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CAE_Jones comments on Open thread, Nov. 09 - Nov. 15, 2015 - Less Wrong Discussion
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Prepare yourself.
This may shock some of you, even by my standards.
Suspend your judgement for a moment to objectively consider the prospect of chemical castration.
There are health benefits, and growing numbers of voluntary eunuchs who don't do it because of prostate cancer or coercion.
I, for one, have felt compelled to chemically castrate for many years. I do not know if the feeling that my sexual urges are more trouble than they are worth is idiosyncratic or more widely shared, but too taboo to act upon. So, I'm opening up the question to the thread!
I have some reservations based on implementation. So, even if I do decide it would be a desirable course of action, the execution may be delayed until the evidence of safety becomes clearer or new techniques emerge.
My concerns specifically are:
I would appreciate any evidence anyone can dig up on bone mineral density loss and chemical castrates, relating to long term use and reversibility. I'm struggling to find what I need. And, in the spirit of improving my research skills - if you can give me suggestions for how to do it myself (keywords for google scholar, for instance) that would be good as an alternative! It seems to be a very long and specific question so it's hard to get clarity!
I'll probably trial depot medroxyprogesterone acetate (antiandrogen associated with bone mineral loss for long term use) and trial Benperidol (antipsychotic that reduces sexual urges) instead of Androcur, since the latter has well known depression and withdrawal side effects. There seems to be a huge vacuum on internet information and research on the antipsychotic. But, it may be easier for me to get access too since I have other, ambiguously psychotic symptoms. Any info on that antipsychotic truly appreciated. Given that it's the most potent neuroleptic (tranquiliser), and I've been on other antipsychotics which were overwhelmingly neuroleptic (and thus I discontinued them), I most likely won't give it a try, actually.
edit: I'm considering this now in light of reflection on other libido reducing substances (antidepressants) that didn't feel very good. Sexual desirelessness felt and probably will feel undesirable in light of this, contrary to my earlier thoughts
It would be the most helpful if done prior to puberty.
I'd worry about cardiovascular side-effects, fat accumulation/redistribution, mental side-effects (something something spatial rotation)... basically, I've studied this on and off since puberty (and not before, because life would be boring if I could do anything right the first time), and concluded that, given my current state of health, castration would probably make more things worse than it improves. Actually, I concluded that circa 2008, and I'm pretty sure I was ever-so-slightly healthier then.
Interesting, might have to look into this some more.
Yeah, the fat distribution thing motivated me not to transition MTF when I was in high school. That and plenty of trannies regret it, most don't pass, and transitioning is more fad than evidence based treatment to gender dysphoria. Plus I reckon in retrospect it was just a bit of transvestic fetishism which isn't good to 'treat' with transitioning.
But yeah, different reasons now.
Really? I'd heard the opposite, that regret is rare and that transitioning clearly improves quality of life. Based on a brief Googling, most studies seem to find low regret and improved quality of life post-transitioning, according to e.g. http://transascity.org/quality-of-life-in-treated-transsexuals/
IIRC, transitioning improves QOL for people who don't fall into a number of exclusions that I'd suspect are very frequently comorbid with self-reports of transgender identity and/or gender dysphoria. On the same token, I reckon lots of people without gender dysphoria can benefit from transitioning, depending on their risk tolerance, undersanding of sexual strategy and such. But that's not gonna be a useful spiel for many if anyone who will read this.
...
Yes, I would hear the opposite too predominately, before I started looking into it with a neutral frame. I'm not saying the evidence would stack that way again now, since I did my informal survey of the evidence for myself years ago. But, some reasons to be skeptical of the answer of 'transition' to the instances of gender dysphoria:
Bias
On the internet, there are some of the most blatant reporting biases. Particularly when there are communities to generate a particular kind of sentiment. Combined with significant political influence and 'alliance' with the other LGBI bla bla bla letters, you get yourself, well, a huge circle jerk.
If you're looking for something with the slightest bias in your keywords, you're likely to find it. Heck, Google's AI could pick up on bias in your keywords 6 months ago in the search results it shows you.
The systematic review linked to is very good, actually. But it's hosted by a trans collective. I'd be suspicious of bias naturally. That may just be an artifact of pay-walling that they're kindly willing to flour though.
methodology
Their primary outcome of interset is suicide risk yet it looks like there are only 3 studies that report on it - 1 saying transtiioning increasing risk the others saying it decreases, then about 20 studies not reporting on it...doesn't give me any confidence in the paper. My general impression from interaction with an (albeit, marginalised subpocket) of transexuals is that the sophistication of current psychological tools are insufficient to grasp the complexities of this issue. They aren't an exception in this, I reckon the same could be said about a number of personality disorders (of which gender dysphoria is not one).
Importantly, the first thing that sets of alarm bells in the article is that they term transitioning as 'treatment'. Standard literature would use the term intervention or an otherwise neutral term. It's just a bit odd. I didn't read through the bulk of the content below the table so I won't comment, but it looks properly cited and I saw words like depression and anxiety.
Oh forgot, the other primary outcome of interest seems to be 'overall impression of quality of life years'. I can't take that seriously based on a number of things - e.g. non-apriori specification of what would constitute better quality of life, QUL measures are, as a class, shit psychometric tools (tell me about validity all you want).
Ok, I've got to the end of this little rant and I'm coming to suspect my frame of mind looking at the paper was to dispute what you said. Not to evaluate it objectively at all. Please frame what I've said in that way - I've been very biased myself here.
Fuck you motivated reasoning.
I'm not sure that any ever do. It is, I have heard, standard wisdom amongst experienced transsexuals, that every time you walk down the street, you will be read (as they call it). Not by everyone all the time, but every time by someone. The most that can be achieved, which is largely up to the people around one rather than oneself, is to be accepted as a transsexual, as someone who has chosen to adopt certain gender appearances and performances. Becoming indistinguishable from the other sex, even if only in non-intimate situations, is not currently possible.