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::'s avatar

you talk here about how it's important to debate subjects freely in order to guide policy decisions, and i think that speaks to a blindness on your part about how gender-critical talking points actually function in a society where gender-affirming healthcare is already locked behind a twenty-year waiting list and entirely unnecessary segregation.

in this context, by accepting gender-critical talking points as even worth discussing, you have already ceded that bodily autonomy and basic decency are conditional. not only does this legitimise the existing segregation of trans healthcare in this country, it also legitimises the existing criminalisation of abortion procurement, and opens the door to further restrictions on contraception and self-presentation.

discussions about the nature of gender and fine-grained inspections of when segregation is appropriate are all well and good, when had in good faith, but the fact is that the only policy question that is of any real consequence to trans people in this country right now is whether humans own their own bodies. anyone who's arguing either way about what gender is with an eye to policymaking has already ceded that bodies instead belong to lawmakers. this, i believe, is why so many people feel so strongly that there is nothing to be gained from such a discussion.

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Alex Potts's avatar

The thing is, the law does already place limits on bodily autonomy. We have term-limits on abortion. Children cannot consent to sex. There is no legal trade in human organs.

Framing the argument exclusively in terms of bodily autonomy is bound to bring these comparisons up. The precedent is clear that it is indeed legitimate for the state to place limitations on bodily autonomy, so these things have to be argued on a case-by-case basis.

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::'s avatar

the examples you cite aren't purely restrictions on bodily autonomy, though; they're protections for one party when interacting with another. they protect people from being exploited (or killed) within power dynamics that render consent impossible. there's no legal trade in human organs, but there are plenty of organ donors

segregating trans people's access to hormones, for instance, instead of just prescribing them under an informed consent model, addresses no power dynamic whatsoever

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Jimmy Nicholls's avatar

To take the point about medicine specifically: there is no right in the UK to obtain any specific medication on request. For me to have access to any particular treatment for a condition I would have to go to a doctor and they would have to be satisfied that prescription was appropriate. In that sense the request for trans-related medical care is no different from any other.

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::'s avatar

oh i one hundred percent agree. the problem is that, at the moment, trans-related medical care is very different from every other. this is what i mean by segregation

cisgender balding men and cisgender women in menopause can be prescribed hormones or hormone blockers by their GP. the only requirement is that they understand what the risks and consequences are, and that the GP believes it will help. in order to obtain the same medicine, transgender people must access a specialist service where they must perform gender stereotypes and answer invasive questionnaires in order to pass some bar of being 'a real trans'. even without the twenty year waiting lists, this arbitrary gatekeeping benefits nobody

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Jimmy Nicholls's avatar

This is outside my expertise, but the risks associated with menopause treatments are different from those associated with interfering with puberty, even if they both involve the use of hormones. I don't think it's unfair that different standards apply to seeking treatment for either condition.

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::'s avatar

your earlier point, which i agree with, is that requests for trans-related medical care should be treated the same as any other: a GP should explain the risks and consequences, and the patient and doctor should make a decision based on that. the substance of those risks is, of course, to be considered on a case-by-case basis. i'm confused about what changed between you asserting that point and now

for what it's worth, cis children with hormone deficiencies can also be prescribed hormones by their GP; if that's not interfering with puberty, i don't know what is

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Jimmy Nicholls's avatar

Patients can refuse treatment, but they can't request it either. Your complaint seems to be that doctors are too reluctant to prescribe treatment that would block puberty, among other things. In general I think their caution is justified. Prescribing a teenage boy treatment to enable normal male puberty should be less contentious then giving them treatment to prevent male puberty, in my view.

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::'s avatar

going through the wrong puberty is pretty horrific, whoever you are, but sure, these things must be handled with care. but by centering 'reluctance' here, you demonstrate that you still don't understand what the current framework for trans healthcare in the UK is

the segregation is not a product of reluctance, it's a product of explicit policy. GPs are not allowed to prescribe medicine that is otherwise simple to prescribe if it is perceived to be part of gender-affirming care for a transgender patient. a GP must instead place the patient on a decades-long waiting list to be put in front of a panel where the patient must then performatively demonstrate their transness to the satisfaction of a panel of people whose decision is based on discredited stereotypes

it's not okay to hold anyone's body to ransom until they tell a stranger what they think about when they masturbate

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Jimmy Nicholls's avatar

"The wrong puberty" is certainly an interesting phrase, but ultimately I don't think you're making fair comparisons here. For people experiencing gender dysphoria it seems entirely sensible that other psychological interventions be explored rather than going straight to physical interventions, the long-term risks of which are unknown and known risks of which include infertility. You can call that "segregation" if you want, but it's hardly some kind of colour bar. It's different approaches for different conditions.

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Alistair Frith's avatar

That last point is an interesting one. What does someone's thoughts during masturbation have to do with their gender? Are you saying that people who are turned on by thoughts of sex with women must be men and vice versa?

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::'s avatar

no, i am not. i do not understand the relevance of the question either. for some reason, though, GICs insist on asking it as part of determining if a patient is trans enough to get healthcare that balding men can get straight from their GP

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Eliot Barrass's avatar

But, I think Alex's point is correct. The state does place limits on bodily autonomy usually to prevent an individual harming themselves or harming each other. Unless you think that there is no case at all where a trans man can harm someone by being in a female-only space (in which case let's start with combat and contact sports), then it's legitimate for authorities to say that 'in X case, Y cannot happen'.

Whether trans people have freer access to hormones is a separate issue entirely, but even if say, medical access for trans people was the state's 1A priority there would still be legitimacy in policing the borders of female-only spaces.

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::'s avatar

thanks for so efficiently demonstrating my point

we do not live in that world, and niche policies about access to particular spaces are, as you have demonstrated here, a great way to distract from the much larger and actually relevant obstacles that all trans people share. the fact that you don't appear to know what a trans man is makes me pretty confident that you're coming to this discussion in bad faith, or at least with woefully little knowledge on the subject. consider, also, that there is no way to police such a restriction that isn't hugely invasive for anyone who dares to be at all gender nonconforming in anyone's eyes

but none of this is relevant to policy decisions in the context of how trans people are treated in this country today

(for the record, trans men who *have* made it through a GIC are often not given access to, for instance, cervical cancer screenings. this is the kind of routine problem that actually affects their lives)

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Eliot Barrass's avatar

What is a trans man, in your view? Let's see if we can agree a common definition before we start opining on each other's motives.

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Spinebuster Keaton's avatar

To answer on someone else's behalf, you seemed to imply that a trans man would require access to female-only places - but a trans man is someone who identifies as male. A trans *woman* would identify as female and would be the person e.g. fighting Ronda Rousey in the UFC. Referring to such a person as a man could be construed as misgendering.

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Eliot Barrass's avatar

In that case I sincerely apologise. No offence was meant or intended (or I hope, taken). Shows how little I have tried to engage with this debate that I haven't internalised the language which, to my slight mitigation, feels counter-intuitive.

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JenClone's avatar

I agree with you on trans rights, but I'm aware that many people who don't understand anything about what trans people go through haven't thought of it/framed it in this way before. Wouldn't a talk including this exact viewpoint be valuable?

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::'s avatar

yes, sure

it doesn't seem like that was what was planned, though, and it's pretty difficult to make this kind of argument and have it stick when other people who have the stage are having an entirely different conversation. it's easy to get sucked into, for instance, debating the legitimacy of trans people's experience of gender when that's what the opposition wants to talk about

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Charles Arthur's avatar

“it's easy to get sucked into, for instance, debating the legitimacy of trans people's experience of gender..”

In a strictly rationalist framework like I imagine Skeptics organises around (never been a member), everything must be up for debate, surely. You have to distinguish between what might be solipsism (“my experience of gender”) and what could more generally be called material reality (“my biological sex”). (Yes I realise that ultimately *everything* could be solipsism but for these purposes we assume we are not brains in a vat.)

Assuming as you seem to that some things just shouldn’t be discussed or questioned is *exactly* the problem here. It’s only a matter of degree to go from “don’t question the legitimacy of my experience of gender” to “don’t allow these people to discuss their findings about a clinic which doesn’t question the legitimacy of people’s experience of gender”.

Also congratulations to James, who could retitle this Substack “Let’s Find A Third Rail To Touch”. I’m here for it.

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James O'Malley's avatar

This is the only Substack where you can hope to find the author both touching the metaphorical third rail, and also possibly discussing actual third rail systems used on railways.

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::'s avatar

i said that i find those conversations valuable, when had in good faith, and i meant it. the nature of the various properties that fall into the bimodal distributions we call sex and gender are interesting. the problem that i (and, i am positing, most people who object to events like this) have is that you can't have those conversations in a way that might influence policy without all sides implicitly accepting that individual bodily autonomy is conditional; these discussions, when not purely academic, can only influence policy in ways that serve to legitimise the state's claim to own the bodies of its subjects

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Charles Arthur's avatar

"i find those conversations valuable, when had in good faith"

I'm going to appear argumentative (because I am), but you accused someone else here of coming to the discussion in bad faith when it was absolutely obvious from what they said that they came from a position where they weren't familiar with the jargon. That's not bad faith, which is a faux naivete. If you don't understand the phrase, or can't recognise when it is and isn't being deployed, I'm not going to trust that you can recognise if someone is arguing "in good faith" (which anyway tends to be in the eye of the beholder).

Sex is not bimodal ("having two separate popular values, or modes, and a spread of lesser values in between and outwith the modes"). It's binary. Please do not make me tap the biologist.

"these discussions, when not purely academic, can only influence policy in ways that serve to legitimise the state's claim to own the bodies of its subjects"

I'm just a humble journalist used to writing for the people on the Clapham omnibus, so you'd need to translate this into language they and I can understand. An example would be helpful, because that phrase I quoted means absolutely nothing concrete to me.

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::'s avatar

the comment you're alluding to said that someone appeared to be either arguing in bad faith or be uninformed on the subject. both possibilities were posited. it appears to have been the latter

sex is a vast and messy collection of properties. the state of a person's genitals at the time of their birth (the property from which we derive the definitions of the terms 'cisgender' and 'transgender') is but one that demonstrates bimodality. performing surgery on intersex children's genitals to make them conform to a constructed binary does not make that binary the truth. there are cisgender women with xy chromosomes and malfunctioning hormone receptors. chromosomes have more than two configurations. biology doesn't end in primary school

an attempt to rephrase my final quoted point: i believe that human bodies belong to the people who live in them, and that you have to reject that position if you're willing to accept that debates on the nature of gender can influence policy

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Charles Arthur's avatar

On the binary sex question, you are simply wrong. How many biological parents do you have? When a transgender person visits a doctor, might the phrase "cross-sex hormones" be used, in which case what should we conclude about how those hormones are delineated? You say "sex is a vast and messy collection of properties", which demonstrates that you don't understand the difference between phenotype, genotype and karyotype, all of which you refer to there but none of which is necessarily definitional of your sex. The single property that *is* definitional of your sex is which of the two types of gametes - big and immotile or small and mobile - your body is organised to produce. "Intersex" (an outdated term: the preferred, because more accurate, term is "DSD", for "differences in sex development", which describes what has happened better). Indeed, biology doesn't end in primary school, but the stuff they should have taught you in secondary school about ova and sperm remains totally true and descriptive. People with DSDs are still either male or female; it's just more difficult to determine.

In general: your beliefs expressed here (and, I'm sure, your resentment at my resistance to them, and my willingness to offer a smattering of science and real-world examples) are part of why this policy question gets mired. For me, if I think that you don't understand what sex is, and that you haven't asked yourself "if sex is bimodal, howcome it's only ever males and females who produce children, and also there's no definition of what the X-axis is measuring on this bimodal scale", then I'm also going to think that your views on males getting access to women's spaces on their say-so about being transgender (with all the definitional questions that arise around that, which we haven't even touched) haven't been well thought-through either.

I don't say these things as a personal attack. What I'm pointing to is what I see as flaws in your reasoning. I agree that your body belongs to you. But what you do with it in society affects all the other people around you, and transgender rights can interfere with the rights of women, and children may not be medically or mentally competent to make vast life-changing decisions, so there has to be a more nuanced policy discussion than "be kind".

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::'s avatar

(i guess, also, side notes: humans are not their gametes, and a woman without eggs is still a woman)

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Charles Arthur's avatar

(Side notes: nobody said that “humans are their gametes”, only that which gametes your body is organised to produce defines your sex, which also answers your ”woman without eggs” assertion: the reason we know Caster Semenya is not female, for example, is the presence of internal testes.)

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::'s avatar

what does 'organised to produce' mean, if not 'actually produces'? in the absence of produced gametes, who decides what the intention of a body's construction is? im not aware of any mature human body that produces eggs, and undescended testes may never produce a single gamete of any kind. human reproductive systems organise themselves based on signals received during early development. sometimes those signals are confused for any number of reasons, many of which lead to a human who is incapable of ever producing gametes, but who is otherwise entirely functional as a human with a sex assigned at birth

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::'s avatar

in the reproductive sense, human sex certainly seems to be binary (although life is weird, and the weizmann institute appears to be putting some doubt to the concreteness of even that binary). but that's not the only context that word gets used in, and it is explicitly irrelevant here since it only correlates with the sex that gets written on your birth certificate. legal sex is the property that has consequences here, and it's that definition that defines the term 'transgender'

on policy, i'd like to bring up an example, since nobody else has. an example of a 'female-only spaces' question that comes up a lot is in gendered toilets. i think there's an understandable knee-jerk reaction to this concept from a lot of people, but you don't have to think very hard or look very far back in history to realise that enforcing any kind of access policy is bad for everyone. for one thing, forcing trans men to go into the women's toilets makes literally everyone uncomfortable, and for another, there is no way to enforce such a policy that isn't ludicrously invasive for everyone suspected of violating it

delaying your puberty is not a vast or life-changing decision. going through the wrong puberty is

full disclosure: i have been assaulted in a gendered toilet because i was crossdressing. i am heavily invested in making these spaces safer

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Charles Arthur's avatar

"The weizmann institute appears to be putting some doubt to the concreteness of even that binary"

I think you may not have understood quite what the Weizmann Institute (and researchers at Cambridge University) have and haven't achieved. Their embryo model work requires pluripotent stem cells, which of course come from humans, who are produced by.. I'll let you guess. Good writeup by Philip Ball: https://www.theguardian.com/science/2023/jul/01/are-human-embryo-models-a-cause-for-hope-or-alarm

"Legal sex is the property that has consequences here"

I agree, mostly; this is a good place to start.

"Gendered toilets". Toilets are generally segregated by sex. Otherwise where are the toilets for non-binary people and two spirits people? The first sex-segregated toilets seem to date to 1739, but public toilets for women were in short supply until the late 19th century. There have also been other segregations: the Romans would have different ones for high-status people and for servants/slaves; and of course there's also apartheid, which I think is what you're actually referring to. Interesting tack to hint that continuing to segregate toilets by sex is a continuation of apartheid.

"forcing trans men to go into the women's toilets makes literally everyone uncomfortable" - You mean "those involved", rather than literally every person everywhere, right? I don't have any way to know how true this is. I'd suppose a lot depends on context (in a lesbian bar, would it?) and how the trans person presents, and perhaps acts. Certainly enforcing it to be 100% correct in every case would be ludicrously invasive - but at present the "enforcement" is still there, in the form of social stigma. A lot of how sex-based delineation happens (in toilets, in sport, elsewhere) is reliant on how those involved perceive the rules. If I just rock up and claim to be playing for the women's team at [sport] and ignore complaints that I obviously am not female and hence not eligible, what happens next? We rely on shared social boundaries, to the extent of stigma, to denote what we deem acceptable. That's what the debate over toilets (and prisons, and sports, etc) revolves around: how do we draw the social boundaries?

"delaying your puberty is not a vast or life-changing decision. going through the wrong puberty is" - delaying puberty is not trivial, and the drugs used to effect that aren't either. Lots of trans people down the years have gone through normal puberty and then lived satisfied lives as the opposite sex. The reporting about the Tavistock was related to the incomplete and in some cases hasty medicalisation at a time when there was - and is - insufficient knowledge about the topic.

I'm sorry to hear you've been assaulted. You don't specify the sex of your assailants. Would they have desisted if there were a sign on the door saying trans people were welcomed? I'm faintly doubtful: the sort of people who are going to assault you in a toilet aren't much troubled by labels. Never let it be forgotten, of course, that Cheryl Tweedy, aka Cheryl Cole, was found guilty of assault in 2003 for punching an attendant in a nightclub toilet who demanded she pay for some lollipops. You'll never make those spaces completely safe.

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Lee Ward's avatar

"sex is a vast and messy collection of properties."

Yes, but nevertheless, the sex binary obtains, regardless of discussion of chromosomes, sex disorders, hormone receptors and the like. The point worth remembering is that there are just *two* routes for genetic information to be reproduced: through eggs, or through sperm. *That* is the binary. This is a useful summary: https://thecritic.co.uk/life-is-diverse-so-what/

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::'s avatar

that is one of the properties we call sex, yes

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Charles Arthur's avatar

No; it's the only one. The others are *associated with* sex. Hence the phrase "secondary sex characteristics" (breasts, wide hips; or facial hair, greater musculature) and "primary sex characteristics" (vagina, penis).

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