How I help transgender teens become who they want to be
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0:01 - 0:05I want you all to think
-
0:05 - 0:10about the third word
that was ever said about you -- -
0:12 - 0:15or, if you were delivering,
-
0:15 - 0:18about the person you were delivering.
-
0:20 - 0:24And you can all mouth it
if you want or say it out loud. -
0:24 - 0:29It was -- the first two were, "It's a ..."
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0:29 - 0:31Audience: (Mixed reply) Girl. Boy.
-
0:31 - 0:32(Laughter)
-
0:32 - 0:34Well, it shows you that --
-
0:34 - 0:37I also deal with issues
where there's not certainty -
0:37 - 0:39of whether it's a girl or a boy,
-
0:39 - 0:42so the mixed answer was very appropriate.
-
0:42 - 0:47Of course, now the answer often comes
not at birth but at the ultrasound, -
0:47 - 0:51unless the prospective parents
choose to be surprised, -
0:51 - 0:53like we all were.
-
0:54 - 1:01But I want you to think about what it is
that leads to that statement -
1:01 - 1:03on the third word,
-
1:03 - 1:05because the third word
-
1:05 - 1:10is a description of your sex.
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1:13 - 1:16And by that I mean,
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1:16 - 1:19made by a description of your genitals.
-
1:20 - 1:23Now, as a pediatric endocrinologist,
-
1:24 - 1:29I used to be very, very involved
and still somewhat am, in cases -
1:29 - 1:35in which there are mismatches
in the externals -
1:35 - 1:39or between the externals
and the internals, -
1:39 - 1:44and we literally have to figure out
-
1:44 - 1:47what is the description of your sex.
-
1:49 - 1:54But there is nothing
that is definable at the time of birth -
1:54 - 1:57that would define you.
-
1:58 - 2:00And when I talk about definition,
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2:00 - 2:05I'm talking about your sexual orientation.
-
2:06 - 2:10We don't say, "It's a ... gay boy!"
-
2:12 - 2:13"A lesbian girl!"
-
2:14 - 2:18Those situations don't
really define themselves -
2:18 - 2:20more until the second decade of life.
-
2:22 - 2:27Nor do they define your gender,
-
2:27 - 2:31which, as different
from your anatomic sex, -
2:31 - 2:34describes your self-concept:
-
2:34 - 2:39Do you see yourself as a male or female,
-
2:39 - 2:43or somewhere in the spectrum in between?
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2:45 - 2:50That sometimes shows up
-
2:50 - 2:53in the first decade of life,
-
2:53 - 2:57but it can be very confusing for parents,
-
2:57 - 3:01because it is quite normative for children
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3:01 - 3:06to act in a cross-gender play and way,
-
3:06 - 3:08and, in fact, there are studies that show
-
3:08 - 3:14that even 80 percent of children
who act in that fashion -
3:14 - 3:21will not persist in wanting
to be the opposite gender -
3:21 - 3:23at the time when puberty begins.
-
3:25 - 3:29But, at the time that puberty begins --
-
3:30 - 3:36that means between about age 10 to 12
in girls, 12 to 14 in boys -- -
3:37 - 3:39with breast budding,
-
3:39 - 3:43or two to three times'
increase in the gonads -
3:43 - 3:46in the case of genetic males,
-
3:46 - 3:47by that particular point,
-
3:47 - 3:52the child who says
they are in the absolute wrong body -
3:54 - 3:56is almost certain to be transgender
-
3:57 - 4:04and is extremely unlikely
to change those feelings, -
4:04 - 4:09no matter how anybody tries
reparative therapy -
4:09 - 4:11or any other noxious things.
-
4:13 - 4:15Now, this is relatively rare,
-
4:15 - 4:18so I had relatively little
personal experience with this. -
4:19 - 4:22And my experience was more typical,
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4:22 - 4:24only because I had an adolescent practice.
-
4:24 - 4:25And I saw someone age 24,
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4:25 - 4:30genetically female, went through Harvard
with three male roommates -
4:30 - 4:31who knew the whole story,
-
4:31 - 4:37a registrar who always listed his name
on course lists as a male name, -
4:37 - 4:40and came to me after graduating,
-
4:40 - 4:44saying, "Help me. I know you know
a lot of endocrinology." -
4:44 - 4:48And indeed, I've treated a lot of people
who were born without gonads. -
4:48 - 4:49This wasn't rocket science.
-
4:49 - 4:51But I made a deal with him:
-
4:51 - 4:53"I'll treat you if you teach me."
-
4:54 - 4:56And so he did.
-
4:57 - 4:59And what an education I got
-
4:59 - 5:02from taking care of all the members
of his support group. -
5:04 - 5:06And then I got really confused,
-
5:06 - 5:09because I thought it was
relatively easy at that age -
5:09 - 5:10to just give people the hormones
-
5:10 - 5:14of the gender
in which they were affirming. -
5:15 - 5:18But then my patient married,
-
5:18 - 5:23and he married a woman
who had been born as a male, -
5:23 - 5:26had married as a male, had two children,
-
5:26 - 5:30then went through
a transition into female. -
5:32 - 5:36And now this delightful female
-
5:37 - 5:42was attached to my male patient --
in fact, got legally married, -
5:42 - 5:45because they showed up as a man
and a woman, and who knew, right? -
5:46 - 5:47(Laughter)
-
5:48 - 5:51And I was confused --
-
5:52 - 5:54"Does this make so-and-so gay?
-
5:54 - 5:56Does this make so-and-so straight?"
-
5:56 - 6:01I was getting sexual orientation
confused with gender identity. -
6:02 - 6:04And my patient said to me,
-
6:04 - 6:05"Look, look, look.
-
6:05 - 6:09If you just think of the following,
you'll get it right: -
6:09 - 6:12Sexual orientation
is who you go to bed with. -
6:12 - 6:15Gender identity is who you go to bed as."
-
6:16 - 6:18(Laughter)
-
6:18 - 6:21And I subsequently learned
from the many adults -- -
6:21 - 6:23I took care of about 200 adults --
-
6:23 - 6:25I learned from them
-
6:25 - 6:30that if I didn't peek as to who
their partner was in the waiting room, -
6:30 - 6:33I would never be able to guess
better than chance, -
6:33 - 6:37whether they were gay,
straight, bi or asexual -
6:37 - 6:40in their affirmed gender.
-
6:40 - 6:41In other words,
-
6:41 - 6:45one thing has absolutely nothing
to do with the other. -
6:45 - 6:48And the data show it.
-
6:50 - 6:52Now, as I took care of the 200 adults,
-
6:52 - 6:54I found it extremely painful.
-
6:55 - 6:58These people -- many of them --
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6:58 - 7:02had to give up so much of their lives.
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7:02 - 7:05Sometimes their parents would reject them,
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7:05 - 7:07siblings, their own children,
-
7:07 - 7:09and then their divorcing spouse
-
7:09 - 7:12would forbid them
from seeing their children. -
7:13 - 7:14It was so awful,
-
7:15 - 7:18but why did they do it at 40 and 50?
-
7:18 - 7:23Because they felt
they had to affirm themselves -
7:23 - 7:25before they would kill themselves.
-
7:25 - 7:31And indeed, the rate of suicide
among untreated transgendered people -
7:31 - 7:34is among the highest in the world.
-
7:35 - 7:36So, what to do?
-
7:37 - 7:41I was intrigued, in going
to a conference in Holland, -
7:41 - 7:43where they are experts in this,
-
7:43 - 7:46and saw the most remarkable thing.
-
7:47 - 7:50They were treating young adolescents
-
7:50 - 7:56after giving them the most intense
psychometric testing of gender, -
7:56 - 8:00and they were treating them by blocking
the puberty that they didn't want. -
8:00 - 8:03Because basically,
kids look about the same, -
8:03 - 8:06each sex, until they go through puberty,
-
8:06 - 8:09at which point, if you feel
you're in the wrong sex, -
8:09 - 8:11you feel like Pinocchio becoming a donkey.
-
8:12 - 8:14The fantasy that you had
that your body will change -
8:14 - 8:17to be who you want it to be, with puberty,
-
8:17 - 8:20actually is nullified
by the puberty you get. -
8:22 - 8:24And they fall apart.
-
8:25 - 8:29So that's why putting the puberty
on hold -- why on hold? -
8:29 - 8:32You can't just give them
the opposite hormones that young. -
8:32 - 8:34They'll end up stunted in growth,
-
8:34 - 8:36and you think you can have
a meaningful conversation -
8:36 - 8:39about the fertility effects
of such treatment -
8:39 - 8:42with a 10-year-old girl,
a 12-year-old boy? -
8:43 - 8:45So this buys time
in the diagnostic process -
8:45 - 8:47for four or five years,
-
8:47 - 8:49so that they can work it out.
-
8:50 - 8:52They can have more and more testing,
-
8:52 - 8:56they can live without feeling their bodies
are running away from them. -
8:56 - 9:01And then, in a program they call 12-16-18,
-
9:01 - 9:05around age 12 is when they
give the blocking hormones, -
9:06 - 9:08and then at age 16, with retesting,
-
9:08 - 9:10they re-qualify to receive --
-
9:10 - 9:13now remember, the blocking
hormones are reversible, -
9:13 - 9:16but when you give the hormones
of the opposite sex, -
9:16 - 9:20you now start spouting breasts
and facial hair and voice change, -
9:20 - 9:21depending on what you're using,
-
9:21 - 9:23and those effects are permanent,
-
9:23 - 9:25or require surgery to remove,
-
9:25 - 9:26or electrolysis,
-
9:27 - 9:29and you can never really affect the voice.
-
9:29 - 9:32So this is serious,
and this is 15-, 16-year-old stuff. -
9:33 - 9:36And then at 18,
they're eligible for surgery. -
9:37 - 9:41And while there's no good surgery
for females to males genitally, -
9:41 - 9:44the male-to-female surgery
has fooled gynecologists. -
9:45 - 9:47That's how good it can be.
-
9:48 - 9:52So I looked at how
the patients were doing, -
9:52 - 9:55and I looked at patients
who just looked like everybody else, -
9:55 - 9:58except they were pubertally delayed.
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9:58 - 10:00But once they gave them the hormones
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10:00 - 10:02consistent with the gender they affirm,
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10:02 - 10:04they look beautiful.
-
10:04 - 10:06They look normal.
-
10:06 - 10:07They had normal heights.
-
10:08 - 10:11You would never be able
to pick them out in a crowd. -
10:13 - 10:15So at that point, I decided
I'm going to do this. -
10:15 - 10:20This is really where the pediatric
endocrine realm comes in, -
10:20 - 10:24because, in fact, if you're going to deal
with it in kids aged 10 to 14, -
10:24 - 10:26that's pediatric endocrinology.
-
10:27 - 10:31So I brought some kids in,
-
10:32 - 10:34and this now became the standard of care,
-
10:34 - 10:37and the [Boston]
Children's Hospital was behind it. -
10:37 - 10:41By my showing them
the kids before and after, -
10:41 - 10:45people who never got treated
and people who wished to be treated, -
10:45 - 10:47and pictures of the Dutch --
-
10:48 - 10:49they came to me and said,
-
10:49 - 10:51"You've got to do
something for these kids." -
10:52 - 10:54Well, where were these kids before?
-
10:55 - 10:57They were out there suffering,
is where they were. -
10:58 - 11:04So we started a program in 2007.
-
11:04 - 11:06It became the first program of its kind --
-
11:06 - 11:09but it's really of the Dutch kind --
-
11:09 - 11:10in North America.
-
11:11 - 11:14And since then, we have 160 patients.
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11:15 - 11:18Did they come from Afghanistan? No.
-
11:18 - 11:2575 percent of them came
from within 150 miles of Boston. -
11:27 - 11:29And some came from England.
-
11:30 - 11:34Jackie had been abused
in the Midlands, in England. -
11:34 - 11:36She's 12 years old there,
-
11:36 - 11:37she was living as a girl,
-
11:37 - 11:40but she was being beaten up.
-
11:40 - 11:42It was a horror show,
they had to homeschool her. -
11:43 - 11:45And the reason the British were coming
-
11:45 - 11:51was because they would not treat
anybody with anything under age 16, -
11:51 - 11:54which means they were consigning
them to an adult body -
11:54 - 11:56no matter what happened,
-
11:56 - 11:58even if they tested them well.
-
11:58 - 12:03Jackie, on top of it, was,
by virtue of skeletal markings, -
12:03 - 12:05destined to be six feet five.
-
12:07 - 12:10And yet, she had just begun
a male puberty. -
12:11 - 12:15Well, I did something
a little bit innovative, -
12:15 - 12:17because I do know hormones,
-
12:17 - 12:19and that estrogen is much more potent
-
12:19 - 12:22in closing epiphyses, the growth plates,
-
12:22 - 12:26and stopping growth, than testosterone is.
-
12:26 - 12:30So we blocked her testosterone
with a blocking hormone, -
12:31 - 12:34but we added estrogen,
not at 16, but at 13. -
12:35 - 12:37And so here she is at 16, on the left.
-
12:38 - 12:40And on her 16th birthday,
she went to Thailand, -
12:40 - 12:43where they would do
a genital plastic surgery. -
12:43 - 12:45They will do it at 18 now.
-
12:45 - 12:47And she ended up 5'11".
-
12:47 - 12:51But more than that,
she has normal breast size, -
12:51 - 12:53because by blocking testosterone,
-
12:53 - 12:56every one of our patients
has normal breast size -
12:56 - 12:59if they get to us at the appropriate age,
-
12:59 - 13:00not too late.
-
13:01 - 13:03And on the far right, there she is.
-
13:03 - 13:07She went public -- semifinalist
in the Miss England competition. -
13:09 - 13:12The judges debated
as to, can they do this? -
13:12 - 13:16And one of them quipped, I'm told,
-
13:16 - 13:20"But she has more natural self
than half the other contestants." -
13:20 - 13:22(Laughter)
-
13:22 - 13:26And some of them
have been rearranged a little bit, -
13:26 - 13:29but it's all her DNA.
-
13:30 - 13:33And she's become a remarkable spokeswoman.
-
13:33 - 13:37And she was offered contracts as a model,
-
13:37 - 13:39at which point
she teased me, when she said, -
13:39 - 13:42"You know, I might have had
a better chance as a model -
13:42 - 13:43if you'd made me six feet one."
-
13:43 - 13:45(Laughter)
-
13:45 - 13:47Go figure.
-
13:48 - 13:51So this picture, I think, says it all.
-
13:52 - 13:53It really says it all.
-
13:54 - 13:57These are Nicole and brother Jonas,
-
13:57 - 13:59identical twin boys,
-
14:00 - 14:02and proven to be identical.
-
14:04 - 14:08Nicole had affirmed herself
as a girl as early as age three. -
14:08 - 14:10At age seven, they changed her name,
-
14:10 - 14:15and came to me at the very
beginnings of a male puberty. -
14:15 - 14:18Now you can imagine
looking at Jonas at only 14, -
14:18 - 14:20that male puberty is early in this family,
-
14:21 - 14:23because he looks more like a 16-year-old.
-
14:23 - 14:25But it makes the point all the more,
-
14:25 - 14:28of why you have to be conscious
of where the patient is. -
14:29 - 14:31Nicole is on pubertal blockade in here,
-
14:32 - 14:36and Jonas is just going --
biologic control. -
14:36 - 14:38This is what Nicole would look like
-
14:38 - 14:40if we weren't doing what we were doing.
-
14:40 - 14:42He's got a prominent Adam's apple.
-
14:42 - 14:46He's got angular bones
to the face, a mustache, -
14:46 - 14:48and you can see there's
a height difference, -
14:48 - 14:51because he's gone through
a growth spurt that she won't get. -
14:51 - 14:53Now Nicole is on estrogen.
-
14:53 - 14:55She has a bit of a form to her.
-
14:56 - 15:00This family went
to the White House last spring, -
15:00 - 15:05because of their work in overturning
an anti-discrimination -- -
15:05 - 15:08there was a bill that would block
-
15:08 - 15:12the right of transgender people in Maine
to use public bathrooms, -
15:12 - 15:15and it looked like the bill
was going to pass, -
15:15 - 15:17and that would have been a problem,
-
15:17 - 15:20but Nicole went personally
to every legislator in Maine -
15:20 - 15:22and said, "I can do this.
-
15:22 - 15:24If they see me, they'll understand
-
15:24 - 15:26why I'm no threat in the ladies' room,
-
15:27 - 15:29but I can be threatened
in the men's room." -
15:29 - 15:30And then they finally got it.
-
15:32 - 15:34So where do we go from here?
-
15:35 - 15:39Well, we still have a ways to go
in terms of anti-discrimination. -
15:39 - 15:43There are only 17 states
that have an anti-discrimination law -
15:43 - 15:45against discrimination in housing,
-
15:45 - 15:48employment, public accommodation --
-
15:49 - 15:52only 17 states, and five of them
are in New England. -
15:52 - 15:53We need less expensive drugs.
-
15:53 - 15:55They cost a fortune.
-
15:55 - 15:59And we need to get
this condition out of the DSM. -
15:59 - 16:04It is as much a psychiatric disease
as being gay and lesbian, -
16:04 - 16:07and that went out the window in 1973,
-
16:07 - 16:08and the whole world changed.
-
16:09 - 16:11And this isn't going to break
anybody's budget. -
16:11 - 16:12This is not that common.
-
16:13 - 16:17But the risks of not
doing anything for them -
16:18 - 16:24not only puts all of them at risk
of losing their lives to suicide, -
16:25 - 16:31but it also says something about
whether we are a truly inclusive society. -
16:31 - 16:32Thank you.
-
16:32 - 16:36(Applause)
- Title:
- How I help transgender teens become who they want to be
- Speaker:
- Norman Spack
- Description:
-
Puberty is an awkward time for just about everybody, but for transgender teens it can be a nightmare, as they grow overnight into bodies they aren't comfortable with. In a heartfelt talk, endocrinologist Norman Spack tells a personal story of how he became one of the few doctors in the US to treat minors with hormone replacement therapy. By staving off the effects of puberty, Spack gives trans teens the time they need. (Filmed at TEDxBeaconStreet.)
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 16:53
Krystian Aparta edited English subtitles for How I help transgender teens become who they want to be | ||
Krystian Aparta edited English subtitles for How I help transgender teens become who they want to be | ||
Krystian Aparta edited English subtitles for How I help transgender teens become who they want to be | ||
Krystian Aparta commented on English subtitles for How I help transgender teens become who they want to be | ||
Krystian Aparta edited English subtitles for How I help transgender teens become who they want to be | ||
Adrian Dobroiu commented on English subtitles for How I help transgender teens become who they want to be | ||
Morton Bast edited English subtitles for How I help transgender teens become who they want to be | ||
Morton Bast approved English subtitles for How I help transgender teens become who they want to be |
Adrian Dobroiu
15:24 lady's room -> ladies' room
Krystian Aparta
The English transcript was updated on 12/7/2015. At 10:34, "and Children's Hospital was behind it" was changed to "the [Boston] Children's Hospital was behind it."