新的性别相关手术限制会带来改变吗？

对于加州一名15岁的青少年来说，性别肯定性胸部手术原本近在眼前，但最近情况发生了变化。

For a 15 year old in California, gender affirming top surgery was on the horizon until recently.

在凯撒医疗决定暂停为未成年人进行性别肯定性手术后，我不得不暂时搁置这一计划，因为自费进行手术并不容易。

After Kaiser made its decision to pause gender affirming surgeries for minors, That was something I had to put on hold for a while because it's not easy to do it out of pocket.

出于对自身安全的担忧，他向NPR的塞莱娜·西蒙斯·达芬讲述了经历，并要求不使用他的姓名。

Fearing for his safety, he spoke to NPR's Selena Simmons Duffin under the condition we don't use his name.

这确实是我想为自己争取的事情，但目前要进入系统并推进这一过程有些困难。

It's definitely something I want for myself, but it's a little bit hard to get into the system for pursuing it at the moment.

对于像他这样的青少年来说，获得性别肯定性手术可能会变得更加困难。

Getting gender affirming surgery may become even harder for teens like him now.

美国整形外科医师协会（ASPS）本周发布了一份声明，建议医生推迟为19岁及以下患者进行与性别相关的手术。

The American Society of Plastic Surgeons or ASPS released a statement this week recommending that surgeons delay gender related surgeries for patients 19 years old.

我觉得将年龄限制设为19岁，明显是在试图同时剥夺成年跨性别者和未成年人的医疗照护。

I feel like that 19 is very distinct to trying to get rid of adult care for trans people as well as for minors.

我认为这种同步措施就像是通往更严格限制性别肯定性护理禁令的一道门。

I think sync is kind of like a gateway to even more restrictive, bans on gender affirming care.

ASPS告诉NPR，这是一次更新，而非对其先前关于未成年人性别肯定护理立场的逆转。

ASPS tells NPR this is an update, not a reversal of its previous stance on gender affirming care for minors.

他们表示，目前缺乏足够证据证明这些手术对患有性别不安的青少年的益处大于潜在风险。

They say there's insufficient evidence that the benefits of these surgeries outweigh the potential risks for youth with gender dysphoria.

然而，这位15岁的加州少年很难相信，这些指南是在特朗普政府限制跨性别护理的同时，以善意发布的。

Still, the 15 year old in California has a hard time believing these guidelines come in good faith at the same time the Trump administration is limiting transgender care.

这很难让人信服。

It's hard for it to be reliable.

当你知道政府正在施压医疗协会，要求它们做出某种声明或采取某种立场时，要信任这些协会确实很难。

Like, it's hard to be able to trust medical associations when you know that the government is putting pressure on them to make a certain claim or, you know, adopt a certain stance.

想想看，特朗普政府将ASPS的声明描述为一个转折点，但未成年人接受性别肯定手术的情况其实很少见。

Consider this, the Trump administration is describing the ASPS announcement as a watershed moment, but gender affirming surgeries in minors are rare.

那么，这究竟会带来多大改变呢？

So how much will this change?

来自NPR，我是胡安娜·萨默斯。

From NPR, I'm Juana Summers.

这是来自NPR的报道。

It's consider this from NPR.

美国整形外科医师协会本周宣布，建议医生将与性别相关的手术推迟至患者年满19岁之后。

The American Society of Plastic Surgeons announced this week that it recommends surgeons delay gender related surgeries until a patient is at least 19 years old.

特朗普政府在一份新闻稿中对这一举措表示欢迎。

The Trump administration celebrated the move in a press release.

美国卫生与公众服务部副部长吉姆·奥尼尔表示，这一举措‘标志着特朗普政府在生物真相上的又一胜利’，并称该组织‘为所有医疗提供机构设立了科学和医学标准’。

Deputy health and human services secretary Jim O'Neill said that the move, quote, marks another victory for biological truth in the Trump administration and that the group, quote, has set the scientific and medical standard for all provider groups to follow.

NPR的塞莉娜·西蒙斯·达芬在这里为您解读这一新闻的背景。

NPR's Selena Simmons Duffin is here to put this news into context.

你好。

Hi there.

嗨，伊瓦娜。

Hi, Iwana.

所以，塞莉娜，首先想确认一下，整形外科医生的这份声明是否改变了他们之前的立场？

So, Selena, just to start, is the statement from the plastic surgeons a change from their previous position?

该组织告诉我，这并不是一种逆转。

The group tells me that it is not a reversal.

这是对2024年一份声明的更新，该声明基本表示他们尚未形成明确立场。

It's updating a statement from 2024 that basically said they didn't yet have a position.

美国整形外科协会没有为NPR安排任何人员进行采访，但回复了邮件提问。

ASPS did not provide anyone to NPR for an interview, but did respond to emailed question questions.

他们的立场声明对跨性别青少年接受手术的潜在益处表现出高度怀疑，并得出结论认为患者应至少等到19岁。

And their position statement seems very skeptical of the potential benefits of surgery for transgender youth and concluded that patients should wait until at least age 19.

再具体一点，这会影响多少人？

Just putting this into focus a bit more, how many people would this affect?

美国整形外科协会告诉我，他们不统计每年这类手术的数量。

ASPS told me they do not gather data on the number of these procedures done in a year.

疾病控制与预防中心估计，约有百分之三的青少年是跨性别者。

The CDC estimates about three percent of teenagers are transgender.

其中只有一小部分人在未成年时寻求手术。

A small portion of them seek surgery as minors.

所以，我们实际上谈论的是一个非常小的群体。

So basically, we're talking about a really small group.

而且，所涉及的手术主要是针对跨性别男孩的乳房或上身手术。

And mostly, the surgery in question is breast or top surgery for transgender boys.

好的。

Okay.

那么，跨性别青少年为什么不愿意等到19岁才做手术呢？

And what are the reasons why transgender youth might not want to wait until they turn 19 for the surgery.

今天我采访了一位来自加利福尼亚的妈妈。

I talked to a mom in California today.

她要求NPR不要使用她的名字，因为她担心家人的安全。

She asked NPR not to use her name because she fears for her family's safety.

她说，她的孩子在13岁时公开了跨性别身份，她和丈夫最初不希望同意手术，因为这让他们感到非常害怕。

She says her child came out as transgender at age 13, and she and her husband did not want to okay surgery because it felt really scary to them.

这是不可逆的。

It's permanent.

这有风险。

There are risks.

所以她说，多年来，她的跨性别儿子一直用衣服、绷带和束胸带来压平胸部。

So she says for years, her transgender son used clothes and bandages and binders to flatten his chest.

在某些时候，这非常痛苦。

It's very painful at some point.

我的意思是，为了能让身体适应外界，能够正常出门过一天，这种生理上的痛苦是真实的。

I mean, physically painful trying to get their bodies to fit in a way that they can go out and just have a normal day.

父母最终同意了胸部手术，她说整个手术过程非常艰难。

The parents finally agreed to top surgery, and she says the process of getting it was arduous.

他的儿子现在17岁。

Her son is now 17.

他两年前做了手术，她说他现在真的绽放了。

He had surgery two years ago, and she says that he's really blossomed.

想想其他可能需要这种手术的孩子，即使需要这种手术的孩子数量极少。

And to think that other kids who might need this, even there's so few kids that do need this.

想到他们不得不活在壳里，把生活暂停，这太不公平了，让我既愤怒又悲伤。

To think that they have to just live in a shell and put their lives on pause is so unfair and makes me so angry and so sad.

所以，塞莱娜，这就是一个受到这条新闻影响的家庭。

So, Selena, that is one family that's been affected by this news.

你有没有听到其他医学团体的任何说法？

What have you heard, if anything, from other medical groups?

关于美国医学会的立场，出现了相互矛盾的报道。

There have been conflicting reports about the American Medical Association's position.

他们给我发了一份声明，称‘美国医学会支持以证据为基础的治疗，包括性别肯定护理’，并补充说，根据现有证据，‘未成年人的外科手术通常应推迟到成年’。

They sent me a statement that, quote, the AMA supports evidence based treatment, including gender affirming care, and then added that based on available evidence, quote, surgical interventions in minors should generally be deferred to adulthood.

美国医学会告诉我，这并非立场逆转，也不意味着支持整形外科医生的新立场。

AMA tells me that is not a reversal or an endorsement of the plastic surgeon's new position.

这只是对该组织现有立场的澄清。

It's a clarification of the group's existing position.

同样，美国儿科学会也发了一份声明，称该组织‘不包括对未成年人进行手术的全面建议’，决定应由医生、患者及其家庭做出，而非政客。

Similarly, the American Academy of Pediatrics sent a statement that the group, quote, does not include a blanket recommendation for surgery for minors and that the decision should be left to doctors and patients and their families, not politicians.

好的。

Okay.

但特朗普政府将这位整形外科医生的立场声明描述为一个分水岭。

But the Trump administration is describing the plastic surgeon's position statement as a watershed.

是这样吗？

Is that right?

是的。

Yeah.

背景是，白宫已将限制甚至终止对跨性别青少年的医疗护理作为关键目标。

And the context is that the White House has made restricting or even ending medical care for transgender youth a key goal.

去年12月，他们提出了一项规则，拟取消向提供性别肯定护理给儿童和青少年的医院发放所有医疗补助资金。

In December, they proposed a rule that would withhold all Medicaid funding from hospitals that provide gender affirming care to children and teens.

尽管该规则尚未最终确定，但仅这一威胁就已导致全国多地医院的性别诊所关闭，因为医院确实无法在没有联邦资金的情况下维持运营。

Even though it hasn't been finalized, just that threat has been shuttering hospital gender clinics all over the country because hospitals really can't afford to operate without that federal funding.

这意味着，在那20多个没有州法律禁止此类护理的州，人们的获取渠道正开始被关闭——而这正是特朗普政府的明确目标。

And that means access is starting to shut down for people in the two dozen states that don't have state laws banning the care, which is the Trump administration's stated goal.

我应该指出，并不是所有人都认为这一立场声明是一个转折点。

I should say that not everyone agrees with the idea that this position statement is a watershed moment.

是的。

Yeah.

比如哪些人？

Such as?

凯伦·贝克是 LGBTQ 智库‘运动进步计划’的一名健康研究员。

Kellen Baker is a health researcher at an LGBTQ think tank called the Movement Advancement Project.

他告诉我，美国整形外科协会的立场实际上与当前针对跨性别青少年的护理标准一致。

He told me that the ASPS position actually aligns with the current standard of care for transgender youth.

这里其实没什么新东西。

There's really nothing new here.

现有的护理标准本来就不建议将手术作为对未成年人护理的常规做法。

The standard of care already does not recommend surgeries for minors as part of the routine approach to this care.

贝克认为，特朗普政府将此描述为一个转折点，声称医疗团体终于醒悟，却刻意回避了政府自身施加的政治压力，这对他们是有利的。

Baker argues that it works to the Trump administration's advantage to describe this as a turning point, as a medical group finally seeing the light without acknowledging the political pressure that the Trump administration itself has been exerting to get this outcome.

NPR的塞莱娜·西蒙斯·达芬，非常感谢您。

NPR's Selena Simmons Duffin, thank you so much.

不客气。

You're welcome.

本集由阿莱哈德拉·马克斯·汉斯制作，音频工程由蒂芙尼·韦拉卡斯特罗负责。

This episode was produced by Alejandra Marquez Hance with audio engineering by Tiffany Veracastro.

本集由黛安·韦伯、多琳·多宁和帕特里克·贾雷南·瓦塔纳南编辑。

It was edited by Diane Weber, Courtney Dorning, and Patrick Jaren Watananen.

我们的执行制片人是萨米·耶尼根。

Our executive producer is Sammy Yenigan.

这是NPR的《就此而言》。

It's Consider This from NPR.

我是胡安娜·萨默斯。

I'm Juana Summers.

想在没有广告插播的情况下收听这个播客吗？

Wanna hear this podcast without sponsor breaks?

亚马逊Prime会员可以通过亚马逊音乐收听无广告的《Consider This》节目，或者您也可以支持NPR的重要新闻报道，获取《Consider This》+@plus.NPR.org。

Amazon Prime members can listen to consider this sponsor free through Amazon Music, or you can also support NPR's vital journalism and get consider this +@plus.NPR.org.

网址是+.npr.org。

That's +.npr.org.