Wikipedia:Fringe theories/Noticeboard/Archive 106#Pathologization of trans identities

Pathologization of trans identities

This is an RFCBEFORE so don't start voting. I'm thinking of an RFC along the lines {{tq|Is the view that identifying as transgender is pathological, or can be caused by mental illness, fringe?}} I'd like people's thoughts on the wording of that and sources. I don't think this should be too controversial given the overwhelming agreement between human rights bodies, international governing bodies, and medical bodies, but we'll see. Update: Sources below chronologically re-ordered / slightly expanded. (01:01, 17 February 2025 (UTC))

In 2011 the World Professional Association for Transgender Health released a statement that {{tq|The expression of gender characteristics, including identities, that are not stereotypically associated with one’s assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative. The psychopathologlisation of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalisation and exclusion, and increasing risks to mental and physical well-being.}}[https://wpath.org/wp-content/uploads/2024/11/de-psychopathologisation-5-26-10-on-letterhead.pdf]

The American Psychiatric Association's 2013 DSM-5 updated it's diagnosis such that {{Tq| “gender identity disorder” was eliminated and replaced with “gender dysphoria.” This change further focused the diagnosis on the gender identity-related distress that some transgender people experience (and for which they may seek psychiatric, medical, and surgical treatments) rather than on transgender individuals or identities themselves. The presence of gender variance is not the pathology but dysphoria is from the distress caused by the body and mind not aligning and/or societal marginalization of gender-variant people.}}[https://www.psychiatry.org/psychiatrists/diversity/education/transgender-and-gender-nonconforming-patients/gender-dysphoria-diagnosis] Their update note said {{tq|DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name “gender identity disorder” with “gender dysphoria,” as well as makes other important clarifications in the criteria. It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dys- phoria is the presence of clinically significant distress associated with the condition.}}[https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf]

In 2018 the World Health Organization ICD-11 moved from diagnosing "transsexualism" as a "mental and behavioral disorder" to "gender incongruence" as a "condition related to sexual health" noting {{tq| This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma. }}[https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd]

The American Psychological Association as of Feb 2024 calls for {{tq|recognition of gender diversity as a part of normal human diversity}}, says {{tq|gender diversity is present throughout the lifespan and has been present throughout history}} and also that {{tq|legislative efforts to restrict access to care have involved the dissemination of misleading and unfounded narratives (e.g., mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence,}}[https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf]

The United Nations says that pathologization of transgender people is a human rights abuse.[https://www.ohchr.org/en/sexual-orientation-and-gender-identity/transgender-people] and that {{tq|Trans children and adults are frequently branded as ill (“pathologized”) based on their gender identity or expression. Trans people are not by definition ill; they are part of the rich diversity of human nature. Being different should not be treated as a disorder. In June 2018, the World Health Organization formally declassified trans identity as a mental illness. The United Nations has highlighted that pathologization is one of the root causes of human rights violations faced by trans people.}}[https://www.unfe.org/en/know-the-facts/challenges-solutions/transgender]

The article covers how there's been 30-40 years of depathologization activism in the same vein as depathologizing homosexuality which have been {{tq|succeeding in influencing the policies of countries and organizations such as the WHO or the UN. The demands for depathologization are also supported by European bodies such as the Council of Europe and the European Parliament [15] as well as professional associations such as the WPATH}}. It concludes {{tq|Defining gender diversity as an illness or otherwise abnormal is unfounded, discriminatory, and without demonstrable clinical utility. The fact that only gender diverse people are pathologized constitutes unequal treatment, resulting in a violation of the right to non-discrimination.}} [https://pmc.ncbi.nlm.nih.gov/articles/PMC6466167/]

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 13:59, 7 February 2025 (UTC)

:Re: the wording, I think there's a difference between "can be caused by a mental illness" and "is often [or generally] caused by mental illness." The former is an existence claim (it's possible for X to exist), whereas the latter is a frequency claim (it's common for X to exist). Some things cannot exist (e.g., a perpetual motion machine); others can exist, and their frequency ranges from extremely rare (e.g., conjoined twins) to common (e.g., brown eyes). Given human complexity and variation across the more than 8B people in the world, as well as the large % of people with mental illnesses (which are themselves quite varied), I think it's a mistake to focus on existence. On the other hand, if what you really mean is something like "it's a fringe view to believe that identifying as transgender is a mental illness" (rather than that it can be or is often caused by a mental illness), then I'd reword it that way. The sources you quoted are saying that it isn't a mental illness. FactOrOpinion (talk) 15:11, 7 February 2025 (UTC)

::{{tq|rather than that it can be or is often caused by a mental illness}}

::Yeah, this is still fringe. Warrenᚋᚐᚊᚔ 15:40, 7 February 2025 (UTC)

:::I assume that there's scientific consensus that identifying as transgender is seldom caused by mental illness, but I'd be surprised if there's a consensus that identifying as transgender cannot be caused by mental illness. WPATH says "The role of mental health professionals includes making reasonably sure that [clients'] gender dysphoria is not secondary to, or better accounted for, by other diagnoses." FactOrOpinion (talk) 17:47, 7 February 2025 (UTC)

::::Just to streamline a bit and maybe avoid falling down a few rabbit holes, I would suggest {{tq|Is it a fringe view among subject-matter experts to assert that identifying as transgender is generally pathological?}} Generalrelative (talk) 18:26, 7 February 2025 (UTC)

::::I do think the consensus is it can't be. MEDORGS agree that being trans is part of normal diversity, and stopped diagnosing "transsexualism". They do still diagnose "gender dysphoria" (the desire to medically transition), but not "gender identity disorder"/"transsexualism".

::::WPATH did not say {{tq|the role of mental health professionals includes making reasonably sure that [clients'] transgender identity is not secondary to, or better accounted for, by other diagnoses.}} Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:14, 7 February 2025 (UTC)

:::::I'm open to being convinced, but I'd want to see some literature saying ~~this~~ "the consensus is it can't be". Consider someone with dissociative identity disorder (formerly called multiple personality disorder) who has two alternate personalities, where the main personality and one of the alters identify as cis, and the other alter identifies as trans. In this situation, I'd say that the existence of the alters is symptom of the mental illness, and therefore the person sometimes identifying as trans (when the trans alter is present) is caused by the mental illness. Do you interpret that differently? I'm just wary of making absolute statements given the range of mental health issues that humans experience. i{{tq|WPATH did not say ...}} My mistake, I was looking at a copy of the 7th edition rather than the current edition. FactOrOpinion (talk) 21:50, 7 February 2025 (UTC)

::::Gender dysphoria itself does not mean trans, it means gender dysphoria. You can't extrapolate that claim by substituting the word "trans" in there. Warrenᚋᚐᚊᚔ 19:18, 7 February 2025 (UTC)

:I agree with FactOrOpinion: I don't think the sources support {{tq|can}} as the fringe position here. They are saying that being trans is not itself a mental illness. (Except the APA, which is also separately saying that being trans is not caused by PTSD, autism spectrum disorder, or ADHD.)

:I think there's also a decent argument here against "is often caused by mental illness" but I don't think there's an argument against "is ever caused by mental illness" with these sources. Loki (talk) 17:56, 7 February 2025 (UTC)

::Oh, I'll also note that since the DSM is a manual of mental illnesses, and since DSM-5 kept a diagnosis of gender dysphoria, one could definitely argue that the authors of the DSM believe that being trans is or usually is a mental illness that's treated by transition.

::(Part of the issue here is US health insurance needs a diagnosis to pay for treatment; pathologization doesn't really seem to have been their intent but whatever wording we use will still need to account for whatever the DSM is doing.) Loki (talk) 18:08, 7 February 2025 (UTC)

:::Michel Foucault had rather a lot to say on that topic. Simonm223 (talk) 18:25, 7 February 2025 (UTC)

:::I don't think "the authors of the DSM-5 believe that being trans is or usually is a mental illness that's treated by transition," but instead believe that the resultant distress is a mental health concern that might be treated by transition. FactOrOpinion (talk) 19:03, 7 February 2025 (UTC)

::::Yeah, on reflection I think you're right. I just wanted to point this out early because it is a possible complication. Loki (talk) 21:02, 7 February 2025 (UTC)

::I'd be worried about removing the "can" and general idea of moving towards "generally". The clearest parallel is homosexuality, which was until 1970 a diagnosis. If we were to ask {{tq|Is the view that identifying as homosexual is pathological, or can be caused by mental illness, fringe}} - we'd think the answer is obviously yes.

::* This is despite the Reparative therapy tactic of "we don't think homosexuality is a mental illness - we think it can be a symptom of one". It also works with Gender exploratory therapy tactic of "we don't think being trans is a mental illness - we think it can be caused by one".

::The DSM update was all about clarifying it's remit is not diagnosing "trans", but "gender dysphoria" - and explains the switch with the pretty unequivocal statements that being trans is part of normal diversity.

::I think a productive line of questioning is Are their MEDRS/MEDORGS that say identifying as transgender is pathological, or can be caused by mental illness? We seem to already have consensus via the ROGD RFC that the claim that kids are turning trans because of the internet and autism is FRINGE Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:49, 7 February 2025 (UTC)

:::I would not think the answer is obviously yes. I would actually think it's almost certain that someone somewhere has identified as gay because of mental illness. Loki (talk) 20:11, 7 February 2025 (UTC)

:@LokiTheLiar, @FactOrOpinion, @Aquillion @Simonm223 - Do y'all think this question works: {{tq|Is the view that transgender identities are inherently or frequently pathological (a mental illness or symptom of one) - as opposed to a natural part of human diversity - fringe?}} Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:47, 9 February 2025 (UTC)

::Yes. Simonm223 (talk) 19:49, 9 February 2025 (UTC)

::I think it's fine, though I feel like there has to be a more natural way to phrase it.

::I'd also like to add that we should make clear (not necessarily in the question itself, just nearby) that we're talking about the identity itself and not gender dysphoria/depression or anxiety due to social stigma/etc. Loki (talk) 19:53, 9 February 2025 (UTC)

:::My suggested wording: {{tq|Is the view that transgender identities are, in themselves, a mental illness or commonly caused by mental illness outside the bounds of mainstream psychology?}}

:::My first priority was to remove the awkward double-barreled phrasing of the first sentence. In the process I also started removing as much jargon as possible, including the term "fringe" itself. I'd be okay with readding it but I do think that disputes about what exactly "is fringe" means took up too much space in the previous threads. Loki (talk) 21:04, 9 February 2025 (UTC)

:Value judgements don't make a source WP:FRINGE, as other editors have described at this board. Chess (talk) (please mention me on reply) 13:28, 11 February 2025 (UTC)

::What does this have to do with anything? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:02, 11 February 2025 (UTC)

::Whether trans people exist is not a value judgement -- Wikipedia needs to explicitly say this stuff. Mrfoogles (talk) 06:15, 25 March 2025 (UTC)

= RfC about the pathologization of trans identities =

{{atop|1=There is consensus to answer the RfC question in the affirmative, i.e., that the claim that transgender identities are themselves a mental illness, or are frequently caused by mental illness, is a fringe view for the purposes of Wikipedia, because in the view of the RfC participants this position is clearly contradicted by the current consensus in mainstream medicine, science and human rights discourse.

Consensus in this discussion is based primarily on the following considerations: The RfC participants noted that there is broad consensus among major medical organizations that transgender identities are not a mental illness, and that that relevant medical authorities no longer categorize "gender incongruence" as a mental disorder, and clarify that gender variance is not itself a mental disorder; they further distinguish between being transgender and experiencing psychological distress (gender dysphoria). Also, participants note that international human rights bodies emphasize that pathologizing trans identities leads to significant stigma and human rights violations.

The view of a small minority (so small as to not preclude a finding of consensus) against considering the position at issue fringe was that gender dysphoria remains a recognized medical condition, that ongoing scientific discussions regarding potential links between neurodiversity and transgender identity remain unresolved and should therefore not be considered fringe, and that generally views in topics of ongoing research should not be readily dismissed as fringe. In addition, there were some procedural and wording concerns about the RfC (ambiguity, combining distinct issues), but these did not materially affect the consensus on the merits. Sandstein 11:15, 29 April 2025 (UTC)}}

Is the view that transgender identities are, in themselves, a mental illness or otherwise frequently caused by mental illness WP:FRINGE within the bounds of mainstream medicine and international human rights? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:01, 17 February 2025 (UTC)

== Survey (trans pathologization) ==

Yes: Just like the medical community treated LGB identities as pathological until around the ~1970s, it did the same for trans people until the 2000's. As you can see from the RfCBEFORE #Pathologization of trans identities we've got the World Health Organization's 11th International Classification of Diseases noting {{tq|current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma}}[https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd], the American Psychiatric Association's globally used DSM-5 no longer diagnosing "gender identity disorder" and noting gender variance isn't a mental health disorder[https://www.psychiatry.org/psychiatrists/diversity/education/transgender-and-gender-nonconforming-patients/gender-dysphoria-diagnosis][https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf], statements from various MEDORGs noting trans identities aren't pathological[https://wpath.org/wp-content/uploads/2024/11/de-psychopathologisation-5-26-10-on-letterhead.pdf][https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf], and the United Nations saying {{tq|Trans children and adults are frequently branded as ill (“pathologized”) based on their gender identity or expression. Trans people are not by definition ill; they are part of the rich diversity of human nature. Being different should not be treated as a disorder ... pathologization is one of the root causes of human rights violations faced by trans people.}}[https://www.ohchr.org/en/sexual-orientation-and-gender-identity/transgender-people][https://www.unfe.org/en/know-the-facts/challenges-solutions/transgender] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:01, 17 February 2025 (UTC)
:Adressing some's concerns about the etiology of trans identites:
:From the Endocrine Society 2020: {{tq|The medical consensus in the late 20th century was that transgender and gender incongruent individuals suffered a mental health disorder termed “gender identity disorder.” Gender identity was considered malleable and subject to external influences. Today, however, this attitude is no longer considered valid. Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity.}}[https://www.endocrine.org/advocacy/position-statements/transgender-health]
:From the World Medical Association 2015: {{tq|being transgender does not in itself imply any mental impairment}}[https://www.wma.net/policies-post/wma-statement-on-transgender-people/]
:Mental health in transgender individuals: a systematic review 2022: {{tq|Transgender and gender-diverse youth experience a high degree of discrimination, such as bullying and peer rejection. Consequently, approximately one out of four transgender or gender-diverse youth experience a high degree of anxiety and symptoms of major depressive disorder, with one out of two of these youth making attempts to complete suicide (Strauss et al., Citation2020). These phenomena are best examined through the minority-stress framework}}[https://www-tandfonline-com.wikipedialibrary.idm.oclc.org/doi/10.1080/09540261.2022.2093629#d1e425]
:MEDORG's consider being trans to be innate and not shaped by external forces (such as mental illness). Sources reviewing the higher rates of mental illness among trans people generally attribute it to minority stress - none argue that the mental illnesses cause the trans identity. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:55, 23 February 2025 (UTC)
Yes. It wasn't always so, and we can argue over when it became so, but there are no serious medical authorities that entertain it now as a matter of science or medicine. Such views are purely political now. --DanielRigal (talk) 01:22, 17 February 2025 (UTC)
Yes - per YFNS and DanielRigal. Surprised we are even doing this RFC, should be commonplace knowledge. User:Bluethricecreamman (Talk·Contribs) 01:34, 17 February 2025 (UTC)
Yes, very much fringe - The DSM-V calls this out as discredited and they're relatively speaking the most positive an academic source gets on it. YFNS has listed tons of examples of big WP:MEDORGs saying this is outside the bounds of mainstream medical science in the discussion above. Loki (talk) 02:22, 17 February 2025 (UTC)
Yes {{summoned by bot}} per YFNS's comments above. TarnishedPath^talk 02:48, 17 February 2025 (UTC)
Yes per sources offered by YFNS.OsFish (talk) 02:55, 17 February 2025 (UTC)
Yes. Unambiguously established by the sources presented above. Generalrelative (talk) 03:04, 17 February 2025 (UTC)

:Yes, the DSM, ICD, and OHCHR sources reflect the mainstream consensus in those fields. –RoxySaunders 🏳️‍⚧️ (talk • stalk) 03:50, 17 February 2025 (UTC)

{{sbb}} Yes. To say that the science on this is still out or hasn't reached a broad and general consensus would be flagrantly (and knowingly) incorrect. No reason to disagree with this characterization per the above arguments and the RFCBEFORE discussion. SmittenGalaxy | talk! 04:55, 17 February 2025 (UTC)
Yes, per YFNS. The fact we even have to discuss this suggests we should be vigilant of WP:PROFRINGE viewpoints proliferating in this topic area. Lewisguile (talk) 10:37, 17 February 2025 (UTC)
Yes There is a vast repository of anthropological literature, such as the work of Pierre Clastres, that goes back decades, that indicates that gender non-conforming identities, including trans identities, are transcultural and are fully capable of integration into society when allowed by the dominant forces of that society. Being trans is not a mental illness though forced suppression of trans identity may lead to mental illness. This understanding is also core to why conversion therapy is seen by legitimate medical bodies as unethical. Simonm223 (talk) 12:47, 17 February 2025 (UTC)
Yes per YNFS. Relm (talk) 13:20, 17 February 2025 (UTC)
The question is unfair. The context is access to medical treatment, not declaring one's identity. I don't think you'll find any Wikipedia editors who think or would admit to thinking being trans is an illness vs part of the spectrum of human identity. So well done in asking a question you already know the answer for. The comparison to LGB identities is also unfair. If a gay person popped along to their GP and said "I'm gay" the doctor would reply "That's nice for you. What exactly did you come here for?" Sure, in the past the response might not be so friendly but we're discussing today's attitudes, not the 1950s. While not every trans person seeks to alter their body, for those who do, they are asking a doctor to perform or prescribe a treatment. One with lifelong consequences and significant effects. This is not like asking a painter to decorate your walls. The medical professional will expect their actions to have evidence of benefit and evidence of acceptable risk of harms. The alternative is just buying pills off the Internet or going to some unregulated country for treatment. Quite how they balance regulation, evidence, medical care and personal autonomy is complex and clearly contentious. -- Colin°^Talk 18:58, 17 February 2025 (UTC)
It's unclear to me what content dispute this RfC was prompted by. This is just about banning bad opinions, in my view. Chess (talk) (please mention me on reply) 03:45, 19 February 2025 (UTC)
:Oppose per {{u|CFCF}}. Chess (talk) (please mention me on reply) 23:24, 20 February 2025 (UTC)

:{{tq| This is just about banning bad opinions, in my view. }} - This is not about opinions, this is about medical claims. If an "opinion" is contradicted by every MEDRS and MEDORG who explicitly state the opposite as fact, it has no place on Wikipedia.
:I will note it's slightly interesting that presented with explicit statements from MEDORGs as to what the correct answer is, nobody is voting "this isn't FRINGE", just opposing the RFC itself... Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:50, 20 February 2025 (UTC)
::You cannot actually identify a content dispute so it's unclear what the scope of this RfC will be. I agree with CFCF's view though. Chess (talk) (please mention me on reply) 01:58, 23 February 2025 (UTC)
:::According to you, {{tq|it's more productive to debate fringe theories rather than fringe organizations.}} This RFC started after discussion about SEGM as to which fringe theory we should debate, followed by an RFCBEFORE here. Here, when presented with a fringe theory, clearly noted to be fringe according to the best MEDRS, you procedurally oppose. Moving the goalpost methinks.
:::* Gender exploratory therapy/Gender identity change efforts rely on the a priori belief that trans identities are frequently or inherently pathological
:::* SEGM has many fringe positions but their overarching one is the claim trans identities are a diagnosis and frequently pathological
:::* Rapid Onset Gender Dysphoria's key claim is that youth are identifying as trans en masse due to mental illness
:::Basically every recurring GENSEX debate about whether a position/source/researcher is FRINGE has come down to "are they claiming that trans identities are a mental illness or frequently a mental illness?"
:::I'm a little unclear. Do you think {{tq| the view that transgender identities are, in themselves, a mental illness or otherwise frequently caused by mental illness}} is not actually a FRINGE view? Or do you think it's FRINGE and just don't think we should have an RFC about it? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 03:15, 23 February 2025 (UTC)
::::I'd rather you mentioned those examples in your first reply. Specifically, I can agree that Rapid Onset Gender Dysphoria is a WP:FRINGE concept, but the claim that rejecting the affirmation model is WP:FRINGE is not at all true. Specifically, the NHS now says that {{tq|in many cases gender variant behaviour or feelings disappear as children reach puberty}} and recommends psychological treatment for kids. [https://www.nhs.uk/conditions/gender-dysphoria/treatment/] And the article you've linked says gender exploratory therapy is {{tq|characterized by requiring mandatory extended talk therapy attempting to find pathological roots for gender dysphoria while simultaneously delaying social and medical transition and viewing it as a last resort.}}
::::Would the NHS's position, which promotes talk therapy and a delay of medical transition, be WP:FRINGE if this RfC passes? Chess (talk) (please mention me on reply) 04:36, 23 February 2025 (UTC)
:::::@Chess Regarding {{tq|but the claim that rejecting the affirmation model is WP:FRINGE is not at all true.}} It is actually FRINGE and the NHS hasn't actually rejected the affirmation model. That document starts with {{tq|Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary}} - the basic tenet of the affirmative model. It also says {{tq|From around the age of 16, young people with a diagnosis of gender incongruence or gender dysphoria who meet various clinical criteria may be given gender-affirming hormones}} This doesn't sound like rejection to me.
:::::They said {{tq|in many cases gender variant behaviour or feelings disappear as children reach puberty}} - they do not say {{tq|gender variant identities}} Nobody has disputed that many kids act more gender-nonconforming before puberty and less after. The NHS stops short of claiming that identifying as trans often stops after puberty because no data supports that. That also doesn't say anything about mental illness being a factor.
:::::{{tq| and recommends psychological treatment for kids}} - so does WPATH and every org that supports gender-affirming care because gender-affirming care has never entailed medical treatment for pre-pubertal kids... The full NHS quote is {{tq|Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.}} They do not say the psychological treatments are aimed at figuring out why a kid is trans, or changing that, and one can have affirming psychotherapy.
:::::{{tq|Would the NHS's position, which promotes talk therapy and a delay of medical transition}} - nowhere does it say the goal of the talk therapy is {{tq|attempting to find pathological roots for gender dysphoria}}. Nowhere does it call for {{tq|simultaneously delaying social transition}} (because whether a youth socially transitions is not a call they make). They allow medical transition at {{tq|around the age of 16}} - which is what the majority of MEDORGs call for.
:::::This question seems based on a lack of understanding of
:::::* 1) what gender-affirming care entails (supportive/non-judgemental talk therapy at any age, hormones in mid-late adolescence) and
:::::* 2) what the NHS is recommending (which is gender-affirming care sans puberty blockers, which are not strictly necessary for gender-affirming care, and their position on that can be discussed separately)
:::::* 3) the difference between "we provide psychological support" and "we require talk therapy to try and figure out the pathological root of your trans identity"
:::::TLDR, the NHS's position on gender-affirming care is broadly in line with the field (the goal is {{tq|to help people live the way they want to}}), with the exception of puberty blockers, which is a separate convo - so this RFC does not make the NHS's overall position fringe. Frankly, this whole noticeboard has been saturated with people claiming countries that support gender-affirming care and debate how best to provide it (usually specifically the role of puberty blockers) have somehow wholly renounced it (see Transgender health care misinformation#European nations are banning gender-affirming care, added by another editor a few days ago).And in case you weren't aware, my personal position, at odds with MEDORGS/MEDRS, is that standalone puberty blockers should be almost entirely removed from trans healthcare. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 05:37, 23 February 2025 (UTC)
::::::This is more or less why I agree with CFCF's reasoning. The word "frequently caused by" makes it unclear what is in scope. Autistic people are more likely to be transgender according to our article on such. Is that WP:FRINGE?
::::::I'd prefer discussions on specific fringe theories, like "is gender exploratory therapy" fringe (yes) or "is the NHS's recommendation fringe" (no). Preferably with impacts on how articles will change. Chess (talk) (please mention me on reply) 07:11, 24 February 2025 (UTC)
:::::::It isn't fringe to cite a source that notes a correlative observation. It is fringe to say this is causal. The second half of this reply I don't feel the need to address because it has already been discussed at length in this very discussion already, and spending more time going over it again to make the survey section more cluttered isn't a good use of my time. SmittenGalaxy | talk! 08:48, 24 February 2025 (UTC)

As I explained in the section below, I think that the question is not formulated correctly and combines two different issues that should be looked at separately.--JonJ937 (talk) 10:09, 19 February 2025 (UTC)

:In case it gets lost in the weeds for the closer: As noted in the section below, at no point did you provide any source that would make {{Tq| the view that transgender identities are ... frequently caused by mental illness}} less than WP:FRINGE. You've tried to conflate "trans people are more likely to suffer mental illness" with that claim (particularly silly as every source that says being trans is not a mental illness notes trans people face higher rates of mental illness), you've tried to conflate "gender dysphoria can be worsened by other mental health issues" with that claim, you've tried to cite the Economist (which 1. you have been repeatedly told is not a WP:MEDRS and 2. does not support the claim), and you've tried to cite a systematic review of DID and gender dysphoria (not trans identity) which still found that the rate of DID for those with GD was the same as those without. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 04:32, 23 February 2025 (UTC)
::At face value, nobody here disputes the first proposition of the RfC: that trans identity is not, in and of itself, a mental illness. We appear to have consensus on that point.
::The issue arises with (1) the lack of clarity in the question, given its multiple subordinate clauses, and (2) the uncertainty about what specific problem this RfC aims to resolve. For example, two related discussions started around the same time, seemingly asking Wikipedia to take a definitive stance on a complex debate by labeling the opposing view as “fringe.” That risks edging into righting great wrongs (WP:RGW). (See Wikipedia:Reliable_sources/Noticeboard#Is the Cass Review a reliable source? https://en.wikipedia.org/w/index.php?title=Wikipedia:Reliable_sources/Noticeboard&oldid=1277208401#Is_the_Cass_Review_a_reliable_source? oldid and Wikipedia:Fringe_theories/Noticeboard#Is_being_anti-trans_WP:FRINGE? https://en.wikipedia.org/w/index.php?title=Wikipedia:Fringe_theories/Noticeboard&oldid=1277210340#Is_being_anti-trans_WP:FRINGE? oldid).
::Any actionable consensus from this RfC needs to be very precise about its scope. We should avoid WP:WEASEL terms like “frequently” unless properly defined—since, for instance, 0.01% might be construed as “frequent” at a population level. This concern about “frequency” hasn’t been adequately addressed yet; it’s arguably beyond what the RfC can be expected to determine.
::We should also acknowledge—and any RfC close should note—that the notion of trans identity without gender dysphoria remains somewhat contentious. Authoritative sources do support it, but in many jurisdictions and under many treatment guidelines, access to gender-affirming therapies (hormones, surgery) still requires a formal diagnosis of gender dysphoria. The World Health Organization is moving toward the term “gender incongruence,” but that terminology hasn’t been universally adopted. We risk getting ahead of actual clinical policy by dictating a universal stance on this.
::I admit I’m personally sympathetic to expanding care—having worked as a clinician with adolescents experiencing gender dysphoria, I’ve seen both deep suffering and the benefits of affirmative treatments. Still, we shouldn’t jump the gun. Wikipedia can’t impose a consensus on a contentious topic where guidelines vary significantly. It’s important to recognize that the existing national and global standards aren’t “fringe,” and specificity about what constitutes consensus is crucial.
::Moreover, stating outright that {{tq|transgender identities are … not frequently caused by mental illness}} isn’t directly supported by evidence.
::At best, one could argue based on current evidence:
:::{{tq|As of February 2025, there is insufficient evidence to reliably quantify how often mental illness might contribute causatively to gender dysphoria or gender incongruence.}}
::Or if you like:
:::{{tq|As of February 2025, there is insufficient evidence to reliably quantify how often mental illness might contribute causatively to transgender identities, as this remains mostly if not entirely unexplored.}}
::That narrower statement might be more accurate, though I’m not sure if this is what you seek.
::I understand the wish to separate “trans identity” from “gender incongruence” or “gender dysphoria,” but we can’t simultaneously do that and pronounce on “frequency” when most international medical literature, policies, and guidelines have yet to adopt or explore that distinction, or how it related to frequency. The best we can do is reflect each authoritative WP:RS/WP:MEDRS source’s statements.
::By lumping together the statement on whether trans identity is a mental illness (we are agreed it is not), with a statement on frequency of causation - when it is largely unexplored - and perhaps should not/can not/will not be explored - we will ensure that consensus is not meaningful.
::CFCF (talk) 12:29, 23 February 2025 (UTC)
:::1) We have sources like the Endocrine Society saying {{tq|Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity.1, 2 Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity.}}[https://www.endocrine.org/advocacy/position-statements/transgender-health]
:::2) Those two discussions were started by Chess without an RFCBEFORE - the RFCBEFORE for this went on about 2 weeks
:::3) {{Tq|the notion of trans identity without gender dysphoria remains somewhat contentious}} no it doesn't - sources are pretty clear that not all trans people have GD and "some countries require it to let people transition" doesn't mean anything. You keep setting up a false dichotomy between GD and GI that has nothing to do whatsoever with the scope of the question.
:::4) We have top-tier MEDRS saying being trans isn't a mental illness. We have none saying it's ever caused by one - or that we don't know how often it's caused by one. A statement like {{tq|As of February 2025, there is insufficient evidence to reliably quantify how often mental illness might contribute causatively to transgender identities, as this remains mostly if not entirely unexplored.}} should not be in Wikivoice unless MEDRS say it, which they don't. A theory that has no backing in MEDRS is FRINGE. This whole line of argument is an appeal to ignorance: consider {{tq|As of February 2025, there is insufficient evidence to reliably quantify how often seeing clowns might contribute causatively to transgender identities, as this remains mostly if not entirely unexplored}}, by your reasoning, since there's no evidence against it, and MEDRS haven't spoken on it, we can't say the theory that seeing clowns makes people trans is FRINGE.... Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:25, 23 February 2025 (UTC)
::::I never once stated that this should be in Wikivoice, but as a summary of consensus of this RfC. I do not think I am the one making appeals to ignorance here, since my argument is that because we at present have no MEDRS stating what proportion/frequency there is/isn't - we should't dictate policy that states that it is WP:FRINGE if an upcoming WP:MEDRS-compliant source should make a statement about frequency. CFCF (talk) 15:49, 23 February 2025 (UTC)
:::::That is not a good summary at all and that's a classic appeal to ignorance. If tomorrow, MEDRS started saying being trans is caused by mental illness X% of the time, we could revisit this - but at the moment you are saying a position supported by no MEDRs can't be FRINGE because MEDRS don't comment on it (ignoring the fact they 1) say it's not a mental illness but rather a normal part of human diversity 2) say being trans is caused by innate biological factors and 3) say higher rates of mental illness among trans people are best accounted for by minority stress). Please explain how this applies to my clowns example - by your line of reasoning, one can't say "being trans is caused by seeing clowns" is FRINGE because MEDRS haven't commented on whether seeing clowns can make people trans and tomorrow a MEDRS might say how often being trans is caused by seeing clowns.
:::::The simple reason there are no MEDRS making a statement about the frequency at which being trans is caused by mental illness, is because they reject the very premise that being trans is caused by mental illness, and you have produced no MEDRS disputing that view. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:15, 23 February 2025 (UTC)
::::2) YFNS, the RFCBEFORE for this was a response to your request "I'd like people's thoughts on the wording of that [potential RfC question] and sources," not really about the substance of the issue. In retrospect, I agree that it would have been better to separate out the two parts of the question, since it's possible for people to have different responses for the first half and the second half. Several of the "yes" !voters explicitly addressed the first half of the question, but I don't think any "yes" !voters explicitly addressed the second half of the question until questions were raised about it, when you added a second comment. Had there been an RFCBEFORE discussion on the substance, it would have made it clear that there was no need for an RfC on the first half of the question (everyone agrees that the answer is "yes"), but that there might be a need for an RfC about the second half. Re: "Those two discussions were started by Chess without an RFCBEFORE," I don't think Chess started any RfCs here (am I mistaken about that?), so the concept of an RFCBEFORE doesn't apply to the discussions {{pronoun|Chess}} started.
::::4) Re: "We have top-tier MEDRS saying being trans isn't a mental illness." No one is contesting that. "We have none saying it's ever caused by one - or that we don't know how often it's caused by one." Do you have any top-tier MEDRS saying that they do know how often it's caused by one? The clown analogy is silly; no MEDRS say anything about clowns vis-a-vis transgender identities, when they clearly do address mental illness vis-a-vis transgender identities.
::::CFCF, re: "a statement on frequency of causation - when it is largely unexplored - and perhaps should not/can not/will not be explored," it may be largely unexplored, but there is some exploration. An [https://academic.oup.com/smoa/article/11/2/qfad018/7161662?login=false example]: {{tq|Mental health providers working with patients with GI should be informed that some patients seeking treatment for GI may have DID or PDID, and they should be aware of the possible comorbidity between the diagnoses. They also need to be aware of the complexity of treating these patients in terms of consent and the iatrogenic effects that GI treatments may have. One should keep in mind that patients asking for GAMST while experiencing DID or PDID are quite rare ...}} (emphasis added).
:::: FactOrOpinion (talk) 16:48, 23 February 2025 (UTC)
:::::To clarify my !vote, since that is apparently a necessity here — I agree with both parts of the initial statement. There are no current MEDRS that support the view that being transgender is a mental illness nor that it is caused by any. This is not an extant concern in medical literature; the consensus is fairly obvious that this is a WP:FRINGE point of view to hold. I didn't feel the need to address it separately because it too is a fringe belief and I did not believe it was necessary to separate these.
:::::{{tq|Do you have any top-tier MEDRS saying that they do know how often it's caused by one?}} I feel like you're mixing up the order of onus; it is not the responsibility of someone to prove a negative. In fact, you can't really do that, logically speaking. This, I feel, is the crux of the arguments made by those who oppose this RfC — there has been no real substantial opposition to the actual question. It's all trivial wordplay and minor nitpicking of phrasing and the merits of the RfC's formation, scope, and prior content disputes; most of which is not a necessity to opening an RfC. Goalpost-moving when there is nothing evidence-based to actually oppose on. SmittenGalaxy | talk! 22:45, 23 February 2025 (UTC)
::::::People have the burden of proof for their claims. If someone makes a negative claim, they have the burden of proof for it. And if the first person to make a claim is a person who made the negative claim, then that's the order of the onus. To be clear, the question of mine that you quoted was a question, not a claim. Also, because it's a pet peeve of mine when people suggest that one can't prove a negative, one can absolutely prove some negative claims logically. (And if your response is that that's only the case for some negative claims, it's also the case that we can only prove some positive claims.) Personally, I don't think it's trivial wordplay or nitpicking to say that there are actually two questions there, and people agree about the first, but there's some disagreement about the second, and that it might have been better to separate the two and focus on whether there's clear evidence about the second one. In terms of goalpost moving, I try hard not to, but if I've nonetheless done that somewhere, just quote where I did it, and I'll have no problem admitting my mistake. I think it's valuable to acknowledge when we're wrong about something. FactOrOpinion (talk) 23:53, 23 February 2025 (UTC)
:::::{{tq|I don't think Chess started any RfCs here (am I mistaken about that?)}} No, you are not mistaken, per previous comments.[https://en.wikipedia.org/wiki/Wikipedia:Fringe_theories/Noticeboard#c-Chess-20250217045500-Your_Friendly_Neighborhood_Sociologist-20250217001800] Chess (talk) (please mention me on reply) 01:26, 26 February 2025 (UTC)
::::YFNS, when I read statements such as what you quote above from the Endocrine Society, I wonder if we have common language around pathology, and therefore around what the word pathologization means.
::::Consider someone writing that {{xt|Considerable scientific evidence has emerged demonstrating a durable biological element underlying}} hereditary cancer syndromes, so cancer isn't pathological and isn't an illness. Or {{xt|Considerable scientific evidence has emerged demonstrating a durable biological element underlying}} Major depressive disorder, so depression isn't pathological and isn't an illness. Or {{xt|Considerable scientific evidence has emerged demonstrating a durable biological element underlying}} Anorexia nervosa, so eating disorders aren't pathological and aren't an illness. That's obviously wrong, and yet that's how this quotation strikes me above.
::::It would be fair to define pathological as any "biological element" underlying something that society believes to be a health problem. (It doesn't have to be durable, as some conditions are temporary.) The Endocrine Society may have been trying to make the point that gender identity is not a voluntary choice, but even if they actually wrote "There's a biological element, and no mental disorders have biological elements, so being trans can't be a mental disorder" (which, to be clear to any bystanders, I believe they would very strongly disagree with any such claim), then that claim would just show that they were wrong. It wouldn't prove that society did/didn't believe being trans to be a mental health problem, and it's society's beliefs about whether it's a health problem that matter – not beliefs about whether this putative health problem is biological in nature. WhatamIdoing (talk) 20:58, 23 February 2025 (UTC)
:::::1) Cisgender people also have gender identities... Your examples are begging the question by replacing "gender identity" with illnesses while a better comparison than those would be {{tq|Considerable scientific evidence has emerged demonstrating a durable biological element underlying sexual orientation}}
:::::2) the endocrine society prefixes that with saying the view that trans people suffer a mental health disorder is no longer valid Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:12, 23 February 2025 (UTC)
::::::Well, that's the point, isn't it? The existence of that "considerable scientific evidence" about "a durable biological element" tells us nothing at all about whether anything is an illness. The statement that "{{xt|Considerable scientific evidence has emerged demonstrating a durable biological element underlying}} _______, {{!xt|so it isn't any type of illness}}" is nonsense. It doesn't matter what you put in the blank; the sentence itself is illogical. WhatamIdoing (talk) 21:24, 23 February 2025 (UTC)

Procedural oppose - As stated above this RfC is not conducive to an actionable consensus summary. The question it poses conflates several several points, while sneaking in a WP:WEASEL-word with "frequently". Without definition of "frequently" this will not give rise to any meaningful position for Wikipedia. "Frequently" can be taken to mean many things. Is 0.1% frequent? Or is 75% frequent?

:The issue is that we are asking multiple questions in one, and they are all different:

::1. Is the view that transgender identities are mental illness WP:FRINGE? - Yes - this I think is noncontroversial, but is not what is asked.

::2. Is the view that gender dysphoria is a mental illness WP:FRINGE? - No. There is considerable academic debate on this topic. We may agree or disagree, but it is not Wikipedia's place to determine at this point. (Note: this is not an endorsement of the view, simply denial that it is fringe).

::3. Is the accepted terminology gender dysphoria or gender incongruence (as per recent publications by the WHO) - this is integral to the question and not something we can brush off with a blanket RfC about transgender identities. (I have no adequate response at this point, but see that this would need to be addressed for and RfC to be actionable).

::4. Is the view WP:FRINGE - that any of the aforementioned conditions are associated with mental illness? - No, this is supported by strong evidence.

::5. Is the view WP:FRINGE - that any of the aforementioned conditions could ever be caused by mental illness? - No, this is supported by some evidence and denial of any potential causality expresses a view that is incompatible with the mainstream view of psychiatric pathology.

::6. Is the view WP:FRINGE that some proportion of the aforementioned conditions can be caused by mental illness? - No, and this is not a question for an RfC, but for high quality WP:MEDRS sources that may evolve over time. Wikipedia's role here is to state what is described in reliable WP:MEDRS-compliant sources.

:The comorbidity of gender dysphoria and mental illness, and even the potential for mental illness to ever be causative should not be taken to be controversial. Implying degree of causality is something for high quality WP:MEDRS sources that are evaluated on a case-by-case basis and not through a blanket-RfC.

:Rather for this RfC to result in anything actionable, the question(s) need to be rephrased with:

::1) appropriate background

::2) clear division of component questions

::3) clear definition of what problem the RfC seeks to adress

::4) preferably with examples of what we can see going wrong on Wikipedia today. Are people citing policy documents when the appropriate document is a medical study? Is WP:MEDRS not being applied?

:It can not be assumed that all respondents to the RfC have the time or prerequisite knowledge to weight the entire page of comments and arguments here. CFCF (talk) 12:40, 20 February 2025 (UTC)

::Nitpicking aside (like the questioning of the word frequent), I don't see what exactly is procedural in favor of opposing and/or closing from these rationale. Please elaborate. SmittenGalaxy | talk! 12:52, 20 February 2025 (UTC)

:::I think the question needs to be revised, and if we want an RfC - it needs to be far more specific. At least if we do not want the onus of interpretation and dictating complex policy to be left a single individual closing the RfC. In my view that would likely just lead to more RfCs, more confusion, and no meaningful change. CFCF (talk) 12:59, 20 February 2025 (UTC)

::::Then we must simply just disagree there. I don't see any current issue with the wording, nor is there any real pressing issue of {{tq|interpretation and dictating complex policy to be left a single individual closing the RfC}}. This isn't trying to rewrite Wikipedia policy wholesale; it's asking if it's fringe to say that it is a mental illness in and of itself or caused by one or more illnesses. It seems quite simple, doubly so once you read the above WP:RFCBEFORE. I don't foresee any more RfCs or confusion coming from this because it's not a complex question and doesn't seek to widely impact the site like you think it is trying to. SmittenGalaxy | talk! 13:03, 20 February 2025 (UTC)

:::::Here we immediately jump to the issue - you state that the RfC is (in part) about whether "[it is] caused by one or more illnesses". There is evidence to state that it can be, and it is not the place of an RfC determine that it can't be. This is precisely what I mean with needing to define "frequent". The issue at hand that transgender identities is not a mental illness is not controversial in itself, but the phrasing of the question may lead to confusion and closing the RfC with an incorrect or flimsy interpretation is unwise. We therefore need very much to be specific in exactly what it is we are discussing - as well as considering what can be the policy result. I also do see it widely impacting sitewide policy, and would certainly hope that we could promote a sitewide policy that we should not give credence to the fringe view that transgenderism is a mental illness. But to do so, we need to be clearer. CFCF (talk) 13:15, 20 February 2025 (UTC)

::::::The argument isn't about whether or not there is evidence (and I still don't agree that there is much — if any — reliable evidence, but regardless). The argument is whether or not this view is fringe. There is evidence to show this view is fringe. I feel like you have some misunderstanding about what this RfC is about. SmittenGalaxy | talk! 13:27, 20 February 2025 (UTC)

:::::::I apologize for my inability to ascertain "what this RfC is about", but I feel that this is perhaps the point. On the assumption that I am of at least average intelligence - is it presumptuous to state that others might also fail to grasp what it "is about"? CFCF (talk) 13:40, 20 February 2025 (UTC)

::The question does not mention gender dysphoria. I think you're misinterpreting what's been asked. FactOrOpinion (talk) 14:04, 20 February 2025 (UTC)

:::Or pointing out a flaw in having a too broad question? CFCF (talk) 14:05, 20 February 2025 (UTC)

::::You seem to be claiming that it's broad based on your having introduced something into the question that literally isn't there. FactOrOpinion (talk) 14:08, 20 February 2025 (UTC)

:::::I disagree fundamentally - as the question compounds transgender identities and mental illness - it must be stated that is very difficult to speak of mental illness in relation to trans issues without either defining or mentioning gender dysphoria. CFCF (talk) 14:21, 20 February 2025 (UTC)

::::::I don't mean this as a personal slight, or anything — but have you actually read the above RFCBEFORE discussion or any of the medical literature discussed? I don't think this is a particularly perplexing question, and you are introducing a reason to oppose not contained within the actual original question or above discussion. It does not mention gender dysphoria. Whether or not you think it should be there is another thing entirely.

::::::Quite frankly I hope that if this does ever get a legitimately uninvolved close that said closer truly weighs the merits of the discussions in this survey section and below, and reads and understands the RFCBEFORE discussion above. I believe it's cut and dry, and not a very complex question or discussion to be had, and that unneeded complexity is being added after the fact. SmittenGalaxy | talk! 14:29, 20 February 2025 (UTC)

::::::I'm not sure what you mean by "compounds" there. Note that in the RfCBEFORE, Loki said "I'd also like to add that we should make clear (not necessarily in the question itself, just nearby) that we're talking about the identity itself and not gender dysphoria/depression or anxiety due to social stigma/etc." The RfC is asking about what you identified as question 1. FactOrOpinion (talk) 14:37, 20 February 2025 (UTC)

::1) Was literally the first part of the question...

::2) Not what was asked, in fact, as others noted, very specifically not what was asked

::3) That's not an integral question - both are used in different contexts but were changed for the same reasons. Gender incongruence refers to your gender identity not matching your sex. Gender dysphoria refers to that causing stress. It's mostly country dependent which ends up used but they link to each other as related/equivalent diagnoses

::4) Not the question, and nobody has denied that - completely irrelevant to the RFC.

::5) That is why the RFC used frequently as opposed to an absolute statement it can never be caused by mental illness. One could argue that in very rare cases, identifying as trans is caused by DID or something. But there is no evidence this is frequent.

::6) This is just a repeat of question 5. Again, this RFC is not about gender dysphoria, or gender incongruence. {{tq| Wikipedia's role here is to state what is described in reliable WP:MEDRS-compliant sources.}} - And what MEDRS say is that being trans is not a mental illness but a part of normal human diversity. Find MEDRS arguing otherwise. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:21, 20 February 2025 (UTC)

:::Your Friendly Neighborhood Sociologist - I am not arguing otherwise, so I have no interest in finding sources that argue for that position. I however, maintain that the question needs to be refined to lead to actionable consensus.

:::For the record, to those comments above by SmittenGalaxy and FactOrOpinion - I have read both considerable portions of the literature on the topic, and know the principles of RfCs, having been through a number of successful and unsuccessful RfCs. The comments I made are on the basis of this experience - and knowing that for an RfC to lead to a reasonable and actionable result, it needs to be more specific, and give more background on the definitions of precisely what is proposed, and especially the limits of the proposal. The current question continues to conflate multiple important points, some which are in principle relevant for an RfC, some which are certainly not. WP:RFCBEFORE does not endorse the construction of RfCs that require participants to take part of 10-pages of text to understand the question. Rather it suggests that discussion can give rise to the precise question that we seek to address. This is not the same, and is precisely what I am trying to do here.

:::To reiterate, we need, as part of the RfC question:

:::1) Appropriate background (concise)

:::2) Clear division of component questions (no omnibus bills or riders)

:::3) Clear definition of what problem the RfC seeks to adress

:::4) Preferably with examples of what we can see going wrong on Wikipedia today

:::5) Clear definition of the various terms that are covered, or could potentially be misconstrued to cover.

::::(Specifically for this RfC: how the RfC envisions differences between identity, disorder, incongruence - based on literature - defining what can be covered in the RfC close)

:::CFCF (talk) 16:49, 20 February 2025 (UTC)

::::{{tq|WP:RFCBEFORE does not endorse the construction of RfCs that require participants to take part of 10-pages of text to understand the question.}} Who said 10 pages? I can almost fit the above discussion in one page-length on my 16:9 monitor. It's not a hard read by any stretch of the imagination and also is pretty important to the RfC. If you really don't want to read just over a screen's length of text in a couple minutes, I still maintain that just the RfC question is quite clear already as-is. The discussion does give a pretty clear and precise question, it seems to be you who finds it confusing and continuing to belabor this point that it is overly complex and has to be refined for some reason.

::::I don't quite believe you have read medical literature on the subject, but I'll assume you have for the sake of brevity and not to go on another tangent about that point. Either way, this is the last I'm personally going to continue this drawn out and off-topic discussion in the survey section. You're welcome to move it to and/or continue below, but I don't intend to further clutter the survey section with more of this than has already been done. SmittenGalaxy | talk! 17:12, 20 February 2025 (UTC)

::::CFCF, I quoted relevant text for you from the RFCBEFORE, and you seem to be choosing to ignore it. WP:RFC does not actually require an actionable item. This is not the first time I've seen someone complain about the lack of one, and I will raise the need to clarify this on WT:RFC. In this case, my guess is that YFNS wants consensus to point to in subsequent Talk page discussions, but I don't actually know, and it's totally reasonable to ask her to clarify what the purpose of the RfC is and add that to the wording. I will follow SmittenGalaxy's lead and not respond further. FactOrOpinion (talk) 17:27, 20 February 2025 (UTC)

::Can I request all this discussion goes down in the discussion section? Including significant parts of the original !vote here, which is IMO too long for the survey section by itself. Loki (talk) 18:49, 20 February 2025 (UTC)

:::No objection to moving the discussion, but the reasoning that underlies the original vote has arguments laid out and intended for that section - and I do not agree that it could be moved. CFCF (talk) 19:51, 20 February 2025 (UTC)

::::I understand you want to lay out your whole argument, but an argument that's that long is IMO more appropriate for the discussion section. Other people with long arguments posted a short !vote in the survey section referring to people to more information in the discussion section. Loki (talk) 20:12, 20 February 2025 (UTC)

:::This is not how any RfC has worked on Wikipedia. !voters can put their full rationale in Survey, and lengthy discussions can go in Discussion. Chess (talk) (please mention me on reply) 23:25, 20 February 2025 (UTC)

::::I agree they can, if they want. In theory we don't even have to have a discussion section in an RFC at all. But we always do, because we collectively agree that it's much easier to parse the survey section if people separate !votes, which are intended to be short enough to be parsed easily by a closer, from extended threaded discussion.

::::I don't think it benefits anyone including CFCF to post over a page of text in the survey section. I was originally intending to just move the discussion down rather than asking CFCF about it, but I found while attempting to do so that CFCF's original comment is long enough by itself that moving the discussion after it down doesn't really help. But I don't want to move their entire !vote down to discussion, and I also don't want to cut it up without asking. Loki (talk) 03:52, 21 February 2025 (UTC)

::I think we can agree that 0.1% is nowhere near frequently, which implies that a significant proportion (even a plurality) is caused by mental illness. Aaron Liu (talk) 15:33, 26 February 2025 (UTC)

:::I'm having trouble parsing this. Are you missing a "not" somewhere? Loki (talk) 17:04, 26 February 2025 (UTC)

::::"Frequently" would imply a significant proportion, which stuff like 0.1% is most definitely not. Aaron Liu (talk) 17:12, 26 February 2025 (UTC)

:::::Right, and that's what I thought you meant, but it's the opposite of what you said. You said that, emphasis mine, that {{tq|implies that a significant proportion ... is caused by mental illness}}. Loki (talk) 17:15, 26 February 2025 (UTC)

::::::Well, we're talking about the question statement, which asks whether an assertion is fringe. CFCF claims that the question statement is too vague to assert fringeness when it's clear that the part in question asserts that GD is significantly caused by mental illness. I'm not claiming that this assertion is true (in fact, I think it's been demonstrated to be fringe), and I really want to know what CFCF was thinking when they claimed 0.1% could even come close to "frequently". Aaron Liu (talk) 17:24, 26 February 2025 (UTC)

:::::::Ah, okay, I got it. You meant {{tq|0.1% is nowhere near frequently, because "frequently" would imply that a significant proportion (even a plurality) is caused by mental illness}}. Loki (talk) 17:46, 26 February 2025 (UTC)

::::::::{{U|Aaron Liu}} - When we speak about population level effects, that is when 0.1% of a condition that affects millions of people - the absolute number will be large.

::::::::We know that underlying mental conditions are more common in people with various forms of gender-nonconformity, by definition implying some causal mechanism behind this. This can not be refuted unless it is all set down to sampling bias. Something underlies this - even if that something is as of yet undefined.

::::::::What that causal mechanism is has not been fully parsed, which most sources are clear on. The mere presence of oppression is not the whole story, and sources are also clear on this, it is not disputed in the literature that oppression is a big part, but nothing authoritative says it is all of it - or even quantifies it. Hence there is nothing to rely on that makes statements about frequency.

::::::::The fact is also that calculating the size of a direct causal relationship between mental disorder and various forms of gender-nonconformity is fraught with methodological issues, and a lack of long-term follow-up.

::::::::This however does not mean that discussing the presence of a causal relationship is fringe, and as has been shown above - many sources do discuss this. They are notably careful when doing so, both from a methodological viewpoint, but also an ethical one. Also, anything that we include on this relationship - that is elevated to article space - must depend on strong WP:MEDRS-sources. That however, does not mean it it fringe to discuss the topic.

::::::::A further analogy, is that in pharmaceutical side effects, 0.1% is considered "common" (by definition).

::::::::I understand that this may fly in the face of common perceptions of what is "frequent", but here we need to abide by epidemiological and medical definitions of such terms. And frankly, the term is not precisely defined, and it is therefore WP:WEASEL. CFCF (talk) 18:58, 26 February 2025 (UTC)

:::::::::That there is some sort of causal mechanism cannot be equivocated to one straight-up causing the other.{{tqb|when 0.1% of a condition that affects millions of people - the absolute number will be large.}}You're talking gross incidence. We're talking frequency, which includes a denominator even in the academic definition. Aaron Liu (talk) 19:35, 26 February 2025 (UTC)

::::::::::First, frequency does not always require an explicit denominator in academic discourse (see Frequency (statistics)). Epidemiology recognizes both absolute frequency (raw case numbers) and relative frequency (proportion per population). My point about large absolute numbers remains valid in discussions of population-level effects.

::::::::::Second, I did not claim a single, direct causal relationship. Rather, I pointed out that the observed co-occurrence of mental disorders and gender diversity suggests there must be some explanatory factor—whether biological, social, developmental, or methodological. This is not the same as asserting a singular causal mechanism, but it also does not refute one.

::::::::::You seem to agree that the causal link is an open question in the literature, which is precisely my point: discussing potential causality is not fringe. The challenge is in quantifying and defining the exact nature of this relationship, which is why MEDRS-compliant sources approach it with caution, but does not invalidate that better studies may find one, or that this cautious approach could not be described when appropriate in article space. CFCF (talk) 19:45, 26 February 2025 (UTC)

:::::::::::That definition has nothing to do with "frequently".{{pb}}Yes, "something" underlies this, but it's very fringe that mental illness majorly causes this. Everything you've said does not refute the established fringeness of "mental illness frequently causes GD". Aaron Liu (talk) 19:53, 26 February 2025 (UTC)

::::::::::::Aaron, the issue is that "frequent" does not have a singular definition in academic discourse. In some contexts, including epidemiology and statistics, "frequent in a population" can simply mean "it occurs in the population" rather than implying a high prevalence. This distinction is crucial because rejecting any discussion of causality based on a rigid interpretation of "frequent" or "frequently" is a misframing of the issue.

::::::::::::Additionally, the established literature does not say that discussing potential causal mechanisms is fringe—only that any causal link remains uncertain and methodologically difficult to study. The fact that sources exercise caution does not mean that exploring these questions is outside mainstream discourse. Conflating open scientific inquiry with fringe theories misrepresents the literature.

::::::::::::If the concern is about specific wording in article space, that is an editorial question, not a basis for dismissing the topic entirely. CFCF (talk) 20:08, 26 February 2025 (UTC)

::::::::::{{outdent|2}} [https://scholar.google.com/scholar?hl=en&as_sdt=0%2C33&q=%22frequent+in+a+population%22&btnG= Here's Google Scholar for "frequent in a population"]. The entire first page either fits the usual meaning of "frequent" as actually significant or compares the frequency to another demographic. Note that I used the word "significant" and you clearly understood what that's widely thought to meant. I believe there is consensus as to what "frequently" means.{{pb}}And, again, you are conflating "trans identities are often caused by mental illness" with "there is some sort of system that should explain the correlation between mental illness and trans identities". The former is fringe, the latter is not. In fact, the latter is a truism and is not what anyone here is arguing to Fringe-ify. Please show how the assertion that is actually the subject of the question is not fringe, or I will not engage you further on this point. Aaron Liu (talk) 23:02, 26 February 2025 (UTC)

::::::::::To clarify by using the classic example of Post hoc ergo propter hoc: Say we're debating whether to Fringe "rooster crowing frequently causes the sun to rise". Assume that we don't know what exactly causes the sun to rise. You say "well, sources establish a strong correlation between the two, so there must be a causal complex behind this. The scientific inquiry on the movements of the sun is still an open question, therefore it is not fringe that rooster crowing frequently causes the sun to rise." Obviously this analogy suffers from how we all know roosters don't lift suns, but you present no evidence of the mainstream acceptance of rooster theory. All you've done is point at specific, small populations such as DID—who are quite rare, even in the population with gender dysphoria. That certain mental conditions can frequently explain and result in gender dysphoria does not mean gender dysphoria is frequently caused by these conditions. Aaron Liu (talk) 12:46, 27 February 2025 (UTC)

:::::::::Plus, even in medicine where the chances of having any side effects is usually far from 100%, 0.1% is the border line between "rare" and "uncommon". I don't think any participants here are "frequently" swayed by any commonalities in your analogy. Aaron Liu (talk) 19:43, 26 February 2025 (UTC)

::::::::::Aaron, I think you're misinterpreting my point. The pharmaceutical analogy was not meant as a direct comparison to gender diversity and autism but rather to illustrate how frequency is defined differently in different fields. In pharmacovigilance, for example, 0.1% can be categorized as "common" (although the cutoff is often more like 1%), showing that what qualifies as "frequent" depends on the professional framework used.

::::::::::More importantly, the core discussion here is not about an arbitrary frequency threshold but about whether discussing potential causality in terms of the undefined term "frequent" is inherently fringe. The elevated co-occurrence of autism and gender diversity is a well-documented empirical fact, and sources acknowledge that some explanatory mechanism must exist. What that mechanism is, and how it should be framed in article space, are separate questions—but dismissing any discussion of causality outright mischaracterizes the scientific literature. CFCF (talk) 19:50, 26 February 2025 (UTC)

:::::::::::There's no such definition or confusion that relates to the topic at hand.{{pb}}We're not dismissing discussion of causality, we're dismissing a specific fringe theory of this causality's nature. Aaron Liu (talk) 19:56, 26 February 2025 (UTC)

Yes per YFNS, and the fact that we even need to do this in this day and age is remarkably bleak. Snokalok (talk) 01:01, 22 February 2025 (UTC)
Comment This seems ready for a WP:SNOWCLOSE tbh Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 04:38, 23 February 2025 (UTC)
Yes for both claims -- 1) that identities are a mental illness and 2) an active implication that mental illness is a "frequent" cause; it's very different to say that mental illness can possibly be related in some cases (not necessarily fringe, but requires a lot of clarifiers) and to say that there's some sort of frequent/predictable causal connection (fringe).~Malvoliox (talk | contribs) 17:02, 23 February 2025 (UTC)
Yes - The DSM-V, which is the most authoritative source on mental illness, says that such views are discredited, not to mention the hundreds of other academic sources and professional medical societies which say the same thing. Nosferattus (talk) 19:14, 23 February 2025 (UTC)
:The direct quote is "gender non-conformity is not in itself a mental disorder", but note that this is not the full question you are voting on. CFCF (talk) 19:02, 26 February 2025 (UTC)
Yes: The question is clear, and the evidence presented is convincing. Aaron Liu (talk) 19:57, 26 February 2025 (UTC)
:For what? That the DSM-V, which is used to support to proposition - intentionally doesn't use the term "mental illness" - that "frequently" is undefined - or just what we all agree upon - that gender identities are not mental illness? CFCF (talk) 20:20, 26 February 2025 (UTC)
::For every part of the question. Far more evidence has been presented than just the DSM-V, including several general professional and academic associations. On the semantics of "frequently", please see my above replies. Aaron Liu (talk) 23:03, 26 February 2025 (UTC)
:FactOrOpinion has a compelling argument below that reliable sources don't usually use "frequently" either. Which is why, as I've stated below, {{tq|that the question was improperly worded doesn't mean we can't find consensus for other wordings. I think we can agree that "gender incongruence is caused by mental illness/disorders" is fringe and different from "can be caused by".}} I also believe everyone here (except Zach) can agree it fringe to consider transgender identities in themselves a mental illness. Aaron Liu (talk) 14:06, 28 March 2025 (UTC)
Yes: After much discussion I haven't seen a single medrs that suggests that gender dysphoria is (frequently) caused by another mental disorder and there's multiple medorg statements saying it isn't. — Preceding unsigned comment added by LunaHasArrived (talk • contribs) 20:09, 26 February 2025 (UTC)
Yes: I would like to reiterate that this opinion is by no means WP:WEIRD. I think a good number of people could learn a lot from the remarkably comprehensive [https://www.spotlightnsp.co.za/wp-content/uploads/2024/06/sahcs-gahc-guidelines-expanded-version_oct-20213.pdf South African guidelines] on the subject. InformationToKnowledge (talk) 18:27, 27 February 2025 (UTC)
:You probably meant to link to the WEIRD bias, which only has an article in mainspace, not projectspace. LightNightLights (talk • contribs) 01:42, 28 February 2025 (UTC)
Yes: I would like to add that the DSM-5-TR's differential diagnosis section in the gender dysphoria chapter lists nearly all of the illnesses that editors in the discussion section have stated may be pathological causes of transgender identity. Gender-related delusions in schizophrenia, autistic gender weirdness, and BDD towards the johnson are distinct from transgender identity, not causative of it. --Flounder fillet (talk) 17:02, 3 March 2025 (UTC)
Support, the view that trans identity is mental illness is fringe The wording and purpose of this RfC is clear. The evidence is there. The mainstream view is that trans identities have no overlap with mental disorder, except to the extent that trans people are persecuted. Other oppressed minority groups similarly experience trauma from societal attacks by hatemongers. Scientific, research, and scholarly evidence aligns with this. The social circumstance of this discussion is inseparable from transgender persecution from hate groups that fake civil debate and discourse, when the intent is only oppression of minorities. Whenever this issue comes up, anyone should be able to point to this discussion to establish the position of Wikipedia's editorial discourse, and its connection to research. Bluerasberry (talk) 00:29, 5 March 2025 (UTC)
Support - I think it's pretty clear and well established that saying trans identity is a mental illness is fringe. The medical community has been moving this way for a while. PackMecEng (talk) 12:07, 5 March 2025 (UTC)
Strong support Every discussion like this is at least 25% transphobes. But just because they're loud doesn't mean they should decide how sources are treated. A policy like this is deeply needed, especially in light of Wikipedia's approval of the Daily Mail on trans topics -- the reason that didn't get rejected is largely because of arguments that whether trans people exist is a matter of opinion. "Frequently" is needed because yes, if a hate group claims "only 99%" of trans people are mentally ill -- it's the same thing. Mrfoogles (talk) 06:18, 25 March 2025 (UTC)
No — I fully agree with @CFCF's reasoning for moving to procedurally close this RfC. The question posed attempts to combine a vast variety of points and questions into one sentence in a way that seems more ideological than logical. Further, I find it very disingenuous that some individuals above are attempting to compare the historical mental illness classification of homosexuality to the classification of Gender Dysphoria as a mental illness. The latter is much more relevant to mental illness as it involves a deep conflict between one's biological sex and one's perceived gender identity, often resulting in a diagnosis and surgical/hormonal/medical steps and procedures to transition. To label the mental illness recognition of transgender identity and Gender Dysphoria as a "fringe idea" does not make any sense. DocZach (talk) 18:41, 27 March 2025 (UTC)
:1) RS have, for ages, noted the fact that transsexuality used to be considered a mental disorder, like homosexuality was, and explicitly compare the two[https://pmc.ncbi.nlm.nih.gov/articles/PMC11272317/][https://www.tandfonline.com/doi/abs/10.3109/09540261.2015.1053847]. Gender dysphoria is not synonymous with identifying as trans, and was in fact created as a diagnosis explicitly so as not to diagnose transsexuality. It is disingenous to ignore that RS consider them incredibly comparable.
:2) What does {{tq|To label the mental illness recognition of transgender identity}} even mean?
:3) Nobody in this entire RFC has provided a single MEDRS that claims trans identity is frequently caused by mental illness. Conversely, we have dozens saying trans identities are a natural human variation and not a mental illness. CFCF's position that one day a MEDRS might say it is pure speculation to get around the fact MEDRS don't say it (see WP:RGW, WP:CRYSTALBALL, and WP:FRINGE: {{tq|We use the term fringe theory in a very broad sense to describe an idea that departs significantly from the prevailing views or mainstream views in its particular field. For example, fringe theories in science depart significantly from mainstream science and have little or no scientific support}}. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:50, 27 March 2025 (UTC)
::I think it should be noted in this context, that there were many mainstream WP:MEDRS-sources discussing the potential of causal pathways, and potential for significant causal pathways between autism (and other mental disorders) and transgender identities.
::What should additionally be noted is that if there are no sources that suggest this - that would imply you are suggesting to classify a non-existant theory as WP:FRINGE, which is precisely what is described in WP:CRYSTALBALL and WP:RGW. The admission that the causal pathway is a subject of current scientific enquiry is the opposite of WP:CRYSTALBALL. For the context of Wikipedia, a theory can't be fringe if it isn't even made in sources that could be cited on Wikipedia. It's just either plain false or unverified. CFCF (talk) 09:14, 28 March 2025 (UTC)
:::That a theory "exists" or has been "discussed" is not the same as it not being fringe. The argument that if an idea gets some kind of platform or attention, even if it is to be dismissed or found unsupported, that it is thereby mainstream and respectable, is a tactic with a poor pedigree. I would like to hope wikipedia editors don't go down that sort of route. OsFish (talk) 10:02, 28 March 2025 (UTC)
::::There is absolutely nothing to indicate that the exploration of causal pathways between autism and gender identity is fringe. There are a multitude of systematic reviews on the topic, including the many high quality WP:MEDRS sources that have been discussed below. They do posit that the evidence is not in on the size and frequency of the link - but the existence and exploration of the link, is decidedly not fringe. Your analogy is false. The problem is in large part here that we are trying to label something as fringe, that just isn't even being described in the relevant literature. All the sources say that we can not tell yet as the studies are being conducted. This is more than enough to handle the issue on Wikipedia - and there hasn't even been a single example of a conduct issue on Wikipedia relating to this. We can't preemptively label something fringe, when all the literature is clear that the size of the causal relationship is as of yet unknown. CFCF (talk) 07:23, 29 March 2025 (UTC)
:You say
:{{quote|The latter is much more relevant to mental illness as it involves a deep conflict between one's biological sex and one's perceived gender identity, often resulting in a diagnosis and surgical/hormonal/medical steps and procedures to transition. To label the mental illness recognition of transgender identity and Gender Dysphoria as a "fringe idea" does not make any sense.}}
:Wikipedia is not a place for WP:Original research. Reliable medical sources are clear that being transgender is not considered a mental illness. That is absolutely where the conversation should end for Wikipedians on this question. That it doesn't for some people is why the RFC is needed.OsFish (talk) 07:09, 28 March 2025 (UTC)
:You are the first person here to claim it's not fringe to consider transgender identity a mental illness. Aaron Liu (talk) 14:00, 28 March 2025 (UTC)

== Discussion (trans pathologization) ==

I would like to note here that I don't like the phrasing of the question, because the questions "Is X WP:FRINGE within the bounds of mainstream medicine?" and "Is X within the bounds of mainstream medicine?" mean exactly opposite things despite being only one word different. (I also don't think there's such a thing as "WP:FRINGE ... within the bounds of human rights". "Human rights" isn't an academic discipline and so there is no such thing as a fringe theory relative to human rights.) Loki (talk) 02:25, 17 February 2025 (UTC)

::I disagree {{U|LokiTheLiar|Loki}} - human rights are most certainly an academic discipline, or at least human rights studies is, with some arguing the entire field is amenable to academic study [https://www.hurights.or.jp/archives/pdf/asia-s-ed/v10/13HR%20as%20an%20Academic%20Discipline,%20Challenges%20and%20Opportunities.pdf Human Rights as an Academic Discipline: Challenges and Opportunities - Buddhadeb Chaudhuri]. Furthermore, there is a generally agreed upon definition - I think it's called the UN's 1948 Universal Declaration of Human Rights. At least I know that document to be frequently cited in policy documents that cover transgender rights as integral to the "rights-based rationale" (such as the [https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30293-9.pdf Lancet-Guttmacher definition of "Sexual and Reproductive Health and Rights for All"]) CFCF (talk) 12:54, 20 February 2025 (UTC)

:I'm more concerned about what comes after the RFC. We vote that this idea is FRINGE for "frequently", but I won't be surprised if it gets used for "never" in practice.
:The OP mentions homosexuality. Remember Chris Birch (stroke survivor)? He was apparently a straight/cisgendered man who had a stroke, survived it, and has been gay since then, complete with switching to a stereotypical career as a hairdresser. Another stroke survivor (whose name I've never seen reported) went the opposite direction: he was gay, had a stroke, and now he's straight.
:Back in the day, we asked: Is a same-sex sexual orientation a mental illness? We now say, "No, we don't think that phenomenon fits that category". But note that this is about words and their meanings, which are determined through the same social construction discourse that defines every word. Deciding what a word means is not science.
:Decades ago, we decide that word A ("illness") is not going to include phenomenon B ("non-heterosexual sexual orientation"). But then we have the men whose sexual orientation changed after a stroke. Their changes in sexual orientation were actually pathological. The end result is that being gay is not normally classified as pathological, but that doesn't mean that it's impossible for it to be caused by a pathological process. {{pmid|23485898}} mentions in passing a trans woman who survived a thalamic stroke and woke up as a cis man.
:We might need two questions:
:* Does society/relevant experts usually consider it appropriate to classify being transgender as a type of mental illness?
:* Are we confident that people never become trans, or even claim to become trans, as a result of a mental or physical condition?
:WhatamIdoing (talk) 07:16, 17 February 2025 (UTC)
:: Is there a confusion here between rarely occurring events and fringe views? Fringe has to do with infrequent opinion, not infrequent occurrence of some malady. Hardly anybody dies from chicken pox (low incidence; ~ 1/100k) but medical opinion about it is that is is very rarely fatal, and therefore that opinion is mainstream and not fringe. If there are sufficient recorded cases of change of sexual orientation or gender identity following a stroke such that medical opinion is aware that it exists and that it is rare, then that opinion is the mainstream medical view about it. That it has extremely low incidence does not make it fringe. Mathglot (talk) 07:46, 17 February 2025 (UTC)
:::I think there is a lot of nuance and complexity in the world, and that RFCs like this get used like sledgehammers to suppress questions and discussion. WhatamIdoing (talk) 16:47, 17 February 2025 (UTC)
::::"Whatcif all the trans people are just crazy," is not a productive question and asking editors to constantly entertain such pointless questions is simply wasting people's time and energy. Kind of like the constant efforts to treat SEGM as reliable for trans topics is a waste of time and energy.Simonm223 (talk) 17:25, 17 February 2025 (UTC)
:::::IMO any question involving the word "crazy" has a low likelihood of resulting in a productive discussion.
:::::However, there are some related questions that could be asked, such as "Do these atypical variations in neurological structure predispose people to being trans?" and "According to the usual Quality of life scales, is being trans actually as desirable as being cis?" and even "Should a would-be mother be allowed to choose an abortion if prenatal testing shows an increased likelihood that the child would be trans?" All of these questions pathologize being trans to varying degrees. WhatamIdoing (talk) 17:41, 17 February 2025 (UTC)
::::::I don't think we should be entertaining eugenic speculation like your last point. Frankly I am appalled anyone would think Wikipedia should entertain such speculation. I suggest you strike. Simonm223 (talk) 17:50, 17 February 2025 (UTC)
:::::::Would you like the citation to the peer-reviewed scholarly paper that explored that specific question? I didn't make up any of these things, and, yes, it came to the expected appalling conclusion. WhatamIdoing (talk) 19:03, 17 February 2025 (UTC)
::::::::Was it from the fringe Journal of Controversial Ideas? Because that rag loves eugenics. Simonm223 (talk) 19:59, 17 February 2025 (UTC)
:::::::::No, it wasn't in that journal (that journal's only been around for a few years), though the paper basically said politically inconvenient things out loud, which I suppose is one typical understanding of "controversial". The paper named the obvious logical consequence of supporting abortion "for any reason", which is that "any reason" includes reasons that you find reprehensible, such as not wanting to have a child that is female/gay/trans/disabled/autistic/fill-in-the-blank-here. WhatamIdoing (talk) 19:12, 21 February 2025 (UTC)
::::::{{tq|Do these atypical variations in neurological structure predispose people to being trans?}} - A better question would {{tq|Are there biological underpinnings to gender identity (not gender roles)}} to which the answer would be yes (for cis and trans people).[https://www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/position_statement_transgender_health_pes.pdf] This doesn't pathologize being trans.
::::::{{tq|According to the usual Quality of life scales, is being trans actually as desirable as being cis?}} - Is an awful question to ask. How does one define desirability in the case of intrinsic identities? If the question is {{tq|According to the usual Quality of life scales, 1) is being trans generally predictive of lower QOL scores than being cis and 2) if so why?}} to which the answer in MEDRS is pretty overwhelmingly 1) yes and 2) social oppression. The question (when asked in the second format as opposed to first) is not pathologizing
::::::{{tq|Should a would-be mother be allowed to choose an abortion if prenatal testing shows an increased likelihood that the child would be trans?}} - That would be, as Simon pointed out, eugenics. That one is pretty straightforwardly pathologizing.
::::::{{tq|However, there are some related questions that could be asked}} by who and to what end? Are these recurring debates on Wikipedia? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:39, 17 February 2025 (UTC)
:::::::IMO these kinds of questions should be asked on wiki if and only to the extent that they are accompanied by sources that one intends to cite in Wikipedia articles. WhatamIdoing (talk) 19:08, 17 February 2025 (UTC)
::::::::For the record, I can't really say that the answers are as clear cut as you make them out to be {{U|Your Friendly Neighborhood Sociologist}}
::::::::There is not sufficient evidence to state that social oppression explains all predictive value of transgender identity in lower QoL scores.
::::::::Stating that aborting a child with increased likelyhood of transgenderism is pathologizing is incorrect. It may be abhorrent, much like aborting girls is - but it is not pathologizing per se.
::::::::Then again, these are likely questions for the dedicated talk-pages and not for here. CFCF (talk) 14:04, 20 February 2025 (UTC)
:::::::::Respectfully, as you have said it twice now, I wish to bring to your attention that 'transgenderism' is not merely the medical term for being transgender. It is a politically charged term which asserts trans identities are not real and are just a product of ideology. [https://glaad.org/term-to-avoid-transgenderism/] [https://glaad.org/transgenderism-definition-meaning-anti-lgbt-online-hate/] [https://dictionary.cambridge.org/us/dictionary/english/transgenderism] International Journal of Transgender Health (who publishes the SOC on behalf of WPATH) formerly went by it, but have since changed its name due to the connotations the word has taken on. [https://www.tandfonline.com/journals/wijt20] Relm (talk) 15:57, 20 February 2025 (UTC)
::::::::::Noted. It might also be noted that this is a policy from GLAAD published on January 10th, and that the term has publications on PubMed from 2025 in a non-derogatory manner, and that the last link you give still uses the old term on the very page of the journal. I am not convinced it is a majority view that the term is derogatory, but will refrain from the term to the best of my abilities out of respect. CFCF (talk) 18:43, 20 February 2025 (UTC)
::Note that the RfC says "frequently caused by" or "in themselves" mental illnesses. These events are not frequent, nor is trans identity "in itself" pathological. That it might be arguably pathological in some circumstances doesn't contradict that.
::I'm also not sure these cases count as "mental illness" anyway, since they are not classically defined psychological or psychiatric conditions, nor are they necessarily "illnesses".
::When people say "mental illness", they usually mean bipolar, depression, schizophrenia, etc. They may, in casual usage, also extend this to cover neurodevelopmental and other neurological conditions, but there's a lot of debate there and many people will disagree with that definition.
::Socially acceptable distress or psychological variation is also generally not considered pathology (e.g., grief after bereavement). This would also cover gender and sexuality. Lewisguile (talk) 11:44, 17 February 2025 (UTC)
:::You will apparently be surprised to discover that grief was pathologized a few years ago in both the ICD-11 and the DSM-5-TR. If you don't get over a serious loss fast enough to suit the clinicians, then you have Prolonged Grief Disorder (ICD-11 code [https://icd.who.int/browse/2025-01/mms/en#1183832314 6B42]). The ICD gives you a minimum of six months, and the DSM a minimum of a year. Queen Victoria, who wore mourning clothes in honor of her late husband for the rest of her life (she lived about 40 years after his death), would not have been amused.
:::More importantly, the decision about whether "Phenomenon A" (whatever that phenomenon is) counts as "psychological variation" is a socially constructed dictionary definition. It is, to use your words, a question of what people mean 'When people say "mental illness"', rather than a universal fact. The Hmong people have decided that a Generalized tonic–clonic seizure is evidence of a "psychological variation" and that the person is spiritually gifted. Western people used to believe that epilepsy was evidence of demon possession, and they now believe that it is a sign of being dangerously sick. Both sides believe their culture's current belief is the correct one. I suggest to you that some seizures appear to provide what we call spiritual experiences (because anything that can be perceived by the brain under other circumstances can be perceived by the brain during a seizure, including smells, sounds, emotions, etc., so if humans are capable of perceiving feelings of oneness with the universe, or bright lights, or anything else that we would take as a marker of a spiritual experience, then they can perceive those things during a seizure) and that the Hmong view is therefore not 100% wrong.
:::This RFC asks for a general statement. However, I expect it to be stretched, and by more editors than just the OP, beyond the question asked and into an absolute declaration that The Community™ has declared this to be the only acceptable POV. I expect this to happen for two reasons:
:::# Because that's the SOP on wiki: We put this statement at the top of every policy: "This page documents an English Wikipedia policy. It describes a widely accepted standard that editors should normally follow, though exceptions may apply" but we treat it as saying "This page documents an English Wikipedia policy. It describes a widely accepted standard that editors must always follow, without exception." It would be astonishing if this RFC managed to escape from our normal behavior.
:::# Because the proponents are tired and stressed: This and the related RFC above are not happening because of curiosity about what editors think. Instead, it is happening because the OP and other proponents are struggling through an extremely difficult real-world political situation, so they are quite rationally trying to acquire tools that will help them keep Wikipedia's trans-related content approximately where it's been for the last decade, despite the ongoing efforts of newer (and newly emboldened) editors who believe that other POVs should be prioritized.
:::WhatamIdoing (talk) 17:30, 17 February 2025 (UTC)
::::I have a similar concern and observation. This is a hotly debated and actively evolving field of medicine. There is a risk that as the field continues to advance via EBM, Wikipedia may not be able to reflect the current state of medical evidence or the positions of major health authorities if editors are trying to freeze it in time through a flurry of RfCs that attempt to take one side of an active international debate and make a community declaration that it is fringe. This is not consistent with what Wikipedia aims to be for the public. Evathedutch (talk) 20:20, 18 February 2025 (UTC)
:::Excellent points. CFCF (talk) 13:03, 20 February 2025 (UTC)
: A bit o/t, but since you raised it: Human rights is a field which attracts [https://scholar.google.com/scholar?start=0&q=Human+rights&num=20 voluminous academic study] and hundreds of college courses (e.g., [https://www.humanrightscolumbia.org/education/undergraduate/undergraduate-courses thirteen at Columbia], [https://chrhs.watson.brown.edu/education/courses thirty at Brown], and even [https://dashboard.wikiedu.org/explore?search=Human+rights a dozen] from Wikipedia Education). Theories about human rights that are far out of the mainstream of academic thinking would be fringe theories about human rights by definition. There seem to be several; "sovereignty absolutism" seems to be one of them. {{ec}} Mathglot (talk) 07:30, 17 February 2025 (UTC)
::Y'know what, I concede the point. Loki (talk) 16:47, 18 February 2025 (UTC)
:::Sorry, didn't see this before making my point above. CFCF (talk) 13:30, 20 February 2025 (UTC)
:{{tq|"Human rights" isn't an academic discipline and so there is no such thing as a fringe theory relative to human rights.)}} - belatedly, I disagree with this assertion. Sociology, pol sci, and history are all academic disciplines and questions like these sometimes do have clear-cut answers there - there's clearly some takes on human rights that would be WP:FRINGEy. For example, arguing that democracy and human rights are incompatible would clearly be a fringe perspective. Or, to use a common example that has come up a lot in actual editing, the view that fascism is not a right-wing movement is firmly WP:FRINGE, as is eg. the Lost Cause of the Confederacy today. People sometimes treat WP:FRINGE as only applying to STEM fields and medicine, and that's really not true. (That said, things can be fringe in specific contexts and not in others, in the way that faith healing is clearly fringe when it comes to the question of its medical efficiency but can still be mainstream as a religious belief.) EDIT: I see other people have already raised this point and it has been hashed out, but I'll leave this here anyway. --Aquillion (talk) 00:26, 21 February 2025 (UTC)
Are we just going to work through every single contentious issue in the field of transgender topics and ask editors to declare it WP:FRINGE? Is that how Wikipedia works today. FRINGE or not-FRINGE. -- Colin°^Talk 19:01, 17 February 2025 (UTC)
:I don't know about the first question, but the answer to your second is pretty close to "yes". WhatamIdoing (talk) 19:10, 17 February 2025 (UTC)
:This reads as a pretty disingenuous characterization of the RfC and above RFCBEFORE discussion. It's a very valid discussion to have on whether or not something that is considered to be non-conforming to the majority in medical literature is fringe. After all, that's what it means both as the word "fringe" and what WP:FRINGE says. I also don't know what other discussions have to do with whether this one is valid or not, or even if it is an endemic problem like you insinuate. You're welcome to link to discussions if this is the case. But even so it wouldn't have bearing on this discussion anyway, because it's a valid RfC that already had prior discussion that in my opinion also validates it. SmittenGalaxy | talk! 19:10, 17 February 2025 (UTC)
:::I don't think anyone is stating that this discussion isn't valid. Rather that - to lead to actionable results that are coherent with WP:PILLARS - it needs to be more specific and clear. CFCF (talk) 13:32, 20 February 2025 (UTC)
::Here are four discussions, in consecutive order, on this noticeboard:
::* Society for Evidence-Based Gender Medicine
::* Puberty blockers in children
::* Is WPATH the gold standard for research on trans healthcare in academia?
::* Pathologization of trans identities
::Humans are pattern-matching creatures. It is not unreasonable, after four discussions in a row, to wonder if there will be a fifth. WhatamIdoing (talk) 19:36, 17 February 2025 (UTC)
:::I still have a hard time grasping why this is a negative to the RfC and reason to go against it. Just feels like a WP:IDONTLIKEIT argument. If something is a fringe medical view it shouldn't be used. SmittenGalaxy | talk! 19:44, 17 February 2025 (UTC)
::::Your inference that wondering how many more of these attempts to nail down The Truth™ are likely to be forthcoming "is a negative to the RfC and reason to go against it" may be unwarranted. WhatamIdoing (talk) 20:00, 17 February 2025 (UTC)
:::::We're starting to wander away from the merits of the RfC and actual discussion here. I feel this is starting to go more towards some kind of personal opinion on the subject matter and is bleeding together with actual policy and evidence-based points in discussion. Along with using {{tq|The Truth™}}, I don't really think you're making good faith arguments here. If you have any actual points or criticism to make of the RfC question, you're welcome to do so, but please refrain from the "just asking questions" type of 'skepticism' and doubt that plagues other medical and scientific fields, like vaccination and climate change.
:::::There is definitive medical literature on the subject, and while under normal circumstances it's better to err on the side of caution that you're not acting in bad faith, your previous replies in both this discussion as well as the above ones — and your reply to me here — make it clear to me you're not acting and making arguments in good faith. Personal views on the topic aren't relevant to the discussion. SmittenGalaxy | talk! 20:17, 17 February 2025 (UTC)
::::::Because of course it depends what you mean by "pathologising trans identities".
::::::If you mean "calling all trans people mentally ill" then sure.
::::::If you mean suggesting it is a FRINGE position that some children and adolescents express a desire to be the opposite sex as a maladaptive coping response to factors like trauma, abuse, homophobia (internal or external), bullying or other mental health issues, and that they would benefit from a supportive non-judgemental therapeutic environment, then no, it is not. Not even close. You might not like it or agree with it, but that's not what makes something FRINGE. [https://cass.independent-review.uk/home/publications/interim-report/ The interim Cass Review has a really good diagram explaining this on page 57]. That is not FRINGE, unless the intent is to declare the Cass Review FRINGE.
::::::I think we're going through all the standard topics that have been at issue over the last year or so across multiple talk pages where FRINGE has been bandied about regularly, to whit:
::::::* Is psychotherapeutic exploration of gender identity "conversion therapy", because it even entertains the possibility that a trans identity might stem from some pathological root, such as abuse or trauma?
::::::* Would a majority of children "desist" in such conditions, and grow up to be gay, lesbian or bisexual adults in all probability?
::::::* Is social contagion a valid hypothesis for at least some of the large unexplained rise in female adolescent presentation of clinical gender dysphoria?
::::::* Is the evidence supporting the use of puberty blockers in children weak?
::::::* What are the rates of regret and detransition?
::::::There are multiple sides on all of the above in the medical literature, with some dubious research across the board, and NPOV demands we present the best quality evidence fairly.
::::::RFCs like this, phrased and framed as they are, will inevitably have the effect of excluding high quality sources that say the "wrong" things. Youth gender medicine is one of the most contentious and divisive topics around, and selectively presenting a few sources to declare one "side" a "winner" is a misuse of FRINGE. Void if removed (talk) 10:48, 18 February 2025 (UTC)
:::::::Everything else aside, I find it funny to use "Cass review" and "high quality sources" in the same statement. I don't really know what other "high quality sources" would come close to supporting any of the assertions made in this discussion, because the Cass review itself is quite novel.
:::::::But other than that, I don't really think the "multiple sides" view is very valid, because the majority of literature is in support of one of these "sides". Because the definition of WP:FRINGE is {{tq|an idea that departs significantly from the prevailing views or mainstream views in its particular field}}, then I would say it's apt to describe anything outside of this point of view as fringe. Claiming NPOV I feel is a misunderstanding. NPOV is {{tq|fairly, proportionately, and, as far as possible, without editorial bias, all the significant views that have been published by reliable sources on a topic}}. For one, you have proportionality; we're not giving equal weight and article prose to fringe views. NPOV isn't "everyone gets the same treatment no matter what". You'll notice we don't publish a lot of content promoting views that are considered fringe for climate change and vaccines. Then you have the problem of "published by reliable sources" because much that does not agree with the mainstream medical literature isn't published in reliable outlets by reliable individuals. We can still mention it, but it would be undue to give it the same weight as the majority of literature.
:::::::I again, like with WhatamIdoing, take issue with the use of phrasing like "sources that say the 'wrong' things" and "selectively presenting a few sources to declare one "side" a 'winner'", making the discussion into some kind of game or sport where there's sides based on personal view and preference rather than anything evidence based. You're free to make evidence-based claims and statements, but I'd reconsider that kind of wording/phrasing.
:::::::I'm also not going to entertain the questions phrased because there's no need to dredge up off-topic discussion here, and frankly those questions can be answered rather than having to leave it open to more discussion by reading the literature yourself. This is not the first time those questions have been asked and there is much study already available on them that will answer them. SmittenGalaxy | talk! 12:07, 18 February 2025 (UTC)
::::::::{{tq | I find it funny to use "Cass review" and "high quality sources" in the same statement.}}
::::::::This is revealing of an insurmountable POV issue I think, and just leads back to the obvious conclusion about the intent and direction of all these RFCs. Void if removed (talk) 13:00, 18 February 2025 (UTC)
:::::::::No. It's not. It's revealing a healthy attitude toward a WP:PROFRINGE source. Simonm223 (talk) 13:19, 18 February 2025 (UTC)
::::::::::Assuming you have a personal belief that it's a pro-fringe source. WhatamIdoing (talk) 21:24, 21 February 2025 (UTC)
:::::::::I concur with User:Simonm223. I can just as easily call referencing the Cass review (and only referencing it) as just an "insurmountable" of a POV issue, given all the discussion both on and off-wiki about its validity and reliability.
:::::::::add. {{tq|leads back to the obvious conclusion about the intent and direction of all these RFCs}} is another POV issue that I won't get into again at risk of repeating myself, but if you believe there is some kind of underlying agenda or whatnot, you're welcome to bring up that opinion elsewhere than this RfC. SmittenGalaxy | talk! 23:39, 18 February 2025 (UTC)
::::::::::Just in case you weren't aware, there's no rule that Wikipedia:Requests for comment can't talk about the bigger picture. Sometimes the "meta" discussion in an RFC turns out to be the important one. WhatamIdoing (talk) 21:26, 21 February 2025 (UTC)
:::::::::::I am aware there is no rule. Just because there isn't an explicit bright-line rule, though, doesn't mean you should do it just because you can. Nothing insofar that I have observed has made this discussion relevant to and on-topic enough for the RfC to justify continuing it, nor can I foresee anything useful coming from it. SmittenGalaxy | talk! 00:37, 22 February 2025 (UTC)
:::::::The diagram on page 57 of the non-peer reviewed Cass interim report is not a summary of research. It does not appear to be based in any assessment of evidence at all. Several of the items such as “settled sexuality”, “longstanding settled gender incongruence” and “gender fluidity” are mentioned only once in the entire report: in that diagram. That is to say, it’s simply not evidence for any kind of evidence-based expert position. It’s really rather odd and doesn’t help the case of those wanting to assert that Cass represents the best quality assessment of the research on offer. OsFish (talk) 14:52, 18 February 2025 (UTC)
:::::::I agree that this is a dangerous misuse of FRINGE to try to knock out / lock out one side of a very active international scientific debate. The research, SRs, and health policy debates will certainly continue in the field of youth gender medicine regardless of what Wikipedia says, but Wikipedia will not be able to reflect the state of medical debate by locking in an illusion that there is no debate. Evathedutch (talk) 20:33, 18 February 2025 (UTC)
::::::::So what RS agree with {{tq|the view that transgender identities are, in themselves, a mental illness or otherwise frequently caused by mental illness}}? If this is a {{tq|very active international scientific debate}}, surely you can find MEDRS supporting that view Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:36, 18 February 2025 (UTC)
:::::::::E.g. this [https://pubmed.ncbi.nlm.nih.gov/39623924/ paper acknowledges the debate] Evathedutch (talk) 15:46, 19 February 2025 (UTC)
:::::This may have been a useful point 10 days ago, at which point 4 discussions had been made within 5 days. However as of today, no new topic has been opened in this subject area, so to answer your question of "how many more?" The answer is (at least for the nearby future) it looks to be none. LunaHasArrived (talk) 08:45, 18 February 2025 (UTC)
:::Oh I can guess the fifth.
:::*Conversion therapy
:::Or did we have that one already?
:::The common thread in all these steps is the Cass Review. There are sources claiming each of the things we've declared to be FRINGE with the Cass Review. Well done.-- Colin°^Talk 22:10, 17 February 2025 (UTC)
::::As previously stated, please keep comments in this section for discussing the actual RfC itself and not off-topic tangents unrelated to it. SmittenGalaxy | talk! 22:17, 17 February 2025 (UTC)
::::WP:AAGF is wearing a little thin here. –RoxySaunders 🏳️‍⚧️ (talk • stalk) 03:34, 18 February 2025 (UTC)
I mean, the core issue is that these debates have happened over, and over, and over, and over on individual talk pages. Centralizing them here might result in a lot of ink spilled all at once, and many of them may fail to reach consensus, but hammering out at least the basic lines of agreement are will ultimately reduce duplicative discussions on talk pages and hopefully reduce the temperature in the topic area a bit in the long term, even if it results in several sprawling discussions right now. Several of the discussions above do look like they're likely to reach a coherent consensus on long-running issues in the topic area that will hopefully improve things going forwards; constantly arguing about eg. the Cass Review or SEGM or WPATH or the basic outlines of which perspectives on trans issues are mainstream, alternative, or fringe every single time any trans topic comes up in every article is a waste of editors' time and energy, so it's worth checking to see if there's a broad consensus on these things. Again, my experience on Race and Intelligence is that it was constantly plagued by circular discussions about the same few things until an RFC similar to these finally resolved it successfully; it may be that consensus here is harder to find but it's worth at least trying to see what we can find. --Aquillion (talk) 00:33, 21 February 2025 (UTC)
:I really appreciate this comment, because it makes me wonder: What's different about gender care and R&I? I think the answer is "settled science". We perpetrated bad science about race and intelligence, and we believed stupid things as a result; we eventually got better information, and now we are adjusting our beliefs to be less stupid. A decade or three from now, we'll hopefully know even more and believe even less stupid things.
:But gender care still seems to be in the early developmental phases. It's operating off of a mix of non-scientific human values (e.g., every person's relationship to their own gender should be equally valued by others; your subjective gender identity should be much more important to other people than your body) and weak scientific evidence (e.g., this drug has this effect in population A, so maybe probably it's sorta kinda not horrible in population B). A decade or three from now, maybe we'll have even better scientific evidence, and maybe we'll have come to some social agreements about the non-scientific parts. WhatamIdoing (talk) 21:59, 21 February 2025 (UTC)
::{{Tq|But gender care still seems to be in the early developmental phases}} - It started in the 1920s. There are reports of people in Europe being institutionalized for wanting to transition for a century before. The journey to modern trans healthcare has been a ~200 year journey from conversion therapy, to gatekeeping transition, to finally respecting trans people as not inherently mentally ill.
::{{tq| It's operating off of a mix of non-scientific human values (e.g., every person's relationship to their own gender should be equally valued by others; your subjective gender identity should be much more important to other people than your body)}} It's operating on the medico-ethical scientifically based values "being cisgender is not inherently better than being transgender" and "being trans is not a mental illness" after centuries of the alternatives causing harm and being shown not to work
::{{tq|and weak scientific evidence (e.g., this drug has this effect in population A, so maybe probably it's sorta kinda not horrible in population B).}} - hard evidence over 2 centuries that "trying to make trans peoples gender match their sex doesn't work and hurts them", and about a century of scientific/sociological evidence that "when you help trans people's body match their gender they're much happier"
::There seems to be this tendency among some trying to present the science as unsettled by leaving out the question "what should the alternative treatment for trans people who want medical transition be if not medical transition?" Is it settled science that "trying to match trans people's gender to their sex is ineffective and dangerous"? Obviously - we have centuries of evidence that doesn't work. Is it settled science that "transgender people exist, are not mentally ill, and are distressed by the mismatch between their gender and sex"? Again, obviously yes. Is it settled science that "the best approach the medical community has ever found is to help trans peoples sex match their gender via hormonal and possibly surgical treatments"? Yes. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:21, 22 February 2025 (UTC)
:::* Gender care medicine is about 100 years old. Race and intelligence is probably as old as the concept of general intelligence (approximately the Renaissance in Western traditions), so if we expect a similar rate of progress, then it'll be a couple more centuries.
:::* There's not really any such thing as {{xt|scientifically based values}}. There are human values informed by facts (and those facts may have been determined through a scientific process). There are also human values dressed up in scientific-sounding language, because it sounds more impressive. But values are not science.
:::* There is an important gap between "trying to make trans peoples gender match their sex doesn't work and hurts them" and "Let's give puberty blockers to biological adults who have already completed all stages of puberty". Puberty blockers do not have magical time-machine qualities, so giving them now cannot "block" or prevent a puberty that happened several years ago.
:::WhatamIdoing (talk) 16:27, 13 March 2025 (UTC)
::::Where is anyone taking about giving puberty blockers to those who have already completed puberty? Aaron Liu (talk) 19:54, 13 March 2025 (UTC)
:::::Sorry, @Aaron Liu, I missed this earlier. In the UK, pre-Cass Review, if you were a trans person and 16 years old and wanted to get cross-sex hormones, you were legally required to spend a year on puberty blockers before GIDS could consider giving you cross-sex hormones. AIUI there is exactly zero research showing that this is a good idea, and there is definitely no research showing that a trans girl can have her voice change at age 13, start taking puberty blockers at age 16, and have her voice go back to its pre-pubertal qualities.
:::::The Dutch protocol research involved early pubescent kids ("population A"). The narrative for it includes things like "time to think" before puberty causes irreversible physical changes. It is being applied to post-pubescent teens who have already experienced those irreversible physical changes ("population B"). If your body is male and your voice hasn't yet changed, then puberty blockers can delay that. But if your voice has already changed, they can't do anything about that. They're not magical time machine drugs. WhatamIdoing (talk) 20:33, 14 April 2025 (UTC)
::::::While I agree forcing 16 year olds to pause puberty for a year before letting them transition is ridiculous (and based on transphobic assumptions that kids will spontaneously grow out of wanting to transition), you seem to think puberty finishes a lot faster than it does... Your average 16 year old doesn't look like a fully grown adult.
::::::* Voice drops: generally starts at Tanner stage 3, and generally finishes around Tanner stage 4
::::::* Facial hair: starts coming in between 11 to 16, usually the latter, and continues to develop 2-4 years up until mid-20s
::::::* Height/muscle mass: somewhat settles by mid puberty, continues up until 20s
::::::* Generally, male puberty usually enters it's final stage 16-17ish and takes a little while
::::::{{tq|It is being applied to post-pubescent teens who have already experienced those irreversible physical changes ("population B") ... They're not magical time machine drugs}}. Nobody has ever said they are - the idea they'd be prescribed to prevent changes that already happened is a strawman nobody has ever argued. A 16 year old is not de-facto post-pubescent. A voice-drop is the not the sole thing that happens at puberty. PBs for a 16 year old can likely prevent further irreversible male-pattern height/muscle growth and facial hair development even if the voice already dropped. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:57, 14 April 2025 (UTC)
::::It took about 3000 years to go from the first documented occurrence of smallpox to the smallpox vaccine, so assuming a similar rate of progress we can expect a working COVID vaccine somewhere in the 51st century. Damn, it would sure be convenient if we didn't have to develop germ theory all over again every time a new disease is discovered. Flounder fillet (talk) 21:06, 13 March 2025 (UTC)
::::{{tq2|Gender care medicine is about 100 years old. Race and intelligence is probably as old as the concept of general intelligence}}
::::This feels like a very dubious assumption to me. Almost all of modern healthcare and biomedical science postdates germ theory. Also race in the modern sense is a surprisingly late concept only forming approximately around the 1700s. And "general intelligence" in a strictly scientific sense is from Charles Spearman in 1927.
::::{{tq2|so if we expect a similar rate of progress, then it'll be a couple more centuries}}
::::Why would we? Do you have any good justification for a linear rate of scientific progress?
::::I guess my TL;DR here is that your response seems to be based on a bunch of unchecked assumptions that, if rigorously investigated, don't support or really have any obvious relevance to the conclusion you're trying to draw from them. It seems to me like you started out assuming that the science of trans medicine is not as old as the science around race or intelligence and worked backwards from there. Loki (talk) 21:26, 13 March 2025 (UTC)

This is a problematic RFC, because it combines two issues that should be looked at separately. The statement by the Royal Australian and New Zealand College of Psychiatrists [https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/role-of-psychiatrists-working-with-trans-gender-diverse-people] says:

"Being Trans or Gender Diverse does not represent a mental health condition". That is the answer to the first part of the question. Then it says: "TGD people experience higher rates of mental illness than the general population. Stigma, discrimination, trauma, abuse, and assault contribute to this mental distress. Distress associated with gender may in some situations be related to a range of psychosocial issues or mental health conditions." So the answer to the second part of the question, is that, mental health problems might be the factors contributing to gender dysphoria. WPATH associated doctors themselves admit that they have patients with mental conditions, for example, they were asking each other how to deal with patients that have dissociative identity disorder.

{{quote frame |In the autumn of 2021 several practitioners mentioned that they had a high number of patients with dissociative identity disorder (DID), formerly known as multiple-personality disorder. The group discussed the challenges of gaining consent from each “alter” (alternative personality) before starting hormone therapy, particularly when the alters had different gender identities. Some members appeared to view DID primarily through the lens of identity. As one therapist put it: “I too would love to hear from others how we as clinicians…can work with these clients to honour their gender identity and fractured ego identities.” For a field sometimes accused of over-medicalisation, such “under-medicalisation” is just as troubling. [https://www.economist.com/united-states/2024/03/05/leaked-discussions-reveal-uncertainty-about-transgender-care]}}

It appears that some individuals diagnosed with gender dysphoria may have underlying mental health conditions that could contribute to their experience. Making broad generalizations in these cases isn’t helpful, as we cannot entirely dismiss the possibility that mental health factors may have an influence on gender-related distress. To me it is also unclear what the point of this RFC is. I don't think anyone questions that being trans is not a mental issue. The second part is a different topic entirely.--JonJ937 (talk) 11:10, 18 February 2025 (UTC)

:No you misread that line. What it actually says is that stigma and a variety of other conditions brough on by being a subaltern group make trans people more vulnerable to psychological distress. That is the opposite of saying that mental illness causes dysphoria. This isn't about a direct relationship between mental health and dysphoria at all. It's about a relationship between oppression and the mental health of the subaltern subject. Simonm223 (talk) 14:59, 18 February 2025 (UTC)

:This RFC is about whether being trans is or is frequently caused by mental illness, not whether being trans can cause mental illness (arguably so, depends on how direct a cause you want) or whether mental illness is common among trans people (definitely is). So none of this is relevant. Loki (talk) 16:52, 18 February 2025 (UTC)

::The first source that I quoted actually says: "Distress associated with gender may in some situations be related to a range of psycho social issues or mental health conditions". So yes, according to that source, in some instances gender dysphoria may be related to mental issues. A particular situation described in another article also points to that. If a person has DID and their alters have different gender identities not all of which consent to transition, it is impossible to say that dysphoria did not result from mental issues. JonJ937 (talk) 09:46, 19 February 2025 (UTC)

:::1. Gender dysphoria and being trans are not the same thing. That’s really basic to this topic. Are you unaware of the difference?

:::2. As has been explained to you already, it is simply invalid to assume that any or all associations (correlations) with gender dysphoria are causes of being trans, especially when there is a really much more plausible set of explanations that point to causation in the opposite direction (eg that gender dysphoria like any stressful event can lead to broader mental health issues if not attended to) and no evidence at all offered in the direction you assert.

:::3. As for your suggestion that we take at all seriously the idea that there are multiple documented cases of people with DID (multiple personalities) who are trans with one identity and cis with another - would you like to post evidence for this claim? OsFish (talk) 16:40, 19 February 2025 (UTC)

:::OsFish is right: The DSM5 differentiates clearly between "gender dysphoria", which is itself a mental illness, and "gender incongruence", which explicitly isn't. Loki (talk) 16:51, 19 February 2025 (UTC)

::::Many sources indicate that transgender individuals experience higher rates of mental health disorders. For example, one study states, "Several lines of evidence indicate the prevalence of mental health disorders in Transgender individuals is higher than that of cisgender individuals or the general population." [https://pubmed.ncbi.nlm.nih.gov/36151828/] However, whether these mental health issues occur before or after a person begins identifying as transgender may vary. In particular, with mental conditions such as DID, when one personality may identify as trans, and another as cis, it can be difficult to determine whether the transgender identity arises independently of the mental disorder or is influenced by it. The source for DID is the Economist, which refers to the doctors who report frequent occurrence of patients with DID. JonJ937 (talk) 11:23, 20 February 2025 (UTC)

:::::Had you read the full text of the {{tq|Mental health in transgender individuals: a systematic review}} one and not just the abstract, you'd notice it was — for one — not a study, and instead a systematic review. Second, it does not support your DID claim. Under Results, subheading "Co-morbid mental health disorders in TG individuals", it states the following:

:::::{{blockquote|"Due to the substantial overlapping between DDNOS and GD manifestations, the DDIS interview could not represent an appropriate instrument to ascertain dissociative disorders in GD individuals. The sample and data were not matched for age, which might affect the average values of dissociation."}}

:::::Furthermore, it only reviews a study that uses gender dysphoria to determine whether or not someone is transgender. I'm unaware of and medical literature that supports the assertion that gender dysphoria is the only way to genuinely identify as transgender, though you're welcome to link to such research.

:::::For your actual claim, however, I don't exactly see anyway how having DID causes gender dysphoria anyway. This doesn't seem to be supported, and instead just reports that those who are transgender (again, specifically only those with gender dysphoria, according to one study) are at increased risk of other mental illness — specifically dissociative identity disorder, in that one study. Nothing there supports the claim that it's caused as a result of a pathological illness that makes one transgender. This is the crux of the actual RfC, and which many seem to already consider fringe, so if you have any actual supporting evidence to the contrary, please provide it. SmittenGalaxy | talk! 12:23, 20 February 2025 (UTC)

::::::You do realize that a systematic review is a study, right? CFCF (talk) 19:55, 21 February 2025 (UTC)

:::::::Yes, but that wasn't my point. My point wasn't "it is a systematic review, and has less weight than other studies", but that it's not a classical review that it itself collects data from a hypothesis for some result. It takes a question and uses existing studies and their data to answer said question. The point instead is that since it is not the study, and merely a review of studies, that if they want to make a claim based on its data, it would benefit them to read the source of said data; to gather information like how it was collected, the sample size, and its results and conclusion.

:::::::The brief mention of one study in a giant results table that compiles dozens of studies doesn't give enough information to know if what you are citing supports your claim, oftentimes. This was the case here, so I pointed out the claim was wrong. In fact, they only quoted the first sentence of the review's abstract. I don't believe they even read the part that mentions DID, because even in the review it mentions the failure of the cited study to answer the question posed. This leads me to believe they only read the abstract, not the actual review, much less the study itself. SmittenGalaxy | talk! 00:44, 22 February 2025 (UTC)

:::::JonJ937, your Economist link defending your claim that lots of trans people are actually suffering from multiple personality disorder is to an article crediting the “WPATH files”, a politically motivated and rather silly attack on mainstream trans health expertise reminiscent of the attacks on climate science in the Climategate affair. It’s not a serious source. No regular competent Wikipedia editor would consider it any sort of source for medical content. Wikipedia is not a political battleground. If you are unhappy with the state of the research in this area, the way you change that is by training and becoming a researcher, not by trying to edit Wikipedia. We can only go off of reliable sources, and in this particular area, sources reliable for medical topics. The Economist citing WPATH files is a demonstration of why the popular press is not considered a reliable source for medical topics. I note that you’ve been told before on this page - and you indicated you heard it - that the Economist isn’t a reliable source on medical issues. So I really don’t know why you think it was appropriate to cite it again. Please make sure you are here for the right reasons. OsFish (talk) 15:48, 20 February 2025 (UTC)

::::::The Economist is a reliable source and is known for fact checking and accuracy. To my knowledge, no one questioned the accuracy of this report. It is corroborated by a MEDRS, which also describes patients with DID who wanted to do or did a medical transition. [https://pmc.ncbi.nlm.nih.gov/articles/PMC9537239/] This study discusses a patient with DID who exhibited eight distinct personalities with different gender identities (two female and six male) and "only the female personalities adhered to his request for HT (hormonal treatment) for GD". Then they discuss another patient who was diagnosed with GD and underwent gender-affirming surgeries (GAS) years before finding out that the patient also suffered from DID. Another one was diagnosed with DID 10 years after GAS, had 33 personalities, "some males and some females, with male personalities dominating, who wished GAS and kept the others away in order to have GAS". So it is evident that, in some cases, transgender identities may stem from a mental health condition. Which is why I believe the question is not formulated correctly. JonJ937 (talk) 14:01, 22 February 2025 (UTC)

:::::::Inevitably, the source you cite to suggest that DID is a frequent cause of being trans actually says “This article provides the first systematic review on GD and DID and shows that DID in a GD sample does not seem to be higher than in the general population.” That’s in the summary right at the beginning where it also says such cases are “rare”. You obviously read that bit. You also appear determined to ignore Wikipedia policy on sourcing for medical articles. You have shown that you know the Economist is not considered a reliable source for medical information, yet you insist on citing it as such. I honestly think you should step away from editing in this subject area, as right now, you’re just being WP:disruptive. OsFish (talk) 17:48, 22 February 2025 (UTC)

Recommended reading The whole thrust of this discussion makes me think there are a lot of people who would benefit to reading No Future by Lee Edelman. Simonm223 (talk) 16:07, 19 February 2025 (UTC)

:"So the answer to the second part of the question, is that, mental health problems might be the factors contributing to gender dysphoria." The question doesn't ask about gender dysphoria. To the extent that you want to divide the question into two parts, the second part is: "Is the view that transgender identities are ... frequently caused by mental illness WP:FRINGE within the bounds of mainstream medicine and international human rights?" As was already pointed out to you, gender dysphoria is distinct from transgender identity. "in some cases, transgender identities may stem from a mental health condition. Which is why I believe the question is not formulated correctly." The second part of the question doesn't ask whether a transgender identity "may" be caused by mental illness; I had a brief exchange with YFNS about this prior to her opening the RfC to encourage her not to frame the question that way. The second part asks whether it is "frequently caused by mental illness." Nothing you've presented suggests that it's frequent. The study about DID that you linked to says "This article provides the first systematic review on GD and DID and shows that DID in a GD sample does not seem to be higher than in the general population." Not only is the RfC question not about GD, but DID is not a frequently occurring mental illness in the general population, therefore it cannot be frequent in the population of people experiencing GD. FactOrOpinion (talk) 14:49, 22 February 2025 (UTC)

::I mentioned DID as one example of possible mental conditions that could contribute to a transgender identity, though there may be others. This study states: "Our findings suggest a high prevalence and significantly higher odds of mental disorder diagnoses in the transgender population compared to the cisgender population, using nationally representative U.S. data." [https://www.sciencedirect.com/science/article/abs/pii/S1047279719302832] However, the source does not seem to clearly state whether these mental disorders contributed to transgender identities or if they developed afterward, so both possibilities may exist. This is why I believe we need to look separately into the two issues combined in the RFC question. JonJ937 (talk) 09:58, 23 February 2025 (UTC)

:::I don't have a problem with separating out the two parts of the question. I'm just saying: be clear about what the second question is, and in your discussion, don't move the goalposts. As proposed, the second question would be: "Is the view that transgender identities are frequently caused by mental illness WP:FRINGE within the bounds of mainstream medicine and international human rights?" Perhaps the most productive step here is to ask YFNS for statements in the medical and international rights literature about that second question, as it seems to me that the earlier quotes she gave were about the first question, not the second one. FactOrOpinion (talk) 14:40, 23 February 2025 (UTC)

::::I think you will find that the lack of sources on this is precisely because this isn't something that hasn't been answered with any reliable degree of evidence in the literature, and as such is not something for us to interpret here.

::::CFCF (talk) 14:46, 23 February 2025 (UTC)

::::We are discussing the same topic in both the Survey and Discussion sections. It would be better to keep the conversation in one place. As for splitting the question, I think we should start by defining the terms. How do we define "frequent"? Is it 10%, 20%, or 50%? For example, in medicine, a side effect occurring in 1-10% of cases is considered "common," and anything above 10% is often seen as "frequent." We know that there is a certain proportion of trans people affected by mental health conditions and some conditions may influence the trans identity. As mentioned by others, at the moment, there does not seem to be sufficient evidence to make any definitive statement about the frequency rates. If there is such statistical or analytical data, it would be helpful to see it. JonJ937 (talk) 09:58, 24 February 2025 (UTC)

:::::"Some conditions may influence the trans identity" - then you have to provide evidence that expert medical opinion, as expressed in medically reliable sources, is that these conditions are considered causal. You have not only failed to do that, you have been citing sources supposedly in defence of your causal claims that actually find the opposite. It's the sort of behaviour that demonstrates why these broad RFCs are necessary. OsFish (talk) 03:48, 25 February 2025 (UTC)

::::::The mental condition of DID that I mentioned (and which other users mentioned too before me) is just one that could influence trans identity. Another mental condition that could affect the trans identity is schizophrenia. For example, this source states:

::::::{{quote frame |Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. [https://pmc.ncbi.nlm.nih.gov/articles/PMC4274821/]}}

::::::Another source: [https://pubmed.ncbi.nlm.nih.gov/30659566/] and yet another source:

::::::{{quote frame |There is an elevated co-occurrence of autism in trans individuals, with recent meta-analyses suggesting that 11% of trans individuals are autistic. The presence of autism in trans young people can create clinical challenges by adding complexity to the presentation, assessment and management of those presenting to gender clinics. Although many trans young people display traits of autism, how these traits relate to the nature of their gender diversity is unclear. [https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(24)00078-6/fulltext}}

::::::ADHD is another similar mental condition. It is evident that, in some cases, mental health issues may influence gender identity. While up to 11% of transgender individuals are autistic, the extent to which this impacts their gender identity remains uncertain. Though, researchers consider a connection plausible. Individually, some of these conditions may not be widespread, but what is their combined prevalence? If, for example, the total rate is around 10% or 15%, would that be considered frequent? Answering these questions would be helpful before making any assessments of overall frequency. JonJ937 (talk) 11:03, 26 February 2025 (UTC)

:::::::Looking at the sources, the first (Rajkumar2014) explicitly says that schizophrenia and gender identity disorder (it was using old terminology) may share common casual mechanisms, meaning they think something else causes both conditions. The second (Stusiński et al 2018) talks about the difficulties of treating patients with both but doesn't actually say anything about schizophrenia causing gender dysphoria and in fact discusses strategies to ensure patients do have gender dysphoria. The third source (Tollit et al 2024) also does not discuss autism causing gender dysphoria. You were asked for medrs sources saying that these conditions caused gender dysphoria, these sources do not say that. LunaHasArrived (talk) 12:09, 26 February 2025 (UTC)

::::::::The source (Stusiński et al., 2018) states that "Gender dysphoria in individuals with schizophrenia may result from the delusionally changed gender identity or appear regardless of the psychotic process." Here's another source, analyzing a patient suffering from the same mental disorder, which says that: "This case presentation depicts a clear pattern of gender identity change from male to female coinciding solely with psychotic breaks of schizoaffective disorder, bipolar type". [https://doi.org/10.36518/2689-0216.1395] There are more such sources, but the key point is that, in some cases, mental disorders can influence gender identities, which is well-documented in the relevant literature. JonJ937 (talk) 10:44, 27 February 2025 (UTC)

:::::::::That second paper introduces a problem you have been ignoring for a long time with this argument (ignoring the fact that nothing here introduces a frequent casual link), namely transgender identity isn't the same as gender dysphoria. You've been given multiple opportunities to provide medrs saying that that other mental disorders frequently cause a transgender identity, all you've provided is evidence that some individuals can have symptoms of gender dysphoria caused by other mental disorders (and individual case studies doesn't really sound like frequently) LunaHasArrived (talk) 14:10, 27 February 2025 (UTC)

::::::::::The sources provided discuss gender identity change, not just dysphoria. They literally mention "gender identity change" and discuss patients who began identifying as a different gender or even underwent surgery. The last source I provided isn't about dysphoria but describes a male patient who starts identifying as female during psychotic episodes from schizoaffective disorder of bipolar type. We have so far no statistical sources on the overall frequency of trans identities influenced by various mental disorders or conditions. JonJ937 (talk) 16:20, 27 February 2025 (UTC)

:::::::A reminder of the question: "Is the view that transgender identities are ... frequently caused by mental illness WP:FRINGE within the bounds of mainstream medicine and international human rights?" It's not a question about whether a mental illness "can" cause someone to identify as transgender, nor is it a question about gender dysphoria. And autism is not a mental illness, so it's odd for you to introduce it into this particular RfC discussion. FactOrOpinion (talk) 13:26, 26 February 2025 (UTC)

::::::::1) Autism is classified as a neurodevelopmental disorder under the DSM-V. There are legitimate arguments and debate that it isn't, but this isn't relevant here and your comment does not invalidate the prior point by JonJ937.

::::::::2) There are multiple MEDRS-compliant sources above making the link to some causal mechanism, noting that the size or characteristics of causality is unclear.

::::::::This refutes the idea that pointing to a potential a causal link of at present undefined size is fringe.

::::::::3) Simple causal inference dictates that if the proportion of individuals with forms of gender-nonconformity with autism is markedly higher than in the general population (by many estimates it is) - it must be caused by something.

::::::::The rejection of this faulty premise in this RfC on determining mentions of frequency as fringe does not dictate that these links must (again does not dictate they must) be elevated to article space.

::::::::It simply rejects that discussions, or sources discussing the potential or frequency of a causal link is fringe.

::::::::CFCF (talk) 18:45, 26 February 2025 (UTC)

:::::::::I know that autism is classified as a neurodevelopmental disorder. That does not imply that it's a mental illness, and since the question is "Is the view that transgender identities are ... frequently caused by mental illness WP:FRINGE...?", there's no apparent relevance that "There is an elevated co-occurrence of autism in trans individuals." You say "There are multiple MEDRS-compliant sources above making the link to some causal mechanism [between A and B]," but you do not specify what A and B are. Unless A and B are identifying as trans and mental illness, how is it relevant? Neither you nor John say how it's relevant to the actual RfC question. FactOrOpinion (talk) 19:25, 26 February 2025 (UTC)

::::::::::Okay, let’s be precise. A neurodevelopmental disorder (NDD) is classified as a mental disorder under the DSM-5. The DSM-5 does not use the term "mental illness" at all, instead opting for "mental disorder" to reflect the complex interplay of biological, psychological, and social factors. Whether a condition is categorized as an "illness" is not always a straightforward determination, and the RfC question itself assumes a distinction that may not be entirely stable or well-defined. Frankly, with this you point out another issue why this RfC is ill-formed.

::::::::::That said, the core issue here is not about whether autism qualifies as a mental illness but rather whether discussing potential causal mechanisms between autism and gender diversity is inherently fringe. The elevated co-occurrence of autism and gender diversity is well-documented in MEDRS-compliant sources. While the nature of this relationship remains uncertain, the mere discussion of potential causal links—whether biological, developmental, or social—does not automatically fall outside mainstream scientific discourse.

::::::::::This does not mean that such discussions must be elevated to article space, but it does mean that categorically dismissing them as fringe is not in the scope of what this RfC can find. If the concern is about how the relationship is framed, that is a separate editorial issue, but acknowledging the association and the fact that researchers have explored possible explanations should not itself be controversial.

::::::::::CFCF (talk) 19:37, 26 February 2025 (UTC)

:::::::::::I wasn't interpreting "mental illness" to include neurodevelopmental disorders, nor do I think that's the common interpretation of "mental illness" in everyday English. But looking back at the second half of the RfC question, "Is the view that transgender identities are ... frequently caused by mental illness WP:FRINGE within the bounds of mainstream medicine ...?", it's not talking about everyday English. If "mental illness" is interpreted in MEDRS to include any kind of mental ill health, including neurodevelopmental disorders, I take your point. That said, correlation ("elevated co-occurrence") is not causation. But it would help if YFNS clarified what she means by "mental illness" (e.g., is it any disorder identified by high quality MEDRS like the DMS-5?). FactOrOpinion (talk) 20:16, 26 February 2025 (UTC)

::::::::::::Thank you for engaging, but I will posit further that the statement that correlation is not causation - does not imply that correlation can’t be or be brought upon by causation.

::::::::::::There have been several MEDRS-compliant sources brought into the debate here that discuss either the potential of some causal relationship, or even that one is assumed, but that the nature, direction and size of causal relationship is not known.

::::::::::::This inherently implies to me that discussion of frequency is not fringe. CFCF (talk) 21:23, 26 February 2025 (UTC)

:::::::::::::Yes, I understand that "the statement that correlation is not causation - does not imply that correlation can’t be or be brought upon by causation." It might or might not correspond to a causal relationship, and if there is a causal relationship, the correlation itself also doesn't tell you the direction of causality. "There have been several MEDRS-compliant sources brought into the debate here that discuss either the potential of some causal relationship, or even that one is assumed." "Potential for" does not imply "is." I haven't seen any comment with a MEDRS saying "one is assumed," and I'd appreciate your pointing me to the comment that cites a MEDRS supporting that. FactOrOpinion (talk) 21:45, 26 February 2025 (UTC)

::::::::::::::It is correct that autism is not a mental illness but rather a neurodevelopmental disorder, which is a mental condition according to our Wikipedia article. A mental condition is not the same as a mental disorder. However, considering that the sources cited in support of an affirmative answer to the RFC question state that "there do not seem to be external forces that genuinely cause individuals to change gender identity", I believe conditions like autism could be viewed as an external influence, if "external influence" is understood as any factor that shapes identity beyond conscious choice. In addition, YFNS appears to acknowledge that we lack sources to determine the frequency of mental health influences on gender identity. You also mentioned in a comment above that YFNS's sources were referring to the first question, and not the second one. If there are indeed no sources addressing the frequency of such influences, can we make any definitive statements about whether they are frequent or rare? JonJ937 (talk) 10:36, 27 February 2025 (UTC)

:::The phrase {{tq|though there may be others}} is doing a lot of heavy lifting for something that is not currently substantiated by MEDRS. Further going on to state {{tq|the source does not seem to clearly state whether these mental disorders contributed to transgender identities or if they developed afterward}} cements my view that this is not a serious question that should be explored. It is not the job of Wikipedia to do our own medical research or to come up with conclusions not stated by sources. That's just plain WP:OR and bordering on WP:SYNTH. If no MEDRS states it, why is it our job to explore these "possibilities" that have no current scientific basis? SmittenGalaxy | talk! 22:22, 23 February 2025 (UTC)

::::Sometimes, discussing the whys and wherefores of a source lead us to greater clarity, which enables us to write a better article.

::::For example, the quote above about "significantly higher odds of mental disorder diagnoses in the transgender population compared to the cisgender population" might lead me to wonder whether Autism (another diagnosis whose status as "a disorder" has been credibly challenged by people with that label, and which is also correlated with being trans) is being counted as "a mental disorder" in that study, and whether the reported correlation holds true when an autism diagnosis is controlled for.

::::To give another example, the same quote might lead an editor to wonder whether it's not the case that "anxiety causes trans" but perhaps that some underlying "durable biological element" causes some people to be (for example) anxious and trans and autistic and to have epilepsy, and that having wondered this, the editor might be inspired to search for and find sources about what it really means for the brain when we say that someone is neurodiverse. This editor might start off with a question, but they should end up with sources. WhatamIdoing (talk) 01:52, 24 February 2025 (UTC)

:::::Even were that what this RfC was trying to accomplish, it is not the job of FTN to interpret and analyze sources. We're also not here to support or oppose based on entirely different topic areas. This is purely about determining if it is fringe to call being transgender an illness and to say it is caused by some or many illnesses. Your suggestion may be valid, but it is not for this discussion or noticeboard. SmittenGalaxy | talk! 02:40, 24 February 2025 (UTC)

::::WP:NOR refers to material in mainspace articles and states "This policy does not apply to talk pages and other pages which evaluate article content and sources." So it's not contrary to policy for someone to present an argument that's not in a source. Many discussions of whether theories are WP:FRINGE require SYNTH, since we may have to look across multiple sources to determine which bucket (mainstream, minority, or fringe) a claim falls into. FactOrOpinion (talk) 02:55, 24 February 2025 (UTC)

:::::I don't refer to this discussion as original research or synthesis of sources. I mean the use of such sources as previously described to insert content into articles to say anything to the effect of "mental illnesses can cause someone to be transgender" when that is verifiably not what they say. Unless I have vastly misunderstood this RfC, it will affect content and disputes over it, so it's good to dispel the notion of using that sort of synthesis logic in general. SmittenGalaxy | talk! 03:30, 24 February 2025 (UTC)

::::::Thanks for clarifying, I misunderstood. FactOrOpinion (talk) 03:45, 24 February 2025 (UTC)

:For those of us who came in late- this question is in relation mainly to the article on Society for Evidence-Based Gender Medicine, right? Are there any other Wikipedia articles that could be changed as a result of the outcome of this discussion? T g7 (talk) 14:03, 2 March 2025 (UTC)

===What does frequent mean?===

I regret that this debate has taken so much time, but we need to clarify the multiple interpretations embedded in the RfC question. Beyond the fact that the DSM-V—on which a great deal of affirmative votes to the question are based—does not even use the term "mental illness," we also need to examine the ambiguity of the word "frequent" or "frequently."

This is a spectacularly poor word choice for the RfC because "frequent" has different meanings in different contexts:

In epidemiology, frequency can refer to both absolute frequency (the total number of cases) and relative frequency (proportion per population). A condition may be considered "frequent" in absolute terms even if its prevalence is low.
In statistical discourse, something is "frequent in a population" if it occurs at any frequency within that population, without necessarily implying a high proportion.
In medical classifications, different words to describe frequency are often defined arbitrarily. For example, in pharmacovigilance, adverse events occurring as rarely as 1% can be considered "common" under certain guidelines.
In general language use, "frequent" typically implies a high proportion or regular occurrence, which is different from the technical definitions above.

Given these variations—and how the discussion takes medical, epidemiological and general perspectives—the framing of the RfC is problematic because it does not define what threshold or definition of frequency is being debated. Are we discussing:

An elevated prevalence/incidence compared to the general population?
A high absolute number due to population size?
A common occurrence in a given group? (And if so, what arbitrary value do we set to be "frequent"?)

Furthermore, it is important to acknowledge that much of the literature does discuss the existence or potential of a causal relationship between certain mental disorders—such as Dissociative Identity Disorder (DID), schizophrenia, and autism—and various forms of gender non-conforming identities. However, these discussions often do not attempt to quantify the extent or characteristics of the causal link. This reinforces the need for careful interpretation rather than assuming that discussing causality itself is fringe.

If the RfC question is not internally coherent due to vague wording, then we must first clarify these issues before debating whether a particular claim is "fringe." Otherwise, the discussion risks being based on unstated assumptions rather than clear definitions.

CFCF (talk) 20:32, 26 February 2025 (UTC)

: I've mentioned this several times in the discussions above and I'll repeat here that in my opinion the RFC question combines two different issues. The first, concerning whether transgender identity itself is a mental illness, has a straightforward answer, with unanimous agreement that it is not. However, the second question regarding frequency is more complex. It would make more sense to split this RFC into two separate questions, allowing voters to present arguments specific to each. Another problem that CFCF raised in this section and which was mentioned by others as well, is that determining whether something is "frequent" first requires a clear definition of the term. Obviously, any vote on frequency should be based on sources that establish it according to the agreed-upon definition. JonJ937 (talk) 10:17, 27 February 2025 (UTC)

:{{tq|1=something is "frequent in a population" if it occurs at any frequency within that population}}{{fake citation needed}}
These are not the definitions relevant to the topic at hand, and participants have already overwhelmingly decided that they clearly understand the meaning of this word. Aaron Liu (talk) 12:48, 27 February 2025 (UTC)

As discussed above, answering the second question requires statistical data. This source provides statistics on the prevalence of psychiatric diagnoses among transgender patients in clinical care in the USA. Since the data is limited to hospitalized individuals, it is difficult to determine how these findings apply to the broader transgender population. However, the results indicate a strong correlation.

{{quote frame |Approximately 58% of transgender patients had at least one DSM-5 diagnosis compared with 13.6% of cisgender patients (p<0.0005). Transgender patients had increased prevalence for all psychiatric diagnoses queried (Table 1), with major depressive disorder and generalized anxiety disorder being the most common diagnoses (31% and 12%, respectively). There was also an increased lifetime prevalence of bipolar disorder (11%) and psychotic disorders (4.7% overall, 2.5% for schizophrenia and 2.2% for schizoaffective disorder) in transgender adults. Ten percent of transgender adults had a history of a substance use disorder, including 4.2% for alcohol and 3.8% for cannabis. [https://pmc.ncbi.nlm.nih.gov/articles/PMC6830528/#B1]}} JonJ937 (talk) 10:47, 1 March 2025 (UTC)

:I feel this has already been made clear, but {{tq|the results indicate a strong correlation}} isn't causation. That would be an interpretation of the data and would fall under WP:NOR. Our job is not to take the data and interpret it; that is the job of reliable sources to do. Nothing here demonstrates causation, which is the whole point of the RfC. SmittenGalaxy | talk! 11:19, 1 March 2025 (UTC)

::It has been made very clear, repeatedly, but Jon repeatedly WP:DIDNTHEARTHAT, which I hope closers note. The whole “what does frequency mean” question is a distraction given that no evidence has been given from MEDRS that any mental illness is considered a cause of transgender identity. We’re pretty much in the territory of asking how many angels dancing on a pinhead is “many”? OsFish (talk) 14:06, 1 March 2025 (UTC)

:::You both seem to intentionally be misinterpreting what is meant when we say: {{tq|correlation is not causation}}. When a phenomenon is repeatedly detected, i.e. persistent across studies - it is with all the certainty one can get out of statistics, valid to assume that something causes it. The potential of causation is discussed in multiple sources above, but there is no clear consensus on whether it is biological, social, or developmental, but there is seeming consensus that it is not methodological in nature. Discussing the nature of this association is not WP:FRINGE, neither is quantizing it. This is precisely why we need to be clear what we speak to when we use undefined words like "frequently". CFCF (talk) 16:39, 1 March 2025 (UTC)

::::No one said that discussing the nature of the correlation is fringe. The issue here is specifically whether A (mental illness) causes B (identification as trans) is fringe. That's distinct from saying that the correlation between A and B is fringe, as other possibilities exist: B causes A, or there exists a C that causes both A and B, or both B and C cause A. None of those other possibilities need be fringe. FactOrOpinion (talk) 17:09, 1 March 2025 (UTC)

:::::Exactly. And we've already talked about these above. Can we please stop repeating ourselves? Aaron Liu (talk) 17:34, 1 March 2025 (UTC)

::::::But there are multiple sources above discussing the issue in a very scientific and valid manner. Albeit very carefully, but that is inherently a strength of the sources, that they posit that there may be a causal relationship that is of unclear size and potentially of unclear direction. There are multiple sources cited for DID, schizophrenia or autism. CFCF (talk) 00:04, 2 March 2025 (UTC)

:::::::Which source has stated that it's possible that trans identities are frequently caused by mental illness? Aaron Liu (talk) 01:12, 2 March 2025 (UTC)

:::::::{{tqb| All you've done is point at specific, small populations such as DID—who are quite rare, even in the population with gender dysphoria. That certain mental conditions can frequently explain and result in gender dysphoria does not mean gender dysphoria is frequently caused by these conditions.|source=yours truly}}In the same, unaddressed comment, I talk about your conflation of "there's some sort of explanation behind the correlation" with "it's not fringe that trans identities are generally caused by mental illness". Aaron Liu (talk) 01:16, 2 March 2025 (UTC)

:::::::And the only thing brought up about autism was "11% of trans people have autism... how that relates to trans nature is unclear." That is just a correlation. To be frank, your "causal complex" thing is just the correlation fallacy with extra steps. Aaron Liu (talk) 01:20, 2 March 2025 (UTC)

:::::::Looking into this further, I suspect that you borrowed your "causal complex" argument against Fringe-ing from Luna:{{pb}}{{tqb|Looking at the sources, the first (Rajkumar2014) explicitly says that schizophrenia and gender identity disorder (it was using old terminology) may share common causal mechanisms, meaning they think something else causes both conditions. The second (Stusiński et al 2018) talks about the difficulties of treating patients with both but doesn't actually say anything about schizophrenia causing gender dysphoria and in fact discusses strategies to ensure patients do have gender dysphoria. The third source (Tollit et al 2024) also does not discuss autism causing gender dysphoria. You were asked for medrs sources saying that these conditions caused gender dysphoria, these sources do not say that.|id=c-LunaHasArrived-20250226120900-JonJ937-20250226110300}}{{pb}}To say the direct opposite of she meant, that is. Aaron Liu (talk) 01:24, 2 March 2025 (UTC)

::::::::Yes, it's clear that this is a situation of "C causes A and B" (to borrow terminology from above). Decidedly not what this RFC is about. The other sources either don't discuss causation, or say that sex delusions in schizophrenia can present similarly to gender dysphoria so be careful (and give some strategies to differentiate between the 2). LunaHasArrived (talk) 08:42, 2 March 2025 (UTC)

::::I won't belabor the point any more than already has been done before me and even by others in this exact reply chain, but I'm not misinterpreting or misrepresenting anything. The RfC does not contend there is no correlation. It asks whether or not it is fringe to say it causes it. If anything, you are the one misrepresenting and misinterpreting the RfC. SmittenGalaxy | talk! 18:25, 1 March 2025 (UTC)

:::::Not at all, the possibility of some causal mechanism between the two is discussed in sources that have been linked above and adhere to WP:MEDRS. That they are careful and do make bold claims is true, but neither are there substantiated rejections of a possible causal mechanism in the literature. CFCF (talk) 00:02, 2 March 2025 (UTC)

::::::The fact there are not blatant rejections of the theory does not mean that we can treat it as mainstream opinion within medical literature. Again, that is the point of this RfC. I really feel this doesn't need to be (re)stated, but here we are. SmittenGalaxy | talk! 02:21, 2 March 2025 (UTC)

:::::::There are rejections plenty, actually. Linked above is:
{{tqb|misleading and unfounded narratives (e.g., mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence)}}{{pb}}{{tqb|trans-related and gender diverse identities are not conditions of mental ill-health}}Not linked yet but still out-there peer-reviewed medical papers include:
{{tqb|Section 3.1.1. Subtheme [of disinformation] 1.1: TGE identity is a mental illness or a product of co-occurring mental health conditions|source={{Cite journal |last1=McNamara |first1=Meredithe |last2=McLamore |first2=Quinnehtukqut |last3=Meade |first3=Nicolas |last4=Olgun |first4=Melisa |last5=Robinson |first5=Henry |last6=Alstott |first6=Anne |year=2024 |title=A thematic analysis of disinformation in gender-affirming healthcare bans in the United States |journal=Social Science & Medicine |volume=351 |pages=116943 |doi=10.1016/j.socscimed.2024.116943 |issn=0277-9536 |pmid=38759383 |url=https://www-sciencedirect-com.wikipedialibrary.idm.oclc.org/science/article/pii/S0277953624003873?via%3Dihub}}}}{{pb}}{{tqb|This model, which has lost most of its followers today, is the model that dominated the professional literature roughly between 1945 and 1970 [see Meyerowitz (2002), for a historical account] and conceptualizes gender dysphoria as a symptom of (severe) underlying psychopathology (see Fig. 13.1). [...] Gender dysphoria is no longer considered a symptom of another psychiatric disorder.|source={{Citation |last=Gijs |first=Luk |title=Psychiatric Comorbidity in Adults with Gender Identity Problems |date=2014 |work=Gender Dysphoria and Disorders of Sex Development: Progress in Care and Knowledge |pages=255–276 |editor-last=Kreukels |editor-first=Baudewijntje P.C. |url=https://link-springer-com.wikipedialibrary.idm.oclc.org/chapter/10.1007/978-1-4614-7441-8_13 |access-date=2025-03-02 |place=Boston, MA |publisher=Springer US |language=en |doi=10.1007/978-1-4614-7441-8_13 |isbn=978-1-4614-7441-8 |last2=van der Putten-Bierman |first2=Ellis |last3=De Cuypere |first3=Griet |editor2-last=Steensma |editor2-first=Thomas D. |editor3-last=de Vries |editor3-first=Annelou L.C.}}}} Aaron Liu (talk) 03:24, 2 March 2025 (UTC)

:::::::::This is another case of chronic WP:IDIDNTHEARTHAT. I hope closers take notice. These RFCs are clearly needed to deal with such behaviour. OsFish (talk) 05:35, 2 March 2025 (UTC)

::::::::I mostly was just trying to say that the "absence of evidence is not evidence of absence" claim won't work, but good to know there are actual outright rejections of the theory. SmittenGalaxy | talk! 06:59, 2 March 2025 (UTC)

:::::::::The last source quoted discusses gender dysphoria, and not transgender identity. Another article states that "trans-related and gender-diverse identities are not conditions of mental ill-health." While this is true in general, I have also cited sources describing cases where mental conditions have influenced trans identities. Therefore, this generalized claim cannot be entirely accurate or rule out such instances. We know that disorders like DID and schizophrenia, as well as conditions such as autism, can potentially affect trans identities. If we claim that certain conditions do not occur "frequently," do we have precise or broad statistical data to support this? Without solid statistical data to support either perspective, how can we determine whether such occurrences are frequent or not?

:::::::::This is my concern with the second part of the RFC question. We are making declarations on quantitative matters without any reliable statistical data, relying instead on personal assumptions. This is a Dutch study that provides certain figures.

:::::::::{{quote frame |One hundred eighty-six psychiatrists responded to the survey. These respondents reported on 584 patients with cross-gender identification. In 225 patients (39%), gender identity disorder was regarded as the primary diagnosis. For the remaining 359 patients (61%), cross-gender identification was comorbid with other psychiatric disorders. In 270 (75%) of these 359 patients, cross-gender identification was interpreted as an epiphenomenon of other psychiatric illnesses, notably personality, mood, dissociative, and psychotic disorders. [https://doi.org/10.1176/appi.ajp.160.7.1332]}}

:::::::::These study results appear to challenge the general claim that transgender identity is not frequently influenced by mental disorders or conditions. At least in the Netherlands, the data does not support this claim. Do we have similar statistics for the USA or other European countries? JonJ937 (talk) 10:39, 3 March 2025 (UTC)

::::::::::{{tqb|While this is true in general}}The question is about in general, therefore we can end it at that.{{pb}}While you did provide a source that states identities are frequently caused by other conditions, that 2003 paper reflects the outmoded historical perspective my last paper referenced. In fact, the last paper I quoted explicitly cites this Dutch study as the opposing view against the consensus {{tq|agreement that sex reassignment therapies are effective and should be tailored to the specific needs of an individual}}, i.e. Fringe.{{pb}}{{tqb|The last source quoted discusses gender dysphoria, and not transgender identity.}}There is widespread consensus that these populations are nearly the same. Aaron Liu (talk) 12:51, 3 March 2025 (UTC)

:::::::::::I have been told multiple times in this discussion that "gender dysphoria and being trans are not the same thing." However, now you claim that "there is widespread consensus that these populations are nearly the same." It would be good to resolve this with those users who disagree with your statement. Regarding the article that I quoted, are there any reliable sources that challenge the accuracy of the statistics it cites? Disagreeing with the researchers' views does not disprove their findings. JonJ937 (talk) 15:48, 3 March 2025 (UTC)

:::::::::::::Hm, that distinction isn't very relevant here IMO, so can we agree that the paper shows that it's fringe that gender dysphoria is frequently caused by mental illness? You also still have the APA consensus for trans identities. I'm sure I can find more sources about this in favor of fringing. Aaron Liu (talk) 17:38, 3 March 2025 (UTC)

::::::::::::::Gender dysphoria is itself a mental disorder. Gender dysphoria is distinct from identifying as trans. The RfC is about the latter, not the former. FactOrOpinion (talk) 23:16, 3 March 2025 (UTC)

::::::::::::Clinician views != fact. You are scraping the bottom of the barrel for sources when all you can present is a WP:MEDPRIMARY from over 20 years ago (using heavily outdated diagnostic criteria) that surveyed psychiatrists for their opinion. The source also noted {{tq|A small number of psychiatrists seem to refer such patients to specialized sex reassignment therapy centers on a regular basis, but others never seem to recommend this treatment route. It appears that the therapy options proposed to patients with gender identity disorder depend heavily on the personal preferences of psychiatrists. Thus, one respondent said he had referred 15 patients to a gender clinic, but another remarked that “the scalpel should not be used to reconcile fantasy with reality.” }} The Cass Review recently surveyed clinicians and found 1/3 believed in the FRINGE position that "there is no such thing as a trans child".[https://en.wikipedia.org/wiki/Cass_Review#Pathologisation]

::::::::::::{{tq|Regarding the article that I quoted, are there any reliable sources that challenge the accuracy of the statistics it cites?}} - the statistic it cites is quite likely accurate (that over 20 years ago, of a group of <200 psychiatrists in one country, many considered "gender identity disorder", an outdated diagnosis, to be caused by other mental illnesses and their recommendations for treatment were based primarily on the psychiatrists own personal preferences), but irrelevant to what we're discussing (does identifying as trans frequently stem from mental illness). Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:26, 3 March 2025 (UTC)

::::::::::::: I agree with YFNS. We have a policy at Wikipedia:Identifying reliable sources (medicine)#Use up-to-date evidence. The DSM changes wildly about every 16 years (though there were comparably quite few changes between 2013 and 2022), so stuff from 2003 reflects wildly outdated sentiment. (Jon,) Do you have a more recent source? Aaron Liu (talk) 17:34, 3 March 2025 (UTC)

::::::::::::::"there is no such thing as a trans child" is not the same as to claim that trans identity cannot be frequently caused by a mental illness. No one questions that trans identity in itself is not a mental illness, but we know that sometimes it could be caused by a mental illness. The research from 2003 suggests that for up to 50% of patients, trans identity could be linked to an underlying mental condition. I don't understand what treatment choices of individual psychiatrists have to do with reliability of the statistics stated in this research. Did any reliable article challenge the statistics? While this research is from 2003, it is highly unlikely that the figures have changed drastically over the last 20 years. If you believe this research is outdated, do you have more recent statistical data proving that mental conditions influencing trans identity are rare? So far I'm the only one citing statistics, even though the claim that the condition is infrequent needs to be backed up by statistical data as well. Without reliable statistical data, we cannot make definitive claims about the frequency/infrequency. JonJ937 (talk) 10:38, 4 March 2025 (UTC)

:::::::{{outdent|7}} {{tqb|it is highly unlikely that the figures have changed drastically over the last 20 years}}Yes they do, that's the entire point of MedDate. DSM-II (1968) had no mention of GD, yet DSM-III (1980) completely pathologized it as "transsexualism", only for DSM-IV (1994) to reverse course. And DSM-5 (2013) finally recognized that several "other" disorders were just autism. Not to mention all the changes in diagnostic criteria, which is the basis for determining whether gender dysphoria is a "symptom".
The trans child thing is an illustration on how such surveys are frequently clouded with politics over truth. Diagnosing GD as a "symptom" since {{tq|the scalpel should not be used to reconcile fantasy with reality}} fully reflects the transphobia at the time, for one. The quoted position is quite Fringe now (though less Fringe than the entire causation thing) against the clinical practice guidelines. And that's another example of how much can change in 20 years.{{tqb|do you have more recent statistical data proving that mental conditions influencing trans identity are rare?}}Yeah, I quoted to you several review papers on Monday. Aaron Liu (talk) 14:07, 4 March 2025 (UTC)

::::::::I would like to further comment on the statement

::::::::{{tq2|it is highly unlikely that the figures have changed drastically over the last 20 years}}

::::::::According to that paper, the estimated lifetime prevalence of gender identity disorder at the time was 0.001-0.002%, with a higher prevalence of 1 in 12000 mtf and 1 in 30000 ftm in the Netherlands. That's orders of magnitude less than the prevalence of schizophrenia alone (up to 20% of schizophrenics suffer from gender-related delusions according to the DSM-5-TR), at 1 in 300. Schizophrenia is probably as common now as it was then; however, GD rates have risen massively and today's estimates of GD prevalence place it within a single order of magnitude of the prevalence of schizophrenia (https://pubmed.ncbi.nlm.nih.gov/28838353/, also DSM-5-TR if you don't trust Zucker). As such, it is massively likely that the figures have changed dramatically. Flounder fillet (talk) 16:58, 4 March 2025 (UTC)

:::::::::If the figures have changed, what are they now? I have been asking for statistical information to support the claim about the infrequency for days now. The sources provided offer no specific statistics. Instead, they make broad claims like "trans-related and gender diverse identities are not conditions of mental ill-health", which is not always true. I have cited several high-quality MEDRS that describe how mental disorders or conditions can sometimes influence trans identity. However, to determine whether these instances are frequent or not, we need specific statistical data. The studies from 20 years ago attempted to establish how often trans identity was influenced by mental conditions, whereas more recent studies seem to avoid this issue. The Dutch study found that roughly 46% of trans identities in patients resulted from underlying mental conditions. A more recent U.S. study (quoted above) found that 58% of transgender patients had a mental disorder. Since there are studies showing that mental disorders or conditions can affect trans identity, some of this 58% obviously fall into that group, but the study did not attempt to differentiate between disorders that influenced trans identity and those that resulted from it. This seems to be due to the increasing politicization of the topic in recent decades, making researchers hesitant to address this complex issue. But how do we know then if it is frequent or not, if we have no reliable statistics in favor of either statement? JonJ937 (talk) 10:20, 5 March 2025 (UTC)

::::::::::In that study with the 58%, we have ≤ 6.2% (schizophrenia + schizoaffective + autism, ≤ due to possible overlap) with a diagnosis mentioned in the DSM-5-TR's differential diagnosis section for gender dysphoria (p. 519-521).

::::::::::{{tq2|the study did not attempt to differentiate between disorders that influenced trans identity and those that resulted from it. This seems to be due to the increasing politicization of the topic in recent decades, making researchers hesitant to address this complex issue.}}

::::::::::The study population is people who have a transgender diagnosis code in the DB, this already excludes everyone whose cross-gender identification is determined to be a result of a mental health condition by the diagnosing psychiatrist. Flounder fillet (talk) 14:39, 5 March 2025 (UTC)

:::::::::::We actually need a reliable source for that, our own judgments won't do. There are studies documenting that some individuals were diagnosed with DID or schizophrenia years after undergoing sex change surgery, meaning the code does not necessarily exclude everyone whose cross-gender identification resulted from a mental health condition. I'm not sure about your figures, the source actually mentioned "an increased lifetime prevalence of bipolar disorder (11%) and psychotic disorders (4.7% overall, 2.5% for schizophrenia and 2.2% for schizoaffective disorder) in transgender adults". [https://pmc.ncbi.nlm.nih.gov/articles/PMC6830528/pdf/trgh.2019.0029.pdf] Even if mental health condition affected identity cases were completely excluded from this study, what was the frequency of those excluded cases? As I said before, we can't assess frequency without statistical data. JonJ937 (talk) 11:05, 6 March 2025 (UTC)

::::::::::::{{tq2|I'm not sure about your figures, the source actually mentioned "an increased lifetime prevalence of bipolar disorder (11%) and psychotic disorders (4.7% overall, 2.5% for schizophrenia and 2.2% for schizoaffective disorder) in transgender adults"}}

:::::::::::::You seem to be confusing bipolar disorder and schizoaffective disorder of bipolar type. Bipolar isn't mentioned in the DSM's DD's. Flounder fillet (talk) 16:51, 6 March 2025 (UTC)

::::::::::::::Jon gave a direct quote from the study on bipolar disorder; 11% bipolar type schizoaffective disorder wouldn't make sense as schizoaffective disorder only constitutes 2.2% in total. The study isn't about differential diagnoses; it's about the comirbidities of people who had gender dysphoria and not its DDs. That said, I fail to see Jon's point about these figures and how he thinks bipolar disorder could cause a transgender identity. He also doesn't seem to realize that your 6.2% was hurt from adding things up. Aaron Liu (talk) 18:56, 6 March 2025 (UTC)

:::::::::::::::{{tq2|That said, I fail to see Jon's point about these figures and how he thinks bipolar disorder could cause a transgender identity.}}

:::::::::::::::He did cite something about how schizoaffective bipolar type can cause gender identity changes earlier, that's why I stated that he seems to be confusing schizoaffective bipolar type with bipolar. Flounder fillet (talk) 19:17, 6 March 2025 (UTC)

:::::::::::: {{tqb|our own judgments won't do}}Well, all of your arguments have rested on your own judgements from results, not the papers' discussions or conclusions. The Dutch survey concluded that psychiatric diagnoses of GD still strongly rested upon personal opinion and sentiments at the time and that there was substantial confusion over diagnostics in the DSM-IV-TR. The "58%" paper suggested that this was due to transgender people having a mental health assessment (which most cis people don't) and the societal persecution of transgender peoples. (And I don't see how you could argue that 4.7% + dissociative disorder's 1.27% is frequent.) Nowhere does any of these papers suggest that transgender identity is frequently caused by mental illness. Aaron Liu (talk) 12:47, 6 March 2025 (UTC)

::::::::::{{tqb|The Axis I diagnoses found in all the studies reviewed were mainly affective and anxiety disorders. The occurrence of severe psychiatric conditions, such as schizophrenia or bipolar disorder, was rare. Only one study looking at Axis I disorders compares a trans group with a cis control group matched for age, natal sex and new assigned sex (Dhejne et al., Citation2011). This study, which uses data from the national register in Sweden, focuses on trans people following gender-confirming medical interventions and found higher rates of psychiatric disorders and suicide in this group. It found, however, that there was an improvement over time, i.e. rates of psychiatric disorders and suicide became more similar to controls over time; for the period 1989–2003, there was no difference in the number of suicide attempts compared to controls.|source=[https://www-tandfonline-com.wikipedialibrary.idm.oclc.org/doi/full/10.3109/09540261.2015.1115753#d1e1434 "Mental health and gender dysphoria: A review of the literature"]}}{{pb}}This is a prose summary of a table of past studies on the subject and the prevalence they found. If the occurrence is rare, then it couldn't be frequently causative. (I could not find any query that would give papers like the one you sent. What query did you search up to find that Dutch paper?){{pb}}
{{tqb|The Dutch study found that roughly 46% of trans identities in patients resulted from underlying mental conditions.}}No, it found that Dutch physicians in 2003 believed 46% of their patients' gender dysphoria diagnoses result from underlying conditions. Aaron Liu (talk) 12:23, 6 March 2025 (UTC)

:::::::::::The Dutch survey of 2023 is the only study that directly addressed the second part of the RFC question, as it was indeed based on diagnoses made by Dutch psychiatrists. But at least it offers certain estimates on the matter in question. I don't exactly remember which search query I used, but I tried a lot of different options. Various mental conditions could potentially influence trans identity. In addition to Axis I disorders, the document you quoted noted higher rates of personality disorders in the transgender group, particularly paranoid and avoidant personality disorders, with reported prevalence rates ranging from 4.3% to 81.4% in various studies. The US study attributed its 58% figure just in part to the societal persecution of transgender individuals, implying that other factors were also involved. The same US study also reported that 11% of transgender individuals had bipolar disorder and 4.7% had psychotic disorders, totaling over 15%. As I understand, the study that you quoted is based on Swedish data, while the US data suggests higher prevalence rates for bipolar and psychotic disorders. In medicine, conditions affecting more than 10% of a population are not considered rare and even lower percentages can indicate that a symptom is relatively common. We are asked to vote on issues that are little researched and lack a solid scientific consensus. To claim an actual consensus, we must rely on a broad range of studies rather than citing only one or two ambiguous sources. JonJ937 (talk) 16:43, 6 March 2025 (UTC)

::::::::::::(I'm assuming you made a typo when referring to the Dutch survey of 2003.) How do you suppose personality disorders could cause a transgender identity? How do you suppose anything other than dissociative and psychotic disorders could?

::::::::::::My point is that you're saying "our own judgements won't do" while your arguments are from your own judgements of the sources. It's way beyond just "one or two" sources that claim trans identities aren't frequently caused by mental illness, and it would be absurd to suggest that all of them based their conditions on nothing. Aaron Liu (talk) 18:56, 6 March 2025 (UTC)

:::::::::::::Yes, 2023 was a typo, sorry. I think further discussion is unnecessary. As I mentioned before, there are no sources directly addressing the frequency or infrequency rate, leaving it to subjective interpretation. The three sources you cited do not discuss frequency: the first one (the WHO) is just a declarative statement not addressing frequency. The second one appears to suggest that mental disorders never influence trans identity, which is not accurate, while the third is about gender dysphoria. Reliable statistics explicitly addressing the second part of the question are simply unavailable. I believe the closer will decide whether it was appropriate to combine the two questions into one. JonJ937 (talk) 12:10, 7 March 2025 (UTC)

:::::::{{outdent|6}} The last review I gave aggregates every study worldwide with statistics from all of them in a big table and concludes that severe psychiatric conditions (which you said could cause trans identities) are rare. This is a secondary, far more up-to-date source based on statistical studies that concludes the opposite of what you're bringing up on frequency. Aaron Liu (talk) 12:23, 7 March 2025 (UTC)

::::::::It is not just mental disorders, but also mental conditions like autism, that are highly prevalent in this segment of the population. JonJ937 (talk) 11:15, 8 March 2025 (UTC)

:::::::::I did ask how you suppose anything other than dissociative and psychotic disorders could cause transgender identity. That people have told you that autism is not a mental illness as understood in the RfC statement (which you did not refute) aside, there is absolutely no suggestion that autism causes transgender identities, and I'm not going back to the "causal complex" circle again. Aaron Liu (talk) 23:35, 8 March 2025 (UTC)

{{od}} I don't understand how disregarding causality can be taken as a coherent argument. Further the scientific and psychiatric community do not reject that autism is a mental disorder, in fact your argument has a faulty premice in that the DSM-V does not use the term mental illness at all, but rather uses mental disorder throughout, under which autism is classified as a neurodevelopmental disorder.

I think your framing is simplistic and antagonistic, the literature of causative mechanisms does not put it in those words, but suggests that whether autism may be causative of trangender identities is an open scientific question. If causation exists it is assumed to run through a mediator, by one or multiple of the traits or behaviors that are caused by autism or causative of autism, including potentially rigidity and obsession. This is an open hypothesis in the scientific literature, and is not fringe.

An extremely cursory search finds these three systematic reviews/meta-analyses that discuss it:

[https://link.springer.com/article/10.1007/s40489-022-00338-2 Theories on the Link Between Autism Spectrum Conditions and Trans Gender Modality: a Systematic Review] 2022
[https://pmc.ncbi.nlm.nih.gov/articles/PMC10313553/ Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis] 2022
[https://pubmed.ncbi.nlm.nih.gov/36996732/ Transidentities and autism spectrum disorder: A systematic review] 2023

It's not hard to find credible academic discussion of the topic. CFCF (talk) 22:25, 12 March 2025 (UTC)

:From that first source: {{Tq|Another observation that stands out when looking at all theories, is the difference in reasoning between certain theories. Some theories reason from the deficit model for ASC (e.g., the theories on rigidity, ToM/mentalizing, and social communication) whereas other theories reason from the neurodiversity model for ASC (e.g., the theories on weakened sex differences and resistance to social norms). There are two reasons to argue that theories based on a neurodiversity model might explain the ASC-TGM link better than that reasoning from a deficit model. First, the neurodiversity model lends itself better for reasoning along both sides of the spectrum: this model may account for the co-occurrence of ASC and TGM as well as for the co-occurrence of neurotypicality and cisgender modalities (Walsh et al., 2018). Second, unlike the deficit model, the neurodiversity model does not have the drawbacks of potential social harm or impeded scientific understanding due to the pathologizing of ASC (Dinishak, 2016).}} So this systematic review is saying that thinking of autism as a mental disorder is not actually helpful to explaining the link.

:From the third {{tq|Many theories about the origin of this cooccurrence have been developed over the years. Some of these are controversial and questioned. Criticisms reported include the risk of a delay in appropriate care with a risk of an aggravation of GD and psychiatric cooccurrences. In addition, a significant number of articles use pathologising and cisnormative discourses (Shapira & Granek, 2019). However, these discriminating terms are gradually giving way to a more inclusive literature, testifying to a progressive collaboration between transgender people, autistic people and health professionals.

Regardless of the origin of the cooccurrence, the majority of authors now recognise the need for specialised transidentity care and the authorisation of gender-affirming medical treatments for autistic people on the same basis as for neurotypical people (Strang, Meagher, et al., 2018; Van Der Miesen et al., 2016; van Schalkwyk et al., 2015). Young autistic people find it difficult to access transgender-specialised care, often being discredited (Autistic Self Advocacy Network et al., 2016; Coleman-Smith et al., 2020; Strang, Powers, et al., 2018). A better understanding of this complex cooccurrence will lead to better psychological and physical health and overall functioning for individuals with this cooccurrence.}}

:I think you've been missing the point of the question. There are a sizeable number of quacks who claim that autistic transgender children are really cisgender and think they are transgender because they're autistic. That is the claim that is FRINGE. Whether autism is even a neurodevelopmental disorder as opposed to neurodivergence is contested. Evidence that autism, defined as a mental illness, ie experiencing cognitive distortions/impairments, doesn't exist. All of the sources you spoke note that one can be trans and autistic, none gave any evidence that autism is making cisgender people think they are trans.

:Question: Do you think that the view that cisgender LGB identities are frequently caused by mental illness is WP:FRINGE? Given the fact that autistic people are more likely to LGB than straight? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:29, 12 March 2025 (UTC)

::I think you are the one arguing beside the point. However, as you state your argument, and from the quotes you pull, it seems you are in favor of allowing high quality WP:MEDRS - which as you quotes take a compassionate, human-rights based approach with ethical reasoning - but explicitly do not refute causal mechanisms. In fact these three WP:MEDRS-compliant sources that discuss the matter at hand in-depth with a balanced approach would be useful to express in article space, and are decidedly not WP:FRINGE. Citing these bodies of work, and similar high-quality work should be the preferred strategy of Wikipedia, and has been so throughout numerous controverses over the years. This is how Wikipedia combats the quacks.

::I don't like to see it that only one side of this particular debate consider the point at hand: whether any discussion of population frequency of a causal relationship can be discussed based on high quality sources - and will therefore not respond to irrelevant analogies - that were not part of my argument, not discussed in the sources that I cited, and serve little but to create an inflammatory and adversary debate environment.

::CFCF (talk) 00:27, 13 March 2025 (UTC)

:::And none of these sources could be used to say "autism makes people transgender", "autism causes people to identify as transgender" or even "there is evidence that autism causes people to be transgender".

:::{{Tq| - and will therefore not respond to irrelevant analogies - that were not part of my argument, not discussed in the sources that I cited, and serve little but to create an inflammatory and adversary debate environment.}} - it is directly relevant.

:::Do you think that the view that cisgender LGB identities are frequently caused by mental illness is WP:FRINGE? Given the fact that autistic people are more likely to LGB than non-autistic people?[https://www.mdpi.com/2076-3425/12/11/1427][https://repositorio.unican.es/xmlui/bitstream/handle/10902/35572/GenderIdentitySexual.pdf?sequence=3]

:::According to your reasoning throughout this whole line of argument, the answer is that's not fringe because there is an unexplained higher rate of LGB identities among the autistic population. That is the standard you have applied throughout this conversation. Please explain how the situation differs otherwise I'll presume that's your answer. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 00:50, 13 March 2025 (UTC)

::::Multiple points here - scientific sources do not make statements about causal relationships with blanket statements that "x makes y" - especially with regard to human behavior, but the sources I linked explicitly discuss whether autism may have a causal role in some cases of transgender identities. They conclude that it is an open scientific question that demands further study. I feel I am being straw-manned here, and I fundamentally disagree that your analogy to other populations is relevant, and I think {{U|Colin}} put it well when he wrote:

:::::{{tq|The comparison to LGB identities is also unfair. If a gay person popped along to their GP and said "I'm gay" the doctor would reply "That's nice for you. What exactly did you come here for?" Sure, in the past the response might not be so friendly but we're discussing today's attitudes, not the 1950s. While not every trans person seeks to alter their body, for those who do, they are asking a doctor to perform or prescribe a treatment. One with lifelong consequences and significant effects. This is not like asking a painter to decorate your walls. The medical professional will expect their actions to have evidence of benefit and evidence of acceptable risk of harms. The alternative is just buying pills off the Internet or going to some unregulated country for treatment. Quite how they balance regulation, evidence, medical care and personal autonomy is complex and clearly contentious.}}

::::I would also note that among your sources, MDPI is a pretty ill-reputed publisher, and as for the second - I can't find mention that it discusses a causal relationship at all regarding your questions, so those arguments are not based on that source. I do not feel this is a productive analogy, in large part for the reasons Colin already stated.

::::CFCF (talk) 01:05, 13 March 2025 (UTC)

:::::I reiterate none of these sources could be used in wikivoice to say {{tq|there is evidence that autism causes people to be transgender}}. Nowhere do any of the sources you provided say that there is evidence for a causal link. Nowhere do they state that cisgender people think they are trans due to autism. They say the link should be studied to provide better care to autistic trans people, not to weed out autistic people who mistakenly think they're trans.

:::::Colin's comment was, and continues to be, irrelevant - this question is not about medical treatment it is whether an identity is frequently caused by mental illness. Being trans is not a diagnosis. People who identify as trans don't necessarily always seek medical treatment. If a trans person pops to their GP to say "I'm trans" the doctor will also ask "That's nice for you. What exactly did you come here for?" unless the person has come to say "I want to medically transition".

:::::My second source says {{tq|Some of the literature reviewed exhibited interest in the theories and factors that might explain this higher prevalence in people with ASD. ...In conclusion, the prevalence of gender dysphoria and non `heterosexual orientation in people with ASD is high, particularly in women. This topic needs to be examined in more depth }} It had a section on {{Tq|Psychosocial factors related to non-heterosexual orientation in people with ASD}}[https://repositorio.unican.es/xmlui/bitstream/handle/10902/35572/GenderIdentitySexual.pdf?sequence=3]

:::::Here's another review {{tq|In terms of sexual orientation, the overwhelming consensus of recent research suggests that autistic people demonstrate greater levels of non-heterosexual attraction compared with normative data ... There appears to be a link between autistic traits and increased rates of non-heterosexuality, both within the general population and within autistic samples, perhaps especially amongst autistic women. Likewise, a possible link between GD and ASD is suggested, and ongoing research may help to understand and clarify this link.}}[https://link.springer.com/article/10.1007/s40474-020-00190-1]

:::::AFAICT, your argument is that

:::::* 1) there is an established un-explained positive correlation between autism and identifying as LGB but saying LGB identities are frequently caused by autism is FRINGE

:::::* 2) there is an established un-explained positive correlation between autism and identifying as trans so saying trans identities are frequently caused by autism is not FRINGE

:::::* 3) the reason for different standards/answers is because trans people sometimes medically transition and for some reason this means different standards should be applied to the same question about the influence of mental illness on identity

:::::Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:51, 13 March 2025 (UTC)

::::::I have made no comment as to LGB, apart from giving arguments that it is an irrelevant comparison. I think we can not come further than to agree to disagree here.

::::::I do not care to reiterate my points again and again, because they are spelled out - but must point out that you do not adequately summarize them.

::::::As for the points that are misconstrued, they are (see above) also addressed in authoritative high quality WP:MEDRS-compliant meta-analysis and systematic reviews:

::::::* A) The question in the RfC contains multiple dimensions that need to be answered separately, and should not have the same answer. There is one clear point of agreement in that trans identities are not mental disorders (this could be potential outcome of a close)

::::::* B) High-quality litterature touches upon and discusses a potential causal link between autism (or other disorders) and trans identities. There is evidence, however it is insufficiently to authoritatively state (this is exactly what they are saying) the size, direction, or mediation of this causal relationship. However, discussing it, either numerically or qualitatively is decidedly Not fringe. That does not mean that misrepresenting the current evidence to be stronger than it is - is not fringe, but that is not what I am arguing, and you know this very well.

::::::* C) There is a massive terminological confusion with multiple definitions applied inconsistently - but this is as true with conflation of mental illness and mental disorder in the original RfC question (where much of the research and professional literature does not use the term mental illness). It does not make sense to be so precise with regard to half of the question, but to remain vague in the other half. This will cause problems along the road if it is not addressed.

::::::* D) The RfC question does not define frequently, and as has been expressed by other such as {{U|WhatamIdoing}} - the way the RfC is worded imprecisely is likely to be interpreted as a blanket ban on discussing the topic of a causal role of mental disorder.

::::::* E) Further, there is little to indicate that better studies exploring these causal roles will not in the future, or upon adequate summary in a systematic review - give rise to numeric estimates. Any RfC close must account for a potential high quality source quantifying the relationship, and discussing a frequency. We frankly do not have evidence to support the second part of the RfC question.

::::::CFCF (talk) 09:39, 13 March 2025 (UTC)

:special:Diff/1278357920/1278368779

:#c-FactOrOpinion-20250226201600-CFCF-20250226193700 Aaron Liu (talk) 00:22, 13 March 2025 (UTC)

::You're just pointing to a terminological missmatch between the RfC question, and the broader literature - or specifically the DSM-V that does not use the term "mental illness". Also, note I never once referred to a "causal complex" - I have referred to causality, and causal inference.

::CFCF (talk) 00:31, 13 March 2025 (UTC)

:::https://health.clevelandclinic.org/autism-myths-and-misconceptions
#c-Aaron_Liu-20250226230200-Aaron_Liu-20250226193500 Aaron Liu (talk) 01:33, 13 March 2025 (UTC)

::::That link is entirely irrelevant, and frankly extremely insulting. Not once did I bring up any of those points. I know I have not, because even though it should not matter for Wikipedia, I've spent several years working with children 5-18 in child psychiatry, in the in-patient and psychiatric emergency departments - with considerable training on, interaction with, and experience treating patients with varying severity of autism.

::::I know intently how autism can bring considerable suffering, best alleviated by a compassionate and inclusive approach that considers specific deficits and helps build strategies to handle these. The collective of medical professional organizations and scientific literature does not deny that autism is a neurodevelopmental disorder. The DSM-V classifies autism as a mental disorder, and posits that for a diagnosis there should be "persistent deficits", and that "Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning."

::::The problem is yet again, that the concept in the RfC-question of "mental illness" is not one that is used in psychiatric diagnostic manuals, which use the term "mental disorder".

::::CFCF (talk) 07:01, 14 March 2025 (UTC)

:::::Just like the non-problem that is "frequently", there are certain things we understand to constitute mental illness, and autism decidedly and verifiably does not. Aaron Liu (talk) 11:20, 14 March 2025 (UTC)

::::::But such an argument is entirely invalid when it comes to gender dysphoria, gender incongruity, gender identity etc.? CFCF (talk) 17:46, 14 March 2025 (UTC)

:::::::#c-Aaron_Liu-20250227124800-CFCF-20250226203200
I'll note that you dropped the "mental illness"' line after FactOrOpinion's refutal until resurfacing it at the start of this subsection ("What does frequent mean?"), which is part of what many mean by frustration at taking round in circles. Here, you are dropping your "causal mechanism" argument. Aaron Liu (talk) 18:30, 14 March 2025 (UTC)

::::::::I should think it possible to have multiple gripes with the question, without having to reiterate each one in every post. They are both equally valid arguments, neither of which have been “dropped”. CFCF (talk) 18:56, 14 March 2025 (UTC)

:::::::::That's the problem: Refuting arguments is much more than simply reiterating and repeating the refuted arguments. Aaron Liu (talk) 19:11, 14 March 2025 (UTC)

::::::::::I would think the problem is rather repetition of non-refutation and repeatedly ignoring arguments. For instance the comment that one must be precise when one discusses mental disorder - neurodevelopmental disorder - mental illness, or about frequency - is brushed off. Yet one must be exacting in every instance of terms like gender dysphoria, gender incongruence or gender identity being mentioned - with a total ignorance of this point when it is raised. CFCF (talk) 21:13, 14 March 2025 (UTC)

:::::::::::Not sure what you mean. Are you saying that there is a commonly different understanding for these terms? There's only one meaning for gender identity disorder.
#c-Aaron_Liu-20250302011200-CFCF-20250302000400 Aaron Liu (talk) 22:46, 14 March 2025 (UTC)

::::::::::::I’m saying that part of the problem here is that there is an insistance on being terminologically exact for some parts of the question, and a simultaneous rejection of any need to be similarly exact for the other aspects, which have at least the same amount of semantic depth. That you fail to grasp this despite it being spelled out at least twice is symptomatic of the broader issue here. WP:ICANTHEARYOU CFCF (talk) 05:39, 15 March 2025 (UTC)

:::::::::::::I mean that I do not understand the reasoning behind thinking the latter 3 terms are too exact. Is there some sort of misunderstanding of what GID means? It's not look GID's criteria have some sort of number (which you've asked for and believe should be the standard for "frequent") at all. I do not see the disparity in specificity you claim, especially when nearly everyone else understands what precisely the terms mean
except "mental illness". But that does not change #c-Aaron_Liu-20250302011200-CFCF-20250302000400. There is still absolutely no suggestion of any possibility for a causal relationship from the numerous correlations you have mentioned. Aaron Liu (talk) 16:13, 15 March 2025 (UTC)

::::::::::::::I'm not saying that they are "too exact", but that the others are "too inexact" as formulated in the RfC question, AND that my attempts to be more exact have been brushed off based off what is "generally understood". CFCF (talk) 17:35, 15 March 2025 (UTC)

I would like to make a quick observation to the people commenting in this section: this discussion you've been having has been going on for a long time, so long people stumbling on this RFC are unlikely to read any significant portion of it, so it's unlikely to influence any editor to change their opinion. It also doesn't appear to be likely to influence a closer, because the opinions in the Survey section above are quite one-sided. And certainly neither side has been able to convince the other over the past month. Because of this, I am wondering why it's still going on. It frankly seems to me like you've been talking in circles for a while without much point. Loki (talk) 21:44, 6 March 2025 (UTC)

:{{u|CFCF}} and {{u|Aaron Liu}}: I want to echo Loki's call for this sub-thread to end. Nothing has been gained or clarified here, especially not in the 9 days since Loki first pointed this out. Please remember WP:LASTWORD. I ask for an uninvolved editor to close this so as to facilitate a timely resolution of the larger RfC. Generalrelative (talk) 16:27, 15 March 2025 (UTC)

::Sorry, I forgot about this since Jon did bring up something that I asked for, and I think it was worthy that we explored that, but I probably should've stopped after that. Aaron Liu (talk) 17:01, 15 March 2025 (UTC)

:::Cheers. I recognize that you and CFCF aren't the only two in the conversation, just the last two to be engaging over the past couple days. Hopefully now that they've gotten the last word in, they'll drop it too. Generalrelative (talk) 17:41, 15 March 2025 (UTC)

{{od}}I think something like 10 people have engaged over the past few days, and I distinctly believe that there is a meaningful discussion to be had - in relation to 1) what language we use to specify mental disorders/mental illness, 2) how we specify terms relating to frequency, 3) how we treat high-quality WP:MEDRS-compliant sources that discuss causal relationships between mental disorders and transgender identities and potentially quantify them, 4) why we are not equally exacting in the parts of the question that relate to this - as we are when it comes to defining transgender identities, gender dysphoria, gender identity, gender identity disorder - etc.

I certainly believe that this is important for the closer of this RfC - and also the broader debate and in future discussions.

CFCF (talk) 17:43, 15 March 2025 (UTC)

=== Closure ===

Comment: I previously closed this RfC but I have overturned it. Even if I was right, which I'm no longer confident that I am, it doesn't hurt to get a second opinion. guninvalid (talk) 06:44, 3 March 2025 (UTC)

:Prior closure text: Procedural closing a discussion that has long-since devolved into a mess of WP:ABF, WP:ADHOMINEM, and WP:DIDNTHEARTHAT, on top of the WP:ILIKEIT, WP:BUTITSTRUE, and WP:OTHERSTUFFEXISTS arguments.

:The only consensus I read here is that the question being asked is too broad to come to a meaningful conclusion. This RfC needs to be redone with a more specific question, such as "Should X theory be considered WP:FRINGE?". If the intention was to come to a broader agreement about the topic as a whole, it would be preferable to use a question with a nonbinary or qualifed answer rather than a yes/no: e.g. "When should a theory of transgender identity be considered WP:FRINGE?" with options such as "A When Person A says so", "B When Publication A says so", etc.

:I would also like to give a general WP:TROUT to editors insisting that editors read pages of WP:RFCBEFORE before engaging in this discussion when every meaningful word of the question itself was litigated to death. guninvalid (talk) 06:48, 3 March 2025 (UTC)

::{{tqb| "When should a theory of transgender identity be considered WP:FRINGE?" with options such as "A When Person A says so", "B When Publication A says so", etc.}}That is not how Fringe works. The definition of Fringe is that only a very minority of sources among all the relevant sources for thing claim a certain property about that thing. Aaron Liu (talk) 13:33, 3 March 2025 (UTC)

::{{tqb|needs to be redone with a more specific question, such as "Should X theory be considered WP:FRINGE?"}}That's exactly what the question says: "Is WP:FRINGE within ?" (And no one is obligated to answer the entire question at once, either. People can and have split that question while responding.) Aaron Liu (talk) 13:39, 3 March 2025 (UTC)

::I also do not understand the citations of ILikeIt and ButItIsTrue at all. Nobody asserted facts without having been backed up with sources.{{pb}}And no one expected people to read the entire RfCBefore. At most, some were pointed to only the quotes contained within the very first comment in the Before. Aaron Liu (talk) 17:42, 3 March 2025 (UTC)

:::I was repeatedly told to read all of it, despite repeatedly stating I had done so and come to a different conclusion. CFCF (talk) 22:14, 12 March 2025 (UTC)

::::Where? Loki (talk) 00:10, 13 March 2025 (UTC)

:::::Just to take a few examples from the closed section "Replies to CFCF": [https://en.wikipedia.org/wiki/Wikipedia:Fringe_theories/Noticeboard#c-SmittenGalaxy-20250220130300-CFCF-20250220125900] / [https://en.wikipedia.org/wiki/Wikipedia:Fringe_theories/Noticeboard#c-SmittenGalaxy-20250220142900-CFCF-20250220142100]

:::::CFCF (talk) 00:50, 13 March 2025 (UTC)

::::::I still stand behind saying that it's not implausible to read the above discussion before this RfC. It isn't particularly long. On my screen it doesn't take up much more than a couple screen lengths, which is perfectly readable. I began asking if you and others actually read the backing medical literature because you had made demonstrably false claims about what they say and what they mean. This to me doesn't seem like an unreasonable question to ask when you assert things that aren't true; you say you have read and understand literature on the subject but repeat false claims. I don't expect anyone to read a bunch of medical literature when responding to an RfC, but if you act like you know what you're talking about, then I'm going to within reason ask if you actually did read it or not. Regardless, I still stand behind this closing being a huge error in judgement. SmittenGalaxy | talk! 04:57, 13 March 2025 (UTC)

:::::::I clarified to you that I had read a considerable amount of the medical literature. Coming to a different conclusion is not the same as making a false claim. I can not see that you have pointed out a single false claim.

:::::::CFCF (talk) 09:43, 13 March 2025 (UTC)

::::::I'll concede that part, then. I think I didn't notice that because of the collapsing that happened around the close. Aaron Liu (talk) 22:48, 14 March 2025 (UTC)

::I'm glad this was self-reverted. It is by no means an accurate reflection of consensus here, and also makes a lot of errors in judgement when reading the survey and discussion section. Aaron has already pointed out the obvious judgement call errors, but my main issue is using the term "procedural close" when nothing in the closing statement seems to support closing procedurally. Comments in the survey and discussion section are brought up, and a number of WP space pages are brought up, but some are essays (one literally being tagged as humor), and nothing is really said about the RfC itself — this would be the reason a discussion would be procedurally closed. If the RfC fundamentally had issues with its question or formatting, that would be a good reason to do so. However, it has none of these, as has been also discussed extensively.

::When it does come time for this discussion to be closed, however, I would prefer it to be an admin closer to prevent more of this from happening. SmittenGalaxy | talk! 22:51, 3 March 2025 (UTC)

:::No matter how this discussion is summarized, I expect some editors to claim "errors of judgment" or "not reflecting the discussion". I therefore only here "didn't support my POV" when I see such claims.

:::I agree with the closer that the question is overly broad. In fact, I dropped by to see what the result was because of a comparison that @Lewisguile made elsewhere to Multiple sclerosis: Why do MS patients not have to get psychotherapy before they get medication? The answer is because MS is accepted as a disease, and medications ("a drug used to diagnose, cure, treat, or prevent disease") are one of the tools we use for diseases. We don't use medications to treat normal human variations; normal human variations do not require medications.

:::This puts us (i.e., the reasonably humane parts of society) in a somewhat awkward position. We want trans people to be just "diseased" enough to qualify for treatment with substances reserved for treating "diseases", but not so much that the individuals are treated like anything is actually wrong with them. You can call this distinction nuance or hairsplitting or sophistry or whatever you'd like, but does not strike me as being susceptible to ham-fisted answers. WhatamIdoing (talk) 22:35, 14 March 2025 (UTC)

::::Arguably, it is gender dysphoria (the diagnosis of which requires significant distress) that is "diseased" enough to qualify for treatment with substances, and it seems to me that for the subset of disorders that we often call mental illnesses, doctors may well want a patient to have psychotherapy before being treated with medication (or in combination with a medication). We often want people to simultaneously hold two ideas in their heads about diseases/disorders: a disease/disorder is a variation from what's healthy (and therefore might be treated), but a person isn't their disease/disorder. How one bounds what is/isn't a "normal human variation" may partly depend on society's response to it. If societal beliefs about gender identity were different, would that influence the proportion of people experiencing gender dysphoria? FactOrOpinion (talk) 00:48, 15 March 2025 (UTC)

::::{{tq| I therefore only here "didn't support my POV" when I see such claims}} This is just a bad faith argument. There have been two (maybe three, depending how you read them) !votes against; and while discussion is consensus based and not on votes or headcounts, none of the people opposing actually give solid rationale against the question itself. It's mostly just saying the question is bad or phrased wrong or too broad. To say that there is no consensus or even consensus against this RfC is just plainly a misread of the discussion. You're free to interpret or read it differently, but I'm also free to disagree with that.

::::{{tq|I agree with the closer that the question is overly broad}} That much is clear, and I don't feel the need to tread over this again as we have already had much discussion about this at length. Comparisons to MS are faulty, personally, and I'm not interfacing with that.

::::{{tq|We want trans people to be just "diseased" enough to qualify for treatment with substances reserved for treating "diseases"}} This to me reads as opposing the question in the RfC that it is fringe to believe that being transgender is a disease or disorder. There isn't reliable medical literature that says this nor literature that says it's caused by a disease or diseases, which is the crux of this RfC. You're free to believe that, but to say it is not fringe requires reliable sources backing it up. SmittenGalaxy | talk! 02:07, 15 March 2025 (UTC)

:::::{{smalldiv|1=sic-ing others is a bit needlessly combative IMO Aaron Liu (talk) 02:30, 15 March 2025 (UTC)}}

::::::{{smalldiv|1=I don't personally think it's all that combative, but I went ahead and removed it nonetheless. SmittenGalaxy | talk! 02:51, 15 March 2025 (UTC)}}

::::@WhatamIdoing, I'm not sure why you're raising my comment here or really why it responds to the RfC. I also think you're still missing my point, so perhaps I wasn't clear enough or perhaps you glossed over what I wrote. I was definitely not saying being trans is a disease (though you seem to be saying it is); in this case, gender dysphoria or another diagnostic label would be considered the thing you're treating (or at least, any distress these might cause), not transness itself.

::::My previous point, broadly speaking, was that a) making people undergo unnecessary treatments is a form of iatrogenic harm in itself, and b) requiring someone to undergo an unnecessary treatment to then obtain another treatment that may be necessary, and which they want, is unethical and absurd. These would also violate basic principles of medicine, such as providing individualised care, requiring informed consent (you can't truly consent if something is mandatory), listening to the patient's needs and wishes, and maintaining a therapeutic relationship. Not to mention that treatments should be acceptable to patients, and should be evidence-based (most experts and international organisations say that a primary psychosocial approach doesn't work, and GET is relatively new/unproven in any case).

::::Most of which is a tangent for this thread, so I apologise for that, but I felt I should clarify my POV, after I was summoned here. To bring it back to the topic at hand, I don't see diagnoses such as gender dysphoria as meaning that transness is a disease, or that it is caused by one. There's no evidence supporting that, and correlation =/= causation. Etc. Lewisguile (talk) 14:05, 15 March 2025 (UTC)

:::::There seems to be broad consensus that being trans is not a disease - that was never really a point of controversy in this RfC. Also, I am not sure the merits of GET are even being discussed here. I am quite certain that WhatamIdoing does not broadly reject hormone therapy, so let's quash that argument before we derail even more.

:::::However, I do feel I must point out that individualized care does not seem to mean what you think it is. You could arguably take that argument the other way, that hormone therapy is not individualized. Further there is not parity of potential harm of different therapies - with hormone therapy not being uncontroversial - as it does confer sterility in a sizable proportion of those who take it, especially if the start early on.

:::::A further point is that therapy being acceptable is not the same as therapy aligns fully with the personal preferences of the patient. There are many medical treatments that are not preferred by patients, ranging from not getting antibiotics for a common cold, to when to perform surgery, to many psychotherapies where the therapy itself is unpleasant. This is a general theme in medicine, and is not exclusive to gender incongruity.

:::::Lastly, we all know that correlation is not causation, but we must also know that correlation likewise can imply causation, and there are high quality WP:MEDRS-compliant sources that discuss the potential for causation, e.g. between autism, DID or other mental disorders or neurodevelopmental disorders and transgender identities (see above).

::::: CFCF (talk) 15:21, 15 March 2025 (UTC)

::::::As I noted above, if there exists a C that contributes to both A and B, one may find a correlation between A and B, despite A itself not causing B, and B not causing A. My impression is that researchers are exploring the potential for C. I must have missed the "high quality WP:MEDRS-compliant sources that discuss the potential for" mental illness itself to frequently cause people to identify as trans. Would you mind linking to the comment where you cited the latter kind of high quality WP:MEDRS-compliant sources? FactOrOpinion (talk) 16:01, 15 March 2025 (UTC)

:::::::[https://en.wikipedia.org/wiki/Wikipedia:Fringe_theories/Noticeboard#c-CFCF-20250312222500-What_does_frequent_mean?] CFCF (talk) 17:23, 15 March 2025 (UTC)

::::::::Thank you. That returns us once again to the question of whether it's common for the field (as represented in relevant MEDRS-compliant publications) to treat "mental illness" as interchangeable with "mental disorder." I don't know the answer to that, and I don't know if @Your Friendly Neighborhood Sociologist ever addressed it. FactOrOpinion (talk) 18:49, 15 March 2025 (UTC)

::::::::Could you quote where these say it's possible that mental illness/disorders frequently cause transgender identification/gender dysphoria? Aaron Liu (talk) 20:30, 15 March 2025 (UTC)

:::::::::As CFCF said, "cause" has not been proven. "Correlation" is the only thing that has been proven.

:::::::::(Also, to get an answer, you'd have to define "mental illness/disorders". For example, is autism included or excluded from that group? What about dementia? And do detransitions due to neurocognitive problems count? [https://www.tandfonline.com/doi/full/10.1080/07317115.2024.2399575] I think they might, since the general case is "medical problem causing any significant change to gender identity", not just in one direction.) WhatamIdoing (talk) 21:48, 15 March 2025 (UTC)

::::::::::Indeed, CFCF is saying that sources believe it's a possibility that trans identities are frequently caused by mental illness (let's just say that includes everything in the DSM -5), therefore the the notion is not fringe. I am asking him to quote such statements. Aaron Liu (talk) 22:07, 15 March 2025 (UTC)

:::::::::::I think the line of reasoning is: (1) the DSM-5 treats autism as a mental disorder, (2) there's a notable correlation between being on the autism spectrum and identifying as trans, (3) some researchers are investigating hypotheses about why (some hypothesize a common cause, others hypothesize direct causality in one or the other direction, more often in the direction of autism → trans identity; for ex., see [https://link.springer.com/article/10.1007/s40489-022-00338-2/tables/3 this table] for a summary from the first systematic review CFCF referred to above), (4) other researchers treat that research as reasonable, and therefore (5) the idea that identifying as trans might often be caused by a mental disorder (autism) isn't fringe. But I don't think you're going to get a quote of the sort that you're looking for. FactOrOpinion (talk) 23:07, 15 March 2025 (UTC)

::::::::::::That is a very interesting table (of which I had the completely preventable misfortune of completely skipping in my skim) and a valid argument. However, (ignoring whether this counts as frequent causation) I'm a bit skeptical whether we can take "ASC → TGM" at face value, as the theory here most mentioned is "TGM is more common among autistic people compared to neurotypical people because they are less susceptible to social norms/prejudice", which I would hesitate to classify as autism causing TGM despite agreeing that it fits into the "ASC → TGM" mechanism category. So I still think we need a quotable RS characterization of what it deems a plausible possibility as "autism frequently causes TGM" before we decide that's not Fringe. I do see why one could think this now, though. Aaron Liu (talk) 01:47, 16 March 2025 (UTC)

::::::::::::I just want to note the review itself concludes that the psychological explanations, particularly {{tq|Obsessions are a manifestation of ASC leading to (temporary) TGM}} as noted in the table, mostly have evidence against against them, saying {{Tq|Secondly, the theories on obsessions and rigidity mostly or solely received claims of evidence against them. Based on this, it may be concluded that neither obsessions nor rigidity are likely to play a role in the ASD-TGM link.}}

::::::::::::They state {{Tq|One paper offered evidence for and four papers offered evidence against obsessions as an explanation. Zucker et al. (2017) claimed evidence for obsessions based on their finding that GD-referred children had elevated rates of obsessions compared to referred and non-referred controls. They considered obsessions an established ASC trait and argued that ASC leads to TGM rather than the other way around}} - Kenneth Zucker of course being a conversion therapist - WP:FRINGE...

::::::::::::So point 4 in the change of reasoning is flawed as 1) the review notes evidence points away from it and 2) the one advancing it as a hypothesis is known to be fringe in this field. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:55, 16 March 2025 (UTC)

:::::::::::::Yeah, that is what one'd usually think of and characterize as "ASC causes TGM" instead of "ASC causes lowered susceptibility for social norms thus causing an increase in TGM". There are other "causality" explanations like the latter and without evidence against or fringidity mentioned in the table, and like I said in the reply above yours I think we should {{tq|need a quotable RS characterization of what it deems a plausible possibility as "autism frequently causes TGM" before we decide that's not Fringe}} Aaron Liu (talk) 19:22, 16 March 2025 (UTC)

::::::::::::::But CFCF isn't saying that there's evidence that "autism frequently causes TGM." As I understand it, CFCF's saying that it's not a fringe theory that autism frequently causes TGM (however one bounds "frequently," which the RfC never identified), because a number of researchers have hypothesized this, and the field isn't treating their hypothesis/research as fringe. FactOrOpinion (talk) 20:17, 16 March 2025 (UTC)

:::::::::::::::Sorry, I meant {{tq|RS characterization of what it deems a plausible possibility as "autism frequently causes TGM"}}. Edited. I've also discussed "frequently" above. Aaron Liu (talk) 21:30, 16 March 2025 (UTC)

::::::::::::::::If you're looking for a statement from a MEDRS-compliant source, I suppose the issue is how those authors would interpret "frequently," not how any of us do. But my guess is that since researchers are still at the stage of hypothesizing about / investigating possible explanations for the correlation, they're not going to make claims about the frequency with which autism might cause someone to identify as trans.

::::::::::::::::That first systematic review that CFCF noted says "The interest in the co-occurrence of ASC and TGM has grown. In just a few years, the number of articles published on the topic has tripled. ... The most recent publication on the [link] is a systematic review by Thrower et al. (2020) ... [who] conclude that their findings suggest a prevalence of ASC in 6–26% of trans people. This is significantly higher than the prevalence of ASC in the general population, which has been estimated to be around 1.85% (Maenner et al., 2020)." If they don't even have a good sense of the rate of co-occurrence, how could they propose a frequency of causality? FactOrOpinion (talk) 22:44, 16 March 2025 (UTC)

::::::::::::::{{outdent|2}} {{tqb|I suppose the issue is how those authors would interpret "frequently," not how any of us do.}}I'm fairly that's how it's supposed to be, in fact, according to NoOriginalResearch. We could decide what words used by researchers count as "frequently" in the future though, I think.{{tqb|they're not going to make claims about the frequency with which autism might cause someone to identify as trans}}Until they do (even just about a possibility), it would be fringe. Aaron Liu (talk) 02:44, 17 March 2025 (UTC)

:::::::::::::::Is there any way to fill in the blank such that you could quote a researcher saying something like "it's possible that transgender identities are frequently caused by ____"? FactOrOpinion (talk) 04:31, 17 March 2025 (UTC)

::::::::::::::::Assuming you mean which blanks would qualify for "mental illness": I think it'd be much better if we stated whatever was in that blank instead. Aaron Liu (talk) 12:35, 17 March 2025 (UTC)

:::::::::::::::::No, not limiting the blank to mental illnesses. I'm asking you if there is ANY way to fill in the blank such that you could quote a researcher saying something like "it's possible that transgender identities are frequently caused by ____."

:::::::::::::::::(There are other sorts of direct causality hypotheses that people are researching. For example, perhaps you can quote a researcher saying something like "it's possible that transgender identities are frequently caused by genetic variations." Or perhaps you can quote a researcher saying something like "it's possible that transgender identities are frequently caused by prenatal hormone exposure. Etc. I'm just asking if there's ANY way to fill in the blank where you'd be able to present a quote for it.) FactOrOpinion (talk) 13:15, 17 March 2025 (UTC)

::::::::::::::{{outdent|3}} Yeah, I think nearly everything under Causes of gender incongruence would qualify. Aaron Liu (talk) 17:47, 17 March 2025 (UTC)

:::::::::::::::Then choose whichever one you want, and present a quote from a researcher saying something along the lines of "it's possible that transgender identities are frequently caused by" whichever one you chose. (If you're wondering why I'm asking for an actual quote, it's because you said "we need a quotable RS characterization of what it deems a plausible possibility as "autism frequently causes TGM" before we decide that's not Fringe." I'm asking you to hold yourself to that same standard for a hypothesis that you don't consider fringe.) FactOrOpinion (talk) 19:06, 17 March 2025 (UTC)

::::::::::::::::I'm going to do Aaron's job for him here.

::::::::::::::::{{tq2|This review of existing family and twin studies summarizes significant and consistent evidence for the role of innate genetic factors in the development of both cisgender and transgender identities, a negligible role for shared environmental factors, and a small potential role for unique environmental factors.}}

::::::::::::::::Direct quote from {{cite journal |last1=Polderman |first1=Tinca J. C. |last2=Kreukels |first2=Baudewijntje P. C. |last3=Irwig |first3=Michael S. |last4=Beach |first4=Lauren |last5=Chan |first5=Yee-Ming |last6=Derks |first6=Eske M. |last7=Esteva |first7=Isabel |last8=Ehrenfeld |first8=Jesse |last9=Heijer |first9=Martin Den |last10=Posthuma |first10=Danielle |last11=Raynor |first11=Lewis |last12=Tishelman |first12=Amy |last13=Davis |first13=Lea K. |title=The Biological Contributions to Gender Identity and Gender Diversity: Bringing Data to the Table |journal=Behavior Genetics |date=March 2018 |volume=48 |issue=2 |pages=95–108 |doi=10.1007/s10519-018-9889-z |pmid=29460079 |url=https://pubmed.ncbi.nlm.nih.gov/29460079/ |access-date=15 December 2024 |issn=1573-3297}} Flounder fillet (talk) 19:17, 17 March 2025 (UTC)

::::::::::::::::Flounder's quote would do it. You also have quotes like {{tq|These findings suggest a role for genetic factors in the development of GID.}} and{{tqb|There are biological theories that explain the possibility of the role of sex hormones that play a vital role in the differentiation of the baby in utero into male and female based on the sex chromosomes. This happens at around 7 months in the uterus while the baby is developing. The early effects of sex hormones on the brain play a role in the development of male and female phenotypes. It has been proposed that gender-incongruent feelings may be due to an atypical sexual development of the brain mediated by the pre-natal hormonal peaks [35].}} Aaron Liu (talk) 20:40, 17 March 2025 (UTC)

:::::::::::::::::I don't think that either quote does what you asked for from CFCF. "X plays a role in TGM" ≠ "X frequently causes TGM." You asked for the latter, but the quotes from both of you are the former. Are you saying that the former is sufficient for you? FactOrOpinion (talk) 20:56, 17 March 2025 (UTC)

::::::::::::::{{outdent|3}} Makes sense, good point. Then these quotes would only be able to source "it's possible that ____ plays a role in gender incongruence" and "it's possible that gender incongruence is caused by ____", for which we don't have sources to fill the blank with "mental illness/disorders" either. (And the blank would exclude sources that just say "it can" or "in certain cases" as opposed to even just "play a role in".) Aaron Liu (talk) 22:04, 17 March 2025 (UTC)

:::::::::::::::I think the more significant issue is: @Your Friendly Neighborhood Sociologist introduced an RfC asking (in part) "Is the view that transgender identities are ... frequently caused by mental illness WP:FRINGE within the bounds of mainstream medicine and international human rights?" (emphasis added), and if researchers aren't saying "transgender identities are ... frequently caused by X" for any X (not just X=mental disorders) then how does one distinguish between the "transgender identities are ... frequently caused by X" claims that are/aren't fringe? (For example, are they all fringe?) FactOrOpinion (talk) 22:47, 17 March 2025 (UTC)

::::::::::::::::It feels like the same thing as "... is caused by" to me (and to Flounder as well), but I concede that it's arguable. Aaron Liu (talk) 01:24, 18 March 2025 (UTC)

:::::::::::::::::I don't understand your response: I don't know what that ellipsis stands for, I don't know what the referrent of "It" is, and I don't see how your response addresses the question I asked. FactOrOpinion (talk) 02:30, 18 March 2025 (UTC)

::::::::::::::{{outdent|3}} I misinterpreted your question mark as identifying a problem that YFNS needs to clarify. Ellipsis stands for "gender incongruence" here. "It" refers to "... is frequently caused by", which feels like the same thing as "... is caused by" to me and Flounder (hence "frequently" would be cited by the latter and would not be fringe as long as the latter isn't fringe), but you have a very good point here and I would not be citing "frequently" with a solely "is caused by" in wikivoice after this conversation. Aaron Liu (talk) 02:41, 18 March 2025 (UTC)

:::::::::::::::I was trying to identify a problem. So I'll try explaining again. Background: in the RFCBEFORE discussion, YFNS presented statements from the mainstream medical community that identifying as transgender isn't itself a mental illness, but she didn't present statements from the mainstream medical community suggesting that the idea "transgender identities are ... frequently caused by mental illness" is fringe. She hasn't presented any such statements in this discussion either. As best I can tell, no one in this discussion has presented evidence from the mainstream medical community suggesting that the idea "transgender identities are ... frequently caused by mental illness" is fringe; instead, most people claim it's fringe and try to shift the burden of proof to those questioning whether it's fringe (an argument from ignorance fallacy).

:::::::::::::::Above, I asked if there's any X at all (not limited to mental disorders) such that someone can find researchers making a claim along the lines of "transgender identities are ... frequently caused by X." You and Flounder had no example. (Maybe an example exists, maybe it doesn't; we don't know.)

:::::::::::::::All of this suggests to me that although researchers are exploring possible causes of gender incongruence, the mainstream medical community simply isn't far enough along with this research to say "this is known to be a frequent (or infrequent) cause" vs. "that ostensible frequent cause is a fringe theory." It makes me think that the second half of YFNS's RfC question is seriously problematic: it's premature vis-a-vis where the research community is. FactOrOpinion (talk) 14:58, 18 March 2025 (UTC)

::::::::::::::::If there are no RS saying mental illness causes people to identify as trans, it is fringe to say mental illness causes people to identify as trans, and doubly fringe to claim it's frequent. That's really the bottom line.

::::::::::::::::Part of the issue here is that {{tq|transgender identities are ... frequently caused by }} takes for granted that things cause gender identities. We have sources like this statement from the Endocrine Society that gender identity (ie, both cisgender and transgender identities) are biologically determined and can't be changed.[https://www.endocrine.org/advocacy/position-statements/transgender-health]

::::::::::::::::Claiming it's "premature" is ignoring that for decades, people thought being trans was caused by psychopathology, and MEDRS realized that was completely wrong.

::::::::::::::::This line of reasoning is like saying {{tq|cisgender identities are ... frequently caused by mental illness}} isn't FRINGE because sources don't explicitly talk about how often being cisgender is caused by mental illness. If you feel that's an unfair comparison, remember that MEDRs consider trans and cis identities equal and simply an expression of human diversity. Or even {{tq|non-heterosexual sexual orientations are ... frequently caused by mental illness}}.

::::::::::::::::If you want to claim that being trans can be caused by mental illness, you need RS saying so. If you want to claim it's frequent, you need RS saying so. You can't claim that because no RS say how often being trans is caused by mental illness we can't say guessing it's frequent is FRINGE - while ignoring that MEDRS have, for a long while now, rejected the premise that being trans is caused by mental illness. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:35, 18 March 2025 (UTC)

:::::::::::::::::Biological determination can still have causes, like prenatal hormone exposure. Even having a cis sex has a cause as in somebody was randomly assigned a certain chromosome or another one. (Also, Fact's argument is that every "frequently" statement would be fringe, not that one isn't fringe; thus the fringing argument would be unfalsifiable.) Aaron Liu (talk) 16:00, 18 March 2025 (UTC)

:::::::::::::::::{{tq|If there are no RS saying mental illness causes people to identify as trans, it is fringe to say mental illness causes people to identify as trans, and doubly fringe to claim it's frequent.}} By that reasoning, it may be fringe to say that any specific factor causes people to identify as trans; at least, I'm unaware of MEDRS saying "X causes people to identify as trans" (or cis, for that matter), where X is explicitly identified. But if you have a MEDRS making that kind of causal statement and identifying X, please present it. This isn't a field in which I have expertise. Moreover, I have no idea whether there are no RSs saying that, as I've made no attempt at a lit. review myself, nor has anyone here presented a systematic review about it.

:::::::::::::::::{{tq|the Endocrine Society [says] that gender identity (ie, both cisgender and transgender identities) are biologically determined and can't be changed.}} They actually say something a bit weaker: "Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity." "An element" does not imply "the only element." If you have a MEDRS saying "gender identity is 100% biologically determined" just present it.

:::::::::::::::::{{tq|If you want to claim that being trans can be caused by mental illness, you need RS saying so}} I already noted that "can be" is an existence claim, and it's foolish to say that in all of human diversity, it cannot be. Here, for example, is [https://academic.oup.com/smoa/article/11/2/qfad018/7161662?login=false a case of DID] where that mental illness seems to have caused a trans identity in one of the alters. If you actually mean "If you want to claim that being trans can frequently be caused by mental illness, you need RS saying so," then that's a huge "if": nowhere have I claimed that identifying as trans can frequently be caused by a mental disorder, and I have zero burden of proof for something I haven't claimed. In contrast, you are saying that it's fringe, so you do have a burden of proof for that, which is part of what I am saying. I'm exploring what CFCF has argued / am trying to understand their chain of reasoning because an openness to thinking about evidence and arguments is a central part of science. That argument includes: the DSM focuses on mental disorders, including neurodevelopmental disorders, which in turn includes autism, and people are currently researching whether autism plays a direct causal role for some people in identifying as trans, and the field isn't treating their hypothesis/research as fringe. Will their research actually confirm this? I have no idea. I, personally, do not use the phrase "mental illness" in a way that includes autism, but I don't actually know how the medical field treats the terms "mental illness" vs. "mental disorder" (i.e., whether they're treated as synonymous or instead as the former being a proper subset of the latter, or if some people say the former and some the latter). In general, I am more tentative than many people about whether we actually know something. In this case, I'm also more tentative about what's been established as fringe vs. the possibility that it's only a minority view. If you interpret my tentativeness and my openness to considering CFCF's argument as a positive assertion on my part that "being trans can frequently be caused by mental illness", then that's a misinterpretation on your end. I've sometimes challenged people on both ends of this disagreement because I find that people are making stronger claims than there's actually evidence for. FactOrOpinion (talk) 17:25, 18 March 2025 (UTC)

::::::::::::::::::I'm not saying you're arguing it's not FRINGE personally, I think you're steelmanning CFCF's argument and am responding to that.

::::::::::::::::::{{tq|In contrast, you are saying that it's fringe, so you do have a burden of proof for that, which is part of what I am saying}} - this is a misunderstanding of how WP:FRINGE works and an argument from ignorance fallacy - the burden is the other way around. WP:FRINGE/WP:PARITY goes in depth about how how RS frequently simply ignore FRINGE positions. Basically, any view about BIOMED topics is FRINGE unless MEDRS say it. To prove it's not FRINGE, one needs to show some MEDRS that say "transgender identities are frequently caused by mental illness". CFCF's argument that a statement with no evidence and no MEDRS support might one day be supported by MEDRS and therefore can't be FRINGE is ridiculous. Especially given that for decades MEDRS thought trans identities were a mental illness or symptom of one (the premise of Gender identity change efforts) and then realized they were wrong and stopped saying so.

::::::::::::::::::The statements that {{tq|[transgender/cisgender/heterosexual/LGB] identities are ... frequently caused by mental illness}} are all equally FRINGE, since in no case do MEDRS agree. The standard "MEDRS don't say it's false and one day MEDRS might say that's true so it can't be FRINGE" applies to all of them. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:28, 18 March 2025 (UTC)

:::::::::::::{{Outdent|:::::}}I wasn't familiar with the term "steelmanning." Interesting. Re: {{tq|this [i.e., you have a burden of proof for your claim that this is fringe] is a misunderstanding of how WP:FRINGE works and an argument from ignorance fallacy}}, no, it's not an argument from ignorance. If I said "if you can't prove it's true, then it's false," that would be an argument from ignorance, but I'm only saying that each of us has a burden of proof for our T/F assertions. If someone can't meet that burden, then the appropriate response is either to say "OK, then we don't know" or to prove them wrong.

:::::::::::::If your approach is {{tq|To prove it's not FRINGE, one needs to show some MEDRS that say "transgender identities are frequently caused by mental illness"}}, aren't all claims of the form "transgender identities are frequently caused by X" fringe? As best I know, MEDRS aren't saying "transgender identities are frequently caused by X," no matter what you substitute for X. My own approach, though, is: if the research community is treating X as a reasonable thing to research, then it's not fringe. FactOrOpinion (talk) 00:27, 19 March 2025 (UTC)

:::::::::::::::::P.S. To be clear: I also think that cis identification can be caused by a mental disorder, as when internalized transphobia leads a trans person to identify as cis. (At least, I'd consider that a mental disorder, but I don't know if there's literature about this.) FactOrOpinion (talk) 18:45, 18 March 2025 (UTC)

::::::::::::::::Sorry, I wasn't clear. I understand the problem that you've identified (and my initial misunderstanding was to whom the question mark was addressed). However, that the question was improperly worded doesn't mean we can't find consensus for other wordings. I think we can agree that "gender incongruence is caused by mental illness/disorders" is fringe and different from "can be caused by". Aaron Liu (talk) 15:51, 18 March 2025 (UTC)

:::::::::::::"the review itself concludes that the psychological explanations, particularly 'Obsessions are a manifestation of ASC leading to (temporary) TGM' as noted in the table, mostly have evidence against against them"

:::::::::::::No, Wattel, Walsh and Krabbendam noted that for 2 of the 7 causal psychological hypotheses (obsessions and rigidity), more papers presented evidence against those hypotheses than for them, and WW&K raised questions about another 3, but WW&K didn't say that the psychological hypotheses in general "mostly have evidence against against them." WW&K actually noted that many of the papers with causal psychological hypotheses didn't present empirical evidence either way.

:::::::::::::"So point 4 in the change of reasoning is flawed as 1) the review notes evidence points away from it and 2) the one advancing it as a hypothesis is known to be fringe in this field."

:::::::::::::No, it's not flawed. Point 4 was "other researchers treat that research as reasonable." That WW&K conclude that a specific hypothesis is unlikely to be an actual explanation in no way implies that they believe the research itself to have been unreasonable, much less that they consider the hypothesis fringe. They excluded a number of papers from the review (many based on title or abstract, but 13 after reading the paper, for unspecified reasons). Do you really think that they said to themselves: "this is a fringe hypothesis / this is fringe research, but let's include this paper in our review anyway"? The fact that all of these research papers (including Zucker's) were included in the review suggests pretty strongly that WW&K don't consider the theories fringe. Minority, perhaps, but not fringe. I can't imagine anyone conducting a systematic review and including a paper that advocates a fringe theory, unless fringe research is the actual focus of the review. FactOrOpinion (talk) 19:48, 16 March 2025 (UTC)

::::::::::::::We have articles Autism and LGBTQ identities and Conditions comorbid to autism that discuss the issue in great detail. It is certainly not fringe to discuss the connection between autism and gender dysphoria/gender identity. It is really difficult to draw the line between dysphoria and identity, because one could cause the other. This study says that there is a connection:

::::::::::::::{{quote frame |The suggested overlap between autism spectrum disorder (ASD) and gender dysphoria/incongruence (GD/GI) has been much disputed. This review showed a relationship between ASD traits and GD feelings in the general population and a high prevalence of GD/GI in ASD. Our meta-analyses revealed that the pooled estimate of the prevalence of ASD diagnoses in GD/GI people was 11% (p < .001) and the overall effect size of the difference in ASD traits between GD/GI and control people was significant (g = 0.67, p < .001). Heterogeneity was high in both meta-analyses. We demonstrated that the chances that there is not a link between ASD and GD/GI are negligible, yet the size of it needs further investigation. --- The findings of the current literature review and meta-analyses suggest that there is (a) a positive relationship between ASD traits and GD/GI feelings among people from the general population, (b) an increased prevalence of GD/GI in the autistic population, and (c) an increased prevalence of ASD diagnoses and ASD traits in the GD/GI population. Overall, these findings suggest the existence of a link between ASD and GD/GI that warrants the investigation of mechanisms that could explain that link and the intensification of clinical attention to autistic GD/GI individuals. [https://pmc.ncbi.nlm.nih.gov/articles/PMC10313553/]}} JonJ937 (talk) 09:47, 17 March 2025 (UTC)

:::::::::::::::Which nowhere mentions any hypothesis about direct causality and so is irrelevant to what I was discussing. FactOrOpinion (talk) 12:36, 17 March 2025 (UTC)

:::::::::::::::I think everyone here can agree that there is a link, at least just a link. Aaron Liu (talk) 12:39, 17 March 2025 (UTC)

::::::::::::::::This may be more relevant to the topic:

::::::::::::::::{{quote frame |Whilst our study does not test causality, a few hypotheses may explain the over-representation of autism and other neurodevelopmental and psychiatric conditions in transgender and gender-diverse individuals. First, autistic individuals may conform less to societal norms compared to non-autistic individuals, which may partly explain why a greater number of autistic individuals identify outside the stereotypical gender binary. Second, prenatal mechanisms (e.g., sex steroid hormones) shaping brain development have been shown to contribute to both autism (and associated neurodevelopmental conditions) and gender role behavior. It is unclear if prenatal sex steroid hormones also contribute to gender identity and this should be investigated in future studies. Neurodevelopmental conditions such as ADHD and learning disorders frequently co-occur with autism, and genetic evidence suggests a shared underlying liability for many of the co-occurring neurodevelopmental and psychiatric conditions. Finally, an alternative but not mutually exclusive explanation is that transgender and gender-diverse individuals have elevated vulnerabilities for multiple psychiatric challenges related to stressful life experiences in the contexts of unfriendly environments, discrimination, abuse and victimization, explaining the elevated rates of mental health diagnoses. [https://pmc.ncbi.nlm.nih.gov/articles/PMC7415151/]}}

::::::::::::::::I believe this indicates that mental conditions may often influence trans identity. JonJ937 (talk) 09:59, 18 March 2025 (UTC)

:::::::::::::::::How so? The underlined part is still just a link. If you mean the part about reduced predisposition to social norms, that just brings us back to #c-Aaron_Liu-20250316014700-FactOrOpinion-20250315230700 and the replies below. Aaron Liu (talk) 12:52, 18 March 2025 (UTC)

::::::::::::::::::This study summarizes existing causality hypotheses and reduced predisposition to social norms is one of the hypotheses that are being debated in the scholarly community. The link between mental disorders/conditions and trans identities is a subject of serious academic research, which is why it is incorrect to label it as fringe. The study also states that these hypotheses seek to explain the "over-representation of autism and other neurodevelopmental and psychiatric conditions in transgender and gender-diverse individuals," suggesting that the occurrence of this link might be frequent. As others have noted, the second part of the RFC question has no definitive answer, meaning the RFC question was not properly worded. We cannot definitively answer yes or no to a question that science has yet to resolve. Therefore, the closure was appropriate. JonJ937 (talk) 11:05, 19 March 2025 (UTC)

:::::::::::::::::::I think the comments by {{U|JonJ937}} and {{U|FactOrOpinion}} present a pretty level-headed take of my arguments. We must consider that there is a difference between a topic being fringe, and being a subject of scientific enquiry where the evidence is not in yet.

:::::::::::::::::::This is not saying that claims do not need high quality WP:RS or WP:MEDRS sources to be made in article-space. Frankly, this is a must for anything even potentially controversial - and is codified in WP:NPOV and WP:DUE.

:::::::::::::::::::There may be interpretations of the link between autism and transgender identity that are fringe, such as those made by controversial politicians, but that is not to say that the link itself, or discussion of causal mechanisms (including size and direction of causality) is fringe. Making wild statements that are unsupported by evidence is not as much fringe as either: plain false, or just not WP:Verified.

:::::::::::::::::::CFCF (talk) 15:08, 19 March 2025 (UTC)

::::::{{outdent|12}} #c-Aaron_Liu-20250316014700-FactOrOpinion-20250315230700
#c-Aaron_Liu-20250318155100-FactOrOpinion-20250319002700 Aaron Liu (talk) 11:19, 19 March 2025 (UTC)

:::::The comparison to multiple sclerosis was just incredibly weird... Aaron Liu (talk) 16:17, 15 March 2025 (UTC)

::::::I don't believe it is from the perspective of a medical professional or a medical editor on Wikipedia. With regard especially to WP:MED, most medical editors are generalists, and also quite used to working on contentious issues, of which there are many. Therefore it is quite apt to see similarities in reasoning from other fields, where the similarity is that we are discussing treatment. Every condition and treatment for every condition is unique, yet there are similarities - sometimes from far afield. CFCF (talk) 17:33, 15 March 2025 (UTC)

:::::::It wasn't my comparison originally, though I obviously found some interesting parallels. There's some research that speculates that taking hormones might increase disease progression in MS.[https://link.springer.com/article/10.1007/s11910-023-01326-7][https://pmc.ncbi.nlm.nih.gov/articles/PMC8883816/]

:::::::IMO MS has more interesting parallels with autism. WhatamIdoing (talk) 20:53, 15 March 2025 (UTC)

:::::About the claim that {{xt|requiring someone to undergo an unnecessary treatment to then obtain another treatment that may be necessary, and which they want, is unethical and absurd}}: This happens every day of the year. This has happened to me; this has happened to people I know. Sometimes it's absurd (e.g., the insurance company with a computer algorithm that prefers an ineffective and expensive treatment over a cheap treatment that works). Sometimes it's just a mistake (e.g., the provider who orders an unnecessary or duplicative test). Sometimes it is the right thing to do (e.g., trying a different treatment before contributing further to the world's antibiotic resistance problem). WhatamIdoing (talk) 20:31, 15 March 2025 (UTC)

=time to close?=

This discussion has reached the point where all of us are simply repeating what we have said before. Rather than exploring consensus through compromise, everyone has become entrenched in their views. So… let me ask: will further discussion resolve anything? I’m thinking it is time to find an uninvolved editor who will be willing to close. Blueboar (talk) 11:41, 28 March 2025 (UTC)

:The RfC has already passed the 30-day window, but I do think it should be formally closed rather than just left alone. SmittenGalaxy | talk! 14:12, 28 March 2025 (UTC)

::The request for formal closure was submitted a while ago. FactOrOpinion (talk) 14:30, 28 March 2025 (UTC)