about the third word that was ever said

別人形容你那句話的第三個詞彙

about you,

或如果你正在接生一個嬰兒

or if you were delivering,

你會如何形容這個孩子？

about the person you were delivering.

請你把答案默念或者大聲說出來

And you can all mouth it if you want

最開頭兩個字是:Ta是...

or say it out loud.

（觀眾：男孩 ... 女孩 ...）

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

好吧，我這話使你知道

Well, it shows you that

我也處理有關到底是 男孩或女孩的問題

I also deal with issues where there's

所以我剛剛那樣的措辭十分得體

not certainty of whether it's a girl or a boy,

當然，現在這問題的答案

so the mixed answer was very appropriate.

通常是在照射超音波時 而非出生時揭曉

Of course, now the answer often comes

除非未來的父母們像我們以前那樣

not at birth but at the ultrasound,

把驚喜留到孩子出生那天 才知道孩子的性別。

unless the prospective parents choose

但我希望你們想一想

to be surprised like we all were.

是什麼決定了

But I want you to think about what it is

那第三個詞彙

that leads to that statement

因為它

on the third word,

描述你的性別

because the third word

我的意思是

is a description of your sex,

它的判斷來自於你的生殖器

and by that I mean,

現在，身為一個小兒科內分泌學家

made by a description of your genitals.

我曾經非常熱衷於研究 （現在也算是）

Now, as a pediatric endocrinologist,

關於種種通過生殖器的判斷會不會出錯

I used to be very, very involved,

外觀上

and still somewhat am,

或內外之間的性別不符合

in cases in which

而我們實際上必須設法釐清

there are mismatches

什麼才能客觀描述你的性別

in the externals

在出生那刻

or between the externals and the internals,

我們實在難以定義你的性別。

and we literally have to figure out

而當我談及定義

what is the description of your sex.

我是在說你的性別取向

But there is nothing that is definable

我們不說:他是個男同志男孩

at the time of birth

她是個女同志女孩

that would define you,

這些情況還要等到 他們10幾歲之後才會出現。

and when I talk about definition,

性取向也不能定義你的性別

I'm talking about your sexual orientation.

而這性別並不等同於解剖學上的

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

而是關乎你的自我意識

"A lesbian girl."

你認為自己

Those situations don't really define themselves

是男性或女性

more until the second decade of life.

或者在這之間徘徊

Nor do they define your gender,

性別混淆有時發生在

which, as different from your anatomic sex,

孩子10歲以前

describes your self-concept.

卻會讓父母十分困惑

Do you see yourself

因為一般而言

as a male or female

孩童表現出跨性別的舉止 或遊戲方式是很正常的

or somewhere in the spectrum in between?

且事實上有許多研究顯示

That sometimes shows up

只有八成的兒童

in the first decade of life,

在那樣的行為模式下

but it can be very confusing for parents

於青春期來臨時

because it is quite normative

不會想再扮演

for children to act in a cross-gender play and way,

其另外一種性別的角色

and that in fact there are studies that show

青春期開始時

that even 80 percent of children

約當於女孩在10到12歲間

who act in that fashion

男孩在12到14歲間

will not persist in wanting to be

胸部開始發育

the opposite gender

而在生理男性方面： 性腺會成長兩到三倍

at the time when puberty begins.

在那特定時間點

But at the time that puberty begins,

聲稱自己處在錯誤身體裡的那些孩子

that means between about age 10 to 12 in girls,

幾乎可以確定將會是跨性別的

12 to 14 in boys,

且改變這樣想法的可能性極小

with breast budding

無論任何人對他做修復療法

or two to three times increase in the gonads

或其他任何有害的事

in the case of genetic males,

現在這種情況相對罕見

by that particular point, the child who says

所以我個人經驗也相對較少

they are in the absolute wrong body

而我的經歷較典型

is almost certain to be transgender

因為我接觸的是青少年治療

and is extremely unlikely to change those feelings,

我曾見過一個24歲的人

no matter how anybody tries reparative therapy

就讀哈佛，基因上是女性

or any other noxious things.

與三位知道它故事的男性室友

Now this is relatively rare,

度過哈佛時光

so I had relatively little personal experience with this,

總在註冊時

and my experience was more typical

在選課單上填寫男性姓名

only because I had an adolescent practice.

並在畢業後尋求我的協助

And I saw someone age 24,

他說:幫我。我知道你是內分泌專家

went through Harvard, genetically female,

事實上我也的確治癒了很多

went through Harvard with three male roommates

出生時缺乏性腺的人

who knew the whole story,

這不是什麼難如登天的科學

a registrar who always listed his name

但我跟他做了個約定:

on course lists as a male name,

如果你教導我，我就治療你

and came to me after graduating saying, "Help me.

他照辦了

I know you know a lot of endocrinology."

而我從照顧

And indeed I've treated a lot of people

他的支持小組所有成員中

who were born without gonads.

真的學到了很多

This wasn't rocket science.

我當時十分困惑

But I made a deal with him:

因我當時認為在那種年紀

I'll treat you if you teach me.

只要為他們施打 想成為的性別的賀爾蒙

And so he did.

事情就能簡單解決

And what an education I got

但接下來我的病患結婚了

from taking care of all the members

他與一個女人結合

of his support group.

而她出生時是生理男性

And then I got really confused,

曾以男性的身分結婚，育有兩個孩子

because I thought it was relatively easy at that age

之後才轉為女性

to just give people the hormones

現在這快樂做自己的女性

of the gender in which they were affirming,

與我的男性病患結合了

but then my patient married,

實際上是合法結婚了

and he married a woman

因為他們看起來是一男一女，誰又看得出來呢?

who had been born as a male,

你說是吧?(笑聲)

had married as a male, had two children,

當我正感到困惑:

then went through a transition into female,

這種情況該說是男同性戀呢?

and now this delightful female

還是正常呢?

was attached to my male patient,

我正是把性傾向

in fact got legally married because they showed up

跟性別自我認可搞混了

as a man and a woman, and who knew?

我的病患跟我說:

Right? (Laughter)

"嘿，聽我說，聽我說。

And while I was confused about,

你只要照我說的去想，就會搞懂了。

does this make so-and-so gay?

性傾向代表你要同床的對象

Does this make so-and-so straight?

性別自我認同就是你赴床上時的身分

I was getting sexual orientation

而我接著從許多成年人身上學到--

confused with gender identity.

我曾照顧了約200個成年人--

And my patient said to me,

我學到了

"Look, look, look.

如果我不看或偷瞄

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

他們在等待室裡的伴侶的話

Sexual orientation is who you go to bed with;

我永遠也沒法猜到--

gender identity is who you go to bed as."

單純用機率都比我準--

And I subsequently learned from the many adults --

他們會是男同、直、女同

I took care of about 200 adults —

或是無性者

I learned from them

換句話說

that if I didn't look, peek as to who

許多事情之間

their partner was in the waiting room,

是沒有絕對的關聯的

I would never be able to guess

而資料也如此顯示

better than chance

現在，當我照顧這200個成年人

whether they were gay, straight, bi,

我發現這極度令人傷痛

or asexual in their affirmed gender.

這些人們

In other words,

大多必須放棄自己的人生

one thing has absolutely nothing to do

他們有時會被父母給否定

with the other.

被手足、自己的子女拒絕

And the data show it.

與他們離婚的配偶

Now, as I took care of the 200 adults,

也會禁止他們與孩子見面

I found it extremely painful.

結果如此悲慘

These people were -- many of them

他們為何要在四、五十歲時這麼做?

had to give up so much of their lives.

因為他們覺得有必要在自殺之前

Sometimes their parents would reject them,

確認自己的性別

siblings, their own children,

而的確，

and then their divorcing spouse

未受治療的跨性別者的自殺率

would forbid them from seeing their children.

在世上是數一數二的高

It was so awful, but why did they do it

所以該怎麼辦?

at 40 and 50?

我曾被一個研討會給吸引去

Because they felt they had to affirm themselves

在荷蘭，那兒有許多專家

before they would kill themselves.

並見識了許多令人印象深刻的事

And indeed, the rate of suicide

他們治療的是年輕的青少年

among untreated transgendered people

先給予最密集的心理測試

is among the highest in the world.

以鑑定性別

So what to do?

再用阻擋他們不想要的青春期

I was intrigued in going to a conference

來治療他們

in Holland, where they are experts in this,

因為基本上，無論哪個性別

and saw the most remarkable thing.

孩子們在經歷青少年時期之前看起來都一樣

They were treating young adolescents

在青少年時期若認為自己性別錯了

after giving them the most intense

感覺就像自己是一個正變成驢子的皮諾丘

psychometric testing of gender,

認為自己身體會隨著青春期而改變

and they were treating them by blocking

成為自己想要的樣子的幻想

the puberty that they didn't want.

實際上正是被自己 所成為的青少年給毀滅

Because basically, kids look about the same,

而他們也因此崩潰了

each sex, until they go through puberty,

所以這就是為什麼要先保留這些青少年--

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

為什麼是保留? 因為你不能 在他們這麼年輕的時候

you feel like Pinocchio becoming a donkey.

就給他們相反性別的賀爾蒙

The fantasy that you had that your body will change

因為那會使他們發育不良

to be who you want it to be with puberty

而你覺得你和一個十歲女孩或十二歲男孩

actually is nullified by the puberty you get.

在這種療程會造成的生殖能力影響上

And they fall apart.

能有什麼有意義的對話嗎

So that's why putting the puberty on hold—

這種情況下

Why on hold? You can't just give them

能夠爭取四到五年的診斷時間

the opposite hormones that young.

所以那些青少年可以有機會克服

They'll end up stunted in growth,

可以做更多檢測

and you think you can have a meaningful conversation

可以好好活著，而不會感到自己的身體

about the fertility effects of such treatment

正離自己而去

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

而接著，在一個叫做12-16-18的計畫中

So this buys time in the diagnostic process

十二歲左右給予阻擋青春期的賀爾蒙

for four or five years

在十六歲時再度測試時

so that they can work it out,

他們必須能夠符合

they can have more and more testing,

現在注意，那些賀爾蒙是可逆的

they can live without feeling their bodies

但只要給予相反性別的賀爾蒙

are running away from them.

他們就能開始長出胸部和臉毛

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

而聲音決定於你要使用什麼

around age 12 is when they give the blocking hormones,

且那些效應是永久的

and then at age 16 with retesting,

或需要手術去移除

they requalify.

或電離法

Now remember, the blocking hormones are reversible,

且你其實沒法真的改變聲音

but when you give the hormones of the opposite sex,

所以這很嚴肅，而且這跟著你有15、16年久了

you now start spouting breasts and facial hair

接著到18歲，他們能夠接受手術了

and voice, depending on what you're using,

雖然女轉男的生殖器 改變手術無法盡善盡美

and those effects are permanent

男轉女的手術卻能騙過婦產科醫師

or require surgery to remove

你看看它有多完善

or electrolysis,

所以我觀察病患的改善情況

and you can never really affect the voice.

也觀察病患順利融入人群，與別人並無二致

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

除了他們青春期有被延遲之外

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

一旦給了與他們所認同的性別

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

相符合的賀爾蒙

the male-to-female surgery has fooled gynecologists.

他們會變得美麗

That's how good it can be.

看起來正常，有著正常的身高

So I looked at how the patients were doing,

你永遠無法在人群中

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

挑出他們來

except they were pubertally delayed.

在那時刻，我決定自己也要往這方面去做

But once they gave them the hormones

這就是我踏入

consistent with the gender they affirm,

小兒科內分泌領域的時候

they look beautiful.

因為事實上

They look normal. They had normal heights.

假如你要治療10-12或10-14歲的孩子

You would never be able to pick them out

那就該是小兒科內分泌學啦

in a crowd.

所以我引入了一些孩子

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

而這現在成了照護的標準

This is really where the pediatric

有兒童醫院在後面支援

endocrine realm comes in,

展示了這些孩子的前後樣貌後

because in fact, if you're going to deal with it

從未受治療的人們

in kids age 10-12, 10-14,

想接受治療的人們

that's pediatric endocrinology.

以及荷蘭人

So I brought some kids in,

都來找我並說:

and this now became the standard of care,

"你必須為這些孩子做點事"

and Children's Hospital was behind it.

那麼，之前這些孩子們在哪?

By my showing them the kids before and after,

他們在那兒承受痛苦

people who never got treated

所以我們在2007年開始了一個計劃

and people who wished to be treated,

它成為這類型中的第一個計劃--

and pictures of the Dutch,

但它其實是之前說的荷蘭方法--

they came to me and said,

不過是在北美洲實行

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

自那時起，我們有了160個病患

Well, where were these kids before?

他們來自阿富汗嗎?不。

They were out there suffering, is where they were.

他們其中有百分之七十五

So we started a program in 2007.

來自距波士頓150哩以內的地方

It became the first program of its kind --

而有些人來自英格蘭

but it's really of the Dutch kind --

傑琪曾在英格蘭的米德蘭茲被虐

in North America.

那時她十二歲

And since then, we have 160 patients.

以女孩的身分過活

Did they come from Afghanistan? No.

但一直受到毒打

They came, 75 percent of them came

那情形慘不忍睹

from within 150 miles of Boston.

他們得讓她在家自學

And some came from England.

這些英國人會來求助的原因是

Jackie had been abused in the Midlands, in England.

在英國任何未滿16歲的人

She's 12 years old there,

都不能接受治療

she was living as a girl

等同於無論多可怕的事會發生

but she was being beaten up.

他們都會被交付一個成年的身軀

It was a horror show.

就算已經做過良好的檢驗了

They had to homeschool her.

在這情況下

And the reason the British were coming was

傑琪雖在骨骼測量中

because they would not treat anybody

被預測能長到約195公分

with anything under age 16,

但她才剛開始進入

which means they were consigning them

男性的青春期

to an adult body, no matter what happened,

我做了件有點創新的事

even if they tested them well.

因為我的確了解賀爾蒙

Jackie, on top of it, was,

知道雌激素在關閉骨端生長板

by virtue of skeletal markings,

是很有能力的

destined to be six feet five.

比睪固酮更能停止成長發育

And yet, she had just begun

所以我們使用了賀爾蒙

a male puberty.

去阻斷她的睪固酮

Well, I did something a little bit innovative,

並在13而非16歲時為她施打雌激素

because I do know hormones,

左邊這個就是她16歲時的樣子

and that estrogen is much more potent

在她16歲生日，她去了泰國

in closing epiphyses, the growth plates,

去做生殖器整形手術

and stopping growth, than testosterone is.

現在他們是在18歲時做

So we blocked her testosterone

結果她只長了約180公分

with a blocking hormone,

更棒的是，她擁有正常的胸部大小

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

因為藉由阻斷睪固酮

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

我們的每個病患

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

都能有正常胸部大小

where they would do a genital plastic surgery.

只要他們及早在適當年齡來找我們

They will do it at 18 now.

而在最右邊，也是她

And she ended up 5'11"

她公開參加英國小姐選美

but more than that, she has normal breast size,

進入準決賽

because by blocking testosterone,