What doctors should know about gender identity | Kristie Overstreet

譯者: Lilian Chiu 審譯者: Melody Tang

About six months into my career as a therapist,

在成為一位醫生大約六個月左右，

I was working at a drug and alcohol rehab facility.

我在一間毒品與酒精勒戒機構工作。

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

戒癮單位的一位護士打電話給我。

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

她請我過去評估

當天早些時候抵達的一位病患。

that had arrived earlier in the day.

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

所以我去了那個單位， 很榮幸見到了安。

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

安是一位女性變性人， 當她和我開始交談時，

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

她和我分享了 她來接受治療的原因。

but I could hear this fear in her voice,

但我能在她的聲音中聽出恐懼，

and I could see this worry in her eyes,

也能在她的眼中看出擔憂。

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

她開始告訴我， 她並不害怕來到勒戒所，

and having to give up drugs and alcohol.

和必須要放棄毒品和酒精。

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

她的恐懼是將要治療她的醫生，

would not treat her as her female self.

可能不會把她當女性來對待。

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

她接著告訴我她一生中 所遭遇的這種持續不斷的痛苦。

of being assigned male but knowing she's female.

她被認定為男性， 但她知道她是女性。

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

她的意思是，當她出生時，

the doctor held her up to her parents

醫生把她抱起來交給她的父母，

and based on her genitalia said,

根據她的生殖器，說：

"It's a boy."

「是個男孩。」

She always knew she wasn't a boy.

她一直都知道她不是男孩。

Many years passed and the feelings that she was feeling

許多年過去了， 她所感受到的感覺，

and holding all this in grew and grew,

被她壓抑在心中，但越來越強。

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

她知道她得要向她的家人坦白。

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

當她坦白時， 結果並沒有很順利。

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

她的父母說： 「絕對不是。你不是女生。

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

我們不是這樣養育你的。 我們搞不懂你在想什麼。

Get out."

滾出去。」

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

接著，安就流落街頭， 進進出出無家可歸者收容所。

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

在那裡，她開始染上毒品和酒精，

to numb this pain she felt inside.

以麻痺她內心感受的痛苦。

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

她告訴我那段不斷進出 醫院和勒戒所的過程。

trying to get sober,

她試著讓自己清醒。

and when she did, the health care providers and doctors

當她清醒時， 健康照護提供者以及醫生

wouldn't use the correct female name or pronouns.

不願意使用她的正確的 女性名字或女性代名詞。

This caused her pain.

這讓她很痛苦。

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

當我還在讀書準備要當醫生時，

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

沒有人教我要如何對待變性病人。

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

我完全不知道 我會接觸到這樣的病人。

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

但我和安以及其他 類似的病人接觸越多，

I began to see my mission evolve,

我發現我的任務有所演變了。

and that was to make sure that the transgender community

那就是要確保變性人族群的

got their health care needs met.

健康照護需求能被滿足。

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

在這方面，我研究越多， 我越能了解這種對於

of violence, discrimination and this lack of acceptance

暴力、歧視，以及 不被接受的真實恐懼感

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

使許多這類病人轉向毒品及酒精。

And I also heard these horror stories

我也聽到許多駭人的故事，

of when these patients were seeking medical care

關於這類病人在尋求醫療照護時，

and how they were treated,

他們所受的對待，

and how a lot of their medical needs were ignored.

以及他們許多醫療的需求 如何被忽視。

Now let me tell you about Leah.

讓我告訴各位莉亞的故事。

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

幾年前，我有榮幸認識了莉亞。

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

她是女性，她有妻子和一個孩子。

See, Leah was also assigned male at birth

莉亞也是出生時被認定為男性，

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

但她從小時候就知道她不是男性，

that she was a female.

她是女性。

She hid it from herself and from everyone she knew,

她將這件事瞞著 自己以及她認識的每個人，

especially from her wife, until the age of 50.

特別是她的妻子，直到五十歲時。

She couldn't take it anymore.

她無法再忍受了。

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

她心想，我不能繼續這樣過日子。

我得要誠實。

I gotta get honest.

她非常害怕將這件事告訴她的妻子。

She was extremely scared to tell her wife.

What if her wife said,

萬一她的妻子說： 「這是不能接受的，

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

我要離婚，滾出去。」怎麼辦？

To her surprise, her wife was accepting.

讓她意外的是，她的妻子接受了。

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

她說：「我愛你，不論你是誰。

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

我想要盡我所能來協助你。」

So she talked with her wife,

所以，她和妻子長談，

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

她決定要做醫學的變性。

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

她有興趣接受 更換荷爾蒙治療法的評估，

也就是大家所知的 HRT。

otherwise known as HRT.

So she made an appointment with her doctor.

所以，她和她的醫生 約了會面時間。

She arrived on the day of her appointment early.

當天，她提早赴約。

She filled out all the paperwork,

她填寫了各種表單，

put the name correctly down there and waited patiently.

把名字正確地填寫好， 耐心地等待。

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

不久後，一位護士把她叫回檢查間。

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

當她去到檢查間時， 她深吸了一口氣，

and the doctor and the nurse walked in.

醫生和護士走進來。

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

她把手伸向醫生，說： 「嗨，我是莉亞。」

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

醫生看著她， 並沒有握她的手，說：

"Why are you here?"

「你為什麼來這裡？」

She took another deep breath and said,

她再次深呼吸，說：

"Well, I'm a transgender female.

「我是女性變性人。

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

我一直都知道這一點， 但都沒讓別人知道，

but I can't do it anymore.

但我無法繼續這樣了。

我妻子支持我，錢我負擔得起。

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

I've got to make these changes.

我得要做這些改變。

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

請考慮我，請評估我是否 適合更換荷爾蒙治療法。」

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

醫生說： 「今天我們什麼都不能做。

You need to go get an HIV test."

你得去做愛滋病病毒檢測。」

She couldn't believe it.

她無法置信。

She was furious.

她很憤怒。

She was angry. She was disappointed.

她很生氣。她很失望。

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

如果連她的醫生都這樣對待她， 世界上的其他人會如何對待她呢？

First, he wouldn't shake her hand,

首先，他不願意和她握手，

and second, when he heard she was transgender,

再者，當他聽到她是變性人時，

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

他在乎的只有愛滋病病毒檢測 以及結束面談。

He didn't even ask her any other questions.

他甚至沒有問她其他問題。

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

我能了解莉亞的感受，

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

因為我在工作上 接觸這個族群的這些年，

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

我每天都會聽到一些謎思， 它們都完全不是真的。

A couple of those are:

其中一些包括：

every transgender person wants to transition with medication or surgery;

每個變性人都想要 用藥物或手術來變性；

transgender people are mentally ill, this is a disorder;

變性人心理有病，這是一種失調；

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

還有，這些人不是 真正的男人或女人。

These are all myths and untrue.

這些都是謎思，且不是真的。

As this community expands and grows older,

隨著這個族群擴大和年紀漸長，

it is imperative that all health care providers be trained

所有的健康照護提供者 都必須要接受訓練，

on how to take care of their health care needs.

了解如何處理 他們的健康照護需求。

Back in 2015, a survey was done

在 2015 年，有一項調查

and found that 72 percent of health care providers

發現 72% 的健康照護提供者

did not feel well-informed

不覺得他們對於 LGBT 族群的

on the health care needs of the LGBT community.

健康照護需求有足夠的資訊。

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

在他們的教育和訓練中， 有很大的缺口。

Today, in this talk,

今天，在這場演說中，

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

我想要將一種 新的思考方式提供給三種人：

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

醫生、變性人族群， 以及剩下的其他人。

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

但在這之前， 我想要先談幾個定義，

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

它們能協助各位 對性別認同多了解一點。

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

我希望你們已經準備好 紙筆要來寫筆記了。

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

咱們就從這個 二元系統的想法開始。

And what this means is,

意思就是，

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

以前我們認為只有兩種性別， 男和女。

Get it? Binary? Right?

懂嗎？二元？對吧？

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

我們漸漸發現，事實不是如此。

Gender identity is a spectrum

性別認同像是光譜，

with maleness on one side

一端是男性，

and femaleness over here on the other side.

另一端是女性。

This spectrum of identities

這個性別認同的光譜

include identities such as gender-nonconforming,

包含了非常規性別、

gender-affirming,

性別確認、

gender-nonbinary,

非二元性別、

two-spirited, three-spirited,

雙靈、三靈，

as well as people that are intersex.

以及陰陽人。

The term transgender is this umbrella term

變性人這個詞是一個總稱，

that encompasses all these different types of identities.

包括上述各類的性別認同。

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

但，在今天的演說， 我希望各位能把變性人

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

視為在出生時被認定的性別

不符合自己本人的認定 和他們的自我感覺。

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

Now, this is very different than biological sex.

這和生物學上的性別是很不同的。

So gender identity is sense of self.

性別認同是自我的感覺。

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

你可把它想成是在你的兩耳之間：

sense of self, who you are.

對自己的感覺，你是怎樣的人。

This is very different than biological sex, right?

這和生物學上的性別 很不一樣，對吧？

Hormones, genitalia, chromosomes:

荷爾蒙、生殖器、染色體：

that's what's between our legs.

那是在我們的兩腿之間。

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

你們可能在想：「克莉絲蒂醫生， 我從來沒有質疑過我是什麼人。

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

我知道我是男人， 或我知道我是女人。」

I get it. You know who you are.

我懂。你知道你是什麼人。

This is how many transgender individuals feel.

許多變性人也有這種感覺。

They just know who they are

他們就是知道他們是什麼人，

with that same conviction.

有著和你們同等的信心。

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

重要的是要知道 有許多不同類型的身分認同，

and I identify as a cisgender female.

而我認同的是順性別的女性。

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

如果你們想要知道如何寫這個詞，

cis is spelled "c-i-s."

「順」性別的順是「c－i－s」。

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

這個詞來自拉丁文， 意思是「在同一邊」。

When I was born,

我出生時，

the doctor held me up to my parents and said,

醫生把我抱起來交給我父母，

說：「是個女孩。」

"It's a girl."

All this, based on my genitalia.

這完全是根據我的生殖器判斷的。

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

雖然我是在喬治亞州的 小農場長大，

very much a tomboy,

是個很男性化的女孩。

I never questioned that I was a female.

我從來沒有質疑過我是女性。

I've always known I was a girl,

我一直都知道我是個女孩，

regardless of how I was as a kid.

不論我在孩提時是怎樣的。

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

這和變性人是非常不同的。

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

「變（trans）」也來自拉丁文， 意思是「在另一邊」——

think about transcontinental airlines,

想想看橫貫（trans） 大陸的航線，

across, on the other side of --

橫越，到另一邊——

someone that's assigned a sex at birth

有人在出生時被認定了一個性別，

and they identify on the other side of the spectrum.

而他們認同的是另一端的性別。

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

男性變性人就是在出生時 被認定為女性，

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

但他們的自我感覺、他們是誰、 要如何過他們的生活，

is as a male.

是男性的。

And the opposite is, as we talked earlier,

相對的，我們前面談過，

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

女性變性人是在出生時 被指定為男性，

但以女性的身分過生活， 且自我感覺是女性。

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

It's also important to point out here

這裡還有一個重點，

that not everyone that has a nonbinary identity

並不是所有非二元性別認同的人，

identifies with the term "transgender."

就一定是「變性人」。

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

為了不要讓大家困惑， 我要談一下性認同，

or orientation.

或是性取向，

That is simply who we're attracted to,

那只是看我們被什麼人吸引，

physically, emotionally, sexually, spiritually.

身體上、感情上、性別上、心靈上。

It's got nothing to do with gender identity.

這和性別認同是沒關係的。

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

在我們繼續下去之前， 先快速回顧一下重點：

gender identity between the ears,

性別認同在兩耳之間，

biological sex, just think of it between your legs,

生物學的性別則是在兩腿之間的，

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

而性認同， 有時我們會用我們的心，

but it's here.

但它在這裡。

Three very different identity spectrums.

三種不同的身分認同光譜。

Now, the average medical student

一般的醫學院學生

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

在上醫學院時會花 大約五小時的時間，

學習關於 LGBT 的健康相關需求。

while they're in medical school.

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

而且這是在我們已經知道

這個族群會面對獨特的健康風險。

to this community.

And there's an estimated 10 million American adults

根據估計，有一千萬名美國成人的

that identify as LGBT.

性別認同是 LGBT。

Most doctors that work with transgender patients,

大部分在工作上需要接觸 變性人病人的醫生，

they learn trial by fire.

他們學的是火審。

That means they figure it out as they go along,

意思就是說，他們邊做邊學，

or the patient ends up spending their time

或是最後反而是病人要花時間

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

來教導醫生如何照顧他們。

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

許多醫生對於詢問病人的 性別認同感覺不自在。

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

有些醫生覺得性別認同 和醫療照護一點關係都沒有。

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

還有些醫生不希望說錯話。

Many doctors who say something inappropriate

當醫生說出了不妥當的話，

or they say something negative,

或是負面的話時，

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

他們不見得是有惡意或是故意的。

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

他們可能從來沒有受過 如何照顧這些人的訓練。

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

但我們不能再接受 把這種狀況當成常態了。

So what happens to a transgender male --

所以，當男性變性人——

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

快速回顧一下， 就是出生時被認定為女性，

but lives their life as a male --

但以男性身分過日子的人——

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

當男性變性人去做每年的 婦科檢查時，會發生什麼事？

How that doctor treats that patient

那位醫生如何對待這個病人，

will set the whole tone for the office.

會決定那間診所的氛圍。

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

如果醫生用正確的代名詞、 正確的名字來對待那位男性，

gives dignity and respect,

給予他尊嚴和尊重，

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

很可能其他工作人員也會這麼做。

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

那是我對於醫生的小小想法，

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

現在，咱們接著來談變性人族群。

I'm here talking about fear,

我要談的是恐懼。

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

你們都知道真正感到 害怕的人是誰，對吧？

It's the transgender community.

是變性人族群。

Earlier I shared the story about Anne

剛才我分享了安的故事，

and how she was so worried about going into treatment

提到她有多擔心要去接受治療時，

不會被當成女性來尊重，

and not being respected as her female self,

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

接著是莉亞， 她害怕的是醫生的反應，

and the second that he didn't shake her hand

當醫生沒有跟她握手，

and ordered that HIV test, her fears came true.

並要求愛滋病檢測的那一刻， 她的恐懼成真了。

The transgender community needs to be empowered

變性人族群需要能夠

to speak up for their health care needs.

大聲說出他們的健康照護需求。

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

保持沉默和接受任何 能得到之治療的日子已經過去了。

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

如果你不大聲說出 自己的健康照護需求，

no one's going to do it for you.

沒有人會為你發聲。

So what about the rest of us?

那麼，我們剩下的人呢？

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

在座很多人， 在下週或是幾個月後，

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

可能已預約了要看醫生，對吧？

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

假設說你照約定的時間去看醫生，

and when it's over,

結束時，

you feel worse than you did when you got there.

你的感覺比去看醫生之前更糟。

What if you felt dismissed by the doctor,

你覺得被醫生打發掉，

that they ignored your needs,

醫生不理會你的需求，

or you even felt judged?

或你甚至覺得受到評斷。

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

美國 140 萬名成年變性人當中，

有許多人就會有這樣的遭遇，

here in the US

if they're lucky enough to get an appointment.

前提是他們夠幸運地 預約到醫生。

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

你們現在可能在想： 「這對我來說有什麼重要的？

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

我又不是變性人。 我也不認識任何變性人。

Why should I even care?"

我幹嘛在乎？」

Think of it this way.

就這樣想吧。

A transgender individual is human,

變性人是人，

just like you and me.

就像你和我一樣。

They deserve competent and trained health care providers,

他們也該能取得有能力 且受過訓練的健康照護提供者，

just like you and me.

和你我一樣。

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

讓我問個問題， 如果不介意，請舉手：

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

你們認識或遇見過任何變性人、

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

非性別常規、無性別、陰陽人、 雙靈、或三靈的人嗎？

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

非常謝謝你們。真好。謝謝。

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

所有沒舉手的人，

in the very near future

在不久的將來，

you will get the opportunity to meet

你們會有機會遇見

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

上述的其中一種，我保證。

The number of this community is increasing.

這個族群的人數在增加。

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

並不是因為這是流行或是很新鮮。

It's safer to come out.

而是他們對站出來感到更安全了。

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

有更多的意識。有更多的能見度。

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

有更多的安全感， 所以大家會展現出真實的自己，

like never before.

以前是不可能的。

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

這就是為什麼，很重要的是 我們的健康照護體制要能上路，

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

確保我們的醫生和健康照護 提供者都受到訓練，

to approach these patients with dignity and respect,

知道如何在接觸這些病人時 保持他們的尊嚴和尊重，

just like we expect.

就像我們所有人都期望得到的。

I remember being in my 11th grade literature class,

我記得我十一歲在上文學課時，

with one of my favorite teachers, Mr. McClain,

麥克連老師是我最喜歡的老師之一，

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

他引述了赫拉克利特的話， 至今我都忘不了。

Y'all may have even heard it.

你們可能也聽過。

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

「唯一不變的即是變。」

Familiar, right?

很耳熟，對吧？

Every single one of us face changes in our lives,

我們每個人在人生中 都會面臨改變，

and often when we're faced with these changes,

通常，當我們面臨這些改變時，

we've got some difficult decisions to make.

我們得要做出一些困難的決定。

Will we remain in fear, stay stuck

我們是否會持續 留在恐懼中，被卡住，

and not grow?

無法成長？

Or, will we face fear with bravery,

或者，我們會勇敢面對恐懼，

evolve, take the opportunity to grow?

進化，抓住機會來成長？

Every one of us face new things.

我們每個人都會面臨新事物。

What will you do?

你們會怎麼做？

Will you remain in fear,

你們會持續留在恐懼中？

or will you grow?

還是你們會成長？

I invite each of you, doctors, the transgender community

我想邀請每個人： 醫生、變性人族群，

and you and I,

以及你和我，

to face fear together

在走進這個勇敢的新世界時，

as we walk into this brave new world.

一起面對恐懼。

Thank you.

謝謝。

(Applause)

（掌聲）