ABOUT THE SPEAKER
Norman Spack - Endocrinologist
At Boston's Children Hospital, endocrinologist Norman Spack treats transgender teens to delay the effects of puberty.

Why you should listen

Norman Spack is a pediatric endocrinologist at Boston's Children Hospital and the co-founder of the hospital's Gender Management Service clinic. Created in 2007, the clinic remains one of the few in the world that treats minors with hormone replacement therapy.

Spack began working with college-aged transgender patients professionally in 1985, but found that once patients had reached adulthood, it was extremely difficult to treat their sexually mature bodies using hormone therapy. When parents of transgender children began seeking him out through online support groups, Spack started to think about possible treatments for patients in their youth, before puberty has permanently changed their bodies. Since then Spack has spoken widely on pediatric hormone therapy and has campaigned for law reform in several states to protect transgender people against hate crimes and discrimination.

More profile about the speaker
Norman Spack | Speaker | TED.com
TEDxBeaconStreet

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

諾曼.史派克: 我是如何幫助跨性別青少年成為他們想變成的樣子

Filmed:
1,359,735 views

青春期對每個人而言都意味著一個怪異的時期,但對跨性別青少年而言它像噩夢,因為一夕之間他們就要長成一副不適合的身軀。在這場打動人心的演說中,內分泌學家諾曼.史派克告訴我們,他如何成為美國少數以賀爾蒙治療青少年的醫生之一。藉由阻擋青春期所帶來的效應,史派克給了跨性別青少年足夠時間去適應一切。(拍攝於TEDxBeaconStreet)
- Endocrinologist
At Boston's Children Hospital, endocrinologist Norman Spack treats transgender teens to delay the effects of puberty. Full bio

Double-click the English transcript below to play the video.

00:12
I want you all to think
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我希望大家回想一些:
00:16
about the third第三 word that was ever said
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別人形容你那句話的第三個詞彙
00:20
about you,
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00:23
or if you were delivering交付,
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或如果你正在接生一個嬰兒
00:26
about the person you were delivering交付.
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你會如何形容這個孩子?
00:31
And you can all mouth it if you want
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請你把答案默念或者大聲說出來
00:34
or say it out loud.
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00:35
It was, the first two were, "It's a ..."
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最開頭兩個字是:Ta是...
(觀眾:男孩 ... 女孩 ...)
好吧,我這話使你知道
00:44
Well, it shows節目 you that
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00:46
I also deal合同 with issues問題 where there's
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我也處理有關到底是
男孩或女孩的問題
00:47
not certainty肯定 of whether是否 it's a girl女孩 or a boy男孩,
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00:50
so the mixed answer回答 was very appropriate適當.
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所以我剛剛那樣的措辭十分得體
00:54
Of course課程, now the answer回答 often經常 comes
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當然,現在這問題的答案
00:56
not at birth分娩 but at the ultrasound超聲,
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通常是在照射超音波時
而非出生時揭曉
00:58
unless除非 the prospective預期 parents父母 choose選擇
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除非未來的父母們像我們以前那樣
01:01
to be surprised詫異 like we all were.
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把驚喜留到孩子出生那天
才知道孩子的性別。
01:05
But I want you to think about what it is
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但我希望你們想一想
01:08
that leads引線 to that statement聲明
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是什麼決定了
那第三個詞彙
01:12
on the third第三 word,
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01:14
because the third第三 word
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因為它
01:17
is a description描述 of your sex性別,
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描述你的性別
01:24
and by that I mean,
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我的意思是
01:27
made製作 by a description描述 of your genitals生殖器.
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它的判斷來自於你的生殖器
01:32
Now, as a pediatric小兒科的 endocrinologist內分泌科醫生,
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現在,身為一個小兒科內分泌學家
01:35
I used to be very, very involved參與,
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我曾經非常熱衷於研究 (現在也算是)
01:37
and still somewhat有些 am,
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01:39
in cases in which哪一個
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關於種種通過生殖器的判斷會不會出錯
01:42
there are mismatches不匹配
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01:44
in the externals的外部
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外觀上
01:47
or between之間 the externals的外部 and the internals內部,
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或內外之間的性別不符合
01:51
and we literally按照字面 have to figure數字 out
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而我們實際上必須設法釐清
01:56
what is the description描述 of your sex性別.
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什麼才能客觀描述你的性別
02:00
But there is nothing that is definable可定義
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在出生那刻
02:02
at the time of birth分娩
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我們實在難以定義你的性別。
02:05
that would define確定 you,
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02:09
and when I talk about definition定義,
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而當我談及定義
02:11
I'm talking about your sexual有性 orientation方向.
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我是在說你的性別取向
02:18
We don't say, "It's a gay同性戀者 boy男孩."
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我們不說:他是個男同志男孩
02:23
"A lesbian女同性戀 girl女孩."
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她是個女同志女孩
02:26
Those situations情況 don't really define確定 themselves他們自己
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這些情況還要等到
他們10幾歲之後才會出現。
02:29
more until直到 the second第二 decade of life.
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02:33
Nor也不 do they define確定 your gender性別,
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性取向也不能定義你的性別
02:38
which哪一個, as different不同 from your anatomic解剖的 sex性別,
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而這性別並不等同於解剖學上的
02:42
describes介紹 your self-concept自我概念.
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而是關乎你的自我意識
02:45
Do you see yourself你自己
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你認為自己
02:47
as a male or female
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是男性或女性
02:51
or somewhere某處 in the spectrum光譜 in between之間?
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或者在這之間徘徊
02:56
That sometimes有時 shows節目 up
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性別混淆有時發生在
03:01
in the first decade of life,
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孩子10歲以前
03:04
but it can be very confusing撲朔迷離 for parents父母
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卻會讓父母十分困惑
03:08
because it is quite相當 normative規範
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因為一般而言
03:11
for children孩子 to act法案 in a cross-gender跨性別 play and way,
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孩童表現出跨性別的舉止
或遊戲方式是很正常的
03:17
and that in fact事實 there are studies學習 that show顯示
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且事實上有許多研究顯示
03:19
that even 80 percent百分 of children孩子
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只有八成的兒童
03:22
who act法案 in that fashion時尚
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在那樣的行為模式下
03:25
will not persist堅持 in wanting希望 to be
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於青春期來臨時
03:30
the opposite對面 gender性別
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不會想再扮演
03:32
at the time when puberty青春期 begins開始.
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其另外一種性別的角色
03:36
But at the time that puberty青春期 begins開始,
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青春期開始時
03:42
that means手段 between之間 about age年齡 10 to 12 in girls女孩,
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約當於女孩在10到12歲間
03:45
12 to 14 in boys男孩,
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男孩在12到14歲間
03:49
with breast乳房 budding芽接
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胸部開始發育
03:50
or two to three times increase增加 in the gonads性腺
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而在生理男性方面:
性腺會成長兩到三倍
03:54
in the case案件 of genetic遺傳 males男性,
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03:57
by that particular特定 point, the child兒童 who says
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在那特定時間點
04:00
they are in the absolute絕對 wrong錯誤 body身體
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聲稱自己處在錯誤身體裡的那些孩子
04:05
is almost幾乎 certain某些 to be transgender變性
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幾乎可以確定將會是跨性別的
04:09
and is extremely非常 unlikely不會 to change更改 those feelings情懷,
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且改變這樣想法的可能性極小
04:16
no matter how anybody任何人 tries嘗試 reparative彌補的 therapy治療
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無論任何人對他做修復療法
04:20
or any other noxious things.
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或其他任何有害的事
04:24
Now this is relatively相對 rare罕見,
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現在這種情況相對罕見
04:27
so I had relatively相對 little
personal個人 experience經驗 with this,
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所以我個人經驗也相對較少
04:30
and my experience經驗 was more typical典型
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而我的經歷較典型
04:33
only because I had an adolescent青少年 practice實踐.
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因為我接觸的是青少年治療
04:35
And I saw someone有人 age年齡 24,
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我曾見過一個24歲的人
04:37
went through通過 Harvard哈佛, genetically基因 female,
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就讀哈佛,基因上是女性
04:39
went through通過 Harvard哈佛 with three male roommates室友
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與三位知道它故事的男性室友
04:41
who knew知道 the whole整個 story故事,
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度過哈佛時光
04:43
a registrar註冊員 who always listed上市 his name名稱
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總在註冊時
04:46
on course課程 lists名單 as a male name名稱,
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在選課單上填寫男性姓名
04:48
and came來了 to me after graduating畢業 saying, "Help me.
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並在畢業後尋求我的協助
04:53
I know you know a lot of endocrinology內分泌."
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他說:幫我。我知道你是內分泌專家
04:55
And indeed確實 I've treated治療 a lot of people
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事實上我也的確治癒了很多
04:57
who were born天生 without gonads性腺.
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出生時缺乏性腺的人
04:59
This wasn't rocket火箭 science科學.
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這不是什麼難如登天的科學
05:01
But I made製作 a deal合同 with him:
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但我跟他做了個約定:
05:02
I'll treat對待 you if you teach me.
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如果你教導我,我就治療你
05:05
And so he did.
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他照辦了
05:08
And what an education教育 I got
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而我從照顧
05:10
from taking服用 care關心 of all the members會員
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他的支持小組所有成員中
05:12
of his support支持 group.
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真的學到了很多
05:15
And then I got really confused困惑,
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我當時十分困惑
05:17
because I thought it was relatively相對 easy簡單 at that age年齡
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因我當時認為在那種年紀
05:20
to just give people the hormones激素
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只要為他們施打
想成為的性別的賀爾蒙
05:22
of the gender性別 in which哪一個 they were affirming肯定,
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事情就能簡單解決
05:26
but then my patient患者 married已婚,
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但接下來我的病患結婚了
05:29
and he married已婚 a woman女人
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他與一個女人結合
05:32
who had been born天生 as a male,
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而她出生時是生理男性
05:34
had married已婚 as a male, had two children孩子,
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曾以男性的身分結婚,育有兩個孩子
05:37
then went through通過 a transition過渡 into female,
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之後才轉為女性
05:43
and now this delightful愉快 female
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現在這快樂做自己的女性
05:48
was attached to my male patient患者,
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與我的男性病患結合了
05:52
in fact事實 got legally法律上 married已婚 because they showed顯示 up
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實際上是合法結婚了
05:54
as a man and a woman女人, and who knew知道?
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因為他們看起來是一男一女,誰又看得出來呢?
05:56
Right? (Laughter笑聲)
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你說是吧?(笑聲)
05:59
And while I was confused困惑 about,
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當我正感到困惑:
06:03
does this make so-and-so誰誰 gay同性戀者?
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這種情況該說是男同性戀呢?
06:05
Does this make so-and-so誰誰 straight直行?
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還是正常呢?
06:07
I was getting得到 sexual有性 orientation方向
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我正是把性傾向
06:10
confused困惑 with gender性別 identity身分.
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跟性別自我認可搞混了
06:13
And my patient患者 said to me,
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我的病患跟我說:
06:15
"Look, look, look.
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"嘿,聽我說,聽我說。
06:17
If you just think of the following以下, you'll你會 get it right:
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你只要照我說的去想,就會搞懂了。
06:20
Sexual有性 orientation方向 is who you go to bed with;
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性傾向代表你要同床的對象
06:23
gender性別 identity身分 is who you go to bed as."
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性別自我認同就是你赴床上時的身分
06:29
And I subsequently後來 learned學到了 from the many許多 adults成年人 --
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而我接著從許多成年人身上學到--
06:32
I took care關心 of about 200 adults成年人
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我曾照顧了約200個成年人--
06:34
I learned學到了 from them
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我學到了
06:36
that if I didn't look, peek窺視 as to who
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如果我不看或偷瞄
06:39
their partner夥伴 was in the waiting等候 room房間,
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他們在等待室裡的伴侶的話
06:41
I would never be able能夠 to guess猜測
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我永遠也沒法猜到--
06:43
better than chance機會
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單純用機率都比我準--
06:45
whether是否 they were gay同性戀者, straight直行, bi,
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他們會是男同、直、女同
06:47
or asexual無性 in their affirmed肯定 gender性別.
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或是無性者
06:51
In other words,
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換句話說
06:52
one thing has absolutely絕對 nothing to do
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許多事情之間
06:55
with the other.
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是沒有絕對的關聯的
06:57
And the data數據 show顯示 it.
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而資料也如此顯示
06:59
Now, as I took care關心 of the 200 adults成年人,
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現在,當我照顧這200個成年人
07:04
I found發現 it extremely非常 painful痛苦.
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我發現這極度令人傷痛
07:06
These people were -- many許多 of them
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這些人們
07:09
had to give up so much of their lives生活.
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大多必須放棄自己的人生
07:13
Sometimes有時 their parents父母 would reject拒絕 them,
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他們有時會被父母給否定
07:16
siblings兄弟姐妹, their own擁有 children孩子,
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被手足、自己的子女拒絕
07:18
and then their divorcing離婚 spouse伴侶
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與他們離婚的配偶
07:20
would forbid禁止 them from seeing眼看 their children孩子.
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也會禁止他們與孩子見面
07:24
It was so awful可怕, but why did they do it
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結果如此悲慘
07:27
at 40 and 50?
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他們為何要在四、五十歲時這麼做?
07:30
Because they felt they had to affirm確認 themselves他們自己
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因為他們覺得有必要在自殺之前
07:34
before they would kill themselves他們自己.
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確認自己的性別
07:37
And indeed確實, the rate of suicide自殺
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而的確,
07:39
among其中 untreated未處理 transgendered變性 people
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未受治療的跨性別者的自殺率
07:43
is among其中 the highest最高 in the world世界.
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在世上是數一數二的高
07:46
So what to do?
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所以該怎麼辦?
07:49
I was intrigued好奇 in going to a conference會議
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我曾被一個研討會給吸引去
07:52
in Holland荷蘭, where they are experts專家 in this,
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在荷蘭,那兒有許多專家
07:54
and saw the most remarkable卓越 thing.
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並見識了許多令人印象深刻的事
07:58
They were treating治療 young年輕 adolescents青少年
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他們治療的是年輕的青少年
08:01
after giving them the most intense激烈
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先給予最密集的心理測試
08:04
psychometric心理 testing測試 of gender性別,
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以鑑定性別
08:07
and they were treating治療 them by blocking閉塞
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再用阻擋他們不想要的青春期
08:09
the puberty青春期 that they didn't want.
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來治療他們
08:11
Because basically基本上, kids孩子 look about the same相同,
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因為基本上,無論哪個性別
08:14
each sex性別, until直到 they go through通過 puberty青春期,
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孩子們在經歷青少年時期之前看起來都一樣
08:17
at which哪一個 point, if you feel you're in the wrong錯誤 sex性別,
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在青少年時期若認為自己性別錯了
08:20
you feel like Pinocchio木偶奇遇記 becoming變得 a donkey.
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感覺就像自己是一個正變成驢子的皮諾丘
08:23
The fantasy幻想 that you had that your body身體 will change更改
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認為自己身體會隨著青春期而改變
08:26
to be who you want it to be with puberty青春期
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成為自己想要的樣子的幻想
08:28
actually其實 is nullified無效 by the puberty青春期 you get.
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實際上正是被自己
所成為的青少年給毀滅
08:33
And they fall秋季 apart距離.
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而他們也因此崩潰了
08:36
So that's why putting the puberty青春期 on hold保持
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所以這就是為什麼要先保留這些青少年--
08:39
Why on hold保持? You can't just give them
161
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為什麼是保留? 因為你不能
在他們這麼年輕的時候
08:41
the opposite對面 hormones激素 that young年輕.
162
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就給他們相反性別的賀爾蒙
08:43
They'll他們會 end結束 up stunted發育不良 in growth發展,
163
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2017
因為那會使他們發育不良
08:45
and you think you can have
a meaningful富有意義的 conversation會話
164
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2588
而你覺得你和一個十歲女孩或十二歲男孩
08:48
about the fertility生育能力 effects效果 of such這樣 treatment治療
165
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在這種療程會造成的生殖能力影響上
08:50
with a 10-year-old-歲 girl女孩, a 12-year-old-歲 boy男孩?
166
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能有什麼有意義的對話嗎
08:54
So this buys購買 time in the diagnostic診斷 process處理
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這種情況下
08:56
for four or five years年份
168
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能夠爭取四到五年的診斷時間
08:58
so that they can work it out,
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所以那些青少年可以有機會克服
09:01
they can have more and more testing測試,
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可以做更多檢測
09:04
they can live生活 without feeling感覺 their bodies身體
171
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可以好好活著,而不會感到自己的身體
09:06
are running賽跑 away from them.
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正離自己而去
09:08
And then, in a program程序 they call 12-16-18,
173
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4182
而接著,在一個叫做12-16-18的計畫中
09:12
around age年齡 12 is when they
give the blocking閉塞 hormones激素,
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十二歲左右給予阻擋青春期的賀爾蒙
09:17
and then at age年齡 16 with retesting复驗,
175
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在十六歲時再度測試時
09:19
they requalify重新認證.
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2112
他們必須能夠符合
09:21
Now remember記得, the blocking閉塞
hormones激素 are reversible可逆,
177
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現在注意,那些賀爾蒙是可逆的
09:25
but when you give the hormones激素 of the opposite對面 sex性別,
178
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2923
但只要給予相反性別的賀爾蒙
09:28
you now start開始 spouting breasts乳房 and facial面部 hair頭髮
179
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他們就能開始長出胸部和臉毛
09:30
and voice語音, depending根據 on what you're using運用,
180
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2102
而聲音決定於你要使用什麼
09:32
and those effects效果 are permanent常駐
181
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2270
且那些效應是永久的
09:35
or require要求 surgery手術 to remove去掉
182
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2078
或需要手術去移除
09:37
or electrolysis電解,
183
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1221
或電離法
09:38
and you can never really affect影響 the voice語音.
184
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且你其實沒法真的改變聲音
09:40
So this is serious嚴重, and this is 15-, 16-year-old-歲 stuff東東.
185
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4299
所以這很嚴肅,而且這跟著你有15、16年久了
09:45
And then at 18, they're eligible合格 for surgery手術,
186
573090
3163
接著到18歲,他們能夠接受手術了
09:48
and while there's no good surgery手術
for females女性 to males男性 genitally生殖器,
187
576253
4335
雖然女轉男的生殖器
改變手術無法盡善盡美
09:52
the male-to-female男變女 surgery手術
has fooled上當 gynecologists婦科醫生.
188
580588
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男轉女的手術卻能騙過婦產科醫師
09:57
That's how good it can be.
189
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2761
你看看它有多完善
10:00
So I looked看著 at how the patients耐心 were doing,
190
588120
3860
所以我觀察病患的改善情況
10:03
and I looked看著 at patients耐心 who
just looked看著 like everybody每個人 else其他,
191
591980
3010
也觀察病患順利融入人群,與別人並無二致
10:06
except they were pubertallypubertally delayed延遲.
192
594990
2439
除了他們青春期有被延遲之外
10:09
But once一旦 they gave them the hormones激素
193
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2059
一旦給了與他們所認同的性別
10:11
consistent一貫 with the gender性別 they affirm確認,
194
599488
2511
相符合的賀爾蒙
10:13
they look beautiful美麗.
195
601999
1978
他們會變得美麗
10:15
They look normal正常. They had normal正常 heights高度.
196
603977
3766
看起來正常,有著正常的身高
10:19
You would never be able能夠 to pick them out
197
607743
2233
你永遠無法在人群中
10:21
in a crowd人群.
198
609976
2595
挑出他們來
10:24
So at that point, I decided決定 I'm going to do this.
199
612571
2356
在那時刻,我決定自己也要往這方面去做
10:26
This is really where the pediatric小兒科的
200
614927
2575
這就是我踏入
10:29
endocrine內分泌 realm領域 comes in,
201
617502
1988
小兒科內分泌領域的時候
10:31
because in fact事實, if you're going to deal合同 with it
202
619490
1981
因為事實上
10:33
in kids孩子 age年齡 10-12, 10-14,
203
621471
2681
假如你要治療10-12或10-14歲的孩子
10:36
that's pediatric小兒科的 endocrinology內分泌.
204
624152
3282
那就該是小兒科內分泌學啦
10:39
So I brought some kids孩子 in,
205
627434
3779
所以我引入了一些孩子
10:43
and this now became成為 the standard標準 of care關心,
206
631213
2657
而這現在成了照護的標準
10:45
and Children's兒童 Hospital醫院 was behind背後 it.
207
633870
2757
有兒童醫院在後面支援
10:48
By my showing展示 them the kids孩子 before and after,
208
636627
4441
展示了這些孩子的前後樣貌後
10:53
people who never got treated治療
209
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1349
從未受治療的人們
10:54
and people who wished希望 to be treated治療,
210
642417
2528
想接受治療的人們
10:56
and pictures圖片 of the Dutch荷蘭人,
211
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3146
以及荷蘭人
11:00
they came來了 to me and said,
212
648091
1129
都來找我並說:
11:01
"You've got to do something for these kids孩子."
213
649220
1991
"你必須為這些孩子做點事"
11:03
Well, where were these kids孩子 before?
214
651211
3307
那麼,之前這些孩子們在哪?
11:06
They were out there suffering痛苦, is where they were.
215
654518
3154
他們在那兒承受痛苦
11:09
So we started開始 a program程序 in 2007.
216
657672
6311
所以我們在2007年開始了一個計劃
11:15
It became成為 the first program程序 of its kind --
217
663983
2152
它成為這類型中的第一個計劃--
11:18
but it's really of the Dutch荷蘭人 kind --
218
666135
2598
但它其實是之前說的荷蘭方法--
11:20
in North America美國.
219
668733
2141
不過是在北美洲實行
11:22
And since以來 then, we have 160 patients耐心.
220
670874
4197
自那時起,我們有了160個病患
11:27
Did they come from Afghanistan阿富汗? No.
221
675071
3277
他們來自阿富汗嗎?不。
11:30
They came來了, 75 percent百分 of them came來了
222
678348
3273
他們其中有百分之七十五
11:33
from within 150 miles英里 of Boston波士頓.
223
681621
5068
來自距波士頓150哩以內的地方
11:38
And some came來了 from England英國.
224
686689
3397
而有些人來自英格蘭
11:42
Jackie成龍 had been abused濫用 in the Midlands米德蘭, in England英國.
225
690086
3819
傑琪曾在英格蘭的米德蘭茲被虐
11:45
She's 12 years年份 old there,
226
693905
2015
那時她十二歲
11:47
she was living活的 as a girl女孩
227
695920
1353
以女孩的身分過活
11:49
but she was being存在 beaten毆打 up.
228
697273
2152
但一直受到毒打
11:51
It was a horror恐怖 show顯示.
229
699425
1053
那情形慘不忍睹
11:52
They had to homeschool家教 her.
230
700478
1996
他們得讓她在家自學
11:54
And the reason原因 the British英國的 were coming未來 was
231
702474
2749
這些英國人會來求助的原因是
11:57
because they would not treat對待 anybody任何人
232
705223
3365
在英國任何未滿16歲的人
12:00
with anything under age年齡 16,
233
708588
1940
都不能接受治療
12:02
which哪一個 means手段 they were consigning托運 them
234
710528
1788
等同於無論多可怕的事會發生
12:04
to an adult成人 body身體, no matter what happened發生,
235
712316
3468
他們都會被交付一個成年的身軀
12:07
even if they tested測試 them well.
236
715784
2024
就算已經做過良好的檢驗了
12:09
Jackie成龍, on top最佳 of it, was,
237
717808
2368
在這情況下
12:12
by virtue美德 of skeletal骨骼 markings標記,
238
720176
2575
傑琪雖在骨骼測量中
12:14
destined注定 to be six feet five.
239
722751
4087
被預測能長到約195公分
12:18
And yet然而, she had just begun開始
240
726838
1971
但她才剛開始進入
12:20
a male puberty青春期.
241
728809
2155
男性的青春期
12:22
Well, I did something a little bit innovative創新,
242
730964
3445
我做了件有點創新的事
12:26
because I do know hormones激素,
243
734409
1950
因為我的確了解賀爾蒙
12:28
and that estrogen雌激素 is much more potent有力的
244
736359
2070
知道雌激素在關閉骨端生長板
12:30
in closing關閉 epiphyses骨骺, the growth發展 plates,
245
738429
3706
是很有能力的
12:34
and stopping停止 growth發展, than testosterone睾酮 is.
246
742135
3317
比睪固酮更能停止成長發育
12:37
So we blocked受阻 her testosterone睾酮
247
745452
2386
所以我們使用了賀爾蒙
12:39
with a blocking閉塞 hormone激素,
248
747838
2558
去阻斷她的睪固酮
12:42
but we added添加 estrogen雌激素, not at 16, but at 13.
249
750396
4339
並在13而非16歲時為她施打雌激素
12:46
And so here she is at 16, on the left.
250
754735
3518
左邊這個就是她16歲時的樣子
12:50
And on her 16th birthday生日, she went to Thailand泰國,
251
758253
2001
在她16歲生日,她去了泰國
12:52
where they would do a genital生殖器 plastic塑料 surgery手術.
252
760254
2143
去做生殖器整形手術
12:54
They will do it at 18 now.
253
762397
1900
現在他們是在18歲時做
12:56
And she ended結束 up 5'11"
254
764297
2864
結果她只長了約180公分
12:59
but more than that, she has normal正常 breast乳房 size尺寸,
255
767161
3307
更棒的是,她擁有正常的胸部大小
13:02
because by blocking閉塞 testosterone睾酮,
256
770468
2263
因為藉由阻斷睪固酮
13:04
every一切 one of our patients耐心
257
772731
1630
我們的每個病患
13:06
has normal正常 breast乳房 size尺寸
258
774361
1875
都能有正常胸部大小
13:08
if they get to us at the appropriate適當 age年齡, not too late晚了.
259
776236
4175
只要他們及早在適當年齡來找我們
13:12
And on the far right, there she is.
260
780411
2280
而在最右邊,也是她
13:14
She went public上市,
261
782691
1715
她公開參加英國小姐選美
13:16
semifinalist半決賽 in the Miss小姐 England英國 competition競爭.
262
784406
3082
進入準決賽
13:20
The judges法官 debated辯論 as to, can they do this?
263
788768
3232
評審們互相辯論,他們該怎麼做
13:24
Can they make her —
264
792000
1868
他們能不能讓她進入決賽
13:25
And one of them quipped調侃道, I'm told,
265
793868
2291
據我所知,其中有一人諷刺道:
13:28
"But she has more natural自然 self
266
796159
2055
"但她比起其他參賽者的一半
13:30
than half the other contestants參賽者."
267
798214
1925
擁有更多的自然的自我"
13:32
(Laughter笑聲)
268
800139
1967
(笑聲)
13:34
And some of them have been rearranged重排 a little bit,
269
802106
4216
雖然其中有些部分被重新排列更動
13:38
but it's all her DNA脫氧核糖核酸.
270
806322
3312
但畢竟全是她的DNA啊
13:41
And she's become成為 a remarkable卓越 spokeswoman發言人.
271
809634
3313
接著她成為一個令人印象深刻的發言人
13:44
And she was offered提供 contracts合同 as a model模型,
272
812947
4010
並得到模特兒的合約
13:48
at which哪一個 point she teased戲弄 me, where she said,
273
816957
1843
當時她開玩笑說:
13:50
"You know, I might威力 have had a better chance機會
274
818800
2080
"你知道的,要是你當時讓我長到185,
13:52
as a model模型 if you'd made製作 me six feet one."
275
820880
2727
現在我就有更好的條件可以當模特兒"
13:55
Go figure數字. (Laughter笑聲)
276
823607
4453
天知道(笑聲)
14:00
So this picture圖片, I think, says it all.
277
828060
3653
所以這張照片,我想,解釋了一切
14:03
It really says it all.
278
831713
1747
真的解釋了一切
14:05
These are Nicole妮可 and brother哥哥 Jonas喬納斯,
279
833460
3851
他們是尼蔻和她兄弟,瓊納斯
14:09
identical相同 twin雙胞胎 boys男孩,
280
837311
2816
同卵雙生男孩
14:12
and proven證明 to be identical相同,
281
840127
2569
經過證實的
14:14
in which哪一個 Nicole妮可 had affirmed肯定 herself她自己
282
842696
2490
但尼蔻早在三歲時
14:17
as a girl女孩 as early as age年齡 three.
283
845186
2230
就確定自己是女的
14:19
At age年齡 seven, they changed her name名稱,
284
847416
2501
七歲時,他們改了她的名
14:21
and came來了 to me at the very beginnings開始
285
849917
3213
並在剛進入青春期時
14:25
of a male puberty青春期.
286
853130
1646
來找我求診
14:26
Now you can imagine想像 looking at Jonas喬納斯
287
854776
1568
現在你們看著14歲的瓊納斯
14:28
at only 14 that male puberty青春期
288
856344
1758
可以想像在他家族裡
14:30
is early in this family家庭,
289
858102
2517
青春期很早開始
14:32
because he looks容貌 more like a 16-year-old-歲,
290
860619
2251
因為他看起來比較像16歲了
14:34
but it makes品牌 the point all the more
291
862870
1840
但這只是再次強調了
14:36
why you have to be conscious意識
292
864710
1657
為什麼你應該更加留意
14:38
of where the patient患者 is.
293
866367
1952
病人的年齡狀況
14:40
Nicole妮可 has doneDONE pubertal青春期 blockade封鎖 in here,
294
868319
3960
尼蔻當時就做了中斷青春期的措施
14:44
and Jonas喬納斯 is just going -- biologic生物 control控制.
295
872279
3793
而瓊納斯只有做生理控制
14:48
This is what Nicole妮可 would look like
296
876072
1538
假如我們不做任何事
14:49
if we weren't doing what we were doing.
297
877610
2180
他是尼蔻會變成的樣子
14:51
He's got a prominent突出 Adam's亞當 apple蘋果.
298
879790
2392
他有一個明顯的喉結
14:54
He's got angular bones骨頭 to the face面對, a mustache鬍子,
299
882182
3707
臉骨有稜有角,有鬍鬚
14:57
and you can see there's a height高度 difference區別
300
885889
1520
且你也看得出有身高差距
14:59
because he's gone走了 through通過
301
887409
1300
因為他經歷了青春期成長
15:00
a growth發展 spurt that she won't慣於 get.
302
888709
2040
而她沒有
15:02
Now Nicole妮可 is on estrogen雌激素.
303
890749
1881
現在尼蔻正使用雌激素
15:04
She has a bit of a form形成 to her.
304
892630
3289
很有成效
15:07
This family家庭 went to the White白色 House last spring彈簧
305
895919
3307
這個家族去年春天去了白宮
15:11
because of their work
306
899226
2621
因為他們的成就
15:13
in overturning傾覆 an anti-discrimination反歧視,
307
901847
3398
也就是翻轉了歧視
15:17
there was a bill法案 that would block
308
905245
2841
在緬因州曾有一個法條
15:20
the right of transgender變性 people in Maine緬因州
309
908086
2257
禁止跨性別的人
15:22
to use public上市 bathrooms浴室,
310
910343
1679
使用公廁
15:24
and it looked看著 like the bill法案 was going to pass通過,
311
912022
3123
這法條一度很有機會通過
15:27
and that would have been a problem問題,
312
915145
1377
將造成一大麻煩
15:28
but Nicole妮可 went personally親自
to every一切 legislator立法者 in Maine緬因州
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但尼蔻個人拜訪了緬因州每個議員
15:32
and said, "I can do this.
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並說:"我能做到。
15:34
If they see me, they'll他們會 understand理解
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如果他們看到了我
15:36
why I'm no threat威脅 in the lady's女士 room房間,
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他們就會了解為什麼我在女廁不會構成任何威脅
15:38
but I can be threatened受威脅 in the men's男裝 room房間."
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而會在男廁受到威脅。"
15:40
And then they finally最後 got it.
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而他們最終真的懂了
15:43
So where do we go from here?
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所以我們究竟能到達怎樣的目標呢?
15:47
Well, we still have a ways方法 to go
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我敢說在反歧視方面
15:49
in terms條款 of anti-discrimination反歧視.
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還有一段很長的路要走
15:51
There are only 17 states狀態 that have
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只有17個州
15:52
an anti-discrimination反歧視 law
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擁有反歧視法律
15:54
against反對 discrimination區別 in housing住房,
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2950
避免在居住、
15:57
employment僱用, public上市 accommodation住所,
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工作、公共場所可能出現的各種歧視
16:00
only 17 states狀態, and five of them are in New England英國.
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只有17州,其中五個在新英格蘭
16:03
We need less expensive昂貴 drugs毒品.
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我們還需要不那麼昂貴的藥
16:05
They cost成本 a fortune幸運.
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藥物是一筆很大的花費
16:06
And we need to get this condition條件
329
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且我們需要把這情況
16:08
out of the DSMDSM.
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2037
帶出《精神疾病診斷與統計手冊》
16:11
It is as much a psychiatric精神病 disease疾病
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這是精神疾病
16:13
as being存在 gay同性戀者 and lesbian女同性戀,
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不單單是男同志或女同志的問題
16:15
and that went out the window窗口 in 1973,
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它在1973年就走了樣
16:18
and the whole整個 world世界 changed.
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使得全世界都改變
16:20
And this isn't going to break打破 anybody's任何人的 budget預算.
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而這不會超出任何人的預算
16:22
This is not that common共同.
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因為這問題沒有那麼普遍
16:25
But the risks風險 of not doing anything for them
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但不為他們做任何事的風險
16:29
not only puts看跌期權 all of them at risk風險
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不只是讓他們
16:33
of losing失去 their lives生活 to suicide自殺,
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處於自殺的危險中
16:36
but it also says something about
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也是考驗著我們這社會
16:39
whether是否 we are a truly inclusive包括的 society社會.
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究竟是不是真正有包容性
16:42
Thank you.
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謝謝
16:45
(Applause掌聲)
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(掌聲)
Translated by Becky Ma
Reviewed by Neoh Yi Yuan

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ABOUT THE SPEAKER
Norman Spack - Endocrinologist
At Boston's Children Hospital, endocrinologist Norman Spack treats transgender teens to delay the effects of puberty.

Why you should listen

Norman Spack is a pediatric endocrinologist at Boston's Children Hospital and the co-founder of the hospital's Gender Management Service clinic. Created in 2007, the clinic remains one of the few in the world that treats minors with hormone replacement therapy.

Spack began working with college-aged transgender patients professionally in 1985, but found that once patients had reached adulthood, it was extremely difficult to treat their sexually mature bodies using hormone therapy. When parents of transgender children began seeking him out through online support groups, Spack started to think about possible treatments for patients in their youth, before puberty has permanently changed their bodies. Since then Spack has spoken widely on pediatric hormone therapy and has campaigned for law reform in several states to protect transgender people against hate crimes and discrimination.

More profile about the speaker
Norman Spack | Speaker | TED.com