+++ /dev/null
-Title: Reply to Scott Alexander on Autogenderphilia
-Date: 2021-12-15 05:00
-Category: commentary
-Tags: autogynephilia, epistemology, two-type taxonomy
-Status: draft
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-[This started out as a draft email to Scott, but I'm really unhappy with the way it's developing; I should try to sculpt it into a defensible public post instead]
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-In ["My IRB Nightmare"](https://slatestarcodex.com/2017/08/29/my-irb-nightmare/), you express skepticism about a screening test for bipolar disorder:
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-> 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.
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-> 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.
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-> 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.
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-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."
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--------
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-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).
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-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?
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-I readily admit that I can't definitely _prove_ that it's not an intersex condition. Nevertheless—if I'm just being honest about the inference procedure my brain is _actually_ using, without pretending that it's more rigorous than it is—I think this question is _actually_ pretty obvious if you have functional parsimony intuitions about how the world works.
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-To me, the qualitative observations are very important, because they have a lot of details about what the psychological phenomenon actually is. (The qualitative observations are what _motivated_ the survey question, to try to get a more quantifiable measurement of something we already had reason to believe exists.) An ordinary cis woman who reads the survey question, "How sexually arousing would you find it to imagine being her?" with no context, is not necessarily in the same headspace as an MtF transsexual, even if they end up giving the same number—just like someone who's never had a real manic–depressive cycle might give the same answer to "Do you ever feel really happy, then really sad?" because they're remembering when their team lost the Super Bowl. (If you were worried about a bipolar screening test not generalizing to a group so different as "hospital inpatients", how much more worried should you be about asking people of _different sexes_ questions _about sexuality_?)
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-Anecdotally, when I talked about my experiences to Sarah Constantin, her _first_ reaction was to say that she
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-[...]
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-Just—_other than_ this mysterious sexualized _desire_ to be female, the biological _and_ psychological traits of the group in question seem to be in the _male_ normal range. Notice how your survey had almost eight times as many lesbian trans women than straight trans women? That's _not_ what the distribution of sexual orientation looks like among cis women. But if we consider that trans women are _male_, and males tend to be attracted to females, the data looks _less confusing_. Or did you know that [the ratio of trans to cis women among Haskell programmers is close to 1:1](http://unremediatedgender.space/2020/Nov/survey-data-on-cis-and-trans-women-among-haskell-programmers/)? That's _way_ off from the ratio in the general population. The data looks _less confusing_ if you think of it as "at least 1.5% of male Haskell programmers wish they were female" rather than "Haskell programmers with female gender identities are equally likely to be trans or cis".
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-Your "If you identify as a gender, and you're attracted to that gender [...]" hypothesis seriously is treating "gender identity" as a causally potent variable that means the same thing in trans people and cis people. And just—the world doesn't look that way
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-Even if it were _true_ that the late-onset type were caused by some
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-You point to your survey data saying that cis gay men are autoandrophilic as something Blanchard–Bailey–Lawrence can't explain, but I don't see my theory as being particularly committed to making predictions about how gay men will answer the "Picture a very attractive man [...]" question. It's a different population!
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-I would totally respect it if you were merely _uncertain_ about the AGP→gender-ID _vs._ gender-ID→AGP causality; I can't expect everyone to share my parsimony intuitions. But on Discord, you said "it just seemed totally wrong"! I just don't think that's something you can possibly conclude based on how _other populations_ are answering similar survey questions!
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