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

Prevodilac: Ivana Krivokuća Lektor: Mile Živković

I want you all to think

Hoću da razmislite

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

o trećoj reči koja je ikada izgovorena

u vezi vas,

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 hoćete

ili je naglas izgovoriti.

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

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

Audience: (Mixed reply) Girl. Boy.

(Laughter)

Well, it shows you that --

Ukazuje vam da

I also deal with issues where there's not certainty

se bavim i pitanjima gde

nema pouzdanosti da li je neko devojčica ili dečak,

of whether it's a girl or a boy,

so the mixed answer was very appropriate.

tako da je mešovit 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 rođenju već na ultrazvuku,

unless the prospective parents choose to be surprised,

osim ukoliko potencijalni roditelji odaberu

da budu iznenađeni kao što smo mi bili.

like we all were.

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

Ali želim da razmislite o tome šta je to

što dovodi do te izjave

on the third word,

treće reči,

because the third word

jer treća reč

is a description of your sex.

je opis vašeg pola,

i time podrazumevam,

And by that I mean,

made by a description of your genitals.

nastala od opisa 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, veoma uključen,

i donekle još uvek jesam,

u slučajevima u kojima

in which there are mismatches in the externals

postoji nesklad

spoljašnjosti

or between the externals and the internals,

ili između spoljašnjosti i unutrašnjosti,

and we literally have to figure out

i bukvalno moramo da otkrijemo

what is the description of your sex.

koji je opis vašeg pola.

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

Ali ne postoji ništa što je definišuće

u vreme rođenja

that would define you.

što bi vas odredilo,

a kada govorim o određivanju,

And when I talk about definition,

govorim o vašoj seksualnoj orijentaciji.

I'm talking about your sexual orientation.

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

Ne kažemo: "Dobili ste gej sina."

"A lesbian girl!"

"Devojčicu lezbejku."

Those situations don't really define themselves

Te okolnosti se ne određuju

more until the second decade of life.

do druge decenije života.

Nor do they define your gender,

Niti određuju vaš pol,

which, as different from your anatomic sex,

koji, kao različit u odnosu na vaš anatomski pol,

describes your self-concept:

opisuje vaš self-koncept.

Do you see yourself as a male or female,

Da li vidite sebe

kao muškarca ili ženu

or somewhere in the spectrum in between?

ili negde između u spektrumu?

That sometimes shows up

To se nekada javlja

in the first decade of life,

u prvoj deceniji života,

but it can be very confusing for parents,

ali može biti vrlo zbunjujuće za roditelje

because it is quite normative for children

jer je prilično normativno

da se deca poigravaju međupolnim igrama i načinima,

to act in a cross-gender play and way,

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 procenata dece

koja se ponašaju na taj način

will not persist in wanting to be the opposite gender

neće nastojati da budu

suprotnog pola

at the time when puberty begins.

u vreme otpočinjanja puberteta.

But, at the time that puberty begins --

Ali u vreme kada pubertet počne,

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

to znači između uzrasta od 10 do 12 godina kod devojčica,

12 do 14 kod dečaka,

with breast budding,

sa grudima koje pupe

or two to three times' increase in the gonads

ili dva do tri puta uvećanja gonada

in the case of genetic males,

u slučaju genetskih muškaraca,

by that particular point,

do te određene tačke, dete koje kaže

the child who says they are in the absolute wrong body

da je u apsolutno pogrešnom telu

is almost certain to be transgender

će gotovo sigurno biti transpolno

and is extremely unlikely to change those feelings,

i izuzetno je malo verovatno da će promeniti ta osećanja,

no matter how anybody tries reparative therapy

bez obzira na to koliko pokušava reparativnu terapiju

or any other noxious things.

ili bilo koju drugu neprijatnu stvar.

Now, this is relatively rare,

Ovo je relativno retko,

so I had relatively little personal experience with this.

tako da sam imao relativno malo ličnog iskustva sa ovim,

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 video sam nekoga sa 24 godine,

genetically female, went through Harvard with three male roommates

prošao Harvard, genetski žensko,

prošao Harvard sa tri muška cimera

who knew the whole story,

koji su znali celu priču,

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

beležnik koji je uvek unosio njegovo ime

na listi kursa kao muško ime,

i došao kod mene nakon diplomiranja govoreći: "Pomozite mi.

and came to me after graduating,

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

Znam da znate puno o endokrinologiji."

I zaista sam lečio mnogo ljudi

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

koji su rođeni bez gonada.

This wasn't rocket science.

To nije bila nuklearna fizika.

But I made a deal with him:

Ali sam se nagodio sa njim:

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

Lečiću te ako me naučiš.

And so he did.

I tako me je naučio.

Kakvu sam samo edukaciju dobio

And what an education I got

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

brinući o svim članovima

njegove grupe podrške.

And then I got really confused,

A onda sam se zaista zbunio,

jer sam mislio da je relativno lako u tim godinama

because I thought it was relatively easy at that age

to just give people the hormones

jednostavno dati ljudima hormone

of the gender in which they were affirming.

pola u kome su se afirmisali,

But then my patient married,

ali onda se moj pacijent venčao,

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

i venčao se sa ženom

koja je rođena kao muškarac,

had married as a male, had two children,

venčala se kao muškarac, imala dva deteta,

then went through a transition into female.

zatim prošla kroz prelazak u ženu,

And now this delightful female

i sada je ova zanosna žena

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

bila vezana za mog muškog pacijenta,

u stvari, oni su se zakonski venčali jer su se pojavili

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

kao muškarac i žena, i ko bi rekao?

Zar ne? (Smeh)

(Laughter)

And I was confused --

I dok sam bio zauzet u vezi:

"Does this make so-and-so gay?

da li je ovo manje-više gej?

Does this make so-and-so straight?"

Da li je manje-više strejt?

I was getting sexual orientation confused with gender identity.

Pomešao sam seksualnu orijentaciju

sa polnim 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 prosto ovako razmišljaš, shvatićeš kako treba:

Sexual orientation is who you go to bed with.

seksualna orijentacija je sa kim ideš u krevet;

polni identitet je kakav ideš u krevet."

Gender identity is who you go to bed as."

(Laughter)

And I subsequently learned from the many adults --

I naknadno sam naučio od mnogo odraslih -

I took care of about 200 adults --

zbrinuo sam oko 200 odraslih -

naučio sam od njih

I learned from them

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

da ako ne gledam, ne gvirim ko je

njihov partner u čekaonici,

I would never be able to guess better than chance,

nikada neću moći da pogodim

bolje od čiste slučajnosti

whether they were gay, straight, bi or asexual

da li su gej, strejt, bi,

ili aseksualni u svom afirmisanom polu.

in their affirmed gender.

In other words,

Drugim rečima,

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.

Dok sam se starao 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 --

Ovi ljudi - mnogi od njih

had to give up so much of their lives.

su morali da da odustanu od mnogo toga u svojim životima.

Dešavalo se da ih roditelji odbace,

Sometimes their parents would reject them,

siblings, their own children,

braća i sestre, sopstvena deca,

and then their divorcing spouse

zatim bi im njihov bračni partner pred razvodom

would forbid them from seeing their children.

zabranio da viđaju decu.

It was so awful,

Bilo je užasno, ali zašto su to činili

but why did they do it at 40 and 50?

u 40-im i 50-im godinama?

Because they felt they had to affirm themselves

Jer su osećali da moraju da se afirmišu

da se ne bi ubili.

before they would kill themselves.

And indeed, the rate of suicide among untreated transgendered people

I zaista, stopa samoubistava

među transrodnim ljudima bez primljenog tretmana

is among the highest in the world.

je među najvišima na svetu.

Šta činiti?

So, what to do?

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

Bio sam zaintrigiran otišavši na konferenciju

where they are experts in this,

u Holandiji, gde su stručnjaci za ovo,

i video sam vrlo neobičnu stvar.

and saw the most remarkable thing.

They were treating young adolescents

Lečili su adolescente

after giving them the most intense psychometric testing of gender,

nakon što su im zadali najintenzivnije

psihometrijske testove pola,

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

i lečili su ih blokiranjem

puberteta koji nisu želeli.

Jer u suštini, deca slično izgledaju,

Because basically, kids look about the same,

each sex, until they go through puberty,

svaki pol, dok ne prođu kroz pubertet,

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

u kom trenutku, ako mislite da ste pogrešnog pola,

you feel like Pinocchio becoming a donkey.

osećate se kao Pinokio koji se pretvara u magarca.

The fantasy that you had that your body will change

Fantazija koju ste imali da će se vaše telo promeniti

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

i da ćete postati ono što želite u pubertetu

actually is nullified by the puberty you get.

zapravo se poništava pubertetom.

And they fall apart.

I raspadaju se.

Zato odlaganje puberteta -

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

zašto odlaganje? Ne možete im prosto dati

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

suprotne hormone tako mladima.

They'll end up stunted in growth,

Završiće zakržljali rastom,

and you think you can have a meaningful conversation

i zar mislite da možete imati smisleni razgovor

about the fertility effects of such treatment

o efektima takvog tretmana na plodnost

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

sa devojčicom od 10 godina, dečakom od 12 godina?

So this buys time in the diagnostic process

Zato ovo kupuje vreme u dijagnostičkom procesu

na četiri ili pet godina

for four or five years,

tako da mogu da reše problem,

so that they can work it out.

They can have more and more testing,

mogu da obave dosta testiranja,

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

mogu da žive bez osećaja da njihova tela

beže od njih.

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

A zatim, u programu koji nazivaju 12-16-18,

around age 12 is when they give the blocking hormones,

oko 12. godine daju blokirajuće hormone,

and then at age 16, with retesting,

u 16. godini ponovo testiraju,

they re-qualify to receive --

budu prekvalifikovani.

Setite se, blokirajući hormoni se mogu preinačiti,

now remember, the blocking hormones are reversible,

but when you give the hormones of the opposite sex,

ali kada date hormone suprotnog pola,

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

počinju da rastu grudi i dlake na licu

i glas, u zavisnosti od toga šta koristite,

depending on what you're using,

i ti efekti su trajni

and those effects are permanent,

or require surgery to remove,

ili zahtevaju hirurgiju za otklanjanje

or electrolysis,

ili elektrolizu,

and you can never really affect the voice.

a nikada ne možete zaista uticati na glas.

Tako da 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 zatim u 18. godini, postaju podesni za 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.

So I looked at how the patients were doing,

Posmatrao sam kako su pacijenti,

i posmatrao sam pacijente koji su izgledali kao bilo ko drugi,

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

except they were pubertally delayed.

osim što im je odložen pubertet.

But once they gave them the hormones

Ali čim bi im dali hormone

consistent with the gender they affirm,

u skladu sa polom u kome se afirmišu,

izgledali su prelepo.

they look beautiful.

Izgledaju normalno. Imali su normalnu visinu.

They look normal.

They had normal heights.

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

Nikada ne biste bili u stanju da ih uočite

u gomili.

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

Tako da sam u tom trenutku odlučio da ću raditi ovo.

Ovde zaista domen

This is really where the pediatric endocrine realm comes in,

pedijatrijske endokrinologije dolazi do izražaja,

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

jer zapravo, ako ćete se baviti

decom uzrasta 10-12, 10-14 godina,

that's pediatric endocrinology.

to je pedijatrijska endokrinologija.

So I brought some kids in,

Izveo sam nekoliko klinaca,

and this now became the standard of care,

a to je sada postalo standard lečenja,

i Dečija bolnica ga je podržala.

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

By my showing them the kids before and after,

Mojim pokazivanjem dece pre i posle,

ljudi koji nikada nisu primili tretman

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

i ljudi koji su želeli da dobiju tretman,

and pictures of the Dutch --

i slike Holanđana,

they came to me and said,

prišli su mi i rekli:

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

"Moraš nešto da učiniš za ovu decu."

Well, where were these kids before?

Pa gde su ta deca bila ranije?

They were out there suffering, is where they were.

Bila su tamo negde i patila, tamo su bila.

So we started a program in 2007.

Tako smo započeli program 2007. godine.

Postao je prvi program te vrste -

It became the first program of its kind --

but it's really of the Dutch kind --

ali je zapravo kao holandski -

in North America.

u Severnoj Americi.

And since then, we have 160 patients.

I od tada, imamo 160 pacijenata.

Did they come from Afghanistan? No.

Da li su došli iz Avganistana? Ne.

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

Došli su, 75 procenata je došlo

sa udaljenosti do 240 km od Bostona.

And some came from England.

A neki su došli iz Engleske.

Jackie had been abused in the Midlands, in England.

Džeki je bila zlostavljana u Midlendsu, u Engleskoj.

Imala je 12 godina tamo,

She's 12 years old there,

živela je kao devojčica

she was living as a girl,

but she was being beaten up.

ali su je prebijali.

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

Bio je to horor.

Morali su da je školuju kod kuće.

And the reason the British were coming

A razlog zbog kojeg su Britanci dolazili je taj

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

što oni ne pružaju tretman nikome

ispod uzrasta od 16 godina,

which means they were consigning them to an adult body

što znači da su ih osudili

na telo odrasle osobe, bez obzira na to šta se dogodi,

no matter what happened,

even if they tested them well.

čak i ako su ih dobro testirali.

Džeki je, povrh svega,

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

usled obeležja skeleta,

destined to be six feet five.

predodređena da bude visoka 196 cm.

A ipak, upravo je otpočela

And yet, she had just begun a male puberty.

muški pubertet.

Well, I did something a little bit innovative,

Uradio sam nešto malčice inovativno,

because I do know hormones,

jer poznajem hormone,

and that estrogen is much more potent

i znam da je estrogen mnogo delotvorniji

in closing epiphyses, the growth plates,

u zatvaranju epifiza, ploča rasta,

and stopping growth, than testosterone is.

i zaustavljanju rasta, od testosterona.

So we blocked her testosterone with a blocking hormone,

Zato smo blokirali njen testosteron

blokirajućim hormonom,

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

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

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

I evo nje ovde u 16. godini, sa leve strane.

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

Na svoj 16. rođendan, otišla je u Tajland,

where they would do a genital plastic surgery.

gde će obaviti 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 180 cm,

But more than that, she has normal breast size,

štaviše, ima grudi normalne veličine,

because by blocking testosterone,

jer blokiranjem testosterona,

every one of our patients has normal breast size

svaki naš pacijent

ima grudi normalne veličine

if they get to us at the appropriate age,

ako dođu kod nas u odgovarajućem uzrastu, ne previše kasno.

not too late.

A evo nje skroz na desnoj strani.

And on the far right, there she is.

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

Izašla je u javnost,

polufinalista u izboru za Mis Engleske.

Sudije su debatovale o tome da li to može tako.

The judges debated as to, can they do this?

And one of them quipped, I'm told,

Da li mogu da je proglase -

a jedan od njih se našalio, rekli su mi:

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

"Ali ona ima više prirodnosti

od polovine ostalih učesnica."

(Laughter)

(Smeh)

And some of them have been rearranged a little bit,

Neke od njih su malo preuređene,

but it's all her DNA.

ali to je sve njena DNK.

And she's become a remarkable spokeswoman.

I postala je izuzetna govornica.

Ponuđeni su joj ugovori kao modelu,

And she was offered contracts as a model,

u tom trenutku me je zadirkivala, rekla je:

at which point she teased me, when she said,

"Znaš, možda bih imala veće šanse

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

kao model da si učinio da imam 196 cm."

if you'd made me six feet one."

(Laughter)

Pa sad vi vidite. (Smeh)

Go figure.

So this picture, I think, says it all.

Ova slika, po meni, sve govori.

It really says it all.

Stvarno sve govori.

These are Nicole and brother Jonas,

Ovo su Nikol i brat Džonas,

identical twin boys,

identični dečaci blizanci,

and proven to be identical.

i dokazano identični,

gde se Nikol afirmisala

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

kao devojčica na ranom uzrastu od tri godine.

At age seven, they changed her name,

U sedmoj godini, promenili su njeno ime,

i došli kod mene na samom početku

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

muškog puberteta.

Now you can imagine looking at Jonas at only 14,

Možete da zamislite posmatrajući Džonas

sa svega 14 godina da muški pubertet

that male puberty is early in this family,

rano dolazi u ovoj porodici,

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

jer on izgleda više kao da ima 16 godina,

ali to još više ističe poentu

But it makes the point all the more,

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

zašto morate biti svesni toga

gde se pacijent nalazi.

Nicole is on pubertal blockade in here,

Nikol je obavila pubertetsku blokadu ovde,

and Jonas is just going -- biologic control.

a Džonas će upravo - biološka kontrola.

This is what Nicole would look like

Ovako bi Nikol izgledala

if we weren't doing what we were doing.

da nismo uradili ono što smo uradili.

He's got a prominent Adam's apple.

On ima izraženu Adamovu jabučicu.

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

Ima četvrtaste kosti lica, brkove,

i možete videti da postoji razlika u visini

and you can see there's a height difference,

jer je prošao kroz

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

ubrzani rast kroz koji ona neće.

Nikol je sada na estrogenu.

Now Nicole is on estrogen.

She has a bit of a form to her.

Ima pomalo oblina.

This family went to the White House last spring,

Ova porodica je išla u Belu kuću prošlog proleća

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

zbog njihovog rada

na preokretu antidiskriminacije,

there was a bill that would block

postojao je predlog zakona koji bi sprečavao

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

prava transrodnih ljudi u Mejnu

da koriste javna kupatila,

and it looked like the bill was going to pass,

i izgledalo je da će ovaj predlog proći,

and that would have been a problem,

a to bi bilo problem,

but Nicole went personally to every legislator in Maine

ali je Nikol lično išla kod svakog zakonodavca u Mejnu

and said, "I can do this.

i rekla: "Mogu ovo.

If they see me, they'll understand

Ako me vide, razumeće

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

zašto nisam pretnja u ženskom toaletu,

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

ali mogu biti ugrožena u muškom toaletu."

And then they finally got it.

I tada su konačno shvatili.

Kuda odavde?

So where do we go from here?

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

Pa, još uvek ima stvari koje treba uraditi

u vezi antidiskriminacije.

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

Samo 17 država imaju

antidiskriminacioni zakon

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 17 država, a pet od njih su u Novoj Engleskoj.

We need less expensive drugs.

Potrebni su nam jeftiniji lekovi.

They cost a fortune.

Koštaju čitavo bogatstvo.

I moramo da uklonimo ovo stanje

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

iz DSM-a.

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

To je psihijatrijski poremećaj isto koliko je i

biti gej i lezbejka,

and that went out the window in 1973,

a to je ukinuto 1973,

and the whole world changed.

i ceo svet se promenio.

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

Ovo neće da poremeti ničiji budžet.

Ovo nije toliko učestalo.

This is not that common.

But the risks of not doing anything for them

Ali rizici od nečinjenja ničega za njih

stavljaju ne samo sve njih pod rizik

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

od gubitka života zbog samoubistva,

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

već takođe govori nešto o tome

da li smo zaista inkluzivno društvo.

Thank you.

Hvala vam.

(Applause)

(Aplauz)