat" also. In any case, WP:NOTCLUELESS and WP:NOCLUE. Stathin (talk) 20:54, 13 June 2022 (UTC)

Touché. Very fair. However, I had already edited a few other articles which gave me a crash course on policy before restarting discussion on that one and was called an SPA for an interest in transgender topics at large. Normally I would not raise such suspicion about others; my suspicion was peaked by the fact your first change was to undue a commit and then jump into an ongoing seemingly deadlocked debate. However, I genuinely hope and believe you are here in good faith and look forward to further collaboration with you on WP (generally with WP as a whole and if we cross paths editing again). TheTranarchist ⚧ Ⓐ (talk) 21:05, 13 June 2022 (UTC)

TheTranarchist, I think we all have to remember to not cast stones if we dont want stones cast on us. Not that WP:NPA condones retaliation. Stathin has only been editiing for two days. Calling them a WP:SPA after editing for two days on one article would be like calling you an SPA when you were only editing the conversion therapy article for several days when you arrived. Some people only edit one page or a limited area, like you do, and are called an SPA. It's not necessarily a bad thing. And Stathin did compliment you in the requested evidence discussion. SangdXurWan (talk). I have really red hair. 00:21, 14 June 2022 (UTC)

Re: And your interpretation of WP:DUE has been discredited multiple times at WP:MED - where do you believe that this happened? I don't know whether you're aware of this, but on Wikipedia Talk pages, we aren't supposed to make WP:ASPERSIONS. Allegations are supposed to be based on evidence in the form of diffs.

Also, you might want to take a look at Whataboutism. Newimpartial (talk) 21:03, 13 June 2022 (UTC)

We all need to remember that "we aren't supposed to make WP:ASPERSIONS. Allegations are supposed to be based on evidence in the form of diffs." SangdXurWan (talk). I have really red hair. 00:21, 14 June 2022 (UTC)