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Gender/Transgender In The Military & In General


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I came in on the tail end of a discussion on the daily status yesterday that I think would be an easier discussion to have in a thread here. A lot of interesting dialogue that will simply disappear otherwise.

 

I pasted some statements that had back and forths, and things I'd like to dig further into:

 

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  • No medical association identifies Transgender as a mental disorder.

Allowing fit and qualified people to fight and work along other fit and qualified people is an experiment?

The figure reported as being too high is infinitesimal when compared to other things that military spends far more money on.

YOU think it's a mental health issue. No qualified medical professional organization or diagnostic manual does.

If you actually wanted those things for that community, having them in the military wouldn't bother you.

Maybe those rates are high because of people who think and speak like you and Presidents that ban them from serving a country they love.

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Just want to clarify Fru - these arent my comments or thoughts ... I pasted them from a rolling status update yesterday. I hope to have some time later today to respond here as well.

 

None of that was directed at you, I know you wouldn't post anything like that. Forgive me if it came off that way.

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It is - just found that out today when I was reading some stuff. I found a couple really good articles Ill post when I get to a computer later. Good education for me and I thought I knew a bit about it already.

 

Also tracked down a couple peer review articles LOMS.

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Gender dysphoria, which leads to transgender....ing? (I know transgender is not a verb, don't know how to express this properly) is a mental disorder/mental health issue, though, is it not?

 

My understanding is that dysphoria is the distress one experiences.

 

Per the APA.

 

"In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning."

 

https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

 

If someone is transgender and functions just fine, then there is nothing to diagnose.

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Transgender people may, or may not experience gender dysphoria.

 

Gender-corrective action or therapy can address the issue for those that do; in a similar way, soldiers who experience a range of other mental health issues from depression to anxiety to schizophrenia to PTSD can get treatment targeting what they experience.

 

It's possible to experience gender dysphoria, which I believe is merely the perception that one's gender and body do not match, without having it be functionally impairing.

 

I think this may be a good resource, but ofc I'd recommend deferring to people who have had occasion to become far more familiar with this topic than I: http://www.apa.org/topics/lgbt/transgender.aspx#isbeing

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Two articles (peer reviewed LOMS, per our discussion on another thread.

 

A summary of the first:

 

  • In a retrospective review of 30 years in sweden looking at people (both men to woman, woman to men) who underwent sexual reassignment
  • Looked at long term survival (mostly reporting within the first 10 years - then lost to followup)
  • Higher incidence (3x) of morbidity and mortality in these folks vs. healthy population (from all causes, including cardiovascular & suicide etc)
  • BUT - it was not stat sig in part of that time. Questions come up due to significantly different surgical procedures and follow-up procedures in the 70's, 80's and 90's
  • Big take away - the surgery isn't enough. They still need support and care to deal with the the other mental health issues they have.
  • DID NOT look at satisfaction, happiness, quality of life etc - simply what was their rate of death vs. healthy people

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

 

 

Another study (retrospective) showed a 3.8% "regret" rate after surgery. Two reasons given: Lack of support from family & the patient belonging to a core group of individuals who are not transitioned.

 

 

Somewhere we discussed whether this was a "cosmetic" procedure or "necessary" - study done in 1991 (I know, old but it must have really been scandalous at that time) looking at Medicaid funded rationale:

Federal requirements for state Medicaid programs are surveyed, and case law regarding Medicaid funding of sex reassignment surgery is reviewed. States have attempted to exclude sex reassignment surgery (SRS) from Medicaid coverage on various bases, concluding, for example, that the procedure constituted "cosmetic surgery." Judicial scrutiny of such exclusions has usually resulted in the state action being found violative of the federal Medicaid statute and accompanying regulations. In those cases upholding the state exclusion, the primary judicial obstacle to funding has been a determination that SRS is "not medically necessary" or is "experimental." The author explores the recent scientific literature concerning long-term outcomes following SRS and concludes that the procedure, for purposes of Medicaid funding, is neither "unnecessary" nor "experimental," and that the categorical exclusion of SRS from Medicaid coverage is therefore inappropriate.

 

https://www.ncbi.nlm.nih.gov/pubmed/2003772

 

It's funny - much of what I can find is from overseas, particularly Sweden, Denmark etc. Funny how those Nordic folks are so much further ahead on the medical part of this debate.

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"Big take away - the surgery isn't enough."

 

 

Is the surgery documented to be beneficial, or is that just an assumption we make along the way? That's the main thing I'm really curious about, being pretty uneducated on the whole situation. It seems culture just took the thing and ran with it but I haven't actually seen any research that explains good/bad healthy/unhealthy ways of approaching body dysmorphia or being transgender.

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That's the thing I guess - the biggest, most recent didn't look at quality of life reports or satisfaction by the participants - it's that that we'd need to determine that (imo). I'm still looking.

 

They also made the point that there was no way you could really attribute their morbitiy mortality to their sex change. That they may have had other issues that caused depression (as we all do) or heart disease etc.

 

The other data I found was that 3.8% number - which was pretty close to satisfaction - not many regret the surgery.

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