All: there's quite a bit that's interesting here, so please don't post predictable things on any side of the discussion. If it's a political talking point, it's a predictable thing, so please omit those. Instead, remember this from the site guidelines: Comments should get more thoughtful and substantive, not less, as a topic gets more divisive. Fortunately there are many commenters in the thread exemplifying that spirit, so no one has far to look for fine examples.

https://news.ycombinator.com/newsguidelines.html

  The transgender and gender-diverse vs. cisgender effect sizes are equivalent to or larger than the autism vs. non-autism effect sizes and the cisgender male vs. cisgender female effect sizes in non-autistic individuals.

if i understand that right, whether you're trans is a better indicator of whether you have autistic traits than a) your assigned sex or b) whether you are diagnosed with autism

That doesn't necessarily surprise me, actually. I suspect a decent chunk of people here a) consider themselves to have autistic behavioural traits, b) don't see the value of a diagnosis.

The term "diagnosis", to me at least, implies a disorder. Deciding what is a behavioural trait and what is a disorder is, at a guess, not robustly decidable.

This is my 2020 paper in a similar vein.

We found attenuated sex differences in amygdala resting-state connectivity between boys and girls with autism, but robust sex differences in amygdala connectivity in typically developing boys and girls. This pattern was observed using both univariate and multivariate analytical approaches, consistent with gender incoherence hypothesis, which stands in contrast with extreme male brain theory. [addendum: We are examining other networks now, and this pattern is found in other prominent brain networks, but not all.]

https://www.sciencedirect.com/science/article/abs/pii/S24519...

oh interesting. I've had a pet theory for awhile now re: trans/autism comorbidity that they're better thought of as symptoms (among others! op's link notes higher incidence of every surveyed mental disorder) of some underlying brain abnormality, rather than being tangled up in some causal relationship with each other. had not heard of gender incoherence theory before

The point in which autism moves from "neuro-diversity" to "disorder that affects quality of life" is a difficult and controversial discussion. In general we try to use sensitive language, and respect the spectrum.

Many of the genes that control brain development are also linked to sex differentiation, and so it not surprising to me that in the presence of greater number of mutations (technical term) in these genes, the more sexual development will be differentially regulated, and will follow a different trajectory. I suspect, but do not know how to model, that this would tend to result in less sexual differentiation, making the binary male/female extreme phenotypes less likely in ASD.

One thing I would respectfully suggest here is to use language like 'atypical' rather than 'abnormal', as it avoids some of the unpleasant subtext of the latter word. (At least so far - the euphemism treadmill makes for an unending race, but it's still worth putting in the effort.)

maybe it's an overly optimistic hill to die on but imo, the best thing we could do for divergent people is to normalize abnormality rather than codify softer language to avoid describing it as abnormal or creating 32 new checkboxes of 'normal'

You mean eliminate "abnormality" and "divergence" as a concept? Yes. Better to focus on needs difficulties and abilities, not irrelevant comparisons to population averages. And better to treat differences as something to accept appreciate, and not arbitrarily idealize the median.

"Normality" is a factor in estimating public health costs, not relevant to individual care.

My mother's family is all autistic engineers. I and two of my cousins transitioned as teenagers, so I've had my own theories about this for years.

I'd love to hear your theories if you'd be willing to share them.

Trans people in general were largely ignored by research until the 2010s, so there's very little we do know at this point.

But as for unresearched hunches...

There's lots of jokes in the trans community about how your stereotypical trans girl is on the autism spectrum, with rainbow-colored hair, and into kink, anime, and programming.

I think there's more of a willingness to challenge societal expectations of us in the neurodiverse community, and many of us feel uncomfortable with expectations placed on us around gender roles and sexuality. So I'm curious how much is a causal relationship, and how much of it is a willingness to reject societal expectations that seem irrational. I value my freedom a lot, and the expectations placed on me when I lived as a boy felt stifling and exhausting.

I can only speak to my personal experiences, and I don't believe in policing peoples' decisions to transition, but I have strong memories from as early as five of wanting to be a girl. I was very sensitive as a child. Typical autism-spectrum stuff like sensitivity to sounds, lights, and pain, but also an intense emotional empathy - I was a huge crybaby until my teens, and never felt like I fit in with guys my age or shared many interests with them. So when I found out that transitioning was an option, I pushed hard for it. It's possible that in today's age of greater gender freedoms I wouldn't have had as much reason to transition. But I just don't identify with the male experience at all, and have no desire to see my body masculinize more and more as I age. Also, I can wear so much more colorful and expressive clothes now :)

I think some people transition because they identify very strongly as the other gender, and others (particularly on the autism spectrum) identify outside of the gender binary, so they transition to better express that identity.

> ...and the expectations placed on me when I lived as a boy felt stifling and exhausting

I don't find that as extremely as you've given it here, but I do know what you mean and I'm a bog-standard cis male. But I never fitted in, never understood the blokey stuff - or maybe I did, but blokes take their nature (which are different from women, no doubt) and then push it to extremes[0] (you like to go out? Great! We must drink whether you like it or not! Maybe you like footy? OK, let's get extreme and tribal about it! But that brightly coloured thing you're wearing makes you look like a poof by the way).

I never fitted in and it can wear you down. As a straight guy I find the company of gays quite fine because they are more accepting.

edit: [0] this seems more prevalent in younger males. As we age, we become less so and more thoughtful, and therefore tolerant.

Interesting. What you describe about not fitting in etc. is very similar to my experience. Only that I’m a straight male. Could it be that transitioning is not so much about gender but about fitting in? If I could put a name to my angst and the barriers with others, it might be “transgender”. Which could give me a community of similar folks, a measure of acceptance, a handle, on why I’m not like the others. The research describes correlation, but maybe the causality is the other way around with “weird” people finding ways to cope with their being in a particular fashion?

I can't speak for anyone else, but I transitioned before I had met another tg person. When I transitioned I was already apart of a social group. I didn't need to fit in or find my place. When I was a kid I got along with both boys and girls making friends with both.

People do seek out others like themselves, but transgender communities are rare, because transgender people are rare. There are not many of them. When there are hundreds of people gossiping about transgendered people for every transgendered person it's easy for faulty information to be spread. There is a lot of misunderstandings about transgender people.

It had nothing to do with fitting in for me. It felt more like I already was a girl, but my body grew into the wrong direction. I just had to transition otherwise I didn't feel like myself, and now I do.

Yeah, not fitting in is probably pretty common among introverted programmer types. But for me, feeling like I identified more as a girl was really what pulled me in that direction.

> also an intense emotional empathy

I've read people saying this before, but DSM-5 299.00 (F84.0) for ASD suggests the complete opposite. So where do you get this description as a trait for ASD?

>I just don't identify with the male experience at all

this is a big part of it imo, your stereotypical effeminate depressed autist has virtually no connection to traditional cultural overtures of masculinity except in the body they inhabit and it's very easy to reach a point where it feels like that body is working against you.

> and into kink, anime, and programming.

The anime one is an interesting example, because I've seen the perspective in the anime community is that trans people are also disproportionately common there, similar to your mention that anime is an interest that is disproportionately common among trans communities.

The common brightly coloured hair seems to come from the fact that society is not fully accepting of trans people and depending on the level of that in your social circles, it may feel like you need to break a taboo just to be yourself, so other social expectations (like modest hair colours) are also downgraded in importance.

>other social expectations (like modest hair colours) are also downgraded in importance

The old school "goth" style, well that was breaking the social clothing/makeup etc conventions. Rebelling against the norms. But there would be a group of 5 people doing the exact same thing, rebelling in the same way, and bonding together over it.

I'm not sure to what extent it generalises to the above, but just a thing that was commonly observable

Is it not seen as societally acceptable in the States to wear colorful clothes as a male teenager/adolescent? I know I grew up in the ‘90s (in Europe) and as a kid I knew I liked colorful shirts (red, yellow) well into my mid-teens, I didn’t see them as male or non-male. The only comment I received about the color of a thing I own happened relatively recently (I’m almost 40 now), as one of my aunts remarked that my car is “girlish” because of its color (red). I found that strange and an interesting sociological input, but nothing more.

In New York City you can literally wear anything and no one will say a word or acknowledge your existence as a human being.

But I also knew a boy from rural Texas who was regularly harassed and beaten growing up because he wore athletic clothes (Adidas track suits) instead of cowboy boots and 10-gallon hats.

I grew up in the 90s in rural Texas and never owned western attire and was just fine. Your friend is overstating the role of clothing in his experience I suspect.

He was college age by the 90s. I’m fairly confident you grew up in different towns, also.

It is a big country, which is the point of the retelling. (Not intending to throw shade on Texas)

> Is it not seen as societally acceptable in the States to wear colorful clothes as a male teenager/adolescent?

Anecdote: I visited the US last year and happened to be invited by a friend to a climbing gym in the bay area. Said friend wore a shirt that was pink/purple. I was there for two hours or so.

In this time he got two comments about the color, jokingly painting a picture of him as being gay.

Anecdotally speaking, not just in their teens. (Certain coastal pockets excluded).

I once overheard an American (M, 30s) visiting Europe commenting on European men wearing coloured trousers (red, orange, turquoise, etc).

You’ll also find colours of outdoor clothing in the US to be more muted, or the overly garish ones in fewer numbers.

On that note, men in tights without over-shorts is increasingly common in my parts of Europe. And nobody here gives me shit for wearing pink.

I thought about something like this in a more broader spectrum.

Also completely judgment free, if not even with a little bit of envy.

Do you know people who have strong hobbies? Like not just building sometimes a lego set but having a basement full of it, sorted etc. Only doing this for a long time as well.

Or people who dress very strongly: Punks, Certain Type of homosexual people,Hippies, Antifa, Nazis.

I was and still not sure what my thing is and i have the feeling that i'm going thorugh my life looking a little bit left, a little bit right. Hardcore fetishes don't bother me but don't have an appeal that i would do it. Wearing stuff like artsy stuff is entertaining to look at but i wouldn't put the effort into it.

But what is the difference to those people who get stuck? Yeah thats what i call it basically. Stuck people. They have been Antifa for 20 years. They go to work, don't throw in window but still a little bit alternative. More extreme, more passionate about those kind of things perhaps?

I'm not an expert at all in Transgen etc. and yes i personally from my simplified worldview, i would probably not risk an op if i would feel different. I would perhaps (and of course i don't know that) just sit it out?

When i see Transgen people on hacker events, they created a subculture.

I'm a nerd but i always wanted to play with all the other 'normal' kids and a subculture is effort and perhaps group thinking and group pressure.

And on the other side, they have their crazy cool lego sets, and train models and are experts in a niche. They know exactly what they will do for the rest of their lives. I will continue to look left and right and just continue.

I would love to understand more what type of shades are out there and why.

I'm not the OC but many of my friends and peers are trans and I find "agender" to be the most useful descriptor to myself.

One thing I've noted is that once you start to identify the ways in which gender is fundamentally a social construct the link with autistic/neurodivergent folks makes much more sense. Anybody who struggles to instinctively navigate social norms and behaviors will also struggle to instinctively navigate gendered norms and behaviors, simply because the two are inextricable.

> Anybody who struggles to instinctively navigate social norms and behaviors will also struggle to instinctively navigate gendered norms and behaviors, simply because the two are inextricable.

But if masculine and feminine gender roles are equally difficult to navigate, that doesn't explain why transitioning would help. You'd just be swapping out one difficult gender role with another.

They may be "equally difficult to navigate" in a grand scheme of things, but they're probably not equally difficult for a particular person. Everyone got their own set of traits and interests that may make adhering to a particular gender role easier than the others.

So that would imply that non autistic people may also feel like their brains don't match their bodies, but since they're better at navigating gender roles, they're more likely to just adapt around the dysphoria instead of transitioning?

I think this is exactly right.

Maybe a neurotypical boy who is born with predominantly feminine traits gets them overridden by social learning, but without that mechanism they would persist.

Suicide rates are higher for men, attempted suicide rates are higher for women. Men just tend to use more successful methods in their attempts.

Even within a given category of method of suicide, men are more successful. If you look at countries where gun suicides are pretty much nonexistent, men still "successfully" complete suicide at a rate approximately 10x that of women.

That should be taken as a sign that "suicide attempt" numbers shouldn't be taken at face value as evidence that women have it harder than men.

That pretty much describes my relationship with gender.

I was undiagnosed as a kid, gender was confusing, different standards were confusing. I just didn't care, among other reasons, I decided to transition.

Very happy, but still have an idea of how I would navigate things different... but that's life, right?

Not OP, but I fancy this rough theory:

According to armchair psychologists and a joke, the answer to every psychological question is 'your mother'.

If you look at ways to deal with conflicts [1], it could be that being transgender is a form of dealing with inner conflicts.

Being autistic means that there is some distortion (no judgement intended) in the relationship to other people. The distortion most likely originates from the first relationship, i.e. the relationship to the mother. Since there is a need for a fulfilled relationship, it will be fulfilled by one way or another. If e.g. the mother is absent, then the mind looks for another way to fulfil it.

One way for fulfilment is becoming the desired object itself. So, to bring it to a point: Autism can origin from an absent mother. One way to replace the need for a mother is becoming a female object for others.

[1] https://en.wikipedia.org/wiki/Defence_mechanism

I'd pursue a different avenue honestly. Autism as I understand it is a difference in brain development, it is not something you can cause by wanting.

Your same logic has previously been tried on gay men too varying levels of insistence, it hasn't stuck yet.

Autistic people somewhat commonly experience Alexithymia, which is an inability to understand their own feelings. The common example is an autistic person chronically dehydrated because they cannot identify their own sensation of thirst. Emotions are also physical sensations.

I think a much more promising angle is to look at incidence of Alexithymia and gender dysphoria.

I think you're overthinking it :) Trans people I know just feel wrong in their bodies. It looks wrong, it feels wrong. There seems no need to suppose it was right at first then got distorted by relationship problems to the point you want your male genitals removed (I know a tgirl who is waiting for that).

The paper that article references was discredited for being bad science, not because of any kind of agenda. They collected their 'data' by surveying parents on online forums - most of them explicitly anti-trans / 'gender critical' - instead of from transgender youth or medical professionals.

To expand on this a bit, the paper can be found at [0] and a notice of republication can be found at [1].

The study's "Methods" section reads in part:

> For this descriptive, exploratory study, recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children. The study’s eligibility criteria included parental response that their child had a sudden or rapid onset of gender dysphoria and parental indication that their child’s gender dysphoria began during or after puberty. To maximize the chances of finding cases meeting eligibility criteria, the three websites (4thwavenow, transgender trend, and youthtranscriticalprofessionals) were selected for targeted recruitment. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques.

The online forums surveyed were:

- 4thwavenow, which describes itself as "A community of people who question the medicalization of gender-atypical youth"

- transgender trend, whose opening paragraph states "This site is for everyone who is concerned about the social and medical ‘transition’ of children, the introduction of ‘gender identity’ teaching into schools and new policies and legislation based on subjective ideas of ‘gender’ rather than the biological reality of sex."

- youthtranscriticalprofessionals, whose site appears to be defunct at this time.

[0]: https://journals.plos.org/plosone/article?id=10.1371/journal... [1]: https://journals.plos.org/plosone/article?id=10.1371/journal...

not op, but i think that western gender roles are a scam. i'm not suggesting that there aren't differences between biological sexes, but gender != sex and the false idea that there are only two ways to express your gender is quite limiting.

And eastern gender roles aren't? Is there something I don't know?

'Western' in this context presumably means the binary model of man/woman dominant in the West (e.g., Europe, North America) and gradually exported to be the default worldwide (via colonisation and later cultural exports).

There have been, and are, exceptions to this model in what might broadly be called 'the East'. Think of the Hijra on the Indian subcontinent, or the Kathoey (Ladyboys) in Thailand.

Thanks. Still I think to call binary genders western is a bit revisionist at best. It has been the most dominant model worldwide for a really long time.

Being from India, I'd like to point out that these groups of people you are talking about actually reinforce a gender binary rather than muddling it. Hijra are men who take on all the societal roles of women. They aren't "non-binary" or some "third" gender at all. They espouse and exude femininity, and in India there are two modes of being in society: feminine and masculine. Hijra do not add a third way of being that is separate from both masculinity and femininity.

I'd also argue that their existence is not a proof that Indians have different ideas about gender than Westerners. They are a marginalized people because most of Indian society thinks it is odd / unfortunate / a disorder to be a man and yet want to be socially a woman.

It isn't Western to have two gender roles in society. Men and women are different in lots of ways and it's valuable to society to reinforce differences between the two for the sake of procreation.

Making a claim about the culture one is familiar with does not exclude that the same might be true in other cultures.

One hypothesis is that disbalance of 'gender-related' hormones during fetal development is a factor that can cause not only gender dysphoria but also autism / Asperger's spectrum related issues.

I've already seen people suggesting that this link exists, but I've always read it the other way around - that there are elevated rates of transgenderism along autistic people, which kinda makes sense to me. People on the spectrum ask themselves more questions about their own bodies and feelings and don't get easily satisfied by adhering to social norms as neurotypicals do.

Some form of interrelationship would make sense right? It seems that a lot of gender is tied up in social signaling, which is less relevant to people on the spectrum. For instance, social signaling might regulate gender-non-conformance in a way which is felt less strongly to people on the spectrum.

I'm gonna be honest, using kernel density estimates on discrete data is almost bad enough to make me discount the result outright. Almost.

"In all five datasets, we investigated if rates of autism diagnosis significantly differed by gender by first conducting χ2 tests (Model 1, unadjusted), and then by conducting logistic regressions adjusted for age and educational attainment as covariates (Model 2, adjusted)."

It appears the kernel density estimates is being used as a display of the data, not the actual method of statistical analysis, or perhaps I missed something.

Using a technique that's entirely inappropriate for the kind of data you're dealing with doesn't exactly inspire confidence. That it doesn't affect the actual result is lucky, I guess.

Adding another 2020 study that observes the autism / transgender overlap: https://www.sciencedirect.com/science/article/pii/S175094671...

Interestingly enough, the correlation is observed to a greater extent with trans men (though not in all studies).

> observed to a greater extent with trans men

I wonder if that's a result of autism being under-diagnosed in women (and that under-diagnosis carrying over to trans women).

I would be surprised if that carried over to trans women, i.e. people assigned male at birth, especially if most are diagnosed as children (and thus prior to transitioning, in most cases).

I'd bet that jauer meant to say trans men (the terminology can be confusing at first) because autism is typically diagnosed earlier in life than a gender transition, so if it's under-diagnosed in women then it would also be under-diagnosed in trans men.

Transitioned a while back, didn't get it backwards :)

To elaborate: I was wondering if trans men (AFAB) acquire the male-gendered autistic traits and trans women (AMAB) acquire the female-gendered traits (and underdiagnoses from diagnostic criteria being focused on male norms).

Why I'm curious: I was diagnosed with Asperger's as an adult (no access to MH care as a child because raised in a cult), transitioned, and after 3 years of HRT got a new psych who laughed at the idea that I could have AS and removed it from my chart. His reasoning was that my interpersonal skills were not impaired in a way that is typical of autistic people. This is a common reason why women with autism are under-diagnosed.

I had terrible interpersonal skills pre-transition. HRT gave me access to a wider range of emotions, which might have something to do with it. E.g. I can actually understand the emotional currents in movies, which is nice. But, now I'm curious if autistic symptoms are another one of those things that change with hormones.

Oh, thanks for the clarification! I'm also wondering if I've become "more autistic" since transitioning (to male), but it's not clear to me how much of it would be due to hormonal changes and how much would be due to no longer needing to perform certain kinds of social/emotional upkeep.

Damn I’m gonna see myself on /r/DontYouKnowWhoIAm :)

It's well documented that autistic individuals are having difficulties resolving or tolerating emotionally conflicting situations.

If a male non-autist has girlish interests, he might be proud of his uniqueness and thereby accept it as part of himself.

For a male autist, the socially conflicting girlish interests will be much more painful, thereby driving a higher percentage of autists to resolve the conflict by adjusting their gender.

That would also explain the data, but with causality reversed.

And from personal experience: I received a lot of criticism as a kid because I was a guy but I liked purple shorts and playing dress-up with my sisters. It's just that since I never identified with the stereotypical guys from movies, I wasn't bothered that other people considered me unequal to them.

But I've seen how much effort my math genius classmate put into proving his manliness, so I assume the gossip about us having girlish interests must have bothered him a lot more than me.

As a trans non-autist who grew up embracing a uniquely girly personality (and was accepted by friends and family as just being uncommonly feminine) I can say that this did not reduce the impact of gender dysphoria. Especially after looking at the community at large, I believe these are entirely unrelated issues.

I was trying to argue the other direction: Maybe some autists will mistake their acceptance issues as gender dysphoria, thereby leading to a higher trans percentage among autists (which was the main observation from the paper).

As such, I disagree with you that trans and autism are unrelated issues, because the paper measured a correlation. It's just that nobody knows in which direction the effect goes.

I love how cis people, after reading (likely only the abstract) of one paper and now fashion themselves experts on the lived experience of trans people.

Measuring a correlation says nothing about causation (either way; there's a lot of room for confounding factors). The implication that autistic people will "mistake" their dysphoria is incredibly patronizing and just frankly rude.

Your post sounds like you strongly disagree with me, but it looks like we do agree on the facts. The paper measured a correlation but whether that implies causation is anyone's guess. The paper argued one direction, I argued the other direction, but both explanations fit the data which just shows that we don't know yet if there is causation.

I see arguments like this a lot, and they usually miss the importance and impact of hormonal transition.

I'm trans, and thus in trans circles a lot, and almost everyone I know had some high impact mental health issue resolve upon starting hormonal transition, even if those were present before they realized they were trans. These range from generic depression over behavior that gets people autism diagnoses that suddenly resolve to a depersonalization. [1] Even if you want to attribute those to placebo, the effect is so pronounced and long-lastingly positive, it wouldn't really matter if it was.

Gender dysphoria is measurable[2], and gender dysphoria severe enough to lead someone to transition seems to be rooted more deeply than just the socially constructed assignments of what constitutes male and female behavior. Of course gender-non-conformance would still be expressed more strongly in such people.

What is also positively correlated to transness are conditions that could be classified as intersex, even if we don't generally diagnose them as such because they have no easy to recognize physical impact. We know about some of those, pre-natal exposure to estrogens for instance. And I'm sure there's a lot of factors we're entirely missing. There are a few neurology studies that show deviations that are are usually associated with the other sex in transgender people, even before they can hormonally transition.

[1]: https://the-orbit.net/zinniajones/2013/09/that-was-dysphoria...

[2]: https://pubmed.ncbi.nlm.nih.gov/30991464/

While a lot of trans people would like it to be the case, quantity doesn't really matter past receptor saturation. Most badly adjusted doses are badly adjusted because they're not consistent instead (estradiol has a very short half life). If you have gonads producing your hormones you don't usually have this issue.

We do however have cases of gender dysphoria when treating cis people with antiandrogens for prostate cancer, so it seems to be a phenomenon not limited to trans people.

This assumes that gender dysphoria is exclusively physiological, an impossibility given that gender itself is partially socially- and psychologically-constructed. As mentioned, perhaps hormone treatment could still benefit people who don't have a clinically-indicated deficiency solely because (even in men and women with functional gonads) their application enhances the secondary sexual characteristics (behavioral, psychological, and physical) that a dysphoric individual might find lacking.

My personal take is that a good deal of dysphoria is misdiagnosed as dysmorphia. Because those people are left to self-medicate, unfortunately you end up with the kind of abuse that makes people question the legitimacy of such treatment. I think, though, it's dangerous to lump in people who could benefit from hormonal support for their exercise and antidepression goals (which, for some cis men, would be a gender affirmative strategy), with people who inject synthol or silicone without any medically-viable rationale and in so doing radically damage their bodies (which is what happens now).

In the end, what I'm hoping to see someday is an understanding of a fundamental similarity between the cis and trans experiences, because it would mean both buy-in from and benefits for both groups.

There are definitely social, psychological and neurological factors involved, and none should be discounted. It's just that the social factor is much harder to control when our society is so hostile to gender-nonconformity. And that explicitly includes internalized transphobia. I would not be surprised in the slightest if social rejection accounts for most of the remaining difference to cis controls for transgender suicidality.

"Gender dysphoria - as a general descriptive term refers to an individual’s discontent with the assigned gender."

That is a very weak definition, if you ask me.

I would consider neither [1] nor [2] to be of any scientific merit.

=== [1] ===

I find your reference [1] to be incredibly intellectually dishonest:

I agree with the initial paragraph that "gender dysphoria" as well as "dysphoria" in general are not well defined terms. Obviously, I was then expecting a definition by the author, but none was given. Instead, the author moves on to use the term as if it was a well-defined scientific thing.

The list of symptoms that follows is so overly generic as to be useless in practice:

1. Continual difficulty with simply getting through the day

That's called depression.

2. A sense of misalignment, disconnect, or estrangement from your own emotions

Usually called borderline/mania

3. A feeling of just going through the motions in everyday life, as if you’re always reading from a script

My feeling after a day of reading mathematics papers.

4. A seeming pointlessness to your life, and no sense of any real meaning or ultimate purpose.

I've heard that a lot from people who studied languages and then ended up working as a supermarket cashier.

5. Knowing you’re somehow different from everyone else, and wishing you could be normal like them.

I believe everyone has these feelings during puberty.

6. A notable escalation in the severity of these symptoms during puberty

Since you just described common puberty side-effects in #1 to #5, this is not an independent symptom anymore.

7. Attempting to fix this on your own through various coping mechanisms.

Reminds me of guys who are awkward at dating and try to push through by getting drunk.

8. Substantial resolution of these symptoms in a very obvious way upon transitioning, particularly upon initiating HRT

That sounds like "try hormone therapy to see how you like it".

After reading the article, I had a strong feeling that the author is probably selling related drugs and has a financial incentive to classify everything as trans symptoms. And while the author is describing herself like a researcher in this article, she's calling herself "adult demon anti-cis pro-trans activist" elsewhere and she has made this statement:

"I don't see a problem with telling straight guys who are exclusionary of trans women partners that they should try to work through that" Which I find incredibly ignorant and selfish, considering that many men plan to have kids the traditional way and for that goal you necessarily need to exclude trans women partners.

=== [2] ===

Your reference [2] appears to be a bit more scientific at first, but they published in the "highly prestigious" journal "Federation of European Neuroscience Societies and John Wiley & Sons Ltd" which allows anyone who is willing to pay the fees to publish practically anything. As such, the article has exactly 2 citations, both of which have shared authors.

They defined "gender dysphoria" as "An experience of incongruence between gender identity and birth‐assigned sex", meaning their working definition is based purely on self-reported feelings after the fact and, therefore, unsuitable for any scientific analysis.

Plus, the peer review for [2] is online here: https://publons.com/publon/10.1111/EJN.14420/ and you can see that their paper was rejected in the first round with the comment:

When we think of the manuscript as a whole: is there a clear and proven evidence of a "cerebral signature of gender dysphoria"? Please consider revising.

But then it was approved later on by the "co-Editors in Chief, EJN", meaning by the people that get paid from the paper printing fees... That looks like the kind of fake review cycle that I would expect from a pay-to-publish journal.

To sum it up, the fact that this uses scientific terminology and is published in a journal doesn't mean anything. It would only have meaning if it was either well-cited or published in a journal with critical peer review.

"After reading the article, I had a strong feeling that the author is probably selling related drugs and has a financial incentive to classify everything as trans symptoms."

For the record, this is just totally false, Zinnia does not sell drugs (do you mean HRT? That would be illegal in the US without a medical or pharmacy license).

"she's calling herself "adult demon anti-cis pro-trans activist" elsewhere"

Pretty sure that's a joke.

"they published in the "highly prestigious" journal "Federation of European Neuroscience Societies and John Wiley & Sons Ltd" which allows anyone who is willing to pay the fees to publish practically anything."

Wiley is the publisher, not the journal. The journal is the European Journal of Neuroscience. I went and checked, and I can see no evidence that this journal is predatory or doesn't meet normal academic peer review standards.

https://en.wikipedia.org/wiki/European_Journal_of_Neuroscien...

"their working definition is based purely on self-reported feelings after the fact and, therefore, unsuitable for any scientific analysis."

Most things in psychiatry (depression, anxiety, etc.) are based on self-reported feelings, does that make psychiatry "unsuitable for scientific analysis"? Heck, there's a whole academic field about the economics of happiness, which is obviously subjective:

https://en.wikipedia.org/wiki/Happiness_economics

"and you can see that their paper was rejected in the first round"

Requesting revisions does not mean rejection, it's a normal part of academic peer review.

I also did not find any evidence of Zinnia benefiting financially from drug sales.

But just reading her writing, I couldn't shake the feeling that Zinnia has a very strong interest in increasing the rate of "gender dysphoria" diagnosis. Plus it is very obvious that Zinnia is not a neutral researcher on this topic.

As for the journal, EJN has an impact factor of 2.9. As a student, I used to publish stuff for fun in an IF 4.3 journal. So I'd consider EJN in the "motivated hobbyists" category. For comparison, Nature (the article discussed here) has an IF of 24.3.

Edit for your edit: Requesting revisions is OK, but accepting a paper that was rejected in the first round and DID NOT fix the issue that caused it to be rejected ... that looks suspicious.

I am generally inclined to regard IF arguments for disregarding research as rather disingenuous. Yes, there are predatory journals which will publish anything if paid, but IF as a metric to judge a journal which doesn't seem to be obviously fraudulent is a farce at best, because IF is also heavily correlated with readership which may not be large for relatively niche topics (to be fair, I haven't actually looked at other articles in EJN). For example, consider Annals of Mathematics, one of the most "prestigious" math journals, has an IF of 3.027.

I'm not trying to claim anything about the science in this particular article because I haven't read it in enough detail but a PI I worked with had this habit of dismissing research based on journal IFs, which was pretty annoying.

Zinnia is in fact not a researcher. She just writes on her and other trans people's experience.

It is an incredible show of bias on your side that you expect my response to an uncited comment to hold up to the standards of the original article, while you don't for the comment I initially responded to.

I took your response as your opinion and it was argued well, which is why I took the time to read your references.

But it did give me a weird feeling that your link 1 pretends to be science when it isn't and link 2 pretends to be solid science when it's just an opinion piece written by researchers.

My statement was clearly identifiable as my private unscientific opinion on the topic, so I consider it safe for outsiders to read.

But articles on medical topics that pretend to be science when they are not, that can cause a lot of pain if outsiders read it without being aware that it's only sudo science.

That's why I thought it would be useful to criticize your references.

I think it is disingenuous to expect me to post rigorously cited studies and contrasting my response to the original article, when I was instead responding to some conjecture made in this thread. Mostly with a personal anecdote, with some sources mirroring and expanding on such.

I also think a lot of your points are made in bad faith:

* Taking a joke way too serious, in order to discredit the author. Based on what exactly?

* Implying transition health care is sold for large profit margins when estradiol is one of the cheapest medications around (and blockers don't exactly have high margins either). Zinnia is also not a health care provider. All these drugs are Rx.

* Doing the exact bad faith "as gospel" misreading of the symptom list zinnia warned against. This is not a diagnostic check list, these are just the things that trans people report.

* You also miss the entire point, that these symptoms resolve or get substantially better, and do not recur.

* You are seemingly content with "generic depression" as a diagnosis when depression is a symptomatic diagnosis, usually with different underlying problems. Especially at the severity we're talking about.

* You misread depersonalization as borderline. This is funny because a different diagnosis that is corelated to trans status, CPTSD, is often misdiagnosed as BPD!

Of course you can say she has a heavy bias, but neither I nor she implied otherwise. It is simply documentation of our experiences.

I don't expect you to provide references as part of our discussion. Just your well-argued opinion is enough to move the thread along.

But I find Zinnia problematic because her playing researcher has the potential to cause harm to others. Plus I wasn't referring to her joke, I was referring to the part where she attempted to shame cis guys into not excluding trans women, which is obviously useful for her, but also obviously manipulative and if she was successful, it might make other people unnecessarily unhappy. Since she gave interviews about it, I am also reasonably confident that it wasn't a joke.

I would say it is fair to judge a self-proclaimed activist by their actions, and hers were of the kind that I would not be able to support her statements in good conscience, even though I support the cause of treating everyone fairly in general.

Zinnia is entitled to her opinion, and at no point was anything in her article implied to adhere to scientific standards. It's a discussion piece, and a piece that might be helpful for those that are considering transition. Usually HN is not so hot on theoretical harm that speech can cause. It also has nothing to do with the content of the article, so I'd appreciate if you didn't try to disregard her speech with unrelated information, so to speak cancel her. I don't believe in cancel culture being real, but the last time someone on HR pointed out someone was a TERF they got dead-flagged, so better not go there.

Anyway, if you just wanted more studies, you could've just let me known. I was not expecting to be attacked on the impact factor or size of the citation pool - I was aiming to provide a study with an easy to read abstract, but have a few studies that are strong in at least one of those factors.

Neurology:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754583/

https://www.sciencedirect.com/science/article/abs/pii/S00223...

https://www.sciencedirect.com/science/article/abs/pii/S00223...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585501/

And the "transition is beneficial" master list:

https://whatweknow.inequality.cornell.edu/topics/lgbt-equali...

It is surely fraught with peril to just say "well here is an explanation that makes sense to my gut", especially when applied to controversial topics.

I presume this is a consequence of the datasets they had to work off but it is really frustrating that they have one catchall "transgender and gender-diverse" category, segmenting by birth sex or particular gender identified with would be interesting/valuable

I realize this might be rude but I'm not sure what the polite way to ask is, isn't your sex always your birth sex for the most part? Outside the effects of the medications and the cosmetic effects of the surgery isn't your body still mostly the same as far as the nuts, bolts, and genetic disorders, are concerned?

That depends on what you mean by "sex." And even then, it's not a neat binary thing by any definition. Most things that involve humans fall on a bimodal distribution. Cropping out the wide fields in that distribution is convenient for statistics, forms, and rhetoric, but it doesn't reflect the true range humans are capable of.

Can you elaborate on this more? I meant "sex" in the way that my physician would use the word. I'm aware of things like intersex conditions but, unless someone is actually intersex or otherwise complicated, your reply doesn't really answer my original question.

I'm not that poster but I can elaborate. Basically your physician couldn't easily use "biological sex" as a blanket term to accurately asses the risk factors and health needs of a medically transitioned person. Our sex is "otherwise complicated."

The reason for this is that medical transition, primarily through the mechanism of hormone replacement therapy, actually changes some aspects of biological sex and the associated risk factors at a "nuts and bolts" level even though its not touching every single aspect of biological sex. It's not purely cosmetic, though that's a common misconception. Hormones ultimately control a lot about how human bodies express sex and the associated medical factors. In reality "biological sex" is composed of multiple sexually differentiated systems within the human biology that can theoretically operate somewhat independent of each other, and changing the dominate hormone in your body will flip or at least shove a lot of those systems towards the other end of the distribution. I guess a way to phrase this in developer terminology would be that "biological sex" is sometimes a leaky abstraction.

As a personal example: despite my birth sex, it would be a mistake for my doctor to ask that I routinely get regular breast cancer screenings in the same way it would be a mistake to ask a cis man to regularly screen himself for breast cancer. My risk of breast cancer is much lower than a cis woman's and comparable to a cis man's. But at the same time I have absolutely zero risk of prostate cancer, and it would also be a mistake to try and test for that based on any possible symptoms I'm having. An ideally perfect doctor would be able take my history and be cognizant of what risk factors of biological sex, exactly, which conditions were associated with, and then be able to map that onto my body to figure out what I'm at risk for. As you can probably imagine, this is very difficult to do. A lot of times what makes a condition linked to sex isn't actually understood in the first place.

I wanted to say thanks for giving such a detailed reply. I still have some things that I'm unsure about as far as the framing of everything but having concrete examples like your point about your lowered risk of breast cancer is immensely helpful in understanding where I'm making social judgements vs. just being ignorant about the topic as a whole. It's often hard to get clear answers like yours because just phrasing these kinds of questions often feels like a minefield. So your patience in answering what I'm sure is an at least somewhat demeaning line of questioning is very appreciated and helps a lot in wrapping my head around this.

I appreciate this, thanks. Answering these kinds of questions can feel like unwrapping bandages in front of strangers. So it's good to hear that it helped somebody out. Thank you for your empathy.

when it comes to this topic, "sex" "gender" "male" "female" "man" "woman" etc etc are overloaded with contradictory meanings by people trying to make sneaky ontological arguments. unless I'm specifically talking about the signifier itself, I don't really care about these kinds of games, so I just try to say unambiguous things

anyway aside from language legerdemain, the word "sex" is also used to refer to what sex you're legally designated as, which is only loosely coupled to biology by now

The terms "gender" and "sex" are defined differently by different people, but in general the definition is something like this: Sex is usually defined in terms of genitalia, genotype (chromosomes) or similar biological properties. However, this is still not a binary male/female property, see for example intersex people. Depending on your definition, undergoing surgery may change your sex, gender, or both.

Should intersex conditions be considered normal human genetic variances (like eye colour), or genetic disorders (like Down Syndrome)?

It’s humane and polite not to describe people as abnormal, but being medically accurate I’d argue that humans are indeed binary sexed, and immutably so.

It really depends where you draw the line of "intersex condition", it's not really a term physicians specialized in the field use anymore, because variance in sexual development is ubiquitous if you look hard enough. "DSD" is typically used when there's a pronounced effect that is physically diagnosable, but it often misses other neurological factors that, for instance, corelate in transgender people.

Then again, a lot of severe conditions that would often fall under the DSD umbrella are often overlooked until they become somehow important. For instance, complete androgen insensitivity, so zero functional testosterone in an XY individual, is often not diagnosed until you notice the lack of periods / cervix.

Calling it bimodal is a much more precise way to go about it that acknowledges we have two broad categories, with lots of exceptions and caveats.

> Should intersex conditions be considered normal human genetic variances (like eye colour), or genetic disorders (like Down Syndrome)?

Doesn't really matter, for this purpose.

> I’d argue that humans are indeed binary sexed, and immutably so.

Unless you defining terms such that the variations are not merely disorders but actually nonhuman, you are clearly wrong; human alignments of sex characteristics are non-binary though bimodal.

> human alignments of sex characteristics are non-binary though bimodal.

You either produce sperm, or ova - or neither (which if caused genetically is an abnormal variant).

“Producing the wrong gamete for one’s perceived gender doesn’t construct an additional sex, nor alter the definition of sex such that there are female sperm / male ova producers - this holds even if that perception has genetic as well as psycho-environmental causes” - in my opinion.

But .. we’re philosophical / political at this point .. which is the problem.

> You either produce sperm, or ova - or neither (which if caused genetically is an abnormal variant).

Or both, at least in theory, though true hermaphroditism with both ovulation and spermatogenesis, while theoretically possible and observed on other mammals has not, AFAIK, been conclusively shown in humans.

But, sure, you can redefine “sex” to be restricted to any one of a number of axes of sexual variation that exist in human and result in either a simple quaternary, trinary (or, if you try a little harder than you have, binary) distinction, but what is the point?

the commonly accepted estimate for intersex conditions is 1.7% of lives births, via https://pubmed.ncbi.nlm.nih.gov/11534012/ from this basis it's not much of a stretch to imagine the reality is that there's a greater spectrum of sex difference that is illegible because it hasn't been medicalized. certainly seems like a more plausible explanation than "ok ok, so there's people who don't fit into our perfect platonic ideal categories, but other than the 1.7% of weirdos the categories are still perfect"

it's god of the gaps thinking, people are addicted to drawing clean lines around discrete categories as a vestige of modernism. taxonomy brain. we don't have good ways to say "there are two major clustering points, which most people are roughly close enough to one or the other to call them that, but there's enough overlap and so many dimensions that it makes drawing clean boundaries impossible"

I suspect as gene sequencing gets commoditized and personalized medicine actually becomes practical, we'll find a lot more cases where it makes sense to analyze people on the basis of their individual traits rather than what broad groups we can class them under

Can someone answer my genuine question on this topic? At my high school in California I knew a trans girl (m to f used she/her) that was super chill and maybe a bit on the spectrum.

At the same time there were a couple dozen girls that called themselves trans and asked everyone to use they/them but acted and dressed all 100% within female stereotypes (not that trans is about stereotypes I’m just illustrating my point). I didn’t know any boys that did this.

Has the term trans grown beyond just (for lack of a better term) those with body dysmorphia? What is this second category of trans because I have yet to figure it out.

> Has the term trans grown beyond just (for lack of a better term) those with body dysmorphia?

As far as I am aware, no. But bear in mind that there’s not always an abrupt transition between gender-associated behavior, due to social circumstances beyond personal preference. High School, a setting which implies an age where parental figures retain overwhelming leverage over minors’ lives, is a fairly good example. E.g. clothing choices at home are open to parental scrutiny, whereas pronoun use at school is not.

Beyond that, though, like any term that is applied at one’s own volition and in response to subjective internal cues, there is going to be some variation in the folks identifying that way. Not in a “liar” sort of way, just in a “there’s no precise cut-off on what behaviors or feelings constitute trans” kind of way.

Especially as social stigma decreases or, depending on one’s precise social micro-environment, possibly even turns into a form of social prestige. Again, without any deceit intended, you can imagine that someone that feels they fall in a gray area and needs to explore their identity may verbalize (or even conceptualize) that feeling differently based on the quality and magnitude of social connotation.

briefly, expecting a trans person to have dysmorphia is called "transmedicalism." it's highly controversial in the trans community because on the one side you have people who suffer from gender dysmorphia who don't always like the idea that other people are transitioning because of a preference; on the other side you have people advocate that gender identity is a personal choice and should not be subject to a particular diagnosis by a professional.

Two big factors go into not liking transmedicalism

* it usually relies on very narrow definitions of gender dysphoria. The relation between gender dysphoria and gender euphoria for instance is often discarded. Gender dysphoria itself is poorly defined and often does not specifically manifest as gender-related until the idea is confronted. Lots of trans people suppressed for years or sometimes decades because they thought their pain was not specific enough to not be rejected by gatekeeping.

* it does not account for people that feel more comfortable outside the gender binary, no matter if they want to medically transition (some do). Transmeds and "truscum" often require strict adherence to binary gender norms, in alignment to historical guidelines where doing anything not absolutely in alignment with your binary gender would set you back significantly.

this has been a contentious argument for at least half a decade that I've seen, and I won't rehash it here, but the magic words to google if you want to read more are "truscum" and "theyfab"

Trans people generally have gender dsyphoria, a different condition from body dysmorphia, which they usually don't have. The actual diagnostic criteria for gender dysphoria in adults and adolescents given by the DSM-5 are quite broad, and would include anyone who exhibits "A strong desire to be of […and…] be treated as a gender other than one's assigned gender" for at least six months. It also explicitly states that gender they identify as does not have to be the one opposite their birth sex. It can be neither i.e. non-binary.

By the diagnostic criteria, those non-binary students you were talking about may well have had gender dysphoria... it might have extended to discomfort with their bodies too: Did you ask any of them? Dress and presentation doesn't necessarily mean that much, especially among teenagers who are still figuring things out and might not be ready to change everything. I knew a teenage trans boy who had long, pink hair. I also knew an adult trans man with a beard who still liked to wear dresses sometimes. Being trans doesn't just mean escaping from one cage that's colored pink into another one that's colored blue.

I think it's more common for teenagers who were assigned female at birth to publicly identify as non-binary because most cis people unfortunately just perceive it as meaning "quirky tomboy," which is more socially acceptable than the transfeminine equivalent, "weird f * * ." I'm a trans woman, but I thought I was non-binary for about a year while I was in high school. I was sure as hell too scared to tell anyone that, though.

I ended up determining that I was the gender opposite the one I was assigned at birth. Some teens who identify as non-binary will probably end up identifying as their assigned gender. Others will continue to identify as non-binary: Kate Bornstein is non-binary and in their 70s. I think it's good that people get the space to explore their identity, even if a few end up having been attracted to a label for the wrong reasons.

Regarding the expanding definition of trans, in the past, trans people had to fall squarely within the norms for the gender they were transitioning to, or else they couldn't usually get treatment. For instance, Harry Benjamin, who was one of the early doctors who performed sexual reassignment surgery in the US, classified trans women into six groups, only two of which he labelled "True Transsexual" and approved for surgery. For a trans woman, you had to be attracted to men, be conventionally feminine, have believed you were a girl from an early age, etc.

Most of the trans community is glad that we've moved past this, but there's a minority that wants to bring back the stricter standards. They're called "transmedicalists" or sometimes "truscum" and and can often be identified by conspicuously using the word "transsexual" rather than "transgender" in 2020 (although some people use it for more benign reasons). They often say things like "we just think you need to have dysphoria to be trans." However, as noted, the clinical definition of gender dysphoria includes just about anyone who self-identifies as trans, and the actual argument is whether you have to be a binary gender, have meet the typical norms for that gender, and have to want to pursue all the medical options for transitioning to that gender. There's no agreed-upon word for trans people who don't meet the arbitrary standards required of a "true transsexual," but some transmedicalists call them "tucutes." Others call them "transgender" and call anyone they thing is really trans "transsexual." To be clear, though, speaking this way is very offensive to most trans people and you should never do it.

Are there leading candidate hypotheses for the cause of autism? Do we know things like heritability, correlation with environmental pollutants, anything?

The short answer is that nobody really knows, although it probably has some genetic component. Wikipedia has a long article covering the different hypotheses: https://en.wikipedia.org/wiki/Causes_of_autism

In psychology how we define a thing is constructed from a series of observable characteristics.

The problem is, there are multiple situations that can cause the same series of characteristics. "Are there leading candidate hypotheses for the cause of autism?" is like asking, "Are there leading candidate hypotheses for the cause of a headache?" There is no single cause.

What we do know is most people with autism do not process facial expressions as much as the average person. This causes a lack of paying attention to body language, which then ripples into most of the characteristics that define autism. Studies have shown eye training on infants can completely remove symptoms of autism.

But a root cause is more complex when there are multiple. Some people get overloaded when they look at people's faces. Some just didn't pick up the proper habits of looking at others when interacting with them. The root cause can vary from person to person.

> Studies have shown eye training on infants can completely remove symptoms of autism.

Do you have any links for these studies? I’ve never heard any credible claims of a treatment for (or prevention of) autism.

There are studies that shows that all of those things have effects on the likelyhood of a person becoming autistic.

Autism is a complex mental thought pattern that I think is best described as having “erroneous“ metacoginitive models. That is people with autism has problems “comprehending” how the mind works on a intuitive level. Not “comprehending” the mind then leads to them having a hard time following other people’s thought trains. And various other problems.

Why people get in to that thought pattern differs between individuals. So “Ultimate” cause is not so easy.

because the definition consists of many different phenomena and in places does not specify whether all or some should be present, i suspect there is never going to be any single cause.

Off topic: I appreciate the HN community for being able to tackle the discussion and a topic like this in a substantive way.

One other correlation I have seen is "intelligence" <-> trans person.

It's very weird how many absurdly smart people happen to be trans. It plays into the idea that mental illness correlates with IQ.

Do you have any source on that? It sounds like it might be just anecdotal due to the fact that trans people tend to be more noticeable.

previous poster's claim is a common piece of folk wisdom that ultimately stems from this paper: https://pubmed.ncbi.nlm.nih.gov/16298429/ 2005, n=187. the authors are blanchardites so the language they use is needlessly confusing, but they find 107.3 mean iq among the male-attracted trans women, 121.7 among the female-attracted

interestingly while pulling this up I also found this one from 1967(!) https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.2... n=34, which found half in the 110-119 range and eight over 140

Interesting, thanks!

Autism has this "savant"[0] stereotype, so what you're seeing might be an autistic symptom in some tg people.

[0] https://en.wikipedia.org/wiki/Savant_syndrome

I noticed the same thing, particularly with programmers.

More than once, I stumble upon some remarkable piece of software, to find that its author is a trans person.

Being "mentally ill" and having the specifics of that diagnosis changed every time the DSM does due to social pressure (from homosexual/bipolar DSM 4 to schizo in DSM 5), I honestly think "mentally ill" has just become another loaded term. Most "menatlly ill" people are simply people who have used the faculties that have to choose to be abnormal. The reasons for that non-conformist decision are varied, but are rarely irrational. Generally, I've found that any non-conformist person, regardless the category of such they've been assigned, has a unique and valuable perspective at some level if you just get to know them. Sadly, that's rare in an age where everything new is threatening and everyone I don't understand is the boogey man. Protected groups do the same villification to those who practice societal norms. A genuine smile and a ready heart for other people that also bleed red and feel more pain than life should ever have allowed is probably a better start than pissing matches over who is right and who is evil.

TLDR - non-conformists are almost always interesting and brilliant in some sense, but they generally lack the ability to reach within the Overton window and effect change.

Autists are disproportionally online. This matters for two reasons.

The first is that on the internet you can easily assume any identity.

The second is that the trans lobby has much stronger control over online than offline spaces. The pattern is clearly visible in this thread. Views that you might hear from "the man on the street" are flagged or downvoted.

If "the man on the street" shared their views when evaluating a transgender person's job / grant application that would invite discrimination lawsuits in many jurisdictions. That's an IRL flagging.

Oh certainly. But this doesn't change my point. That autists and neurotypicals come across different perspectives due to the differences in how they socialize.

Not just “higher”, the paper is talking about 3,4,5 or even more times higher.

Hanging out in trans circles (as a non-binary person myself), this seems commonly known within the community. Interesting to see research done here, but I'd be careful about over generalizing (e.g. "All trans people are neurodiverse").

Edit: Also, happy to answer questions about being non-binary (specifically, gender fluid) if folks have good faith questions.

Have you heard of Abigail Shrier's book "The Transgender Craze Seducing Our Daughters"? She was on Joe Rogan's podcast recently though I have yet to listen to it. A quick search turned up, not surprisingly, some negative critiques and others that are more positive.

If you have heard of it, or read it, I'd love to hear what you think of her position.

I appreciate the offer to be part of a dialogue. I think it's important to improve understanding for people. As a white, middle aged (45) cismale I know I'm viewing a lot of this stuff through a very specific lens.

It’s not sound and ultimately it’s based in the grief of people who believe they have somehow lost their child (or spouse, or sibling) because they transitioned. I don’t want to minimize the pain of people who have this mindset, no matter how destructive it is. Their sense of loss is genuine and it drives them to the same level of commitment that you see from parents who lose a child to a drunk driver. But, while the pain is real, the loss is either not real or is self-inflicted. Trans people leave the lives of people who won’t let them be themselves, but we don’t stop loving our family because we’re trans.

More people are transitioning, at all ages. More of the people who do so are visible, because of modest reductions in stigma and because there’s no longer a requirement that we disappear and cut all ties (the medical establishment used to require this). Your typical 40-50 year old parent has no idea how many of the people they went to High School and College with are trans, because they were hidden. In much the same way people had no idea how many people were gay. So this looks like an explosive change. I do expect we will see much less late transition (later than early adulthood), because more of those trans people will transition earlier.

So, why are more people transitioning? Because it’s possible and they understand it to be possible, not because there are more people who are trans. This is why it’s happening across all ages. I am a late transitioner. I started to transition as soon as I understood three things: that being trans and transitioning was a real thing, that I would not destroy my life by doing so, and that trans people can live happy fulfilled lives.

What about desistance? Some small percentage of people who transition decide that it wasn’t right for them. Most of them because of oppression, but some because it doesn’t work for them. This is much smaller than the set of people who regret that they didn’t transition, or that they waited so long to do so. It’s lower than the rate of regret for any elective surgery. There is some risk that non-binary kids who emphatically reject their assigned sex at birth are getting social pressure to conform to the other end of the binary. The pressure to be not trans at all is still very high. High enough that I don’t worry about cis kids being pressured into transition.

And there are many trans people who don’t need or want to transition, who find sufficient expression or acknowledgement in other ways. They aren’t less trans, you just don’t know they are.

Thank you for the thoughtful response. I have no agenda here. I have one trans friend (that I know of). After seeing the topic on Rogan's podcast I did some quick searching online and it opened up a few lines of thought I hadn't considered or wasn't aware of.

Edit: added "(that I know of)" to acknowledge my limited knowledge of my friend's gender or sexuality.

Rogan has been, at best, insensitive to trans people. Given the volume of people who hold agendas against trans people and trans rights and Rogan's willingness to host people without holding a critical eye to their opinions, I'd be very careful about using his podcast as a jumping off point to the topic. I'd really recommend reading the stories of trans people directly and engaging with the scientific community.

so could you produce some numbers about transitions? because frankly this discussion (just as the more street-oriented fraction of BLM...) seems driven by a very vocal but ultimately minuscule number of people. And if now in some avantgarde-circles (which never were related to the majority of people and also today generally have their very own orthodoxy... ) trans is en vogue, I doubt that this is the mass phenomenon you think it is.

It’s not a mass phenomenon. Neither is Autism. Fewer people are trans than are gay, but nobody really knows. At the bottom end it’s 0.3%-0.6% of the population, but that’s only people who are out. If you survey people in their low 20s, it’s higher. We’re a little less common than redheads in all likelihood. Gay people in the early 80s knew there were a lot more gay people than straight people saw, but they had no idea what the true numbers were. It’s like that.

Most of the trans people I know aren’t remotely avant-garde. I know a bunch of suburban women in monogamous relationships with their spouses or partners. I know a couple of suburban trans guys who are still married to the men they married before they figured it out, one of them with kids. I know several trans guys in health care. I do know a few trans people who are artist and writer types and are more flamboyant. The first trans woman I met worked at the same Wall Street brokerage I did and was very quiet.

When I go to (back when travel was a thing) places that are less friendly than the coasts and people see the trans flag pin on my bag, I frequently have people come out to me and talk about how they can never transition.

There is really no orthodoxy beyond believe people about their gender. Trans people are very different from each other and their experience of being trans varies wildly. There’s some agreement around language and tropes that seem to provoke violence towards us, but many trans people use language to describe themselves that other trans people would be offended by. But that’s true of gay people too.

I haven't heard of it. Reading the synopsis on Amazon suggests that it's not something I'd find much to agree with. While I do believe that trans identities are in the forefront of the discourse right now and that some folks might be inclined to question their identities more, I don't find the idea that kids are being forced into a craze very compelling. (Shrier's writing reminds me of the satanic panic of the 80s, where my parents were asking me if I was worshiping satan because I played D&D.)

I went through, as an adult, a period where I was sure I was a trans woman, and I sought therapy. This led to experimentation and further discussions that no, that wasn't the right label for me. I do regret, even as someone who is masculine presenting most of the time, that I didn't have more of a choice in my hormonal changes during my teens. Many bodily changes via testosterone are irreversible, and it would have really helped me had someone said, "let's hold off on those changes for just a little bit so we can figure out what makes you feel right."

So, that's a bit anecdotal, and it definitely doesn't apply to every child's situation, but I sure wish that we had the resources and available knowledge back then that we do now, because I probably would have taken a different path.

I've watched the stream, and it painful. Not only is the book built on very little evidence, but Shrier just gets so many things wrong on stream, I have to wonder if she actually did her homework. Things that aren't even up for debate like effects of HRT, even in instances where it'd strengthen the optics of her argument.

It doesn't help that Rogan only seems to have one hard opinion (legalize drugs) and seems to disagree with most of his guests very little, which makes for a good stage for his guests but not a very balanced discussion.

I'm still hoping he'll eventually have a trans person on (that's not Debbie Hayton, Blair White or Buck Angel).

> I'm still hoping he'll eventually have a trans person on (that's not Debbie Hayton, Blair White or Buck Angel).

why not one of them?

I'm going to assume this is not a gotcha question.

Debbie Hayton is trans exclusionary feminist, while being trans. She also writes on transgender topics for RT. I have no idea what her motivations are, she doesn't usually talk about them and in fact blocks people on twitter when they ask.

Blair White is a transmedicalist, who is so concerned about her own validity as a trans person that she insists on narrow diagnostic critera that just about include her. This makes her popular with a certain crowd. Her take on trans people that aren't exactly like her has been inconsistent. For a critical discussion with her and someone confronting her with said inconsistencies, see https://www.youtube.com/watch?v=-o_yuAuzl6Q

Buck Angel is similarly a transmedicalist, but more by virtue of transitioning at a time where only extremely few trans people were allowed to transition. Buck is a bit of a special case as one of the first trans men to transition, but he heavily relates to the Harry Benjamin Standards of Care, about which you can read some fun things here: https://twitter.com/orclesbian/status/1190481639501160449

I'm not really opposed to either of these people being on JRE, but their views on trans people have already been represented on the show a few times, whereas I haven't really seen any more inclusive advocates discuss this issue with Rogan.

This is part of a wider issue with the JRE guest selection, but that'd go too far for a HN comment already way too long.

> Have you heard of Abigail Shrier's book "The Transgender Craze Seducing Our Daughters"? She was on Joe Rogan's podcast recently though I have yet to listen to it. A quick search turned up, not surprisingly, some negative critiques and others that are more positive.

So, you're asking an honest question, but it's pretty insensitive and I hope you're curious because this is the truth. Framing that as a curious question makes me wonder if you even read the title of the book -- the title is quite obviously meant to be antagonizing to trans people. So that's not a great start. But here we go.

As for the contents of the book itself, it's little different from much trans-antagonistic pseudoscience and literature -- the main difference being that it's focused on guys rather than gals. It cherry-picks studies and anecdotes to promote harmful stereotypes, and presents trans-ness as a status symbol (it's not, it fucking sucks to be trans in the presence of cisgender people who know that).

To address the "craze", we need only look at history. I'll use mine. In the 1990s, when I was in middle school, I noticed distinct feelings that I now understand to be gender dysphoria. I didn't get it at the time; but sexual orientation was quite the buzz, and I knew I was bi very early on. In the 2010s, our society underwent a phase transition on its view of trans people. I met some other trans people, had some curious conversations, and started to put the pieces together. It took me several years to overcome my transphobic cultural upbringing; and several more to overrule the same of my ex-spouse. Coming out was hard. As with many, I lost friends and family to their prejudice. But even so, it's way easier now than it was in the 90s or even the 00s.

One commonality between trans and autistic people is that we don't always feel welcome around cis / allistic people. Not really knowing why, we form cliques of people who are feeling the same stuff. Many of the trans people I know are, yes, autistic, but also were outcasts as kids. In speaking with other late-transitioning people of my age, I've seen a pattern: others in our friends group have transitioned in the intervening years. Do groups of trans kids gravitate towards one another and have shared gender discoveries? Well duh, of course they do! It's not a "craze", it's a result of teenagers talking to eachother about their feelings, having appropriate language to talk about them, and having even the slimmest feeling of safety in coming out.

It never says that the crazy describes all trans people. It doesn't call all trans fakes. You seem to even admit you didn't make it past the title with your uncharitable read, so how do you expect to respond to something it actually claims?

It points out that there are some social contagion factors to some expressions in our youth. Which is completely reasonable given how much clout gives you in modern social media, for example. And that an impressionable girl with low self-esteem can suddenly "become trans" and win social favor, which I don't see how you could find unreasonable if you've ever been a teen.

Maybe approach it a little more open-mindedly. You basically dismiss everyone in the book as just being unable to "cope with loss" which isn't much different than dismissing any group (like trans people) with some convenient reason that leaves your world-view untouched.

Also not sure how your anecdote disproves the craze, especially since the craze is talking about the last 5 years. Your experience in the 90s has little bearing on 2020 where you get instant social proof on social media in some circles by putting a rainbow flag in your username. Times are different. You don't think social contagion could explain any part of the 800% increase in trans identity among the youth? I don't see how you couldn't believe that on any 800% increase in what the youth are doing.

It's like amphetamine abuse among kids. I have extreme ADHD and to some degree depend on the drug to get what I want in life. Just because you could write a book about kids claiming to have ADHD just to get prescribed a great recreational drug (and I bet you could even call it a craze, as it seemed in uni) doesn't mean I can't have ADHD or that everyone is an abuser. I would consider myself weirdly defensive to the point of dismissing inconvenient truths if I were to believe that, yet that's what I see you doing.

That you give yourself so much authority on trans matters, especially in response to such a reasonable point, is kind of an example of what I see as modern trans clout these days. Why wouldn't a teen want that? As the book points out, it's incredibly easy to "be trans" when the rest of your friend group in high school is suddenly on the non-binary spectrum unlike when you were a kid.

> That you give yourself so much authority on trans matters, especially in response to such a reasonable point, is kind of an example of what I see as modern trans clout these days.

Your insistence that you have more authority than an actual transperson to explain the emotions driving trans identity because you've read a book about the 'transgender craze' is probably a more realistic reflection of 'modern trans clout'...

> "become trans" and win social favor

This is not how it works in the real world, is it?

Someone becoming trans will lose access to a large number of potential dating partners, they will be bullied and ostracized, they face increased levels of violence, they face reduced worker protections, etc etc.

I think it depends on how they maintain their social circle. If they spend most of their time in online communities, it'd be easy to surround themselves with people telling them how brave and beautiful they are for transitioning. Abigail Shrier said that one of the trans people she interviewed said that after Katelyn Jenner transitioned and being trans became more "popular", they would regularly have strangers approach them on the street and at restaurants to tell them how brave they are for being trans.

> how brave they are for being trans

Doesn't this confirm my point? Why is it brave to be trans? It's because you face increased violence, ostracism (often from your own family), etc etc.

Not everyone has to deal with that though; some have supportive families and social circles. It's like when people say that everyone in the military is a hero, even if they have no idea what the person did in the military. People do the same thing when they call every trans person "brave", even when they don't know their background, and whether or not they face daily struggles due to being trans.

Hi, are you here for a curious conversation? Please review the guidelines, because you're cross-examining and attacking the weakest interpretation of what I've said.

> Be kind. Don't be snarky. Have curious conversation; don't cross-examine. Comments should get more thoughtful and substantive, not less, as a topic gets more divisive.

> Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.

I specifically referenced the title of the book, because it should be a dead giveaway that the book isn't a great start for this conversation. Nowhere did I say that I only looked at the title, that's your weakening interpretation. I read about a dozen reviews, pro and con, and I'm quite familiar with the literature and science on the subject of trans people.

> It never says that the crazy describes all trans people. It doesn't call all trans fakes.

Sorry, did you even read what I wrote? I didn't say anything about "all trans people". I said that the book is cherrypicking. I'm not denying that those cases exist, I'm saying that those cases are rare.

> You basically dismiss everyone in the book as just being unable to "cope with loss"

Who are you responding to??? I didn't say anything about that.

> Your experience in the 90s has little bearing on 2020 where you get instant social proof on social media in some circles by putting a rainbow flag in your username.

Oh hey, an actual reference to something that I wrote! I'll respond to that. I specifically noted my experience in the 90s, because my transition was delayed 'til the 2010s. I specifically explained why we're seeing a massive increase in the rate of people coming out. But you missed it, because you're focused on attacking the weakest interpretation of what I said.

> That you give yourself so much authority on trans matters, especially in response to such a reasonable point, is kind of an example of what I see as modern trans clout these days.

Yeah, I've got so much "clout". People in my industry are happy to give plaudits for my "bravery", but multiple previous co-authors have ghosted me. Co-workers don't take me seriously like they used to. So professionally, I experience tokenization and isolation. I've lost family, I've lost friends, but if I had a twitter account I'm sure I'd get some followers. But some of my trans friends do get extra followers for being trans -- many of them chasers and trans antagonists who are variously bent on making their lives hell. Whoop di fucking doo. I'd strongly prefer to not be trans, but that's not a choice I've got.

Am I an authority on trans matters? Well, I am a member of the community and I see the good the bad and the ugly -- both from within, and from without. I'm also in regular contact with high-school age trans kids through group counselling -- I don't share their experiences because that would violate their confidentiality.

So what's your basis for authority? All I see is your experiences with amphetamines and you may have read a book about trans people that was written by a blatant transphobe. And you're imploring me to have an open mind. Guffaw.

You might be interested in his interview with Dr. Debra Soh. There is a lot of misunderstanding among parents regarding what counseling/therapy psychologists can provide and that interview clarifies some recent changes.

> "The Transgender Craze Seducing Our Daughters"?

Some parents of trans children talk about "rapid onset gender dysphoria". They claim their child was happy until they got to about 12 and then all of a sudden BAMN they became trans because the Internet told them to. They'll sometimes claim that science supports them.

There's no evidence that ROGD exists. It's a term that's only ever used by people who are trans-excluding, or by people debunking it.

https://www.psychologytoday.com/us/blog/political-minds/2020...

> The paper claims that there is a new diagnostic entity called "rapid-onset gender dysphoria." This term comes from a paper published in the journal PLoS One, in which the author anonymously surveyed parents recruited from websites that focus on the theory that trans youth identify as transgender due to "social contagion" and online influences. Unfortunately, the paper did not survey any of the youth themselves or their clinicians. The only thing the paper established is that some people online believe that youth rapidly become transgender as a result of watching trans-related content on Youtube and Reddit. article continues after advertisement

> People should be aware that parents often think that transgender youth became transgender "all of a sudden," because youth were closeted prior to coming out, due to fear of family rejection. Presumably, youth with parents who believe being transgender is a disease would be likely to conceal their identity for prolonged periods of time. It would be important to interview the youth themselves to know if this were the case.

https://medium.com/@KatyMontgomerie/jkrs-claims-part-6-lisa-...

> There was a lot wrong with Littman’s paper. Firstly the study involved no trans people, just the parents of trans people. Secondly all of the participating parents were found on just a handful of websites such as “Transgender Trend” and “Youth Trans Critical Professionals”, which run forums specifically for unsupportive parents of trans kids. As JKR notes the controversial paper received a lot of criticism from within the scientific community:

> "The journal took the paper offline and re-reviewed it before republishing it."

> But it is deceptive of JKR to describe what happened in this way. The post-publication review resulted in major corrections to the paper and an apology from the editor of the journal. The editor noted “the corrected article now provides a better context of the work, as a report of parental observations, but not a clinically validated phenomenon or a diagnostic guideline”. For a comprehensive takedown of this paper see here.

That last sentence links here: https://genderanalysis.net/2018/02/rapid-onset-gender-dyspho...

This interview is well worth the time.

It don’t think it should be part of the conversation because it seems transparently little more than culture war scapegoating for an audience hungry for a moral panic.

If you want a more considered text for a general audience, I’d recommend Brynn Tanehill’s, “Everything You Ever Wanted to Know about Trans (But Were Afraid to Ask).”

Also useful is this point-by-point, sourced rebuttal to the misinformation Rogan repeatedly spreads (which references the above text):

https://www.adamconover.net/adding-evidence-to-the-discussio...

The part of the rebuttal about puberty blockers being 100% reversible seems outdated. The NHS recently said that there isn't enough information about puberty blockers to say for certain that there are no long-term side effects from their use.

Thanks for the link and info.

What is the distinguishing characteristic of someone who is gender fluid vs. someone who is not?

Simplified explanation that leaves out the discussion of people who are agender, genderqueer, etc.:

If you conceptualize gender as 'manliness' or 'femininity', you can pretty easily see that some folks are more or less 'manly', that gender must therefore exist as a spectrum. There are men who are very feminine, and women who are quite manly, so in my mind, these spectrums have some overlap.

Most folks have a pretty rigid understanding of where they fit -- they see themselves as a manly man, or ladylike, or a tomboy, etc. and that remains relatively unchanging over time. For me, it's not so simple, there are days I feel masculine and days where someone using "Mr." or "Sir" feel really viscerally wrong.

That's the quick version of how I conceptualize my own gender fluidity.

I think you might overestimate how strongly or rigidly people in general conceive of how they “fit” on a daily basis, or how strongly they link activities, dress, or title to “manliness” or “womanliness.”

For a simple example, some days I want to listen to Tori Amos and cry, and other days I want to listen to Metallica and punch things, but nothing in any of this has any bearing on my identification with any gender.

I have some pretty obvious male secondary sex characteristics so it would be a big problem if that caused me daily discomfort, but that doesn’t really seem to be what genderfluidity is about?

Many of us are not tightly attached to all parts of our identities. For some, they might care deeply about their identity as a devout Christian/Muslim, others might not really care. Some might care about their political party affiliation, others might not care. Some might care about their gender deeply, others might not care.

But for you, as gender fluid, it seems the thing you care deeply about is the ability to be free to conform or not conform to gender expectations of any particular sort?

If so, isn’t this freedom something that would just be good for anyone?

I think so, unfortunately many people do not. Ideally I'd be free to express myself however I wanted without facing prejudice for it, but we're not in that world today.

There isn't one, besides them identifying as genderfluid. Same as any other gender identity (like man or woman). I think this makes the terms slightly less useful but it is very important to some people that they're used this way

> Same as any other gender identity (like man or woman).

I think there are some distinguishing characteristics for someone who is male vs someone who is female.

It’s not clear to me what this means. I’ve never made any positive choice to be a man. I’ve never told anyone “I’m a man”. But everyone somehow concludes that I’m a man.

What does it mean to “identify as” something?

It means you come to a conclusion that you are that something. This may or may not coincide with your outward appearance or anything else.

If someone said "you're a woman", would you disagree?

Only on the basis of everyone until that person having said differently, up to and including someone else already having defined “man” as a male human.

Some people feel differently. If you were addressed as "ma'am" everywhere you went, you may not be that bothered. You might find it really frustrating.

Even within the bounds of a gender (e.g. masculine), people will find themselves wanting to be seen as a particular point within that gender's spectrum. (E.g. you might want to be seen as a tough guy, or a sensitive man, etc.) It can be frustrating to feel like you are the tough guy but no one seems to treat you that way.

The point is that experience is different for different people. Many people are comfortable with whatever, others aren't and want to try to take deliberate actions to make themselves be perceived more like how they see themselves.

If everyone called me ma’am all the time everywhere I went, I wouldn’t be bothered. That’s how I ended up getting sir’d in the first place.

I guess if they suddenly changed en masse, I’d wonder what’s up.

I think I wouldn’t really care, to be honest. Nobody has ever done that, so I can’t be sure.

In that case, perhaps you're one of the people out there who doesn't strongly identify with any particular gender.

On further thought, whether I disagree with someone calling me a “woman” depends on what they mean by that term.

If they’re using it in the traditional definition (someone with a uterus and XX chromosomes) then I would disagree, because they are factually wrong. If they’re using it in the more modern sense to describe some abstract “gender”, I wouldn’t disagree because I don’t really know what that means. In either case, it wouldn’t offend me.

What is the difference between being gender fluid and having some traits & preferences typically associated with the other gender?

Great question. For me it's that sometimes I have those traits and sometimes I don't. I don't really have a set of traits and preferences that is consistent from day to day or hour to hour. Some days I'd prefer others see me as a man, other days I find that repulsive.

So, gender fluid, because my gender is dynamic and shifting. I don't always see myself as femme, or masculine, but rather shifting between and around them.

but why bother with gender at all in this case?

The feeling of gender dysphoria is not a pleasant one. Coming to an understanding helped me rationalize and address my anxiety.

Ultimately, gendered stuff is all around us and it is not so easy to "just not bother".

so you are a non-transsexual transgender? or did you transition to a suitable body?

because yes, gendered stuff is all around us, but in most "though" cases, it mostly seems to relate to sex, because that's something which is easily determinable for a large fraction of human beings.

So your problem was that other people didn't accept you for what you are: is this really different from society not accepting that you would like to have 5 wives, your parents wishing you to be a lawyer, whilst you want to be a shepherd or any other discrimination? Why do we have to divide people on a spectrum (which also suggests that personality is a measurable, which is disturbing...) to remedy this? And why is it necessary for people to advertise their pronouns, when most of the communication, where you need that is non-personal anyway?

There isn't a body that's suitable for me, unfortunately. The best I could hope for might be a somewhat waifish androgyny, but even that would only be a very, very loose approximation.

> So your problem was that other people didn't accept you for what you are

No, the problem is that my identity didn't match my external presentation. Yes, fixing that comes with some stigma (and that sucks), but fundamentally the problem is making the outside match the inside.

> And why is it necessary for people to advertise their pronouns

Being called he causes dysphoric feelings and anxiety for me. This is not something that I have conscious control over. I have learned some adaptive behaviors, but ultimately it's much less uncomfortable for people to use they/them for me. I ask people to do this, and generally people don't have an issue. You could also use my name and avoid pronouns if you want. Ultimately, you can choose not to use my pronouns knowing it makes me uncomfortable. I ain't going to yell at you, but I'll also remember that you made a choice knowing how it impacts me.

> Why do we have to divide people on a spectrum

Great question. I actually think of gender as much more complex than a spectrum, but there are folks who see it as two, concrete points and will loudly exclaim "ONLY TWO GENDERS" to me. I'm just sharing my own observations about the behaviors I've seen and how I choose to interpret them.

Some detractors often say transgender people have mental health issues.

But they mean it in the sense that they should be in an asylum or should not be catered to.

A reality is that:

A) Gender dysphoria is an imbalance of neural state. Therefore that would by definition be a mental health issue but not like the detractors say.

B) Acknowledging and accommodating gender dysphoria discomfort costs cisgender people nothing and unlocks the productiveness of an additional population in society.

> But they mean it in the sense that they should be in an asylum or should not be catered to.

I have often heard it in a sense of "should not be catered to but rather given medical help". A fellow student once told me that he considers the current way of treating gender dysphoria irresponsible and that, if we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to aknowledge the voices they hear and pretend we hear them too.

I didn't know how to respond to that. I still don't, actually. My knowledge about anything mental health is quite limited.

People making claims like that generally no nothing of the procedure by which mental health issues are diagnosed - which is to say, mental health treatment is about addressing issues which are negatively affecting someone's quality of life, until they are not. This is the same reason you can't just go through the DSM V and ascribe mental health conditions to people on TV or in the media or whatnot - it doesn't work that way.

People who hear voices don't have a problem because they hear voices, they have a problem because in general schizophrenia presents those voices as hostile and aggressive towards the person. People who hear voices that are positive or helpful (which is not uncommon, though it seems to be less common in Western culture socialized people) don't have a problem, probably don't even need treatment if they do not cause any distress.

That trans-people live happier lives after transitioning means that the treatment they receive (hormones,gender reassignment surgery, remembering that all of those are quite optional) is completely adequate.

Don’t they have much higher suicide rates? How happy can that be?