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  • I want you all to think

    我希望大家回想一些:

  • 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