Unnecessary Mastectomy Math
Quantifying the Harms of Teen Gender Therapy, and the Harms of Not
I understand the argument for puberty blockers in trans youth. I imagine a lot of adult transitioners who are fully committed to transitioning wish they could roll back the clock and begin the transition earlier, so their bodies developed over time more like they wished them to. Especially regarding things like facial and bone structure, which are heavily hormonally influenced during someone’s growth years. But I’m not convinced that everyone getting these sorts of treatments in their youth would have ended up fully committed to trans if the treatment didn’t occur. Puberty is, in part, nature’s way of trying to unconfuse you about your gender if you’re on the fence about it before puberty kicks in. And the for-profit doctors who benefit from providing this sort of treatment have no real incentive to recommend against it, so there’s a market driver to push kids one direction instead of another.
That market driver appears in all medicine. If you have back problems and go to a chiropractor, they will recommend chiropractic. If you go to an orthopedic surgeon, they will recommend surgery. If you go to a personal trainer, they will recommend dead lifts. And in truth the personal trainers are probably more correct than the other two, even though they make the least amount of money. We see this same dynamic across all fields of medicine. Obstetricians funnel women into cesarean sections instead of live births, for instance, but women have viable alternatives with midwives. For children with amblyopia, ophthalmologists recommend eye patches and surgery while optometrists recommend vision therapy. Where else do possibly-trans kids go for a second opinion? It seems to me as if the only options on the table are either gender transition doctors or church, with no other counterweight to the treatment plan. There’s a case that something like a ”trans midwife” would be valuable, as an alternative to medical interventions.
The “trans youth” discussion is, at its root, about weighing harms. On one side of the scale, the modifications that natural hormones do to someone’s body who’s committed to trans are unwanted, and in their view damaging, and some of them are mostly irreversible. So that’s an irreversible harm. On the other side of the scale, any early misdiagnosis could lead to affirmation therapy, then to medical intervention, then to surgery. And if this misdiagnosis is identified after the fact, then the surgeries are also an irreversible harm. The harms must be weighed against each other.
And when you dig up that root and distil it into Argument Tea, it tastes like a disagreement about how much of each of these harms is on either side of the scale. Is there a way we can quantify these harms mathematically?
When Gallup tracks LGBT identification over time they peg the current national average at 5.6%, up from 3.5% in 2012. 11.3% of those identify as trans, which translates to a national population transgender rate of 0.6%.
Let’s put these numbers into perspective.
If your children have 3000 kids in their high school, and 168 of them come out as gay with 18 trans, that shouldn’t be alarming at all. That should be expected, based on historical averages. If 504 come out as gay with 54 trans, then that would mean that two out of three trans are probably actually just gay, and two thirds of the whole group are posers doing it for attention. And those are exactly the sorts of rates we’re seeing with modern Gen Z high schoolers, where one in six identify as LGBT, and 1.8% of youth identify as trans.
High schoolers do all sorts of stupid stuff for attention. I was a high schooler once. I cannot enumerate how many stupid things I did in high school. And I don’t necessarily think it’s particularly damaging for a high schooler to pose as gay to gain virtue within Woke subculture. But getting irreversible surgery to fit in might be.
HWFO has gone deep on the morality structure of the emergent Woke pseudoreligion many times before, but it’s worth restating here. The Woke classify every person using the lens of “intersectionality,” which states that all people belong to a nested layer of “privileged” and “marginalized” groups. They then grant more social virtue to the marginalized to compensate for historical social subjugation and promote social equity. The more boxes you check in the “marginalized” column of the intersectionality matrix, the more social virtue you accrue in the Woke system. It systemizes “the meek shall inherit the earth” and enforces it with social rule.
Some marginalized categories are genetic, some are not. Someone within Woke culture used to be able to identify as anything they wanted, and seize more virtue, but the Woke evolved the rules to plug some of these holes but not others. Since the 2015 Rachel Dolezal cancellation, a Woke can no longer identify as black, but they can still identify as gay or trans and accrue virtue that way. And trans gains more virtue than gay because trans is more marginalized.
Intersectional virtue climbing is a real thing, and we see very public examples of it in Rachel Dolezal, Jussie Smollett, and such.
The idea that someone would identify as trans to gain virtue or popularity is very counter to the experience of most adult trans folks, who have had a very hard time with the social pressures they experienced in the 90s or earlier trying to live their life in the way they prefer. They’ve had a long row to hoe. But the pendulum of acceptance has swung so far to the left for the modern youth that not being gay is a social detriment in some circles, and some kids are under the opposite pressure. Sometimes this pressure even comes from Woke parents who themselves would gain social virtue on Facebook for bragging about their “stunning and brave” trans kid to their Woke friends.
If two sets of Woke parents meet for dinner, and they randomly discover they both have trans kids, the natural odds of that happening is around one in twenty-eight thousand. Those parents should consider the possibility that one or both of their kids are doing it to be cool, and think very hard before encouraging medical transition.
The transgender community itself has a word for this. “Transtrenders.” Clever, albeit some of the trans community don’t like this word, or speaking about this topic, so some of their conversations about this must remain private. I also think “transposers” would have also been a good word, but I suppose 80s skate punk lingo doesn’t have a huge overlap with the modern transgender culture.
Born That Way
When the public debate over gay marriage was raging in this country, one of the strongest and in my opinion most believable cases made in favor was that gay folks are “born that way.” And based on my own personal experiences with gay folks, I believe they are.
If you're "born that way" then the true rate should be stable, flat out. If you're not "born that way" and it's environmental, then "pray the gay away camps" actually work. One or the other must be true. And if it’s a complex dance of both, as most things turn out to be, then we need to tease out that complexity to have a meaningful discussion on the topic, specifically differentiating between genetics, physical environmental factors, and social environmental factors.
If we presume that genetic dispensation towards identifying trans is a fixed number based on genes, and that the gene pool of the country has not significantly changed over the past few years, then the recent rise in transgender identification is environmental in nature. Environmental factors can be subclassified as either “of the physical environment,” such as things like hormones in the water supply, microplastics, soy, pesticides, or any other explanation up to and including the latest Alex Jones rant, or “of the social environment,” which would include an overall increase in societal acceptance of alternative sexual lifestyles but would also include intersectional virtue climbing.
If we presume that the physical environmental factors affect males and females equally, and we further presume that overall acceptance of transgender lifestyles has risen equally for both MTF and FTM trans identifiers, then the rates of FTM and MTF transitioners among high schoolers should rise equally. This is not the case. There are far more FTM transitioners than MTF transitioners, so the delta between those two rates must be due to intersectional virtue climbing by process of elimination. To be clear, some of the rise in MTF transitioner rate could also be due to intersectional virtue climbing, but the delta in the rates must be, if the other presumptions above hold. Numbers on this are hard to come by, but some clinicians are seeing 65% to 70% rates of FTM transitioners out of the total pool.
And this matches what we know about the psychology of high school girls, who are far more body conscious, far more focused on popularity, and far more focused on in-group identification than are high school boys.
“Physical environment factors” equally applying to boys and girls is a presumption, but I don't think it's a bad presumption if you go through the possible physical environment candidates. Most of the hormone research has been about excess estrogen in the water supply, and most of the microplastics research has similarly been about estrogen related stuff. The "testosterone apocalypse" research shows T levels are dropping in humans and animals. If anything, the environmental factors should be weighted towards MTF instead of FTM, yet FTMs are the preponderance of high schoolers identifying as trans. If anything, the presumption of gender neutral physical environment factors should be the most conservative case.
If 33% of transitioners are MTF, and 67% are FTM, and if the “true rate” driven by either genetic or physical environment factors should be relatively balanced, then it stands to reason that approximately half of the FTM transitioners are doing so because of social pressures or Woke virtue climbing.
What are the overall rates of these surgeries? Honestly not that high, at least not yet. According to the American Society of Plastic Surgeons, there are around 10,000 gender transition surgeries performed per year in the United States, 70% of which are FTM. If it turned out that the delta between FTM and MTF was explainable by social factors, then that would mean around 4000 mastectomies are performed per year on women and girls who are identifying as trans for social reasons. In a country of 330 million people, that’s only about 1.21 per 100,000, which isn’t a very high rate. But our perception of that rate might change depending on what we compare against. For instance, that’s about the same rate as cervical cancer death, and it’s a 4.5 times higher rate than the rate of domestic homicide against women by intimate partners.
This is all just a spitball calculation, but if we presume that 4000 gender reassignment surgeries per year are not truly necessary, that means that around 6000 are, and that hormone blockers in pre-teens would be beneficial to those 6000 patients. Then we put the 6000 cases on one side of the scale, and the 4000 on the other side, and we weigh how important the hormone blockers are to one side versus how bad getting an unnecessary surgery is on the other. Then we see which way the scale tips.
I don’t pretend to have any way to assign those weights, so we’re at the end of the thought experiment without the answer we’re looking for. If not getting hormone blockers early is just as bad to the truly trans as getting an unnecessary mastectomy is to the transtrenders, then hormone blockers in kids are a good idea. If getting an unnecessary mastectomy is twice as bad an outcome as not getting hormone blockers, then hormone blockers in kids should be banned.
And the best overall outcome would be if we scrapped intersectional virtue climbing entirely so the transtrenders went away and the transgender rates normalized around a number determined by nature.