About six months into my career as a therapist, I was working at a drug and alcohol rehab facility. I got a call from one of the nurses down at the detox unit. She asked me to come down and assess one of the new patients that had arrived earlier in the day. So I went down to the unit and had the pleasure of meeting Anne. Anne's a transgender female, and as her and I started talking, she was sharing with me about what brought her into treatment, but I could hear this fear in her voice, and I could see this worry in her eyes, and she began to tell me that she didn't fear coming into rehab and having to give up drugs and alcohol. Her fear was that the doctors that were going to be treating her would not treat her as her female self.
﻿在我治疗师的职业生涯 开始大约六个月， 我在毒品和酒精戒毒所工作。 我接到排毒病房的护士 打来的电话。 她让我下去检查一个 当天早些时候 过来的新病人。 于是我下去病房并与安妮 有了一场愉快的会面。 安妮是跨性别女性， 随着我俩开始交谈， 她和我分享了她接受治疗的原因， 但我能在她声音中听到这个恐惧， 我也能从她的眼中看到这个担忧， 她开始告诉我说她不怕来戒毒所 并且放弃毒品和酒精。 她担心的是给她治疗的医生 不会把她当女性看待。
She then told me about this ongoing pain that she has experienced her whole life of being assigned male but knowing she's female. And what she meant by that is, when she was born, the doctor held her up to her parents and based on her genitalia said, "It's a boy." She always knew she wasn't a boy. Many years passed and the feelings that she was feeling and holding all this in grew and grew, and she knew she had to come out to her family. And when she did, it didn't go over so well. Her parents said, "Absolutely not. You're not a girl. This is not how we raised you. We don't know what you're thinking. Get out." So Anne then found herself on the streets and in and out of homeless shelters, and it's here where she started using drugs and alcohol to numb this pain she felt inside. She told me about her journey of being in and out of hospitals and rehabs trying to get sober, and when she did, the health care providers and doctors wouldn't use the correct female name or pronouns. This caused her pain.
她告诉了我她在整个人生中 所经历的痛苦， 知道自己是女性 却被分配了男性角色。 她意思是，当她出生时， 医生扶着她，根据她的生殖器 跟她父母说， “是个男孩。” 她一直知道她不是个男孩。 多年过去后，她对这一切的感觉 和感受与日俱增， 她知道她得跟家人坦白。 她做了，但事情并不顺利。 她父母说，“绝对不可能， 你不是女孩。 我们不是这样抚养你的， 我们不知道你在想什么。 出去。” 于是安妮发现自己在大街上， 在无家可归的收容所进出， 在那开始她开始使用毒品和酒精 来麻木她内心的痛苦。 她告诉我她在医院和戒毒所 进进出出 试图清醒过来的经历， 当她这样做时， 医疗保健提供者和医生 不会对她使用正确的 女性名字或代名词。 这引发了她的痛苦。
You see, when I was studying to become a therapist, I wasn't taught how to work with transgender patients. I had no idea these would be the patients I'd be working with. But the more I worked with Anne and other patients like Anne, I began to see my mission evolve, and that was to make sure that the transgender community got their health care needs met. The more I looked into this, I saw how this very real fear of violence, discrimination and this lack of acceptance caused so many of these patients to turn to alcohol and drugs. And I also heard these horror stories of when these patients were seeking medical care and how they were treated, and how a lot of their medical needs were ignored.
你看， 当我学习成为 一名治疗师时， 我没有接受过如何处理 跨性别病人的训练。 我对处理这样的病人毫无概念。 但我遇到安妮和像安妮这样的人 越来越多后， 我开始看到我的使命的演变， 那就是确保跨性别群体 得到他们所需的医疗服务。 我见到的案例越来多， 我看到这种 对暴力，歧视和不被接受的 真正恐惧 是如何导致如此多的人 转向酒精和毒品的。 我也听到了这些可怕的故事， 当这些病人寻求医疗服务时 他们是如何被治疗的， 以及他们的医疗需求 是如何被忽视的。
Now let me tell you about Leah. I had the pleasure of meeting Leah a few years back. She's a female and she has a wife and a child. See, Leah was also assigned male at birth and she knew since she was a young child that she was not a male, that she was a female. She hid it from herself and from everyone she knew, especially from her wife, until the age of 50. She couldn't take it anymore. She was like, I can't keep living like this. I gotta get honest. She was extremely scared to tell her wife. What if her wife said, "This is unacceptable, I want a divorce, get out"? To her surprise, her wife was accepting. She said, "I love you regardless of who you are. I want to help you in every way I can." So she talked with her wife, and she made the decision that she wanted to medically transition, and she was interested in being assessed for hormone replacement therapy, otherwise known as HRT. So she made an appointment with her doctor. She arrived on the day of her appointment early. She filled out all the paperwork, put the name correctly down there and waited patiently. A little bit of time passed and a nurse called her back to the exam room. When she got back there, she took a deep breath, and the doctor and the nurse walked in. She extended her hand to the doctor and said, "Hi, I'm Leah." The doctor looked at her, didn't shake her hand and said, "Why are you here?" She took another deep breath and said, "Well, I'm a transgender female. I've known this my whole life, I've hid it from everyone, but I can't do it anymore. My wife's supportive, I can financially afford it, I've got to make these changes. Please consider me, and let's evaluate me for HRT." The doctor said, "We can't do anything today. You need to go get an HIV test."
现在我让告诉你们 关于利亚的故事。 几年前我有幸与利亚会面。 她是个女性， 并且有妻子和孩子。 利亚出生时被分配的角色 是男性， 然而她从小开始就知道 她不是男性， 而是个女性。 她瞒着自己和她认识的每个人， 特别是她的妻子， 直到50岁的时候。 她无法继续忍受了。 她就像， 无法这样继续活着了。 我得诚实。 她特别害怕告诉她的妻子。 如果她的妻子说： “这真是不可接受，我要离婚， 出去” 会怎样？ 让她惊讶的是，她妻子接受了。 她说：“不管你是谁，我都爱你。 我会尽一切可能帮你。” 于是她跟她妻子交谈后， 她决定去做医学转变手术， 她对激素替代疗法 很感兴趣， 也被称为HRT。 于是她与医生做了预约。 她在预约那天早早过去。 她填写了所有的文件， 把名字写对，耐心等候。 过了一会，护士叫她回到检查室。 当她回到那边，她深吸了一口气， 医生和护士走了进来。 她向医生伸出手说 “嗨，我是利亚。” 医生看着她，并没握她的手说， “你为什么来这？” 她再深吸了一口气说， “我是个跨性别女性。 我毕生都知道这点， 我曾隐瞒了所有人， 但我无法再继续隐瞒下去了。 我妻子很支持，我可以负担费用， 我要做这些改变。 请考虑我， 让我参与HRT评估。” 医生说： “我们今天什么都不能做。 你需要去做个HIV检查。”
She couldn't believe it. She was furious. She was angry. She was disappointed. If her doctor treated her this way, how would the rest of the world treat her? First, he wouldn't shake her hand, and second, when he heard she was transgender, all he cared about was getting an HIV test and ending the appointment. He didn't even ask her any other questions.
她无法相信。 她很愤怒。 她很生气，她很失望。 如果她的医生都这样对她，那 这个世界的其他人又会怎么对她？ 首先，他不和她握手， 第二， 当他听到她是个跨性别者时， 他关心的是让她做HIV检查 并草草结束会面。 他甚至没问她其他任何问题。
See, I can understand where Leah's coming from, because the years that I've worked with the community, I hear myths every single day that aren't true at all. A couple of those are: every transgender person wants to transition with medication or surgery; transgender people are mentally ill, this is a disorder; and: these people aren't real men and women. These are all myths and untrue. As this community expands and grows older, it is imperative that all health care providers be trained on how to take care of their health care needs.
我理解利亚的困扰， 因为我与这个人群工作的这些年， 我每天都听到一些 完全没有事实基础的偏见。 其中一些是： 每个跨性别人都想通过药物 或手术来完成转变； 跨性别者有精神病，是种障碍； 以及：这些人都不是 真正的男人和女人。 这些都是无稽之谈。 随着这个人群扩大和变老， 所有医疗保健提供者都需要接受 如何照顾他们的培训。
Back in 2015, a survey was done and found that 72 percent of health care providers did not feel well-informed on the health care needs of the LGBT community. There's a huge gap in the education and training.
回到2015年， 一个那时做的调查发现 72%的医疗提供者 对LGBT群体的 医疗保健需求没有充分了解。 他们在教育和培训上 存在巨大的鸿沟。
Today, in this talk, I want to offer a new way of thinking for three groups of people: doctors, the transgender community and, well, the rest of us. But before we do, I want to cover a couple of definitions that's going to help you wrap your head around gender identity a little bit more. So I hope you've got your paper and pen. Get ready to take some notes.
今天，在这个演讲中， 我想要为三个人群的人们 提供新的思考方式： 医生，跨性别群体 还有所有其他人。 但在我们开始前， 我想要讲清楚几个定义 以更好帮助你理解性别认同。 所以我希望你们有纸和笔。 准备好做些笔记。
So let's start out with this idea of a binary system. And what this means is, before, we always thought there was only two, male and female. Get it? Binary? Right? So we've come to find out that this isn't true. Gender identity is a spectrum with maleness on one side and femaleness over here on the other side. This spectrum of identities include identities such as gender-nonconforming, gender-affirming, gender-nonbinary, two-spirited, three-spirited, as well as people that are intersex. The term transgender is this umbrella term that encompasses all these different types of identities. But for today's talk, I want you to think about transgender as someone who is assigned a sex at birth that doesn't match with who they are as a person and their sense of self.
让我们从二元系统的概念开始。 二元的意思是， 过去，我们一直认为 有两种性别，男性和女性。 懂吗？二元？对吗？ 所以我们是来证明这不是真的。 性别认同是一个谱系， 一边是男性， 另一边是女性。 这一系列的性别认同 包括性别错位， 性别确认， 非二元性别， 双灵，三灵， 还有阴阳人。 跨性别者这个词是个统称 它包含了所有这些 不同类型的性别认同。 但今天的演讲 我想让你们把跨性别者 理解为某人出生时分配的性别与 自我认知和意识不匹配的那种。
Now, this is very different than biological sex. So gender identity is sense of self. So think of it as what's between your ears: sense of self, who you are. This is very different than biological sex, right? Hormones, genitalia, chromosomes: that's what's between our legs.
这和生理性别很不一样。 所以性别认同就是自我意识。 把它想成你两耳之间的东西： 自我意识，你是谁。 这与生理性别很不同，是吧？ 激素、生殖器、染色体： 那是我们两腿之间的东西。
Now, you may be thinking, "Dr. Kristie, I have never questioned who I am. I know I'm a man, or I know I'm a woman." I get it. You know who you are. This is how many transgender individuals feel. They just know who they are with that same conviction.
你可能在想，“克里斯蒂医生， 我从来没有问过我是谁。 我知道我是个男人， 或者我知道我是女人。” 我懂，你们知道你是谁。 这也是很多跨性别个体所感受的。 他们有同样的信念 知道自己是谁。
It's important to know that there are many different types of identities, and I identify as a cisgender female. Now, for all y'all out there that like to know how to spell things, cis is spelled "c-i-s." It's the Latin term for "on the same side of." When I was born, the doctor held me up to my parents and said, "It's a girl." All this, based on my genitalia. Even though I grew up in a small farm town in Georgia, very much a tomboy, I never questioned that I was a female. I've always known I was a girl, regardless of how I was as a kid.
知道有不同类型的 性别认同是很重要的， 我自己就是个顺性别女性。 现在， 有想要知道 怎么拼写的人，注意， 顺的拼法是c-i-s。 在拉丁语中的意思是 “同一边”。 当我出生时， 医生扶起我，对我父母说， “她是个女孩。” 这一切都基于我的生殖器。 尽管我在乔治亚州的 一个小农场长大， 很像假小子， 我从没怀疑过我是女性这点。 我一直知道我是个女孩， 不管作为孩子时的我是什么样。
Now, this is very different than someone who's transgender. Now, trans is a Latin term for "on the other side of" -- think about transcontinental airlines, across, on the other side of -- someone that's assigned a sex at birth and they identify on the other side of the spectrum. A transgender male is someone who was assigned female at birth, but their sense of self, who they are, how they live their life, is as a male. And the opposite is, as we talked earlier, a transgender female, someone that's assigned male at birth but lives their live and sense of self as a female. It's also important to point out here that not everyone that has a nonbinary identity identifies with the term "transgender."
这和跨性别人很不一样。 跨在拉丁语中是 “另一边”的意思—— 想想横跨大陆的航班， 跨，另一边—— 一个人在出生时被分配一个性别， 但他们认同的是谱系的另一边。 跨性别男性是 出生时被分配为女性的人， 但他们的自我意识， 他们是谁，他们的生活方式， 则是男性。 反之，就如我们早先谈到的， 跨性别女性， 出生时被分配了男性角色， 但生活方式和自我意识是女性。 这里需要重点指出的是 不是每个非二元性别的人 都确认为跨性别者
Just so nobody gets confused, I want to point out sexual identity, or orientation. That is simply who we're attracted to, physically, emotionally, sexually, spiritually. It's got nothing to do with gender identity. So just for a quick recap, before we continue on: gender identity between the ears, biological sex, just think of it between your legs, and then sexual identity, well, sometimes we use our heart, but it's here. Three very different identity spectrums.
为了不让大家困惑， 我想指出性认同， 或者性取向。 这只是我们在身体上， 感情上，肉体上，精神上 被某人吸引的意思。 与性别认同无关。 在我们继续之前， 先简单回顾一下： 性别认同在两耳之间， 生理性别， 把它想成两腿之间的东西， 然后是性认同， 好吧，有时候我们会用心， 但它就在这里。 三个非常不同的认同谱系。
Now, the average medical student spends about five hours learning about the LGBT health-related needs while they're in medical school. Now, this is despite us knowing that there are unique health risks to this community. And there's an estimated 10 million American adults that identify as LGBT. Most doctors that work with transgender patients, they learn trial by fire. That means they figure it out as they go along, or the patient ends up spending their time trying to teach the doctor how to take care of them. Many doctors don't feel comfortable asking about gender identities. Some don't feel like it's relevant at all to their medical care and others just don't want to say the wrong thing. Many doctors who say something inappropriate or they say something negative, they may not be coming from a malicious or mean place, they may have never been trained on how to care for these individuals. But this can't be accepted as a norm anymore either.
现在一般医学生在 医学院，要花5个小时学习 LGBT人群的医疗需求。 尽管我们知道这个人群有独特的 健康风险。 并且估计有1000万美国成年人 认定自己是LGBT群体。 很多与跨性别病人工作的医生， 他们是在救火式的训练中学习。 这意味着他们在 独自前进中搞懂， 或者病人反过来花费时间 教会医生如何照顾他们。 很多医生在询问性别认同时 感到不自在。 有些人认为这跟他们的 医疗治疗没有一点关系， 另一些人则不想说错话。 很多说了不当的话 或者一些负面话语的医生， 可能并非出于恶意或卑鄙， 他们可能只是从来没有接受过 如何照顾这些人的训练。 但这再也不能被当作 正常来接受了。
So what happens to a transgender male -- for a quick recap, that's someone who is assigned female at birth but lives their life as a male -- what happens when this transgender male goes for their yearly gynecological visit? How that doctor treats that patient will set the whole tone for the office. If that doctor treats that male with the correct pronouns, correct name, gives dignity and respect, it's highly likely that the rest of the staff will too.
那么跨性别男性发生了什么—— 快速回想下， 是某个出生时被分配了女性， 但却以男性的方式生活的人—— 这个跨性别男性 每年去做妇科检查会发生什么？ 医生如何治疗那位病人 将决定整个办公室的基调。 如果那个医生用正确的代词， 正确的名字，给以尊严和尊重 去治疗那个男性， 很可能其他员工也会这么做。
So that's a little bit about my thoughts on doctors, and now let's move on to the transgender community. I'm here talking about fear, but y'all know who is really fearful, right? It's the transgender community. Earlier I shared the story about Anne and how she was so worried about going into treatment and not being respected as her female self, and then Leah who was scared about how her doctor would react, and the second that he didn't shake her hand and ordered that HIV test, her fears came true. The transgender community needs to be empowered to speak up for their health care needs. The days of remaining silent and taking whatever treatment you can get are over. If you don't speak up for your health care needs, no one's going to do it for you.
所以这是我对医生的一点思考， 现在让我们转到跨性别人群。 我这里要谈到恐惧， 但我们都知道谁真的害怕不是吗？ 是跨性别群体。 早些时候我分享的安妮的故事， 她是如此担忧接受治疗， 害怕因自己的女性认同 而不被尊重， 然后是利亚担心她的医生的反应， 其次是医生不握她的手， 命令她去做HIV检查， 她的担忧果然成真。 跨性别人群需要被赋权 说出他们的医疗需求。 保持沉默和照单全收 接受治疗的日子已经结束了。 如果你不说出你的医疗诉求， 没人会为你们发声。
So what about the rest of us? A lot of y'all, maybe in the next week or a couple of months, are going to have a doctor's appointment, right? So let's say you go to your doctor's appointment and when it's over, you feel worse than you did when you got there. What if you felt dismissed by the doctor, that they ignored your needs, or you even felt judged? That's what happens for many of the 1.4 million transgender adults here in the US if they're lucky enough to get an appointment.
那么我们剩下的其他人呢？ 很多人，可能在下周或几个月后， 要去看医生，对吗？ 假设你去看了医生， 医疗结束时， 你却感觉比刚进门时更糟。 假如你的感受被医生漠视了， 他们忽视你的需求，或者你觉得 自己受到了评判，你会怎么办？ 这就是发生在美国140万 跨性别群体上的事情， 假如他们足够幸运 能预约到医生的话。
Now, you may be thinking, "Why is this important to me? I'm not transgender. I don't know anybody that's transgender. Why should I even care?" Think of it this way. A transgender individual is human, just like you and me. They deserve competent and trained health care providers, just like you and me.
现在，你可能在想： “这为什么对我重要？ 我不是跨性别者， 我不认识任何跨性别人。 我为什么要关心这个？” 要用这样的思维方式想。 跨性别者也是人， 就跟你和我一样。 他们理应得到有能力和 训练有素的医疗提供者的服务， 就像你和我一样。
So let me ask, if you don't mind raising your hand: Do you know or have you met anyone who is transgender, gender-nonconforming, agender, intersex, two-spirited, three-spirited?
那么让我问问， 如果你不介意举起你的手： 你们谁知道或者遇到过跨性别者， 性别错位，无性别者， 阴阳人，双灵，三灵人吗？
Thank y'all so much. Lovely. Thank y'all. Every one of y'all who did not raise your hand, in the very near future you will get the opportunity to meet someone that falls into one of these identities, I guarantee it. The number of this community is increasing. That's not because it's a fad or the new thing to do. It's safer to come out. There's more awareness. There's more visibility. There's more safety, so people are speaking up about their true self like never before. That's why it's so important that our health care system get on board and make sure that our doctors and health care providers are trained to approach these patients with dignity and respect, just like we expect.
谢谢，很好，谢谢大家。 你们所有人，那些没有举手的人， 在不远的将来 可能会有机会遇到 有其中这些身份认同的人， 我保证。 这个群体的数量正在增长。 这并非因为这是时尚或新事物。 而是因为现在说出来 比以前说出来更安全。 现在有更多的觉悟， 更多的可见性。 更多的安全，所以人们 在从所未有的谈论他们 真实的自我。 所以我们的医疗系统到位 非常的重要， 并且要确保我们的 医生和医疗提供者训练有素 用尊严和尊重的态度对待这些病人， 就如我们所期望的那样。
I remember being in my 11th grade literature class, with one of my favorite teachers, Mr. McClain, and he shared this quote by Heraclitus that sticks with me to this day. Y'all may have even heard it. It's, "The only thing that is constant is that things will change." Familiar, right? Every single one of us face changes in our lives, and often when we're faced with these changes, we've got some difficult decisions to make. Will we remain in fear, stay stuck and not grow? Or, will we face fear with bravery, evolve, take the opportunity to grow? Every one of us face new things. What will you do? Will you remain in fear, or will you grow? I invite each of you, doctors, the transgender community and you and I, to face fear together as we walk into this brave new world.
我记得我上11年级的文学课时， 我最喜欢的老师麦克莱恩先生， 他分享的赫拉克利特这句话， 我至今铭记在心。 你们可能也听过。 它是：“唯一不变的事情 是改变。” 很熟悉，对吧？ 我们每个人都要面对生活中的改变， 往往当我们面对这些改变时， 我们需要做一些艰难的决定。 我们会继续恐惧，停滞不前， 不成长吗？ 或者，我们会勇敢面对恐惧， 进化，抓住机会成长吗？ 我们每个人都面对新事物。 你会做什么？ 你会继续恐惧， 还是你会成长？ 我邀请你们每个人， 医生，跨性别群体 还有你和我， 去共同面对恐惧， 一起走进这个勇敢的新世界。
Thank you.
谢谢。
(Applause)
（鼓掌）