THB in the Efficacy of Gender Affirming Care

I did a writeup on this debate (heavily AI assisted, so apologies for any errors):
https://debate.miraheze.org/wiki/THB_in_the_Efficacy_of_Gender_Affirming_Care

I agree that its not even close to interesting!

I agree that the data can be a desired result. I've got issues with using that as an argument in this debate, but I think it's valid point to make.

By given definition of efficacy by both sides, it follows that data itself can be a desired result, irrelevant of if voters "buy" that it can be, thus his main argument for long term should have been the need for knowledge which only said long term care can provide, as stopping said care makes it impossible to know if said care has long term benefits and removes the possibility of progress in medicine, since medicine is based on testing, therefore said care by mere continued existence provides desired result of knowledge which is crucial if medicine is going to get anywhere, as great majority of medicine is based on testing to obtain useful knowledge, and almost never based on "we cant test this until we are certain it works", as the latter would make testing pointless. Thus, you can either argue that testing is not beneficial (has no desired results as its outcome), which is nonsense as there is a desire to find out what works and what not, or you can concede.

I also just plain wouldn't have bought it as a voter. Believing in the efficacy of GAC requires support of said efficacy from the data, not just the presence of said data.

But that's not very interesting.

You should have just said that one of the desired results is to see how well the care works, so that would make it effective by tautology even without current data on long term benefits, as one of the main desired results is knowledge which would be gained in long term by giving care regardless of if it turns out good or bad.

Yeah, I think the main issue was just dealing with the variables in some way, either by recognizing that there are certain things you simply cannot account for and focusing on studies that account for the rest, or by finding other ways to jumble those variables into your analysis. Either one is tricky, and regardless, it makes hard-and-fast conclusions more difficult, particularly when it comes to suicide.

As for the logical incongruity point, the main conclusion I came away from that with was that claims of reduced suicides are difficult to prove and may even swing in the other direction. It's not the kind of point that can demonstrate that GAC does increase suicides, but it is a basis for questioning claims that GAC decreases suicides. On that front, I think it worked just fine.

Given both of you have provided some thoughts (especially you Whiteflames), I'm compelled to also drop some pointers.

1. In terms of what Ben did well, the point of social affirmation was one I understood as strong, and hence strategically (and perhaps uncharitably) granted less consideration. I think it's a good point and, under the definition of GAC provided would qualify - however if push came to shove, I would have made the point of showing that even if social affirmation were successful that this is not synonymous with GAC being holistically good.

2. Personally, out of all the studies and arguments I issued, I did not expect the first study to lose as much mileage as it did. Looking back I think this might have been an oversight from me, given the link could have been expanded on more clearly.

3. Whiteflame - one main point you bring up throughout both Ben and I's points (but mainly mine) was that there lacked a quality study which eliminated the extraneous variables. However, as you admit, this is extremely difficult to find because there hasn't been such a study, and also that such a study would be extremely difficult to conduct. (First, you would have to essentially force some gender dysphoric individuals into not seeking gender affirming care. Second, if you found people with gender dysphoria but didn't want to transition and used them as the control, even that wouldn't really work because of the clear symmetry breaker being that one group wants GAC and the other doesn't).

4. Regarding my logical incongruity point, it was basically an original thought I had, hence, a lot of the links were pretty sketchy, but still I think it's a line of reasoning worth investigating. For instance, you mentioned "within those subsequent years after 2010, a substantial number of those suicides came from those who received GAC". I agree that I am unable to show a clear causal linkage between the two, but I think the argument grants cumulative reasons to suspect something is afoot - it seems fishy that absent an explanation, why this claim of morality when denying transgender individuals treatment does not seem to be ameliorated when a thousand fold increase in such treatment is provided.

It's a tough debate to have because, like was said multiple times, there are a lot of variables that complicate a direct assessment of the efficacy of GAC. A couple of things that came to mind as I was reading through it that didn't make it into my RFD:

- One of the metrics used was whether individuals were "more likely to be treated for anxiety disorders." That isn't necessarily a positive or negative. You could argue that the decision to receive treatment isn't necessarily indicative of the status of that person before GAC, i.e. someone can have an anxiety disorder, not get treated for it, but decide to seek treatment after starting GAC. It could even be framed positively: their decisions to seek treatment show a genuine desire to address psychological issues that they might have bottled up before. It does make it inherently more difficult to ascertain an incidence rate for anxiety disorders, but I think it's worth pointing out that this isn't necessarily demonstrative of Bones' point.

- Among the possible responses to Benjamin's point about "ideal circumstances" could have been that this is an issue of social affirmation vs. social acceptance. The former is mainly about how one conveys oneself to the world around them, and the latter is an issue of how society looks back on them. Prejudice isn't going away anytime soon and its presence in the world is anything but ideal, but it could be argued that it must play some part in how we assess the efficacy of GAC. If it negatively impacts how an individual is perceived, then that is necessarily a negative impact of GAC, because even it achieved its intended purpose, it failed to account for (or tried to ignore) the issues that would accompany it. On the other side, you could argue that there's a need to change that perception and that more people getting GAC could noticeably alter social acceptance. I don't think this issue necessarily has to stand solely as a variable that impedes our understanding of the efficacy of GAC, though it does complicate things. Maybe treat it as another dimension of the issue to consider in your impacts.

I should have done more research, used all my characters and added more sources in R1, and then been more focused and efficient in my back and forth rebuttals.

From the start I did not expect how good arguments and sources you could conjure up so that's my mistake for underestimating the challenge this debate posed. You did really well.

Thank you all very much.

Thank you Ben, it was an intense debate and we both held our own.

Congrats.

Thanks for the vote

In progress as I type.

I look forward to seeing what you have to say on this.

Vote bump.

I've finished reading the debate, but I want to dig back into the rounds a bit more to come up with a decision. Should be able to manage that over the next few days and write up a decision this weekend.

Still got a couple of weeks, won’t be a problem.

Hopefully you have some time to cast a vote, or at least give the two of us your general thoughts.

I haven't forgotten about this. I'm spending some time on a flight this week, so I'm going to have time to read through it and start writing out thoughts.

Vote bump.

Thank you for voting

I do say so.

If you say so

1. In R1 I outlined my case with 6 sources. You also had only 6 sources in R1. In R2 you had 9 new sources. In my R2 I rebutted your sourced. In R3 I added 10 new sources, the 8 others you counted were sources that you originally cited, and where I linked two claims seperated by some text to the same source. For example, I cited the 43 year Netherland study, it was actually you that first brought it up in R2 as evidence for 8 year average time to regret. Of course looking into the source revealed less than favorable data for the CON side, that is why I elected to include it in my R3. But yeah, if I hadn't been squeezed for time IRL at that point, I would have provided many more sources in R1, which would have made the distribution more even. But I reject your claim that I blitzed random claims without reading sources. All of my new sources support arguments I already made or refuted claims that you had been making. All of them had lot of academic weight. It was NOT a gish gallop.

2. You say that I abandoned any source that you critiqued. But I affirmed all of the sources and repeated them in R3. You say that a meta-study on 8000 GAC recipients may contain bias or influence by cofounders. I defend by saying that even granting 90% of regrets as unreported due to bias, it still doesn't flip the result, it would still be less than 10% regret. With regards to the hormone treatment source, what is there to say. You quoted that causal inference was somewhat limited, which is valid. But I never abandoned it or conceeded its result to be false. With regards to puberty blockers for children. You never actually attack my source. Instead you introduce other sources that claim the opposite. In response I explain why those sources are unreliable or don't say what you want them to say, and then I bring up new sources to elaborate on my previous claims and further solidify my case.

Why would I waste characters to "defend" my sources when you never launches an adequate attack against them to begin with. Especially when there are hundreds of research papers that all support the PRO positon, why should I not bring up more of them.

You claim that I manipulated my sources. Give me a single example where I claim that my source says X but the source says Y not X.

Since you are so gracious as to tell me the things you did wrong, I'll give a two (because unlike you I actually have sounds argument and don't rely on spamming) word of advise.

1. Try a little harder to hide your incompetency by spreading out your copy and pasted sources, as opposed to blitzkrieging them in the last round.
In the first round, you provided 6 sources for your arguments. In the second round, you provided 0 new sources for your arguments (two in the meta debate analysis). In the third and final round, you provided 18 new sources to the substantive of your argument (not even new rebuttal sources, but completely new, [akin to a first round] bearing new arguments). I know the only way you can win is by spamming things you haven't read in the very final round (so then I'm forced to make a closing statement, defend my arguments, rebut your arguments, and address your new sources) but maybe try a little more to hide it (compare this to my third round, in which there is not one single new study introduced).

2. Actually address your oppositions arguments. Another interesting observation of your bad faith - building on the statistics above (you introducing 6 sources in the first round, 0 new in the second and 18 in the last round) what makes your blitzkrieging even more blatant is the fact that whenever a response is issued to your source, you instantly abandon it. For example, in the first round, you made the following substantive claims.

i. With supervision, these reversible drugs safeley and effectively delay a child's development until they are ready.
ii. There is an extremely low prevalence (<1%) of regret in transgender patients after gender affirming surgery.
iii. Gender affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress.
iv. 73% less likely to experience suicidality when compared to youths who did not receive gender-affirming interventions.

**Every** single one of these are addressed in my second round (check rebuttals 1, 2, 3), where your manipulation of sources, mischaracterising and simple ineptitude is made apparent. After I address your studies, how many of them do you defend? Zero. In this debate, you have not one single time defended a source once. Sure, you defend the claims, by blitzkrieging different sources to prove your point, but not once do you come back and attack my critique of your sources. That is to say, by the third round, every single source you introduced in your first round was abandoned by you. Essentially, the entire debate was a dance, where you brought up a source, I shot it down, and you bring up a new one, thereby implicitly admitting that the sources shot down were truly dead.

Try harder Benjamin

Usually, it is in bad faith to mount additional clarifications of your arguments for it might sway the potential voters, though to be fair, being bad faith has never of concern to you. Of course, all of your claims are absolutely and unequivocally incorrect.

1. You made the egregious claim that puberty blockers were "reversible drugs that can safely and effectively delay a child's development until they are ready". I disputed this with seven sources (two of which referred to bone density). You responded by asserting that bone density is not effected in those post pubescent consumers of hormone therapy which is absolutely irrelevant to your initial claim pertaining to children (you of course also ignore the 5 other sources I provided.

2. This is completely irrelevant. I've made this point like 4 times (all of which you've ignored) but GAC is something which effects your **entire life**, and you are making an inference based on a survey (funny that you have to stoop to online responses) which only requires you to have had **some** treatment for two years. So the conditional you are proposing is IF GAC produces happy online respondents within 2 years, THEN GAC is an effective **lifetime** treatment.

3. You absolutely did make this claim. Crying about transphobia being on the rise in your introduction is absolutely a way of poisoning the well, preemptively shielding the undeniable decrease in transgender mental health decrease with untested extraneous variables.

4. I'm not sure if you're actually stupid or you seriously do not understand what I am saying. It seems as though you have not actually read the section which I quoted clearly, highlighting so as to aid you away from your confusion. The line you cited explains what they ought not do, and then **immediately following**, the writer claims "to be responsive to some of the letter writers’ interest" follower by an explanation of what they decided to do, which is "creat(ing) a matched group of individuals with a gender incongruence diagnosis who have not received surgery... found no significant difference in the prevalence of treatment for mood disorders and no significant difference in the prevalence of hospitalization after suicide attempt". I won't be surprised if you're not following, so to dumb it down, the authors said "let's not do this thing", and then "since people have said let's not do this thing, I'll do this other thing" concluding with "this other thing seems to find that GAC doesn't help".

5. This was one of your stupidest moments in the debate. You said "the third study of his measures psychiatric morbidity in general, not gender dysphoria specifically like CON is insinuating" which is absolutely stupid - if you even cared to look at the second line of the study, you would see it said their entire purpose was "to investigate psychiatric morbidity before and after sex reassignment surgery". I don't really care what inference you are trying to make - the fact is, I used this study, to support the notion that transitioning does **not** help, which if it is shown that "no significant difference in psychiatric morbidity or mortality was found between male to female and female to male" is absolutely sound.

You don't have to respond to this comment. But here are 5 things you wrote in the third round that were 100% wrong. 5 mistakes you could have avoided by reading better.

1. You claim that I was missing the point and forgot to adress your claim that "puberty blockers have deleterious impact on children". Not only did you never make this claim before R3, it is also not true. The FDA does approve of puberty blockers in children because of decades of evidence that it is safe for children. None of your R2 or R3 sources claimed reduced bone mass in children, only in adolescents who took PB + Cross-X HT. That is the claim which I refuted in R3 and demonstrated to be not a problem in the long run. So I did not miss the point.

2. You also claimed that the 2015 American survey of 20 000 transgenders had no validity because "they could have received their surgery a month prior to the study and still be feeling rapid onset dysphoria.". But that is literally not true. Read my citation in R2: "they only counted those that had surgery at least 2 years prior".

3. You said that "When gender dysphoria doesn't seem to be alleviated, this is in spite of GAC" which is a lie, I never said that. I rejected the claim that gender dysphoria seems to no be alliviated. What I actually said is that health outcomes could still be negative DESPITE reduced gender dysphoria. That is not the same as saying gender dysphoria is unaffected by GAC.

4. You said that "PRO has quoted the studies admission that their former findings (the ones which support GAC) were false, and taken it to be an admission that the new revision is false". But the line which I cited explained why GAC recipient to GAC non-recipient is a bad comparison. So it refuted the usefullness of a new comparison they made after reading the letters. It is literally not possible that this quote is an admission that their original study has a wrong conclusion, because it is about a comparrison that wasn't included the original study. You may disagree with the writers but don't accuse me of misreading them.

5. You claim that I didn't adress your third study. But I literally did. In R3 I said: " the third study of his measures psychiatric morbidity in general, not gender dysphoria specifically like CON is insinuating." So I did not resign answering this third source. I pointed out that it found GAC recipients to have increased depression and anxiety in general, but didn't say that gender dysphoria specifically had increased. So you could maybe argue that continued gender dysphoria potentially caused these problems, but don't lie and say I didn't mention it.

So maybe next time spend some more time to read what you wrote in earlier rounds, read what your opponent actually wrote and read what the sources actually say.

I think I can squeeze this into the next two months somewhere...

Do you think you have time the next two months to write a vote for this debate? You are known for the highest quality votes, especially when it comes to science debates and evaluating sources.

Source battle!