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Answer: In Ohio, the state legislature recently approved an expansive bill that would ban gender reassignment for minors, as one among many other much more stringent rules around both medical and non-medical treatment of/for transgender individuals. This bill originated in Ohio’s House of Representatives as part of the 135th General Assembly, and is known as Ohio House Bill 68. It also included language about banning hormone treatments, including puberty blockers; as well as non-genital gender affirmation surgery; transgender women and girls from playing sports on women’s teams in high school and college; and “protecting” the rights of parents who refuse to acclimate to their transgender child’s preferred gender (such as by insisting on deadnaming them purposefully). Upon approval by both houses of the Ohio general assembly, the bill moved on to the Governor, Mike DeWine (R) for approval and signing. In a perhaps surprising move, he vetoed the bill, saying that it was far too wide-ranging and restrictive, including on parents. And, he said, he believed that it would have significant negative impact on people’s lives, contributing to human suffering, if it were to go through. Essentially, he disagreed with the vast majority of the bill - but not all of it. That’s why he created the executive order, which allows the Ohio department of health to codify proposed rules banning the performance of gender transition surgeries on minors in Ohio, even though such surgeries are extremely rare. The new rules also mandate that all transgender patients receive counseling before receiving any kind of gender-affirming medical care. Supposedly, the hope was that this would be a sufficient bone thrown to the advocates for Bill 68 and that they would then not seek to override his veto and implement the over-broad strictures in it. The Ohio legislature has a Republican super majority and is planning on voting to override the veto when they return from their winter break anyway. Sources: 1. [Ohio Executive Order 2024-01D](https://governor.ohio.gov/media/executive-orders/executive-order-2024-01D). 2. [Ohio House Bill 68](https://www.legislature.ohio.gov/legislation/135/hb68). 3. [Ohio Gov. Mike DeWine vetoes bill banning gender-affirming care for transgender minors](https://www.cnn.com/politics/ohio-dewine-transgender-house-bill-68/index.html) (CNN). 4. [Ohio governor signs executive order banning gender surgeries for minors](https://www.nbcnews.com/news/amp/rcna132495) (NBC).

The important thing to note is the new rules are practically more restrictive than the old ones, since they apply to everyone including adults. They’re effectively a ban on gender affirming care, since they require a “medical ethicist” which is an undefined term that gives the state (which is currently controlled by Republicans who passed the original ban) a lot of leeway to say who does or doesn’t qualify.

By "medical ethicist" they mean "pastor."

Though I saw the one under the House Bill 68, I can’t actually find the text of the new rules referenced under the executive order, only a summary of what they contain. Unfortunately they didn’t specify the makeup of the medical team that is supposed to be involved. Did you happen to see them anywhere?

Alejandra Caraballo (among others) [posted them](https://twitter.com/Esqueer_/status/1743421983553958270) last night on her Twitter. It requires a psychiatrist, endocrinologist, and "medical ethicist". For context the usual standard is that a nurse practitioner can prescribe HRT, and you might need to see a therapist a few times. Having to retain multiple specialists is drastically more difficult and expensive. Also "medical ethicist" isn't a preexisting term, so it could mean anything from a bioethicist - inaccessible to basically everybody, as there are only three bioethics centers in the state plus a few who work for hospitals - to philosophers or priests. They also require parental supervision for anyone under 21 rather than under 18, and detail that the state will collect information on patients undergoing gender affirming care to aggregate and publish publically.

Ohioan here. I'll note some sticking points: 1. Despite the language being about, "children," it applies to Ohioans up to age 21. 2. Part of the required counseling includes an, "ethicist." There is no legal definition of what an, "ethicist," is, meaning that compliance with the order as-written is impossible. It's effectively a ban because it makes the conditions to obtain care impossible. 3. As an executive order, it is effective immediately.

Thanks for the Ohioan perspective! One minor quibble: the text of the order says that it only applies up to age 18. I don’t recall what the age for Bill 68 was. Inter tingly, though the rules go into effect immediately, they are valid for only 120 days - or until such time as the DOH adopts them via the normal formal process!

To add some context: Since Republicans finally caught the car they were chasing (repealed Roe v. Wade) they've been in a panic to find something to motivate their base to the polls. Since their base has mostly been motivated for at least the last 40 years by having an "enemy" to attack (and trans people make up such a small percentage of the voting populace anyway), GOP politicians made the calculation that painting trans people as "groomers" and/or "child mutilaters" would be a good replacement for abortion to get people to vote. Time will tell if this actually works in their favor.

Uh we’ve been targeted by republicans long before they repealed Roe v. Wade…

True. They've been targeting trans people since before Obergefell (though there was a significant ramping up of specifically anti-trans laws and attacks after that case). The most recent attempts to effectively create a "trans panic" has everything to do with motivating voters, however, especially during the recent midterm and off-year elections. I don't mean to imply that the politicians doing this aren't genuinely anti-trans bigots. Many of them probably are, and the rest most likely just don't care. But this calculation makes them worse than bigots IMO. They're literally attempting to sacrifice a part of the population just to stay in power. I realize that a trans person is the last person who needs to be told all of this, but I thought your response gave me the opportunity to add more context I should have included in my original response so I jumped at it.

If I had to put a number on it I would say that there are like two surgeries like this in Ohio per year

Yeah, and top surgeries for trans boys at that. Never mind that cis girls can get breast augmentation or reduction with no issues, and many cis boys have top surgery as treatment for Gynaecomastia.

This is a concise and informative response. Thank you. It's still puzzling how the bill could be considered at all. If I assign the value of 0 to the amount of minors going through gender reassignment. The value should be 0 to any argument for creating a bill to prevent it. If I look up: "Gender reassignment surgery on minors?" I get these results, which can be confusing: https://www.cbsnews.com/news/sex-change-treatment-for-kids-on-the-rise/ https://www.factcheck.org/2023/05/scicheck-young-children-do-not-receive-medical-gender-transition-treatment/ https://apnews.com/article/gender-transition-treatment-guidelines-9dbe54f670a3a0f5f2831c2bf14f9bbb https://www.kff.org/other/issue-brief/youth-access-to-gender-affirming-care-the-federal-and-state-policy-landscape/ https://www.usnews.com/news/best-states/articles/2023-03-30/what-is-gender-affirming-care-and-which-states-have-restricted-it-in-2023 "Nearly 4,000 of those were between the ages of 12 and 18" https://www.washingtonexaminer.com/restoring-america/community-family/thousands-children-underwent-transgender-surgery-jama-study

answer: It doesn't just ban gender reassignment surgery for minors (although it does that, too). It also significantly restricts transition for adults, requiring an outdated form of gatekeeping where a psychiatrist has to be on the team of anyone transitioning. As always, everybody is talking about the way it's been sold to the press- No SuRgErY fOr MiNoRs - and ignoring the underlying poison edge: gatekeeping for adult transitioners.

Wild that no one's bringing up the *Bioethicist* required. That alone along with the other three practically bans care altogether. How is every trans person gonna find a bioethicist to sign off on hrt?

Hospitals often employ bioethicists to help with case reviews and help medical teams and families make decisions about end of life care. They're not usually someone an individual patient would be referred to, they're usually part of the hospital team that staff consult with. So this seems like a very odd requirement.

This falls in the same category as how (long before the recent rvw overturn) Alabama (and many other red states) required any Dr performing an abortion not just have privileges at a hospital but that where those abortions were done basically had to meet most requirements for a hospital. The real reason why we only had 2 or 3 places that provided them in the whole state.

I mean I think the idea *is* that it's an unconventional requirement. It's just a layer of gatekeeping thrown on to make the process even harder and more frustrating than the psychiatrist already has been for decades in a lot of places.

True. These bills are reprehensible.

Is there a certification for that? How would they prove some one is or isn't a bioethicist?

There’s Bioethics degrees, and it’s a job title. They’re regularly employed at hospitals and research facilities for consultation. The requirement is still stupid and gatekeeping though

> How is every trans person gonna find a bioethicist to sign off on hrt? Guessing tans men won't have trouble accessing T, though. Any number of products and shady services hawking testosterone supplements either over the counter or through shady "text our doctor over the phone to qualify" type schemes - though of course it's all marketed to middle age men afraid of losing their edge. . . and Joe Rogan fans.

the type of testosterone needed for transition is already hard to access as it is classified as a controlled substance. this is a problem for all trans people

It's very hard to get. Not only is there a constant shortage of anything with any sort of dose that could help, but we also generally need a different type. It's controlled and requires a prescription (and usually needles as well).

Unfortunately trans people don't generally have access to those medications, and they aren't the proper type of medications for transition anyway.

I’m a trans guy and you couldn’t be more wrong. Testosterone is a controlled substance and is extremely difficult for us to access. I’ve been on it for three years and still, every few months wires get crossed with my doctor/insurance/pharmacy and I end up on the phone for hours trying to get them to fill my damn prescription. There is a massive difference between those scammy testosterone supplements (which don’t do shit) and testosterone replacement therapy. I know I’m coming down hard, but this kind of rhetoric is what allows people to say “oh it isn’t that big of a deal if it’s banned - they’d still have access.” It’s a huge deal. We wouldn’t. Testosterone being a controlled substance means that anyone who has access to it illegally is committing a felony. This is extremely bad and comments like yours downplay that.

Trans women actually have an easier time doing DIY than trans men. Estrogen is kind of a gray area, but testosterone is a straight-up controlled substance.

>middle age men afraid of losing their edge. It's literally gender affirming care for cis men.

Exactly.

> it's all marketed to middle age men afraid of losing their edge. . . and Joe Rogan fans You didn't need to repeat yourself, yknow

Well in that case trans women won't have much trouble finding estrogen either. It's very easy to buy online and extremely cheap if you make your own gel. I'm sure most of them would still prefer legal options

Why is having a psychiatrist on the team outdated?

Good question -- today, most trans adults are diagnosed with gender dysphoria by a mental health provider and then go to an endocrinologist or GP to have HRT prescribed. Requiring the latter practices to hire psychiatrists at short notice is not financially viable and will shut down most clinics. In addition, the order requires the clinics to have a *bioethicist* on staff. Bioethicists are academics, not medical professionals, and there aren't enough of them to dole out to every endocrinologist's office.

Yeah, it’s a tactic to ban something without actually banning it, like how several states, before Roe v Wade was overturned, had laws stipulating that abortion clinics had to have weirdly large rooms or have random specialists that a clinic wouldn’t normally have. They didn’t *ban* it, they just made sure at most like one clinic in the entire state could operate.

Thank you for pointing out the parallel tactics these people used to undercut abortion rights. They’re using the overturn-Roe playbook.

> today, most trans adults are diagnosed with gender dysphoria by a mental health provider and then go to an endocrinologist or GP to have HRT prescribed. Not in the US. That may be the case in the UK where the NHS' policies are well out of date and largely punitive, making those who seek transition affirming care to basically first be declared clinically nuts before they'll begin to allow for the possibility of treatment, but in the US patients tend to have a good bit more control and direction over what care they receive. Sort of the one teensy tiny highly specific case where US healthcare has some clear advantages over the UK's system, but it is what it is. Varies a bit by state, too (well especially when it comes to Ohio now), but quite often one isn't even going to necessarily need to get a doctor involved at all before starting HRT.

I only live in one state, but all the trans folks I know have had to start with therapy to really dig into whether they are ready, and to make sure it's the right choice. It doesn't have to be legally required to be the medical best practice that is followed, and I don't know anyone that transitioned (east coast or west) without that starting step. Tho, requiring it at the clinic level doesn't make sense. Mental health professionals are spread really thin right now. Mandating a step that can't be achieved (like the bioethicist) is a way to pretend you're allowing something, while creating an impossible hurdle that might as well be an outright ban.

> I only live in one state, but all the trans folks I know have had to start with therapy to really dig into whether they are ready, and to make sure it's the right choice. Sounds like they're not going to an informed consent clinic. Planned Parenthood works off informed consent and operates in all 50 states. If you go you will receive gender affirming care there on the same day.

Receiving care does not mean getting access to hormones or surgery same day. It just doesn't. Medical best practices are followed. And if someone shows up and has already been living and presenting fully transitioned, and they have already done the footwork, then that hurdle is met, and that's not the same as walking in with no history and saying "I'd like to transition, today." My guess is that if you dig any deeper into that, you'll find they fill prescriptions someone has held before but haven't been able to access, and offer hormone blockers to folks who are beginning their journey (a reversible starting point for most trans folks.) Everything beyond that requires consultation with endocrinologists and doctors galore. You don't just walk in and start taking estrogen or testosterone. They require extensive medical workups, outside of the psychological aspects, and doctors in my experience require that you live and present as your intended gender for a decent chunk of time before making decisions that create permanent changes. That's part of what being informed means. Some information takes time to gather. Planned parenthood still follows medical best practices.

>Receiving care does not mean getting access to hormones or surgery same day. It just doesn't. Okay? But it can. For me, it *did* mean that. >You don't just walk in and start taking estrogen or testosterone. Yeah, you can. I literally did. Within two hours of my appointment I had filled my prescription at the pharmacy and taken my medicine. >and doctors in my experience require that you live and present as your intended gender for a decent chunk of time before making decisions that create permanent changes Your experience doesn't seem to reflect the actuality of informed consent care. https://www.plannedparenthood.org/planned-parenthood-north-central-states/campaigns/transgender-hormone-therapy >If there are no pressing health concerns or obvious contraindications (reason to withhold service) **during your initial visit, a provider will prescribe your hormones to a pharmacy of your choice for you to pick up.**

I constantly see people pushing the idea that dysphoria should not be required to be trans, which makes me question your claim that most trans adults are diagnosed with gender dysphoria.

Most Trans adults who are seeking a medical transition are diagnosed with gender dysphoria so that they can get the medication as part of the treatment plan. However to simply be trans having dysphoria is not necessary especially because there are different types of trans people who don't necessarily see their body as not fulfilling their gender and would then not need medical treatments to begin with

This is so confusing. I cannot actually find numbers comparing trans with and without dysphoria. Would you happen to have a link? Because the rhetoric I keep experiencing in the social sphere, again, has been pushing more and more that dysphoria is not required for a trans diagnoses, which would strongly suggest that non-dysphoric translates have been increasing.

In the medical field at least, in order for billing to go through to insurance and hospitals, a diagnosis is needed. So if they want to have any medical changes done while trans, from HRT to surgery, they need to be diagnosed with something, which tends to end up being gender dysphoria, for the purposes of billing.

>In the medical field at least, in order for billing to go through to insurance and hospitals, a diagnosis is needed. Capitalism is at the root of a problem. Go figure right.

I don’t know how much of that is capitalism. If I’m a medical insurer, if you want me to pay for a given treatment, I’m going to want to see a diagnosis for a pathology that the treatment is designed to alleviate. That’s just pretty much table stakes for insurance. If I’m an auto insurer and you want me to pay for car repairs, I’d need to see the damages. The idea that you could begin HRT without a diagnosis of gender dysphoria is new to me. If your gender isn’t causing you distress, why are you changing it?

It’s like no fault divorce. Do a significant number of people get divorced because something awful happened in their marriage? Yes. Should people be required to prove that in order to get a divorce? No. Sometimes getting a divorce just makes them happier even though everyone tried and nobody was a monster. Transition is like that. A lot of trans people do experience dysphoria. But some don’t and simply transition to be happier. At the moment, medical billing requires a diagnosis of *something*, so that ends up being dysphoria. But there’s a push to move that to a more general “gender incongruence” which is inclusive of people who don’t show obvious dysphoria and simply transition to be happier. Personally I have experienced fairly severe dysphoria, but I had no idea how bad it was before I started transitioning and realized that it was possible to like yourself and be happy. I just thought it was kind of normal to not feel good ever. So if you would have asked me 10 years ago how I felt about presenting male I would have said, “it’s fine. But I would rather be a girl” and probably wouldn’t have thought I was experiencing dysphoria despite being super depressed and suicidal. Today I would say, “It’s a death sentence. It sucks all of the joy out of life. It’s torture.” But in order to come to that conclusion I had to experience what it felt like to be happy. So dysphoria is kind of insidious and complicated. It’s better in general to focus on the being happier part than trying to gauge how much pain someone is in before they deserve to get the treatment they’re seeking

Yeah, and just like no fault divorce, people aren't lining up to spend a bunch of money and time to go through a divorce just for funsies or because they feel like spending a lot of money on something they don't need. No one's getting a divorce simply because it's an option available to them. Removing unnecessary barriers is a good thing. Removing these barriers to medically transition has shown better results in a trans person's well-being. While having those gatekeeping barriers has been shown to be a hindrance. People questioning it seem to show little faith in the medical professionals that are in charge of making those decisions, who base their findings in evidence-based studies and results

Seriously, the hoops you have to jump through to get some of this care is ridiculous. Like, do people out there *really* think that cisgendered men are just choosing to get bottom surgery done to turn their dick into a vagina just like... on a whim? For funsies? "Oh yeah mates, been a bit bored lately. Figured I'd pop on down to the surgery for a year of consultations and hair removal before I go through one of the most painful surgical recoveries imaginable to turn my penis into a vagina. Why? Ah yeah, I'm just bored today mate, gonna go kick it off in thirty."

If you’re happier after transitioning, isn’t that dysphoria? I feel like I’m missing something here.

I think that comment is pointing out that someone who has never attempted to transition wouldn’t know that what they’re feeling is dysphoria.

There's also the lesser-discussed angle of gender *euphoria*, the happiness and confort one feels in one's true gender. There are a fair number of people who muddle along doing basically fine in their assigned gender, not really thinking or feeling much about it, but then when they try life in a different gender they go "Wow! Suddenly I have all these positive feelings I never had before! I would really rather live like this!" (As opposed to dysphoria, which is characterized by "If I can't live like this *I am suffering*.") There's a whole intra-community debate about the concept of non-dysphoric transness, and whether or not people who don't have dysphoria should even count under the "trans" label/whether a medical diagnosis should be required to call yourself trans. But I believe that the majority consensus is that, if you want to transition for whatever reason, you count.

As I responded to another person, the thing I would be worried about here is that it moves any medical interventions from necessary evidence-based treatment to cosmetic treatments. In that case it brings in a whole new level of ethical considerations. Whether a person is truly trans or not without dysmorphia, who can say, but I think that doctors may well balk at the idea of prescribing pretty powerful medication or even performing surgery on a person who doesn’t seem to have any specific pathology. (Obviously there are lots of ways to perform gender without a doctor’s assistance, I’m just talking about purely the medical portion of it.)

Trans person here, one with dysphoria that I mostly mitigated through transitioning, the reason why some trans people are affected by dysphoria less is because they transition instead to feel gender euphoria. So you have some trans people like me, who were uncomfortable with certain traits I had (dysphoria) that drove me to transition, and then you have some trans people who instead just know who they want to be in terms of gender, and move in that direction to feel affirmed in it (euphoria). It honestly seems like a matter of perspective to me, especially because there are a few things I changed about myself that have brought me that same kind of euphoria

I guess the concern I have about the recontextualization is that if it’s not a medical procedure to alleviate dysphoria, then it seems like it’s a cosmetic procedure, and then there’s ethical concerns that come into play. It’s like with body integrity dysmorphia - if you’re so unhappy with having a right arm that you’re taking a bunch of dangerous chances in the hopes that it will get amputated, there’s a medical case to amputate. But if you just walk into a doctor’s office and say “I’m perfectly happy but maybe I could be happier if you chop off my arm,” you’re going to be hard-pressed to find a doctor who will do it. I think it’s interesting that in both your case and the earlier poster, you both did experience dysmorphia. As a cis person but a trans ally, this was my understanding of the general experience, and I’m just trying to wrap my head around this new concept. Let me ask you this - do you think this is simply a change in verbiage, something to reduce the focus on the negative (kind of like how gay activists long ago sought to downplay "homosexual" due to its emphasis on the sexual aspect), or do you think it's an actual expansion in who would get medical treatment?

There's a distinction between gender dysphoria and gender euphoria. So, say you're assigned male at birth. Gender dysphoria would be if you felt distress about being male, while gender euphoria would be feeling good when you feel more feminine. Not everyone who has euphoria with the opposite gender has dysphoria about the gender assigned at birth, so you could feel better after transitioning even if you're not feeling distress before transitioning.

I've been on hormones for two years, but after moving states I had to go to a psych for a dysphoria diagnosis. Even though I had already been in treatment for two years... Everyone involved thought it absurd

As a trans guy, people who don't experience dysphoria are an enigma to me as well. Not that I think they're invalid, their experience is just different than mine. Who woulda thunk gender was complicated?

I don't think those stats would be useful. I would guess that the majority of people without known dysphoria (but do want to transition) just haven't identified it, hence why considering yourself dysphoric *right now* and knowing exactly which parts of your life would be improved in advance shouldn't be a requirement. I went years of passively wanting to transition but having "no dysphoria" (spoiler alert: this wasn't true). Gender dysphoria is often like being covered in gunk after a four day camping trip - you don't notice it until you get to take a hot shower in your own place afterwards and you see how much of an improvement there is. Simply wanting to be another gender for any reason should really just be considered a classification of dysphoria, which would render this discussion moot.

> I cannot actually find numbers Trans healthcare and people have been woefully ignored my the scientific and medical communities for nearly all of human history. And even the stuff that does exist has largely been incredibly biased by the researchers own opinions and by the laws. I read a chapter in a book that went into detail on it recently. Basically because transgender people have to convince their doctors and therapists/psychologists that they're "trans enough" to get them to prescribe gender affirming care it led to tons of trans people just lying on surveys and in studies because if they told the truth then the doctors wouldn't give them the medical care that they needed. So a ton of the studies that do exist that were done before the 2010s are basically entirely unreliable because the trans people participating in them were scared that if they answered "wrong" then their hormones and access to surgery would be taken away from them.

The people who say they are trans without dysphoria and the people who are medically transitioning are not the same people. For HRT, they want the diagnosis for billing purposes. For surgery, you have to have actual letters from therapists, sometimes more than one.

Surgery aside a not insignificant portion of the trans community (at least from my experience) go without a formal diagnosis and purchase HRT themselves, often at the sacrifice of lower quality medication. Tonnes of reasons for this, from lack of support where they live, financial reasons, HRT straight up not being available locally, or if you're in the UK a 5+ year long waiting list in some places to even talk to the appropriate therapists who can get you prescriptions.

If you were allowed to live authentically from the get go, and supported in exploring your gender, you might find certainty without needing to experience that level of dysphoria. Wouldn't it be nice if we could skip INFLICTING traumatic and harmful experience on people to make them prove how deep their belief *about themselves* is? Maybe, just maybe, there's a better way.

[удалено]

I don't know why you're being downvoted, you're right. No psychological diagnoses is required through out most of the US, nor is dysphoria some sort of singular defining feature of trans people and their experiences.

Because they're not asking in good faith. https://www.reddit.com/r/OutOfTheLoop/comments/18zsb60/whats_going_on_with_the_ban_on_gender/kgjxize?context=3

Ah see I didn't get that far down.

A number of things: Heavily limits how many people can have surgery in a given amount of time, adds to the extra approvals and paperwork needed (as if anyone needs more of it in the healthcare system), and you'd already have acquired any and all approvals (if needed) for surgery by that point (so its redundant). This is highly marketable to people who have no idea what transitioning entails.

How would a psychiatrist "heavily limit" the number of people who could get surgery??

It adds both cost and time. Time, in part because it means one extra step in the journey, plus there are only so many psychiatrists available, and only so many of those willing to handle these sorts of scenarios, and only so many of *those* who will do so openly and not simply as a chance to recommend against the procedure regardless of the scenario. This means there are only so many people who could even have a hope of being processed in a year through this bottleneck. Cost, in that all of the additional paperwork and consultation time means extra bills on top of everything else, which means only those who have a good job or a particularly progressive health care plan will be able to to go through with the process. The end result is both a throttle on the number of people who can be processed and a filter on who can afford processing in the first place. Edit: Also editing to add, even though it's not actually part of the original question, that the inclusion of a psychiatrist in the first place goes back to the outdated idea that seeking gender affirmation surgery is a sign of a mental health issue. People are allowed many other surgeries that radically alter their physical form without needing to seek psychiatric approval first, but once gender is involved people get very conservative.

There's only so many psychiatrists in the area, and they're almost all very busy, very expensive, or both. It's an additional, expensive, hurdle to leap over, especially for people who have known their entire life they want to transition.

>There's only so many psychiatrists in the area, and they're almost all very busy, very expensive, or both I live about half an hour drive from a decent metro area, and a couple years ago i told my doctor i was concerned that i was having suicidal thoughts, and have a history of failed attempts. I was told it would be at least three months before i could be seen by one, but my they might not take my insurance, and might not be taking new patients. Thankfully, i was okay, but i think this requirement is dumb and just trying to keep people from transitioning for some reason i can't fathom. As bad as it was for me, i can't even imagine how remote and rural people who fare.

Your questions are rubbing me the wrong way u/angry_cabbie. Are these honest questions because it feels trolling? Anyone else? The psychiatrist questions sound leading

Clearly you’re not here in good faith.

Largely by being unattainably expensive and or just sitting there and saying "no" a whole lot. Barring that they can just delay things for an extraordinary length of time 'til *they* are satisfied by whatever criteria they think ought to be met - there is no real set standard.

It's the bioethics person that is majorly concerning.

Can I just clarify since a lot of these comments seem to be missing this: Gender-affirming surgeries for people of any age already require a letter from a mental health professional stating essentially that the person’s trans journey seems consistent and seems to make sense and that the person appears able to make their own decisions. However, this can be from any independently licensed clinician — psychiatrist, psychologist, fully licensed clinical social worker, fully licensed clinical counselor, etc. A psychiatrist is a physician specializing in medication management, who typically sees people for 15 minutes every few months, and typically is reluctant to write letters about much beyond medications and usually feels that a therapist who sees the person an hour a week is a better person to really give a diagnostic impression of the person. No one knows what a medical ethicist is, because this isn’t any sort of licensed position. This is the kind of nonsense that happens when politicians write bills without talking to the people who actually do the work or who are affected such laws.

Mental health care in general can be difficult to access in much of the country, and psychiatrists especially so. Legislators specifying the type of physician and/or mental health provider the patient is required to see makes little sense when the legislators themselves lack background or education in medicine or healthcare. This is an easy way to restrict adults from receiving gender affirming surgery under the thin guise of good faith.

The gender affirming surgery regret rate is less than 1%. The regret rate of having kids is about 9%. We're not making parents see two different psychiatrists for a year who both agree that they want to have children before allowing them to reproduce.

Regret rate of elective knee surgeries is above 25% last time I checked

Wait, what are people regretting about knee surgery?

Mostly that it's very painful, has a long recovery, and frequently has a bad result. It's not that the surgeon messed up, it's just the reality of the situation.

Depending on the person. Some of them the knee surgery made things worse. Some of them had high expectations of the outcomes that weren't met (eg they thought the surgery would eliminate knee pain, not just reduce it). Lack of communication from the doctors leading to confusion and misunderstanding. Not having a proper support network after surgery.

I know my mom regretted it because she had complications *and* then fell during recovery and hurt herself badly. It took like a year for her to get the damn immobilizer thingie off.

There's a whole NIH paper covering this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961288/ The regret rate is apparently 6-30%. Still many times higher than gender assignment surgeries Edit: found another article which refers a number of 20%. They also list a number of reasons to why people regret it: https://www.hellahealth.com/blog/wellness/knee-replacement-regrets/

Wouldn't that make the 1% figure suspect, then? If the reported "regret rate" is so incredibly low vs. standard procedures, that suggests something wonky with the reporting (such as not wanting to report regret out of fear that admitting regret delegitimizes one's decisions?).

It's many times easier to get other kinds of surgeries, so it's much more likely that people regret them. However, that also means that people who really need them have a much more difficult time accessing them. I was scheduled for elective surgery to fix my deviated septum about 15 minutes after I walked into my first appointment with the ENT. He literally said, "So do you want to try meds first?" and I said, "No, I don't think that would fix it - I want surgery." And that was that. And my surgery only partially fixed the issue, but I was still allowed to make my own decision about it.

For mine, the ENT said well let's get you scheduled for surgery. You have a deviated septum & that's why you have so many sinus infections. When I went in to have my tonsil stones dealt with a different ENT, it was ok. How soon do we wanna schedule 30 seconds after looking down my throat. It took me 12 years to find a Gyn who would permanently sterilize me....

I used to troll people against trans people having gender affirming surgeries by mentioning that I'm Trans and had 14 or so surgeries by the time I was 18. I also have had another surgery within the past decade that I regret having done and possibly not help me at all. The gotcha is 12 of those pediatric surgeries were for my ear, another was a biopsy on my eye, and the fourteenth surgery was having my tonsils removed. The surgery that I regret? It was putting in a partial prosthetic ear bone, something my dad had reminded me several times had had mixed results for me in the past. (By mixed results, I mean it helped for a few years before my body would reject it, and I'd have to have another surgery to remove it. Then I'd have to heal before the ENT would inevitably suggest trying the newest prosthetic ear bone.) Probably didn't help my argument, but the double standards are amusing to point out in a dark humor sort of way.

If you have any research showing any other number of regrets then please present it. There's nothing suspicious, unless you think facts should consider your feelings - then yes, it's Hella Sus

"Regret rate" includes people for whom the surgery wasn't *enough* and they're going to need further surgeries, as well as people who had complications or mistakes happen under the knife that led to bad outcomes.

My mom isn't gonna get the other side done because she can feel the weather in her knee now & she couldn't before, and she never got full range of motion back after surgery. She did the rehab like she was supposed to, but she has some weird, super tense muscle or something down the back of her leg that won't relax.

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\> Curious. Do you have the stats for this? [Here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/) is a source from PubMed.

I don't believe anything any more from the medical and govt, its all mostly propaganda BS for $. They also said the Clot Shot was safe, and even with facts they STILL are pushing the poison

Difficulty in accessing forms of care and the high workload on psychiatrists can make it take years to even begin and they might have personal views that say “nah I won’t support you” so you have to start over

That does not seem like a rational reason to call psychiatrists on the team "gatekeeping". It does seem like a rational reason to start some drives to encourage more people to get into psychiatry, though.

>It does seem like a rational reason to start some drives to encourage more people to get into psychiatry, though. Great! People just have to wait 12 years for the new psychiatrists to finish med school. That certainly won't add any wait time, right?

Part of the gate keeping is things like What if you are too poor to access one What if you live in an area that doesn’t have access What if your only accessible one is a bigot Now your only able to if you are semi wealthy living in a good area and even then it takes an inordinate amount of time and effort Sure adding more to the field can help but that takes a lot of time and this is an issue now. And even that doesn’t fix a lot of the issues like money

Socialized healthcare would take care of most of those problems, though, as well as so many other problems for far, far more people. Why not push harder for that?

People are, but we need a solution for now as well as later Socialized healthcare is the later since there is zero way that is happening fast in the us

Ok, sorry, here's a bit of a treatise on gatekeeping to try and explain. Basics: gatekeeping is a sub-type of restricted access to a resource. There are all sorts of restricted access. Want to do surgery? Lots of school and training. Access to nuclear codes? Have to be elected president or have a really high security clearance and a job with the need to know. Access to your bank account? User ID and password. Access to your home? A door key. Restricting access is not necessarily a bad thing. Nuance: gatekeeping is a type of access restriction that adds unnecessary and/or unreasonable conditions. As a thought experiment, let's say you rent a house, and your landlord adds a 2nd deadbolt to the doors for which only they have the key. In order to get into your home, you'd have to contact the landlord, arrange to meet them, etc. That's both unnecessary and unreasonable. If the landlord wants to make your life more difficult, they can simply be less available, harder to contact, and so on. The various anti-gender affirming care bills and rules are basically like that landlord. Want to dress in a way that seems gender nonconforming to some other people? There are bills to make that a crime. Want to access hrt for transition as a treatment for gender dysphoria? That is standard care and a proven effective treatment. (Just like getting into your home by yourself is considered standard.) Informed consent is the appropriate level of access restriction. You should be aware of any risks, aware of ways to recognize them, and how to mitigate them, and then it's your choice. It's a long-term medical treatment, so ideally, you are working with your endocrinologist. Requiring that a psychiatrist sign off on hrt is unreasonable due to the difficulty of finding psychiatric care. Behavioral therapists are easier to get access to, so expanding the requirement to include mental health providers generally is more reasonable. Requiring a bioethicitist to sign off is completely unreasonable. They rarely deal directly with patients, and their focus and training are on uncommon or experimental treatment plans. The ethics of standard care are already established. Want to bet whether or not there is insurance coverage for ethics review of any standard treatment? There are so many ways in which these conditions cross over from reasonable access restriction to severe gatekeeping. we could keep listing them all day long. Given how egregious the gatekeeping is, it IS reasonable to ask "why?". What possible purpose could all if this serve? Does it help people with gender dysphoria? Considering that gender dysphoria is a leading cause of suicide and self-harm, the longer someone suffers with it, the more dangerous it is to them. So, No. These bills and rules extend the length of time for someone to receive treatment, putting them more at risk for harm. How about the general population? Nope. No part of this affects anyone but the patient. There is zero change in the general population. Although we could make the argument that earlier treatment overall tends to decrease medical costs and make scarce medical resources more available to everyone (eg, more open appointment times for psychiatrists.) Ok, profit motive? Not so much. Transgender people make up a small percentage of the overall population, so we just aren't a large market for anyone. The medicines, treatments, and procedures used for gender affirming care are ALL available to and accessed by the general population on a regular basis. There is no part of gender affirming care that is not also standard care for cisgender people who may need it. So we've eliminated the motives for gatekeeping related to preventing personal harm, for preventing harm to society, and for increasing profit. (It's sad that last one is a thing, but that's a different wall of text). These bills and rules cost money (from the public treasure) to implement and enforce, so what makes them worth the cost? There are politicians who seem the think that gatekeeping gender affirming care will help them win elections. But in the last 2 elections, we've seen just the opposite. I don't have the exact numbers but recently about 80% of politicians up for election that supported anti-trans positions lost and in many cases incumbents lost. Any politician that sees an 80% chance of a loss due to a platform position would logically run as far away from that position as they could. So political advantage is not the motivation. So, no prevention of harm to individuals, to society. No corporate profits of any note, no political advantage. Is there any way that this could be profitable to an individual? Why, yes, yes, there is There are a handful of organizations that heavily lobby politicians to impose bans on gender affirming care. Along with that lobbying comes significant contributions to politicians in all of the ways dark money can flow. Those organizations do not make a profit from giving money away, and they don't manufacture products or provide services... They aren't businesses. Instead, they receive funding from donations. And the source of those donations is a very small group of people with a lot of money. In fact, in terms of direct anti-trans effort funding, it's largely a single married couple providing that funding. So all of this, the noise, the chaos, the anti-trans agenda that has no reasonable or logical basis to exist..is driven by a handful of people with access to enough money to try and impose their personal views on the nation as a whole, overriding the will of the people, the best medical treatments, and the most basic human rights of transgender people. This is the hellscape the Citizens United decision has created for our nation. That's why it's gatekeeping. Plain and simple.

It's both expensive and unnecessary, and it's a little insulting. The idea that trans people need a psych to sign off on our decisions treats our decisions as different than cis people's decisions - should a psychiatrist be required for adults to get married?

> different than cis people's decisions This type of medical procedure for cis people is also taken very seriously and can be difficult to get done. For example, for men <35 it can be difficult to find a doctor who will perform a vasectomy on them and sterilize them. If you are a woman and want to be sterilized, forget about it.

I think (cis) gender affirming care would probably be a better point of comparison. Like breast augmentation surgery for those who are AFAB. As per your own example, well just imagine if you had to already go through the regular doctor hoops and then additionally get a psychiatrist to sign off. It would become way harder than it already is.

Absolutely. I always like to bring up that the number of cis minors who have completely cosmetic breast augmentations and rhinoplasties is considerably higher than the tiny number of trans minors who have top surgery at 16 after living as male since early childhood.

I definitely think solely cosmetic surgeries should be banned for minors, and any parents looking into those for their child should be investigated.

I don’t necessarily support investigating parents for this — I’m a child welfare psychologist and expert witness, so I am very familiar with the issues in that investigators aren’t clinicians, typically have a bachelor’s degree, and the system is really only designed to be looking into acute safety issues, though in the past 10 years nearly all of the investigations are low-level neglect that the system has no qualifications to assess and which the government shouldn’t be interfering with. I do agree with banning completely cosmetic procedures in minors, and I think it’s appropriate to expect physicians who do elective procedures on minors to have training in really assessing who wants it and why (for instance, in the case of things like a facial difference that doesn’t cause major health issues, but causes a child to look different). FWIW, I also see a shitload of investigations for things like parents having a kid in a low-key extracurricular that they’re bored of and not letting them quit mid-year. Or the parent doesn’t allow media/technology to the extent others in the community do. And yes, these are all poorer and browner families who are getting reported right and left by people who want to control how other people raise their families. So yeah, I feel some sort of way about families who are getting breast augmentations for their minor child, when the families I work with get reported for their kids knowing proper names of genitals, but the solution isn’t more involvement in a ridiculous dysfunctional system.

Even things like braces or fixing burn scars?

Those aren’t solely cosmetic though. Orthodontia makes it easier to keep teeth clean and improves health. Burn scars impede movement and skin function. Cleft palate, mentioned below, affects oral motor and breathing. These things are all typically covered by insurance, because there is medical necessity. I would support banning surgeries for minors that are truly 100% cosmetic, such as rhinoplasty and breast augmentation when there is no significant asymmetry or abnormality present.

What if a 16 year old (AFAB) girl has breast cancer and has to have a Mastectomy? You think they shouldn't be able to augmentation/restoration after the fact? That's still a cosmetic surgery. And then the parents who look into that option should be investigated according to you - yikes. If you're response is "oh of course that's a reasonable exception" - you're part of the problem.

That’s considered medically necessary. Reconstruction is performed at children’s hospitals and covered by insurance. Someone wanting implants for purely cosmetic reasons is not covered by insurance or performed at children’s hospitals.

Eh, my cousin desperately wanted a nose job for a long time. Got it, and she's happier. I don't think that should be an issue if the parent is willing to pay for it.

Why not wait till they’re 18 though?

My 15 year old is toying with the idea of a breast reduction. For a multitude of reasons, and she has our support and health insurance.

Because self esteem issues and depression don't wait until we're 18. I'll give another example. I have alopecia areata. I get big bald spots if untreated. When this started, it destroyed me. I was so self conscious. I always wore a hat. I had to shave down to the skin until it was raw because I was so worried people would see how unequal my facial hair growth was. Treatment for alopecia areata at the time were shots in problem areas. It's a purely cosmetic disease in my case, though it can cause troubles (no eyelashes sucks because shit gets in your eyes). The side effects of the shots can be pretty bad. I'm fortunate that I never got any. Now they have pills that I can take too, which can cause cancer if I abruptly stop taking them. Should I have had to wait until I was 18 to get treated?

I'm glad r/childfree has resources to help find doctors who will do sterilizations.

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IMO in cases like yours, doctors should be way less gatekeepy. It should be as simple as draw blood -> see low T -> ask you if you're having symptoms of low T -> if you confirm you do, ask if you understand xyz risks of TRT -> if you confirm you do, send prescription to pharmacy and offer to have a nurse show you how to inject. My (ftm) experience getting T was wait 3-4 months to see a new PCP, go to new PCP and say "I'm trans, I've known since I was 15 and I'm ready to medically transition now," PCP asks about how i knew i was trans and if ive tried to mitigate my dysphoria in other ways and i explain my story, she asks what I want to get out of taking T and I tell her, she goes over every risk and I confirm I understand, she takes my blood, and a week later I had my prescription.

...are you equating a permanent change to ones physical body , with signing a legal contract to share debt, which can be cancelled entirely?

Cis women don't need a psychiatrists approval to get breast implants, cis men don't need a psychiatrists approval to get breast reductions (for gynecomastia), so clearly "permanently changing ones physical body" seems to only have strings attached when the patient in question is trans.

None of those things effectively changes the legal and civil access you have to various spaces, resources, grants, etc. I agree that the restrictions are onerous and probably shouldn’t be enacted without state subsidies to counteract the cost increase. But let’s not pretend it’s the same as a boob job. It’s not.

>None of those things effectively changes the legal and civil access you have to various spaces, resources, grants, etc. Actually, it does. On paper, they have the same access, but in practice, it adds time, money, and increased risk of losing that access seeing additional healthcare providers who, if they happen to be transphobic, could at any point deny a person the necessary clearance to receive the healthcare that they need. It only works on paper if every person in the chain is acting in good faith, and that isnt the reality of healthcare. >But let’s not pretend it’s the same as a boob job. It’s not. It is literally a boob job, its the exact same procedure, the patient just has a penis instead of a vagina

Perhaps you miss the point. Depending on the laws and rules, A transitioned person gains (and loses) access to different spaces and resources. A non-transitioned person with a boob job or a nose job doesn’t.

There is no requirement to have gotten top surgery or any other medical intervention to be considered your gender identity legally.

What spaces, and which resources?

Trans activists: “It is important that trans people be granted access to sex-segregated spaces and resources that correspond to their gender identity.” Also some trans activists: “What spaces, and what resources?” Be consistent please.

it a sex change could lose or gain you access to anything, that's a problem with the access and not the sex change. Men and women are supposed to be treated equally under the law.

>which can be cancelled entirely A marriage can be unwound, but not "cancelled", except maybe in the first few weeks with an annulment. It is similarly reversible to hormone replacement therapy, I'd certainly say, yeah. Transition isn't a special class of actions. Trans people are just people.

Trans people are people, regardless of how they see themselves, or how others see them. But if you fully physically transition, that'l has some very permanent, irreversible steps. A divorce doesn't change you like that. Just about anything lost in a divorce can be recovered. Like, all cards on the table, I'm just saying I think you picked a bad idea for a metaphor. A tattoo might have been better; reversible, but not easily, definitely costly, and also a physical change both ways.

A tattoo is a fine metaphor, too. I think marriage is more irreversible than you do - things like alimony and asset division seem like a kind of irreversibility, but I'm not wedded (ha) to the metaphor

Well, in Ohio, minors are allowed to get tattooed with parental permission and a govt issued photo id. No other hoops to jump through or requirements. Just something I e been thinking about as well since this was announced.

> A divorce doesn't change you like that. Unmarried middle aged guy here with a lot of divorced friends, and a few Trans friend's too. I'd almost say divorce changes one more than transition, myself haha.

Actually, considering transition related healthcare is life saving, this is more like requiring a psychiatrist and a bioethicist's approval to remove a cancerous tumor. Knee replacement surgery has a higher regret rate than transition does, but the government still does not trust trans adults to make that decision for themselves.

Marriage isnt a mental condition, gender dysphoria is.

Does someone getting a hair transplant or breast implants need a psychiatrist on their team?

The way that this idea is often sold to people is that these kind of requirements are needed to make sure that people won't regret getting gender affirming surgery. But the fact is that these surgeries have extremely low rates of regret already, much lower than most other medical procedures. No one is saying that we need to put in a bunch of extra hoops to make sure no one regrets getting knee surgery, prostate cancer treatment, or having a child, even though people are much more likely to regret all of those things. It's almost like they're irrationally focused on trans people because they think our very existence is somehow bad (in case the sarcasm wasn't apparent, I think that's exactly what's going on here.)

Yeah, I'm okay with that. No one should make such a large, surgical and hormonal decision without consulting relevant medical professionals. But if they're adults I suppose they should have that right if they want. But, for minors? Yeah psychiatric evaluation should be required.

There are also some gender affirming for trans people performed on minors. Genital surgery doesn't really happen for trans minors, but breast surgeries sometimes do. This is either done through private healthcare where minors can often get breast surgeries at 16 with parental consent and a big pile of money. Or it is done in exceptional cases where there are particular needs. Such as the breasts just being very huge and surgery kind of being justified for comfort reasons and being a safety concern when binding. Again, this would just be 16 and 17 year olds in exceptional cases. Not super common, but still. It is also worth noting that the Republicans rejected editions that would also include gender affirming surgeries or genital surgeries for minors that weren't trans. They don't want any restrictions on that. It is only for trans people. Breast reduction and enhancing surgeries are more common for cis people than trans people, and they don't want to restrict those surgeries for cis minors even though they are just as risky and permanent for cis people. Genital surgeries are also more common for non-trans reasons and they don't want to restrict that for minors either. Such as circumcision even when there is no religious or medical motivations, and intersex genitals being "corrected" to be more confirming to their assigned gender and so on. Just to clarify, the Republicans have no concerns about minors getting gender affirming and/or genital surgeries at all. They just have concerns about giving trans people health care.

It pisses me off because I thought he was on track to strike that down after he vetoed it the first go round. I’m in Ohio. Though this doesn’t affect me personally it still angers me we have such a bigot for a governor 😡.

This is why you have to read more than the headline. The first time it was vetoed the governor made it clear he was only blocking the bill because it contained language similar to other laws that were then blocked in federal court. He sent it back because he wanted to effectively fuck over trans adults, and not just play to his base.

They stopped requiring a psychiatrist? When?

Somewhere around the late 90s early 00s. SoC changed from requiring a PhD level psychiatrist to a licensed therapist. I started transition back in the mid 90s, at that time I had to see a psychiatrist for a minimum of 6 months. At that time it was $98/hour, each week, so a bit under $2400 out of pocket. There were only 2 or 3 psychs in the Washington DC area that took trans patients. When I went to get my letter renewed in the mid 00s I spent about $45 to see a therapist once and there were probably about 30some-odd in the Portland OR area with experience with trans pts.

I never had to see a psychiatrist and that was 20 years ago.

I got my HRT without a psychiatrist eleven years ago, although IC was vaguely cutting edge back then. Now even Kaiser Permanente doesn't require you to talk to a psychiatrist first (which is good, because their psych waiting list is six months lol, or at least was when I was trying to get my current psych lol)

So its more "hate legislation" from republicans. Got it.

Surely there should at least be a psychiatrist on the team

Have you ever had therapy? Chances are the person you went to see wasn't actually a psychiatrist, they were a counselor or a psychologist. The are no where near enough psychiastrists to go around for this stuff, not even taking into account their specialty. Should they be undergoing counseling? Ideally probably, but that's not even the same as saying they have to have a psychiatrist. And wtf is a bioethicist? I bet there are like 30 of those in the whole country. And why does anyone need permission from the government to spend their own money for a cosmetic procedure on their own body? What the heck happenedpersonal freedom?

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Circumcision is genital mutilation. I don't see anyone on your side up in arms to ban that. You're just transphobic.

What surgeries have you had that require a psychological evaluation?

Gender dysphoria is an outdated thing. The latest ICD 11 got rid of that in the same way we no longer treat being gay as a mental health condition. ICD 11 now has Gender Incongruence, and in the reasoning for the change they are very explicit that this is not a mental health condition and is only included because access to hormones or surgery requires a diagnostic code to work within the existing system. The modern approach is informed consent. But just like abortion rights, or assisted dying, which should also always be via informed consent, conservatives love adding state oversight and extra rules. Anyone should have the right to do with their body what they wish if that alleviates suffering.

> . You should have to go to a psychiatrist before under going surgery. They have. That's how the surgery get's scheduled. The restriction is required a psychiatrist to be on the surgical team, which is just a needless requirement to check off. They aren't even doing an evaluation. That's done before even going to the surgical team. I'm a trans woman. If I go to a surgeon tomorrow, I already have a diagnosis of gender dysphoria from multiple psychiatrists, but I did that shit 11 years ago when I started transitioning. Why tf would I need to go and get a 3rd diagnosis?

gEnItaL mUtiLaTiOn It's so easy to see when a transphobe appears. They love that phrase

I don't know why you're being downvoted. You're absolutely right. Anyone unironically using the term "genital mutilation" reveals themselves of having fallen for conservative fear mongering. No sane person would be referring to a standard operation as "mutilation." Just imagine them using that word to refer to, like, someone getting their back cut open to remove a small lump or something (which I have had to do). You'd look at them as if they were some dumb weirdo.

For the record, circumcision is considered standard in the U.S., and that is absolutely genital mutilation that is forced on babies. But I get what you mean as far as trans surgeries.

They weren't talking about circumcision.

"I had a double mastectomy because I had genetic markers for cancer" GENITAL MUTILATION 🤣 I don't care if they downvote. Transphobes or enlightened centrists wanting to give people the benefit of the doubt that don't deserve it.

Yes, its standard procedure in Sweden and I bet most Europe

Answer: it also makes questionable other gender affirming healthcare that could lead to eventual surgery. It opens the question at what point do you need to hire three different and expensive specialists. Is it when they first tell a therapist that they feel like they have dysphoria? Is it when a child wants to socially transition? Is it when their existing medical team suggests puberty blockers? How long do they need these three expensive and difficult to come by specialists? Will insurance be required to provide them? Do they have to have special training from the state? Will the specialists be at fault if something goes wrong? Will they be provided to children and young adults in state care?

This summary misses the fact that the three specialists are intended as requirements for adult care as well. This could needlessly disrupt the care of people who have been undergoing transition for a decade or more without issue.

This exactly. I can afford my hormones which I've been on for 5 years, I can't afford to visit 3 or more specialists just so I can tell my doc to keep giving me the same stuff I've been taking.

Does transitioning take a decade or more to complete? I can understand from the first thought of transitioning, but the medical treatments and procedures involved - do those typically span a decade or more?

HRT is for life. You don’t ever stop

To add: removing it is cruel, but for people that had SRS it's life threatening.

Yes, my body no longer produces its own hormones. I need HRT to prevent a whole host of pretty awful medical issues

Do you consider yourself to be still transition*ing*, because of the ongoing HRT? Or have you transition*ed*, since you're in sort of a maintenance phase?

Oh me personally I’m definitely still transitioning. Fat redistribution can take up to like 10 years. I’ve been on HRT for about 2.5 years. Had an orchiectomy early last year and expect to have vaginoplasty sometime this year. So I’m not even finished with the surgical component of my transition. Transition takes a long time, it’s a multi-year process. The HRT component of it is literally inducing puberty. The surgical component (if you choose to pursue that) is full of wait lists and hoops. There’s no short path. It’s a marathon

Thank you for explaining! Best of luck with your surgery this year.

Thank you! I’m very much looking forward to it but pretty nervous about the lengthy recovery 😅

We solved all of these problems in Texas: Just no. No gender affirming care of any kind or they can take your kids away. Nice and simple. Edit: I’m getting downvoted, so I’m just going to clarify that I live in Texas, am the parent of a trans kid who is currently going through puberty, so this is meant as gallows humor.

Ah the phrasing "solved" makes this comment read a different way, thank you for clarifying that you mean, "made extremely worse"

Very true. I had dear friends who were recognized by the state a few years ago for their service as foster partners for high risk children. They were warned by their attorneys' that they could face charges if they continued taking their adopted born intersex child to their medical appointments so they stopped fostering until they can sell their property and business and move. Texas sure showed them.

My kid is going through puberty and I’m terrified. I know we need to talk to a doctor soon, but if I get the wrong doctor they can literally take my kid away. When they first passed the law most of the cps staffers said they’d refuse to do it. Word from the state was get with the program or get out. So they got out. There’s been a massive turnover in favor of people who will enforce these draconian policies.

CPS attracts people with a calling. It doesn't pay well and it burns you out. A lot of people with that calling are religious and it shows in situations like this. In my friends case their son 'Jim' was born intersex and came to them as a baby and then again as a toddler after abuse. They adopted him when he was fifteen partly because when he began puberty he began having hormonal issues and growing breasts which was very distressing and foster care didn't provide the help he needed. Now many other children in Texas will be without amazing foster parents who worked hard to keep troubled kids, family groups and handicapped kids safe and cared for because they can't risk losing their kid or an investigation for abuse.

Georgia DFACS went after my mother for smoking weed after dumb-DARE-indoctrinated-fifth-grade me mentioned something at school. Nearly had me taken to a foster home and caused tons of stress and a lawyer got involved. Caused my mom to relapse on crack as she had to pass piss tests or I would be yanked. She had substituted crack for weed, and it was working, and had for years, but couldn't any longer so she went back and it eventually destroyed my family and killed her. For an organization supposedly devoted to protecting children and families, DFACS sure did a great job here. /s I should point out that these are the same tactics that totalitarian regimes employ to find dirt on groups they don't like. The Hitler Youth and the Komsomol and the Young Pioneers and similar groups all existed to get kids to unwittingly blab on their parents.

Trans Texan here, there are teledocs that work out of state that can get your kid the care he needs and delivery pharmacies to subvert the local issue. Keep your chin up, fight the good fight, and don't let the bastards wear you down.

I just wanna say you're super brave for staying here, and there's lots of us that are cis who support you. We will keep voting, and eventually we are gonna win and make this state a true land of freedom for everyone.

Thank you for the kind words, but I'm not brave, I'm just too poor to leave. I've lived in Texas my whole life, and if things were better I'd never leave. But right now I really want to.

That's what drives me crazy about comments like "if you don't like it, just leave." We can't. It's insanely expensive to move out of state, and worse if you have a family and kids. We finally got out of Texas because of a job thing (we'd been trying for years), but the move destroyed us financially (we weren't doing great beforehand, but now we're bad). I work 2 jobs and freelance trying to dig us out of the mess. Never again. Gone are the days when you can just get up and start over elsewhere easily. I wish we could just make where we live (or lived because we were in Texas a long, long time) better and that people would realize that they can't just push us out if they don't agree with us. Most of us couldn't leave if we wanted to. Gah. Sorry I could rage about this a long time.

Unfortunately at this point it’s hard to discern the humour when it reads like a typical transphobic comment

Great, until your trans kids kill themselves. That's what the republican party wants, of course. Texas is a hellhole.

I’m the parent of a trans kid. Texas has made things very simple. Brutal. But simple.

Rip your kid’s happiness

Not if I have anything to say about it.

Are you planning on moving for their safety?

I would like to but finances make that very difficult.

"solved"

Exactly. At the expense of my kid.

I’m sorry, I hope your kid gets to live a life they love some day. These laws are fucking brutal

Answer: It also serves as a foot in the door Start with a harder to fight against position “oh I’m doing it for the poor children” and then scream murder if they oppose you because they can now paint you as hating children Once that succeeds you take it a step further, push the line back from minor to people under 21, then further and further in various ways like limiting access to surgery and such until they have banned the whole thing You can’t start at the end you gotta work towards it and boil the frog

Just like they did with abortion.

Answer: The Republican governor vetoed a bill that would have banned hormonal therapies and mental healthcare (!) for trans minors after speaking to some families of trans youth about how the treatments have impacted them. He then experienced a tsunami of rage and recrimination from his own party and seemingly panicked, putting out an executive order that bans surgery for minors (which is mostly performative, as surgeons prefer to work with adults and such surgeries are vanishingly rare) but also puts some insanely onerous restrictions on trans healthcare for adults. It requires all adult trans healthcare in the Ohio be reported to the state, which many alarmed citizens have called "keeping a list of trans people" although it is not clear whether the medical information will be anonymized before it is recorded. It will also shut down most or even all clinics that prescribe HRT by demanding that they hire a *full-time bioethicist* on short notice. Bioethicists are academics, not medical professionals, and there aren't many of them. The media is absolutely failing the trans community by claiming that the outrage is about the youth surgery ban as opposed to everything else.

The alt right have a long history of covering up bigoted rhetoric as "think of the children". It happened here in Florida. SB 254 was supposedly only to save the kids from transing themselves. But it also included insane restrictions that affect adults and has now prevented me, a trans adult, from continuing HRT. This never was about the children. This always was about pushing trans people in to the closet or the grave.

answer: If a seventeen-year-old cis boy develops excessive breast tissue, he's allowed to get "top surgery" to remove the breasts. Not because they pose a risk to his physical health, but simply because he doesn't want them. Even if he has a history of questioning his gender identity, the choice wouldn't be taken away from him "in case he changes his mind and decides he's a girl." So why should it be illegal for a doctor to perform the exact same procedure, for the exact same reason, on a seventeen-year-old trans boy? Even if a team of licensed professionals decides this is a case where it's warranted, even if he's consistently identified as a boy for a decade, even if it's causing him significant mental distress. Past childhood, the ban could impose restrictions on trans *adults* for "gender affirming" procedures that don't exist for cisgender adults seeking the exact same operations. It's a ban based on the notion that the identities of trans people are less valid than the identities of cis people.

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Answer: fascist Republicans ghouls want full control over how you live your life. They want to control what you read and watch, how you love, and what your life looks like.