Treating Transgender Youth

Interesting comments from Dr. Will Powers, who specializes in trans medicine:

“Approximately 20% of my transgender women (Male to Female) and 85% of my transgender men (Female to Male) have considerable hormone abnormalities which deviate more than 95% from “average” values.

20% MtF (Elevated Estrone/Estradiol/Free Estradiol/SHBG, Low FSH/LH, very low T/DHT)

85% FtM (Massively elevated androgens in one or more categories, Androstenedione, Androstanediol, Androsterone, DHEA-S, Testosterone or DHT (Or a normal testosterone with a massively elevated free T due to a near lack of SHBG)”


“I have lots of kids come to me that have hormonal disruption that I fix and then they no longer feel trans. This is most commonly done with my patients in FtMs. They come in with some insane androgen level, I fix it with drugs, and then they no longer feel like they want to transition.

I have never seen this work in someone over the age of twenty-five, but the younger they are, the more likely they seem to change their position on taking hormones once the underlying dysfunction is corrected.”


On Protecting Your Mental Health

Disclaimer: I’m not a professional. This is based on my own informal data collection and drawn from many observations of people I’ve met; to my knowledge, it hasn’t been rigorously tested. More ideas, corrections, and links to relevant studies would be appreciated.

“You can’t beat the Axis if you get VD”

Mental health is important, and worth prioritizing. Effective altruism tries to encourage maximization – getting the biggest possible number according to a particular metric. For charitable donations, this can be helpful, but trying to optimize a whole life this way usually does more harm than good. Reading biographies of top scientists and businessmen shows that most have had friends, families, hobbies, and lives that they basically enjoyed, not ones rigorously optimized for “success”. This is because, under extreme, unhealthy conditions with no Slack, the human brain stops working well and burns itself out. Concentration gets worse, thoughts become muddled, teams get less effective, and projects ultimately fail. Grabbing more money, power, and fame won’t help if you aren’t in a place where you can use them effectively (Tim Ferriss).

Likewise, poor mental health will make you aware of problems, but it usually won’t help solve them, and may actually make them worse. It’s perfectly possible – common, even – to think about a problem in ways that make the problem worse, not better. I’ve seen depressed people avoid treatment because “the world really is terrible”… which may be true, but getting depressed doesn’t help, both because of the extra intrinsic unhappiness and because it causes loss of motivation. That doesn’t mean it’s good to stick your head in the sand, but if you can’t enjoy a normal day doing normal activities, something is definitely wrong. People in psychotic or manic states can also be convinced that only they can really understand the true fabric of reality – but they can’t explain it to anyone else, and the feeling wears off when the episode ends.

Dare To Be OK

Try hard to have a life that is basically okay and sustainable. Everyone has issues, but some things are a huge burden that will keep grinding a person down, especially over months and years. If this happens, prioritize fixing it – not only will it be a huge relief, it’ll make other goals easier to achieve. Some common problems are:

  1. Your expenses exceed your income, so you’re always burning savings or getting deeper into debt.
  2. You live with abusive people you really hate (partners, parents, roommates).
  3. Your job is terrible and soul-crushing, not just on occasion, but every time you go in.
  4. You live in a horrible place, whether that’s a slum, a rural village with nothing to do, a trailer full of toxic fumes, or a generally awful country like Saudi Arabia.
  5. You have nasty medical issues that make daily life much harder (not always fixable, but usually worth trying a lot).
  6. You’re a parent, and all your time and energy goes into your kids, leaving you with nothing to spare (Bryan Caplan explains why this is bad).

These things can become generic existential angst factories, making it seem like everything is terrible, and killing your life and your effectiveness as a person. Try to get out as soon as you can. If this seems impossible, don’t trust that initial impression; gather some friends and family, grab a whiteboard, and give it a solid effort before giving up.

“I Didn’t Know It Could Be This Good”

Average mental health care is, sadly, pretty bad. This makes many people give up on ever getting any. However, there’s a huge amount of variance, because providers differ a lot; there are tons of possible treatment options, many of which aren’t well-known (some for depression, some for anxiety); and there’s a lot of individual differences in problems, lives, and biochemistry. Hence, it’s probably the wrong move to give up on getting treatment after one or two failures; keep trying new (different) things. See Kate Donovan on finding a good therapist.

One is the Loneliest Number

Friendships are important to invest in, especially long-term ones. Avoid social isolation, and especially avoid holing up in a cabinet and not doing anything. This one is straight from CGP Grey’s “Ways to Maximize Misery“:

“Remain indoors as much as possible, preferably in the same room. Be the human equivalent of a pile of laundry — inert, unmoving. Don’t let a beautiful day tempt you for a walk. Avoid anything even vaguely exercisial. This keeps reward chemicals out of your brain which could diverge you and stillness guides you towards medical problems which will keep this wheel turning. Stillness is the most effective thing you can do, so be the laundry pile. Make your bedroom your allroom. Live and work and play and sleep in the smallest radius you can.”

In some cultures, like coastal California or business networking events, there’s a tendency to act friendly and interested in everyone, and to pretend that each relationship matters more than it really does. Try to avoid this, get to know people better, and focus on those who really care about you. Likewise, try to spend at least some time with people who are doing okay themselves. A circle whose members are all themselves depressed, anxious, or psychotic may actually make things worse.

A Healthy, Open Debate

Geek Social Fallacy #4 says that not all of your friends will want to be friends with each other. Not only is this true, but it’s good to specifically seek out and befriend people who don’t. Don’t draw all of your social interaction from the same company, church, ingroup, or clique. Likewise, have friends with differing opinions, who are willing to disagree with you and with others you know. That way, if any one person goes off the rails, others can notice and call them out on it, or point out weak spots in a bad argument. This helps avoid groupthink, bias, and more personal problems, like abusive partners pretending their abuse is good for people. At the extreme end, cults and gurus aren’t good for your well-being:

The True Infohazards

Some websites are out to get you. They make money from ads, and their goal is to lure you in with some useful content, then trap you in an endless cycle of sadness or anger, until you spend all your time obsessing over the site. Again, CGP Grey explains why this is bad:

“Use your screen to stoke your negative emotions, to feed your anger or anxiety about things over which you have no control or influence. Be well informed while doing nothing. The things you care about could be navigational guides out of the sea, reasons to leave your allroom and take meaningful action with the humans around you. But you can instead use the things you care about as further sources of misery. Focus on the bad to fuel your resentment or despair. If you must contribute, do so only in meaningless token ways and be disappointed in the lack of change.”

Be Careful Out There

There are many useful tools in the world. Some are like lithium, a drug for bipolar disorder. Use a little, and it’s great. But use too much, or on the wrong person, and things get very bad very quickly. Tools for “self-improvement” or “hacking your mind” seem to follow this pattern. Anna Salamon explains:

“About six months into a year into CFAR’s workshop-running experience, a participant had a manic episode a couple weeks after a workshop in a way that seemed plausibly triggered partly by the workshop. (Interestingly, if I’m not mixing people up, the same individual later told me that they’d also been somewhat destabilized by reading the sequences, earlier on.) We then learned a lot about warning signs of psychotic or manic episodes and took a bunch of steps to mostly-successfully reduce the odds of having the workshop trigger these. In terms of causal mechanisms: It turns out that workshops of all sorts, and stuff that messes with one’s head of all sorts, seem to trigger manic or psychotic episodes occasionally. E.g. Landmark workshops; meditation retreats; philosophy courses; going away to college; many different types of recreational drugs; and different small self-help workshops run by a couple people I tried randomly asking about this from outside the rationality community.”


“My current view is that being at workshops for too much of a year is actually really hard on a person, and maybe not-good. It mucks up a person’s codebase without enough chance for ordinary check-sums to sort things back to normal again afterward. Relatedly, my guess is also that while stints at CFAR do level a person up in certain ways (~roughly as I anticipated back in 2013), they unfortunately also risk harming a person in certain ways that are related to “it’s not good to live in workshops or workshop-like contexts for too many weeks/months in a row, even though a 4-day workshop is often helpful” (which I did not anticipate in 2013). Basically: you want a bunch of normal day-to-day work on which to check whether your new changes actually work well, and to settle back into your deeper or more long-term self. The 2-3 week “MIRI Summer Fellows Program” (MSFP) has had… some great impacts in terms of research staff coming out of the program, but also most of our least stable people additionally came out of that. I believe that this year we’ll be experimentally replacing it with repeated shorter workshops; we’ll also be trying a different rest days pattern for staff, and sabbatical months, as well as seeking stability/robustness/continuity in more cultural and less formal ways.”

Anna doesn’t mention it, but I strongly suspect that drugs like LSD and psilocybin, and especially research chemicals with little history of human use, also fall into this category. Even commonly prescribed drugs like SSRIs can do this (eg., by causing mania in someone with bipolar disorder).

Snap Back To Reality, Oh There Goes Gravity

Physical reality is great. MIT’s motto, Mens et Manus – Mind and Hand – is an inspiration to engineers everywhere. Likewise, psychosis is defined as a state where “thought and emotions are so impaired that contact is lost with external reality”. I strongly suspect that some kinds of work and activities tend to promote a healthy relationship with reality, while others will erode or destroy that connection. People vary, but very roughly, I would sketch out a spectrum like:

  1. Direct physical work. Welding and construction. Flying drones. Growing crops. Chemical synthesis and wet-lab biology. Emergency medicine.
  2. Work with some amount of abstraction. Computer programming, mathematics, statistics, logic. Theoretical physics. Architecture. Game design.
  3. Work with a high level of abstraction, and fuzzy success criteria. Philosophy. Sociology. Art, music, and literature.
  4. Work that largely involves manipulating people or jumping through hoops. Online marketing. Corporate law. Regulatory compliance. Telemarketing and scams.
  5. Management consulting. Public relations. Corporate hierarchies and moral mazes. Postmodernism. Bullshit.

Everyone’s life involves some of each of these. But it seems very important to not become ungrounded, lose the balance, and drift off too far towards the bottom end. My hypothesis is that this is good for sanity, and also for other goals like social cohesion, helping the world, having fun, and identifying immoral mazes.

Imperial Focus Points – You Only Get Seven

(from this game)

The world is really big. Even smaller things, like people, companies, or machines, have thousands of moving parts. It’s good to work hard, be smart, do good, and focus on what matters… but no man can ever do everything, or pay attention to everything. Some things will get dropped, some problems will go unsolved, and that’s okay. You can avoid getting overwhelmed, and think at the margin – ninety-nine problems is better than a hundred, and being poor and hungry is better than being poor and hungry with a broken arm.

In Conclusion

Rudyard Kipling, Hymn of Breaking Strain:

THE careful text-books measure
(Let all who build beware!)
The load, the shock, the pressure
Material can bear.
So, when the buckled girder
Lets down the grinding span,
‘The blame of loss, or murder,
Is laid upon the man.
Not on the Stuff—the Man!

But in our daily dealing
With stone and steel, we find
The Gods have no such feeling
Of justice toward mankind.
To no set gauge they make us—
For no laid course prepare—
And presently o’ertake us
With loads we cannot bear:
Too merciless to bear.

The prudent text-books give it
In tables at the end
‘The stress that shears a rivet
Or makes a tie-bar bend—
‘What traffic wrecks macadam—
What concrete should endure—
but we, poor Sons of Adam
Have no such literature,
To warn us or make sure!

We hold all Earth to plunder—
All Time and Space as well—
Too wonder-stale to wonder
At each new miracle;
Till, in the mid-illusion
Of Godhead ‘neath our hand,
Falls multiple confusion
On all we did or planned—
The mighty works we planned.

We only of Creation
(0h, luckier bridge and rail)
Abide the twin damnation—
To fail and know we fail.
Yet we – by which sole token
We know we once were Gods—
Take shame in being broken
However great the odds—
The burden of the Odds.

Oh, veiled and secret Power
Whose paths we seek in vain,
Be with us in our hour
Of overthrow and pain;
That we – by which sure token
We know Thy ways are true—
In spite of being broken,
Because of being broken
May rise and build anew
Stand up and build anew.

The Fossil Fuel Industry's Coming Collapse

My financial advisor, Colby Davis, has written a thorough explanation of why fossil fuels are an obsolete, declining industry. His timelines are fairly aggressive, but the basic thesis is almost certainly right.

Chinese GDP Growth May Be Overstated

Paper by the Brookings Institution:

Why Websites Are Great, And Social Media Sucks

A great summary by Matthias Ott:

Discussion on Hacker News:

America’s incarceration rate is at a two-decade low


Cuba, North Korea Slowly Moving Towards Capitalism

Although still dictatorships, these countries are slowly allowing more economic freedom than during the Cold War era.


North Korea: