Let me just open a transgender transitioning can of worms thread

[msnobody]

I can understand your point. I don't think it's an issue with people choosing to change gender, the issue is that there are people who do not wish to change gender who also have severe anxiety because of other reasons and won't receive the same help. In the UK I do believe there are things that will be covered for anxiety reasons. I know someone who got an eye lift on the NHS because of severe anxiety about her hooded eyelids. She also got compensation for a scar on her foot. Some people know how to work the system.

Yes, thank you, Pirate.

[Res Ipsa]

For nursing?

Sample letters for physicians that, seem to me, to guide the physician in proper wording to assist with approval for procedures or treatments. They look to me to also outline or mimic the criteria for approval. I think they would be helpful for the patient’s entire care team.

Sorry, I wasn’t clear. Is the training for nurses? Doctors?

[Morley]

Why would you think that gender dysphoria (or dysmorphia) would be influenced by social media? Do you also believe that social media turns people gay? If so, what would you cite as evidence?

All I’m saying is that our life experiences can shape our world view, our thoughts about ourselves and others.

Msnobody, they do indeed. The things that we eat change us, too. The books that we read change us. The people whom we associate with change us. None of these things brings on gender dysphoria.

[Marcus]

I can understand your point. I don't think it's an issue with people choosing to change gender, the issue is that there are people who do not wish to change gender who also have severe anxiety because of other reasons and won't receive the same help. In the UK I do believe there are things that will be covered for anxiety reasons. I know someone who got an eye lift on the NHS because of severe anxiety about her hooded eyelids. She also got compensation for a scar on her foot. Some people know how to work the system.

I don't understand. You said "the issue is that there are people who do not wish to change gender who also have severe anxiety because of other reasons and won't receive the same help," and then you gave several examples of people getting help for anxiety because of other reasons.

When you said "some people know how to work the system," were you referring to gender change requests, or anxiety requests?

[Dwight]

I know women who have had elective breast reduction surgery. They just weren't happy. On the other hand I know a woman that was experiencing beyond discomfort, real problems and it was done on insurance. I know women who have had mastectomies for breast cancer who got implants, and others who opted to not. A couple that have gone that route electively for their different reasons. I had a friend get laser eye surgery to treat some sort of macular degeneration or something that the prognosis was he would go partially, or completely blind if left to progress. I don't know that it was 100% necessary that they corrected his vision to where he still doesn't need corrective lenses 20+ years later, but it was done on insurance. Other friends have paid out of pocket to have laser eye surgery.

So it seems in the US insurance and / medical community does see that there can be degrees to things, and how something might not just be nice to have. I'm also okay that there are guides for medical professionals to know how to word things for certain cases. That it might be possible to game the system some, but I don't think this triggers a fear that doctors and/or nurses aren't going to be running around giving out free transgender transitioning care cards and there won't be any medical care for others.

[Gadianton]

I'll be a bit contrarian and say that while I don't believe reading social media posts and unkind words cause people to turn trans, I do seriously wonder about an entire generation of kids who have grown up in cyberworld, many of whom are ill-equipped to deal with reality in all kinds of ways; how does this brand-new category of community affect its members? I wouldn't be surprised if it has consequences on identity that can in fact include gender identity. I think there are probably limits to the fluidity of how one is able to perceive themselves, but I would bet there is something to it. Maybe I read too much Michel Foucault.

I only know a couple of people in real life my age who have children who identify as trans. Big challenge in both cases, even though in both cases the parents are liberal -- I think. As the facts have been related to me, I remain unconvinced that either is a situation of an identity that metaphorically might be termed as "hard-wiring" and I know in one case, the child has moved away from the identity significantly upon entering their twenties. Once you get to the point where a person is absolutely ready to cut it off, then it's serious. I believe there are certain fundamentals about sex drive, at least for dudes, that disallow a person to be influenced by friends and Internet or culture to the point where they need to whack it off in order to feel whole, or where they would be influenced to be gay, and so there must really be something "hard-wired" for these folks -- in most cases, at least.

An analogy for cases of soft-wiring brings me to a growing-up story. I had an English teacher as a freshman who seemed pretty typical of the small town I lived in, who talked about wanting to be a boy when she grew up. I can't remember the context. She was having a good laugh about it now, but back then it was very serious for her and she got scolded for it. She cut her hair short, wanted to wear pants, and all these things, and in her telling, she wanted to be a boy because they got to have all the fun while girls were expected to stay pretty and play with dolls. For the time, she may have been about as trans as many of the kids today who outrage their parents by identifying as something other than binary. In fact, language itself may even need translating -- in today's world she might have just as easily said, "I am a boy" rather than "I want to be a boy" and vice verse. And there is no privileged standpoint for language to be more correct one way or the other.

It's worth pointing out that gender roles as they are thought about by conservative Christians are arbitrary as well, in terms of biology or hard-wiring. The fact that men wear suites and women wear dresses has no grounding in biological reality.

[msnobody]

Sample letters for physicians that, seem to me, to guide the physician in proper wording to assist with approval for procedures or treatments. They look to me to also outline or mimic the criteria for approval. I think they would be helpful for the patient’s entire care team.

Sorry, I wasn’t clear. Is the training for nurses? Doctors?

Really, the training is for the entire care team, but the sample letters would be more geared toward the physicians. Nurses are often the ones drafting letters for physicians. Sample letters were only a part of the training.

[IWMP]

I can understand your point. I don't think it's an issue with people choosing to change gender, the issue is that there are people who do not wish to change gender who also have severe anxiety because of other reasons and won't receive the same help. In the UK I do believe there are things that will be covered for anxiety reasons. I know someone who got an eye lift on the NHS because of severe anxiety about her hooded eyelids. She also got compensation for a scar on her foot. Some people know how to work the system.

I don't understand. You said "the issue is that there are people who do not wish to change gender who also have severe anxiety because of other reasons and won't receive the same help," and then you gave several examples of people getting help for anxiety because of other reasons.

When you said "some people know how to work the system," were you referring to gender change requests, or anxiety requests?

I was saying I understood what msnobody was saying and there are plenty of cases that are evident of what she was saying. And I agree for the most part.

However in the UK, there are some situations where other things will be covered depending on whether you know how to get around it or not. I personally wouldn't know how to achieve that and know people who deserve treatments but can't get it. But then there are people I know that somehow managed to play the system to get what they want. I was highlighting just how much that person can get done when I said she managed to get compensation for a scar on her foot. She got £10000 because this scar (which I've never noticed) affects her emotional wellbeing. It is not usual for cosmetic procedures to be done on the NHS.

[IWMP]

I'll be a bit contrarian and say that while I don't believe reading social media posts and unkind words cause people to turn trans, I do seriously wonder about an entire generation of kids who have grown up in cyberworld, many of whom are ill-equipped to deal with reality in all kinds of ways; how does this brand-new category of community affect its members? I wouldn't be surprised if it has consequences on identity that can in fact include gender identity. I think there are probably limits to the fluidity of how one is able to perceive themselves, but I would bet there is something to it. Maybe I read too much Michel Foucault.

I only know a couple of people in real life my age who have children who identify as trans. Big challenge in both cases, even though in both cases the parents are liberal -- I think. As the facts have been related to me, I remain unconvinced that either is a situation of an identity that metaphorically might be termed as "hard-wiring" and I know in one case, the child has moved away from the identity significantly upon entering their twenties. Once you get to the point where a person is absolutely ready to cut it off, then it's serious. I believe there are certain fundamentals about sex drive, at least for dudes, that disallow a person to be influenced by friends and Internet or culture to the point where they need to whack it off in order to feel whole, or where they would be influenced to be gay, and so there must really be something "hard-wired" for these folks -- in most cases, at least.

An analogy for cases of soft-wiring brings me to a growing-up story. I had an English teacher as a freshman who seemed pretty typical of the small town I lived in, who talked about wanting to be a boy when she grew up. I can't remember the context. She was having a good laugh about it now, but back then it was very serious for her and she got scolded for it. She cut her hair short, wanted to wear pants, and all these things, and in her telling, she wanted to be a boy because they got to have all the fun while girls were expected to stay pretty and play with dolls. For the time, she may have been about as trans as many of the kids today who outrage their parents by identifying as something other than binary. In fact, language itself may even need translating -- in today's world she might have just as easily said, "I am a boy" rather than "I want to be a boy" and vice verse. And there is no privileged standpoint for language to be more correct one way or the other.

It's worth pointing out that gender roles as they are thought about by conservative Christians are arbitrary as well, in terms of biology or hard-wiring. The fact that men wear suites and women wear dresses has no grounding in biological reality.

I don't fully understand and don't want to get sucked in deep here because I haven't got set opinions and I don't understand enough. But I'll share some things I've noticed.

My son, when he was little declared he was a girl inside and he was so upset because his sister got hair clips and he didn't. He wanted to grow his hair long. I didn't know what to do about it. I asked the Dr and he said just let him be who he wants to be. I chose to not respond too much. I told him I would make boy hair clips. Eventually he didn't talk about it anymore. A few years later he was able to explain what was going on. He, didn't really have friends at school but when he was around the girls (boys were a bit much for him) they would say girls are the best and boys suck and he said that he genuinely believed that girls were better and he didn't want to suck so he wanted to be a girl too. But I wasn't aware of that at the time. I am so glad I didn't encourage him because he had such a logical explanation but didn't at that time have the maturity to explain his thinking.

I know a boy who was encouraged to dress as a girl. He was clearly very boyish but he changed his name and wore girls clothes (really quite young) and now, he doesn't identify as that at all. He is definitely a boy but also clearly autistic.

There is a (not sure of the situation) biological boy who dresses as a girl in my daughter's class. My daughter and the teachers call this child she but this child's mum calls them he. It brings up a lot of questions.

My (nephew) is maybe non binary and I believe goes by they but I've heard others say she. I haven't had a chance to ask. They dress in drag. Amazingly stunning agony aunt old woman drag. Also autistic. However as a child, I had a feeling that (he at the time) was different even before anyone was told, so I don't think any of us are surprised. But this was in the teenage years

I think, it is better to take a back seat and not encourage or discourage in this area because there is evidence of people regretting making these decisions. My kids have asked lots of questions and I've said just be happy. Don't stress and if you decided when you are older that that is the case then it isn't a big deal. I don't think they are thinking along those lines. I think they just like asking questions. We've discussed about how gender expectations are social constructs. Like how people behave, what toys they play with, the clothes they wear... People decide these things. Like centuries ago boys wore pink and dresses and that was normal then. And now men do look after babies so boys playing with dolls is more relevant to how children grow up in today's world.

[honorentheos]

It seems like there are two parallel points. The first being whether or not certain procedures should be paid entirely out of pocket by the individual. And the second questioning if the cultural increase in discourse over gender identity could be influencing folks to self-diagnose gender dysphoria; and a tag on concern that folks online may misrepresent their own circumstances while influencing others.

Regarding the first, I'm inclined to err on the side of providing care for any cause that may result in high risk of self harm if treatment is withheld. So if a person is suffering from body dysmorphia over hair loss and a mental health professional assesses their potential for self harm over it is high, I'm not concerned about my insurance rates going up slightly to cover that. Frankly I'd be glad to find out my rates went up because health care became a more common and folks were dealing with their mental health through professional care at higher rates.

Regarding the second, that's an interesting question. Certainly we all know the joke that a person who looks up their symptoms on WebMD could probably think they are at high risk of dying from a rare disease. And frankly, one of my frustrations I have with our healthcare in the US is how much work the healthcare consumer is expected to put on to their own care choices. Health care shouldn't be driving by the same dynamics as buying a car. Yet here we are.

But I don't think there is a solution in being skeptical of folks who may self diagnose their feelings of anxiety, social distress, and other symptoms as misguided. My daughter's friend group though high school and college included at least a half dozen of her friends who explored their identity as they went through that period of self discovery. And anecdotally I can say the one parent pair who refused to accept the attempts to find themselves and forced the school to only use their birth name and gender destroyed their kid's trust and enforced antisocial outlooks. The parents who participated in the exploration helped their children through it and some ultimately transitioned while others found themselves somewhere more comfortable with their gender being a spectrum rather than binary but expressed closer to what folks might consider traditional.

I guess I don't see the ideas in either the first or second as seeing people going through this as people but as antisocial misfits who should learn to conform. This assumes the system requiring conformity is inherently correct. And I'd argue any time someone tries to force nature into a binary rather than analog spectrum then they are probably misunderstanding the nature of nature.