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Why We Don’t Know the Size of the Transgender Population (fivethirtyeight.com)
57 points by ryan_j_naughton on Dec 14, 2014 | hide | past | favorite | 47 comments


I think it's a really hard question, I would change gender if a magician could do it with no ill effects. But I wouldn't consider myself transgender, and I think it would be unfair to count me or John as part of that group.

On the topic of gender I'm basically like John, just more open about it. But at some point in my life realized that I don't care enough about my gender that there's any point for me to put in any effort into this. There's just so many things that I would rather put energy into, like building nice things for people.

When there's a free text field for gender I fill in whimsical things like programmer or mathematician depending on context.


How about if the medical procedure and preparation was better and the social consequences ere nil?

How is that different than saying "If I could have sex exclusively with men without being disowned by my family, I would, but it's just not that important to me?"

You're not alone.


To the first question, any sufficiently advanced technology/society is indistinguishable from magic.

To the second, not that much really. If there were no social consequences, my choices might have been different.


The opening caught my eye:

In 2001, Kerith Conron was working on LGBT issues in Boston’s health department. She discovered that homeless transgender people were sleeping on benches because the shelters, which were segregated by gender, didn’t know what to do with them. As a result, transgender people weren’t included in the city’s assessment of who needed shelter.

Years ago, I took a class on Homelessness and Public Policy. I don't recall this coming up as an issue at all. But apparently this is a very serious issue, so serious it can bar you from access to basic services when things are at their very worst.


I am not a fan of GLAAD definition. I think it does more harm than good. Gender Dysphoria, the condition associated with transgender individuals, is most likely neurological in nature - that is to say, there are plenty of studies correlating sex-atypical differences in the brain with gender dysphoria. (http://transcience-project.org/brain_sex.html)

Lumping in cross-dressers and run-of-the-mill gender variance denies this very real condition the attention it deserves, it reduces it to a choice. There is nothing wrong with the choice, and people should have the right to express their gender however they choose, I just think that we need to be careful about maintaining a separation between gender dysphoria and gender variance.

On the actual question at hand, clinical intake studies have been pretty consistent in this regard. The number of people who have gender dysphoria that becomes severe enough to prompt treatment (in western European countries) is about 1:10000 (for transgender women) and 1:27000 (for transgender men). (Judge, Ciaran, Claire O'Donovan, and Donal O'Shea. "Gender dysphoria-prevalence and co-morbidities in an Irish adult population." Neuroendocrine Science 5 (2014): 87)

That being said it is difficult to estimate the number of individuals with gender dysphoria who choose not to seek treatment (or those who choose to self medicate). People like John are unfortunate, and a hopefully the bi-product of an age we are on our way out of. That being said, John is clearly not transgender, they may suffer from gender dysphoria, but they are not transgender.

Today we have a much better understanding of gender dysphoria and have a number of long term studies which show hormonal and surgical transitioning to be an effective treatment (e.g Gorin-Lazard, A., Baumstarck, K., Boyer, L., Maquigneau, A., Gebleux, S., Penochet, J.-C., Pringuey, D., Albarel, F., Morange, I., Loundou, A., Berbis, J., Auquier, P., Lançon, C. and Bonierbale, M. (2012), Is Hormonal Therapy Associated with Better Quality of Life in Transsexuals? A Cross-Sectional Study. Journal of Sexual Medicine, 9: 531–541. doi: 10.1111/j.1743-6109.2011.02564.x). I

“First you ask about what sex is on your birth certificate. Then later in the survey you ask, ‘What is your gender?’? - This, of course, doesn't work in first-world countries where gender dysphoria is treated like an intersex condition and the individuals are free to amend their birth certificates.


> there are plenty of studies correlating sex-typical differences in the brain with gender dysphoria.

There are also plenty of studies showing the opposite, as well as studies showing trans people being, on average, somewhere in between the male and female averages (on the specific area of the brain observed - generally different in each study!). The fact is, we just don't know.

And that's why GLAAD's definition is good. Trans people deserve respect and fair treatment regardless of what causes some people to be trans and others not to be trans. If we find out tomorrow that brain differences can't explain being trans, that doesn't change how trans people should be treated.

And it will probably be quite some time before we have a good answer there. We still don't know why some people are gay and some aren't, for example, and that has received far more research interest. The answer to that question, and to the trans question, will likely be quite complex, scientifically. But ethically, the answer is simple - just treat people nicely regardless.


> There are also plenty of studies showing the opposite, as well as studies showing trans people being, on average, somewhere in between the male and female averages (on the specific area of the brain observed - generally different in each study!). The fact is, we just don't know.

That should have been sex-atypical differences, which would accommodate for the "in-between" studies.

Taken as a whole, the science is pretty clear, when looking at various parts of the brain, patients with gender dysphoria (both prior and after treatment) show differences from cisgender controls, and typically, those differences align with those of their identified gender.

> And that's why GLAAD's definition is good. Trans people deserve respect and fair treatment regardless of what causes some people to be trans and others not to be trans.

These two don't follow each other. Of course transgender people deserve respect and fair treatment, like all people. I just think we have to be careful when we conflate gender variance with gender dysphoria - one is a very evolving cultural concept, the other is a major contributor to suicide in transgender individuals.


After dating a transwoman, I came away with the strong opinion about what being transgender is from a biological/psychological point of view.

What I learned was - it boils down to is a missmatch between the software, and the wetware - the thing is, many people have this, many who are successful and happy in the body they have - but there are some, a minority of those afflicted who simply cannot deal with that missmatch - I don't know why they can't (up bringing, inability to extend beyond classic gender identity, something biological, not really sure) - but whatever the cause, they can't, and those are the folks that generally end up identifying as transgender, and going thru the process of transition to remove the discongruity between the hardware and software.

I don't (well try not to, I'm only human) place a value judgement on it, its about finding your own happy place where you can flower into a good person.


> Taken as a whole, the science is pretty clear

I don't think it is, unless you pick and choose what you read.

For example,

http://en.wikipedia.org/wiki/Transgender#Transsexual_people_...

mentions several studies showing no brain differences.


Yes, there are several studies showing no differences in various task-based studies. There is also at least 1 MRI study I am aware of that didn't find sex-atypical differences, but did find a difference between the subjects and the cisgender controls.

However, and I repeat myself, as a whole - we now at around 30-40 studies most of which fall on the side of there being neurological differences in subjects with gender dysphoria. And in a few key areas we have replication of these findings too.

When you couple this together with long term treatment studies a picture starts to emerge - one of gender dysphoria being an intersex condition which response to hormone therapy and gender confirmation surgery. And most psychologists and endocrinologists now accept that when you take this approach, it is the most successful in producing happy and healthy patients.


The treatments do not depend on the cause being an intersex condition or a brain syndrome. Modern medical support for trans people helps them far better than anything we had before, but not because it is tied intrinsically to any theory of what causes one to be trans. Instead, the treatment makes sense for someone that feels as their physical form is inappropriate - it helps change that. It doesn't matter why they feel that way.

The danger, as I see it, with your approach is that you predicate society's view of trans people on medical grounds. Being trans is a medical condition, from your perspective. Of course, being trans can be medically relevant, but we aren't talking about that here - we are talking about how society should treat them. For that, the cause is simply irrelevant, and tying it to scientific findings is risky as we don't know what science will find.


And its not uncommon in the trans community to tie "biological causes" with "more valid and real." Ultimately I bet gender dysphoria is indeed a biological issue, but it seems presumptuous to think the science is completely settled on it.


The problem is that not everyone who is gender dysphoric can transition. That might be a shock to bi-coastal progressives, but for a large chunk of people, stuff like cross dressing might be the only way to deal with it (very, very secretly for people assigned male at birth).


"These two don't follow each other. Of course transgender people deserve respect and fair treatment, like all people. I just think we have to be careful when we conflate gender variance with gender dysphoria - one is a very evolving cultural concept, the other is a major contributor to suicide in transgender individuals."

Why can't crossdressers be considered gender dysphoric? It may simply be the way that some people deal with their biological gender dysphoria. Ugh, stupid trans community politics and shit. Yay lets all argue about terminology!

Disclaimer: I am a trans woman.


Those incidence numbers strike me as implausibly low. I happen to know two transpeople fairly well by completely random chance. One is good friend of my (now adult) kids, whose parents are also friends of mine who I met through work, the other is an adult child of my girlfriend.

Unless you hypothesize that for some reason I befriend people who have a vastly increased probability of having trans offspring, numbers like 1:10E4 give me a 1:200000 of being in this position. I would generously assume I know 25 people as well as I know these people, so the probability of finding two in that group who are trans would be 1E-4251E-4*24 = 0.000006. Tiny.

Now, in a world with a few billion adults in it there are going to be a few tens of thousands of people like me, who know more then one transperson from completely unrelated means, but it would be interesting to know if anyone else here does. I'm pretty sure people in my situation are not as rare as those numbers would indicate.


I think it's worth considering that people with non-traditional sexual identities tend to concentrate in certain geographic areas. So perhaps your random selection is taking place over a highly self-sorted population.


Yeah, in general I think the HN commentariat is not remotely representative of society as a whole. Especially when it comes to the intersection of tech and sexuality.


I know (at levels varying from 'friend' to 'acquaintance', so the field is more like 100-200 than your 25; but these are all people I have at least conversed with multiple times) two trans men and at least seven trans women (off the top of my head.) These are all people who are, at a minimum, currently taking prescribed hormones corresponding to their self-identified gender.

But I understand that there may be a self-selection effect where a lot of trans women end up in technical fields, so my sample may well be biased.


Yeah, I think that trans women might be slightly more prevalent in Silicon Valley than they (we) really should be.


I know a few, and my "know people well" metrics are similar to yours.


> Gender Dysphoria ... is most likely neurological in nature

As opposed to what?


Psychological. Many early theories tended along the line that gender dysphoria was an extension of sexual fetishistic behaviour. We know now this to be very wrong, but there are still many who advocate for this position.


I'm curious as to the distinction here. Can you explain? Either way sounds like something wired abnormally.

I don't think people necessarily choose their sexual fetishes either, though gender dysphoria strikes me as more of a compulsion than a sexual thing.


Sure. Although it is a vary leaky abstraction :)

We used to consider depression as a psychological phenomena. That is, we used to think that we could make a person think their way out of it. Either though CBT or some other kind of psychological treatment.

Since then we have learned that neurological factors, in particular neurochemistry which are correlated with depression. We now know a person cannot think their way out of depression - we have developed treatments with varying success, although we still have a way to go.


CBT, and medication have fairly similar efficacy rates for treatment of depression.

So it's not true that "We now know a person cannot think their way out of depression."


The argument doesn't make sense in the first place. Neurological problems are expressed psychologically and psychological problems are expressed neurologically. The brain will indeed literally rewire itself based on what you do and think. Which is not at all, of course, to say you can simply wish yourself out of depression. Indeed that's exactly what can make depression such a problem.


Neurological would mean it's a hardware thing. An analogy would be a CPU that's physically wired wrong. So no matter how good the software is, running it will produce errors.

In the nature vs. nurture debate, this is a nature-side of things.

Psychology would mean it's a software thing. The analogy would be software with some logic errors in it s.t. no matter how good the hardware is, you end up with the incorrect result.

In a nature vs. nurture debate, this is a nurture issue. For example, childhood trauma might turn into some kind of aberrant behavior in adulthood.

Either condition might produce similar or even equivalent results, but the root causes are different and "fixing" them requires different approaches.

And then there might be poor folks with a combination of both factors.


The issues raised by the fuzzy region between the well-defined genders is a complex one.

We tend, maybe especially us in the software world, to build systems that cater for definitions that neatly fit into specific boxes (M/F), or that rely on simplified models ("sex at birth is all you'll ever be").

Despite the fact that transgenders people have always existed, we are only starting to acknowledge their existence and recognise that they are citizen that have the same rights and duties as anyone else and that they should be treated with the same respect and consideration as anyone else.

I think we, as creators of systems that model the world, should be more knowledgeable and have more consideration for the complexities of dealing with sex and gender.

We can ask ourselves whether asking someone's M/F status is really necessary (what do we need it for?), whether we can allow at least a third option where neither are selected or present a perfectly valid "Prefer not to say/I don't fit in a box" option.

This also affects how we choose to address people with Mr/Mrs/Ms/etc. Allowing no title to be selected (or a title of the user's choosing) should also be possible, as well as selecting a title that doesn't traditionally fit with the selected sex (like choosing Mr even if the user selected F as their sex).

We then have to assume that these attributes can change over time and allow users to redefine them at will, without hindrance.

There is a lot more to be done but these simple steps, all fairly easy to implement, are a start in the right direction.


I really don't get most of these kinds of questions on web forms - sex, name, title. I think that except for legal purposes, where it's necessary to provide your legal name/sex/whatever, you should only have a field called "how should we address you" and nothing else.


[deleted]


Actually it is with simplified models.

Sexual differentiation in humans is split into many different pieces. There is chromosomal differentiation (at conception), hormonal differentiation (mostly through puberty), hormonal exposure in the womb (between 3-9 months), neurological differentiation (well into early adulthood in some cases).

Intersex conditions exist, and many go undetected until well into adolescence.

With all this, coming up with a consistent definition of male and female is actually pretty complicated, with lots of edge cases.

> Male/female have precise scientific terms that apply to all animal species.

Lookup how fruit flies are sexed, then compare to humans :) The animal kingdom can be a very different world.


A related problem (from an academic standpoint) is what to do with the size of the transgender population. If it is .3% of the entire population, then there is a temptation to say that the other 99.7% is cisgender (which, depending on definitions, may be accurate). However, this does not consider the questions of what percent of those 99.7% would also be cisgender if they suddenly changed genders.


This is an interesting question to consider. Would you want to change back to your former gender if by magic you woke up tomorrow the oposite gender to who you are today? I am male and have no desire to be female, but if I were to wake up tomorrow in a female body I am not sure I would go to the effort to change to male.


"...wake up tomorrow in a female body..." - a proper one or a fake one (reproduction, gender features, psychology etc.)?


Since this is just a thought experiment a real one. Of course this is rather hard to know what I would really think if I was suddenly female.


I wouldn't bother with the operation: unusual experience is interesting and superbugs made operations an uncertain adventure anyway. Hopefully in future choosing full biological gender could be a day-to-day fashion-like decision.


I'm pleased to see ongoing efforts to get data on these kinds of things.

@brighteyes: Indeed! Just treat people nicely goes a long, long way. Well said.

@jensnockert: IMHO, there are a lot more people not fitting exactly into the boxes than any of us realize. As I get to know more people well in my life, and they come to understand I'm not discriminatory in any way on these things, they say stuff. If the "no ill effects" path were reality, I sometimes wonder just what people would do and how many of them would do it.

And millenials appear to be past a lot of this, notably valuing people presenting as who they are honestly to a much higher degree than we've seen in the past.


If John selects male on the census check box, dresses as a male, and tells everyone publicly that he is a male, there is just no way to know that he really wishes he were female.

He flat out said he'll check male unless it's an anonymous survey--and even if the survey is anonymous, he said he'd check male as long as anyone else is in the room with him.


I would not be surprised if the "transgender community", to the extent it can have a group preference, prefers to remain basically uncounted. They are a miniscule percentage, and "man on the street" estimates of the size of small groups tend to wildly overshoot. This gives them more influence than they would have were their true numbers known.


On the other hand, there is a chance that the estimates may undershoot. Identifying as transgender is difficult for many people because of the stigma involved. There are also costs; costs for HRT and surgery if you go that route,the cost of replacing old clothes with new clothes, the possibility of emotional costs if friends or relatives do not support. Also, there is anxiety, and one might have fears like, "what if I don't pass?" I think a lot of transgender individuals may not come out or delay coming out for these reasons.

Then there is also the challenge of lack of information. I grew up in a Christian, conservative environment. I attended a catholic school where genders were rigidly segregated. So the idea of "biological sex = gender" was ingrained in me. I did not even hear the term "transgender" for the first time until 1.5 years ago.


I don't think I've seen anyone post this estimate of the transgender population yet:

http://ai.eecs.umich.edu/people/conway/TS/TSprevalence.html

The takeaway is that about 1 in 1000 people medically transition without SRS.

Notice this is written by Lynn Conway - very accomplished chip designer/electrical engineer/systems engineer

http://ai.eecs.umich.edu/people/conway/conway.html#Memoirs

I know a lot of trans people in my local community - but I'm trans myself so that's only logical. Still, intuitively, it can't be anywhere near as rare as 1:10,000


> Notice this is written by Lynn Conway - very accomplished chip designer/electrical engineer/systems engineer

And also an outrageously biased and partisan activist whose claims, when writing on anything but chip design, should be checked with a microscope and then promptly thrown out as cherry-picked or misleading in some way you weren't competent to figure out.


You should figure out exactly where she went wrong in her estimate and email her - I'm sure she'd be more than happy to correct her article.


Why do we expect that anything as complex as gender to break out into nice neat categories? We really should move on from the obsession of putting labels on people and get on with helping everyone to feel happy with who they are.


Is gender really that complex? Article suggests somewhere over 1 in 1,000 don't have a simple personal view of their gender, and also most transgender people are trans - changing from one to the other - rather than inter-gender. If people don't want to be male or female, or biologically aren't, or just don't want to identify as either, fine. But to say gender is complex as a result seems like a reach.


I was really surprised by the article's premise and conclusion. I'm pretty sure the likes of Google and Facebook have extensive datasets that can be mined which provide useful insights. It seems to me that since the definition is so unclear, perhaps we should do away entirely with categorizations like this.

Rather than have homeless shelters for specific categories, why can't we just have homeless shelters for human beings, no questions asked? From a public policy and economic standpoint, $1 spent on a homeless shelter for men is equivalent to one for women. There is a fortune at the bottom of the pyramid [0], and I'm surprised there aren't more entrepreneurs tackling social issues such as these.

[0] http://en.m.wikipedia.org/wiki/The_Fortune_at_the_Bottom_of_...


>Rather than have homeless shelters for specific categories, why can't we just have homeless shelters for human beings, no questions asked?

Even if you have a shelter for men and women, the dorms are still separated by gender so it's not that easy.

Unisex dorms don't work for obvious reasons--Many homeless women aren't going to be comfortable sharing bunk beads with men, especially at women's shelters that are set up to provide support for women with small children.

I'm sure there's a solution (a 3rd gender neutral sleeping area?), but it's not as easy as just building one big "human shelter".


In the case of the shelters, the problem is not how to allocate the funding; the problem is what dorm to put them in.

I agree that it is clear that the socially-desirable action is to give shelter independent of gender; it's also clear that some existing systems for support do not allow that without effort, and so far the effort has been allocated elsewhere.

Ugh, just think about being trans and using a public restroom. Now think about being of high-school age, and being trans, and needing to use a bathroom. And yet if (more than) 0.1% of Canada is trans (dunno if that's true), then all of my high schools had (at least) one trans person, presumably closeted. Poor bastard. But on the other hand, what action can the administration take that isn't worse than nothing?




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