I was working at a drug and alcohol rehab facility.

在成為一位醫生大約六個月左右，

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

我在一間毒品與酒精勒戒機構工作。

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

戒癮單位的一位護士打電話給我。

that had arrived earlier in the day.

她請我過去評估

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

當天早些時候抵達的一位病患。

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

所以我去了那個單位， 很榮幸見到了安。

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

安是一位女性變性人， 當她和我開始交談時，

but I could hear this fear in her voice,

她和我分享了 她來接受治療的原因。

and I could see this worry in her eyes,

但我能在她的聲音中聽出恐懼，

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

也能在她的眼中看出擔憂。

and having to give up drugs and alcohol.

她開始告訴我， 她並不害怕來到勒戒所，

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

和必須要放棄毒品和酒精。

would not treat her as her female self.

她的恐懼是將要治療她的醫生，

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

可能不會把她當女性來對待。

of being assigned male but knowing she's female.

她接著告訴我她一生中 所遭遇的這種持續不斷的痛苦。

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

她被認定為男性， 但她知道她是女性。

the doctor held her up to her parents

她的意思是，當她出生時，

and based on her genitalia said,

醫生把她抱起來交給她的父母，

"It's a boy."

根據她的生殖器，說：

She always knew she wasn't a boy.

「是個男孩。」

Many years passed and the feelings that she was feeling

她一直都知道她不是男孩。

and holding all this in grew and grew,

許多年過去了， 她所感受到的感覺，

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

被她壓抑在心中，但越來越強。

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

她知道她得要向她的家人坦白。

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

當她坦白時， 結果並沒有很順利。

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

她的父母說： 「絕對不是。你不是女生。

Get out."

我們不是這樣養育你的。 我們搞不懂你在想什麼。

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

滾出去。」

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

接著，安就流落街頭， 進進出出無家可歸者收容所。

to numb this pain she felt inside.

在那裡，她開始染上毒品和酒精，

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

以麻痺她內心感受的痛苦。

trying to get sober,

她告訴我那段不斷進出 醫院和勒戒所的過程。

and when she did, the health care providers and doctors

她試著讓自己清醒。

wouldn't use the correct female name or pronouns.

當她清醒時， 健康照護提供者以及醫生

This caused her pain.

不願意使用她的正確的 女性名字或女性代名詞。

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

這讓她很痛苦。

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

當我還在讀書準備要當醫生時，

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

沒有人教我要如何對待變性病人。

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

我完全不知道 我會接觸到這樣的病人。

I began to see my mission evolve,

但我和安以及其他 類似的病人接觸越多，

and that was to make sure that the transgender community

我發現我的任務有所演變了。

got their health care needs met.

那就是要確保變性人族群的

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

健康照護需求能被滿足。

of violence, discrimination and this lack of acceptance

在這方面，我研究越多， 我越能了解這種對於

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

暴力、歧視，以及 不被接受的真實恐懼感

And I also heard these horror stories

使許多這類病人轉向毒品及酒精。

of when these patients were seeking medical care

我也聽到許多駭人的故事，

and how they were treated,

關於這類病人在尋求醫療照護時，

and how a lot of their medical needs were ignored.

他們所受的對待，

Now let me tell you about Leah.

以及他們許多醫療的需求 如何被忽視。

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

讓我告訴各位莉亞的故事。

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

幾年前，我有榮幸認識了莉亞。

See, Leah was also assigned male at birth

她是女性，她有妻子和一個孩子。

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

莉亞也是出生時被認定為男性，

that she was a female.

但她從小時候就知道她不是男性，

She hid it from herself and from everyone she knew,

她是女性。

especially from her wife, until the age of 50.

她將這件事瞞著 自己以及她認識的每個人，

She couldn't take it anymore.

特別是她的妻子，直到五十歲時。

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

她無法再忍受了。

I gotta get honest.

她心想，我不能繼續這樣過日子。

She was extremely scared to tell her wife.

我得要誠實。

What if her wife said,

她非常害怕將這件事告訴她的妻子。

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

萬一她的妻子說： 「這是不能接受的，

To her surprise, her wife was accepting.

我要離婚，滾出去。」怎麼辦？

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

讓她意外的是，她的妻子接受了。

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

她說：「我愛你，不論你是誰。

So she talked with her wife,

我想要盡我所能來協助你。」

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

所以，她和妻子長談，

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

她決定要做醫學的變性。

otherwise known as HRT.

她有興趣接受 更換荷爾蒙治療法的評估，

So she made an appointment with her doctor.

也就是大家所知的 HRT。

She arrived on the day of her appointment early.

所以，她和她的醫生 約了會面時間。

She filled out all the paperwork,

當天，她提早赴約。

put the name correctly down there and waited patiently.

她填寫了各種表單，

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

把名字正確地填寫好， 耐心地等待。

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

不久後，一位護士把她叫回檢查間。

and the doctor and the nurse walked in.

當她去到檢查間時， 她深吸了一口氣，

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

醫生和護士走進來。

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

她把手伸向醫生，說： 「嗨，我是莉亞。」

"Why are you here?"

醫生看著她， 並沒有握她的手，說：

She took another deep breath and said,

「你為什麼來這裡？」

"Well, I'm a transgender female.

她再次深呼吸，說：

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

「我是女性變性人。

but I can't do it anymore.

我一直都知道這一點， 但都沒讓別人知道，

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

但我無法繼續這樣了。

I've got to make these changes.

我妻子支持我，錢我負擔得起。

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

我得要做這些改變。

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

請考慮我，請評估我是否 適合更換荷爾蒙治療法。」

You need to go get an HIV test."

醫生說： 「今天我們什麼都不能做。

She couldn't believe it.

你得去做愛滋病病毒檢測。」

She was furious.

她無法置信。

She was angry. She was disappointed.

她很憤怒。

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

她很生氣。她很失望。

First, he wouldn't shake her hand,

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？

and second, when he heard she was transgender,

首先，他不願意和她握手，

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

再者，當他聽到她是變性人時，

He didn't even ask her any other questions.

他在乎的只有愛滋病病毒檢測 以及結束面談。

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

他甚至沒有問她其他問題。

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

我能了解莉亞的感受，

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

因為我在工作上 接觸這個族群的這些年，

A couple of those are:

我每天都會聽到一些謎思， 它們都完全不是真的。

every transgender person wants to transition with medication or surgery;

其中一些包括：

transgender people are mentally ill, this is a disorder;

每個變性人都想要 用藥物或手術來變性；

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

變性人心理有病，這是一種失調；

These are all myths and untrue.

還有，這些人不是 真正的男人或女人。

As this community expands and grows older,

這些都是謎思，且不是真的。

it is imperative that all health care providers be trained

隨著這個族群擴大和年紀漸長，

on how to take care of their health care needs.

所有的健康照護提供者 都必須要接受訓練，

Back in 2015, a survey was done

了解如何處理 他們的健康照護需求。

and found that 72 percent of health care providers

在 2015 年，有一項調查

did not feel well-informed

發現 72% 的健康照護提供者

on the health care needs of the LGBT community.

不覺得他們對於 LGBT 族群的

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

健康照護需求有足夠的資訊。

Today, in this talk,

在他們的教育和訓練中， 有很大的缺口。

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

今天，在這場演說中，

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

我想要將一種 新的思考方式提供給三種人：

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

醫生、變性人族群， 以及剩下的其他人。

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

但在這之前， 我想要先談幾個定義，

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

它們能協助各位 對性別認同多了解一點。

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

我希望你們已經準備好 紙筆要來寫筆記了。

And what this means is,

咱們就從這個 二元系統的想法開始。

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

意思就是，

Get it? Binary? Right?

以前我們認為只有兩種性別， 男和女。

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

懂嗎？二元？對吧？

Gender identity is a spectrum

我們漸漸發現，事實不是如此。

with maleness on one side

性別認同像是光譜，

and femaleness over here on the other side.

一端是男性，

This spectrum of identities

另一端是女性。

include identities such as gender-nonconforming,

這個性別認同的光譜

gender-affirming,

包含了非常規性別、

gender-nonbinary,

性別確認、

two-spirited, three-spirited,

非二元性別、

as well as people that are intersex.

雙靈、三靈，

The term transgender is this umbrella term

以及陰陽人。

that encompasses all these different types of identities.

變性人這個詞是一個總稱，

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

包括上述各類的性別認同。

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

但，在今天的演說， 我希望各位能把變性人

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

視為在出生時被認定的性別

Now, this is very different than biological sex.

不符合自己本人的認定 和他們的自我感覺。

So gender identity is sense of self.

這和生物學上的性別是很不同的。

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

性別認同是自我的感覺。

sense of self, who you are.

你可把它想成是在你的兩耳之間：

This is very different than biological sex, right?

對自己的感覺，你是怎樣的人。

Hormones, genitalia, chromosomes:

這和生物學上的性別 很不一樣，對吧？

that's what's between our legs.

荷爾蒙、生殖器、染色體：

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

那是在我們的兩腿之間。

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

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 get it. You know who you are.

我知道我是男人， 或我知道我是女人。」

This is how many transgender individuals feel.

我懂。你知道你是什麼人。

They just know who they are

許多變性人也有這種感覺。

with that same conviction.

他們就是知道他們是什麼人，

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

有著和你們同等的信心。

and I identify as a cisgender female.

重要的是要知道 有許多不同類型的身分認同，

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

而我認同的是順性別的女性。

cis is spelled "c-i-s."

如果你們想要知道如何寫這個詞，

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

「順」性別的順是「c－i－s」。

When I was born,

這個詞來自拉丁文， 意思是「在同一邊」。

the doctor held me up to my parents and said,

我出生時，

"It's a girl."

醫生把我抱起來交給我父母，

All this, based on my genitalia.

說：「是個女孩。」

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

這完全是根據我的生殖器判斷的。

very much a tomboy,

雖然我是在喬治亞州的 小農場長大，

I never questioned that I was a female.

是個很男性化的女孩。

I've always known I was a girl,

我從來沒有質疑過我是女性。

regardless of how I was as a kid.

我一直都知道我是個女孩，

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

不論我在孩提時是怎樣的。

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

這和變性人是非常不同的。

think about transcontinental airlines,

「變（trans）」也來自拉丁文， 意思是「在另一邊」——

across, on the other side of --

想想看橫貫（trans） 大陸的航線，

someone that's assigned a sex at birth

橫越，到另一邊——

and they identify on the other side of the spectrum.

有人在出生時被認定了一個性別，

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

而他們認同的是另一端的性別。

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

男性變性人就是在出生時 被認定為女性，

is as a male.

但他們的自我感覺、他們是誰、 要如何過他們的生活，

And the opposite is, as we talked earlier,

是男性的。

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

相對的，我們前面談過，

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

女性變性人是在出生時 被指定為男性，

It's also important to point out here

但以女性的身分過生活， 且自我感覺是女性。

that not everyone that has a nonbinary identity

這裡還有一個重點，

identifies with the term "transgender."

並不是所有非二元性別認同的人，

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

就一定是「變性人」。

or orientation.

為了不要讓大家困惑， 我要談一下性認同，

That is simply who we're attracted to,

或是性取向，

physically, emotionally, sexually, spiritually.

那只是看我們被什麼人吸引，

It's got nothing to do with gender identity.

身體上、感情上、性別上、心靈上。

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

這和性別認同是沒關係的。

gender identity between the ears,

在我們繼續下去之前， 先快速回顧一下重點：

biological sex, just think of it between your legs,

性別認同在兩耳之間，

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

生物學的性別則是在兩腿之間的，

but it's here.

而性認同， 有時我們會用我們的心，

Three very different identity spectrums.

但它在這裡。

Now, the average medical student

三種不同的身分認同光譜。

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

一般的醫學院學生

while they're in medical school.

在上醫學院時會花 大約五小時的時間，

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

學習關於 LGBT 的健康相關需求。

to this community.

而且這是在我們已經知道

And there's an estimated 10 million American adults

這個族群會面對獨特的健康風險。

that identify as LGBT.

根據估計，有一千萬名美國成人的

Most doctors that work with transgender patients,

性別認同是 LGBT。

they learn trial by fire.

大部分在工作上需要接觸 變性人病人的醫生，

That means they figure it out as they go along,

他們學的是火審。

or the patient ends up spending their time

意思就是說，他們邊做邊學，

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

或是最後反而是病人要花時間

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

來教導醫生如何照顧他們。

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

許多醫生對於詢問病人的 性別認同感覺不自在。

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

有些醫生覺得性別認同 和醫療照護一點關係都沒有。

Many doctors who say something inappropriate

還有些醫生不希望說錯話。

or they say something negative,

當醫生說出了不妥當的話，

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

或是負面的話時，

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

他們不見得是有惡意或是故意的。

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

他們可能從來沒有受過 如何照顧這些人的訓練。

So what happens to a transgender male --

但我們不能再接受 把這種狀況當成常態了。

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

所以，當男性變性人——

but lives their life as a male --

快速回顧一下， 就是出生時被認定為女性，

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

但以男性身分過日子的人——

How that doctor treats that patient

當男性變性人去做每年的 婦科檢查時，會發生什麼事？

will set the whole tone for the office.

那位醫生如何對待這個病人，

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

會決定那間診所的氛圍。

gives dignity and respect,

如果醫生用正確的代名詞、 正確的名字來對待那位男性，

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

給予他尊嚴和尊重，

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

很可能其他工作人員也會這麼做。

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

那是我對於醫生的小小想法，

I'm here talking about fear,

現在，咱們接著來談變性人族群。

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

我要談的是恐懼。

It's the transgender community.

你們都知道真正感到 害怕的人是誰，對吧？

Earlier I shared the story about Anne

是變性人族群。

and how she was so worried about going into treatment

剛才我分享了安的故事，

and not being respected as her female self,