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

譯者: Becky Ma 審譯者: Neoh Yi Yuan

I want you all to think

我希望大家回想一些：

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

別人形容你那句話的第三個詞彙

or, if you were delivering,

或如果你正在接生一個嬰兒

about the person you were delivering.

你會如何形容這個孩子？

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

請你把答案默念或者大聲說出來

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

最開頭兩個字是:Ta是...

（觀眾：男孩 ... 女孩 ...）

Audience: (Mixed reply) Girl. Boy.

好吧，我這話使你知道

(Laughter)

Well, it shows you that --

I also deal with issues where there's not certainty

我也處理有關到底是 男孩或女孩的問題

of whether it's a girl or a boy,

so the mixed answer was very appropriate.

所以我剛剛那樣的措辭十分得體

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

當然，現在這問題的答案

通常是在照射超音波時 而非出生時揭曉

unless the prospective parents choose to be surprised,

除非未來的父母們像我們以前那樣

把驚喜留到孩子出生那天 才知道孩子的性別。

like we all were.

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

但我希望你們想一想

是什麼決定了

那第三個詞彙

on the third word,

because the third word

因為它

is a description of your sex.

描述你的性別

我的意思是

And by that I mean,

made by a description of your genitals.

它的判斷來自於你的生殖器

Now, as a pediatric endocrinologist,

現在，身為一個小兒科內分泌學家

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

我曾經非常熱衷於研究 （現在也算是）

關於種種通過生殖器的判斷會不會出錯

in which there are mismatches in the externals

外觀上

or between the externals and the internals,

或內外之間的性別不符合

and we literally have to figure out

而我們實際上必須設法釐清

what is the description of your sex.

什麼才能客觀描述你的性別

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

在出生那刻

我們實在難以定義你的性別。

that would define you.

而當我談及定義

And when I talk about definition,

我是在說你的性別取向

I'm talking about your sexual orientation.

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

我們不說:他是個男同志男孩

"A lesbian girl!"

她是個女同志女孩

Those situations don't really define themselves

這些情況還要等到 他們10幾歲之後才會出現。

more until the second decade of life.

Nor do they define your gender,

性取向也不能定義你的性別

which, as different from your anatomic sex,

而這性別並不等同於解剖學上的

describes your self-concept:

而是關乎你的自我意識

Do you see yourself as a male or female,

你認為自己

是男性或女性

or somewhere in the spectrum in between?

或者在這之間徘徊

That sometimes shows up

性別混淆有時發生在

in the first decade of life,

孩子10歲以前

but it can be very confusing for parents,

卻會讓父母十分困惑

because it is quite normative for children

因為一般而言

孩童表現出跨性別的舉止 或遊戲方式是很正常的

to act in a cross-gender play and way,

and, in fact, there are studies that show

且事實上有許多研究顯示

that even 80 percent of children who act in that fashion

只有八成的兒童

在那樣的行為模式下

will not persist in wanting to be the opposite gender

於青春期來臨時

不會想再扮演

at the time when puberty begins.

其另外一種性別的角色

But, at the time that puberty begins --

青春期開始時

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

約當於女孩在10到12歲間

男孩在12到14歲間

with breast budding,

胸部開始發育

or two to three times' increase in the gonads

而在生理男性方面： 性腺會成長兩到三倍

in the case of genetic males,

by that particular point,

在那特定時間點

the child who says they are in the absolute wrong body

聲稱自己處在錯誤身體裡的那些孩子

is almost certain to be transgender

幾乎可以確定將會是跨性別的

and is extremely unlikely to change those feelings,

且改變這樣想法的可能性極小

no matter how anybody tries reparative therapy

無論任何人對他做修復療法

or any other noxious things.

或其他任何有害的事

Now, this is relatively rare,

現在這種情況相對罕見

so I had relatively little personal experience with this.

所以我個人經驗也相對較少

And my experience was more typical,

而我的經歷較典型

only because I had an adolescent practice.

因為我接觸的是青少年治療

And I saw someone age 24,

我曾見過一個24歲的人

genetically female, went through Harvard with three male roommates

就讀哈佛，基因上是女性

與三位知道它故事的男性室友

who knew the whole story,

度過哈佛時光

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

總在註冊時

在選課單上填寫男性姓名

並在畢業後尋求我的協助

and came to me after graduating,

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

他說:幫我。我知道你是內分泌專家

事實上我也的確治癒了很多

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

出生時缺乏性腺的人

This wasn't rocket science.

這不是什麼難如登天的科學

But I made a deal with him:

但我跟他做了個約定:

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

如果你教導我，我就治療你

And so he did.

他照辦了

而我從照顧

And what an education I got

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

他的支持小組所有成員中

真的學到了很多

And then I got really confused,

我當時十分困惑

因我當時認為在那種年紀

because I thought it was relatively easy at that age

to just give people the hormones

只要為他們施打 想成為的性別的賀爾蒙

of the gender in which they were affirming.

事情就能簡單解決

But then my patient married,

但接下來我的病患結婚了

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

他與一個女人結合

而她出生時是生理男性

had married as a male, had two children,

曾以男性的身分結婚，育有兩個孩子

then went through a transition into female.

之後才轉為女性

And now this delightful female

現在這快樂做自己的女性

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

與我的男性病患結合了

實際上是合法結婚了

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

因為他們看起來是一男一女，誰又看得出來呢?

你說是吧?(笑聲)

(Laughter)

And I was confused --

當我正感到困惑:

"Does this make so-and-so gay?

這種情況該說是男同性戀呢?

Does this make so-and-so straight?"

還是正常呢?

I was getting sexual orientation confused with gender identity.

我正是把性傾向

跟性別自我認可搞混了

And my patient said to me,

我的病患跟我說:

"Look, look, look.

"嘿，聽我說，聽我說。

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

你只要照我說的去想，就會搞懂了。

Sexual orientation is who you go to bed with.

性傾向代表你要同床的對象

性別自我認同就是你赴床上時的身分

Gender identity is who you go to bed as."

(Laughter)

And I subsequently learned from the many adults --

而我接著從許多成年人身上學到--

I took care of about 200 adults --

我曾照顧了約200個成年人--

我學到了

I learned from them

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

如果我不看或偷瞄

他們在等待室裡的伴侶的話

I would never be able to guess better than chance,

我永遠也沒法猜到--

單純用機率都比我準--

whether they were gay, straight, bi or asexual

他們會是男同、直、女同

或是無性者

in their affirmed gender.

In other words,

換句話說

one thing has absolutely nothing to do with the other.

許多事情之間

是沒有絕對的關聯的

And the data show it.

而資料也如此顯示

現在，當我照顧這200個成年人

Now, as I took care of the 200 adults,

I found it extremely painful.

我發現這極度令人傷痛

These people -- many of them --

這些人們

had to give up so much of their lives.

大多必須放棄自己的人生

他們有時會被父母給否定

Sometimes their parents would reject them,

siblings, their own children,

被手足、自己的子女拒絕

and then their divorcing spouse

與他們離婚的配偶

would forbid them from seeing their children.

也會禁止他們與孩子見面

It was so awful,

結果如此悲慘

but why did they do it at 40 and 50?

他們為何要在四、五十歲時這麼做?

Because they felt they had to affirm themselves

因為他們覺得有必要在自殺之前

確認自己的性別

before they would kill themselves.

And indeed, the rate of suicide among untreated transgendered people

而的確，

未受治療的跨性別者的自殺率

is among the highest in the world.

在世上是數一數二的高

所以該怎麼辦?

So, what to do?

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

我曾被一個研討會給吸引去

where they are experts in this,

在荷蘭，那兒有許多專家

並見識了許多令人印象深刻的事

and saw the most remarkable thing.

They were treating young adolescents

他們治療的是年輕的青少年

after giving them the most intense psychometric testing of gender,

先給予最密集的心理測試

以鑑定性別

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

再用阻擋他們不想要的青春期

來治療他們

因為基本上，無論哪個性別

Because basically, kids look about the same,

each sex, until they go through puberty,

孩子們在經歷青少年時期之前看起來都一樣

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

在青少年時期若認為自己性別錯了

you feel like Pinocchio becoming a donkey.

感覺就像自己是一個正變成驢子的皮諾丘

The fantasy that you had that your body will change

認為自己身體會隨著青春期而改變

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

成為自己想要的樣子的幻想

actually is nullified by the puberty you get.

實際上正是被自己 所成為的青少年給毀滅

And they fall apart.

而他們也因此崩潰了

所以這就是為什麼要先保留這些青少年--

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

為什麼是保留? 因為你不能 在他們這麼年輕的時候

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

就給他們相反性別的賀爾蒙

They'll end up stunted in growth,

因為那會使他們發育不良

and you think you can have a meaningful conversation

而你覺得你和一個十歲女孩或十二歲男孩

about the fertility effects of such treatment

在這種療程會造成的生殖能力影響上

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

能有什麼有意義的對話嗎

So this buys time in the diagnostic process

這種情況下

能夠爭取四到五年的診斷時間

for four or five years,

所以那些青少年可以有機會克服

so that they can work it out.

They can have more and more testing,

可以做更多檢測

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

可以好好活著，而不會感到自己的身體

正離自己而去

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

而接著，在一個叫做12-16-18的計畫中

around age 12 is when they give the blocking hormones,

十二歲左右給予阻擋青春期的賀爾蒙

and then at age 16, with retesting,

在十六歲時再度測試時

they re-qualify to receive --

他們必須能夠符合

現在注意，那些賀爾蒙是可逆的

now remember, the blocking hormones are reversible,

but when you give the hormones of the opposite sex,

但只要給予相反性別的賀爾蒙

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

他們就能開始長出胸部和臉毛

而聲音決定於你要使用什麼

depending on what you're using,

且那些效應是永久的

and those effects are permanent,

or require surgery to remove,

或需要手術去移除

or electrolysis,

或電離法

and you can never really affect the voice.

且你其實沒法真的改變聲音

所以這很嚴肅，而且這跟著你有15、16年久了

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

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

接著到18歲，他們能夠接受手術了

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

雖然女轉男的生殖器 改變手術無法盡善盡美

the male-to-female surgery has fooled gynecologists.

男轉女的手術卻能騙過婦產科醫師

That's how good it can be.

你看看它有多完善

So I looked at how the patients were doing,

所以我觀察病患的改善情況

也觀察病患順利融入人群，與別人並無二致

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

except they were pubertally delayed.

除了他們青春期有被延遲之外

But once they gave them the hormones

一旦給了與他們所認同的性別

consistent with the gender they affirm,

相符合的賀爾蒙

他們會變得美麗

they look beautiful.

看起來正常，有著正常的身高

They look normal.

They had normal heights.

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

你永遠無法在人群中

挑出他們來

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

在那時刻，我決定自己也要往這方面去做

這就是我踏入

This is really where the pediatric endocrine realm comes in,

小兒科內分泌領域的時候

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

因為事實上

假如你要治療10-12或10-14歲的孩子

that's pediatric endocrinology.

那就該是小兒科內分泌學啦

So I brought some kids in,

所以我引入了一些孩子

and this now became the standard of care,

而這現在成了照護的標準

有兒童醫院在後面支援

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

By my showing them the kids before and after,

展示了這些孩子的前後樣貌後

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

從未受治療的人們

想接受治療的人們

and pictures of the Dutch --

以及荷蘭人

they came to me and said,

都來找我並說:

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

"你必須為這些孩子做點事"

Well, where were these kids before?

那麼，之前這些孩子們在哪?

They were out there suffering, is where they were.

他們在那兒承受痛苦

So we started a program in 2007.

所以我們在2007年開始了一個計劃

它成為這類型中的第一個計劃--

It became the first program of its kind --

but it's really of the Dutch kind --

但它其實是之前說的荷蘭方法--

in North America.

不過是在北美洲實行

And since then, we have 160 patients.

自那時起，我們有了160個病患

Did they come from Afghanistan? No.

他們來自阿富汗嗎?不。

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

他們其中有百分之七十五

來自距波士頓150哩以內的地方

And some came from England.

而有些人來自英格蘭

Jackie had been abused in the Midlands, in England.

傑琪曾在英格蘭的米德蘭茲被虐

那時她十二歲

She's 12 years old there,

以女孩的身分過活

she was living as a girl,

but she was being beaten up.

但一直受到毒打

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

那情形慘不忍睹

他們得讓她在家自學

And the reason the British were coming

這些英國人會來求助的原因是

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

在英國任何未滿16歲的人

都不能接受治療

which means they were consigning them to an adult body

等同於無論多可怕的事會發生

他們都會被交付一個成年的身軀

no matter what happened,

even if they tested them well.

就算已經做過良好的檢驗了

在這情況下

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

傑琪雖在骨骼測量中

destined to be six feet five.

被預測能長到約195公分

但她才剛開始進入

And yet, she had just begun a male puberty.

男性的青春期

Well, I did something a little bit innovative,

我做了件有點創新的事

because I do know hormones,

因為我的確了解賀爾蒙

and that estrogen is much more potent

知道雌激素在關閉骨端生長板

in closing epiphyses, the growth plates,

是很有能力的

and stopping growth, than testosterone is.

比睪固酮更能停止成長發育

So we blocked her testosterone with a blocking hormone,

所以我們使用了賀爾蒙

去阻斷她的睪固酮

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

並在13而非16歲時為她施打雌激素

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

左邊這個就是她16歲時的樣子

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

在她16歲生日，她去了泰國

where they would do a genital plastic surgery.

去做生殖器整形手術

They will do it at 18 now.

現在他們是在18歲時做

And she ended up 5'11".

結果她只長了約180公分

But more than that, she has normal breast size,

更棒的是，她擁有正常的胸部大小

because by blocking testosterone,

因為藉由阻斷睪固酮

every one of our patients has normal breast size

我們的每個病患

都能有正常胸部大小

if they get to us at the appropriate age,

只要他們及早在適當年齡來找我們

not too late.

而在最右邊，也是她

And on the far right, there she is.

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

她公開參加英國小姐選美

進入準決賽

評審們互相辯論，他們該怎麼做

The judges debated as to, can they do this?

And one of them quipped, I'm told,

他們能不能讓她進入決賽

據我所知，其中有一人諷刺道:

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

"但她比起其他參賽者的一半

擁有更多的自然的自我"

(Laughter)

(笑聲)

And some of them have been rearranged a little bit,

雖然其中有些部分被重新排列更動

but it's all her DNA.

但畢竟全是她的DNA啊

And she's become a remarkable spokeswoman.

接著她成為一個令人印象深刻的發言人

並得到模特兒的合約

And she was offered contracts as a model,

當時她開玩笑說:

at which point she teased me, when she said,

"你知道的，要是你當時讓我長到185，

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

現在我就有更好的條件可以當模特兒"

if you'd made me six feet one."

(Laughter)

天知道(笑聲)

Go figure.

So this picture, I think, says it all.

所以這張照片，我想，解釋了一切

It really says it all.

真的解釋了一切

These are Nicole and brother Jonas,

他們是尼蔻和她兄弟，瓊納斯

identical twin boys,

同卵雙生男孩

and proven to be identical.

經過證實的

但尼蔻早在三歲時

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

就確定自己是女的

At age seven, they changed her name,

七歲時，他們改了她的名

並在剛進入青春期時

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

來找我求診

Now you can imagine looking at Jonas at only 14,

現在你們看著14歲的瓊納斯

可以想像在他家族裡

that male puberty is early in this family,

青春期很早開始

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

因為他看起來比較像16歲了

但這只是再次強調了

But it makes the point all the more,

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

為什麼你應該更加留意

病人的年齡狀況

Nicole is on pubertal blockade in here,

尼蔻當時就做了中斷青春期的措施

and Jonas is just going -- biologic control.

而瓊納斯只有做生理控制

This is what Nicole would look like

假如我們不做任何事

if we weren't doing what we were doing.

他是尼蔻會變成的樣子

He's got a prominent Adam's apple.

他有一個明顯的喉結

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

臉骨有稜有角，有鬍鬚

且你也看得出有身高差距

and you can see there's a height difference,

因為他經歷了青春期成長

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

而她沒有

現在尼蔻正使用雌激素

Now Nicole is on estrogen.

She has a bit of a form to her.

很有成效

This family went to the White House last spring,

這個家族去年春天去了白宮

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

因為他們的成就

也就是翻轉了歧視

there was a bill that would block

在緬因州曾有一個法條

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

禁止跨性別的人

使用公廁

and it looked like the bill was going to pass,

這法條一度很有機會通過

and that would have been a problem,

將造成一大麻煩

but Nicole went personally to every legislator in Maine

但尼蔻個人拜訪了緬因州每個議員

and said, "I can do this.

並說:"我能做到。

If they see me, they'll understand

如果他們看到了我

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

他們就會了解為什麼我在女廁不會構成任何威脅

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

而會在男廁受到威脅。"

And then they finally got it.

而他們最終真的懂了

所以我們究竟能到達怎樣的目標呢?

So where do we go from here?

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

我敢說在反歧視方面

還有一段很長的路要走

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

只有17個州

擁有反歧視法律

against discrimination in housing,

避免在居住、

employment, public accommodation --

工作、公共場所可能出現的各種歧視

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

只有17州，其中五個在新英格蘭

We need less expensive drugs.

我們還需要不那麼昂貴的藥

They cost a fortune.

藥物是一筆很大的花費

且我們需要把這情況

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

帶出《精神疾病診斷與統計手冊》

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

這是精神疾病

不單單是男同志或女同志的問題

and that went out the window in 1973,

它在1973年就走了樣

and the whole world changed.

使得全世界都改變

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

而這不會超出任何人的預算

因為這問題沒有那麼普遍

This is not that common.

But the risks of not doing anything for them

但不為他們做任何事的風險

不只是讓他們

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

處於自殺的危險中

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

也是考驗著我們這社會

究竟是不是真正有包容性

Thank you.

謝謝

(Applause)

(掌聲)