In a previous post, ["Sexual Dimorphism in Yudkowsky's Sequences, in Relation to My Gender Problems"](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/), I told the story about how I've "always" (since puberty) had this obsessive erotic fantasy about being transformed into a woman and used to think it was immoral to believe in psychological sex differences, until I read these Sequences of _super great_ blog posts about how reasoning works by some guy named Eliezer Yudkowsky—where one _particularly_ influential-to-me post was [the one that explained](https://www.lesswrong.com/posts/QZs4vkC7cbyjL9XA9/changing-emotions) why the idea of "changing sex" is much easier said than done, [because the tantalizingly short English phrase doesn't capture the complex implementation details of the real physical universe](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/#changing-sex-is-hard).
-At the time, this was my weird personal thing, which I did not anticipate there being any public interest in blogging about. In particular, I didn't think of myself as being "transgender." The whole time—the dozen years I spent reading everything I could about sex and gender and transgender and feminism and evopsych and doing various things with my social presentation (sometimes things I regretted and reverted after a lot of pain, like trying to use my initials as a name) to try to seem not-masculine—I had been _assuming_ that my gender problems were not of the same kind as people who were _actually_ transgender, because the standard narrative said that that was about people whose ["internal sense of their own gender does not match their assigned sex at birth"](https://www.vox.com/identities/21332685/trans-rights-pronouns-bathrooms-sports), whereas my thing was obviously at least partially an outgrowth of my weird sex fantasy—I had never interpreted the beautiful pure sacred self-identity thing as an "internal sense of my own gender".
+At the time, this was my weird personal thing, which I did not anticipate there being any public interest in blogging about. In particular, I didn't think of myself as being "transgender." The whole time—the dozen years I spent reading everything I could about sex and gender and transgender and feminism and evopsych and doing various things with my social presentation (sometimes things I regretted and reverted after a lot of pain, like [trying to use my initials as a name](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/#literary-initials)) to try to seem not-masculine—I had been _assuming_ that my gender problems were not of the same kind as people who were _actually_ transgender, because the standard narrative said that that was about people whose ["internal sense of their own gender does not match their assigned sex at birth"](https://www.vox.com/identities/21332685/trans-rights-pronouns-bathrooms-sports), whereas my thing was obviously at least partially an outgrowth of my weird sex fantasy—I had never interpreted the beautiful pure sacred self-identity thing as an "internal sense of my own gender".
_Why would I?_ In the English of my youth, "gender" (as a single word, rather than part of the phrase "gender role") was understood as a euphemism for _sex_ for people who were squeamish about the potential ambiguity betweeen _sex_-as-in-biological-sex and _sex_-as-in-intercourse. (Judging by this blog's domain name, I am not immune to this.) In that language, my "gender"—my sex—is male. Not because I'm necessarily happy about it (and I [used to](/2017/Jan/the-erotic-target-location-gift/) be pointedly insistent that I wasn't), but as an observable biological fact that, whatever my pure beautiful sacred self-identity feelings, _I am not delusional about_.
[aside (footnote?) on the blog name: I had already claimed _ultimatelyuntruethought@gmail.com_ in 2014, to participate in [a contest](http://celebbodyswap.blogspot.com/2014/02/magic-remote-caption-contest.html) by one of the [transformation/bodyswap captioned-photo erotica blogs](/2016/Oct/exactly-what-it-says-on-the-tin/) / it's a little bit awkward having the blog title and URL be different, and people think "space" is a separate word]
-Besides writing to tell everyone else about it, another obvious response to my Blanchardian enlightenment was that I wanted to try hormone replacement therapy. Not to actually socially _transition_, which seemed as impossible (to actually pull off) and dishonest (to try) as ever, but just [to try as a gender-themed drug experiment](/2017/Sep/interlude-ix/). Everyone else was doing it—why should I have to miss out just for being more self-aware?
+Besides writing to tell everyone else about it, another obvious response to my Blanchardian enlightenment was that I decided to try hormone replacement therapy. Not to actually socially _transition_, which seemed as impossible (to actually pull off) and dishonest (to try) as ever, but just [to try as a gender-themed drug experiment](/2017/Sep/interlude-ix/). Everyone else was doing it—why should I have to miss out just for being more self-aware?
A friend who once worked for [our local defunct medical research company](https://en.wikipedia.org/wiki/MetaMed) still offered lit-reviews as a service, so I paid her $5,000 to do [a post about the effects of hormone replacement therapy](https://srconstantin.github.io/2016/10/06/cross-sex-hormone-therapy.html), in case the depths of the literature had any medical insight to offer that wasn't already on the informed-constent paperwork. Meanwhile, I made the requisite gatekeeping appointments with [my healthcare provider](http://kp.org/) to get approved for HRT, first with a psychologist that I had seen before, then with a couple of licensed clinical social workers before finally getting approved for an HRT perscription.
I was happy to sit through the sessions as standard procedure rather than [going DIY](https://diytrans.wiki/How_to_Begin_HRT), but I was pretty preoccupied with the thing about how [_everyone had been lying to me about the most important thing in my life for fourteen years_](/2017/Jan/im-sick-of-being-lied-to/) and the professionals were _in on it_, and spent a lot of the sessions ranting about that. I gave the psychologist and one of the LCSWs a copy of _Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism_. (The psychologist said she wasn't allowed to accept gifts with a monetary value of over $25, so I didn't tell her that it actually cost $40.)
-Actually, [it's worse](/2016/new-clothes/) than if they were in on it. In some ways, it would be _better_ if the professionals secretly agreed with me about the typology and were cynically lying in order to rake in that sweet pharma cash. But they're not—lying. They just, have this whole paradigm of providing ["equitable" and "compassionate" "gender-affirming care"](https://thrive.kaiserpermanente.org/care-near-you/northern-california/eastbay/departments/gender-affirming-care/) which is transparently garbage-tier epistemology ([for a belief that needs to be affirmed is not a belief at all](/2020/peering-through-reverent-fingers/)), but is so pervasive within its adherents' milieu, that they don't even know how to interpret observations someone not buying it even when you state your objections very clearly. Before one of my appointments with the LCSW, I wrote to the psychologist expressing frustration about the culture of lying (and noting that I should probably chill out before tinkering with my biochemistry), and she wrote back:
+Actually, [it's worse than if they were in on it; in some ways, it would be _better_](/2016/new-clothes/) if the professionals secretly agreed with me about the typology and were cynically lying in order to rake in that sweet pharma cash. But they're not—lying. They just, have this whole paradigm of providing ["equitable" and "compassionate" "gender-affirming care"](https://thrive.kaiserpermanente.org/care-near-you/northern-california/eastbay/departments/gender-affirming-care/) which is transparently garbage-tier epistemology ([for a belief that needs to be affirmed is not a belief at all](/2020/peering-through-reverent-fingers/)), but is so pervasive within its adherents' milieu, that they don't even know how to interpret observations someone not buying it even when you state your objections very clearly. Before one of my appointments with the LCSW, I wrote to the psychologist expressing frustration about the culture of lying (while noting that I should probably chill out before tinkering with my biochemistry), and she wrote back:
> I agree with you entirely, both about your frustration with people wanting to dictate to you what you are and how you feel, and with the importance of your being emotionally stable prior to starting hormones. Please explain to those who argue with you that it is only YOUR truth that matter when it comes to you, your body and what makes you feel whole. No one else has the right to dictate this.
> I'm not sure you do! I know condescending to patients is part of your usual script, but I hope I've shown that I'm smarter than that. This solipsistic culture of "it is only YOUR truth that matters" is _exactly_ what I'm objecting to! People can have false beliefs about themselves! As a psychologist, you shouldn't be encouraging people's delusions; you should be using your decades of study and experience to help people understand the actual psychological facts of the matter so that they can make intelligent choices about their own lives! If you think the Blanchard taxonony is _false_, you should _tell_ me that I'm wrong and that it's false and why!
-Similarly, the notes from my first call to the gender department claim that I was "exploring gender identity" and that I was "interested in trying [hormones] for a few months to see if they fit with his gender identity". That's not how I remember that conversation! _I_ distinctly remember asking if the department would help me if I wanted to experiment with HRT _without_ socially transitioning. That is, I was asking if they would provide medical services _not_ on the basis of "gender identity". Apparently my existence is so far out-of-distribution that the nurse on the phone wasn't capable of writing down what I actually said.
+Similarly, the notes from my first call to the gender department claim that I was "exploring gender identity" and that I was "interested in trying [hormones] for a few months to see if they fit with his gender identity". That's not how I remember that conversation! _I_ distinctly remember asking if the department would help me if I wanted to experiment with HRT _without_ socially transitioning: that is, I was asking if they would provide medical services _not_ on the basis of "gender identity". Apparently my existence is so far out-of-distribution that the nurse on the phone wasn't capable of writing down what I actually said.
However weird I must have seemed, I have trouble imagining what anyone else tells the shrinks, given the pile of compelling evidence summarized earlier that most trans women are, in fact, guys like me. If I _wanted to_, I could cherry-pick pieces of evidence from my life to weave a more congruent narrative about always having been a girl on the inside. (Whatever than means! It still seems kind of sexist for that to mean something!) As a very small child, I remember asking for (and receiving, because I had good '90s liberal parents) [Polly Pocket](https://en.wikipedia.org/wiki/Polly_Pocket), and a pink-and-purple girl's scooter with hearts. I could go on about [my beautiful pure sacred self-identity thing](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/#beautiful-pure-sacred-self-identity) that emerged shortly after puberty.
-But (as I told the LCSW) I would _know_ that I was cherry-picking. HSTS-taxon boys are identified as effiminate _by others_. [You know it when you see it, even when you're ideologically prohibited from _knowing_ that you know.](TODO: write "Gaydar Jamming" and linky) That's—not me. I [don't even _want_ that to be me](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/#if-i-have-to-choose). I definitely have a gender _thing_, but I have a pretty detailed model of what I think the thing actually is in the real physical universe, and my model doesn't _fit_ in the ever-so-compassionate and -equitable ontology of "gender identity", which presupposes that what's going on when I report _wishing_ I were female is the _same thing_ as what's going on with actual women who (correctly) report being female. I don't think it's the same thing, and I think you'd have to be [crazy or a liar](https://www.lesswrong.com/posts/y4bkJTtG3s5d6v36k/stupidity-and-dishonesty-explain-each-other-away) to say it's plausibly the same thing.
+But (as I told the LCSW) I would _know_ that I was cherry-picking. HSTS-taxon boys are identified as effiminate _by others_. [You know it when you see it, even when you're ideologically prohibited from _knowing_ that you know.](TODO: write "Gaydar Jamming" and linky) That's—not me. I [don't even _want_ that to be me](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/#if-i-have-to-choose). I definitely have a gender _thing_, but I have a pretty detailed model of what I think the thing actually is in the real physical universe, and my model doesn't _fit_ in the ever-so-compassionate and -equitable ontology of "gender identity", which presupposes that what's going on when I report _wishing_ I were female is the _same thing_ as what's going on with actual women who (objectively correctly) report being female. [I don't think it's the same thing](TODO: linky autogenderphilia reply?), and I think you'd have to be [crazy or a liar](https://www.lesswrong.com/posts/y4bkJTtG3s5d6v36k/stupidity-and-dishonesty-explain-each-other-away) to say it's plausibly the same thing.
-[TODO: another thing that happened about this time was my break with progressive morality; I had never been progressive along all dimensions (Ayn Rand, registered libertarian), but antisexism was very important to me, and even after I had mostly unwound the dysfunctional parts of that, I still thought of myself as on the Blue team http://zackmdavis.net/blog/2016/10/late-onset/ http://zackmdavis.net/blog/2017/03/brand-rust/ ]
+Another consequence of my Blanchardian enlightenment is that around this time (maybe [specifically on 7 October 2016](http://zackmdavis.net/blog/2016/10/late-onset/))
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+[TODO: another thing that happened about this time was my break with progressive morality; I had never been progressive along all dimensions (Ayn Rand, registered libertarian), but antisexism was very important to me, and even after I had mostly unwound the dysfunctional parts of that, I still thought of myself as on the Blue team
+http://zackmdavis.net/blog/2017/03/brand-rust/ ]
[TODO: October 2016: another thing that happened around this time I wrote Eliezer to ask about the conflict with "Changing Emotions" and made a Cheerful Price offer to talk about it https://www.lesswrong.com/posts/MzKKi7niyEqkBPnyu/your-cheerful-price (shut up, we're not a cult) ]
If we notice further patterns _within_ the group of cases that make up a category, we can spit it up into sub-categories: for example, a diagnosis of bipolar I requires a full-blown manic episode, but hypomania and a major depressive episode qualify one for bipolar II.
-Is the two-type typology of bipolar disorder a good theory? Are bipolar I and bipolar II "really" different conditions, or slightly different presentations of "the same" condition, part of a "bipolar spectrum" along with cyclothymia? In our current state of knowledge, this is debateable, but if our understanding of the etiology of bipolar disorder were to advance, and we were to find evidence that that bipolar I has a different underlying _causal structure_ from bipolar II with decision-relevant consequences, like responding to different treatments, that would support a policy of thinking and talking about them as mostly separate things—even while they have enough in common to both be kinds of "bipolar". The simple high-level category ("bipolar disorder") is a useful approximation, in the absence of knowing the sub-category (bipolar I _vs._ II) and the subcategory is a useful approximation in the absence of knowing the patient's detailed case history.
+Is the two-type typology of bipolar disorder a good theory? Are bipolar I and bipolar II "really" different conditions, or slightly different presentations of "the same" condition, part of a "bipolar spectrum" along with cyclothymia? In our current state of knowledge, this is debateable, but if our understanding of the etiology of bipolar disorder were to advance, and we were to find evidence that that bipolar I has a different underlying _causal structure_ from bipolar II with decision-relevant consequences, like responding to different treatments, that would support a policy of thinking and talking about them as mostly separate things—even while they have enough in common to both be kinds of "bipolar". The simple high-level category ("bipolar disorder") is a useful approximation in the absence of knowing the sub-category (bipolar I _vs._ II), and the subcategory is a useful approximation in the absence of knowing the patient's detailed case history.
With a _sufficiently_ detailed causal story, you could even dispense with the high-level categories altogether and directly talk about the consequences of different neurotransmitter counts or whatever—but lacking that supreme precise knowledge, it's useful to sum over the details into high-level categories, and meaningful to debate whether a one-type or two-type taxonomy is a better statistical fit to the underlying reality whose full details we don't know yet.
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-In the case of male-to-female transsexualism, we notice a pattern where androphilic and non-androphilic trans women seem to be different from each other—not just in their sexuality, but also in their age of dysphoria onset, interests, and personality. Many authors have noticed this bimodal clustering of traits under various names, [while disagreeing about the underlying causality](/2021/Feb/you-are-right-and-i-was-wrong-reply-to-tailcalled-on-causality/).
+In the case of male-to-female transsexualism, we notice a pattern where androphilic and non-androphilic trans women seem to be different from each other—not just in their sexuality, but also in their age of dysphoria onset, interests, and personality.
[Blanchard]
+But many authors have noticed this bimodal clustering of traits under various names, [while disagreeing about the underlying causality](/2021/Feb/you-are-right-and-i-was-wrong-reply-to-tailcalled-on-causality/).
+
[Veale, Clarke, and Lomax](/papers/veale-lomax-clarke-identity_defense_model.pdf) attribute the differences to whether defense mechanisms are used to suppress a gender-variant identity. [Anne Vitale](http://www.avitale.com/developmentalreview.htm) identifies distinct groups (Group One and Group Three), and hypothesizes that the difference is due to degree of prenatal androgenization.
[Serano 2020]
Let me explain.
-What are the reasons a male-to-female transition might seem like a good idea to someone? Why would a male be interested in living socially as a woman? I see three prominent reasons, depicted as the parents of the transition node in a graph.
+What are the reasons a male-to-female transition might seem like a good idea to someone? _Why_ would a male be interested in undergoing medical interventions to resemble a female and live socially as a woman? I see three prominent reasons, depicted as the parents of the "transition" node in a graph.
-First and most obviously, femininity: if you happen to be a male with female-typical psychological traits, then [...]
+First and most obviously, femininity: if you happen to be a male with unusually female-typical psychological traits, then [...]
Second—second is hard to explain if you're not already familiar with the phenomenon, but basically, [...]
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