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== Guillamon et.al (source 23) == |
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== Issue With DSM-5 Prevalence Estimate == |
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The information under “symptoms” for this source comes from the intro/abstract of this paper and references Blanchard’s typology, which has been discredited. The information also contradicts the previous paragraph which states sexual orientation does not impact GD. ] (]) 18:27, 17 October 2024 (UTC) |
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Hi, so at the start of the "Epidemiology" section it states: |
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== Is this correct? == |
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{{Blockquote|text=The DSM-5 estimates that about 0.005% to 0.014% of people assigned male at birth (5-14 per 100k) and 0.002% to 0.003% of people assigned female at birth (2-3 per 100k) are diagnosable with gender dysphoria.}} |
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About this paragraph in the introduction, does this correctly describe the stances of the referenced sources? |
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And the citation links to ]. |
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{{blockquote|Some researchers and transgender people argue for the <b>declassification of the condition</b> because they say the diagnosis <b>pathologizes gender variance and reinforces the binary model of gender</b>.<ref name="Karl Bryant">{{cite encyclopedia |title=Gender Dysphoria |encyclopedia=] |url=https://www.britannica.com/science/gender-dysphoria |access-date=August 16, 2018 |date=2018 |archive-url=https://web.archive.org/web/20200418213857/https://www.britannica.com/science/gender-dysphoria |archive-date=April 18, 2020 |vauthors=Bryant K |url-status=live}}</ref> However, this declassification could carry implications for healthcare accessibility, as HRT and gender-affirming surgery could be deemed cosmetic by insurance providers, as opposed to medically necessary treatment, thereby affecting coverage.<ref name="Zack Ford">{{cite web |title=APA Revises Manual: Being Transgender is No Longer a Mental Disorder |url=http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc |url-status=dead |archive-url=https://web.archive.org/web/20130202082602/http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc |archive-date=February 2, 2013 |access-date=April 7, 2013 |website=] |vauthors=Ford Z}}</ref>}} |
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Are they really calling for the declassification of <b>gender dysphoria</b> or the declassification of free self identification? As gender dysphoria has lots of severe ] right? So it is unclear to me how anyone can argue that symptoms should be declassified? Is enough context given here? Are they maybe arguing this out of questioning whether the symptoms are caused by the dysphoria or by environmental factors (discrimination)? I can only really think of possible arguments to declassify gender dysphoria that would indeed lead to "implications" stated in the second sentence, that it would deemed cosmetic. |
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I can't verify since I'm not sure the specific sources used, but my reading of the "Prevalence" section in the DSM is that they are getting these estimates based on face-value number of referrals compared to the general pop. Specifically it says: |
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So to wrap up a bit, it is not clear to me what exactly the first sentence here means with "declassification", is it an emotional argument out of activism, or is there some solid logic here? If there is solid logic, I don't see it. ] (]) 15:55, 27 October 2024 (UTC) |
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{{Blockquote|text=Since not all adults seeking hormone treatment and surgical reassignment attend specialty clinics, these rates are likely modest underestimates. Sex differences in rate of referrals to specialty clinics vary by age group.}} |
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:This looks like a fair summary of the existing sources, although one is old and the other is ] so I imagine more nuanced coverage of both stances probably exists. |
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If these rates are just based on the amount of a population going to specialty clinics, I don't know if it's appropriate at all to use it as an estimate of the % of the population *diagnosable* with gender dysphoria (it'd be an estimate of the % of the population *diagnosed* with GD at one point in time). At the very least it should be qualified, since that's a much stronger statement that could be, e.g., cross referenced with the current amount of people identifying as trans women to say "X% of those identifying as trans women do not have diagnosable gender dysphoria", which wouldn't be a valid conclusion based on my reading of what the DSM is saying. ] (]) 23:28, 4 April 2024 (UTC) |
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:* From Britannica: {{tqb|Critics have argued that GD diagnoses continue a long-standing history of pathologizing oppressed peoples. Some argue that the diagnosis stigmatizes groups that are simply expressing variation, not pathology. Critics suggest that the diagnosis individualizes a broad cultural and social phenomenon and reinforces a binary mode of gender.}} |
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:* From ThinkProgress: {{tqb|On the other hand, insurance companies have been more willing to cover the expenses associated with transition under this language, because treatment for a disorder is considered medically necessary, rather than cosmetic.}} |
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:Yes, they are very unrealistic numbers and extremely low. Far too low to be representative of the general population based on available surveys. says: {{tq|The prevalence of gender dysphoria is difficult to determine in the general population. Previously, the prevalence in adults was thought to range from 0.005% to 0.014% for people assigned male gender at birth and 0.002% to 0.003% for people assigned female gender at birth.18 These estimates are based on referrals to surgical gender reassignment clinics, however, and are therefore likely an underestimate.}} ] (]) 03:09, 5 April 2024 (UTC) |
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:Hope this helps. –] (] • ]) 17:24, 27 October 2024 (UTC) |
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:Yeah, this does seem ripe for rewording. At the very least, @{{u|VoeVoeVoe}} you're correct that it's not accurate to paraphrase the DSM5 prevalence number as an estimate of {{tq|people ... diagnosable with gender dysphoria}}, and as @{{u|Hist9600}} points to, there are newer, more confident and likely more accurate prevalence estimations in the literature. ]<sup>]</sup> 03:20, 5 April 2024 (UTC) |
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::I can't speak for others, but if it helps you conceptualize the "anti-" argument, I offer the following clumsy analogy: I was born with a rare birth mark that spells out "Kick Me". I'm depressed because everyone keeps kicking me. I go to the doctor to get it removed. He says I have kick-me sad-brain disorder. He gives me antidepressants and says not to let it bother me as much when people kick me. I turn to leave. He kicks me. –] (] • ]) 17:34, 27 October 2024 (UTC) |
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::I'm looking at the page in the DSM-5, and even the DSM-5 says that, "not all adults seeking hormone treatment and surgical reassignment attend specialty clinics", and further says that the numbers are likely to be underestimates (p. 454). Yet the numbers were used rather uncritically in the article here. Not a good use of this source. ] (]) 15:36, 5 April 2024 (UTC) |
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::The first quote doesn't seem to establish declassification. |
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::I've updated the article to at least use the DSM-5 source better and include the caveats clearly stated in the DSM-5 itself. Additional criticism of these numbers from other sources may also be appropriate. ] (]) 16:29, 5 April 2024 (UTC) |
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::It only the seems to claim that the formulation and/or application of the current diagnosis allegedly leads to reductionisticly or even entirely wrongly labelling people with a variation-question with a pathological label (second sentence from first quote), and seems to claim that before mentioned of the current diagnosis seems to lack neutrality/objectivity, specifically failing to detect (binary) gender stereotypes. |
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:::Nice edit, and agreed. ]<sup>]</sup> 16:30, 5 April 2024 (UTC) |
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::So is it then correct that declassification is argued for? ] (]) 18:09, 27 October 2024 (UTC) |
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:::With "before mentioned" I meant "the formulation and/or application" again, not sure if there is a more compact/clear way to write that without repeating that entirely. ] (]) 18:11, 27 October 2024 (UTC) |
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== Bachmann et al. == |
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::@] Also, there is another implication of declassification. The sentence "People with gender dysphoria commonly identify as transgender" says "commonly", thus declassifying would also unavoidably impact people who have gender dysphoria but aren't transgender. ] (]) 20:04, 30 October 2024 (UTC) |
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:::Which is not addressed in that paragraph.. |
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(Bachmann et al. 2024) has been to support the following claim: |
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:::{{blockquote|However, this declassification could carry implications for healthcare accessibility, as HRT and gender-affirming surgery could be deemed cosmetic by insurance providers, as opposed to medically necessary treatment, thereby affecting coverage.}} |
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<blockquote>A recent study in Germany found that more than half of young people aged 5-24 across every age subgroup diagnosed with "gender identity disorder" no longer had the diagnosis after five years. Specifically, the persistence rate was 27.3% in 15- to 19-year-old females and 49.7% in 20- to 24-year-old males.</blockquote> |
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:::It doesn't even mention what the impact of declassification would be on people with gender dysphoria who aren't transgender. I know from very close experience that is seems to exist, as this page also seems to suggest/confirm. ] (]) 20:06, 30 October 2024 (UTC) |
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The source is a "Kurzmitteilung" (a short summary as opposed to a full research article) of a study on insurance data from the German ], published only a few days ago. |
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The relevant parts of the source are, from the ''Ergebnisse'' section: |
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<blockquote>In der Längsschnittkohorte (n = 7 885, 47,1 % 20- bis 24-jährig, 37,7 % männlich) wiesen nach fünf Jahren insgesamt nur noch 36,4 % eine gesicherte F64-Diagnose auf, eine Diagnosepersistenz < 50 % zeigte sich in allen Altersgruppen (27,3 % bis 49,7 % ).</blockquote> |
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and from the ''Diskussion'' section: |
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<blockquote>Die diagnostische Persistenz von unter 50 % in allen Altersgruppen im 5-Jahres-Follow-up entspricht der Literatur und spiegelt vermutlich die Fluidität des Konzepts „Geschlechtsidentität“ im Kindes- und Jugendalter wider (5), kann aber auch als Hinweis auf die Notwendigkeit eines umfassenden, standardisierten diagnostischen Vorgehens interpretiert werden (www.cass.independent-review.uk/publications/final-report).</blockquote> |
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The authors stress the fact that they have not (for obvious reasons) investigated whether the diagnoses were "valid", and their conclusion is that more work needs to be done to investigate whether the reaults from their initial study hold true, and what the reasons may be for the low persistence of diagnoses. They also conclude that offering various treatment options for gender identity disorder is crucial. |
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I strongly believe that the source can't be used for the sweeping claim it was used to support, and I am curious why that particular bit of the study was used, and not the bit where the authors show that there is a robust increasing trend in gender dysphoria diagnoses, or the conclusion that it is important to offer a range of gender affirming treatments. But above all, I don't think a primary source consisting of a short summary of research on which insurance codes are used in German health care data is useful as a source. --'']'' <small>] ]</small> 09:35, 15 June 2024 (UTC) |
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:Just FYI, it’s very likely the data in this paper isnt particularly meaningful. It is about diagnostic persistence in the German medical system which requires associated billing events over time. I.e. somebody who is diagnosed with GD but parents don’t let them transition (and as such, there is no ongoing billing events occurring) are counted as desistors in this paper. As are people who delay their transition. Insurance billing events are not a good way of measuring persistence of GD or transgender identity. ] (]) 01:37, 16 June 2024 (UTC) |
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The information under “symptoms” for this source comes from the intro/abstract of this paper and references Blanchard’s typology, which has been discredited. The information also contradicts the previous paragraph which states sexual orientation does not impact GD. Wren Armstrong (talk) 18:27, 17 October 2024 (UTC)
About this paragraph in the introduction, does this correctly describe the stances of the referenced sources?
So to wrap up a bit, it is not clear to me what exactly the first sentence here means with "declassification", is it an emotional argument out of activism, or is there some solid logic here? If there is solid logic, I don't see it. Wallby (talk) 15:55, 27 October 2024 (UTC)
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