You love the idea of creating new body parts and want to be one of the first surgeons to

你喜歡創造新的身體部位的想法，並想成為第一批外科醫生之一。

break into this up-and-coming field.

闖入這個新興的領域。

Let’s debunk the public perception myths of what it means to be a gender surgeon and

讓我們揭穿公眾對性別外科醫生意味著什麼的神話，並且

give it to you straight.

直接告訴你吧。

This is the reality of gender surgery.

這就是性別手術的現實。

Dr. Jubbal, MedSchoolInsiders.com.

Jubbal博士，MedSchoolInsiders.com。

Welcome to our next installment in So You Want to Be.

歡迎來到《你想成為什麼樣的人》的下一篇文章。

In this series, we highlight a specific specialty within medicine, such as gender surgery, and

在這個系列中，我們強調醫學中的一個特定專業，如性別手術，以及

help you decide if it’s a good fit for you.

幫助你決定它是否適合你。

You can find other specialties on our So You Want to Be playlist.

你可以在我們的 "你想成為 "播放列表中找到其他專業。

If you have a specific specialty you want covered, make sure you’re subscribed to

如果你有想要報道的特定專業，請確保你訂閱的是

vote in upcoming polls.

在即將到來的投票中投票。

Also, consider becoming a YouTube channel member to receive additional perks and priority

此外，考慮成為YouTube頻道會員，以獲得額外的福利和優先權

in helping us decide future specialties.

在幫助我們決定未來的專業。

Click the JOIN button underneath this video for more information.

點擊本視頻下方的加入按鈕，瞭解更多資訊。

If you’d like to see what being a gender surgeon looks like, be sure to check out my

如果你想看看作為一名性別外科醫生是什麼樣子的，請務必查看我的

Day in the Life of a Gender Surgeon video with Dr. John Brosious on my second channel,

在我的第二個頻道上，與約翰-布羅休斯博士一起觀看《性別外科醫生的一天》視頻。

Kevin Jubbal, M.D., and subscribe for more Day in the Life videos covering other specialties

Kevin Jubbal, M.D.，並訂閱更多涵蓋其他專業的《生活中的一天》視頻。

in the future.

在未來。

Gender surgery is the field of medicine concerned with alleviating gender dysphoria through

性別手術是指通過以下方式緩解性別障礙的醫學領域

surgical procedures.

外科手術。

Gender dysphoria is defined as the unhappiness that patients in the gender expansive community

性別恐懼症被定義為性別暴露群體中的患者的不快樂

feel due to the incongruence between their gender identity and their physical characteristics.

由於他們的性別認同和他們的身體特徵之間的不協調而感到。

We often think of gender surgery as synonymous with genital surgery; however, the scope of

我們經常認為性別手術是生殖器手術的同義詞；然而，性別手術的範圍是

a gender surgeon is much broader.

一個性別外科醫生的範圍要廣得多。

Any surgical procedure that is done to help alleviate gender dysphoria can be considered

任何為幫助緩解性別障礙而進行的外科手術都可以被認為是

gender surgery.

性別手術。

This includes masculinization and feminization of the face and chest, tracheal shaves, voice

這包括面部和胸部的男性化和女性化，氣管剃鬚，聲音

modification, body contouring, and even limb lengthening and shortening procedures.

修改，身體塑形，甚至是肢體延長和縮短的手術。

Gender surgeons work with the full spectrum of gender patients including transgender,

性別外科醫生為包括變性人在內的所有性別病人提供服務。

non-binary, gender fluid, and intersex.

非二元性、變性和雙性。

Transgender patients are individuals whose gender identity differs from their assigned

變性患者是指其性別認同與所指定的性別不同的人。

gender at birth.

出生時的性別。

Within the gender surgery community, the appropriate terminology is either “assigned male”

在性別手術界，適當的術語是 "指定男性"

or “assigned female” at birth.

或在出生時被指定為女性。

We use this terminology as opposed to “biologically male” or “biologically female” as the

我們使用這一術語，而不是 "生物學上的男性 "或 "生物學上的女性"，因為

latter terms do not take into account the mental and psychological aspects of biology.

後面的術語沒有考慮到生物學的精神和心理方面。

Non-binary individuals do not identify as solely male or solely female but rather view

非二元個體並不只認定為男性或女性，而是認為

themselves as having features of both.

他們本身就具有這兩方面的特徵。

There are also gender-fluid individuals whose gender identity varies depending on the social

還有一些性別流動的人，他們的性別認同因社會的不同而不同。

situation.

情況。

For example, these individuals may identify as one gender while at work and another while

例如，這些人在工作時可能被認定為一種性別，而在工作時則是另一種性別。

outside of work.

工作以外的時間。

This isn’t to be confused with cross-dressing which is typically done for sexual satisfaction

這不能與通常為滿足性慾而進行的變裝混為一談。

as opposed to being an integral part of that person’s identity.

而不是作為該人身份的一個組成部分。

Lastly, there are intersex individuals who are born with some variation of both male

最後，還有一些雙性人，他們生來就具有男性和女性的某種差異。

and female sex organs.

和女性性器官。

Because gender surgeons work with a wide variety of gender patients, each with their own unique

因為性別外科醫生面對的是各種各樣的性別病人，每個人都有自己獨特的特點。

goals and needs, the treatment plan often varies significantly from patient to patient.

目標和需要，治療計劃往往因病人不同而有很大差異。

When it comes to gender surgery, there is no one-size-fits-all solution.

談到性別手術，沒有一個放之四海而皆準的解決方案。

This brings me to an important method of differentiating a gender surgeon’s practice: top surgery

這使我想到了區分性別外科醫生業務的一個重要方法：頂級手術

vs bottom surgery vs other masculinization and feminization surgeries.

VS 底部手術 VS 其他男性化和女性化的手術。

The majority of gender surgeons focus primarily on top surgeries.

大多數性別外科醫生主要關注的是頂部手術。

This includes a variety of chest masculinization and feminization procedures including mastectomies

這包括各種胸部男性化和女性化的手術，包括乳房切除術。

for trans-men and breast augmentations for trans-women.

變性男人的 "變性 "和變性女人的 "隆胸"。

This is the most common type of gender surgery as these procedures are very similar to routine

這是最常見的性別手術類型，因為這些手術與常規手術非常相似。

breast augmentation, reduction, and mastectomy procedures.

豐胸、縮胸和乳房切除手術。

They are also less functional compared to genital surgeries so there is often less risk

與生殖器手術相比，它們的功能也較少，所以風險通常較小。

of complications.

的併發症。

The combination of these two factors means that more surgeons are comfortable performing

這兩個因素的結合意味著，更多的外科醫生可以自如地執行

these types of procedures.

這些類型的程序。

Gender surgeons who perform bottom surgery, which includes vaginoplasty, phalloplasty,

進行底部手術的性別外科醫生，其中包括陰道整形術、陰莖整形術。

and metoidioplasty, are much less common.

和metoidlasty，則要少得多。

The reason being is that the surgical creation of a vagina or penis is still quite new and

原因是，通過外科手術創造陰道或陰莖仍然是相當新的，而且是非常重要的。

these procedures are constantly evolving.

這些程序是不斷髮展的。

It has only been within the last few years that training to perform these procedures

只是在過去的幾年裡，執行這些程序的培訓才開始。

has become more readily available.

已經變得更加容易獲得。

In the past, physicians interested in performing genital surgery had to do much of the research

在過去，有興趣進行生殖器手術的醫生必須進行大量研究

on their own and seek out mentors who were willing to train them.

自己，並尋找願意培訓他們的導師。

That being said, bottom surgery does not always involve the creation of a new sex organ.

也就是說，底部手術並不總是涉及創造一個新的性器官。

Sometimes the role of the gender surgeon is to simply remove the incongruent sex organ

有時，性別外科醫生的作用是簡單地切除不協調的性器官。

to combat hormone production or to allow the patient to live more in accordance with their

以對抗荷爾蒙的分泌，或讓病人更符合他們的生活方式。

gender identity.

性別認同。

For example, a trans-female that has an orchiectomy to remove one or both of the testicles may

例如，進行睪丸切除術以切除一個或兩個睪丸的變性女性可能會

be able to significantly reduce the amount of testosterone-blocking medications that

能夠顯著減少睪丸激素阻斷藥物的用量。

she has to take – thereby reducing the risks and side effects of the medications.

她必須採取的措施 - 從而減少藥物的風險和副作用。

In addition, a trans-male may find having menstrual periods as a male to be very traumatic

此外，變性人可能會發現以男性身份來月經是一件非常痛苦的事情。

psychologically.

在心理上。

In this scenario, having a hysterectomy to remove the uterus may allow him to live more

在這種情況下，進行子宮切除術以切除子宮，可能會讓他活得更多

in accordance with his gender identity.

根據他的性別認同。

Lastly, there are other gender surgeons that don’t perform top or bottom surgeries, but

最後，還有一些性別外科醫生不做頂部或底部手術，但

rather other procedures that help alleviate gender dysphoria.

而是其他有助於緩解性別障礙的程序。

This includes plastic surgeons that perform facial masculinization or feminization, body

這包括進行面部男性化或女性化的整形外科醫生、身體

contouring, or fat grafting procedures; ENT surgeons performing tracheal shave or voice

塑形或脂肪移植手術；耳鼻喉科醫生進行氣管剃鬚或嗓音治療。

modification procedures; and even orthopedic surgeons performing limb-lengthening or shortening

修改程序；甚至骨科醫生也在進行肢體延長或縮短的手術。

procedures.

程序。

Let’s clear up some of the misconceptions about gender surgery.

讓我們澄清一些關於性別手術的誤解。

But rather than telling you myself, I’m going to hand it over to my friend, Dr. John

但我不打算親自告訴你，而是要把它交給我的朋友約翰博士。

Brosious.

Brosious.

He’s the only practicing gender surgeon in the state of Nevada that performs genital

他是內華達州唯一的性別問題外科醫生，在內華達州進行生殖器手術。

surgery and just recently opened Nevada’s first gender surgery practice, Vegas Plastic

他最近剛剛開設了內華達州的第一個性別手術診所--拉斯維加斯整形外科。

Surgery Institute.

外科研究所。

Without further ado, here is Dr. Brosious.

閒話少說，這裡是布羅休斯博士。

To start, many people believe that you have to be a part of the LGBTQ+ community, or have

首先，許多人認為，你必須是LGBTQ+社區的一部分，或有

a family member that is, in order to do gender surgery.

一個家庭成員是，為了做性別手術。

As a heterosexual, cisgender, white male, who grew up in a religious household, I can

作為一個在宗教家庭中長大的異性戀、雙性戀、白人男性，我可以

tell you that you do not.

告訴你，你不知道。

If you are a kind, empathetic, and down-to-Earth individual that truly wants to help gender

如果你是一個善良的、有同情心的、腳踏實地的人，真正想要幫助性別

patients, there will always be a place for you within the gender surgery community.

患者，在性別手術社區中，總會有你的一席之地。

Gender surgery is currently such a niche specialty that we don’t need every gender surgeon

性別手術目前是一個小眾的專業，我們不需要每個性別外科醫生。

to fit some sort of perfect ideal.

以適應某種完美的理想。

We need more physicians to go into gender surgery, period.

我們需要更多的醫生去做性別手術，就這樣。

As it stands right now, the gender expansive community is extremely underrepresented in

就目前的情況而言，性別廣泛的社區在《世界日報》上的代表人數極少。

healthcare and we can’t gatekeep the specialty and wait for there to be more representation

醫療保健，我們不能對專業進行把關，等待有更多的代表。

before we start expanding our ability to offer services to these patients.

在我們開始擴大為這些病人提供服務的能力之前。

Doing so would only be a disservice to this already deeply marginalized population.

這樣做只會是對這個已經被深深邊緣化的人群的傷害。

Many people also believe that gender surgery is purely cosmetic – it definitely is not.

許多人還認為，性別手術是純粹的美容，它絕對不是。

When you look at the data, patients with gender dysphoria are at a significantly higher risk

當你看數據時，有性別恐懼症的病人的風險明顯更高。

of mental illness and substance abuse than the general population.

精神病和藥物濫用的人比一般人多。

According to one study, approximately 82% of transgender youth experience suicidal ideation

根據一項研究，約有82%的變性青年有自殺的念頭。

and approximately 40% have attempted suicide.

而大約40%的人曾試圖自殺。

I commonly see this in my own practice as well.

我在自己的實踐中也經常看到這種情況。

Many of my patients have long histories of self-harm as a result of the mental strain

我的許多病人都有長期的自我傷害歷史，這是由於精神壓力造成的。

that being transgender, non-binary, gender fluid or intersex has placed on them.

作為變性人、非二元人、變性人或雙性人給他們帶來的影響。

I’ve even had patients who have taken their own lives because of it.

我甚至有病人因為這個原因而自殺。

As such, I don’t see gender surgery as cosmetic.

是以，我不認為性別手術是整容。

It truly is life-saving surgery.

這確實是拯救生命的手術。

I cannot tell you how many patients I have performed surgery on that have told me I saved

我無法告訴你我為多少病人做了手術，他們告訴我我救了他們。

their lives.

他們的生活。

It’s easy for people outside of the gender expansive community to say that one’s gender

性別廣泛的社區以外的人很容易說，一個人的性別

identity is a choice and these procedures should be considered cosmetic; however, anyone

身份是一種選擇，這些程序應被視為美容；然而，任何人

who works with these patients will tell you it’s far from the truth.

與這些病人打交道的人都會告訴你這與事實相去甚遠。

This isn’t a matter of novelty or sex life.

這不是一個新奇或性生活的問題。

Gender surgery is about the patient’s identity and safety more than anything.

性別手術關係到病人的身份和安全，比什麼都重要。

That being said, another misconception is that every transgender patient wants the full

話雖如此，另一個誤解是，每個變性人都希望有完整的

spectrum of surgery.

外科手術的範圍。

Although many patients come to me specifically because I offer these services, this isn’t

雖然許多病人專門來找我，因為我提供這些服務，但這並不是

the case for all people in the gender-expansive community.

在兩性平等的社區中，所有的人都是如此。

What it means for someone to be “fully transitioned” varies from patient to patient.

對於一個人來說，"完全過渡 "意味著什麼，因病人而異。

It’s not for me, society, or anyone else to determine, but rather for the patient to

這不是由我、社會或其他任何人來決定的，而是由病人來決定的。

decide for themselves.

自己決定。

For some, fully transitioning might just mean that they’ve accepted their gender identity,

對一些人來說，完全轉型可能只是意味著他們已經接受了自己的性別認同。

dress differently, and act more in accordance with their gender identity.

穿著不同，行為也更符合他們的性別認同。

For others, their journey may include the full spectrum of surgery and hormones.

對於其他人來說，他們的旅程可能包括全方位的手術和荷爾蒙。

Most patients, however, fall somewhere in the middle.

然而，大多數病人屬於中間地帶。

As a gender surgeon, it’s important to remember that surgery is not always a part of the patient’s

作為一名性別外科醫生，重要的是要記住，手術並不總是病人的一部分。

personal journey.

個人旅程。

Becoming a gender surgeon is a bit more complicated than most other specialties.

成為一名性別外科醫生比大多數其他專業的醫生要複雜一些。

After medical school, there are a few different pathways to become a gender surgeon, and which

醫學院畢業後，有幾種不同的途徑可以成為性別外科醫生，而哪些

pathway you choose will be dependent on which area of gender surgery you wish to go into.

你選擇的途徑將取決於你希望進入的性別手術的哪個領域。

The most common pathway to becoming a gender surgeon is to complete plastic surgery residency

成為一名性別外科醫生最常見的途徑是完成整形外科住院醫師培訓

followed by either a one year gender surgery fellowship or a one year microvascular fellowship.

隨後是為期一年的性別外科研究項目或為期一年的微血管研究項目。

To learn more about how to become a plastic surgeon, check out our So You Want to Be a

要了解更多關於如何成為一名整形外科醫生的資訊，請查看我們的 "你想成為一名整形外科醫生嗎？

Plastic Surgeon video.

整形外科醫生視頻。

The plastic surgery pathway allows you to perform the widest variety of gender surgeries

整形外科的途徑使你可以進行最廣泛的性別手術

including chest masculinization and feminization procedures, vaginoplasty, phalloplasty, and

包括胸部男性化和女性化手術、陰道成形術、陰莖成形術和男性化手術。

metoidioplasty, as well as facial masculinization and feminization surgery, body contouring,

甲狀腺整形術，以及面部男性化和女性化手術，身體塑形。

and fat grafting.

和脂肪移植。

If you want to be fully-trained in all aspects of gender surgery, then plastic surgery is

如果你想在性別手術的所有方面接受全面培訓，那麼整形手術是

the route you should take.

你應該採取的路線。

That being said, plastic surgery is far and away the most competitive pathway to becoming

也就是說，整形手術是迄今為止競爭最激烈的途徑，以成為

a gender surgeon.

一位性別外科醫生。

For the past several years, it has been the number one most competitive specialty to match

在過去的幾年裡，它一直是第一大最具競爭力的專業，以配合

into and requires you to be at the top of your class with great grades, Step scores,

成，並要求你在班上名列前茅，成績優異，階梯分數。

and research.

和研究。

In addition, gender surgery fellowships are incredibly new and only recently came about

此外，性別手術獎學金是令人難以置信的新事物，最近才出現的。

within the last few years.

在過去的幾年裡。

As such, there are only a handful of gender surgery fellowships available – most of

是以，目前只有少數幾項性別手術研究金--大多數都是

which only accept one fellow per year despite having many applicants per spot.

儘管每個名額有很多申請人，但每年只接受一名研究員。

Getting into one of these fellowship programs is incredibly difficult - even among plastics

進入這些獎學金項目是非常困難的--即使在塑膠行業中也是如此。

surgeons who have already “beaten the odds,” so to speak.

可以說，那些已經 "戰勝了困難 "的外科醫生。

That being said, there are other, less competitive, pathways to becoming a gender surgeon as well.

話雖如此，也有其他競爭不激烈的途徑來成為一名性別外科醫生。

Physicians interested in performing bottom surgery may also enter the field through completing

對進行底層手術感興趣的醫生也可以通過完成以下工作進入該領域

residency in either urology or OB/GYN and then seeking additional training afterwards.

泌尿外科或婦產科的住院醫師，之後再尋求額外的培訓。

Physicians that are interested in performing procedures such as tracheal shaves or voice

有意進行氣管刨削或語音等手術的醫生

modification surgery are able to do so by completing ENT residency.

修改手術是通過完成耳鼻喉科住院醫師培訓來實現的。

Although ENT, urology, and OB/GYN are competitive to match into in their own right, they are

雖然耳鼻喉科、泌尿科和婦產科本身就很有競爭力，但它們是

still easier to match into than plastic surgery.

仍然比整形手術更容易匹配。

In terms of competitiveness, ENT and urology are considered tier 2 or highly competitive

就競爭力而言，耳鼻喉科和泌尿科被認為是第二級或高度競爭的領域。

and OB/GYN is considered tier 4 or less competitive.

而婦產科被認為是第4級或競爭力較弱。

To learn more about the competitiveness of each specialty, check out my video going over

要了解更多關於每個專業的競爭力，請看我的視頻，其中包括

Why Every Doctor Specialty Seems Competitive - link in the description.

為什麼每個醫生的專業似乎都很有競爭力--描述中的鏈接。

Given the sheer competitiveness of gender surgery and the length of training relative

鑑於性別手術的巨大競爭性和培訓時間的相對長短。

to other medical specialties, students best-suited for this specialty tend to be highly motivated

與其他醫學專業相比，最適合這個專業的學生往往是高度積極的。

and are often at the top of their class.

並經常處於班級的前列。

Given the stigma associated with working with the gender-expansive community, these students

鑑於與性別廣泛的社區合作所帶來的恥辱，這些學生

also tend to be very open-minded and down to earth as well.

也往往是思想非常開放，也很踏實。

There’s a lot to love about gender surgery, so I’ll hand it back to Dr. Brosious to

關於性別手術有很多值得喜愛的地方，所以我將把它交還給布羅休斯醫生。

tell you all about it.

告訴你這一切。

The thing I love most about gender surgery is that you get to work with one of the most

我最喜歡的是性別手術，因為你可以和一個最重要的人一起工作。

marginalized communities in the world and have the opportunity to truly change your

在世界的邊緣化社區，有機會真正改變你的生活。

patients’ lives forever.

徹底改變了病人的生活。

Many of my patients come to me feeling like they’ve lived their entire lives in someone

我的許多病人來找我，感覺他們的一生都生活在某個人的陰影下。

else’s body, and I have the privilege of helping them fix that.

別人的身體，而我有特權幫助他們解決這個問題。

And unlike hormone treatments and medications which can take months, if not years, to show

而且與激素治療和藥物不同，這些治療和藥物可能需要幾個月，甚至幾年的時間才能顯示出來。

significant changes, gender surgery provides you with near-instant gratification.

顯著的變化，性別手術為你提供了近乎即時的滿足。

Within hours, I can remove a body part that someone has lived their entire life being

在幾個小時內，我可以移除一個人一生都在使用的身體部分。

too ashamed to look at and replace it with a new body part that finally makes them feel

羞於見人，用一個新的身體部位取代它，最終使他們感到

whole.

整個。

In my opinion, there is no other specialty that gives you a more profound, yet instant,

在我看來，沒有其他專業能給你帶來更深刻的，而又即時的。

gratification than gender surgery.

比起性別手術來，更容易獲得滿足感。

The patients that you get to work with as a gender surgeon are also some of the most

作為一名性別外科醫生，你所接觸到的病人也是一些最重要的病人。

interesting and down-to-earth people you’ll ever meet.

你將會遇到的有趣而樸實的人。

Society has judged them their entire lives.

社會對他們的整個人生進行了評判。

Many have lost friends and family members or been verbally and physically abused just

許多人失去了朋友和家人，或受到口頭和身體上的虐待。

for being true to themselves.