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

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I want you all to think

Želim da svi razmislite

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

o trećoj riječi koja je ikada izgovorena o vama,

or, if you were delivering,

ili, ako ste se porađali,

about the person you were delivering.

o osobi koju ste rodili.

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

Možete je promrmljati ako želite, ili je naglas izgovoriti.

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

To je, prve dvije su bile: "Dobili ste ..."

Audience: (Mixed reply) Girl. Boy.

Publika: Djevojčicu. Dječaka.

(Laughter)

(Smijeh)

Well, it shows you that --

To vam pokazuje

da se bavim i pitanjima gdje nije sigurno,

I also deal with issues where there's not certainty

radi li se o djevojčici ili dječaku,

of whether it's a girl or a boy,

so the mixed answer was very appropriate.

tako da je mješovit odgovor bio vrlo prikladan.

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

Naravno, danas odgovor često dolazi ne na porodu, već na ultrazvuku,

unless the prospective parents choose to be surprised,

osim ako budući roditelji odaberu da budu iznenađeni,

like we all were.

kao što smo mi bili.

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

No, želim da razmislite o tome što je to što dovodi do te izjave,

on the third word,

do te treće riječi,

because the third word

jer je treća riječ

is a description of your sex.

opis vašeg spola.

A pod time podrazumijevam,

And by that I mean,

made by a description of your genitals.

da je nastala prema opisu vaših genitalija.

Now, as a pediatric endocrinologist,

Kao pedijatar endokrinolog,

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

bio sam veoma uključen, i donekle još jesam,

u slučajevima gdje postoje nepodudarnosti u vanjštini,

in which there are mismatches in the externals

or between the externals and the internals,

ili između vanjštine i nutrine

and we literally have to figure out

i doslovno moramo otkriti

koji je opis vašeg spola.

what is the description of your sex.

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

Ali ne postoji ništa što je određeno u vrijeme rođenja,

that would define you.

a što bi vas definiralo.

A kada govorim o određivanju,

And when I talk about definition,

I'm talking about your sexual orientation.

govorim o vašoj spolnoj orijentaciji.

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

Ne kažemo: "Dobili ste gay sina."

"A lesbian girl!"

Ili "Djevojčicu lezbijku."

Those situations don't really define themselves

Te situacije zapravo se ne preciziraju

more until the second decade of life.

do drugog desetljeća života,

Nor do they define your gender,

niti određuju vaš spol,

which, as different from your anatomic sex,

koji, za razliku od anatomskog spola,

describes your self-concept:

opisuje vas same;

Do you see yourself as a male or female,

vidite li sebe kao muškarca ili ženu,

or somewhere in the spectrum in between?

ili negdje između unutar spektra?

That sometimes shows up

To se nekada javlja

in the first decade of life,

u prvom desetljeću života

but it can be very confusing for parents,

i može biti vrlo zbunjujuće za roditelje,

because it is quite normative for children

jer je prilično uobičajeno kod djece

to act in a cross-gender play and way,

da se poigravaju međuspolnim igrama i načinima

and, in fact, there are studies that show

i, zapravo, postoje studije koje pokazuju

that even 80 percent of children who act in that fashion

da čak 80% djece koja se ponašaju na taj način,

will not persist in wanting to be the opposite gender

neće biti uporni u nastojanju da budu suprotnog spola

at the time when puberty begins.

kada uđu u pubertet.

But, at the time that puberty begins --

Ali, u vrijeme kada pubertet počne,

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

to znači u dobi od 10 do 12 godina kod djevojčica, 12 do 14 kod dječaka,

with breast budding,

s rastom grudi,

or two to three times' increase in the gonads

odnosno povećanja spolnih žlijezda 2-3 puta

in the case of genetic males,

kod muškog spola,

by that particular point,

do te određene točke,

the child who says they are in the absolute wrong body

dijete koje kaže da je u apsolutno pogrešnom tijelu,

is almost certain to be transgender

gotovo sigurno će biti transrodno

and is extremely unlikely to change those feelings,

i izuzetno je malo vjerojatno da će promijeniti te osjećaje,

no matter how anybody tries reparative therapy

bez obzira na ičije pokušaje reparativne terapije,

or any other noxious things.

ili bilo čega drugog što je štetno.

Now, this is relatively rare,

Ovo je relativno rijetko,

so I had relatively little personal experience with this.

tako da sam s ovim imao relativno malo osobnog iskustva.

And my experience was more typical,

I moje iskustvo je bilo tipičnije

only because I had an adolescent practice.

samo zato što sam imao adolescentsku kliniku

And I saw someone age 24,

i vidio sam nekoga od 24 godine,

genetically female, went through Harvard with three male roommates

genetski ženska osoba, završila Harvard s tri muška cimera,

who knew the whole story,

koji su znali cijelu priču,

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

osoba koja je uvijek unosila njegovo ime na listi predavanja kao muško ime,

and came to me after graduating,

i tako je došao k meni nakon diplomiranja

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

govoreći: "Pomozite mi. Znam da znate puno o endokrinologiji."

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

I zaista sam liječio mnogo ljudi koji su rođeni bez spolnih žlijezda.

This wasn't rocket science.

Nije to bila nuklearna fizika.

But I made a deal with him:

Ali sam se nagodio sa njim:

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

"Liječit ću te ako me podučiš."

And so he did.

To je i učinio.

I što sam samo sve naučio,

And what an education I got

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

brinući o svim članovima njegove grupe za podršku.

And then I got really confused,

A onda sam se zaista zbunio,

because I thought it was relatively easy at that age

jer sam mislio da je relativno lako u tim godinama

to just give people the hormones

samo dati ljudima hormone

of the gender in which they were affirming.

onog spola kojeg potvrđuju.

But then my patient married,

No, onda se moj pacijent vjenčao,

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

i to ženom koja je rođena kao muškarac,

had married as a male, had two children,

vjenčala se kao muškarac, imala dva djeteta,

then went through a transition into female.

a zatim prošla kroz promjenu spola u ženu.

And now this delightful female

Sada je ova divna žena

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

bila vezana za mog muškog pacijenta, zapravo, zakonski su se vjenčali,

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

jer su se pojavili kao muškarac i žena i tko bi uopće znao, zar ne?

(Laughter)

(Smijeh)

And I was confused --

Bio sam zbunjen --

"Does this make so-and-so gay?

"Čini li ovo tu osobu gej?

Does this make so-and-so straight?"

Čini li ovo tu osobu hetero?"

I was getting sexual orientation confused with gender identity.

Pomiješao sam seksualnu orijentaciju sa spolnim identitetom.

And my patient said to me,

Pacijent mi je rekao:

"Look, look, look.

"Vidi, vidi, vidi.

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

Ako samo ovako razmišljaš, shvatit ćeš kako treba:

Sexual orientation is who you go to bed with.

Seksualna orijentacija znači s kim ideš u krevet.

Spolni identitet znači kakav ideš u krevet."

Gender identity is who you go to bed as."

(Laughter)

(Smijeh)

And I subsequently learned from the many adults --

Naknadno sam naučio od brojnih odraslih,

I took care of about 200 adults --

zbrinuo sam oko 200 odraslih,

I learned from them

naučio sam od njih

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

da ako ne gledam tko je npr. njihov partner u čekaonici,

I would never be able to guess better than chance,

samo pukom slučajnošću bih mogao pogoditi

whether they were gay, straight, bi or asexual

jesu li gej, hetero, bi, ili aseksualci

in their affirmed gender.

u svom izjašnjavanju.

In other words,

Drugim riječima,

one thing has absolutely nothing to do with the other.

jedno nije imalo apsolutno nikakve veze sa drugim.

And the data show it.

I podaci to pokazuju.

Brinući se o 200 odraslih osoba,

Now, as I took care of the 200 adults,

I found it extremely painful.

smatrao sam to izuzetno bolnim.

These people -- many of them --

Ti ljudi, mnogi od njih,

had to give up so much of their lives.

morali su odustati od mnogo toga u svojim životima.

Ponekad bi ih roditelji odbacili,

Sometimes their parents would reject them,

siblings, their own children,

braća i sestre, vlastita djeca,

and then their divorcing spouse

a njihov bi im bračni partner u razvodu

would forbid them from seeing their children.

zabranio viđati vlastitu djecu.

It was so awful,

Bilo je užasno,

but why did they do it at 40 and 50?

ali zašto su to činili u 40-im i 50-im godinama?

Because they felt they had to affirm themselves

Jer su osjećali da se moraju izjasniti, potvrditi,

kako si ne bi oduzeli život.

before they would kill themselves.

And indeed, the rate of suicide among untreated transgendered people

I zaista, stopa samoubojstava među transrodnim osobama bez tretmana

is among the highest in the world.

među najvišima je u svijetu.

I što učiniti?

So, what to do?

Bio sam zaintrigiran, otišavši na konferenciju u Nizozemsku,

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

where they are experts in this,

kako stoje stručnjaci po ovom pitanju

and saw the most remarkable thing.

i vidio nešto zaista vrijedno pažnje.

They were treating young adolescents

Liječili su adolescente

after giving them the most intense psychometric testing of gender,

nakon što su im dali najintenzivnije psihometrijske testove spola

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

i liječili su ih blokiranjem puberteta kojeg nisu željeli.

Because basically, kids look about the same,

Jer u biti, djeca izgledaju skoro jednako,

each sex, until they go through puberty,

oba spola, sve dok ne prođu kroz pubertet,

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

kada, ako osjećate da ste pogrešnog spola,

you feel like Pinocchio becoming a donkey.

osjećate se kao Pinokio koji se pretvara u magarca.

The fantasy that you had that your body will change

Maštanje koje ste imali da će vam se tijelo promijeniti

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

u ono kakvo vi želite, kroz pubertet,

actually is nullified by the puberty you get.

zapravo se pubertetom poništava.

And they fall apart.

I tada se oni raspadnu.

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

Zato odlaganje puberteta -- zašto odlaganje?

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

Ne možete im samo dati hormone suprotnog spola tako mladima.

They'll end up stunted in growth,

Zakržljat će rastom,

and you think you can have a meaningful conversation

a mislite da možete voditi smisleni razgovor

about the fertility effects of such treatment

o utjecaju takvog tretmana na plodnost,

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

s djevojčicom od 10 godina, ili dječakom od 12 godina?

So this buys time in the diagnostic process

Zato ovo kupuje vrijeme u dijagnostičkom procesu

for four or five years,

na četiri ili pet godina,

kako bi oni to riješili.

so that they can work it out.

They can have more and more testing,

Oni mogu obaviti dosta testiranja,

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

mogu živjeti bez osjećaja da ih njihova tijela napuštaju.

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

A zatim, u programu kojeg zovu 12-16-18,

around age 12 is when they give the blocking hormones,

oko 12. godine počinju im davati hormone blokatore,

and then at age 16, with retesting,

a sa 16 godina, ponovnim testiranjem,

they re-qualify to receive --

smiju primiti --

now remember, the blocking hormones are reversible,

zapamtite, hormoni blokatori mogu imati i suprotan učinak,

but when you give the hormones of the opposite sex,

no kada dajete hormone suprotnog spola,

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

počinju rasti grudi i dlačice na licu, glas se mijenja,

depending on what you're using,

ovisno o tome što koristite

and those effects are permanent,

i ti učinci su trajni,

or require surgery to remove,

ili je potrebna operacija za otklanjanje,

or electrolysis,

ili elektroliza,

and you can never really affect the voice.

a nikada ne možete zaista utjecati na glas.

I zato je ovo ozbiljno, to se tiče osobe od 15, 16 godina.

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

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

A onda u 18. godini mogu ići na operaciju.

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

I dok nema dobre operacije za pretvaranje ženskih genitalija u muške,

the male-to-female surgery has fooled gynecologists.

operacija muškarca u ženu zna prevariti ginekologe.

That's how good it can be.

Toliko dobro može biti izvedena.

Promatrao sam kako su pacijenti

So I looked at how the patients were doing,

i promatrao sam pacijente koji su izgledali poput svih ostalih,

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

except they were pubertally delayed.

osim što im je pubertet odgođen.

But once they gave them the hormones

No, jednom kada su im se dali hormoni,

consistent with the gender they affirm,

u skladu sa spolom kojeg potvrđuju,

they look beautiful.

izgledali su prelijepo.

They look normal.

Izgledaju normalno.

Normalne su visine.

They had normal heights.

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

Nikada ih ne biste mogli prepoznati u masi.

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

Tada sam odlučio da ću to učiniti.

Ovo je zaista područje pedijatrijske endokrinologije,

This is really where the pediatric endocrine realm comes in,

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

jer, zapravo, ako ćete se baviti time kod djece dobi između 10 i 14 godina,

that's pediatric endocrinology.

to je pedijatrijska endokrinologija.

So I brought some kids in,

I tako sam uveo u to nekoliko klinaca

and this now became the standard of care,

i to je sada postao standard liječenja

i bostonska dječja bolnica ga je podržala.

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

By my showing them the kids before and after,

Pokazujući im djecu prije i poslije,

ljudi koji nikada nisu primili tretman i ljudi koji su željeli primiti tretman,

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

and pictures of the Dutch --

te slike Nizozemaca --

prišli su mi i rekli,

they came to me and said,

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

"Moraš nešto učiniti za te klince."

Well, where were these kids before?

Ali, gdje su ti klinci bili do sada?

They were out there suffering, is where they were.

Bili su tamo negdje vani i patili, eto gdje su bili.

So we started a program in 2007.

I tako smo 2007. započeli program.

Bio je to prvi program takve vrste,

It became the first program of its kind --

but it's really of the Dutch kind --

ali je, zapravo, bio nizozemski --

in North America.

u Sjevernoj Americi.

And since then, we have 160 patients.

I od tada imamo 160 pacijenata.

Did they come from Afghanistan? No.

Jesu li došli iz Afganistana? Ne.

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

75% njih došlo je iz kruga unutar 240 km od Bostona.

And some came from England.

I neki iz Engleske.

Jackie je bila zlostavljana u Midlandu, u Engleskoj.

Jackie had been abused in the Midlands, in England.

She's 12 years old there,

Ovdje je imala 12 godina,

živjela je kao djevojčica,

she was living as a girl,

but she was being beaten up.

no počeli su je premlaćivati.

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

Bio je to užas, morala se obrazovati kod kuće.

And the reason the British were coming

A razlog zašto su Britanci dolazili je,

to što nisu liječili nikoga ničim ispod 16. godine,

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

which means they were consigning them to an adult body

što znači da su ih osudili na tijelo odrasle osobe,

no matter what happened,

bez obzira što se dogodi,

even if they tested them well.

čak i ako su ih dobro testirali.

Jackie je, uz sve to, uslijed koštanih markera,

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

destined to be six feet five.

bila predodređena na visinu od preko 180 cm.

A ipak, upravo je ušla u muški pubertet.

And yet, she had just begun a male puberty.

Well, I did something a little bit innovative,

Učinio sam nešto inovativno,

because I do know hormones,

budući poznajem hormone

and that estrogen is much more potent

i znam da je estrogen mnogo jači

in closing epiphyses, the growth plates,

u zatvaranju epifize, važne za rast,

and stopping growth, than testosterone is.

te kod zaustavljanja rasta, od testosterona.

So we blocked her testosterone with a blocking hormone,

Zato smo joj blokirali testosteron hormonom blokatorom,

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

ali smo dodali estrogen, ne u 16., već u 13. godini.

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

I ovdje je ona sa 16 godina, na lijevoj strani.

Na svoj 16. rođendan otišla je na Tajland,

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

where they would do a genital plastic surgery.

gde će joj izvesti plastičnu operaciju genitalija.

They will do it at 18 now.

Sada to rade sa 18 godina.

And she ended up 5'11".

I na kraju je dostigla oko 160 cm.

But more than that, she has normal breast size,

Osim toga, ima grudi uobičajene veličine,

because by blocking testosterone,

jer blokiranjem testosterona,

every one of our patients has normal breast size

svaki naš pacijent ima grudi uobičajene veličine

if they get to us at the appropriate age,

ako nam dođu u prikladnoj dobi,

not too late.

ne prekasno.

Ovdje desno je ona.

And on the far right, there she is.

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

Izašla je u javnost -- polufinalistica za Miss Engleske.

Žiri je raspravljao može li to tako?

The judges debated as to, can they do this?

A jedan od njih se našalio, pričali su mi:

And one of them quipped, I'm told,

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

"Ali ona ima više prirodnosti od polovine ostalih natjecateljica."

(Laughter)

(Smijeh)

And some of them have been rearranged a little bit,

Neke od njih su bile i malo dorađene,

but it's all her DNA.

ali kod nje je sve u njenoj DNK.

And she's become a remarkable spokeswoman.

I postala je izuzetna glasnogovornica.

Ponuđeni su joj ugovori kao modelu,

And she was offered contracts as a model,

u tom trenutku me je zadirkivala,

at which point she teased me, when she said,

"Znaš, možda bih imala veće šanse kao model,

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

if you'd made me six feet one."

da si me učinio visokom oko180 cm."

(Laughter)

(Smijeh)

Go figure.

Pa sada vi vidite.

Dakle, mislim da ova slika sve govori.

So this picture, I think, says it all.

It really says it all.

Zaista sve govori.

These are Nicole and brother Jonas,

Ovo su Nicole i brat Jonas,

identical twin boys,

identični blizanci, dječaci,

and proven to be identical.

i dokazano identični.

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

Nicole se u dobi od tri godine potvrdila kao djevojčica.

At age seven, they changed her name,

U sedmoj godini promijenili su joj ime

te došli k meni odmah na početku muškog puberteta.

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

Now you can imagine looking at Jonas at only 14,

Možete zamisliti, promatrajući Jonasa sa samo 14 godina,

that male puberty is early in this family,

da muški pubertet rano dolazi u ovu obitelj,

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

jer on izgleda više kao 16-godišnjak.

Zato je još važnije

But it makes the point all the more,

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

zašto trebate biti svjesni toga gdje se pacijent nalazi.

Nicole is on pubertal blockade in here,

Nicole je obavila pubertetsku blokadu ovdje,

and Jonas is just going -- biologic control.

a Jonas upravo prolazi biološku kontrolu.

This is what Nicole would look like

Ovako bi Nicole izgledala,

if we weren't doing what we were doing.

da nismo učinili sve što smo učinili.

He's got a prominent Adam's apple.

Ima izraženu Adamovu jabučicu.

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

Ima četvrtaste kosti lica, brkove,

a vidite i razliku u visini,

and you can see there's a height difference,

jer je on prošao kroz ubrzani rast kroz koji ona neće.

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

Nicole je sada na estrogenu.

Now Nicole is on estrogen.

She has a bit of a form to her.

Poprima određenu formu.

This family went to the White House last spring,

Ova obitelj je bila u Bijeloj kući prošlo proljeće,

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

zbog svog rada na antidiskriminaciji --

there was a bill that would block

postojao je prijedlog zakona koji bi sprečavao

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

pravo transrodnih osoba u državi Maine na korištenje javnih WC-a

and it looked like the bill was going to pass,

i izgledalo je da će zakon biti izglasan,

a to bi bio problem,

and that would have been a problem,

but Nicole went personally to every legislator in Maine

no Nicole je osobno išla svakom zakonodavcu u Mainu

and said, "I can do this.

i rekla, "Ja to mogu.

If they see me, they'll understand

Ako me vide, razumjet će

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

zašto nisam prijetnja u ženskom WC-u,

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

no mogli bi mi prijetiti u muškom."

And then they finally got it.

I tada su konačno shvatili.

I kamo sada dalje?

So where do we go from here?

Pa, još uvijek ima dosta toga za učiniti po pitanju antidiskriminacije.

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

Samo je 17 država koje imaju antidiskriminacijski zakon

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

against discrimination in housing,

protiv diskriminacije stanovanja,

employment, public accommodation --

zapošljavanja, javnih usluga.

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

Samo njih 17, a pet od njih je u Novoj Engleskoj.

We need less expensive drugs.

Potrebni su nam jeftiniji lijekovi.

They cost a fortune.

Koštaju čitavo bogatstvo.

I moramo ukloniti ovo stanje iz DSM klasiifikacije.

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

To je psihijatrijski poremećaj koliko je i biti gej ili lezbijka,

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

and that went out the window in 1973,

a to je ukinuto 1973.

and the whole world changed.

i cijeli svijet se promijenio.

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

I ovo neće utjecati na ničiji budžet.

Ovo nije toliko učestalo.

This is not that common.

But the risks of not doing anything for them

Ali, ne čineći ništa za njih,

ne samo da ih sve izlaže riziku od gubitka života zbog samoubojstva,

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

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

već i govori nešto o tome jesmo li zaista inkluzivno društvo.

Thank you.

Hvala.

(Applause)

(Pljesak)