#理想家生活##长文创作激励计划##头条创作挑战赛##头等旺事#
Pan Bolin, a plastic surgeon with 20 years of experience.
2016,
He initiated the first "transgender multidisciplinary comprehensive outpatient clinic" in China.
For patients with gender dysphoria and gender misidentity
Provide professional and comprehensive sequence medical assistance,
To date, it has helped more than 2,500 transgender people.
Since the establishment of the outpatient clinic,
Pan Bolin experienced the incomprehension of his peers,
The team also suffered a lot from the patient's family
and external doubts, and even reports.
But seeing the once anxious, desperate transgender people,
Here you can find hope and re-accept yourself,
"Our work is valuable."
In June, a piece of medicine visited this special clinic in Beijing.
Chat with Pan Bolin and his team.
Here's what Pan Bolin had to say.
Editor: Lu Yuhan
Editor-in-charge: Ni Chujiao
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Pemberlin
The definition of "transgender" is explained many times in my daily work. Because the visibility and acceptance of this group of people in society are too low.
We ordinary people generally believe that there are only two genders in the world, male and female. In the absence of a physical abnormality, a set of genitals at birth will be assigned to which sex, which is also commonly called "biological sex".
However, people's psychological state is very complex, and there may be a wide variety of feelings and cognitions about sex and gender. For example, if the biological sex is male, but identifies as a female (trans-female) or vice versa (trans-female), this type of person is called "transgender people".
According to the United Nations Development Programme, the proportion of gender disidentity in the Asia-Pacific region is 3 per 1,000, and according to this ratio, there are about 4 million transgender people in China, which is not a small number.
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One once reported on a national transgender hotline, initiated by Walnut, a transgender woman
We don't consider "transgender" to be a disease at the moment, but there is a wide need for medical assistance in this population due to varying degrees of gender dysphoria.
Transgender medical care in the mainland can be traced back to 1983, when the first male-to-female reassignment surgery was completed in China at Peking University Third Hospital.
The early '90s was the golden age of the program, and the doctors who saw it were amazed at how there were so many people in this group.
Data from 2017 shows that 80% of transgender people need hormone therapy and 60% need surgery, but only 6% of people who can actually get these resources in hospitals are hormone therapy, and surgery is in the dozens, which is far from meeting the demand.
Some people do not have formal access to hormone drugs and may reach out to groups who sell them privately. Some children do not have the money to buy them, and are encouraged to obtain these drugs through aid deals.
Others are so disgusted with their genitals that they are ashamed to go to the hospital, or they risk their own pain and life to have them removed without the need for surgery. Similar extremes can be said to be endless.
The so-called "if the road is not smooth, the small road will be rampant." "Instead of putting them at such a high risk, it's better to give them a more decent medical help.
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The team is in operation
My job is as a plastic surgeon, which is probably the most common specialty for the transgender community. From facelifts, body contouring, to final lower body surgery, plastic surgery techniques are required.
I first came into contact with this demographic in 2005. At that time, I was still a resident doctor, and a transgender man named Xiaoyu came to the ward, and wanted to come for gender readjustment surgery, which is what people call "sex reassignment surgery".
At first, like most ordinary people, I didn't know much about this group, and I was even a little scared. After contact, I found that Xiaoyu is a very honest and kind person.
After the surgery, Xiaoyu consulted me about hormone therapy, but at that time, I did not find relevant experts and references. Xiaoyu told me that many transgender people have endocrine medical needs, but such resources cannot be found in China. When I was discharged from the hospital, Xiaoyu also brought me a foreign literature on transgender medical care and recommended me to read it.
At that time, I had mixed feelings, I was a doctor, and I still needed "patients" to guide, and to be honest, I was a little excited.
At that time, transgender medical care in China was limited to a few psychiatric hospitals issuing diagnosis certificates to them, and there were a few plastic surgeons who performed gender reassignment surgeries on them. As for the concept of complete sequence medicine, it is a missing in the country.
In 2016, as the initiator, I invited some doctors from related specialties to establish a multidisciplinary medical team, hoping to provide more professional and comprehensive medical services for transgender people.
Since 2018, we have established a dedicated transgender comprehensive medical clinic. In the past 6 years, more than 2,500 transgender children have been treated, with an average annual growth rate of more than 60%.
From the original one person to the present, we now have five outpatient units a week, four doctors are on call, almost every outpatient unit is full, and every doctor is overloaded.
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A transgender person who is picking out women's clothing for herself
Because "transgender" is not a disease in itself. They don't have any lesions that need to be forcefully corrected, their bodies are normal, so we don't use the words "patient" and "disease".
Their anxiety comes from not accepting their own body, and the ultimate goal of the clinic is to help them relieve their anxiety and accept themselves.
Transgender people who come to the clinic are usually called "children" and "children" because most of them are young people in their 20s. The male-to-female and female-to-male ratio is about 3:1, but this does not mean that the ratio is the same among the entire group, but the demand for medical care is more common among male-to-female.
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Fill out the questionnaire during the medical procedure
There will be a relatively clear process for outpatient visits. The first step is to ask a psychiatrist to make a preliminary judgment, and if it is a "transsexual", "gender dysphoria", "gender identity disorder", we will further accompany the child to explore himself.
In the process, we will learn some of their real thoughts, including the lack of recognition of the duration of time, the non-acceptance of their own aspects, the willingness to change, the psychological preparation for post-change stress, and so on.
If we find that the child's wishes are not so strong and affirmative, or that they are not coming because of gender misidentity, we will screen them out and avoid making medical decisions that they may regret.
In the outpatient process, we advocate starting with small changes to find out how to fit your lifestyle and medical help. You don't have to use medical methods right away, and there are many non-medical methods that can be tried.
For example, anxiety can be relieved by distracting from talking to friends, focusing on study, work, or hobbies.
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Walnut, the initiator of the transgender hotline, is putting on makeup for herself
Or if you are not satisfied with your appearance, you can try to change your appearance, such as trans women can change into women's clothes, grow long hair, and wear makeup. Theoretically, these modalities are the safest without any side effects.
If you still can't achieve self-acceptance by using these methods alone, you can consider medical treatments that will help you.
Some may ask, is it possible to "restore" gender identity through some psychotherapy? This is academically called "torsion therapy", which involves correcting a person's behavior through injections, electric shocks, humiliation, and behavioral restraint.
In fact, many scholars have tried this in the past, but in the end they found that this method is not only ineffective, but also aggravates the suffering of children, and is no longer advocated.
A more scientific medical treatment, which we call "gender affirmation therapy" academically, means to help obtain sexual characteristics that are more in line with one's identity through medical treatment, including hormone therapy (using exogenous hormones to change some sexual characteristics), non-genital surgical treatment (such as Adam's apple removal, mastectomy, vocal cord surgery, etc.), and finally genital surgical treatment.
Unlike other diseases where the diagnosis and treatment of diseases are entirely doctor-driven, in Gender Affirmation Therapy, we interact with the client.
Some people just don't like a certain part of themselves, some people just don't agree with it from head to toe, and we need to design according to their needs.
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The movie "Tracey" tells the story of a man who, at the age of 50, transforms himself into a woman from body to heart
If you eventually want to change your gender identity, you need to have genital surgery.
Genital excision and reconstructive surgery is a devastating and irreversible treatment with relatively greater risks, so there is also a certain threshold. According to the requirements of the National Health Commission, before the operation, the child needs to prepare a diagnosis certificate of transsexuality, a certificate of no criminal record issued by the public security department, his own application and the parents' statement of knowledge, etc.
In addition to these documents, it is necessary to undergo a multidisciplinary discussion and ethical review to confirm that both the psychological and physical conditions are well prepared before the surgery can be performed.
This group of people can be said to be "unswerving" in realizing their gender identity. Whenever given the opportunity, they will want to make these transformations for themselves. The oldest people we met were in their 60s.
One of them made a big impression on us. After looking at the case, I found that TA had actually been seen in our hospital in the 90s, and at that time he wanted to come for lower body surgery, and he had already been admitted to the hospital and scheduled for surgery.
But the night before, he thought a lot, thinking that he already had a lover, a child, and parents at that time, and if it changed like this, it seemed that he was sorry for all his family. After thinking about it, I finally gave up on surgery.
Decades have passed, parents have passed away, children have grown up to study outside on their own, and they have retired. But this wish has never been let go.
TA's lover has always known about this situation and has been encouraging him. When he proposed this idea to his lover again, his lover was also very happy, and said okay, I support you in making this decision, and the two of them went through the divorce procedures.
We meet a lot of transgender people, and it is difficult to win the understanding of parents, but we find that many times their partners are more willing to understand and support them. In fact, the power of love is very great, "I love this person, not his gender." ”
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A minor and his mother
Teenagers account for about 1 in 10 of the transgender group who come to see a doctor.
Most of the adolescent patients we see are in a very depressed and anxious state. During puberty, they develop more pronounced anxiety because of the rapid development of sexual characteristics. In fact, it was the time when medical help was most needed.
But at this time, because I am too young and my perception of myself is not mature enough, it is inevitable that there will be some extreme ideas. So we will take some relatively mild and reversible treatment, which is puberty blockade.
Figuratively speaking, this treatment is to press a pause button on their puberty development, such as stopping breast development, menstruation, etc., so that they can experience whether this is the state they want. If after a period of time, you slowly identify with your original gender, then stop the drug, and puberty will proceed at the same rate as before, without irreversible changes.
After the age of 16, if there is a more definite idea, we will consider the use of hormone therapy, and at least after the age of 18, we will consider the option of surgical treatment.
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Parents and children argue, and Pemblin plays a round
In addition to doctors, a large part of our identities are science popularization workers and family mediators caught between parents and children.
Many parents who accompany their children to the clinic may not have been exposed to the concept of "transgender" in their lives. They often ask: What's wrong with my child? Why is my child like this? Will my child ever be able to get back to normal?
Since 2019, we have made parent education a very important part of outpatient comprehensive sequential therapy, and we have done it at the beginning of the consultation. Only by helping them understand the phenomenon of "transgender" will they be able to embrace this diversity.
After all, more parents care about their children, and despite a lot of reluctance and helplessness in their hearts, in the end they are still willing to accept and support their children. If we can do that, our work will be worthwhile.
I still remember a mother sharing that her child was silent at home every day, just like a wooden man. She accompanied the child to the outpatient clinic that day, and when the calling system called the child's name, the mother found that the child's eyes were suddenly different, and she felt that there was light in an instant.
She didn't understand why the child had such troubles, and wondered if it was adolescent rebellion. Such a small fragment also touched the mother to spend more time to understand the child.
On the other hand, we also understand the difficulties of parents. Adolescent children are still immature in their thinking, and sometimes their practices are indeed paranoid and extreme. We often see in the outpatient clinic that parents and children come to the clinic together, and when discussing or even describing the situation, they chat and quarrel, and finally break up unhappily, and the effect of the treatment is not achieved.
In fact, sometimes parents are not blindly opposed, but they really don't understand it, after all, it is emotionally difficult to accept such a fact. But the child does not give them enough patience and room to learn and adapt gradually.
Therefore, we sometimes teach our children so that parents can understand you and support you in a short period of time, which is not realistic and requires parents to give some time.
Parents are willing to come with you, it means that they are willing to help you, and there may be many parents of children who will not come at all, and you are already much luckier than those children.
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A still from the transgender-themed movie "The Secret Seams of Life".
"Transgender" is not an active choice, but rather a situation, a very passive and helpless situation, which in most cases accompanies life. The life of this group of people is far more difficult than we think.
According to a survey conducted by the transgender community and adolescent mental health institutions, the proportion of anxiety and depression among transgender people is 71% and 70% respectively, and nearly 6 percent of people have had such suicidal thoughts or even actions within a year, and their suicide rate is about 5~10 times that of the general population.
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Proportion of depression and anxiety in the transgender group
Source: 2021 National Transgender Health Survey Report
Unlike primary depression and anxiety in the strict sense, transgender people have a clear cause for anxiety and depression, and if this cause is not improved, their anxiety and depression are actually difficult to alleviate.
In fact, they really want to be able to express their gender in life, such as dressing according to their identity and even socializing with others, they will feel more comfortable, but less than 10% of people dare to do so, and most people still choose to hide and suppress their gender expression.
This group of people can also be very sensitive, and it can cause a strong sense of discomfort when people around them don't deal with them as they identify with.
Therefore, the World Professional Association for Transgender Health has a special section on how we should talk to transgender people, including how to address them and what words to avoid.
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A woman and a man who came to the clinic
Being in a state of anxiety and depression for a long time, they often have difficulty expressing their true thoughts. We often encounter such situations in our work, when the child arrives at the consultation room, after sitting down, he keeps his head down and can't say anything.
I remember a father came with his child, and we asked about the child's appeal, and the person said at the end, I want to use hormone therapy. However, the age of TA is still a few months away from reaching the age of 16, and from a medical point of view, its practical puberty blockade will be more secure.
After the child listened, there was no clear expression, and at this time the father also persuaded TA to use puberty to block, and finally the child nodded, and the two left.
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Dr. Poon received a message from the child's father
While waiting to be hospitalized, one day we suddenly received a message from this father. He said that he was very grateful for the help we had provided before, but he didn't need it anymore because the child had committed suicide two days ago.
I immediately called and asked what was going on. He said that after the child returned home, he was very silent, and finally asked if he could use hormone therapy. But out of the mentality of protecting the child, the parents still persuaded TA to wait a few more months and use it when he reached the age of 16.
We were shocked and saddened. The child seems to be calm, but perhaps there is already a strong struggle inside. To be liberated in such a way in the end is also a painful lesson.
So, no matter what stage it is, it is very important not to let your child feel hopeless. We always send them a positive signal to help them make a life plan, and when they see hope for the future, they may be able to avoid these extreme negative events.
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Clip from the transgender-themed film "Women Are Women".
Many people have misconceptions about this group, thinking that they have strange personalities, some bad habits, and even antisocial behavior. In fact, these are all presuppositions based on stereotypes.
The discovery of this phenomenon or a group of people is less than a century away. It was difficult for people to understand this iconoclastic phenomenon from the very beginning, so it was given a difficult name at that time, "sexual perversion", or "transsexuality".
Later, it was discovered that this group of people did not actively choose this way of life, and there was a certain amount of suffering, believing that it was a mental disease, and once called it "transsexuality".
However, in the bodies of these people, no lesions related to "gender identity" were found, but there were symptoms such as anxiety, so it was later changed to "transsexuality". This also represents a growing awareness of transgender phenomena.
Now most countries have not considered giving this group of people more choice and space.
More than two-thirds of transgender people try to avoid going to the toilet in public. During college, if they can, they will rent a house outside. There are only two options for men and women in various forms, and they are very difficult in this situation.
Transgender people spend their whole lives just trying to make their lives normal. It's hard to get everyone to agree with this kind of sexual diversity, but at least show basic respect.
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A gender-neutral restroom in Beijing
It can be seen from many things that the state and society are slowly waking up to the plight of transgender people.
Since 2009, the national health department has brought gender reassignment surgery to the official level and formulated corresponding medical technology management norms.
Since then, there have been two revisions, each of which has been more cautious and friendly in terms of wording, and has removed some unnecessary thresholds, and we can see that the health department's awareness and management of the field and the population is constantly improving.
In 2020, there was a labor arbitration case in China in which a transgender employee was treated unfairly due to his or her gender identity in the labor process. We note that there are some very promising and powerful statements in the Court's closing arguments:
"We need to re-examine and recognize transgender, and although it will take a process, it is true that more and more people are choosing to be inclusive, and we do need to change our attitudes.
Because only when we tolerate pluralistic ways of living can we lay a cultural foundation for tolerance in a society governed by the rule of law. Our respect for the personality, dignity, and legitimate rights and interests of transgender people is based on our respect for the dignity and rights of our citizens..."
These are a recognition of the idea of inclusive multiculturalism and a call to the masses.
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The team is translating a comprehensive transgender medical literature abroad
I am very grateful to every professional doctor in our team, and I also admire all the seniors and peers who have contributed and contributed to this field for so many years. It is even more gratifying to see that more and more medical students are interested and interested in this field.
One time we had a patient at our clinic, who was also a medical student, and had just found a job. I asked him which major he had chosen, and told me that he had gone to pediatrics and that he was going to work and research on the "puberty block" part of transgender medicine.
Because he also experienced gender dysphoria during puberty, but never found medical care to help him, it was the best stage of his life, and he finally spent it in unbearable pain. TA hopes that through her own efforts, she can help other transgender children who are anxious about adolescence and prevent them from experiencing the same pain as themselves.
Peers will also ask me, why did you choose this major? Objectively speaking, this is still a project with negative economic benefits, and it is better to be an ordinary plastic surgeon, and the income may be more.
My idea is actually quite simple. People always want to realize their own value all their lives, and it is a very popular field that everyone is doing, so I will do it again. But there are always things that people don't want to do, but people need to do, and I think it's good for me to do it.
(Excerpted from a WeChat public account)