What doctors should know about gender identity | Kristie Overstreet

翻译人员: jacks peng 校对人员: Annie Zhang

About six months into my career as a therapist,

在我治疗师的职业生涯 开始大约六个月，

I was working at a drug and alcohol rehab facility.

我在毒品和酒精戒毒所工作。

I got a call from one of the nurses down at the detox unit.

我接到排毒病房的护士 打来的电话。

She asked me to come down and assess one of the new patients

她让我下去检查一个 当天早些时候

that had arrived earlier in the day.

过来的新病人。

So I went down to the unit and had the pleasure of meeting Anne.

于是我下去病房并与安妮 有了一场愉快的会面。

Anne's a transgender female, and as her and I started talking,

安妮是跨性别女性， 随着我俩开始交谈，

she was sharing with me about what brought her into treatment,

她和我分享了她接受治疗的原因，

but I could hear this fear in her voice,

但我能在她声音中听到这个恐惧，

and I could see this worry in her eyes,

我也能从她的眼中看到这个担忧，

and she began to tell me that she didn't fear coming into rehab

她开始告诉我说她不怕来戒毒所

and having to give up drugs and alcohol.

并且放弃毒品和酒精。

Her fear was that the doctors that were going to be treating her

她担心的是给她治疗的医生

would not treat her as her female self.

不会把她当女性看待。

She then told me about this ongoing pain that she has experienced her whole life

她告诉了我她在整个人生中 所经历的痛苦，

of being assigned male but knowing she's female.

知道自己是女性 却被分配了男性角色。

And what she meant by that is, when she was born,

她意思是，当她出生时，

the doctor held her up to her parents

医生扶着她，根据她的生殖器

and based on her genitalia said,

跟她父母说，

"It's a boy."

“是个男孩。”

She always knew she wasn't a boy.

她一直知道她不是个男孩。

Many years passed and the feelings that she was feeling

多年过去后，她对这一切的感觉

and holding all this in grew and grew,

和感受与日俱增，

and she knew she had to come out to her family.

她知道她得跟家人坦白。

And when she did, it didn't go over so well.

她做了，但事情并不顺利。

Her parents said, "Absolutely not. You're not a girl.

她父母说，“绝对不可能， 你不是女孩。

This is not how we raised you. We don't know what you're thinking.

我们不是这样抚养你的， 我们不知道你在想什么。

Get out."

出去。”

So Anne then found herself on the streets and in and out of homeless shelters,

于是安妮发现自己在大街上， 在无家可归的收容所进出，

and it's here where she started using drugs and alcohol

在那开始她开始使用毒品和酒精

to numb this pain she felt inside.

来麻木她内心的痛苦。

She told me about her journey of being in and out of hospitals and rehabs

她告诉我她在医院和戒毒所 进进出出

trying to get sober,

试图清醒过来的经历，

and when she did, the health care providers and doctors

当她这样做时， 医疗保健提供者和医生

wouldn't use the correct female name or pronouns.

不会对她使用正确的 女性名字或代名词。

This caused her pain.

这引发了她的痛苦。

You see, when I was studying to become a therapist,

你看， 当我学习成为 一名治疗师时，

I wasn't taught how to work with transgender patients.

我没有接受过如何处理 跨性别病人的训练。

I had no idea these would be the patients I'd be working with.

我对处理这样的病人毫无概念。

But the more I worked with Anne and other patients like Anne,

但我遇到安妮和像安妮这样的人 越来越多后，

I began to see my mission evolve,

我开始看到我的使命的演变，

and that was to make sure that the transgender community

那就是确保跨性别群体

got their health care needs met.

得到他们所需的医疗服务。

The more I looked into this, I saw how this very real fear

我见到的案例越来多， 我看到这种

of violence, discrimination and this lack of acceptance

对暴力，歧视和不被接受的 真正恐惧

caused so many of these patients to turn to alcohol and drugs.

是如何导致如此多的人 转向酒精和毒品的。

And I also heard these horror stories

我也听到了这些可怕的故事，

of when these patients were seeking medical care

当这些病人寻求医疗服务时

and how they were treated,

他们是如何被治疗的，

and how a lot of their medical needs were ignored.

以及他们的医疗需求 是如何被忽视的。

Now let me tell you about Leah.

现在我让告诉你们 关于利亚的故事。

I had the pleasure of meeting Leah a few years back.

几年前我有幸与利亚会面。

She's a female and she has a wife and a child.

她是个女性， 并且有妻子和孩子。

See, Leah was also assigned male at birth

利亚出生时被分配的角色 是男性，

and she knew since she was a young child that she was not a male,

然而她从小开始就知道 她不是男性，

that she was a female.

而是个女性。

She hid it from herself and from everyone she knew,

她瞒着自己和她认识的每个人，

especially from her wife, until the age of 50.

特别是她的妻子， 直到50岁的时候。

She couldn't take it anymore.

她无法继续忍受了。

She was like, I can't keep living like this.

她就像， 无法这样继续活着了。

I gotta get honest.

我得诚实。

She was extremely scared to tell her wife.

她特别害怕告诉她的妻子。

What if her wife said,

如果她的妻子说：

"This is unacceptable, I want a divorce, get out"?

“这真是不可接受，我要离婚， 出去” 会怎样？

To her surprise, her wife was accepting.

让她惊讶的是，她妻子接受了。

She said, "I love you regardless of who you are.

她说：“不管你是谁，我都爱你。

I want to help you in every way I can."

我会尽一切可能帮你。”

So she talked with her wife,

于是她跟她妻子交谈后，

and she made the decision that she wanted to medically transition,

她决定去做医学转变手术，

and she was interested in being assessed for hormone replacement therapy,

她对激素替代疗法 很感兴趣，

otherwise known as HRT.

也被称为HRT。

So she made an appointment with her doctor.

于是她与医生做了预约。

She arrived on the day of her appointment early.

她在预约那天早早过去。

She filled out all the paperwork,

她填写了所有的文件，

put the name correctly down there and waited patiently.

把名字写对，耐心等候。

A little bit of time passed and a nurse called her back to the exam room.

过了一会，护士叫她回到检查室。

When she got back there, she took a deep breath,

当她回到那边，她深吸了一口气，

and the doctor and the nurse walked in.

医生和护士走了进来。

She extended her hand to the doctor and said, "Hi, I'm Leah."

她向医生伸出手说 “嗨，我是利亚。”

The doctor looked at her, didn't shake her hand and said,

医生看着她，并没握她的手说，

"Why are you here?"

“你为什么来这？”

She took another deep breath and said,

她再深吸了一口气说，

"Well, I'm a transgender female.

“我是个跨性别女性。

I've known this my whole life, I've hid it from everyone,

我毕生都知道这点， 我曾隐瞒了所有人，

but I can't do it anymore.

但我无法再继续隐瞒下去了。

My wife's supportive, I can financially afford it,

我妻子很支持，我可以负担费用，

I've got to make these changes.

我要做这些改变。

Please consider me, and let's evaluate me for HRT."

请考虑我， 让我参与HRT评估。”

The doctor said, "We can't do anything today.

医生说： “我们今天什么都不能做。

You need to go get an HIV test."

你需要去做个HIV检查。”

She couldn't believe it.

她无法相信。

She was furious.

她很愤怒。

She was angry. She was disappointed.

她很生气，她很失望。

If her doctor treated her this way, how would the rest of the world treat her?

如果她的医生都这样对她，那 这个世界的其他人又会怎么对她？

First, he wouldn't shake her hand,

首先，他不和她握手，

and second, when he heard she was transgender,

第二， 当他听到她是个跨性别者时，

all he cared about was getting an HIV test and ending the appointment.

他关心的是让她做HIV检查 并草草结束会面。

He didn't even ask her any other questions.

他甚至没问她其他任何问题。

See, I can understand where Leah's coming from,

我理解利亚的困扰，

because the years that I've worked with the community,

因为我与这个人群工作的这些年，

I hear myths every single day that aren't true at all.

我每天都听到一些 完全没有事实基础的偏见。

A couple of those are:

其中一些是：

every transgender person wants to transition with medication or surgery;

每个跨性别人都想通过药物 或手术来完成转变；

transgender people are mentally ill, this is a disorder;

跨性别者有精神病，是种障碍；

and: these people aren't real men and women.

以及：这些人都不是 真正的男人和女人。

These are all myths and untrue.

这些都是无稽之谈。

As this community expands and grows older,

随着这个人群扩大和变老，

it is imperative that all health care providers be trained

所有医疗保健提供者都需要接受

on how to take care of their health care needs.

如何照顾他们的培训。

Back in 2015, a survey was done

回到2015年， 一个那时做的调查发现

and found that 72 percent of health care providers

72%的医疗提供者

did not feel well-informed

对LGBT群体的

on the health care needs of the LGBT community.

医疗保健需求没有充分了解。

There's a huge gap in the education and training.

他们在教育和培训上 存在巨大的鸿沟。

Today, in this talk,

今天，在这个演讲中，

I want to offer a new way of thinking for three groups of people:

我想要为三个人群的人们 提供新的思考方式：

doctors, the transgender community and, well, the rest of us.

医生，跨性别群体 还有所有其他人。

But before we do, I want to cover a couple of definitions

但在我们开始前， 我想要讲清楚几个定义

that's going to help you wrap your head around gender identity a little bit more.

以更好帮助你理解性别认同。

So I hope you've got your paper and pen. Get ready to take some notes.

所以我希望你们有纸和笔。 准备好做些笔记。

So let's start out with this idea of a binary system.

让我们从二元系统的概念开始。

And what this means is,

二元的意思是，

before, we always thought there was only two, male and female.

过去，我们一直认为 有两种性别，男性和女性。

Get it? Binary? Right?

懂吗？二元？对吗？

So we've come to find out that this isn't true.

所以我们是来证明这不是真的。

Gender identity is a spectrum

性别认同是一个谱系，

with maleness on one side

一边是男性，

and femaleness over here on the other side.

另一边是女性。

This spectrum of identities

这一系列的性别认同

include identities such as gender-nonconforming,

包括性别错位，

gender-affirming,

性别确认，

gender-nonbinary,

非二元性别，

two-spirited, three-spirited,

双灵，三灵，

as well as people that are intersex.

还有阴阳人。

The term transgender is this umbrella term

跨性别者这个词是个统称

that encompasses all these different types of identities.

它包含了所有这些 不同类型的性别认同。

But for today's talk, I want you to think about transgender

但今天的演讲 我想让你们把跨性别者

as someone who is assigned a sex at birth that doesn't match

理解为某人出生时分配的性别与

with who they are as a person and their sense of self.

自我认知和意识不匹配的那种。

Now, this is very different than biological sex.

这和生理性别很不一样。

So gender identity is sense of self.

所以性别认同就是自我意识。

So think of it as what's between your ears:

把它想成你两耳之间的东西：

sense of self, who you are.

自我意识，你是谁。

This is very different than biological sex, right?

这与生理性别很不同，是吧？

Hormones, genitalia, chromosomes:

激素、生殖器、染色体：

that's what's between our legs.

那是我们两腿之间的东西。

Now, you may be thinking, "Dr. Kristie, I have never questioned who I am.

你可能在想，“克里斯蒂医生， 我从来没有问过我是谁。

I know I'm a man, or I know I'm a woman."

我知道我是个男人， 或者我知道我是女人。”

I get it. You know who you are.

我懂，你们知道你是谁。

This is how many transgender individuals feel.

这也是很多跨性别个体所感受的。

They just know who they are

他们有同样的信念

with that same conviction.

知道自己是谁。

It's important to know that there are many different types of identities,

知道有不同类型的 性别认同是很重要的，

and I identify as a cisgender female.

我自己就是个顺性别女性。

Now, for all y'all out there that like to know how to spell things,

现在， 有想要知道 怎么拼写的人，注意，

cis is spelled "c-i-s."

顺的拼法是c-i-s。

It's the Latin term for "on the same side of."

在拉丁语中的意思是 “同一边”。

When I was born,

当我出生时，

the doctor held me up to my parents and said,

医生扶起我，对我父母说，

"It's a girl."

“她是个女孩。”

All this, based on my genitalia.

这一切都基于我的生殖器。

Even though I grew up in a small farm town in Georgia,

尽管我在乔治亚州的 一个小农场长大，

very much a tomboy,

很像假小子，

I never questioned that I was a female.

我从没怀疑过我是女性这点。

I've always known I was a girl,

我一直知道我是个女孩，

regardless of how I was as a kid.

不管作为孩子时的我是什么样。

Now, this is very different than someone who's transgender.

这和跨性别人很不一样。

Now, trans is a Latin term for "on the other side of" --

跨在拉丁语中是 “另一边”的意思——

think about transcontinental airlines,

想想横跨大陆的航班，

across, on the other side of --

跨，另一边——

someone that's assigned a sex at birth

一个人在出生时被分配一个性别，

and they identify on the other side of the spectrum.

但他们认同的是谱系的另一边。

A transgender male is someone who was assigned female at birth,

跨性别男性是 出生时被分配为女性的人，

but their sense of self, who they are, how they live their life,

但他们的自我意识， 他们是谁，他们的生活方式，

is as a male.

则是男性。

And the opposite is, as we talked earlier,

反之，就如我们早先谈到的，

a transgender female, someone that's assigned male at birth

跨性别女性， 出生时被分配了男性角色，

but lives their live and sense of self as a female.

但生活方式和自我意识是女性。

It's also important to point out here

这里需要重点指出的是

that not everyone that has a nonbinary identity

不是每个非二元性别的人

identifies with the term "transgender."

都确认为跨性别者

Just so nobody gets confused, I want to point out sexual identity,

为了不让大家困惑， 我想指出性认同，

or orientation.

或者性取向。

That is simply who we're attracted to,

这只是我们在身体上，

physically, emotionally, sexually, spiritually.

感情上，肉体上，精神上 被某人吸引的意思。

It's got nothing to do with gender identity.

与性别认同无关。

So just for a quick recap, before we continue on:

在我们继续之前， 先简单回顾一下：

gender identity between the ears,

性别认同在两耳之间，

biological sex, just think of it between your legs,

生理性别， 把它想成两腿之间的东西，

and then sexual identity, well, sometimes we use our heart,

然后是性认同， 好吧，有时候我们会用心，

but it's here.

但它就在这里。

Three very different identity spectrums.

三个非常不同的认同谱系。

Now, the average medical student

现在一般医学生在

spends about five hours learning about the LGBT health-related needs

医学院，要花5个小时学习

while they're in medical school.

LGBT人群的医疗需求。

Now, this is despite us knowing that there are unique health risks

尽管我们知道这个人群有独特的

to this community.

健康风险。

And there's an estimated 10 million American adults

并且估计有1000万美国成年人

that identify as LGBT.

认定自己是LGBT群体。

Most doctors that work with transgender patients,

很多与跨性别病人工作的医生，

they learn trial by fire.

他们是在救火式的训练中学习。

That means they figure it out as they go along,

这意味着他们在 独自前进中搞懂，

or the patient ends up spending their time

或者病人反过来花费时间

trying to teach the doctor how to take care of them.

教会医生如何照顾他们。

Many doctors don't feel comfortable asking about gender identities.

很多医生在询问性别认同时 感到不自在。

Some don't feel like it's relevant at all to their medical care

有些人认为这跟他们的 医疗治疗没有一点关系，

and others just don't want to say the wrong thing.

另一些人则不想说错话。

Many doctors who say something inappropriate

很多说了不当的话

or they say something negative,

或者一些负面话语的医生，

they may not be coming from a malicious or mean place,

可能并非出于恶意或卑鄙，

they may have never been trained on how to care for these individuals.

他们可能只是从来没有接受过 如何照顾这些人的训练。

But this can't be accepted as a norm anymore either.

但这再也不能被当作 正常来接受了。

So what happens to a transgender male --

那么跨性别男性发生了什么——

for a quick recap, that's someone who is assigned female at birth

快速回想下， 是某个出生时被分配了女性，

but lives their life as a male --

但却以男性的方式生活的人——

what happens when this transgender male goes for their yearly gynecological visit?

这个跨性别男性 每年去做妇科检查会发生什么？

How that doctor treats that patient

医生如何治疗那位病人

will set the whole tone for the office.

将决定整个办公室的基调。

If that doctor treats that male with the correct pronouns, correct name,

如果那个医生用正确的代词， 正确的名字，给以尊严和尊重

gives dignity and respect,

去治疗那个男性，

it's highly likely that the rest of the staff will too.

很可能其他员工也会这么做。

So that's a little bit about my thoughts on doctors,

所以这是我对医生的一点思考，

and now let's move on to the transgender community.

现在让我们转到跨性别人群。

I'm here talking about fear,

我这里要谈到恐惧，

but y'all know who is really fearful, right?

但我们都知道谁真的害怕不是吗？

It's the transgender community.

是跨性别群体。

Earlier I shared the story about Anne

早些时候我分享的安妮的故事，

and how she was so worried about going into treatment

她是如此担忧接受治疗，

and not being respected as her female self,

害怕因自己的女性认同 而不被尊重，

and then Leah who was scared about how her doctor would react,

然后是利亚担心她的医生的反应，

and the second that he didn't shake her hand

其次是医生不握她的手，

and ordered that HIV test, her fears came true.

命令她去做HIV检查， 她的担忧果然成真。

The transgender community needs to be empowered

跨性别人群需要被赋权

to speak up for their health care needs.

说出他们的医疗需求。

The days of remaining silent and taking whatever treatment you can get are over.

保持沉默和照单全收 接受治疗的日子已经结束了。

If you don't speak up for your health care needs,

如果你不说出你的医疗诉求，

no one's going to do it for you.

没人会为你们发声。

So what about the rest of us?

那么我们剩下的其他人呢？

A lot of y'all, maybe in the next week or a couple of months,

很多人，可能在下周或几个月后，

are going to have a doctor's appointment, right?

要去看医生，对吗？

So let's say you go to your doctor's appointment

假设你去看了医生，

and when it's over,

医疗结束时，

you feel worse than you did when you got there.

你却感觉比刚进门时更糟。

What if you felt dismissed by the doctor,

假如你的感受被医生漠视了，

that they ignored your needs,

他们忽视你的需求，或者你觉得

or you even felt judged?

自己受到了评判，你会怎么办？

That's what happens for many of the 1.4 million transgender adults

这就是发生在美国140万

here in the US

跨性别群体上的事情，

if they're lucky enough to get an appointment.

假如他们足够幸运 能预约到医生的话。

Now, you may be thinking, "Why is this important to me?

现在，你可能在想： “这为什么对我重要？

I'm not transgender. I don't know anybody that's transgender.

我不是跨性别者， 我不认识任何跨性别人。

Why should I even care?"

我为什么要关心这个？”

Think of it this way.

要用这样的思维方式想。

A transgender individual is human,

跨性别者也是人，

just like you and me.

就跟你和我一样。

They deserve competent and trained health care providers,

他们理应得到有能力和 训练有素的医疗提供者的服务，

just like you and me.

就像你和我一样。

So let me ask, if you don't mind raising your hand:

那么让我问问， 如果你不介意举起你的手：

Do you know or have you met anyone who is transgender,

你们谁知道或者遇到过跨性别者，

gender-nonconforming, agender, intersex, two-spirited, three-spirited?

性别错位，无性别者， 阴阳人，双灵，三灵人吗？

Thank y'all so much. Lovely. Thank y'all.

谢谢，很好，谢谢大家。

Every one of y'all who did not raise your hand,

你们所有人，那些没有举手的人，

in the very near future

在不远的将来

you will get the opportunity to meet

可能会有机会遇到

someone that falls into one of these identities, I guarantee it.

有其中这些身份认同的人， 我保证。

The number of this community is increasing.

这个群体的数量正在增长。

That's not because it's a fad or the new thing to do.

这并非因为这是时尚或新事物。

It's safer to come out.

而是因为现在说出来 比以前说出来更安全。

There's more awareness. There's more visibility.

现在有更多的觉悟， 更多的可见性。

There's more safety, so people are speaking up about their true self

更多的安全，所以人们 在从所未有的谈论他们

like never before.

真实的自我。

That's why it's so important that our health care system get on board

所以我们的医疗系统到位 非常的重要，

and make sure that our doctors and health care providers are trained

并且要确保我们的 医生和医疗提供者训练有素

to approach these patients with dignity and respect,

用尊严和尊重的态度对待这些病人，

just like we expect.

就如我们所期望的那样。

I remember being in my 11th grade literature class,

我记得我上11年级的文学课时，

with one of my favorite teachers, Mr. McClain,

我最喜欢的老师麦克莱恩先生，

and he shared this quote by Heraclitus that sticks with me to this day.

他分享的赫拉克利特这句话， 我至今铭记在心。

Y'all may have even heard it.

你们可能也听过。

It's, "The only thing that is constant is that things will change."

它是：“唯一不变的事情 是改变。”

Familiar, right?

很熟悉，对吧？

Every single one of us face changes in our lives,

我们每个人都要面对生活中的改变，

and often when we're faced with these changes,

往往当我们面对这些改变时，

we've got some difficult decisions to make.

我们需要做一些艰难的决定。

Will we remain in fear, stay stuck

我们会继续恐惧，停滞不前，

and not grow?

不成长吗？

Or, will we face fear with bravery,

或者，我们会勇敢面对恐惧，

evolve, take the opportunity to grow?

进化，抓住机会成长吗？

Every one of us face new things.

我们每个人都面对新事物。

What will you do?

你会做什么？

Will you remain in fear,

你会继续恐惧，

or will you grow?

还是你会成长？

I invite each of you, doctors, the transgender community

我邀请你们每个人， 医生，跨性别群体

and you and I,

还有你和我，

to face fear together

去共同面对恐惧，

as we walk into this brave new world.

一起走进这个勇敢的新世界。

Thank you.

谢谢。

(Applause)

（鼓掌）