-In ["My IRB Nightmare"](https://slatestarcodex.com/2017/08/29/my-irb-nightmare/), you express skepticism about a screening test for bipolar disorder:
-
-> You ask patients a bunch of things like "Do you ever feel really happy, then really sad?". If they say 'yes' to enough of these questions, you start to worry.
-
-> Some psychiatrists love this test. I hate it. Patients will say "Yes, that absolutely describes me!" and someone will diagnose them with bipolar disorder. Then if you ask what they meant, they'd say something like "Once my local football team made it to the Super Bowl and I was really happy, but then they lost and I was really sad." I don't even want to tell you how many people get diagnosed bipolar because of stuff like this.
-
-> There was a study that supposedly proved this test worked. But parts of it confused me, and it was done on a totally different population that didn't generalize to hospital inpatients.
-
-The reason it makes any sense at all for you to be skeptical, is because our beliefs about the existence and etiology of "bipolar disorder", don't completely stand or fall on this particular test. People _already_ had many observations pointing to the idea of "bipolar disorder" as a common cluster of symptoms. From your years of clinical experience, you know with your eyes what the cluster looks like. So when people whose favorite team lost the Super Bowl happen to answer "Yes" to the some of the same survey questions as people who you've _seen_ in the frenzy of mania and depths of depression, you generate the hypothesis: "Gee, maybe different populations are interpreting the question differently." Not as a _certainty_—maybe further research will provide more solid evidence that "bipolar disorder" isn't what you thought—but there's nothing un-Bayesian about thinking that your brain's pattern-matching capabilities are on to something important that this particular survey instrument isn't catching. You're not scientifically obligated to _immediately_ jump to "Bipolar Is Common and Not Especially Related to Mania or Depression."
-
--------
-
-In the case of the etiology and taxonomy of MtF, it seems to me that informed observers typically _agree_ that there's a pretty stark bimodality in the data (very large effect sizes, even if not of course not literally everyone fits the stereotype, because _nothing_ in psychology is that clean): that androphilic MtF transsexuals tend to have been overtly feminine their entire lives in a way that's noticeable to others (such that they "stick out" in Society as effeminate men if they _didn't_ transition), but gynephilic/bi/asexual MtF transsexuals don't fit this profile (living as ordinary men before "coming out"), and very frequently report a history of erotic female transformation fantasies (autogynephilia)—which shows up not only in easily-quantifiable surveys, but also qualitatively if you [just _read_ the things non-androphilic MtFs write in their own forums when the general public isn't looking](https://www.reddit.com/r/MtF/search?q=fetish&restrict_sr=on).
-
-Anyway, if we agree on the basic observations, what's at issue? [What's at issue is the _causality_](http://unremediatedgender.space/2021/Feb/you-are-right-and-i-was-wrong-reply-to-tailcalled-on-causality/): does AGP cause gender identity (such that these are, basically, straight males with a fetish), or does gender identity (presumably caused by some underlying brain intersex condition) get eroticized and manifest as AGP?