What if there were a test?

[Zumbagirl]

All this conversation lately about SRS on demand has me thinking about something just a little bit different. Instead of thinking about from a TG persons perspective lets think from the point of view of a doctor who would treat someone.

Suppose there was a medical test that could prove if one was transgender or not, would you take it? Let's say that you took the test and medical science proved that you were not a transgender person at all, would it be okay to deny you the ability to transition? What if you knew deep down in your heart of hearts that you were a transgender person but a doctor said you were not because of the test, would that doctor be considered ethical to deny treatment? If someone tested positive for transgender but desired not to transition would that be adequate to ignore that persons condition or to perform treatment?

I am only asking because at that point transgender treatment would be like testing for diabetes or other medical conditions that require lifetime medical treatment. I'd be interested in hearing other people's thoughts on this.

[Jessica Merriman]

I would take the test. If I passed wonderful, if not, I would be part of the 41% of our community plain and simple.

[Sephirah]

I think the test would be far too narrow, and far too exclusionary to account for the various nuances of dysphoria, identity, and self-analysis that people go through - binary or non-binary. So it would be fundamentally flawed, and no better, or more accurate than a therapist telling you that you aren't who you know you are because you don't fall in line with what they've been trained to look out for. It would be taking the power of decision away from the individual and putting it into the hands of the medical profession. That doesn't sit well with me. If someone tested positive, it would only be positive by the criteria set out by the person/people creating the test.

Sorry, but I don't do people telling me who I am. I spent about 25 years under that regime. And it sucked. I'm sorry, but I feel instinctively wary of anyone thinking they know me better than I know myself.

[captains]

I absolutely recognize how problematic and potentially dangerous such a test could be if it both existed and was offered in reality. HOWEVER, this is my greatest dream/fantasy as a questioning person, and I think I'd break down in literal tears of friggin joy if it were a thing.

Uncertainty is scary as ->-bleeped-<-, emotions freak me out, and introspection ain't my strongest suit. I want this decision out of my hands: objectively, quantifiably. Like, listen, I'm not the kind of person who likes to circle-jerk to the empirical, but if I could get a number scale on this? Yes, yes, yes! Give me something that said ''you weren't delusional and here is the proof'' because I'm gonna tell you right now that without it, I'll be spending the next 7-10 years talking myself in circles. I don't care about the subjectivity of human existence anymore. I don't want to hear how my feelings are my own, and only I can know what they're like. I mean, it's true, but jeez, send me a clear and tangible evaluation and I'll die a happy man.

I'm a medical student: blood tests I understand. But all this? Friggin BEYOND me. Hell, I'd take a Sorting Hat at this point. ''Welome to Hogwarts, you're a man/woman/non-binary person, as degreed by this magical talking hat!''

[Sammie Blade]

I absolutely recognize how problematic and potentially dangerous such a test could be if it both existed and was offered in reality. HOWEVER, this is my greatest dream/fantasy as a questioning person, and I think I'd break down in literal tears of friggin joy if it were a thing.

Uncertainty is scary as ->-bleeped-<-, emotions freak me out, and introspection ain't my strongest suit. I want this decision out of my hands: objectively, quantifiably. Like, listen, I'm not the kind of person who likes to circle-jerk to the empirical, but if I could get a number scale on this? Yes, yes, yes! Give me something that said ''you weren't delusional and here is the proof'' because I'm gonna tell you right now that without it, I'll be spending the next 7-10 years talking myself in circles. I don't care about the subjectivity of human existence anymore. I don't want to hear how my feelings are my own, and only I can know what they're like. I mean, it's true, but jeez, send me a clear and tangible evaluation and I'll die a happy man.

I'm a medical student: blood tests I understand. But all this? Friggin BEYOND me. Hell, I'd take a Sorting Hat at this point. ''Welome to Hogwarts, you're a man/woman/non-binary person, as degreed by this magical talking hat!''

^^^ This

I questioned it and tormented my mind with twisters of insanity for 20 years.  A blood test would have been nice! 

[kelly_aus]

I wouldn't take it, I'd fail. I don't really make a GD diagnosis under the current DSM, let alone some kind of blood test. Lacking physical dysphoria caused my therapist pause, but hey, transition has worked out just fine for me.

As for those calling for the test, what about if it said the complete opposite of what you thought?

[captains]

I wouldn't take it, I'd fail. I don't really make a GD diagnosis under the current DSM, let alone some kind of blood test. Lacking physical dysphoria caused my therapist pause, but hey, transition has worked out just fine for me.

As for those calling for the test, what about if it said the complete opposite of what you thought?

I think I'd probably just go ''ok, so that was a weird phase!'' or something similar and do my very best to shuck the internal label of 'transgender.' I'm on a precipice wrt transition, but I haven't stepped over that edge. A ''no'' would be fairly low stakes for me, although I'd probably be distressed about the extent of my self delusion.* A ''yes'' would be validating. For me (and I truly only speak for myself), a serious fence-sitter, the firmness of this hypothetical test makes it seem win-win.

* It's important to me that I clarify that I DO NOT think that any trans folks who feel that they would ''score a no'' are self delusional. It's just that that's my greatest fear at the moment, and the route I suspect my inner voice would take.

I think that those who don't care about a test are more self assured and more comfortable with themselves than I am. Whether you're the 'known since age 4' type or you're simple further along in the process of healthy understanding than I am -- honestly, kudos. I still feel like each day I wake up with ten pounds of intellectual and emotional muck to rake through: 1/3 internalized transphobia and 2/3 the borderline-masturbatory overthinking that seems to come with being in one's early 20s. I hope that someday I'll be in a place where I get myself well enough to say ''screw the test! I know me!'' Instead, right now, I'm just hoping someone will absolve me of responsibility over my own life. I'm not proud.

I don't know if any of this makes sense.

[Carrie Liz]

IF such a test could be made, such that it really could tell someone for 100% certain whether they are trans or not, whether they need to go on HRT or not, and whether they need SRS or not, it would be absolutely amazing.

I for one don't like having doubts, and don't like spinning my brain around in a mental rut wondering if this is all really the right thing for me or not.

(To be fair, they're not really legitimate doubts, I just think and worry too much, so I'd appreciate the peace of mind.)

I'm sorry, but I just don't have the conviction that others have. So if I could somehow be happy without having to live each moment of my life feeling like I'm only begrudgingly accepted by people and constantly having to worry about passing and feeling inadequate to cis-women, plus somehow be happy with my body without going through an invasive medical procedure with a lengthy painful recovery period and constant upkeep afterward, I'd want to know, damn it!

With that said, I don't think it would be ethical to deny treatment if someone failed this hypothetical test. Because sometimes whether someone is trans or not, they need to transition in order to fully understand themselves. It's the same philosophy my therapist has... she'll provide me with guidance and suggestions, and she'll let me know if she ever thinks I'm doing the wrong thing, but she's not there to stop me if I really truly feel like I need something, and she'd write me a letter for whatever I wanted.



With that said, the current DSM diagnostic manual's criteria are supposedly already 94.8% accurate at identifying if someone is trans or not. So it's not like a 100% accurate test would be that much of an improvement. You can be pretty damned sure that you're trans if you fit the current criteria.

[Taka]

i thought like that too at some point. thinking about it a whole lot more, i realized i wanted that proof for the world, not myself.

if you want super accurate tests, why not come to norway or denmark? health authorities here seem to habe this wonderful extensive questionnaire, mostly about sexual habitbut we all know how important those are to determining whether or not someone is really transsexual. as long as you answer honestly, you're guaranteed to get an accurate answer to the question, it is proven by how over half of the applicants to official trans status fail. it is a little worrisome though, that some of thosr who managed to pass actually lied to get through. if only the test had a lie detector attached, we coyld have avoided granting those unworthy individuals access to a happier future (how did they manage to become so happy when the test would have failed them as transsexual?)

well, another worry about passing a test, would be if this individual doesn't want to transition. the (blood) test is always right, so of course all who test positive for transsexualism would want to transition. or...?

you might want to read a certain graphic novel, the day of revolution by tsuda mikiyo (or did she write it as zaoh taishi?). it's about an xx boy who finds out his stomach cramps are caused by female chromosomes. and his life after a sex change that his parents were all too supporting of. only when it was too late, did the boy learn that most boys who find out they're genetically girls, usually decide to live on as boys. it's interestingly thought provoking, despite being a comedy and thus somewhat shallower thab it could have been.

[Ms Grace]

i thought like that too at some point. thinking about it a whole lot more, i realized i wanted that proof for the world, not myself.

I was a bit that way years ago when I took the chromosome test for XXY - if I was it would be PROOF, so "haha world, stick that in your pipe and smoke it!!!"

Turns out I wasn't XXY but that didn't change how I felt so I can't imagine any other test would make any difference either.

[Jaime R D]

I think that if they figured out a way to accurately test for it, then they would also want to try to "cure" us as well.   Personally, I don't think I'd bother.

[CosmicJoke]

Like a fingerprint scanner that turns blue if the person is male or pink if the person is female?

[Jill F]

I would take the test. If I passed wonderful, if not, I would be part of the 41% of our community plain and simple.

DAAAAMMNN girl, that's brutal!

Unfortunately there IS a pretty accurate test, but it can only be done post-mortem when they slice and dice your brain.

Believe me, I tried every stupid pseudo-scientific (at best) test on the internet, and they all came up female/MTF.  Part of me really didn't want to believe it and I got a therapist.  Oh, I so wished I could have just been a standard issue nut instead! 

Her best diagnostic tool was to see how someone felt on a low dose of cross-sex hormones.  I felt better than I had since I was about 12 within 2 hours of my first dose and told her I wanted to take it every day for the rest of my life.  Yup, I'm a girl.

I personally think that if you just ask someone, "Do you feel male, female, neither, both, or a mixture of the two?" is a pretty good indicator.

I think that if they figured out a way to accurately test for it, then they would also want to try to "cure" us as well.   Personally, I don't think I'd bother.

The only "cure" is to transition.  And oh yes, did I bother!  You can't exactly make a girl brain into a boy brain, but you can at least feed it properly.

[Shantel]

Oh hell, I'd take the test and probably fail according to their criteria and I'd go ahead and transition anyway. Hmmmm come to think of it that's exactly what I did!

[suzifrommd]

A test that is 100% accurate would be OK. A test with false positives and false negatives could destroy people.

[Taka]

A test with false positives and false negatives could destroy people.

yea, many lives have been ruined in norway and denmark because of the ridiculous criteria that our national sexology clinics use to determine whether or not someone is trans enough.

i'd never believe in a test, what about us non-binary folks? has enough research even been done on how this variation happens and what treatment would be best?

[Zumbagirl]

yea, many lives have been ruined in norway and denmark because of the ridiculous criteria that our national sexology clinics use to determine whether or not someone is trans enough.

i'd never believe in a test, what about us non-binary folks? has enough research even been done on how this variation happens and what treatment would be best?

I think what I was trying to get at is that this condition is self-reported, in other words we tell health care providers, hey I'm a TG person. So barring any test, which we all know doesn't exist, then the question becomes how does a reasonable person determine who is truly TG? The only way I can see it working is by observation over a period of time long enough that a reasonable person would say, I agree you are a TG person.

So we have 2 extremes, patient demands something and the medical provider assumes all risk including potential malpractice or patient assumes no risk but would be subjected to determination of the medical provider. If the medical provider assumes all risk and potential malpractice they are going to be very reluctant to provide services to any but perfectly qualified candidates. On the other hand, a test may turn away people who may actually be TG but on a medical determination that is not yet known. Neither extreme looks very promising in my mind.

Barring that all we have left is observation over time, which is why we have real life experiences etc. there may be some medical providers who can determine genuine candidates easier than others and I do believe that the rules can and should be adjusted as needed for individual cases, and used later to adjust the overall bar. For example if after 1,000 people transition with a 6 month RLE then it would be worth moving the bar from 12 months to something less than 12 months, maybe as short as 6.

[Natkat]

All this conversation lately about SRS on demand has me thinking about something just a little bit different. Instead of thinking about from a TG persons perspective lets think from the point of view of a doctor who would treat someone.

Suppose there was a medical test that could prove if one was transgender or not, would you take it? Let's say that you took the test and medical science proved that you were not a transgender person at all, would it be okay to deny you the ability to transition? What if you knew deep down in your heart of hearts that you were a transgender person but a doctor said you were not because of the test, would that doctor be considered ethical to deny treatment? If someone tested positive for transgender but desired not to transition would that be adequate to ignore that persons condition or to perform treatment?

I am only asking because at that point transgender treatment would be like testing for diabetes or other medical conditions that require lifetime medical treatment. I'd be interested in hearing other people's thoughts on this.

I wont want a test like that,

where I live we are expected to take such text if we want threatment and I feel it very problematic specilly because a high number are being denyed. these people dont have anywhere to go, one can say it unetichal for a doctor not to threat a patient but if they say its because the person is not transgender or its another issue then it dosent matter because nobody is going to belive you anyway.

I dont belive much in the whole psykiatry where you can test for all kind of things, I still belive there is way to much mystery about gender for us to be able to test it. Even if there was enough knowlegde I would still be sceptical cause honestly I dont feel it should be about filling up to a certain standard, but simple listen to your patient what they need.

bonus info: if we had a test which could prove if we where trans or not that would also open up for posibilities to "cure" or make abortions of transgender people.

[Mariah]

I would be against a test for the fact that a test really can't accurately compensate for the differences and variety of people in our population. False-positives and False-negatives would result in more harm then good being done. When I came out and told the primary care doctor, who I used to have, that I was transgendered. Besides getting baselines for my hormone levels he also had chromosomal tests run. Due to my past medical history I had been wanting that done for years. By the time I had come to terms with the fact that I am transgendered and that what ever the chromosomes showed didn't matter to me anymore since I know who I am. They finally decided to run those tests. I didn't care what the results came up. Turns out it showed xy, which didn't matter anymore because I knew who I was and what I needed to do about. I have looked back since. I'm healthier and happier because of it.

[Tessa James]

I think what I was trying to get at is that this condition is self-reported, in other words we tell health care providers, hey I'm a TG person. So barring any test, which we all know doesn't exist, then the question becomes how does a reasonable person determine who is truly TG? The only way I can see it working is by observation over a period of time long enough that a reasonable person would say, I agree you are a TG person.

So we have 2 extremes, patient demands something and the medical provider assumes all risk including potential malpractice or patient assumes no risk but would be subjected to determination of the medical provider. If the medical provider assumes all risk and potential malpractice they are going to be very reluctant to provide services to any but perfectly qualified candidates. On the other hand, a test may turn away people who may actually be TG but on a medical determination that is not yet known. Neither extreme looks very promising in my mind.

Barring that all we have left is observation over time, which is why we have real life experiences etc. there may be some medical providers who can determine genuine candidates easier than others and I do believe that the rules can and should be adjusted as needed for individual cases, and used later to adjust the overall bar. For example if after 1,000 people transition with a 6 month RLE then it would be worth moving the bar from 12 months to something less than 12 months, maybe as short as 6.

I'm not clear why anyone would think that a medical provider assumes all risk...?  I was a provider for 33 years and clearly provided informed consent for my patients about the anesthesia risks they faced.  When I started HRT i signed a long detailed and comprehensive statement about the risks i would face.  I have also signed informed consent documents for my surgery detailing a long list of possible complications, side effects and possible death.  We can be sued readily without being a provider or gatekeeper. 

And back to the question.  I would be interested in any helpful and peer reviewed research about transgender people but doubt the efficacy of a test that would be anything but 100%.  We are so many shades of grey and colors of the rainbow for me to believe one size or test will fit all.