How I help transgender teens become who they want to be
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0:01 - 0:04I want you all to think
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0:04 - 0:09about the third word that was ever said
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0:09 - 0:12about you,
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0:12 - 0:15or if you were delivering,
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0:15 - 0:20about the person you were delivering.
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0:20 - 0:22And you can all mouth it if you want
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0:22 - 0:24or say it out loud.
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0:24 - 0:30It was, the first two were, "It's a ..."
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0:32 - 0:34Well, it shows you that
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0:34 - 0:36I also deal with issues where there's
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0:36 - 0:39not certainty of whether it's a girl or a boy,
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0:39 - 0:42so the mixed answer was very appropriate.
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0:42 - 0:44Of course, now the answer often comes
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0:44 - 0:47not at birth but at the ultrasound,
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0:47 - 0:50unless the prospective parents choose
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0:50 - 0:54to be surprised like we all were.
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0:54 - 0:56But I want you to think about what it is
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0:56 - 1:01that leads to that statement
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1:01 - 1:03on the third word,
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1:03 - 1:05because the third word
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1:05 - 1:13is a description of your sex,
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1:13 - 1:15and by that I mean,
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1:15 - 1:20made by a description of your genitals.
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1:20 - 1:23Now, as a pediatric endocrinologist,
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1:23 - 1:26I used to be very, very involved,
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1:26 - 1:27and still somewhat am,
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1:27 - 1:30in cases in which
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1:30 - 1:33there are mismatches
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1:33 - 1:35in the externals
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1:35 - 1:39or between the externals and the internals,
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1:39 - 1:44and we literally have to figure out
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1:44 - 1:48what is the description of your sex.
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1:48 - 1:51But there is nothing that is definable
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1:51 - 1:54at the time of birth
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1:54 - 1:58that would define you,
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1:58 - 2:00and when I talk about definition,
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2:00 - 2:06I'm talking about your sexual orientation.
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2:06 - 2:12We don't say, "It's a gay boy."
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2:12 - 2:14"A lesbian girl."
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2:14 - 2:18Those situations don't really define themselves
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2:18 - 2:22more until the second decade of life.
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2:22 - 2:27Nor do they define your gender,
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2:27 - 2:30which, as different from your anatomic sex,
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2:30 - 2:34describes your self-concept.
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2:34 - 2:36Do you see yourself
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2:36 - 2:39as a male or female
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2:39 - 2:45or somewhere in the spectrum in between?
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2:45 - 2:50That sometimes shows up
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2:50 - 2:53in the first decade of life,
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2:53 - 2:56but it can be very confusing for parents
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2:56 - 2:59because it is quite normative
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2:59 - 3:06for children to act in a cross-gender play and way,
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3:06 - 3:08and that in fact there are studies that show
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3:08 - 3:11that even 80 percent of children
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3:11 - 3:13who act in that fashion
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3:13 - 3:18will not persist in wanting to be
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3:18 - 3:20the opposite gender
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3:20 - 3:24at the time when puberty begins.
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3:24 - 3:30But at the time that puberty begins,
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3:30 - 3:34that means between about age 10 to 12 in girls,
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3:34 - 3:3712 to 14 in boys,
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3:37 - 3:39with breast budding
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3:39 - 3:43or two to three times increase in the gonads
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3:43 - 3:46in the case of genetic males,
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3:46 - 3:49by that particular point, the child who says
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3:49 - 3:53they are in the absolute wrong body
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3:53 - 3:57is almost certain to be transgender
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3:57 - 4:04and is extremely unlikely to change those feelings,
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4:04 - 4:09no matter how anybody tries reparative therapy
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4:09 - 4:13or any other noxious things.
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4:13 - 4:15Now this is relatively rare,
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4:15 - 4:19so I had relatively little
personal experience with this, -
4:19 - 4:21and my experience was more typical
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4:21 - 4:24only because I had an adolescent practice.
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4:24 - 4:25And I saw someone age 24,
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4:25 - 4:28went through Harvard, genetically female,
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4:28 - 4:30went through Harvard with three male roommates
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4:30 - 4:31who knew the whole story,
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4:31 - 4:35a registrar who always listed his name
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4:35 - 4:37on course lists as a male name,
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4:37 - 4:42and came to me after graduating saying, "Help me.
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4:42 - 4:44I know you know a lot of endocrinology."
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4:44 - 4:46And indeed I've treated a lot of people
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4:46 - 4:47who were born without gonads.
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4:47 - 4:49This wasn't rocket science.
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4:49 - 4:51But I made a deal with him:
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4:51 - 4:54I'll treat you if you teach me.
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4:54 - 4:57And so he did.
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4:57 - 4:59And what an education I got
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4:59 - 5:00from taking care of all the members
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5:00 - 5:03of his support group.
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5:03 - 5:06And then I got really confused,
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5:06 - 5:08because I thought it was relatively easy at that age
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5:08 - 5:10to just give people the hormones
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5:10 - 5:14of the gender in which they were affirming,
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5:14 - 5:18but then my patient married,
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5:18 - 5:20and he married a woman
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5:20 - 5:22who had been born as a male,
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5:22 - 5:26had married as a male, had two children,
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5:26 - 5:31then went through a transition into female,
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5:31 - 5:36and now this delightful female
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5:36 - 5:40was attached to my male patient,
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5:40 - 5:43in fact got legally married because they showed up
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5:43 - 5:45as a man and a woman, and who knew?
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5:45 - 5:48Right? (Laughter)
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5:48 - 5:51And while I was confused about,
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5:51 - 5:54does this make so-and-so gay?
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5:54 - 5:56Does this make so-and-so straight?
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5:56 - 5:58I was getting sexual orientation
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5:58 - 6:01confused with gender identity.
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6:01 - 6:04And my patient said to me,
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6:04 - 6:05"Look, look, look.
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6:05 - 6:09If you just think of the following, you'll get it right:
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6:09 - 6:12Sexual orientation is who you go to bed with;
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6:12 - 6:18gender identity is who you go to bed as."
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6:18 - 6:20And I subsequently learned from the many adults --
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6:20 - 6:23I took care of about 200 adults —
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6:23 - 6:25I learned from them
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6:25 - 6:27that if I didn't look, peek as to who
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6:27 - 6:29their partner was in the waiting room,
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6:29 - 6:32I would never be able to guess
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6:32 - 6:33better than chance
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6:33 - 6:36whether they were gay, straight, bi,
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6:36 - 6:40or asexual in their affirmed gender.
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6:40 - 6:41In other words,
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6:41 - 6:44one thing has absolutely nothing to do
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6:44 - 6:45with the other.
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6:45 - 6:48And the data show it.
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6:48 - 6:52Now, as I took care of the 200 adults,
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6:52 - 6:55I found it extremely painful.
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6:55 - 6:58These people were -- 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 - 7:04Sometimes their parents would reject them,
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7:04 - 7:07siblings, their own children,
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7:07 - 7:09and then their divorcing spouse
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7:09 - 7:13would forbid them from seeing their children.
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7:13 - 7:16It was so awful, but why did they do it
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7:16 - 7:18at 40 and 50?
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7:18 - 7:23Because they felt they had to affirm themselves
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7:23 - 7:25before they would kill themselves.
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7:25 - 7:28And indeed, the rate of suicide
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7:28 - 7:31among untreated transgendered people
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7:31 - 7:35is among the highest in the world.
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7:35 - 7:37So what to do?
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7:37 - 7:40I was intrigued in going to a conference
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7:40 - 7:43in Holland, where they are experts in this,
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7:43 - 7:47and saw the most remarkable thing.
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7:47 - 7:50They were treating young adolescents
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7:50 - 7:53after giving them the most intense
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7:53 - 7:56psychometric testing of gender,
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7:56 - 7:57and they were treating them by blocking
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7:57 - 8:00the puberty that they didn't want.
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8:00 - 8:03Because basically, kids look about the same,
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8:03 - 8:05each sex, until they go through puberty,
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8:05 - 8:08at which point, if you feel you're in the wrong sex,
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8:08 - 8:12you feel like Pinocchio becoming a donkey.
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8:12 - 8:14The fantasy that you had that your body will change
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8:14 - 8:17to be who you want it to be with puberty
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8:17 - 8:22actually is nullified by the puberty you get.
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8:22 - 8:25And they fall apart.
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8:25 - 8:27So that's why putting the puberty on hold—
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8:27 - 8:30Why on hold? You can't just give them
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8:30 - 8:32the opposite hormones that young.
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8:32 - 8:34They'll end up stunted in growth,
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8:34 - 8:36and you think you can have
a meaningful conversation -
8:36 - 8:39about the fertility effects of such treatment
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8:39 - 8:43with a 10-year-old girl, a 12-year-old boy?
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8:43 - 8:45So this buys time in the diagnostic process
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8:45 - 8:47for four or five years
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8:47 - 8:50so that they can work it out,
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8:50 - 8:52they can have more and more testing,
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8:52 - 8:55they can live without feeling their bodies
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8:55 - 8:56are running away from them.
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8:56 - 9:00And then, in a program they call 12-16-18,
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9:00 - 9:05around age 12 is when they
give the blocking hormones, -
9:05 - 9:08and then at age 16 with retesting,
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9:08 - 9:10they requalify.
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9:10 - 9:13Now remember, the blocking
hormones are reversible, -
9:13 - 9:16but when you give the hormones of the opposite sex,
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9:16 - 9:19you now start spouting breasts and facial hair
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9:19 - 9:21and voice, depending on what you're using,
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9:21 - 9:23and those effects are permanent
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9:23 - 9:25or require surgery to remove
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9:25 - 9:26or electrolysis,
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9:26 - 9:29and you can never really affect the voice.
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9:29 - 9:33So this is serious, and this is 15-, 16-year-old stuff.
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9:33 - 9:36And then at 18, they're eligible for surgery,
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9:36 - 9:41and while there's no good surgery
for females to males genitally, -
9:41 - 9:45the male-to-female surgery
has fooled gynecologists. -
9:45 - 9:48That's how good it can be.
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9:48 - 9:52So I looked at how the patients were doing,
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9:52 - 9:55and I looked at patients who
just looked like everybody else, -
9:55 - 9:57except they were pubertally delayed.
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9:57 - 9:59But once they gave them the hormones
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9:59 - 10:02consistent with the gender they affirm,
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10:02 - 10:04they look beautiful.
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10:04 - 10:08They look normal. They had normal heights.
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10:08 - 10:10You would never be able to pick them out
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10:10 - 10:13in a crowd.
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10:13 - 10:15So at that point, I decided I'm going to do this.
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10:15 - 10:18This is really where the pediatric
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10:18 - 10:19endocrine realm comes in,
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10:19 - 10:21because in fact, if you're going to deal with it
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10:21 - 10:24in kids age 10-12, 10-14,
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10:24 - 10:27that's pediatric endocrinology.
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10:27 - 10:31So I brought some kids in,
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10:31 - 10:34and this now became the standard of care,
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10:34 - 10:37and Children's Hospital was behind it.
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10:37 - 10:41By my showing them the kids before and after,
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10:41 - 10:42people who never got treated
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10:42 - 10:45and people who wished to be treated,
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10:45 - 10:48and pictures of the Dutch,
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10:48 - 10:49they came to me and said,
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10:49 - 10:51"You've got to do something for these kids."
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10:51 - 10:55Well, where were these kids before?
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10:55 - 10:58They were out there suffering, is where they were.
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10:58 - 11:04So we started a program in 2007.
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11:04 - 11:06It became the first program of its kind --
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11:06 - 11:09but it's really of the Dutch kind --
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11:09 - 11:11in North America.
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11:11 - 11:15And since then, we have 160 patients.
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11:15 - 11:18Did they come from Afghanistan? No.
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11:18 - 11:22They came, 75 percent of them came
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11:22 - 11:27from within 150 miles of Boston.
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11:27 - 11:30And some came from England.
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11:30 - 11:34Jackie had been abused in the Midlands, in England.
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11:34 - 11:36She's 12 years old there,
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11:36 - 11:37she was living as a girl
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11:37 - 11:39but she was being beaten up.
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11:39 - 11:40It was a horror show.
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11:40 - 11:42They had to homeschool her.
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11:42 - 11:45And the reason the British were coming was
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11:45 - 11:49because they would not treat anybody
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11:49 - 11:51with anything under age 16,
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11:51 - 11:52which means they were consigning them
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11:52 - 11:56to an adult body, no matter what happened,
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11:56 - 11:58even if they tested them well.
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11:58 - 12:00Jackie, on top of it, was,
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12:00 - 12:03by virtue of skeletal markings,
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12:03 - 12:07destined to be six feet five.
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12:07 - 12:09And yet, she had just begun
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12:09 - 12:11a male puberty.
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12:11 - 12:14Well, I did something a little bit innovative,
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12:14 - 12:16because I do know hormones,
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12:16 - 12:18and that estrogen is much more potent
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12:18 - 12:22in closing epiphyses, the growth plates,
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12:22 - 12:25and stopping growth, than testosterone is.
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12:25 - 12:28So we blocked her testosterone
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12:28 - 12:30with a blocking hormone,
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12:30 - 12:35but we added estrogen, not at 16, but at 13.
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12:35 - 12:38And so here she is at 16, on the left.
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12:38 - 12:40And on her 16th birthday, she went to Thailand,
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12:40 - 12:42where they would do a genital plastic surgery.
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12:42 - 12:44They will do it, 18 or not.
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12:44 - 12:47And she ended up 5'11"
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12:47 - 12:50but more than that, she has normal breast size,
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12:50 - 12:53because by blocking testosterone,
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12:53 - 12:54every one of our patients
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12:54 - 12:56has normal breast size
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12:56 - 13:00if they get to us at the appropriate age, not too late.
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13:00 - 13:03And on the far right, there she is.
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13:03 - 13:04She went public,
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13:04 - 13:07semifinalist in the Miss England competition.
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13:09 - 13:12The judges debated as to, can they do this?
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13:12 - 13:14Can they make her —
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13:14 - 13:16And one of them quipped, I'm told,
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13:16 - 13:18"But she has more natural self
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13:18 - 13:20than half the other contestants."
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13:20 - 13:22(Laughter)
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13:22 - 13:26And some of them have been rearranged a little bit,
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13:26 - 13:30but it's all her DNA.
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13:30 - 13:33And she's become a remarkable spokeswoman.
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13:33 - 13:37And she was offered contracts as a model,
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13:37 - 13:39at which point she teased me, where she said,
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13:39 - 13:41"You know, I might have had a better chance
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13:41 - 13:44as a model if you'd made me six feet one."
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13:44 - 13:48Go figure. (Laughter)
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13:48 - 13:52So this picture, I think, says it all.
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13:52 - 13:53It really says it all.
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13:53 - 13:57These are Nicole and brother Jonas,
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13:57 - 14:00identical twin boys,
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14:00 - 14:03and proven to be identical,
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14:03 - 14:05in which Nicole had affirmed herself
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14:05 - 14:07as a girl as early as age three.
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14:07 - 14:10At age seven, they changed her name,
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14:10 - 14:13and came to me at the very beginnings
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14:13 - 14:15of a male puberty.
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14:15 - 14:16Now you can imagine looking at Jonas
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14:16 - 14:18at only 14 that male puberty
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14:18 - 14:21is early in this family,
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14:21 - 14:23because he looks more like a 16-year-old,
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14:23 - 14:25but it makes the point all the more
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14:25 - 14:26why you have to be conscious
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14:26 - 14:28of where the patient is.
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14:28 - 14:32Nicole has done pubertal blockade in here,
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14:32 - 14:36and Jonas is just going -- biologic control.
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14:36 - 14:38This is what Nicole would look like
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14:38 - 14:40if we weren't doing what we were doing.
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14:40 - 14:42He's got a prominent Adam's apple.
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14:42 - 14:46He's got angular bones to the face, a mustache,
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14:46 - 14:47and you can see there's a height difference
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14:47 - 14:49because he's gone through
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14:49 - 14:51a growth spurt that she won't get.
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14:51 - 14:53Now Nicole is on estrogen.
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14:53 - 14:56She has a bit of a form to her.
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14:56 - 14:59This family went to the White House last spring
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14:59 - 15:02because of their work
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15:02 - 15:05in overturning an anti-discrimination,
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15:05 - 15:08there was a bill that would block
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15:08 - 15:10the right of transgender people in Maine
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15:10 - 15:12to use public bathrooms,
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15:12 - 15:15and it looked like the bill was going to pass,
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15:15 - 15:17and that would have been a problem,
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15:17 - 15:20but Nicole went personally
to every legislator in Maine -
15:20 - 15:22and said, "I can do this.
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15:22 - 15:24If they see me, they'll understand
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15:24 - 15:26why I'm no threat in the lady's room,
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15:26 - 15:29but I can be threatened in the men's room."
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15:29 - 15:32And then they finally got it.
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15:32 - 15:35So where do we go from here?
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15:35 - 15:37Well, we still have a ways to go
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15:37 - 15:39in terms of anti-discrimination.
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15:39 - 15:40There are only 17 states that have
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15:40 - 15:43an anti-discrimination law
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15:43 - 15:45against discrimination in housing,
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15:45 - 15:48employment, public accommodation,
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15:48 - 15:52only 17 states, and five of them are in New England.
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15:52 - 15:53We need less expensive drugs.
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15:53 - 15:55They cost a fortune.
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15:55 - 15:57And we need to get this condition
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15:57 - 15:59out of the DSM.
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15:59 - 16:02It is as much a psychiatric disease
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16:02 - 16:03as being gay and lesbian,
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16:03 - 16:06and that went out the window in 1973,
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16:06 - 16:08and the whole world changed.
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16:08 - 16:11And this isn't going to break anybody's budget.
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16:11 - 16:13This is not that common.
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16:13 - 16:18But the risks of not doing anything for them
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16:18 - 16:22not only puts all of them at risk
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16:22 - 16:24of losing their lives to suicide,
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16:24 - 16:27but it also says something about
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16:27 - 16:31whether we are a truly inclusive society.
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16:31 - 16:33Thank you.
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16:33 - 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."