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Some parents have found refuge in anonymous online support groups. There, people share tips on finding caregivers who will explore the causes of their children’s distress or tend to their overall emotional and developmental health and well-being without automatically acceding to their children’s self-diagnosis.
一些父母在匿名在线支持小组中找到了避风港。在那里，家长们分享寻找护理人士的经验，这些护理人士会探索孩子痛苦的成因，照顾他们的整体情感和发展健康与福祉，而不是自动接受孩子的自我诊断。
Many parents of kids who consider themselves trans say their children were introduced to transgender influencers on YouTube or TikTok, a phenomenon intensified for some by the isolation and online cocoon of Covid. Others say their kids learned these ideas in the classroom, as early as elementary school, often in child-friendly ways through curriculums supplied by trans rights organizations, with concepts like the gender unicorn or the Genderbread person.
认为自己是跨性别者的孩子的不少父母表示，他们的孩子是通过 YouTube 和 TikTok 上的跨性别网红接触到这些观点的。对一些孩子来讲，这种现象因新冠肺炎疫情期间的隔离以及网上信息茧房而加剧。其他家长则提到，他们的孩子从小学开始就在课堂上学到了这些概念，通常是通过跨性别权利组织提供的儿童友好的教学课程，其中包括「性别独角兽」和「性别姜饼人」这样的概念。
「你想要一个死去的儿子还是活着的女儿？」
After Kathleen’s 15-year-old son, whom she described as an obsessive child, abruptly told his parents he was trans, the doctor who was going to assess whether he had A.D.H.D. referred him instead to someone who specialized in both A.D.H.D. and gender. Kathleen, who asked to be identified only by her first name to protect her son’s privacy, assumed that the specialist would do some kind of evaluation or assessment. That was not the case.
当 Kathleen 15 岁的儿子（她形容是个有强迫倾向的孩子）突然告诉父母他是跨性别者后，原本要评估他是否患有注意缺陷与多动障碍（ADHD）的医生转而把他介绍给一位既擅长 ADHD 又擅长性别问题的专家。为保护儿子的隐私，凯瑟琳要求只透露自己的名字（first name）。她以为这位专家会进行某种评估或检查。事实并非如此。
The meeting was brief and began on a shocking note. “In front of my son, the therapist said, ‘Do you want a dead son or a live daughter?’” Kathleen recounted.
会面很简短，一开始就让人震惊。「在我儿子面前，治疗师说：『你想要一个死去的儿子还是活着的女儿？』」Kathleen 回忆道。
Parents are routinely warned that to pursue any path outside of agreeing with a child’s self-declared gender identity is to put a gender dysphoric youth at risk for suicide, which feels to many people like emotional blackmail. Proponents of the gender-affirming model have cited studies showing an association between that standard of care and a lower risk of suicide. But those studies were found to have methodological flaws or have been deemed not entirely conclusive. A survey of studies on the psychological effects of cross-sex hormones, published three years ago in The Journal of the Endocrine Society, the professional organization for hormone specialists, found it “could not draw any conclusions about death by suicide.” In a letter to The Wall Street Journal last year, 21 experts from nine countries said that survey was one reason they believed there was “no reliable evidence to suggest that hormonal transition is an effective suicide prevention measure.”
家长们经常被警告，除非同意孩子自我宣称的性别认同，否则采取其他任何路径都可能使患有性别不安的青少年面临自杀风险，这让许多人感觉仿佛遭受了情绪勒索（emotional blackmail）。性别肯定模式的支持者引用了一些研究，显示这种护理标准与较低的自杀风险相关。然而，这些研究被发现存在方法学缺陷，或被认为不完全具有结论性。三年前，《内分泌学会杂志》（The Journal of the Endocrine Society）发表的一项关于跨性别激素对心理影响的研究综述得出结论，称「无法得出有关自杀死亡的任何结论」。去年，来自九个国家的 21 位专家在给《华尔街日报》（The Wall Street Journal）的一封信中指出，这项综述是他们认为「没有可靠证据表明性激素过渡是有效的自杀预防措施」的理由之一。
Moreover, the incidence of suicidal thoughts and attempts among gender dysphoric youth is complicated by the high incidence of accompanying conditions, such as autism spectrum disorder. As one systematic overview put it, “Children with gender dysphoria often experience a range of psychiatric comorbidities, with a high prevalence of mood and anxiety disorders, trauma, eating disorders and autism spectrum conditions, suicidality and self-harm.”
此外，由于自闭症谱系障碍（Autism Spectrum Disorder）等伴随疾病的高发率，性别不安青少年的自杀念头及未遂的发生率也变得更加复杂。正如一项系统性综述所指出的：「患有性别不安的儿童通常会经历一系列精神『共病』，情绪和焦虑障碍、创伤、进食障碍、自闭症谱系障碍、自杀倾向和自残的患病率都很高。」
But rather than being treated as patients who deserve unbiased professional help, children with gender dysphoria often become political pawns.
可是，这些本应得到公正而专业的帮助的性别不安的孩子，却往往成为政治棋子。
Conservative lawmakers are working to ban access to gender care for minors and occasionally for adults as well. On the other side, however, many medical and mental health practitioners feel their hands have been tied by activist pressure and organizational capture. They say that it has become difficult to practice responsible mental health care or medicine for these young people.
保守派立法者正努力禁止未成年人，偶尔也禁止成年人获得性别护理。然而，另一方面，受到活动人士施加的压力与组织的挟持，许多医疗和心理健康从业者感到束手无策。他们说，已经很难为这些年轻人提供负责任的心理健康护理和医疗服务了。
Pediatricians, psychologists and other clinicians who dissent from this orthodoxy, believing that it is not based on reliable evidence, feel frustrated by their professional organizations. The American Psychological Association, American Psychiatric Association and the American Academy of Pediatrics have wholeheartedly backed the gender-affirming model.
儿科医生、心理学家和其他认为目前的正统治疗模式没有可靠证据支持的临床医师对他们的专业组织感到失望。美国心理学会（American Psychological Association）、美国精神病学会（American Psychiatric Association）和美国儿科学会（American Academy of Pediatrics）全力以赴地支持性别肯定模式。
In 2021, Aaron Kimberly, a 50-year-old trans man and registered nurse, left the clinic in British Columbia where his job focused on the intake and assessment of gender-dysphoric youth. Kimberly received a comprehensive screening when he embarked on his own successful transition at age 33, which resolved the gender dysphoria he experienced from an early age.
2021 年，50 岁的跨性别男性兼注册护士 Aaron Kimberly 离开了所在加拿大不列颠哥伦比亚省的诊所。在那里，他的工作重点是接诊和评估患有性别不安的青少年。Kimberly 自己在 33 岁开始跨性别时，接受了医疗机构的全面筛查，最终顺利地完成了性别过渡。这一过渡也解决了他从小经历的性别不安。
But when the gender-affirming model was introduced at his clinic, he was instructed to support the initiation of hormone treatment for incoming patients regardless of whether they had complex mental problems, experiences with trauma or were otherwise “severely unwell,” Kimberly said. When he referred patients for further mental health care rather than immediate hormone treatment, he said he was accused of what they called gatekeeping and had to change jobs.
但是，当性别肯定模式在他的诊所推行时，无论新来访的患者是否存在复杂的心理问题、创伤经历以及其他「严重不适」，他都被指示应支持开始激素治疗，Kimberly 说。当他将患者转介以进一步接受心理健康护理，而不是立即进行激素治疗时，他说自己被指责从事所谓的「把关」（gatekeeping）活动，并因此被迫辞职。
“I realized something had gone totally off the rails,” Kimberly, who subsequently founded the Gender Dysphoria Alliance and the L.G.B.T. Courage Coalition to advocate better gender care, told me.
「我意识到事情已完全脱离了正轨，」Kimberly 告诉我。他后来创立了性别不安联盟（Gender Dysphoria Alliance）和 LGBT 勇气联盟（LGBT Courage Coalition），以倡导更好的性别护理。
Aaron Kimberly
Gay men and women often told me they fear that same-sex-attracted kids, especially effeminate boys and tomboy girls who are gender nonconforming, will be transitioned during a normal phase of childhood and before sexual maturation — and that gender ideology can mask and even abet homophobia.
男同性恋和女同性恋们常常告诉我，他们担心同性恋的孩子，特别是那些性别角色不合常规的娘娘腔男孩和假小子女孩，会在尚未性成熟的童年正常阶段就被推向性别过渡——以及，性别意识形态（gender ideology）可能掩盖乃至助长恐同的现象（homophobia）。
As one detransitioned man, now in a gay relationship, put it, “I was a gay man pumped up to look like a woman and dated a lesbian who was pumped up to look like a man. If that’s not conversion therapy, I don’t know what is.”
一位曾转变为跨性别女性，现逆跨性别并处于男同性恋关系中的男子这样说道：「我原本是一个靠激素变得外表像女人的男同性恋，我约会的对象则是一个靠激素变得外表像男人的女同性恋。如果这还不能算是矫正疗法，我真不知道什么才算得上了。」
“I transitioned because I didn’t want to be gay,” Kasey Emerick, a 23-year-old woman and detransitioner from Pennsylvania, told me. Raised in a conservative Christian church, she said, “I believed homosexuality was a sin.”
「我跨性别是因为我不想变成同性恋，」来自宾夕法尼亚州的 23 岁女性，曾转变为跨性别男性，现逆跨性别的 Kasey Emerick 告诉我。自幼在一个保守基督教会中长大的她说道：「我曾相信同性恋是一种罪。」
When she was 15, Emerick confessed her homosexuality to her mother. Her mother attributed her sexual orientation to trauma — Emerick’s father was convicted of raping and assaulting her repeatedly when she was between the ages of 4 and 7 — but after catching Emerick texting with another girl at age 16, she took away her phone. When Emerick melted down, her mother admitted her to a psychiatric hospital. While there, Emerick told herself, “If I was a boy, none of this would have happened.”
15 岁时，Emerick 带有悔意地向母亲坦白了自己的同性恋倾向。她母亲将她的性取向归咎于创伤——Emerick 的父亲在她 4～7 岁时多次强奸和侵犯她，后被判有罪。然而，在 16 岁时，母亲发现 Emerick 与另一个女孩互发短信后，没收了她的手机。当 Emerick 情绪崩溃时，母亲把她送进了一家精神病院。在那里，Emerick 对自己说：「如果我是个男孩，这一切都不会发生。」
In May 2017, Emerick began searching “gender” online and encountered trans advocacy websites. After realizing she could “pick the other side,” she told her mother, “I’m sick of being called a dyke and not a real girl.” If she were a man, she’d be free to pursue relationships with women.
2017 年 5 月，Emerick 开始在网上搜索「gender」一词，接触到了跨性别倡导网站。在意识到她可以「选另一边站」后，她告诉母亲：「我受够了自己被叫作阳刚女同志[4]，以及不是一个真正的女孩。」如果她是个男人，就可以自由地与女性交往。
That September, she and her mother met with a licensed professional counselor for the first of two 90-minute consultations. She told the counselor that she had wished to be a Boy Scout rather than a Girl Scout. She said she didn’t like being gay or a butch lesbian. She also told the counselor that she had suffered from anxiety, depression and suicidal ideation. The clinic recommended testosterone, which was prescribed by a nearby L.G.B.T.Q. health clinic. Shortly thereafter, she was also diagnosed with A.D.H.D. She developed panic attacks. At age 17, she was cleared for a double mastectomy.
那年 9 月，她和母亲会见了一位注册心理咨询师，进行了两次 90 分钟咨询的第一次。她告诉咨询师，她以前就想当一名男童子军，而不是女童子军。她说，她不喜欢变成同性恋或假小子女同。她还告诉咨询师，她一直饱受焦虑、抑郁和自杀意念（suicidal ideation）的折磨。诊所建议使用睾酮，附近一家 LGBTQ 健康诊所开了处方。此后不久，她还被诊断出患有 ADHD。她开始出现惊恐发作（panic attacks）。17 岁时，她获准进行双侧乳房切除手术。
“I’m thinking, ‘Oh my God, I’m having my breasts removed. I’m 17. I’m too young for this,’” she recalled. But she went ahead with the operation.
「我当时想，『天啊，我要把乳房切掉了。我才 17 岁。我太年轻了，不该这样做，』」她回忆道。但她还是做了手术。
“Transition felt like a way to control something when I couldn’t control anything in my life,” Emerick explained. But after living as a trans man for five years, Emerick realized her mental health symptoms were only getting worse. In the fall of 2022, she came out as a detransitioner on Twitter and was immediately attacked. Transgender influencers told her she was bald and ugly. She received multiple threats.
「当我无法掌控生活中的任何事情时，跨性别就像是掌控某些事情的一种方式，」Emerick 解释道。但在作为跨性别男性生活了五年后，Emerick 意识到她的心理健康症状每况愈下。2022 年秋，她在 Twitter 上公开自己逆跨性别者的身份后，立马遭到了攻击。跨性别社群的网红告诉她，她不但是个秃子，还是个丑八怪。她收到了多条威胁。
“I thought my life was over,” she said. “I realized that I had lived a lie for over five years.”
「我想我的日子完了，」她说。「我意识到，我曾在谎言中生活了五年之多。」
Kasey Emerick
Today Emerick’s voice, permanently altered by testosterone, is that of a man. When she tells people she’s a detransitioner, they ask when she plans to stop taking T and live as a woman. “I’ve been off it for a year,” she replies.
如今，在睾酮的影响下，Emerick 的声音永久地变成了男人的声音。当她告诉人们自己是逆跨性别者时，他们会问，她打算什么时候停止服用睾酮，过上女人的生活。「我停了一年了，」她回答道。
Once, after she recounted her story to a therapist, the therapist tried to reassure her. If it’s any consolation, the therapist remarked, “I would never have guessed that you were once a trans woman.” Emerick replied, “Wait, what sex do you think I am?”
有一次，在她向一位治疗师讲述了自己的故事后，治疗师试图安慰她。如果这算是种安慰的话，治疗师说：「我从来没想到你原来是跨性别女性。」Emerick 回答道：「等等，你以为我是什么性别？」
To the trans activist dictum that children know their gender best, it is important to add something all parents know from experience: Children change their minds all the time. One mother told me that after her teenage son desisted — pulled back from a trans identity before any irreversible medical procedures — he explained, “I was just rebelling. I look at it like a subculture, like being goth.”
对于跨性别活动人士的信条，即「孩子最了解自己的性别」，重要的是要补充一点所有父母都知道的经验：孩子的想法总是在变。一位母亲告诉我，她十几岁的儿子在进行任何不可逆转的医疗程序之前——就收回了自己对跨性别的身份认同——之后，他解释道：「我只是在反叛。我把它看作一种亚文化，就像哥特（Goth）一样。」
“The job of children and adolescents is to experiment and explore where they fit into the world, and a big part of that exploration, especially during adolescence, is around their sense of identity,” Sasha Ayad, a licensed professional counselor based in Phoenix, told me. “Children at that age often present with a great deal of certainty and urgency about who they believe they are at the time and things they would like to do in order to enact that sense of identity.”
「儿童和青少年的工作是尝试和探索他们在世界上的定位，这种探索的一大部分，尤其是在青春期，是围绕着他们的身份认同进行的，」凤凰城的注册心理咨询师 Sasha Ayad 告诉我。「这个年龄段的孩子往往表现出对自己当下身份极大的确定性和紧迫感，他们想做的事情也是为了实现这种身份感。」
Ayad, a co-author of “When Kids Say They’re Trans: A Guide for Thoughtful Parents,” advises parents to be wary of the gender affirmation model. “We’ve always known that adolescents are particularly malleable in relationship to their peers and their social context and that exploration is often an attempt to navigate difficulties of that stage, such as puberty, coming to terms with the responsibilities and complications of young adulthood, romance and solidifying their sexual orientation,” she told me. For providing this kind of exploratory approach in her own practice with gender dysphoric youth, Ayad has had her license challenged twice, both times by adults who were not her patients. Both times, the charges were dismissed.
Ayad 是《当孩子说自己是跨性别者：给深思熟虑父母的指南》（When Kids Say They're Trans: A Guide for Thoughtful Parents）一书的合著者，她建议父母对性别肯定模式持谨慎态度。她告诉我：「我们一直清楚，青少年在与同龄人和社会环境的互动中非常容易受影响，而他们的探索行为往往是为了应对这一成长阶段的种种挑战，例如青春期的生理变化、适应成年初期的责任和复杂现实、处理恋爱关系以及确定自己的性取向。」由于在临床实践中为性别不安的青少年提供这种探索性的方法，Ayad 的执照曾两次遭到挑战，挑战者均为非她治疗的成年人。这两次指控均被驳回。
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