"Bound by law to offer gender affirming advice."

[foreverbull]

I just don't think there can be a meaningful conversation about transition without fleshing out various subtypes of people seeking to transition for it appears a very heterogenous group.

In males, Blanchard (when originally writing about the in 1990's uses very non pc term transexual) makes a distinction between:

• homosexual transitioners (e.g., the boy with gender dysphoria, loved doing girly things before/after puberty, will grow up and date males, regardless of if they transition)
• heterosexual transitioners (e.g., those who transition later in life, usually into masculine things before/after puberty, did not have gender dysphoria until later in life, often have autogynephilia, will adopt a lesbian identity post transition, often to not get bottom surgery)

In females, who are comparatively rare when compared to male transitioners:

• Females with gender dysphoria
• Females with late/rapid onset gender dysphoria

The final cluster includes the biological rare cases, endocrine disorders, congenital malformations, etc.

Rapid onset is not a legitimate phenomenon with gender dysphoria. This idea came about in a research study because parents who were told later about their kids’ identities were in shock and denial, not that the phenomenon itself was rapid. Social contagion happens but is also not rapid onset because it’s not real—it’s moreso that teens are exploring their identity and labels and then drop them later.

Research says that those with gender dysphoria from childhood with the stable feature of a child saying “I am a ——“ (opposite gender identity that is stable over time) that persists into adolescence and then adulthood is unlikely to subside without transition.

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[foreverbull]

The GOP and far right LOVE to rally people on this issue by fearmongering. It works.

The reality is that practitioners do not rush children or adolescents into surgery in the U.S. from everything I’ve seen in my training in this over the years. It is a careful process of exploration. I’ve talked about this before in this forum. I don’t know any psychologist who rushes people into surgery. If it is happening, I’d like to know where and who is involved.

Gender affirming just means you’re open to exploration rather than judgment, and recognize that society can be wrong about its treatment of folks. And, if it is stable over time, you’re open to taking further steps to help the person get additional treatment for gender dysphoria.

Check out the WPATH standards for more info and refer out when it is out of your competence.

One last thing I want to add is that we need to make sure boys and girls are allowed to express themselves fully in childhood—ie expressing both masculine and feminine traits without stigmatizing it or saying they don’t fit into their gender. Our society needs to tolerate a range of expressions from even cis folks so that kids don’t get confused that things like playing with an opposite gender toy automatically means gender dysphoria. It doesn’t.

 

[borne_before]

Rapid onset is not a legitimate phenomenon with gender dysphoria. This idea came about in a research study because parents who were told later about their kids’ identities were in shock and denial, not that the phenomenon itself was rapid. Social contagion happens but is also not rapid onset because it’s not real—it’s moreso that teens are exploring their identity and labels and then drop them later.

Research says that those with gender dysphoria from childhood with the stable feature of a child saying “I am a ——“ (opposite gender identity that is stable over time) that persists into adolescence and then adulthood is unlikely to subside without transition.

This feels a little agendized to me.

 

[WisNeuro]

This feels a little agendized to me.

Can you be more specific?

 

[foreverbull]

This feels a little agendized to me.

Rapid-onset gender dysphoria controversy - Wikipedia

en.m.wikipedia.org

This has a good summary. Littman’s paper should be accessible online. Keep in mind Littman popularized the term that you’re using from this one flawed study/theory, which tells me how much the idea has spread (speaking of agendas).

 

[borne_before]

Rapid-onset gender dysphoria controversy - Wikipedia

en.m.wikipedia.org

This has a good summary. Littman’s paper should be accessible online. Keep in mind Littman popularized the term that you’re using from this one flawed study/theory, which tells me how much the idea has spread (speaking of agendas).

I mean like all research has flaws.

 

[WisNeuro]

I mean like all research has flaws.

Can you point out your specific concerns about this research?

 

[ClinicalABA]

I mean like all research has flaws.

Not true. All research is limited in it's application and interpretation based on things like sampling distribution, experimental design, choice of statistics, etc. However, I think you'll find that (probably) most research in appropriately peer reviewed journals follows acceptable methodologies with good controls on internal validity and at least some mind to external validity. Sure, you don't always see a good power analysis and every now and then you still see a bunch of planned comparisons (and occasionally post-hoc ones too) without appropriate alpha adjustments, but I don't think that's what you're talking about.

Flawed uses of the research (including ignoring the limitations that the authors themselves point out), you betcha. Actual flaws in the research design- much less so. Certainly not "all research".

 

[ClinicalABA]

Rapid-onset gender dysphoria controversy - Wikipedia

en.m.wikipedia.org

This has a good summary. Littman’s paper should be accessible online. Keep in mind Littman popularized the term that you’re using from this one flawed study/theory, which tells me how much the idea has spread (speaking of agendas).

Even ignoring the concerns with the sampling procedures, Littman's Conclusion section begins "This descriptive, exploratory study of parent reports..." Anyone with rudimentary knowledge of statistics (yep- I'm employing argumentum ad ridiculum) should know that whatever follows should be treated cautiously- certainly not taken as evidence of a clearly defined, new psychological condition/diagnosis.

ETA- A major flaw with the sampling in this study is that the researcher recruited survey respondents from online discussion groups where parents had already concluded that their children experienced rapid onset gender dysphoria, and then use this as evidence for suggesting that rapid onset gender dsyphoria is an actual clinical phenomenon.

 

[MiniLop]

In children I do worry about munchie and personality disordered parents imposing a trans identity on a three year old. Those are probably edge cases but there are a select group of highly publicized early transitioning kids whose parents sure as hell are getting a lot of media attention and the kids transition launch was as savvy as any marketing campaign. My boy is currently working for a “rainbow dinosaur dress” - maybe I could be publishing this on social media and show how I’m the kind of parent who supports their kiddo.

And if anyone has any leads on cool rainbow dinosaur dresses please help me.

I'm sure that's possible, but I work with this population a lot and I've never seen this. In fact, the vast majority of parents I see of trans/non-binary teens are the opposite: "Not my kid! No way this could be true! I refuse to see any evidence to the contrary!"

 

[borne_before]

Not true. All research is limited in it's application and interpretation based on things like sampling distribution, experimental design, choice of statistics, etc. However, I think you'll find that (probably) most research in appropriately peer reviewed journals follows acceptable methodologies with good controls on internal validity and at least some mind to external validity. Sure, you don't always see a good power analysis and every now and then you still see a bunch of planned comparisons (and occasionally post-hoc ones too) without appropriate alpha adjustments, but I don't think that's what you're talking about.

Flawed uses of the research (including ignoring the limitations that the authors themselves point out), you betcha. Actual flaws in the research design- much less so. Certainly not "all research".

I've never read a perfect study methodologically.

 

[R. Matey]

I've never read a perfect study methodologically.

Trying to get a sense of the logic here: "study is not perfect, therefore it's conclusions should be dismissed" ?

 

[ClinicalABA]

I've never read a perfect study methodologically.

I call BS and think you are being disingenuous here, but whatever.

Since it would be so difficult/time consuming to look at all studies (or even just all studies that you have read) so as to make such a task impossible, I can't prove or disprove your statement.

Let's look just at the study in question. The sampling procedures in this study were such that any other results would be highly unlikely, therefore the existence of this phenomena cannot confirmed or disproven from the results of this study.

Let's say that I was doing survey research on the existence of "Republican Hatred for the Environment Disorder." Firstly, survey research would not be a good way to confirm or disprove the existence of such a phenomena. If I drew my sample only from the "Joe Biden is the sexiest man alive" and "Prius Owners of America" online chat forums, I'd be unlikely to reach any other conclusion than that such a predominant view exists among Republicans.

Survey research has it's uses, and it is IMHO, important to get information from parents who's children have experienced gender related issues that the parents did not notice earlier. But to only survey parents who already self-identify as not having noticed the issues earlier (through their online-behavior) severely limits conclusions drawn from those survey results because it would be highly unlikely to get anything other that a preponderance of reports supporting the existence of sudden onset gender issues. It does not mean the data is useless in total, just that there is a VERY MAJOR threat to internal validity.

This is not my area of study, and I am not up on the research. I am, however, somewhat "learned" in the topic of research design. Looking just at the Littman study, all I can conclude is that this group of parents has reported that their children began discussing gender confusion issue after engaging in certain social media or friend groups. This could be for several potential reasons, one of which being that there is an actual phenomenon of rapid onset gender dysphoria. Also possible- the children have experienced this issue for much longer, and only brought it up with the encouragement and sense of belonging offered by these groups. Also possible- the children or parents are malingering. The null-hypothesis of "there is no such thing as the existence of sudden onset gender dysphoria" cannot be disproven given the research design. Moreover, the sampling methods and data analysis procedures (for what they were) were unlikely to result in anything other than parents reporting a sudden onset of gender dysphoric issues.

TLDR- Does sudden onset gender dysphoria exist? The Littman study is unable to answer that questions and the sampling methods are unlikely to result in anything other than what seems like (but isn't technically) support for a position that it does exist. Therefore, only reading this study, I don't know if it exist or not.

 

[borne_before]

Trying to get a sense of the logic here: "study is not perfect, therefore it's conclusions should be dismissed" ?

I agree.

I call BS and think you are being disingenuous here, but whatever.

Since it would be so difficult/time consuming to look at all studies (or even just all studies that you have read) so as to make such a task impossible, I can't prove or disprove your statement.

Let's look just at the study is question. The sampling procedures in this study were such that any other results would be highly unlikely, therefore the existence of this phenomena cannot confirmed or disproven from the results of this study.

Let's say that I was doing survey research on the existence of "Republican Hatred for the Environment Disorder." Firstly, survey research would not be a good way to confirm or disprove the existence of such a phenomena. If I drew my sample only from the "Joe Biden is the sexiest man alive" and "Prius Owners of America" online chat forums, I'd be unlikely to reach any other conclusion than that such a predominant view exists among Republicans.

Survey research has it's uses, and it is IMHO, important to get information from parents who's children have experienced gender related issues that the parents did not notice earlier. But to only survey parents who already self-identify as not having noticed the issues earlier (through their online-behavior) severely limits conclusions drawn from those survey results because it would be highly unlikely to get anything other that a preponderance of reports supporting the existence of sudden onset gender issues. It does not mean the data is useless in total, just that there is a VERY MAJOR threat to internal validity.

This is not my area of study, and I am not up on the research. I am, however, somewhat "learned" in the topic of research design. Looking just at the Littman study, all I can conclude is that this group of parents has reported that their children began discussing gender confusion issue after engaging in certain social media or friend groups. This could be for several potential reasons, one of which being that there is an actual phenomenon of rapid onset gender dysphoria. Also possible- the children have experienced this issue for much longer, and only brought it up with the encouragement and sense of belonging offered by these groups. Also possible- the children or parents are malingering. The null-hypothesis of "there is no such thing as the existence of sudden onset gender dysphoria" cannot be disproven given the research design. Moreover, the sampling methods and data analysis procedures (for what they were) were unlikely to result in anything other than parents reporting a sudden onset of gender dysphoric issues.

TLDR- Does sudden onset gender dysphoria exist? The Littman study is unable to answer that questions and the sampling methods are unlikely to result in anything other than what seems like (but isn't technically) support for a position that it does exist. Therefore, only reading this study, I don't know if it exist or not.

These are good points.

There is just so many unknowns and lack of longitudinal data. I may reconsider my conceptualization of ROGD.

 

[Ollie123]

Just going to throw out there for context, that most estimates I've seen suggest much higher levels of regret for knee and hip replacements than for gender reassignment surgeries. Admittedly those estimates are based on adult populations. Still, if we're going to take a strong stance on not doing surgeries because "People might regret them later" and not because of political/religious beliefs, we probably need to take those ortho surgeons to task.

As with most things politics these days, I feel like the forest is being lost for the trees. We can provide a positive, non-judgmental environment for people to explore their identity. We can encourage people to think carefully before making major life-altering decisions. We can recognize that the average person probably will think hard before making major life-altering decisions, but can consider impulsivity and maturity level in our analysis of the situation. We can accept that perfect decision-making is impossible and some people may regret their decision, but that this isn't a rationale to categorically deny everyone a possible outcome.

I feel like the only thing making this hard is people involving religion and politics.

 

[PsyDWannabe]

A patient refusing to consent to a pre-surgery evaluation because they are in denial of XYZ diagnoses versus the clinician refusing to do a pre-surgery evaluation because the patient is in denial of XYZ diagnoses are two different things. And one has to wonder whether the latter is best practice? In my opinion, I think not.

I think a competent psychologist would do whatever they could with the patient, and then offer their opinion to the referral source, inclusive of all of the above. That way your job is done, and the surgeon can take it from there. Refusing someone a pre-surgical eval because they don’t want to acknowledge the potential that they have autism can be interpreted as withholding care, and opens you up to malpractice. Especially with a population as litigious as those typically seen in VA’s.

Just my two cents. Despite our differences of opinion on here, I would hate to see a psychologist jeopardize their license and their ability to earn a living because of politics and ideology. Especially in a completely avoidable situation.

 

[ClinicalABA]

I agree.

These are good points.

There is just so many unknowns and lack of longitudinal data. I may reconsider my conceptualization of ROGD.

Phew! I was expected some retort along the lines of "well it doesn't prove the null hypothesis either", after which I'd hop in my pickup (a 4-cylinder Tacoma- gotta keep that lib cred, right?) and drive all the down there and give you a really sad look and then we'd drink something nice, go fishing, and not talk politics or psychology for a while.

 

[texanpsychdoc]

I find it funny that people on here are more willing to side with the notion that the GOP and "the far right" and conservatives have a skewed agenda and are a group of people who are largely ignorant and wrong.

It's funny people don't have these same sentiments to those on the liberal side of things.

Is it possible this is playing out on both sides. Consider your bias as someone who is more liberally oriented. Is it possible the extant literature you are pulling and how you are interpreting things are with a a certain tinted spectacles? Is it possible for all of us to have a bias on this topic?

 

[texanpsychdoc]

Phew! I was expected some retort along the lines of "well it doesn't prove the null hypothesis either", after which I'd hop in my pickup (a 4-cylinder Tacoma- gotta keep that lib cred, right?) and drive all the down there and give you a really sad look and then we'd drink something nice, go fishing, and not talk politics or psychology for a while.

Ford F-150 here.

 

[texanpsychdoc]

A patient refusing to consent to a pre-surgery evaluation because they are in denial of XYZ diagnoses versus the clinician refusing to do a pre-surgery evaluation because the patient is in denial of XYZ diagnoses are two different things. And one has to wonder whether the latter is best practice? In my opinion, I think not.

I think a competent psychologist would do whatever they could with the patient, and then offer their opinion to the referral source, inclusive of all of the above. That way your job is done, and the surgeon can take it from there. Refusing someone a pre-surgical eval because they don’t want to acknowledge the potential that they have autism can be interpreted as withholding care, and opens you up to malpractice. Especially with a population as litigious as those typically seen in VA’s.

Just my two cents. Despite our differences of opinion on here, I would hate to see a psychologist jeopardize their license and their ability to earn a living because of politics and ideology. Especially in a completely avoidable situation.

I think there is a distinction between simply refusing to do the pre-surgical eval because of some bias or that the patient in question is in denial vs. good clinical practice to DDX for something that could be contributing to their current experiences before someone elects to engage in a life-altering procedure. Simply turning a blind eye to the fact that there may be a significantly contributing factor to the person's endorsed symptoms, etc., and we are not willing to entertain those first would be like diagnosing someone with a mood disorder without first recognizing any medical or physiological conditions that could be contributing first before we decided to have a physician prescribe a mood stabilizer.

I am not confident that the example you've provided rises to the level of some biased clinician denying someone access to care. I should also add that from an ethics standpoint, if someone does find they may have a bias (for either in favor or not in favor of something), then they need to consider that and make appropriate preparations to have that person seen by an objective clinician.

I have taken on cases from my colleagues because some aspects of a patient hit too close to home (i.e., child molester, a husband who beats his wife, a soldier who loves to talk about how many people he killed, and some others). In these cases, our chief would delegate theses cases to me so that they would be provided care from an objective unbiased person. We aren't required to work with everybody. Knowing your limitations is equally as important as knowing you're how solid you are as a clinician.

 

[borne_before]

Phew! I was expected some retort along the lines of "well it doesn't prove the null hypothesis either", after which I'd hop in my pickup (a 4-cylinder Tacoma- gotta keep that lib cred, right?) and drive all the down there and give you a really sad look and then we'd drink something nice, go fishing, and not talk politics or psychology for a while.

Hey, my 74 year old father with Parkinson’s just traded in his Tundra for a Tacoma. He likes it because it’s a lot easier to get in and out of and it fits in the garage.

I’m dead serious - I respect the hell outta you and, even, wisneuro and many more on this forum. Y’all have been around the block longer than me - and im sure I bug the hell outta y’all sometimes, too. But, I just appreciate the convo. We’re all on the rocket ship of discovery together. Differing perspectives are only valuable if you appreciate that. I also recognize that i’m not the sharpest tool in the shed and am happy to outsource some of that flaw to more thoughtful people.

I also drive a lifted Tundra.

 

[Sanman]

Hey, my 74 year old father with Parkinson’s just traded in his Tundra for a Tacoma. He likes it because it’s a lot easier to get in and out of and it fits in the garage.

I’m dead serious - I respect the hell outta you and, even, wisneuro and many more on this forum. Y’all have been around the block longer than me - and im sure I bug the hell outta y’all sometimes, too. But, I just appreciate the convo. We’re all on the rocket ship of discovery together. Differing perspectives are only valuable if you appreciate that. I also recognize that i’m not the sharpest tool in the shed and am happy to outsource some of that flaw to more thoughtful people.

I also drive a lifted Tundra.

Now that there seems to be a bit more of the meeting of the minds, what is with all the pickup trucks? 🤔

 

[Shiori]

My husband has a lifted tundra. We have acquired many decent free items. I won't admit it to him, but I'm team pickup truck. Except when they're driving behind me in the dark.

 

[borne_before]

Now that there seems to be a bit more of the meeting of the minds, what is with all the pickup trucks? 🤔

I live out west and tow stuff. It's also a bit of a culture thing of how I grew up.

 

[Therapist4Chnge]

Yes, many unserious people do indeed believe such garbage. And for those in our field, it's quite obvious that they've never talked or had any experience with providers or clinics who do this type of work. Willful ignorance.

They let their feelings drive things, not facts or science.

 

[texanpsychdoc]

Hey, my 74 year old father with Parkinson’s just traded in his Tundra for a Tacoma. He likes it because it’s a lot easier to get in and out of and it fits in the garage.

I’m dead serious - I respect the hell outta you and, even, wisneuro and many more on this forum. Y’all have been around the block longer than me - and im sure I bug the hell outta y’all sometimes, too. But, I just appreciate the convo. We’re all on the rocket ship of discovery together. Differing perspectives are only valuable if you appreciate that. I also recognize that i’m not the sharpest tool in the shed and am happy to outsource some of that flaw to more thoughtful people.

I also drive a lifted Tundra.

I am looking at getting my truck lifted. That way I can totally stir the pot with my colleagues at work. They already know I am gun-toting, gay conservative that drives a Ford F-150. I just need to get it lifted to really fit within the cliche.

 

[borne_before]

I am looking at getting my truck lifted. That way I can totally stir the pot with my colleagues at work. They already know I am gun-toting, gay conservative that drives a Ford F-150. I just need to get it lifted to really fit within the cliche.

You’re in Texas - squat it.

 

[smalltownpsych]

I am pretty sure that there is fear-mongering on both sides of this. Unfortunately, my patients get caught in the middle. I have worked with patients who have been transitioned from a very early age and were some of the most difficult cases to treat at a place that worked with difficult cases to start with. We had many transgender clients ranging in age from 14 to 25 and we found that each of them were unique individuals (just like the rest of our patients 😉) and that some staff and parents were pushing them in one direction and some in another. To be a bit overly broad and categorical for the sake of brevity, some of our patients were on the gender identity being more of a result or symptom or even deflection from their dysfunction and for others their dysfunction was more of a result of the challenges of being or experiencing and maturing in the world as a transgender individual. Political fights don’t help my patients but coming alongside them and helping them navigate their own personal journey from a non-judgemental stance is what really counts.

 

[Shiori]

I think we are all also working from different experiences. Right now my main objective is for them to allow me to advertise that we offer any services related to the LGBTQ+ community. Even the staff don't know what we have available. I would also love if they would stop misgendering my clients and forcing them to go to the wrong bathroom. We have some wonderful staff and we have some folks who have their beliefs and share them...aggressively. My goal is to reduce hostility. I'm not even to the fun, nuanced conversations. When I'm discussing my perspective, it is from that place.

 

[R. Matey]

I find it funny that people on here are more willing to side with the notion that the GOP and "the far right" and conservatives have a skewed agenda and are a group of people who are largely ignorant and wrong.

By all means, put up your position to the group. I'd love to see a post from you that didn't involve name-calling.

 

[WisNeuro]

By all means, put up your position to the group. I'd love to see a post from you that didn't involve name-calling.

Well, that's easier than actually evaluating the literature.

 

[cara susanna]

I think we are all also working from different experiences. Right now my main objective is for them to allow me to advertise that we offer any services related to the LGBTQ+ community. Even the staff don't know what we have available. I would also love if they would stop misgendering my clients and forcing them to go to the wrong bathroom. We have some wonderful staff and we have some folks who have their beliefs and share them...aggressively. My goal is to reduce hostility. I'm not even to the fun, nuanced conversations. When I'm discussing my perspective, it is from that place.

Have you seen the Safe Zone magnets you can put on your door? We have those at our VA.

 

[Shiori]

Have you seen the Safe Zone magnets you can put on your door? We have those at our VA.

I did! I just found out about the training last week, so I'm delving into things. I have been pressing to get any sort of financial buy-in and approval to put up anything. There is a whole approval process and no one is responding to me. I might just have to get in trouble to make them make a decision. I have gotten radio silence on just about everything. I can also think of a few folks who like to think of themselves as safe, but are very not safe. That is a future me issue though. I appreciate the suggestion.

 

[borne_before]

I think we are all also working from different experiences. Right now my main objective is for them to allow me to advertise that we offer any services related to the LGBTQ+ community. Even the staff don't know what we have available. I would also love if they would stop misgendering my clients and forcing them to go to the wrong bathroom. We have some wonderful staff and we have some folks who have their beliefs and share them...aggressively. My goal is to reduce hostility. I'm not even to the fun, nuanced conversations. When I'm discussing my perspective, it is from that place.

I kinda understand part of the bathroom bans. Using Blanchard's taxonomy - I am totally okay with a "homosexual transexual" using mine or my daughter's restroom. I have far more reservations about a "heterosexual transsexual" with autogynephilia using the restroom while my daughter is there. Just to be clear, no super stoked about autogynephilia - seems to a stretch, but if it exists and is driving someone's dysphoria - then that raises an issue of consent. But regardless, I don't want a biological male who considers herself a "lesbian" around my child in a vulnerable setting.

Now, there's a question about governing. I don't really think a law, with the threat of governmental monoply of force, could handle such nuance. And I am totally against hurting homosexual transgender people via discrimination.

I know I am going to killed for this, but I just wanted to discuss this. Now tell me how I am wrong.

 

[foreverbull]

I did! I just found out about the training last week, so I'm delving into things. I have been pressing to get any sort of financial buy-in and approval to put up anything. There is a whole approval process and no one is responding to me. I might just have to get in trouble to make them make a decision. I have gotten radio silence on just about everything. I can also think of a few folks who like to think of themselves as safe, but are very not safe. That is a future me issue though. I appreciate the suggestion.

It irks me when people say they are competent to work with LGBTQ folks but it’s just because they know someone who is gay or read the one chapter in Sue and Sue for a multicultural class. I’ve witnessed someone who said they worked with trans folks and gay folks use outdated or offensive terms like “transgendered” and “Sexual preferences.” Which I’m sure doesn’t bode well with LGBTQ clients they see.

It’s clear that there’s some hubris when it comes to competence in LGBTQ issues our field. Just because you live in a “liberal” city with diversity doesn’t make you competent. Very few folks have actually read about the community or attended trainings but then list LGBTQ identities as part of their competence. Especially where I live, which is known to be a very gay-friendly area. I doubt most people know about the hidden systemic discrimination and microaggressions that LGB folks face when it comes to day to day life. Things like having children (states have ruled against non-birth parents in custody battles but they would never do that to a hetero couple), etc. I just adopted my own child to ensure that when traveling, some other red state can’t say I have no rights in a medical emergency, divorce, etc. My then fiancée years back was kicked out of my hospital room and told to wait in the lobby when I was out of it on pain meds listening to the doctor talk about my health because the nurse was “old school” the other nurses said (meaning bigoted). My fiancée finally just walked back in on her own when she realized why she was kicked out and that no one was going fo invite her back in and ignored him. This is in a “liberal” area.

LGB discrimination isn’t “over.”

 

[PsyDWannabe]

I am not confident that the example you've provided rises to the level of some biased clinician denying someone access to care. I should also add that from an ethics standpoint, if someone does find they may have a bias (for either in favor or not in favor of something), then they need to consider that and make appropriate preparations to have that person seen by an objective clinician.

Correct. And if that is what it is, then the clinician should call it what it is: a bias, plain and simple. Rather than dress it up as the patient being uncooperative resulting in a healthcare service not being provided. Again, I’ve seen cases where situations like this lead to bad licensure problems. It’s not a line that I would toe, personally, but of course you’re free to do as you want. I’m just throwing in my experience for the sake of discussion.

Also, to your other point, refusing to treat someone because you don’t agree with their being trans is very different from refusing to treat someone due to being triggered by their child abuse history. It’s disingenuous to conflate the two.

 

[borne_before]

It irks me when people say they are competent to work with LGBTQ folks but it’s just because they know someone who is gay or read the one chapter in Sue and Sue for a multicultural class. I’ve witnessed someone who said they worked with trans folks and gay folks use outdated or offensive terms like “transgendered” and “Sexual preferences.” Which I’m sure doesn’t bode well with LGBTQ clients they see.

It’s clear that there’s some hubris when it comes to competence in LGBTQ issues our field. Just because you live in a “liberal” city with diversity doesn’t make you competent. Very few folks have actually read about the community or attended trainings but then list LGBTQ identities as part of their competence. Especially where I live, which is known to be a very gay-friendly area. I doubt most people know about the hidden systemic discrimination and microaggressions that LGB folks face when it comes to day to day life. Things like having children (states have ruled against non-birth parents in custody battles but they would never do that to a hetero couple), etc. I just adopted my own child to ensure that when traveling, some other red state can’t say I have no rights in a medical emergency, divorce, etc. My then fiancée years back was kicked out of my hospital room and told to wait in the lobby when I was out of it on pain meds listening to the doctor talk about my health because the nurse was “old school” the other nurses said (meaning bigoted). My fiancée finally just walked back in on her own when she realized why she was kicked out and that no one was going fo invite her back in and ignored him. This is in a “liberal” area.

LGB discrimination isn’t “over.”

Holy hell... I'm so sorry.

 

[Sanman]

I kinda understand part of the bathroom bans. Using Blanchard's taxonomy - I am totally okay with a "homosexual transexual" using mine or my daughter's restroom. I have far more reservations about a "heterosexual transsexual" with autogynephilia using the restroom while my daughter is there. Just to be clear, no super stoked about autogynephilia - seems to a stretch, but if it exists and is driving someone's dysphoria - then that raises an issue of consent. But regardless, I don't want a biological male who considers herself a "lesbian" around my child in a vulnerable setting.

I know I am going to killed for this, but I just wanted to make it clear. Now tell me how I am wrong.

Here is the thing, any law can be abused by party who wishes to do so. In this case, any person can claim any gender identity. I think the issue there becomes weighing the rights of an entire subgroup vs the chances of negative consequences to society at large.

I am afraid about the possibility of school shootings and the risks to my child. Does that mean we should ban guns or open/concealed carry to ensure that no gun violence occurs against the public at large? I picked guns, but this can generalize to any issue.

 

[WisNeuro]

I kinda understand part of the bathroom bans. Using Blanchard's taxonomy - I am totally okay with a "homosexual transexual" using mine or my daughter's restroom. I have far more reservations about a "heterosexual transsexual" with autogynephilia using the restroom while my daughter is there. Just to be clear, no super stoked about autogynephilia - seems to a stretch, but if it exists and is driving someone's dysphoria - then that raises an issue of consent. But regardless, I don't want a biological male who considers herself a "lesbian" around my child in a vulnerable setting.

Now, there's a question about governing. I don't really think a law, with the threat of governmental monoply of force, could handle such nuance. And I am totally against hurting homosexual transgender people via discrimination.

I know I am going to killed for this, but I just wanted to discuss this. Now tell me how I am wrong.

You seem to have a solution in search of a theoretical problem here. Given that these bans do not exist in many places, is there any evidence for an increase of these instances that you are afraid of above what existed prior?

 

[borne_before]

Here is the thing, any law can be abused by party who wishes to do so. In this case, any person can claim any gender identity. I think the issue there becomes weighing the rights of an entire subgroup vs the chances negative consequences to society at large.

I am afraid about the possibility of school shootings and the risks to my child. Does that mean we should ban guns or the open and concealed carry to ensure that no gun violence occurs against the public at large? I picked guns, but this can generalize to any issue.

This is an excellent point. And from a mostly behavioral psychologist - i'm uncomfortable with autogynephilia because it conflates so much to internal behavior.

 

[WisNeuro]

Here is the thing, any law can be abused by party who wishes to do so. In this case, any person can claim any gender identity. I think the issue there becomes weighing the rights of an entire subgroup vs the chances negative consequences to society at large.

I am afraid about the possibility of school shootings and the risks to my child. Does that mean we should ban guns or open/concealed carry to ensure that no gun violence occurs against the public at large? I picked guns, but this can generalize to any issue.

Except that gun violence occurs at shockingly regular intervals, whereas the theoretical issue raised in the prior post is largely imaginary.

 

[Sanman]

Except that gun violence occurs at shockingly regular intervals, whereas the theoretical issue raised in the prior post is largely imaginary.

Regardless of base rates, the question remains the same. The answers may differ based on everyone's individual perspective and tolerance for risk. That is what political discourse is for if done is a respectful manner.

 

[texanpsychdoc]

By all means, put up your position to the group. I'd love to see a post from you that didn't involve name-calling.

I regularly do post my position, and have already done so. Scroll up to read. Not sure what you are referencing about name calling, but okay...


Seems like you'd rather take cheap shots at someone they apparently disagree with on a fundamental level, so how is that different than name calling? The function is still the same in this case.

Well, that's easier than actually evaluating the literature.

I do reference the literature. It may be that maybe the studies we look at are different, or that the interpretations we take of the data is different from one another, but it is still based on scientific principles. I think we have lately been going with a trend that just because it's noted with numbers in statistical form that it equates to being methodologically-sound. We should be able to question things when constructs and methodology frankly do not represent the population we seek to to examine. As someone who does peer-reviews for journals, this is absolutely something I look for when presented a manuscript for publication.


Are you looking for all of us to start a running total of peer-reviewed references on this topic? If so, could we get CEU credits for this little academic exercise?

 

[texanpsychdoc]

Correct. And if that is what it is, then the clinician should call it what it is: a bias, plain and simple. Rather than dress it up as the patient being uncooperative resulting in a healthcare service not being provided. Again, I’ve seen cases where situations like this lead to bad licensure problems. It’s not a line that I would toe, personally, but of course you’re free to do as you want. I’m just throwing in my experience for the sake of discussion.

Also, to your other point, refusing to treat someone because you don’t agree with their being trans is very different from refusing to treat someone due to being triggered by their child abuse history. It’s disingenuous to conflate the two.

I guess I am a bit confused then...it sounds like we are in agreement on the matter, no?

 

[PsyDr]

I hoped that the next "big thing" in psychology was going to be interesting. "It" turned out to just be politics.

 

[Shiori]

I kinda understand part of the bathroom bans. Using Blanchard's taxonomy - I am totally okay with a "homosexual transexual" using mine or my daughter's restroom. I have far more reservations about a "heterosexual transsexual" with autogynephilia using the restroom while my daughter is there. Just to be clear, no super stoked about autogynephilia - seems to a stretch, but if it exists and is driving someone's dysphoria - then that raises an issue of consent. But regardless, I don't want a biological male who considers herself a "lesbian" around my child in a vulnerable setting.

Now, there's a question about governing. I don't really think a law, with the threat of governmental monoply of force, could handle such nuance. And I am totally against hurting homosexual transgender people via discrimination.

I know I am going to killed for this, but I just wanted to discuss this. Now tell me how I am wrong.

The most practical reason is it's against VA policy. When Veterans inquire about how they will be treated when they come to the hospital, they are told they will be allowed to choose their preferred bathroom. We also are required to call them by their preferred pronouns. These are our workplace standards. It is doubly upsetting when patients try to avoid places that are uncomfortable treating them just to have our staff treat them like they're going to be a threat to someone. National says one thing and local VAs do another. It's the VA way for just about everything. We create the expectation that we're changing and are supportive and then staff does things that are well-known to make the experience unwelcoming and sometimes hostile. It is not unheard of for someone to receive a brief sermon about their sins. This isn't just for LGBTQ+ folks. It's a thing. I am basically creating a mental network of providers who won't do mean and dehumanizing things.

 

[borne_before]

The most practical reason is it's against VA policy. When Veterans inquire about how they will be treated when they come to the hospital, they are told they will be allowed to choose their preferred bathroom. We also are required to call them by their preferred pronouns. These are our workplace standards. It is doubly upsetting when patients try to avoid places that are uncomfortable treating them just to have our staff treat them like they're going to be a threat to someone. National says one thing and local VAs do another. It's the VA way for just about everything. We create the expectation that we're changing and are supportive and then staff does things that are well-known to make the experience unwelcoming and sometimes hostile. It is not unheard of for someone to receive a brief sermon about their sins. This isn't just for LGBTQ+ folks. It's a thing. I am basically creating a mental network of providers who won't do mean and dehumanizing things.

I want to be very clear - I always use a person's preferred pronouns. There is an exception, when they use something like "she/they" or neopronouns. But in those cases, I will simply use their name.

 

[R. Matey]

I regularly do post my position, and have already done so. Scroll up to read. Not sure what you are referencing about name calling, but okay...


Seems like you'd rather take cheap shots at someone they apparently disagree with on a fundamental level, so how is that different than name calling? The function is still the same in this case.

All I did was ask you to engage in the discourse by stating your position clearly. If you did, point me to the post, I may have missed it.

I find it funny that people on here are more willing to side with the notion that the GOP and "the far right" and conservatives have a skewed agenda and are a group of people who are largely ignorant and wrong.

Calling people ignorant is name calling.

 

[Shiori]

I want to be very clear - I always use a person's preferred pronouns. There is an exception, when they use something like "she/they" or neopronouns. But in those cases, I will simply use their name.

Oops! Didn't mean to imply that you didn't. My brain was thinking about our hospital issues, specifically.

 

[WisNeuro]

All I did was ask you to engage in the discourse by stating your position clearly. If you did, point me to the post, I may have missed it.



Calling people ignorant is name calling.

I used the term willful ignorance in relation to people who believed a very specific thing. I wouldn't call it name calling in certain contexts. We are all ignorant of things. I am ignorant of the nuances of cricket. However, I do not espouse very strong opinions on this matter of which I am woefully ignorant.