Norman Spack: How I help transgender teens become who they want to be

Translator: Nana Ginnerup Reviewer: Anders Finn Jørgensen

I want you all to think

Jeg vil have jer alle til at overveje

about the third word that was ever said about you --

det tredje ord, der nogensinde blev sagt

om jer,

or, if you were delivering,

eller hvis I har født;

about the person you were delivering.

om den person, I fødte.

And you can all mouth it if you want or say it out loud.

Og I kan alle mumle det, hvis I vil,

eller sige det højt.

It was -- the first two were, "It's a ..."

Det var, de første to var: "Det' en ..."

Audience: (Mixed reply) Girl. Boy.

(Laughter)

Well, it shows you that --

Det viser jer, at

I also deal with issues where there's not certainty

jeg også håndterer problemer, hvor der

ikke er er usikkerhed om det er en pige eller dreng,

of whether it's a girl or a boy,

so the mixed answer was very appropriate.

så det blandede svar var passende.

Of course, now the answer often comes not at birth but at the ultrasound,

Selvfølgelig kommer svaret ofte

ikke ved fødslen, men ved ultralydsscanningen,

unless the prospective parents choose to be surprised,

medmindre forældrene vælger

at blive overraskede, som vi alle blev.

like we all were.

But I want you to think about what it is that leads to that statement

Men jeg vil have jer til at overveje, hvad det er,

der fører til denne erklæring

on the third word,

af det tredje ord,

because the third word

for det tredje ord

is a description of your sex.

er en beskrivelse af jeres køn,

og ved dette mener jeg,

And by that I mean,

made by a description of your genitals.

lavet ud fra en beskrivelse af jeres kønsorganer.

Now, as a pediatric endocrinologist,

Som en pædiatrisk endokrinolog

I used to be very, very involved and still somewhat am, in cases

plejede jeg at være meget involveret,

og er på sin vis stadigvæk,

i sager, hvor

in which there are mismatches in the externals

der er uoverensstemmelse

i det ydre

or between the externals and the internals,

eller mellem det ydre og det indre,

and we literally have to figure out

og vi bogstaveligt talt har brug for at finde ud af,

what is the description of your sex.

hvad beskrivelsen af jeres køn er.

But there is nothing that is definable at the time of birth

Men der er intet, der er definerbart

ved fødselstidspunktet,

that would define you.

som vil definere dig,

og når jeg taler om definition,

And when I talk about definition,

taler jeg om seksuel orientering.

I'm talking about your sexual orientation.

We don't say, "It's a ... gay boy!"

Vi siger ikke: "Det er en bøsse-dreng."

"A lesbian girl!"

"En lesbisk pige."

Those situations don't really define themselves

De situationer definerer ikke rigtig sig selv

more until the second decade of life.

før det andet årti af livet.

Nor do they define your gender,

De beskriver heller ikke dit opfattede køn,

which, as different from your anatomic sex,

der, når forskelligt fra dit anatomiske køn,

describes your self-concept:

beskriver din selvopfattelse.

Do you see yourself as a male or female,

Ser du dig selv

som mand eller kvinde

or somewhere in the spectrum in between?

eller et sted i spektrummet imellem?

That sometimes shows up

Det viser sig nogle gange

in the first decade of life,

i det første årti af livet,

but it can be very confusing for parents,

men det kan være meget forvirrende for forældre,

because it is quite normative for children

fordi det er meget normalt

for børn at agere på tværs af køn i leg,

to act in a cross-gender play and way,

and, in fact, there are studies that show

og faktisk er der studier, der viser,

that even 80 percent of children who act in that fashion

at 80% af de børn,

der agerer på den måde,

will not persist in wanting to be the opposite gender

vil ikke fortsætte med at ville være

det modsatte køn

at the time when puberty begins.

på tidspunktet for starten af puberteten.

But, at the time that puberty begins --

Men på det tidspunkt, hvor puberteten begynder,

that means between about age 10 to 12 in girls, 12 to 14 in boys --

hvilket er mellem en alder af 10 og 12 år for piger,

12 til 14 for drenge

with breast budding,

med spirende bryster

or two to three times' increase in the gonads

eller en to eller tre ganges forøgelse i kønskirtlerne

in the case of genetic males,

i tilfældet af genetiske mænd,

by that particular point,

ved dette bestemte sted er barnet, der siger,

the child who says they are in the absolute wrong body

de er i den helt igennem forkerte krop,

is almost certain to be transgender

næsten helt sikkert transkønnet,

and is extremely unlikely to change those feelings,

og det er ekstremt usandsynligt, at de følelser kan blive ændret,

no matter how anybody tries reparative therapy

lige meget hvordan nogen som helst forsøger med omvendingsterapi

or any other noxious things.

eller andre skadelige ting.

Now, this is relatively rare,

Det er utroligt sjældent,

so I had relatively little personal experience with this.

så jeg havde relativt lidt personlig erfaring med det,

And my experience was more typical,

og min erfaring var mere typisk

only because I had an adolescent practice.

kun på grund af, at jeg havde en ungdomspraksis.

And I saw someone age 24,

Og jeg så nogen af alderen 24,

genetically female, went through Harvard with three male roommates

kom igennem Harvard, genetisk kvinde,

med tre mandlige værelseskammerater,

who knew the whole story,

der kendte hele historien,

a registrar who always listed his name on course lists as a male name,

en registrator, der altid listede hans navn

på kursuslisterne som et drengenavn,

og kom til mig efter dimission, og sagde: "Hjælp mig.

and came to me after graduating,

saying, "Help me. I know you know a lot of endocrinology."

Jeg ved, at du ved meget om endokrinologi."

Og jeg har ganske vist behandlet mange,

And indeed, I've treated a lot of people who were born without gonads.

der var født uden kønskirtler.

This wasn't rocket science.

Det var ikke raketvidenskab.

But I made a deal with him:

Men jeg lavede en aftale med ham:

"I'll treat you if you teach me."

Jeg vi behandle dig, hvis du vil undervise mig.

And so he did.

Og det gjorde han så.

Og sikke en uddannelse jeg fik

And what an education I got

from taking care of all the members of his support group.

af at tage mig af alle medlemmerne

af hans støttegruppe.

And then I got really confused,

Og så blev jeg virkelig forvirret,

for jeg troede, at det var relativt nemt

because I thought it was relatively easy at that age

bare at give folk i den alder

to just give people the hormones

hormonerne tilhørende det køn, de identificerer sig med,

of the gender in which they were affirming.

But then my patient married,

men så blev min patient gift,

and he married a woman who had been born as a male,

og han giftede sig med en kvinde,

som var blevet født som en mand,

had married as a male, had two children,

havde gift sig som en mand, fået to børn,

then went through a transition into female.

og så gået igennem en transition til kvinde,

And now this delightful female

og nu var denne dejlige kvinde

was attached to my male patient -- in fact, got legally married,

knyttet til min mandlige patient,

de blev gift lovligt, fordi de dukkede op

because they showed up as a man and a woman, and who knew, right?

som en mand og en kvinde,

og hvem vidste bedre, ikke sandt?

(Laughter)

And I was confused --

Og imens var jeg forvirret over,

"Does this make so-and-so gay?

om det gjorde dem og dem homoseksuelle?

Does this make so-and-so straight?"

Gør det dem heteroseksuelle?

I was getting sexual orientation confused with gender identity.

Jeg fik mikset seksuel orientering

sammen med kønsidentitet.

And my patient said to me,

Og min patient sagde til mig:

"Look, look, look.

"Hør her;

If you just think of the following, you'll get it right:

hvis du bare tænker følgende, så får du styr på det:

Sexual orientation is who you go to bed with.

Seksuel orientering er hvem, du går i seng med;

kønsidentitet er hvem, du går i seng som."

Gender identity is who you go to bed as."

(Laughter)

And I subsequently learned from the many adults --

Og efterfølgende lærte jeg fra mange voksne -

I took care of about 200 adults --

jeg tog mig af omkring 200 voksne -

af dem lærte jeg,

I learned from them

that if I didn't peek as to who their partner was in the waiting room,

at hvis jeg ikke smugkiggede på

deres partner i venteværelset,

I would never be able to guess better than chance,

så ville jeg aldrig kunne gætte

bedre end ved chancen,

whether they were gay, straight, bi or asexual

om de var homo-, hetero- eller biseksuelle

eller aseksuelle i deres identificerede køn.

in their affirmed gender.

In other words,

Med andre ord,

one thing has absolutely nothing to do with the other.

det ene har intet at gøre

med det andet.

And the data show it.

Og data bekræfter det.

Da jeg tog mig af de 200 voksne,

Now, as I took care of the 200 adults,

I found it extremely painful.

fandt jeg det ekstremt smertefuldt.

These people -- many of them --

Disse folk - mange af dem

had to give up so much of their lives.

blev nødt til at opgive så store dele af deres liv.

Nogle gange afviste deres forældre dem,

Sometimes their parents would reject them,

siblings, their own children,

søskende, deres egne børn,

and then their divorcing spouse

og så deres fraskilte ægtefælle,

would forbid them from seeing their children.

som forbød dem at se deres børn.

It was so awful,

Det var så forfærdeligt. Men hvorfor gjorde de det

but why did they do it at 40 and 50?

ved en alder af 40 eller 50?

Because they felt they had to affirm themselves

Fordi de følte, at de blev nødt til at bekræfte dem selv,

før de tog deres eget liv.

before they would kill themselves.

And indeed, the rate of suicide among untreated transgendered people

Og ganske vist er antallet af selvmord

hos ubehandlede transkønnede

is among the highest in the world.

blandt de højeste i verden.

Så hvad kan man gøre?

So, what to do?

I was intrigued, in going to a conference in Holland,

Jeg blev fascineret af at tage til en konference

where they are experts in this,

i Holland, hvor der var eksperter i dette,

og så det mest bemærkelsesværdige.

and saw the most remarkable thing.

They were treating young adolescents

De behandlede unge teenagere

after giving them the most intense psychometric testing of gender,

efter at have givet dem de mest intense

psykometriske testning af køn,

and they were treating them by blocking the puberty that they didn't want.

og de behandlede dem ved at blokere

den pubertet, de ikke ønskede.

Because basically, kids look about the same,

For dybest set ser børn ens ud,

each sex, until they go through puberty,

begge køn, indtil de rammer puberteten ,

at which point, if you feel you're in the wrong sex,

hvor, hvis du føler, at du er det forkerte køn,

you feel like Pinocchio becoming a donkey.

du vil føle dig som Pinocchio, der transformeres ind til et æsel.

The fantasy that you had that your body will change

Fantasien om at din krop vil ændre sig

to be who you want it to be, with puberty,

til det, du vil have under puberteten,

actually is nullified by the puberty you get.

bliver faktisk ophævet med den pubertet, du undergår.

And they fall apart.

Og de falder fra hinanden.

Så det er derfor, at sætte puberteten i bero -

So that's why putting the puberty on hold -- why on hold?

Hvorfor i bero? Man kan ikke bare give dem

You can't just give them the opposite hormones that young.

de modsatte hormoner i den alder.

They'll end up stunted in growth,

De ville ende op forkrøblede,

and you think you can have a meaningful conversation

og tror du, at du kan have en meningsfuld samtale

about the fertility effects of such treatment

om fertilitetseffekterne af sådan en behandling

with a 10-year-old girl, a 12-year-old boy?

med en 10-årig pige, en 12-årig dreng?

So this buys time in the diagnostic process

Så det vinder tid i udredningsforløbet

for four or five years,

for fire eller fem år,

så de kan finde ud af det,

so that they can work it out.

They can have more and more testing,

de kan blive testet mere og mere,

they can live without feeling their bodies are running away from them.

de kan leve uden at føle, at deres krop

løber fra dem.

And then, in a program they call 12-16-18,

Og så, i et program, de kalder 12-16-18,

around age 12 is when they give the blocking hormones,

omkring en alder af 12 giver de blokerende hormoner,

and then at age 16, with retesting,

og så ved en alder af 16 en efterprøvning,

they re-qualify to receive --

kvalificerer de sig igen.

Husk på, at de blokerende hormoner er vendbare,

now remember, the blocking hormones are reversible,

but when you give the hormones of the opposite sex,

men når man giver hormonerne fra de modsatte køn,

you now start spouting breasts and facial hair and voice change,

starter man brystudviklingen og ansigtsbehåringen

og stemme, afhængigt af hvad, man bruger,

depending on what you're using,

and those effects are permanent,

og disse effekter er permanente

or require surgery to remove,

eller kræver kirurgi for at fjerne

or electrolysis,

eller elektrolyse,

and you can never really affect the voice.

og du kan aldrig rigtigt gøre noget ved stemmen.

Så det er seriøst, og det er 15-, 16-års-ting.

So this is serious, and this is 15-, 16-year-old stuff.

And then at 18, they're eligible for surgery.

Og ved en alder af 18, er de berettigede til kirurgi,

And while there's no good surgery for females to males genitally,

og mens der ikke er nogen god form for kirurgi for kvinde- til mandekønsorganer,

the male-to-female surgery has fooled gynecologists.

har mand-til-kvinde-kirurgi narret gynækologer.

That's how good it can be.

Det er så godt, det kan gøres.

So I looked at how the patients were doing,

Så jeg tjekkede op på, hvordan det gik patienterne,

og jeg så patienter, der så ud præcis ligesom alle andre,

and I looked at patients who just looked like everybody else,

except they were pubertally delayed.

bortset fra, at de var sent i puberteten.

But once they gave them the hormones

Men lige så snart, man gav dem hormonerne,

consistent with the gender they affirm,

der passer med det køn, de føler sig som,

er de smukke.

they look beautiful.

De så normale ud. De havde normale højder.

They look normal.

They had normal heights.

You would never be able to pick them out in a crowd.

Man ville aldrig kunne udpege dem

i en forsamling.

So at that point, I decided I'm going to do this.

Så på det tidspunkt besluttede jeg, at gøre dette.

Det er her, det pædiatriske

This is really where the pediatric endocrine realm comes in,

hormonforstyrrende rigtigt kommer ind,

because, in fact, if you're going to deal with it in kids aged 10 to 14,

for faktisk, hvis du giver det til

børn i alderen 10-12, 10-14,

that's pediatric endocrinology.

så er det pædiatrisk endokrinologi.

So I brought some kids in,

Så jeg tog nogle børn ind,

and this now became the standard of care,

og nu er det her blevet standarden for pleje,

og Children's Hospital stod bag det.

and the [Boston] Children's Hospital was behind it.

By my showing them the kids before and after,

Ved at jeg viste dem børnene før og efter,

people who never got treated and people who wished to be treated,

aldrig behandlede folk

og folk, der ønskede behandling,

and pictures of the Dutch --

og billeder af hollænderne,

they came to me and said,

kom de til mig og sagde:

"You've got to do something for these kids."

"Du bliver nødt til at hjælpe de børn."

Well, where were these kids before?

Hvad var de børn førhen?

They were out there suffering, is where they were.

De var lidende, det var, hvad de var.

So we started a program in 2007.

Så vi startede et program i 2007.

Det blev det første af sin slags -

It became the first program of its kind --

but it's really of the Dutch kind --

men egentligt er det den hollandske slags -

in North America.

i Nordamerika.

And since then, we have 160 patients.

Og siden da har vi haft 160 patienter.

Did they come from Afghanistan? No.

Kom de fra Afghanistan? Nej.

75 percent of them came from within 150 miles of Boston.

75 % af dem kom

fra en radius af 240 km fra Boston.

And some came from England.

Og nogle kom fra England.

Jackie had been abused in the Midlands, in England.

Jackie var blevet misbrugt i the Midlands, i England.

Hun er 12 år gammel der,

She's 12 years old there,

hun levede som en pige,

she was living as a girl,

but she was being beaten up.

men hun blev banket.

It was a horror show, they had to homeschool her.

Det var et rædselsshow.

Hun blev nødt til at få hjemmeundervisning.

And the reason the British were coming

Og grunden til, at briterne kom var,

was because they would not treat anybody with anything under age 16,

at de ikke ville behandle nogen

under alderen 16 med noget som helst,

which means they were consigning them to an adult body

hvilket betød, at de tilskrev dem

en voksenkrop, lige meget hvad, der skete,

no matter what happened,

even if they tested them well.

selv hvis de gennemtestede dem.

Jackie var ydermere,

Jackie, on top of it, was, by virtue of skeletal markings,

i henhold til sin skeletstruktur,

destined to be six feet five.

bestemt til at blive 195 cm høj.

Og alligevel havde hun lige begyndt

And yet, she had just begun a male puberty.

en mandelig pubertet.

Well, I did something a little bit innovative,

Jeg gjorde noget lidt innovativt,

because I do know hormones,

fordi jeg ved noget om hormoner,

and that estrogen is much more potent

og at østrogen er langt bedre

in closing epiphyses, the growth plates,

til at lukke epifyser, vækstpladerne,

and stopping growth, than testosterone is.

og stoppe vækst, end testosteron er.

So we blocked her testosterone with a blocking hormone,

Så vi blokerede hendes testosteron,

med et blokeringshormon,

but we added estrogen, not at 16, but at 13.

men vi tilsatte østrogen, ikke ved en alder af 16, men af 13.

And so here she is at 16, on the left.

Så her er hun i en alder af 16, til venstre.

And on her 16th birthday, she went to Thailand,

Og da hun blev 16, tog hun til Thailand,

where they would do a genital plastic surgery.

hvor de ville give hende plastikkirurgi.

They will do it at 18 now.

De vil gøre det i en alder af 18 nu.

And she ended up 5'11".

Hun endte med at blive 180 cm høj,

But more than that, she has normal breast size,

men udover det har hun en normal størrelse bryster,

because by blocking testosterone,

fordi ved at blokere testosteronet,

every one of our patients has normal breast size

har alle vores patienter fået

en normal bryststørrelse,

if they get to us at the appropriate age,

hvis de kommer til os ved en passende alder, ikke for sent.

not too late.

Og yderst til højre, der er hun.

And on the far right, there she is.

She went public -- semifinalist in the Miss England competition.

Hun stod offentlig frem,

semifinalist i Miss England-konkurrencen.

Dommerne debatterede, om de kunne gøre det.

The judges debated as to, can they do this?

And one of them quipped, I'm told,

Kan de få hende til -

Og jeg er blevet fortalt, en af dem vittigt sagde:

"But she has more natural self than half the other contestants."

"Men hun er mere naturligt sig selv,

end halvdelen af de andre deltagere."

(Laughter)

And some of them have been rearranged a little bit,

Og nogle af dem er blevet omarrangeret en lille smule,

but it's all her DNA.

men det er hele hendes DNA.

And she's become a remarkable spokeswoman.

Og hun blev en fantastisk talskvinde.

Og hun er blevet tilbudt kontrakter som model,

And she was offered contracts as a model,

hvortil hun drillede mig ved at sige:

at which point she teased me, when she said,

"Jeg ville måske have haft en bedre chance

"You know, I might have had a better chance as a model

som en model, hvis du havde gjort mig 185 cm."

if you'd made me six feet one."

(Laughter)

Go figure.

Regn det ud.

So this picture, I think, says it all.

Så dette billede, vil jeg sige, siger alt.

It really says it all.

Det siger virkeligt alt.

These are Nicole and brother Jonas,

Disse er Nicole og bror Jonas,

identical twin boys,

identiske tvillingebrødre

and proven to be identical.

og bevist til at være identiske,

ved hvilken Nicole bekræftede sig selv

Nicole had affirmed herself as a girl as early as age three.

til at være en pige, så tidligt som alderen 3.

At age seven, they changed her name,

Ved en alder af 7, ændrede de hendes navn,

og kom til mig lige i starten

and came to me at the very beginnings of a male puberty.

af den mandelige pubertet.

Now you can imagine looking at Jonas at only 14,

Ved at se på 14-årige Jonas,

kan I forestille jer, at puberteten

that male puberty is early in this family,

er tidlig i denne familie,

because he looks more like a 16-year-old.

da han mest af alt ligner en 16-årig,

men det understreger pointen endnu mere,

But it makes the point all the more,

of why you have to be conscious of where the patient is.

hvorfor man skal være opmærksom

på hvor patienten er.

Nicole is on pubertal blockade in here,

Nicole har fået lavet en pubertal blokade her,

and Jonas is just going -- biologic control.

og Jonas fortsætter bare - biologisk kontrol.

This is what Nicole would look like

Det er sådan, Nicole ville se ud,

if we weren't doing what we were doing.

hvis vi ikke gjorde, hvad vi gør.

He's got a prominent Adam's apple.

Han har et prominent adamsæble.

He's got angular bones to the face, a mustache,

Han har kantede knogler i ansigtet, et overskæg,

og du kan se en højdeforskel,

and you can see there's a height difference,

fordi han har været igennem

because he's gone through a growth spurt that she won't get.

en vækstspurt, hun ikke vil gennemgå.

Nu tager Nicole østrogen .

Now Nicole is on estrogen.

She has a bit of a form to her.

Hun har fået lidt form.

This family went to the White House last spring,

Sidste forår tog familien til det Hvide Hus

because of their work in overturning an anti-discrimination --

på grund af deres arbejde

for at stoppe antidiskrimination.

there was a bill that would block

Der var et lovforslag, der ville forhindre

the right of transgender people in Maine to use public bathrooms,

transkønnede personer i Maine

at bruge de offentlige toiletter,

and it looked like the bill was going to pass,

og det så ud til at gå igennem,

and that would have been a problem,

hvilket ville være et problem,

but Nicole went personally to every legislator in Maine

men Nicole tog personligt til hver enkelt lovgiver i Maine

and said, "I can do this.

og sagde: "Jeg kan gøre det her.

If they see me, they'll understand

Hvis de ser mig, vil de forstå,

why I'm no threat in the ladies' room,

hvorfor jeg ikke er en trussel på dametoilettet,

but I can be threatened in the men's room."

men at jeg kan blive truet på herretoilettet."

And then they finally got it.

Og de forstod det endelig.

Så hvad gør vi herfra?

So where do we go from here?

Well, we still have a ways to go in terms of anti-discrimination.

Vi har stadig vej at gå

i forhold til antidiskrimination.

There are only 17 states that have an anti-discrimination law

Der er kun 17 stater, der har

en anti-diskriminationslov

against discrimination in housing,

imod diskrimination på boligmarkedet,

employment, public accommodation --

ansættelse, i offentligheden,

only 17 states, and five of them are in New England.

kun 17 stater, og 5 af dem er i New England.

We need less expensive drugs.

Vi har brug for billigere medicin.

They cost a fortune.

De koster en formue.

And we need to get this condition out of the DSM.

Og vi skal have denne tilstand

ud af DSM.

It is as much a psychiatric disease as being gay and lesbian,

Det er lige så meget en psykisk sygdom

som det at være homoseksuel,

and that went out the window in 1973,

og det blev smidt ud af vinduet i 1973,

and the whole world changed.

og hele verden ændrede sig.

And this isn't going to break anybody's budget.

Og det her kommer ikke til at springe nogens budget.

Det er ikke så almindeligt.

This is not that common.

But the risks of not doing anything for them

Men risikoen ved ikke at gøre noget for dem,

putter ikke bare dem i risiko

not only puts all of them at risk of losing their lives to suicide,

for at begå selvmord,

but it also says something about whether we are a truly inclusive society.

men siger også noget om

vi i sandhed er et inkluderende samfund.

Thank you.

Tak.

(Applause)