Meta-Analysis criticism
https://www.ncbi.nlm.nih.gov/pubmed/7950571
https://towardsdatascience.com/how-to-avoid-three-common-mistakes-in-meta-analysis-eb64427e8569
https://en.wikipedia.org/wiki/Meta-analysis#Challenges

In short – meta-analysis CAN be useful, but is subject to numerous problems that can make it unreliable. Worse, to show if a particular meta-analysis is unreliable, you must examine their entire inclusion set of studies *and also the studies that were EXCLUDED*

A bunch of studies I want to point out. Please note that I'm not *agreeing* with any and every conclusion. I comment on my take on these studies.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885
This study is bashed a lot because it didn’t produce the “right” results. The study is often misunderstood, though. This isn’t a study on whether mental health improves post or pre transition.
It shows significantly higher mental health issues and suicides in the transgender population over time. The fact that it’s bashed so much is part of the reason I say this whole debate is biased. There’s a “correct” result that people seem to want.

https://www.psychiatry.org/newsroom/news-releases/study-finds-long-term-mental-health-benefits-of-gender-affirming-surgery-for-transgender-individuals
Sorry to post a news article, but I can’t find the study itself.
The title is actually misleading: the results show that hormone replacement therapy does NOT show the trend the title claims – it was only observed in sex reassignment individuals.
They also measure “mental wellbeing” by “mental health use”, a vague term that seems to mean how often they seek help. I shouldn’t have to explain why this is a dubious marker for mental health…

https://link.springer.com/article/10.1007/s00238-016-1252-0
Again, title is misleading – this shows that mental wellbeing increases in the short term, but over the long term decreases.
It tries to “explain away” this decrease by aligning it with the general population, but the mental wellbeing still remains below average compared to the general population.

https://eje.bioscientifica.com/content/164/4/635.full.pdf
Mortality relative to the general population for MtF was still 51% higher than the general population, mainly due to suicide after HRT.
In FtM, it was “not significantly different”, probably due to how much easier it is for FtM to pass.
The sample size is pretty low for this one, so I wouldn’t blame you for disregarding.

https://journals.lww.com/prsgo/Fulltext/2018/08001/Abstract___Sex_Reassignment_Surgery_Is_It_Good_for.194.aspx
An examination of the literature around sex reassignment surgery. Basically – while the procedure itself has gotten better and led to more satisfaction with the outcome by patients, the actual effects long term are hard to measure and we don’t know if it’s actually good or not.
And frankly, if we don’t know if something is good or not, we shouldn’t be doing it in medicine, especially when it’s irreversible.

https://www.theguardian.com/society/2004/jul/30/health.mentalhealth
This is a news article, not a paper.
This is referring to a meta-analysis, *so the conclusions shouldn’t be taken seriously*. What’s important here and what I wanted to highlight is the criticisms of the studies that were in the meta-analysis body.
“Its review warns that the results of many gender reassignment studies are unsound because researchers lost track of more than half of the participants. For example, in a five-year study of 727 post-operative transsexuals published last year, 495 people dropped out for unknown reasons. Dr Hyde said the high drop out rate could reflect high levels of dissatisfaction or even suicide among post-operative transsexuals. He called for the causes of their deaths to be tracked to provide more evidence.”

------------------------------------------------------------------------------------------------------

American Psychiatric Association guidelines on gender dysphoria:
https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

Despite gender dysphoria being an actual mental disorder, the language has been changed because “Persons experiencing gender dysphoria need a diagnostic term that protects their access to care and won’t be used against them in social, occupational, or legal areas.”
Basically, this is an admission that the term was changed because of SOCIAL, OCCUPATIONAL, or LEGAL reasons, not for any medical reason. This is what I meant when I said “political pressure”.

This has led to widespread misinformation like this:

[see image, articles from NTY and Vox (both heavily left leaning publications)]

https://www.nhs.uk/conditions/gender-dysphoria/treatment/
The current recommended treatment for adults is transitioning, rather than psychiatric drugs to control and alleviate dysphoric symptoms.


Despite the fact that other forms of dysphoria and dysmorphia are treated psychiatrically with medication and cognitive behavioral therapy.
Body Dysphoria:
https://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/diagnosis-treatment/drc-20353944
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414653/
RSD:
https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria#1
PMDD:
https://www.health.harvard.edu/womens-health/treating-premenstrual-dysphoric-disorder

Common line is that serotonin uptake inhibiters can treat dysphoric symptoms.

---------------------------------------------------------------------------------------------------

Despite this, there is a dearth of any studies of treating gender dysphoria psychiatrically rather than with transition “therapy”.
The notion is considered transphobic and the idea that it could even be possible is treated as a “myth”.
Here is a biased “source” for this:
https://genderanalysis.net/2016/12/myth-pimozide-and-gender-dysphoria-gender-analysis/

This article does a good job of showing the problems in the medical community where “Hundreds of studies throughout several decades, including tens of thousands of patients, have found that the most effective treatment for gender dysphoria is transitioning.”

Criticisms of the sources cited in this article:
de Vries et al., 2014: https://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958
Followup evaluation was *one year* after transition.

 Fisher et al., 2014 https://www.ncbi.nlm.nih.gov/pubmed/23171237
Doesn’t included genital reassignment surgery – only conclusion was that FtM have an easier time socially adapting than MtF, which is common sense, since they pass better.

Murad et al., 2010; https://www.academia.edu/29737088/Paul_McHugh_Is_Wrong_Transitioning_Is_Effective
Not a scientific study. An opinion article and meta-analysis, which we’ve already shown to be stupid.


I got tired at this point, but I’m going to assume that the rest of these “sources” are of similar quality.

------------------------------------------------------------------------------------------------------

Long story short, here’s my argument.
At *best* we don’t know the long term effects of HRT and sex reassignment surgery.
Considering how radical these treatments are, they shouldn’t be recommended. I’ve shown that they ARE recommended.

I’ve shown you that other forms of dysphoria and dysmorphia are treated in a different way with gender dysphoria being the only one we treat by trying to bring the patient’s body in line with the perception.

Additionally, I’ve shown you the bias in all of this. Publication bias is one of the reasons that the conclusions of meta-analysis are unreliable.
Publication bias is the observed effect that negative or inconclusive studies are less likely to be published than positive or conclusive studies.
I’ve shown you that there is non-medical reasons why the language around this has been altered. The entire subject is politically charged and it seems the medical community has fallen onto one specific side.
Because of all of this, you are unlikely to see any negative results studies out there, or they’ll be buried. This gives the illusion to the average person that the “evidence” is all on one side, when in reality, you’re just seeing what you’re supposed to see.

If you demand a single additional citation from me on any of this shit, I’m just blocking you.
This is the furthest I’ve ever gone in a stupid argument with someone like you that citation trolls everything.
I’ve explained my point of view on the subject ad nauseum and I’m just tired of it at this point.
I knew I was gonna regret ever fucking opening my mouth on the subject.