Talk:Gender dysphoria/Archive 5

Semi-protected edit request on 26 December 2018
I would like to add, in "Causes", more about studies of MZ and DZ twins, since there is just one study mentioned and the current literature indicates that biopsychosocial components are in play, just to give a broader view to the issue. I would also like to add that further investigation is needed in order to draw more appealing conclusions.

Here is an article about the concordance of gender dysphoria in MZ and DZ twins, if somebody else would like to do it or just to take a look: https://www.researchgate.net/publication/51856870_Gender_Identity_Disorder_in_Twins_A_Review_of_the_Case_Report_Literature Sebasgaravano (talk) 01:12, 27 December 2018 (UTC)


 * ❌. You need to make a request with exactly what you want to add, not a desire that something be added generally.  You can, however, make a general suggestion on the talk page without an edit request template and see what other people think.  –Deacon Vorbis (carbon &bull; videos) 02:24, 27 December 2018 (UTC)

Image
I noticed there's no images at all here; could somebody add File:2013 Rally for Transgender Equality 21175.jpg in here somewhere? Thanks :) Madness Darkness 20:43, 6 February 2019 (UTC)
 * Seems reasonable. ✅. -sche (talk) 23:04, 6 February 2019 (UTC)
 * thanks! Madness Darkness 23:15, 6 February 2019 (UTC)

Irreversible changes


About reverted changes. Hormone therapy commonly causes gynecomastia in transgender females, which itself is irreversible as even if one wishes to stop taking hormones, breast tissue won't magically go away. Some other things like hair growth and skin changes are reversible, as they'll change back to a male pattern. Please consider this. Laitr Keiows (talk) 06:49, 28 December 2018 (UTC)
 * Thanks for your comment at my Talk page (now moved here for better visibility and comment). I assume you are talking about your undo of my earlier revert of your Dec 18 03:06 edit at Gender dysphoria.
 * Penectomy, orchiectomy, and hysterectomy are irreversible. Lowering of voice from typical female pitch range to male range after taking T is irreversible.  Growth of breast tissue is not irreversible.
 * When you make a change and are reverted for cause, rather than just undo the revert to enforce your own preference, please instead raise the issue at the article talk page and try to gain consensus for your point of view through discussion with other editors. See WP:BRD. Cordially, Mathglot (talk) 08:45, 28 December 2018 (UTC)
 * According to the sources I've seen, breast tissue growth is reversible up to a point. Basically the more breast tissue grows, the harder it is to reverse. It probably shouldn't be characterized as either "reversible" or "irreversible". Kaldari (talk) 05:13, 7 February 2019 (UTC)

Semi-protected edit request on 26 February 2019
Please change

"Evidence from studies of twins suggest that people who identify with a gender different from their assigned sex may experience such distress not only due to psychological or behavioral causes, but also biological ones related to their genetics or exposure to hormones before birth"

to

"Evidence from studies of twins suggest that people who identify with a gender different from their assigned sex may experience such distress due to psychological or behavioral causes, but also potentially biological ones related to their genetics or exposure to hormones before birth."

because

the fourth citation and the sentence preceding it claim that there is a genetic predisposition for gender dysphoria based on the research provided. However the research article in full does not make such a concrete claim and instead only discusses a potential genetic contribution to gender dysphoria.

The following is the discussion section of the cited article, "Gender Identity Disorder in Twins: A Review of the Case Report Literature."

"The etiology of GID is a complex process of biopsychosocial components with unexplained interactions. Twin literature on GID supports the contribution of genetic factors to the development of gender identity with a higher tendency in males than in females. Since sample size is still limited and genotype studies are lacking, conclusions must be drawn with caution. Therefore, detailed registers of GID twins, preferably on MZ twins discordant for GID and DZ twins are needed, to gain more decisive information about the influence of genetic vs. environmental factors in the development of GID."

Since the article cannot make a decisive claim, the statement made in the Wikipedia entry should be changed as described previously.

Thank you for your time. Howardoc (talk) 19:36, 26 February 2019 (UTC)
 * The proposed new sentence has terrible grammar and is difficult to read or make sense of. How about just adding the word "potentially": "Evidence from studies of twins suggest that people who identify with a gender different from their assigned sex may potentially experience such distress not only due to psychological or behavioral causes, but also biological ones related to their genetics or exposure to hormones before birth" Kaldari (talk) 20:40, 26 February 2019 (UTC)

Please excuse the format and grammar of the previously presented sentence. The intention was to retain as much of the previous author's original sentence as possible. Your suggested revision,

"Evidence from studies of twins suggest that people who identify with a gender different from their assigned sex may potentially experience such distress not only due to psychological or behavioral causes, but also biological ones related to their genetics or exposure to hormones before birth"

makes it unclear what "potentially" is modifying. Instead, may I suggest this revision?

"A concordance study suggests that gender dysphoria not only has psychological and behavioral causes, but may have biological causes as well."

Thank you again Howardoc (talk) 21:43, 26 February 2019 (UTC)
 * ✅ That's a big improvement. I made the change you suggest with some minor tweaks. I kept the "studies of twins" wording since I think that provides more context, and I also got rid of "behavioral causes" (whatever those are) as that isn't mentioned in the cited reference. Kaldari (talk) 21:23, 1 March 2019 (UTC)

Vandalism using short description
Hello,

I'd like to make everyone aware of Short description, which allows indirect vandalism of an article my modifying the wikidate, and changing the short description of an article, which appears on the mobile app.

I have reverted the vandalism, and will add a short description in the article itself so any changes to the short description will appear directly in the edit history.

Please see Short description for info on how to turn on short description in settings, so it is visible for you on desktop.

If you suspect any other articles are susceptible to vandalism in this way, please apply the Template:Short description.

Thanks,

WildComet (talk) 03:19, 16 April 2019 (UTC)

See for the wikidata. WildComet (talk) 03:23, 16 April 2019 (UTC)

WP:Student editing
Regarding this and this, like I stated, there are some WP:MEDRS-compliant sources in that. In fact, I was surprised to see good sources. For example, the Springer International Publishing book source is a WP:MEDRS-compliant source. Kam.peyton, if you haven't read WP:MEDRS, please do. And stick to sources like that Springer International Publishing source and the American Psychiatric Pub book source. Flyer22 Reborn (talk) 02:35, 18 April 2019 (UTC)

Per WP:MEDRS and WP:SCHOLARSHIP, generally avoid WP:Primary sources. An American Psychiatric Pub source, as long as it's up-to-date, is fine because the American Psychiatric Association is an authoritative body and publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM). Flyer22 Reborn (talk) 02:42, 18 April 2019 (UTC)

Serenenn48, and other student editors, regarding this, this and this, the lead is meant to summarize the article. This is per WP:Lead. Despite my revert and then moving things lower, the "mental disorders" aspect was covered lower in the article already. But whether or not it should be mentioned in the lead is a matter of WP:Due. You need to stop adding links to your log-ins; we do not have access to that. It's your log-in. And per what I stated above about sourcing, make sure that you don't add thesis material. Flyer22 Reborn (talk) 02:36, 26 April 2019 (UTC)

Also, make sure that you add page numbers with your sources when there is a page number. Flyer22 Reborn (talk) 02:37, 26 April 2019 (UTC)

Adjust initial definition of Gender Dysphoria
Hello everyone. The definition currently stated for GD on Wikipedia is as follows: "Gender dysphoria (GD) is the distress a person experiences as a result of the sex and gender they were assigned at birth. In this case, the assigned sex and gender do not match the person's gender identity, and the person is transgender." This is quite confusing, and the first sentence listed above makes it appear as if cis people can also experience gender dysphoria. A more accurate definition would be: "Gender dysphoria (GD) is the distress a person may feel if their birth-assigned sex and gender do not match the person's gender identity."

If not the above, then here it is as defined by the American Psychologic Association (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."

Here is the definition provided by the NHS: "Gender dysphoria is a condition where a person experiences discomfort or distress because there's a mismatch between their biological sex and gender identity."

Either of these would be better and clearer than what is currently listed.

Jay Hendricks — Preceding unsigned comment added by Jayndricks (talk • contribs)
 * I gave it a go. Hopefully it's an improvement. Kaldari (talk) 20:30, 1 May 2019 (UTC)


 * Regarding this and this, I don't understand use of "may." It's an "is" matter, and the sources don't state "may." So I changed it back to "is." As for the original wording, I don't see what was confusing about it or how "the first sentence [made] it appear as if cis people can also experience gender dysphoria." It's not much different than the suggestions by Jayndricks. If anything, the current wording of "People who experience gender dysphoria are typically transgender." can lead people to people to think that cis people can also experience gender dysphoria. And if we consider the children who experience gender dysphoria as a phase, then, yeah, cisgender people have also experienced gender dysphoria. So I guess "typically" is best. But let's not forget that non-binary people fall under the transgender umbrella. The sources are almost always talking about transgender people when they talk about gender dysphoria. And when one goes by those sources, although not every transgender person has gender dysphoria, everyone with gender dysphoria is transgender. Even kids who cease to have gender dysphoria were considered transgender for a time. Flyer22 Reborn (talk) 12:34, 2 May 2019 (UTC)
 * I'm cool with getting rid of "may". I had a hard time figuring out good wording for explaining the relationship between gender dysphoria and being transgender. I agree that basically anyone who has gender dysphoria is transgender, however, I was reluctant to write something like "People who experience gender dysphoria are transgender" is it sounds like the two things are equivalent in that case. I also considered "Gender dysphoria (GD) is the distress a transgender person feels due to their birth-assigned sex and gender not matching their gender identity." Let me know if you have ideas on improving it further. FWIW, I do agree with Jay Hendricks that the previous wording was a bit vague. Kaldari (talk) 17:19, 2 May 2019 (UTC)

Semi-protected edit request on 12 May 2019
I would like to make a clarification about the causes of gender dysphoria. these are: studies link Autism Spectrum Disorder to Gender Dysphoria Fora-Phae (talk) 00:35, 12 May 2019 (UTC)


 * ❌ You'll need to specify exactly which studies. See WP:CITE and WP:MEDRS. MPS1992 (talk) 01:31, 12 May 2019 (UTC)

Correction of terminology
This article begins by saying that sex and gender are assigned at birth. I feel that this language can be improved for the sake of greater precision. Sex in almost all cases is assigned by chromosomes, that is before birth. Gender is to some extent assigned, but is also assumed by the child as it develops. Making a correction on these lines would greatly clarify the matter for a reader. --82.251.155.245 (talk) 14:39, 10 April 2019 (UTC)Sirin

I agree with this request. The term "assigned at birth" seems largely to be used for political purposes, to confuse sex (which is *recorded* at birth in most countries, accurately apart from the very rare exception of intersex people) and gender, which is a complex mix of societal and personal developments. JCBradfield (talk) 10:46, 1 May 2019 (UTC)
 * "Assigned at birth" is the terminology that is normally used, regardless of if some people are technically assigned before birth and regardless of whether it would be more accurate to say the sex is "recorded" at birth. See this Google N-gram. Note that no usage is found for the other phrases. Kaldari (talk) 20:39, 1 May 2019 (UTC)
 * "Natal sex" shows up more often in Google N-grams than "sex assigned at birth": . I don't know if that's counting things like "pre-natal sex determination", though. Cheers, gnu 57 20:56, 1 May 2019 (UTC)
 * "Natal sex" would work in most contexts, but Wikipedia discourages the use of jargon. I believe "sex assigned at birth" is understandable by more people. See the guidelines at MOS:JARGON. Kaldari (talk) 01:35, 2 May 2019 (UTC)
 * It is absurd to suggest that the phrase "sex assigned at birth" is somehow more correct because it happens to be in currency. It doesn't matter how *common* it is, it matters whether or not it accurately describes the subject matter. In this case, it is clearly not correct. The first sentence could very simply be changed to: "...the distress a person feels due to their sex not matching their assumed gender". This would be a vast improvement, and does not contain anything that could be described as jargon.2001:861:3F42:DF90:911A:5460:26E3:6E67 (talk) 19:50, 28 May 2019 (UTC)Sirin

Semi-protected edit request on 30 May 2019
The World Professional Association for Transgender Health (WPATH) and its journal, the International Journal of Transgenderism, do not allow for dissenting articles to be published in their peer review. For this reason, I do not think this article should be citing them. 70.27.89.82 (talk) 18:22, 30 May 2019 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. DannyS712 (talk) 18:26, 30 May 2019 (UTC)

Footnote 47 is vague
The section entitled "Gender as a social construction" contains the sentence "However, research has found that the anxiety associated with gender dysphoria persists in cultures, Eastern or otherwise, which are more accepting of gender nonconformity" with footnote 47 citing the DSM V. The citation for the research is unclear which research is being referred to for further understanding. Can information be added to either identify the specific studies that have found this or to specify which cultures more accepting of gender nonconformity have shown this anxiety? Perhaps a direct quotation from the DSM V would be appropriate here?

Cwgaray (talk) 22:29, 29 May 2019 (UTC)

This sentence could be clarified by changing it from "However, research has found that the anxiety associated with gender dysphoria persists in cultures, Eastern or otherwise, which are more accepting of gender nonconformity" to "Individuals with gender dysphoria have been reported across many countries and cultures. The equivalent of gender dysphoria has also been reported in individuals living in cultures with institutionalized gender categories other than male or female. It is unclear whether with these individuals the diagnostic criteria for gender dysphoria would be met."

The source is still DSM V, but adding pg 457 would help to provide users a way to easily find the citation. Furthermore, it's worth noting that the suggestion for replacement is a direct quotation from pg 457 of the DSM V. Cwgaray (talk) 15:28, 31 May 2019 (UTC)

Semi-protected edit request on 15 June 2019
in the "cause" section I would like to add studies that suggest a link between ASD and gender dysphoria

source 1: https://www.liebertpub.com/doi/abs/10.1089/lgbt.2018.0252?journalCode=lgbt source 2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889781/ source 3: https://www.autism.org/gender-dysphoria-autism Fora-Phae (talk) 10:02, 15 June 2019 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. NiciVampireHeart 12:16, 16 June 2019 (UTC)

Semi-protected edit request on 15 June 2019
The study that reports the 41% rate is never cited in the article. As far as I can tell, it's this study: http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf

This study also reports the national average for suicide attempts at 4.6% rather than 1.6% in the article. My guess is that 1.6% reflects the rate of successful suicides rather than suicide attempts, but I can't tell since that number also has no source.

Change "compared to a national average of 1.6%." to "compared to a national average of 4.6%. " — Preceding unsigned comment added by 2a02:8388:1782:380:881b:138c:e8c9:2ce1 (talk • contribs)
 * Red information icon with gradient background.svg Not done: The study is cited. The following sentence also talks about the same study, and the source at the end of the second sentence is the citing both sentences. It is now a dead link, so I've provided the archived version of it in the article. It says "A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general population". NiciVampireHeart 22:30, 29 June 2019 (UTC)

Foundations II Group 3A Goals
My goals were to improve the grammar and syntax of the article. This topic was given very late in the project and has therefore not been given as much time as the other articles in our group. With that being said. 1) the goals were addressed 2) the format matches the intentions of the wiki style 3) the content improves the overall article 4) the article is written in easy to read and understand terms and there is no plagiarism that stood out --Inshaqari (talk) 02:15, 8 August 2019 (UTC)

Recent edits
Vmastropietro and Chrysanthemum123, regarding this and this, be sure to stick to WP:MEDRS-compliant sources for the medical material. For example, we should typically avoid primary sources for this topic. See WP:Primary sources and WP:SCHOLARSHIP. Also, peer review is not the same thing as literature review. Per WP:MEDDATE, sourcing for history and some other society and culture material is more relaxed. Please read and study WP:MEDRS.

I restored this wording by Chrysanthemum123, but I did not restore "many cultures." That needs a reliable source. I also did not restore changing the "Management" title to "Support"; for why, see WP:MEDSECTIONS.

Regarding Vmastropietro citing MedlinePlus, I'm pinging Doc James about using this in our medical articles. Doc, would you consider MedlinePlus a decent source to use in this case and something that is a step up from WebMD? I know that per Identifying reliable sources (medicine), use of these sources is a case-by-case matter. Flyer22 Reborn (talk) 00:34, 21 November 2019 (UTC)


 * This from medlineplus is a content from ADAM.
 * ADAM is not a very good source. It is not content produced by the US government but simple content they have licensed. They have also talked about getting ride of ADAM.
 * Doc James (talk · contribs · email) 15:08, 21 November 2019 (UTC)
 * Thanks for commenting/the information, Doc James. Flyer22 Reborn (talk) 21:00, 21 November 2019 (UTC)

Semi-protected edit request on 27 November 2019
Remove "They frequently engage in transvestic behavior with sexual excitement." from signs and symptoms. The source cited for that section (Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. 2013. pp. 455–456. ISBN 978-0-89042-554-1) does not corroborate that information. 174.253.194.86 (talk) 20:25, 27 November 2019 (UTC) Prepubertal natal boys with gender dysphoria may express the wish to be a girl or assert they are a girl or that they will grow up to be a woman. They have a preference for dressing in girls’ or women’s clothes or may improvise clothing from available materials (e.g., using towels, aprons, and scarves for long hair or skirts). These children may role-play female figures (e.g., playing “mother”) and often are intensely interested in female fantasy figures. Traditional feminine activities, stereotypical games, and pastimes (e.g., “playing house”; drawing feminine pictures; watching television or videos of favorite female characters) are most often preferred. Stereotypical female-type dolls (e.g., Barbie) are often favorite toys, and girls are their preferred playmates. They avoid rough-and-tumble play and competitive sports and have little interest in stereotypically masculine toys (e.g., cars, trucks). Some may pretend not to have a penis and insist on sitting to urinate. More rarely, they may state that they find their penis or testes disgusting, that they wish them removed, or that they have, or wish to have, a vagina.

In both adolescent and adult natal males, there are two broad trajectories for development of gender dysphoria: early onset and late onset. Early-onset gender dysphoria starts in childhood and continues into adolescence and adulthood; or, there is an intermittent period in which the gender dysphoria desists and these individuals self-identify as gay or homosexual, followed by recurrence of gender dysphoria. Late-onset gender dysphoria occurs around puberty or much later in life. Some of these individuals report having had a desire to be of the other gender in childhood that was not expressed verbally to others. Others do not recall any signs of childhood gender dysphoria. For adolescent males with late-onset gender dysphoria, parents often report surprise because they did not see signs of gender dysphoria during childhood. Expressions of anatomic dysphoria are more common and salient in adolescents and adults once secondary sex characteristics have developed.

Adolescent and adult natal males with early-onset gender dysphoria are almost always sexually attracted to men (androphilic). '''Adolescents and adults with late-onset gender dysphoria frequently engage in transvestic behavior with sexual excitement. The majority of these individuals are gynephilic or sexually attracted to other posttransition natal males with late-onset gender dysphoria.''' A substantial percentage of adult males with late-onset gender dysphoria cohabit with or are married to natal females. After gender transition, many self-identify as lesbian. Among adult natal males with gender dysphoria, the early-onset group seeks out clinical care for hormone treatment and reassignment surgery at an earlier age than does the late-onset group. The late-onset group may have more fluctuations in the degree of gender dysphoria and be more ambivalent about and less likely satisfied after gender reassignment surgery.

I bolded the part in question. Flyer22 Reborn (talk) 22:47, 27 November 2019 (UTC)

Shouldn't references to "GID" be changed to read as "GD"?
It seems weird to me that the first couple graphs of the article state that the APA DSM has moved away from using "Gender Identity Disorder" but significant sections of the article (especially the Causes, Management, and Society and Culture sections) use the retired initialism.

Unfortunately, I'm too much of a n00b to know how to request the protected edit, so I can really only post this here. Part2343 (talk) 00:59, 7 January 2020 (UTC)
 * This was discussed before. Most of the references are referring to the condition before the name was changed to "gender dysphoria" and the diagnosis was somewhat altered. So it may be fine to change "GID" to "GD" for some parts (as has been done), but not for others. Flyer22 Reborn (talk) 05:43, 8 January 2020 (UTC)

Undid: Gene variations
Why was my addition of the recent news regarding gene variations and their affect on gender dysphoria removed? Spiel (talk) 01:49, 9 February 2020 (UTC)
 * Spiel, did you not read the the WP:MEDRS guideline I pointed you to when I reverted you? Read it, especially its WP:MEDPOP section in this case. Read Reliable sources as well. Flyer22 Frozen (talk) 02:06, 9 February 2020 (UTC)

A discussion that concerns this page
Categories_for_discussion/Log/2020_February_5

WanderingWanda (talk) 06:51, 12 February 2020 (UTC)

Text
I guess we are discussing

"At the same time, transgender people who experience distress—even if that distress occurs as a result of social rejection and violence—nonetheless have a mental disorder according to DSM-5. This classification stands in contrast to the World Health Organization's eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), which does not classify "gender incongruence" as a mental disorder." "

With the quote being "A challenge to DSM‐5 conceptualization of Gender dysphoria is, therefore, the question of whether distress and dysfunction related to the social consequences of gender variance (e.g., stigmatization, violence) can be distinguished from distress related to transgender identity itself."

Might be better summarized... Doc James (talk · contribs · email) 06:01, 15 February 2020 (UTC)


 * I'll work on a better summary.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  06:16, 15 February 2020 (UTC)
 * Summarizing is not the issue. And I hope that you do not keep adding this disputed content to the lead as though there is consensus for it. You can make proposed changes here on the talk page. WP:Bold and WP:BRD do not mean repeatedly adding contested material. Furthermore, per WP:Lead, the lead is meant to summarize the article, not introduce material not covered lower. Flyer22 Frozen (talk) 06:24, 15 February 2020 (UTC)
 * Flyer22 Frozen - Regarding summarizing, I was responding to Doc James, not you. ¶ "I hope that you do not keep adding this disputed content to the lead as though there is consensus for it." - Since you made it clear you would delete/change/revert anything I edited in the lede, I have not edited/added/modified anything in the lede. ¶ "WP:Bold and WP:BRD do not mean repeatedly adding contested material." - I know. I am not a new editor. Plus, you already told me this on my Talk page. ¶ "Furthermore, per WP:Lead, the lead is meant to summarize the article, not introduce material not covered lower." - Fair point. I will write up some material for the body of the article and post it here first.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  06:37, 15 February 2020 (UTC)


 * The idea that gender dysphoria (under whatever name) is only from societal stigmatization, and has nothing to do with having an assigned sex (including sex characteristics) incongruent with one's gender identity, seems... questionable at best. Very likely WP:UNDUE. And I note that the quote only calls it a question. Crossroads -talk- 06:40, 15 February 2020 (UTC)


 * "The idea that gender dysphoria (under whatever name) is only from societal stigmatization ...." - Where did I make that claim?  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  07:22, 15 February 2020 (UTC)
 * The material you want to summarize as a "challenge to DSM5" makes that point. Crossroads -talk- 07:23, 15 February 2020 (UTC)


 * Crossroads - Please read the article again because your understanding of the authors' argument is not accurate.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  17:06, 15 February 2020 (UTC)


 * Markworthen, and I was responding to you. WP:Consensus is not about you and Doc James coming to an agreement. And per my commentary above about not needing to ping me, I again ask that you stop pinging me to this talk page. It is not needed.


 * In any case, we've worked well together before, and I'd rather us not bicker. Flyer22 Frozen (talk) 06:43, 15 February 2020 (UTC)


 * I agree on both counts. :0) ¶ Please consider how someone might experience your tone (your choice of words; how you phrase a critique of another editor's work) as condescending, even though that is not your intention—along the lines of "seek first to understand; then seek to be understood." Thank you.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  17:06, 15 February 2020 (UTC)

_____

Multiple issues cleanup tag
Someone removed the multiple issues cleanup tag I had added. I added it back because it should not have been removed per WP:WNTRMT, specifically, "You should not remove maintenance templates if any of the following apply ... The issue has not yet been resolved; There is ongoing activity or discussion related to the template issue ...." - Mark D Worthen PsyD  (talk)   (I'm a man—traditional male pronouns are fine.)  07:18, 15 February 2020 (UTC)
 * You left off the part where it says "(with the exception of POV-related templates)", which these are. Crossroads -talk- 07:22, 15 February 2020 (UTC)
 * No, they are not all POV-related templates.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  07:25, 15 February 2020 (UTC)
 * See: Crossroads -talk- 19:44, 15 February 2020 (UTC)

Let's move away from U.S.-centric articles (DSM-5 vs. ICD-11)
See these edits and reverts for context. - Mark D Worthen PsyD  (talk)   (I'm a man—traditional male pronouns are fine.)  05:32, 15 February 2020 (UTC)
 * I added a multiple issues tag to the article:

- Mark D Worthen PsyD  (talk)   (I'm a man—traditional male pronouns are fine.)  05:45, 15 February 2020 (UTC)
 * The examples and perspective in this article may not represent a worldwide view of the subject.
 * The neutrality of this article is questioned because it may show systemic bias.
 * This article may lend undue weight to certain ideas, incidents, or controversies.
 * And those tags make not a bit of sense since this diagnosis is all wrapped up in the DSM/DSM history. It doesn't lend WP:Undue weight to the DSM in any way. There is also what I stated below. Flyer22 Frozen (talk) 05:53, 15 February 2020 (UTC)
 * I disagree with your assertion and your rationale. But I'll wait for other folks to chime in before debating specifics.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  06:04, 15 February 2020 (UTC)
 * Agree with on this point. Bondegezou (talk) 11:10, 15 February 2020 (UTC)
 * Flyer22 Frozen (and Bondegezou) - You offered an explanation for opposing the "undue weight" (WP:NPOV) tag, but you have not yet explained your opposition to the "systemic bias" and "may not represent a worldwide view of the subject"  tags.   - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  16:54, 15 February 2020 (UTC)
 * I've been clear about that above in this section and in the section immediately below this one. I fail to see how there is a systemic bias that we can address when this diagnosis is so thoroughly intertwined with the DSM. One cannot read up on this topic without the DSM being mentioned first and foremost. The ICD is not discussed as much with regard to the topic as the DSM is discussed with regard to the topic. What systemic bias? Flyer22 Frozen (talk) 22:34, 15 February 2020 (UTC)

Recent lead changes
As seen here and here, I reverted Markworthen on changes to the lead. And here's why: We do not state things like "an American Psychiatric Association diagnosis" in the lead sentence. We simply go with the common name. And use of "gender dysphoria" is not just an American thing. And even if it were, it's still the common name for this topic with regard to more recent sources since 2013. And the DSM-5 is not something that only American psychiatrists, psychologists and sexologists go by. And by that, I mean it's also used internationally. This is something Legitimus has made clear before, and might be willing to elaborate on here as well. So pinged him. Per WP:ISAWORDFOR, we also don't state "defined as" since this article is not about the term. And stating "mental disorder diagnosis"? The DSM-5 specifically moved away from the term "disorder" to avoid stigma. This was just discussed at Categories for discussion/Log/2020 February 5. And we don't unduly add ICD-11 material to the lead. Again, the ICD-11 will not come into effect until 2022. Also, "nonetheless have a mental disorder according to DSM-5" is WP:Synthesis unless a reliable academic source states that.

Also pinging Doc James for his thoughts. Flyer22 Frozen (talk) 05:42, 15 February 2020 (UTC) Updated post. Flyer22 Frozen (talk) 05:58, 15 February 2020 (UTC)
 * Diagnosis are generally applied by psychiatrists and psychologists. I would not really say "is an American Psychiatric Association diagnosis" in the first sentence here just like I would not use that wording for depression. Doc James  (talk · contribs · email) 05:56, 15 February 2020 (UTC)

Here are the problems that stood out to me with this:

1. The condition that the article is about exists outside America. Calling it an "American psychiatric diagnosis" is America-centric.

2. How in the world is At the same time, transgender people who experience distress—even if that distress occurs as a result of social rejection and violence—nonetheless have a mental disorder according to DSM-5. This classification stands in contrast to the...(ICD-11), which does not classify "gender incongruence" as a mental disorder not WP:Editorializing and WP:SOAPBOXing?

3. You introduced a contradiction. The mainline text says, The ICD-11, which will come into effect on 1 January 2022, but you added a note saying, The World Health Organization (WHO) refers to an effective date only twice on its website, and in both instances the phrase "come into effect" is not explicated. You made the article argue with itself.

4. Closely related - if something has an "effective date", that date is the date it is effective, or comes into effect. The wordings are obviously equivalent.

5. The note went on to say, In addition, WHO has also stated, "... ICD11 is now available for implementation, following its adoption at the World Health Assembly on 25 May 2019." Sure, implementation takes time. Computer systems need to be updated, people trained, etc. That doesn't change the fact that it has not come into effect yet.

6. "Gender dysphoria" is by far the most common term on PubMed. Searching with quotes, we get only 119 for "gender incongruence", but 1,223 results for "gender dysphoria", over 10 times as many. This includes a full page of 20 results just since the start of this year. "Gender incongruence" does not even have that many since the start of the year. By no means can we put WP:UNDUE weight on that term. Crossroads -talk- 06:02, 15 February 2020 (UTC)


 * Flyer22 Frozen - Please don't use a pedantic tone, "We don't do this or that ...." It's condescending and unnecessary. ¶ I don't see a problem with "an American Psychiatric Association diagnosis" because that's what it is, but perhaps we could compromise on "a DSM-5 diagnosis". ¶ "And use of 'gender dysphoria' is not just an American thing." - What other countries routinely use it as a diagnosis? I imagine there are a couple, but DSM-5 is an American publication that is not used in most countries. The Wikipedia article, Diagnostic and Statistical Manual of Mental Disorders states, "While the DSM is the most popular diagnostic system for mental disorders in the U.S., the ICD is used more widely in Europe and other parts of the world, giving it a far larger reach than the DSM." ¶ You probably hadn't seen it yet since I just added it a little while ago, but here's what I wrote about ICD-11 at Categories for discussion/Log/2020 February 5: (α) The World Health Organization (WHO) published ICD-11 online on 18 Jun 2018. ¶ (β) Member nations will implement (begin using) ICD-11 at different times over the next 10 years or so. WHO does not explain the term "comes into effect", but it probably is the date when WHO will be ready to receive health statistics using ICD-11 codes. (However, note that the ICD-11 Implementation or Transition Guide (p. 1) states, "ICD11 is now available for implementation, following its adoption at the World Health Assembly on 25 May 2019...."). ¶ (γ) Most importantly, the fact that some nations will begin reporting health statistics using ICD-11 codes in 2022 does not render ICD-11 content meaningless. WHO developed ICD-11 over several years (for a brief summary, see the ICD-11 Reference Guide at 1.2.3 Revision major steps and 1.7.12 Preparations for the Eleventh Revision) with input from scientific and medical societies, government organizations, subject matter experts, etc., from around the world. And, in an exceptionally transparent process (in contrast to DSM-5 development), WHO encouraged and took seriously comments and proposed modifications from anyone with an email address. (WHO continues to welcome such comments and proposals as part of the ICD-11 continuous improvement effort.) Plus, even though WHO did not publish the official ICD-11 until mid-2018, research, analysis, and scholarly debate on the eleventh revision began in the 2000s and will continue into the future. A PubMed search reveals 935 articles and book chapters with "ICD-11" in the title or abstract, and a Google Scholar search indicates 811 publications where "ICD-11" appears in the title and 23 400 (twenty-three thousand, four hundred) publications where "ICD-11" appears anywhere in the publication. ¶ (δ) When a company produces a for-profit diagnostic manual, along with several related books, guides, and training programs (all for sale), the "effective date" (publication date) is important. When WHO publishes the eleventh ICD revision online—at no cost to anyone—for member nations to begin using when they are ready, an official "effective date" does not have the same meaning. After all, the ICD-11 content available today will not magically become meaningful on 1 Jan 2020 2022. ¶ I disagree with most everything else you wrote, but I'll wait for other folks to chime in.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  06:06, 15 February 2020 (UTC)
 * You call it being pedantic. I call it stating things based on how WP:Med articles are usually formatted and based on our guidelines such WP:ISAWORDFOR. It wasn't meant to be condescending. Your categorization of the DSM with regard to other countries is lacking accuracy, and I hope that Legitimus takes the time to comment on that. I saw what you wrote in the category discussion. I stand by what I stated above. Flyer22 Frozen (talk) 06:18, 15 February 2020 (UTC)


 * On a side note: No need to ping me since this article is on my watchlist. Flyer22 Frozen (talk) 06:26, 15 February 2020 (UTC)


 * Crossroads - 1. "The condition that the article is about exists outside America." - Is it a "condition" or a mental disorder? ... I proposed "DSM-5 diagnosis" instead of "American Psychiatric Association diagnosis". Would you be okay with that compromise? ¶ 2. You wrote that my (since removed) edit, "At the same time, transgender people who experience distress—even if that distress occurs as a result of social rejection and violence—nonetheless have a mental disorder according to DSM-5. This classification stands in contrast to the...(ICD-11), which does not classify 'gender incongruence' as a mental disorder" constitutes editorializing. - I agree that it could be written with less specificity. How would you phrase it? Or would you simply ignore perspectives other than DSM-5? ... I'll respond more later.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  06:26, 15 February 2020 (UTC)
 * Is it a "condition" or a mental disorder? My wording in these comments are not important. Anyway, answer me this: What does the D in ICD-11 stand for?
 * I proposed "DSM-5 diagnosis"...Would you be okay with that compromise? Definitely not. It's casting doubt in the lead sentence. Our article on evolution doesn't start with, "Evolution is a biology concept..." The article should begin with "Gender dysphoria (GD) is the distress a person feels due to a mismatch between their gender identity and their sex assigned at birth" because the article is about "the distress a person feels due to a mismatch between their gender identity and their sex assigned at birth", not a mere diagnostic category.
 * As for perspectives other than the DSM-5, they will be treated with WP:Due weight. PubMed overwhelmingly refers to "gender dysphoria", as I noted. Crossroads -talk- 06:53, 15 February 2020 (UTC)
 * Repeatedly tagging the article with 3 templates after you didn't get your way with your changes, and when there is no consensus that the problems are there, is disruptive. Crossroads -talk- 07:19, 15 February 2020 (UTC)
 * Removing the templates, in violation of WP:WNTRMT, is what's actually disruptive.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  07:28, 15 February 2020 (UTC)
 * As I said below, removal is permitted per WNTRMT for POV tags. Crossroads -talk- 19:09, 15 February 2020 (UTC)
 * But you have yet to provide a rationale for removing all three tags. You have simply labeled them "POV" and declared, ipse dixit, that they should therefore be removed.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  19:21, 15 February 2020 (UTC)
 * Tag 1, "globalize": Links to WikiProject Countering systemic bias. What is that? Under "explanation of systemic bias on Wikipedia", it links to Systemic bias. That essay in its first sentence states, "The Wikipedia project strives for a neutral point of view in its coverage..." and links to WP:NPOV.
 * Tag 2, "systemic bias": Links to WP:NPOV, WP:NPOVD, and the already discussed systemic bias essay.
 * Tag 3, "undue weight": Links to WP:UNDUE, which is part of WP:NPOV.
 * Q.E.D. Yes, these are "POV-related templates". Crossroads -talk- 19:41, 15 February 2020 (UTC)

I will reiterate something Legitimus stated elsewhere. He stated that the DSM is used all over the world. And that while the ICD "is an overtly 'international' system, it lacks depth when it comes to mental health diagnosis. [...] Many countries outside the USA use both for this reason." He also questioned using "terms from [the] ICD-11, which hasn't been fully approved or implemented yet, much less adopted by any kind of majority."

Was Legitimus correct in stating that the DSM is used all over the world? Yes. This 2018 "Abnormal Psychology: Contrasting Perspectives" source, from Macmillan International Higher Education, page 70, states, "When it comes to diagnosing emotional distress, the Diagnostic and Statistical Manual of Mental Disorders (DSM) (introduced in Chapter 1) and the mental, behavioral, and neurodevelopmental disorders section of the International Classification of Diseases (ICD) are the two most prevalent diagnostic systems. They are generally referred to as forms of psychiatric diagnosis because even though every kind of mental health practitioner uses them, primarily psychiatrists develop them. [...] Both manuals are used all over the world." The source does state that the ICD is "the clinical and research standard for the world, for both physical and mental disorders" to many. But "to many" doesn't mean "to most" or "to all." And it doesn't negate the fact that this diagnosis (gender dysphoria) is thoroughly intertwined with the DSM. One cannot read up on this topic without the DSM being mentioned first and foremost. The ICD is not discussed as much with regard to this topic as the DSM is discussed with regard to this topic. On page 71, the source adds, "Despite being an American rather than international undertaking, some consider the DSM (rather than the ICD) the standard for research and practice throughout the world (Paris, 2015)." This 2013 "The Social Science Encyclopedia" source, from Routledge, page 681, states, "Although developed by psychiatrists in the USA, this classification is widely used by psychiatrists in other countries, and by other mental health professionals."

Was Legitimus correct in stating that, compared to the DSM, the ICD lacks depth when it comes to mental health diagnosis? Well, one can look at just how many pages the DSM devotes to entries compared to what the ICD devotes to entries.

Was Legitimus correct to question using terms from the ICD-11 when the ICD-11 has not yet come into effect? Well, clearly I feel that it's an undue issue if placed in the lead. What terminology the ICD-11 will use is in the "Diagnosis" section. Flyer22 Frozen (talk) 22:34, 15 February 2020 (UTC)

2nd paragraph of lead
Earlier today, Doc James rewrote part of the 2nd paragraph of the lead to paraphrase the APA quotation in Wikipedia's own voice: Gender nonconformity is not the same thing as gender dysphoria, with gender nonconformity not itself being a mental disorder. The critical element of gender dysphoria is the presence of significant distress.

Although I agree it is awkward to use a quotation in the lead, I prefer the earlier version of the paragraph. The new version strongly implies that gender dysphoria is a mental disorder, and although this is the mainstream POV, it's also a contested POV, and thus should be attributed in the text to be on the safe side. Kaldari (talk) 16:40, 15 February 2020 (UTC)


 * I agree with Kaldari's 2nd paragraph revision and her cogent rationale. ¶ In many countries, and in international organizations such as WHO, gender incongruence is not a mental disorder. I'm working on adding substantive copy to the body of the article discussing the American Psychiatric Association's controversial decision to continue classifying many transfolk as suffering from a mental disorder, and why many scholars argue that APA's conceptualization lacks empirical evidence and semantic coherence. I will post a draft here first.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  17:16, 15 February 2020 (UTC)
 * Kaldari themselves admits that this is the mainstream POV. It's contested, sure, but by whom? By WP:MEDRS compliant sources? And by how many of those? I see nobody has yet engaged with what I said above about the overwhelming 10-to-1 dominance of "gender dysphoria" over "gender incongruence" in PubMed.
 * As for "many scholars argue that APA's conceptualization lacks empirical evidence and semantic coherence", these need to be WP:MEDRS sources and must meet WP:Due. For example, we don't include Thomas Szasz's rants in our Featured Article Schizophrenia.
 * I agree with Doc James; there is no need to use in-text attribution to the American Psychiatric Association. There is yet no source of equal weight rebutting it, so attribution is not needed. Crossroads -talk- 19:06, 15 February 2020 (UTC)
 * Everyone agrees that "gender nonconformity" is not a mental disorder. We do not say in that text that "gender dysphoria" is universally accepted as one just that it is accepted as one by some. Doc James  (talk · contribs · email) 19:21, 15 February 2020 (UTC)
 * Hold your horses Crossroads. I said I'm working on adding material to the article and that I will post a draft here first. There's no need to lecture me on Wikipedia policies.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  19:34, 15 February 2020 (UTC)
 * Markworthen, like I stated at Categories for discussion/Log/2020 February 5, the condition technically falls under the definition of a mental disorder or psychiatric disorder (if one prefers the latter term) because of the distress involved. Significant distress. And in the infobox, we list things such as suicide and depression as complications of the condition. It technically falls under the category of a psychiatric disorder/psychiatric diagnosis regardless of what it is named. See the "Definitions" section in the Mental disorder article. This 2018 "Abnormal Psychology: Contrasting Perspectives" source, from Macmillan International Higher Education, page 70, states, "When it comes to diagnosing emotional distress, the 'Diagnostic and Statistical Manual of Mental Disorders (DSM)' (introduced in Chapter 1) and the mental, behavioral, and neurodevelopmental disorders section of the 'International Classification of Diseases (ICD)' are the two most prevalent diagnostic systems. They are generally referred to as forms of psychiatric diagnosis because even though every kind of mental health practitioner uses them, primarily psychiatrists develop them. Given that psychiatrists are medical doctors, it should come as no surprise that both the 'DSM' and 'ICD' use a medical model in which clusters of symptoms are organized into distinct syndromes consisting of symptoms (presenting complaints) and signs (physical changes) (Kawa & Giordano, 2012; Paris, 2015). In this respect, they utilize categorical diagnosis, where similar patterns of symptoms and signs are grouped into categories and distinguished as distinct disorders."


 * How would you personally categorize the condition? As simply a condition? What are those with gender dysphoria suffering from if not a psychiatric condition? Would you categorize it as a medical condition instead? What kind? The Encyclopædia Britannica states, "Although the revisions to DSM-5 have assuaged some criticism, it has been argued that the diagnosis of GD mistakenly categorizes a medical condition as a mental health disorder. [...] Whereas some have lobbied for the elimination of the diagnosis, others have suggested that GD could be redesignated as a benign medical condition instead of a psychiatric disorder. However, because many transsexuals seek the services of medical and mental health professionals, some members of transsexual and transgender communities worry that removing or reforming the GD diagnosis could jeopardize the availability of sex reassignment surgeries and other procedures. There is also concern that, without the diagnosis, insurance reimbursements for such procedures could be threatened." We have a "Classification as a disorder" subsection in the "Society and culture" section, which goes over this debate.


 * Regardless of how one wants to categorize the condition, numerous people with gender dysphoria have categorized it as suffering. Mental suffering. Some transgender people do categorize it as a disorder because they state that their brain is out of step with the body they should have and it is very distressing as a result. To many involved with the DSM, there was/is no malice in the condition being categorized as a psychiatric condition, but the DSM-5 still removed disorder due to the stigma associated with that term. And, yes, the ICD-11 uses "gender incongruence" and its under a chapter titled "Conditions Related to Sexual Health." But the professionals behind the move have also noted that it's not ideal because it's important to keep gender identity issues and sexual issues separate; those things are confused or conflated enough. Still, the professionals behind the ICD-11 did not want to remove the diagnosis entirely, because, like Sam Winter, a public health professor at Australia's Curtin University, stated, "Quite a few trans people seek substantial ongoing healthcare — it can be life changing, or even life saving. So we need a diagnosis." Flyer22 Frozen (talk) 22:34, 15 February 2020 (UTC)
 * The problem here is that gender dysphoria is actually two different, but related things. It is a mental disorder that can entail distress and suffering, but it's also a medical diagnosis that persists long after a person has transitioned and may no longer experiences mental distress (but still needs to maintain hormone therapy). This tension is reflected in the ICD's effort to minimize the "disorder" aspect and frame it as a "condition". Perhaps there is some way that the lead can accurately reflect this evolving dual-nature. Kaldari (talk) 05:01, 16 February 2020 (UTC)
 * If distress is not there, then it's no longer gender dysphoria, and what one is referring to is a transgender person who no longer has gender dysphoria. There is no such thing as gender dysphoria without distress. Yes, the article states that the "ICD-11 defines gender incongruence as 'a marked and persistent incongruence between an individual's experienced gender and the assigned sex', with presentations similar to the DSM-5 definition, but does not require significant distress or impairment.", but it goes by a different name and is not exactly the same diagnosis. This can make one wonder if gender incongruence should be its own article. But since the topics are pretty much the same thing (although not exactly the same diagnosis), with "gender dysphoria" being the far more popular term, it's not beneficial to fork the content. At least not at this point in time. Flyer22 Frozen (talk) 21:40, 16 February 2020 (UTC)

Proposed first sentence
I propose beginning the article with this sentence:

→ Gender dysphoria (GD) is a mental disorder in which a person experiences significant distress or functional impairment related to gender incongruence—a mismatch between their gender identity and their sex assigned at birth.

I am not sure if the first six words—"Gender dysphoria is a mental disorder"—are controversial. The phrasing is common for Wikipedia articles about DSM-5 mental disorders. For example:


 * Major depressive disorder (MDD), also known simply as depression, is a mental disorder characterized by ...


 * Schizophrenia is a mental illness characterized by ...


 * Dysthymia, also known as persistent depressive disorder (PDD), is a mood disorder ...


 * Alcohol dependence is a previous (DSM-IV and ICD-10) psychiatric diagnosis ...


 * Autism is a developmental disorder ...


 * Dementia is a broad category of brain diseases ...


 * Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by ...

| - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  06:54, 16 February 2020 (UTC)
 * There's a whole section of the article about the label "disorder" and how the DSM stopped using GID.  Eve rgr een Fir  (talk) 07:08, 16 February 2020 (UTC)
 * A far more neutral start is required than the loaded label "disorder", the neutrality of the existing opening is far better. This proposed change is very much a case of ~ why mess with something that does not need changing. ~ BOD ~ TALK 09:12, 16 February 2020 (UTC)
 * Agreed with the others, this is not needed, and gender dysphoria is not directly comparable to the other things you listed. Crossroads -talk- 16:49, 16 February 2020 (UTC)


 * (1) My thinking has evolved on this point, thanks to feedback from editors with whom I have disagreed. (Proving the value of argumentation in general, and the Bold-Revert-Discuss cycle specifically.)


 * (2) What I see us doing—and I was guilty of this tendency myself—is allowing our personal beliefs to influence our diction and phrasing. In this instance, it seems most (or perhaps all) of us would rather not classify transgender experience as a mental disorder. Consequently, we want to do things like:


 * (a) highlight contrasting views right away, such as my initial edit contrasting DSM-5 with ICD-11 in the very beginning of the article; or


 * (b) avoid the terms, "disorder" and "mental disorder", when referring to gender dysphoria. We have resolved "(a)", so I want to talk about "(b)": Our reluctance to call a mental disorder a "mental disorder". Is that truly encyclopedic? If we are trying to persuade readers to avoid calling gender dysphoria a mental disorder, despite the fact it is listed as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, then we are writing an essay, not an encyclopedia article.


 * What do you think?  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  17:01, 16 February 2020 (UTC)


 * Proposing additions because you find them "self-evident" even tho others already point out the most  recent  and high  quality  sources  strongly disagree is unhelpful. So is accusing other editors of having personal beliefs that go  against  their ability to edit fairly,  see WP:PA. Rab V (talk) 19:29, 16 February 2020 (UTC)


 * In an attempt to compose clear, crisp prose, I have come across as accusatory. I am sorry as that was not my intention (except for the accusations I leveled against myself). Allow me to rephrase: If it is perhaps possible that you might have personal views which could possibly influence your decisions regarding how we describe gender dysphoria, particularly in the lede, I ask you to consider the above arguments.


 * DSM-5 says that gender dysphoria is a mental disorder. Assuming that DSM-5 is a "high quality source", in what ways does DSM-5 "strongly disagree" that gender dysphoria is a mental disorder?  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  20:54, 16 February 2020 (UTC)


 * Oppose per my initial statements in the section, which has nothing to do with my personal beliefs. As noted on my user page/talk page, I'm not about using Wikipedia to engage in activism or other "because I personally feel this way" editing. Disorder categorization was just discussed at Categories for discussion/Log/2020 February 5. We are going to remove this article from "disorder" categories (except for Category:Psychiatric diagnosis) and yet categorize it as one in the lead sentence? Labeling it as such in the lead sentence (or in the lead at all, unless addressing the debate on that) goes against the DSM-5 removing the word disorder due to the stigma associated with the diagnosis. It also goes against the ICD-11 removing "gender identity disorder." Considering that, the aforementioned category discussion (which pointed to news articles on "disorder" being controversial for this topic), what the Encyclopædia Britannica states, and this Wikipedia article having a section about it, I don't see how anyone could question that stating "gender dysphoria is a mental disorder" is controversial. And before it's proposed, I think it's unnecessary to state "Gender dysphoria is a psychiatric diagnosis" in the lead sentence. But as for use of "diagnosis"? It's also not needed in the lead sentence. As for using "diagnosis" elsewhere in the lead? Even though Doc James removed "diagnostic" and "diagnosis" with this edit, it is completely fine to refer to gender dysphoria as a diagnosis in the lead (just like it is referred to as one elsewhere in the article). It is a diagnosis, and "diagnosis" is not the controversial word being debated (although as noted by the Encyclopædia Britannica, "some have lobbied for the elimination of the diagnosis"). Flyer22 Frozen (talk) 21:40, 16 February 2020 (UTC)


 * That makes sense Flyer22 Frozen. You have persuaded me. I withdraw my proposed first sentence. I appreciate you taking the time to clearly and carefully explain why using the word "disorder" or "mental disorder" is, on balance, not the most consistent, reliable, and accurate way to write this encyclopedia article. Thank you.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  22:00, 16 February 2020 (UTC)


 * Sidebar: I felt misunderstood and attacked by other editors. I was becoming grumpy and thinking of throwing up my hands in disgust and quitting Wikipedia. Fortunately, I recognized that these feelings and thoughts were probably a sign that something had gone awry with me. I therefore went on a reading spree, consulting Wikipedia essays and other articles that I thought might help me work through this grump-fest. They helped! Here are the essays that I found helpful, with a sentence or two from each article that epitomizes a point that helped me develop a more mature perspective.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  23:31, 16 February 2020 (UTC)

Changes in terminology from DSM-III to DSM-5
The 2nd sentence of the lede (first paragraph) currently reads, "The diagnostic label gender identity disorder (GID) was used until 2013 with the release of the DSM-5." The sentence is not entirely correct because it implies that "gender identity disorder" was the analogous diagnosis for many years before 2013, when it was actually from 1994–2013 (DSM-IV). Neither DSM-I (1952) nor DSM-II (1968) contained an analogous diagnosis. Gender Identity Disorder first appeared as a diagnosis in DSM-III (1980), where it appeared under "psychosexual disorders" but was used only for the childhood diagnosis, Gender Identity Disorder of Childhood (GIDC). Adolescents and adults received a diagnosis of Transsexualism (homosexual, heterosexual, or asexual type). DSM-III-R (1987) added "Gender Identity Disorder of Adolescence and Adulthood, Non-Transsexual Type" (GIDAANT).

I had modified the 2nd sentence to read, "The label gender identity disorder (GID) was the previous (DSM-IV) diagnosis but this changed in 2013 with the release of DSM-5" (diff), but my edit was reverted, so I figured it would be best to discuss here first.

I would change my (proposed) 2nd sentence a bit to: "Gender identity disorder (GID) was the analogous DSM-IV diagnosis, but a conceptual change to gender dysphoria occured in 2013 with the release of DSM-5."

There are of course several other ways the 2nd sentence could be written. My main point is that we should (IMHO) seek greater specificity and accuracy in that sentence. - Mark D Worthen PsyD  (talk)   (I'm a man—traditional male pronouns are fine.)  23:04, 17 February 2020 (UTC)
 * All that information would be great to add to the History section. I'm neutral about elaborating on it in the lead. Kaldari (talk) 04:29, 18 February 2020 (UTC)
 * Ah, great point re: the History section! I will work on that.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  15:23, 18 February 2020 (UTC)


 * Use of "a conceptual change" is vague. And how is it to good to state "to gender dysphoria" when it wasn't renamed "gender dysphoria" until 2013? Also, the stigma aspect should continue to be mentioned. I don't see why this proposal is definitely needed for the lead. The lead isn't misleading anyone by not including what you've proposed. Flyer22 Frozen (talk) 23:43, 18 February 2020 (UTC)

__

Edit request for "Intimate relationships" section
"Intimate relationships between heterosexual women and male-to-female people with GID often suffer once the GID is known or revealed. Researchers say the fate of the relationship seems to depend mainly on the woman's adaptability."

I'm pretty sure the last two words of this is trying to refer to the cishet woman, not the trans women. Therefore, I propose the word "cisgender" to be inserted before the word "woman's" (the second to last word in the quote). — Preceding unsigned comment added by 2607:F140:6000:5:B5D9:CF93:B234:2CA2 (talk) 05:10, 27 February 2020 (UTC)
 * Changed to "cisgender." Will look at the source later. At some point, I will be updating sources in the article anyway. Flyer22 Frozen (talk) 23:47, 27 February 2020 (UTC)

Intimate relationships
Our "intimate relationships" section is cited to a single source (Transsexual and Other Disorders of Gender Identity: A Practical Guide to Management) and that source doesn't mention gender dysphoria or gender identity disorder at all in the cited section of the book ("Intimate relationship issues and outcomes"). Instead it discusses dual-role transvestism and transexualism. It also seems pretty clear from reading both the book section and our summary of it, that the material is more related to transexualism than gender dysphoria, as it is completely about the gender transition itself and doesn't mention anything about anxiety or distress (and some people with gender dysphoria don't transition at all). I would like to propose that we move this section to transexualism, where it would be more appropriate (both per the reference and practically). Kaldari (talk) 07:10, 1 March 2020 (UTC)
 * Give me a chance (a few days) to look over this source and other sources on this aspect. Like I noted in the section immediately above this one, I had planned to look at the source later and I will be updating sources in the article anyway. It might be best to continue to mention something about intimate relationships with regard to gender dysphoria. If the text in question doesn't concern gender dysphoria, then "GID" should have never been used for the text. As for an alternative article to place the material in, it might be better to place it in the Attraction to transgender people article, which is linked at the top of the section, or in both that article and the Transsexual article. Flyer22 Frozen (talk) 00:22, 2 March 2020 (UTC)


 * Or if not those articles, then the Transgender sexuality article, which needs a bit of cleanup after student editing. Flyer22 Frozen (talk) 00:27, 2 March 2020 (UTC)
 * Yes, I'm not sure why "GID" was mentioned in our text other than to shoehorn it into the article, as the source text does not reflect this. If you can find any sources that do, that would be great, but I imagine that most sources are going to concentrate on how transitioning affects relationships rather than how gender dysphoria itself affects relationships. Kaldari (talk) 14:32, 2 March 2020 (UTC)
 * Any update? Kaldari (talk) 01:18, 7 March 2020 (UTC)


 * Still reading some sources. But, yes, the material might fit best in the Transgender sexuality article instead of in this one. Material on it should be in that article regardless. Flyer22 Frozen (talk) 23:27, 7 March 2020 (UTC)


 * I deleted the entire intimate relationships section because its sole reference offers only anecdotal accounts of relationship patterns—it is not based on research findings.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  20:24, 8 March 2020 (UTC)
 * Regarding the removed content, I'm not sure what you mean by "it is not based on research findings." The source passes WP:MEDRS, and other academic sources discuss the same matters. We go by what the WP:Reliable sources state with WP:Due weight. These aspects should be addressed on Wikipedia regardless of if they are addressed in this article. And as made clear above in this section, I am handling the "sole reference" matter. This material will be covered on Wikipedia. Flyer22 Frozen (talk) 00:41, 9 March 2020 (UTC)
 * I wouldn't be opposed to having the material in Transgender sexuality, although I agree it would be preferable to have more than one source to base it on (and hopefully sources that are more recent). Kaldari (talk) 16:58, 10 March 2020 (UTC)
 * Flyer22 Frozen - If "other academic sources discuss the same matters", I look forward to seeing your citations. ¶ Would you kindly substantiate your claim that the cited book "passes WP:MEDRS"? I do not regard that part of the book as a reliable source because it contains only anecdotal reports of relationship patterns. If I'm wrong, please help me understand my error. ¶ Your statement, "this material will be covered on Wikipedia", sounds like an edict. Am I misinterpreting what you wrote?  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  08:35, 11 March 2020 (UTC)
 * I'd rather not list sources on the matter here on this talk page after you removed the text and it seems that the text is best suited for a different article. The material will be added to a different article when I get around to it; I'm not going to rush myself on it. You "do not regard that part of the book as a reliable source"? Again, we go by what the WP:Reliable sources state with WP:Due weight. In what way does the source fail WP:MEDRS? Even with regard to WP:MEDDATE, it holds up because the material is not outdated since what it covers are things that still happen today between transgender people and their intimate partners. I stated that "this material will be covered on Wikipedia" because it will be, as there is no valid reason that it should not be covered on Wikipedia. Given how transition affects transgender people and their intimate partners, and that this is covered by reliable academic sources, it is material that should obviously be covered on Wikipedia. Flyer22 Frozen (talk) 03:36, 12 March 2020 (UTC)

Flyer22 Frozen - Fair enough - thank you for your response. To clarify, I don't have anything against the author of the book cited in the section I deleted (Dr. James Barrett). He's a recognized expert in the area and is not "anti-trans" or anything like that, as evidenced by a couple of recent articles he has written:

Barrett, James. "Doctors are failing to help people with gender dysphoria: Conservatism in treating trans people in primary care is unacceptable." BMJ: British Medical Journal (Online) 352 (2016).

Barrett, James. "Gender dysphoria: assessment and management for non-specialists." Bmj 357 (2017): j2866.

Perhaps a better way for me to express my concern is: I want to avoid relying on one (somewhat dated) source that seems to rely on anecdotal accounts. (Maybe Dr. Barrett based what he wrote (in his 2007 book) on research, but since he didn't cite studies for his conclusions re: intimate relationships, it's hard to know.)

On a related point, there is a lot written about this topic, most of it published in non-medical journals. This is one of those instances where WP:MEDRS applies to some extent, e.g., to articles in endocrinology, surgery, and other medical journals, but WP:MEDRS, while a useful guide, will not necessarily apply to all of the relevant trans/queer literature. In particular, there are not as many well-regarded textbooks, meta-analytic studies, and systematic reviews on this topic as there are for most biomedical topics.

Here are some potentially relevant articles I pulled rather quickly (so apologies for the different citation styles), which show a range of non-medical, peer-reviewed journals publishing articles in this area, as well as non-medical books on the subject.

Bishop, Katelynn. "Body modification and trans men: The lived realities of gender transition and partner intimacy." Body & Society 22, no. 1 (2016): 62-91.

Brown, N.R. The Sexual Relationships of Sexual-Minority Women Partnered with Trans Men: A Qualitative Study. Arch Sex Behav 39, 561–572 (2010).

Goldberg, Abbie E., and Adam P. Romero, eds. LGBTQ divorce and relationship dissolution: psychological and legal perspectives and implications for practice. New York: Oxford University Press, 2018.

Iantaffi, Alex, and Walter O. Bockting. "Views from both sides of the bridge? Gender, sexual legitimacy and transgender people's experiences of relationships." Culture, health & sexuality 13, no. 03 (2011): 355-370.

Nash, C., Browne, K. (Ed.). (2010). Queer Methods and Methodologies (Open Access). London: Routledge.

Pfeffer, Carla A. "Bodies in relation—Bodies in transition: Lesbian partners of trans men and body image." Journal of Lesbian Studies 12, no. 4 (2008): 325-345.

Pfeffer, Carla A. "“Women's work”? Women partners of transgender men doing housework and emotion work." Journal of Marriage and Family 72, no. 1 (2010): 165-183.

Pfeffer, Carla A. Queering families: The postmodern partnerships of cisgender women and transgender men. Oxford University Press, 2017.

Reback, Cathy J., Rachel L. Kaplan, Talia M. Bettcher, and Sherry Larkins. "The role of the illusion in the construction of erotic desire: narratives from heterosexual men who have occasional sex with transgender women." Culture, health & sexuality 18, no. 8 (2016): 951-963.

Riggs, Damien W., Henry von Doussa, and Jennifer Power. "The family and romantic relationships of trans and gender diverse Australians: An exploratory survey." Sexual and Relationship Therapy 30, no. 2 (2015): 243-255.

Rossiter, Hannah. "She's always a woman: Butch lesbian trans women in the lesbian community." Journal of Lesbian Studies 20, no. 1 (2016): 87-96.

Sanger, Tam. "Queer(y)ing gender and sexuality: Transpeople's lived experiences and intimate partnerships." In Feeling Queer or Queer Feelings?, pp. 84-100. Routledge, 2014.

Ward, Jane. "Gender labor: Transmen, femmes, and collective work of transgression." Sexualities 13, no. 2 (2010): 236-254.

Whitfield, Darren L., Robert WS Coulter, Lisa Langenderfer-Magruder, and Daniel Jacobson. "Experiences of intimate partner violence among lesbian, gay, bisexual, and transgender college students: the intersection of gender, race, and sexual orientation." Epub ahead of print, Journal of interpersonal violence (19 November 2018).

Yavorsky, Jill E., and Liana Sayer. "“Doing fear”: The influence of hetero-femininity on (trans) women's fears of victimization." Sociological Quarterly 54, no. 4 (2013): 511-533.

Going forward, it would probably be a good idea to solicit suggestions, feedback, and requests for collaborative efforts on the Talk pages of WikiProject LGBT studies, WikiProject Psychology, and WikiProject Sexology and sexuality. I realize that such requests often do not generate any responses, but it's worth a try. (And I don't mean to imply that you [Flyer22 Frozen] have not solicited feedback from those WikiProjects in the past—you probably have.)  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  22:55, 12 March 2020 (UTC)
 * The vast majority of the sources you offer here are primary sources, and hence strongly disfavored per WP:SCHOLARSHIP and WP:PSTS. Also, I don't get disfavoring the Barrett source for supposedly rely[ing] on anecdotal accounts, but then offering sources that are no more systematic. Crossroads -talk- 00:15, 13 March 2020 (UTC)
 * As I said, those are potentially relevant articles that show the range of non-medical, peer-reviewed journals publishing in this area. To reiterate, many of the relevant articles on queer, trans, and cisgender (inter-)relationships are not published in biomedical journals. The citations I posted are examples of the diversity of journals where such articles are published, most of which will not appear in PubMed (i.e., they are not routinely indexed in MEDLINE). To emphasize, I did not state that these specific articles should be cited in this article or related articles—they are examples of journal diversity. ¶ If you have read most of the substantial literature on queer, trans, and cisgender (inter-)relationships, i.e., in social work, sociology, psychology, gender studies, queer theory, and biomedical journals, and you want to restore the section on intimate relationships with additional citations that meet the requirements of WP:SCHOLARSHIP and WP:PSTS, please do so as it will help improve the article.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  01:07, 13 March 2020 (UTC)

Recent reverts on grammatical errors
Where are you seeing these? Maneesh (talk) 06:14, 4 December 2020 (UTC)
 * Here: On 1 December 2020, a UK High Court ruled that children if they are competent to understanding the nature of the treatment. is not a complete sentence. Also, why did you change it away from "doubtful"? Crossroads -talk- 06:25, 4 December 2020 (UTC)
 * Indeed, don't know why I wasn't picking it up after looking at it a few times. Maneesh (talk) 06:27, 4 December 2020 (UTC)

Reinsertion of factually untrue statement
Apart from all the other problems I outlined above, the sentence "a High Court ruling in the case brought by Keira Bell against the T&P stated that children under 16 with gender dysphoria are unlikely to be able to give informed consent to undergo treatment with puberty-blocking drugs." is not true. I corrected this in the version that I wrote yesterday, which was reverted. As you can verify at https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Judgment.pdf the court ruled that it was "doubtful" that children under 16 could consent, and "unlikely" that children under 14 could consent. Kaldari (talk) 17:28, 4 December 2020 (UTC)
 * Also, the court said absolutely nothing about GnRHas specifically. I don't understand why y'all are singling out that drug specifically. There are lots of puberty blocking drugs and the court case was about puberty blocking in general, not a specific drug. Kaldari (talk) 17:30, 4 December 2020 (UTC)
 * You've removed 'informed consent'. The essence of the ruling is informed consent. Read the pdf: "The issue at the heart of this claim is whether informed consent in the legal sense can be given by such children and young persons", "The difficulty of achieving informed consent in these circumstances is further exacerbated by the lack of evidence as to the efficacy of PBs in treating GD and the long-term outcomes of taking it". In the concluding paragraphs, I don't think it is giant leap to infer it is discussing informed consent "A child under 16 may only consent to the use of medication intended to suppress puberty where he or she is competent to understand the nature of the treatment. That includes an understanding of the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life changing consequences for a child." Maneesh (talk) 17:53, 4 December 2020 (UTC)
 * Good point. I've changed the wording to say "informed consent" so that it is more clear. Kaldari (talk) 17:57, 4 December 2020 (UTC)
 * Also the inews link is back in, I can't read it with an ad blocker. The BBC article reads fine and seems like a higher quality source. Maneesh (talk) 18:06, 4 December 2020 (UTC)
 * The BBC article uses a misleading headline, but yeah, at least it doesn't block people with ad blockers. I'll add it as well. Kaldari (talk) 18:43, 4 December 2020 (UTC)
 * How would you say it is misleading? It correctly extract the focus on informed consent: '"Puberty blockers: Under-16s 'unlikely' to be able to give informed consent"'? The judgement uses 'highly unlikely' for 13 and under and 'doubtful' 14,15. Bundling all that up as 'unlikely' is pretty sensible for a headline, but to each his own. Maneesh (talk) 18:59, 4 December 2020 (UTC)
 * I guess I'm just splitting hairs, but if the BBC is going to actually put quotation marks around "unlikely", it should be the word actually used in the decision, which was "doubtful" (with regard to under-16). Kaldari (talk) 23:35, 4 December 2020 (UTC)