性╱別如何製造：台灣變性醫療的一項田野研究

Abstract

在台灣不管身處社會互動、醫療地點或論述語境之不同場域當中，跨性別一詞時常被等 同於變性慾者來看待，而對變性慾者的理解也必然導引至變性手術的實施。跨性別-變性慾- 變性手術一體不分（辨）的想像、認知並不完全符合現實生活中多元多樣的跨性別主體。從 跨性別團體與諸多跨性別、變性主體自不同管道、界面與場合所發出的聲音，得知跨性別、 變性主體彼此間有所差異的性╱別想像、身體規劃與走出來各有分殊的性╱別路徑。本研究 基本上將「跨性別」視為一種性╱別多樣的聚合或連續體，跨性別者、變性慾者具差異的身 分表達與互為主體的情境狀態，主要源於所在的資源、環境與生活各種場域的可能與條件， 彼此互動、相互交織而形成。 鑑於「跨性別-變性慾-變性手術」相當程度上的一體不分與既定的邏輯思維，本研究將 以三年的研究期程結合不同科別的專業醫師對變性醫療的整體環節：心理評估、荷爾蒙治療 與變性手術，進行瞭解。一方面從提供諮詢、專業判斷與照護的醫療體系著手。另一方面從 中釐清變性醫療環境之所以形成的沿革、法規與制度的面向，如何形塑這個專業場域／文化 及其運作之樣態。再進一步本研究將透過不同因緣結識的跨性別朋友的生命經驗與主體陳 述，提出跨性別、變性慾者的變性醫療經驗（的有無），及其援用的資源途徑，所作的選擇 以及與之互動的策略考量。本研究最終希望帶出醫療服務端與主體需求之間的可能落差、磨 合或共識，一方面呈現變性醫療體系的建制與狀態，另一方面顯示跨性別、變性主體交織著 階級、族群、位置與地點而來具差異的性別構想、概念與性別打造／藍圖。

In Taiwan, under various circumstances—be they social interactions, medical situations or deliberative discourses, transgenderism is often considered a synonym of transsexualism. And the imagination of transsexuals is also often linked to the performance of sex reassignment surgery. Such indifference to or failure in telling the differences between transgenderism, transsexualism and sex reassignment surgery does not quite match the diversity found among the transgendered population as we observed in the real world. Voices raised by transgendered groups, transgendered and transsexual subjects via various channels in different situations all suggest that there do exist, between transgendered and transsexual people, different sexual/gender imagination about their minds, bodies and social roles. This research will treat “transgenderism” as a continuum of sex/gender diversity. It is the interaction and intertwinement of the resources, the environment and possibilities in life available to transgendered and transsexual people that explain the differences in how they express themselves. In view of the fact that the notions of transgenderism, transsexualism and sex reassignment surgery are, to a certain degree, so confusingly indistinguishable and the logic behind each of these concepts so perplexing, this research will spend three years looking in depth into the whole range of medical treatments for transsexuals as adopted by practicing medical doctors that include psychiatric evaluation, hormonal therapy and sex reassignment surgery. No only will we study the whole system of treatment that includes provision of counseling, professional judgment and medical care, but will also try to sort out the way of how the current system of treatment is formed, what current law is in regulating transsexuals, and how the professional field and its operation is shaped. Furthermore, this research will try to bring to light inner voices of transgendered and transsexual subjects about the existent treatment system that they confronted, the (source of) resources they used, the choices they made and the strategic consideration they took to realize their choices. We will also compare and make contrast possible gaps and/or consensus between the demand side and the supply side of medical services in hopes of contributing to the buildup of a more friendly treatment environment and a more humane legal institution for transgendered and transsexual people.