Assigned female at birth, Ran was troubled by their voice and chest. It took five years for Ran to feel truly comfortable with themselves. © Amnesty International

The Chinese transgender individuals forced to take treatment into their own hands

Huiming* (not photographed) was in her early twenties when she decided to remove her male genitalia. But living in China, her options were limited. 

For one, gender-affirming surgery in the country is only available to individuals diagnosed as mentally ill, which Huiming was not. It also requires the permission of an individual’s family – something Huiming felt certain she would not obtain.

Going overseas for the operation was another option, but one Huiming simply could not afford. “Operations were rumoured to cost more than $30,000 back then,” she said. “That is more than the lifetime savings of many families.”

In desperation, Huiming* tried putting ice on her male genitals to stop them functioning and even booked a surgery with a black-market doctor, but the doctor was arrested before her surgery was done.So she felt she had only one choice left: Huiming would perform the surgery herself.

“I was very happy and scared. I was scared because I was bleeding so badly – I could have died right there. I was also scared because I would still die a man, since I only did part of the surgery,” Huiming, now 30, told Amnesty International.

Her story is shocking, but in China it is sadly not unique. Discrimination and stigma against the transgender community pervades all walks of life – including the medical and legal professions – and has left individuals such as Huiming to take drastic and often dangerous measures in their quest to become themselves.

Since puberty, Huiming had felt deeply uncomfortable with her assigned gender. As a child she was disgusted by her developing male sex characteristics. “I would pluck the hairs on my legs with one hand, and do my schoolwork with the other,” she recalls.

She had no access to the internet until she was in her late teens – her only previous source of information on transgender life being illegal publications covering stories of “ladyboys” from Thailand. It was after she began investigating online that she took the first steps towards self-medication.

Desperate to align her sexual characteristics with her gender identity, she began to take hormone pills – designed to be taken monthly – every day. Her body changed rapidly, but still she struggled to accept herself.

“I saw myself as a pervert who was neither man nor woman,” Huiming said, describing a constant struggle between the intense urge to get rid of her male sex organs and the fear of being disowned by her family if she transitioned.

While self-medication and self-surgery may seem like extreme options, seeking professional help is also fraught with problems. These stem largely from the view in Chinese society that being transgender is an illness.

Yasi, 22, had long been tormented by the idea of “being a man” when she went to see a psychiatrist in 2017. Her experience was typical of many transgender people who seek medical advice.

“When I spoke to him, I felt that he didn’t see transgender people as one of the communities in society. He saw us as patients that needed to be cured,” she said.

“At best, most of the doctors understand the concept of being transgender, but they do not have the knowledge to offer you help.”

Bizarrely, one of the criteria to be eligible for gender-affirming surgery in China is to obtain familial consent – even as an adult. It’s a conversation that is often avoided, and frequently traumatic for those brave enough to raise it.

When 20-year-old Zijia from Chongqing came out as a transgender woman, her family thought she was sick.

“They asked me to suppress my gender identity, get married and have a child – all so everyone in the family can be happy,” she said.

But the lack of support did not stop Zijia from pursuing the life she wanted. For years she had felt like a fraud, forced to disguise herself as a man when she saw herself as a woman.

So in 2017, she started taking hormone medication. Her body gradually started to align with her gender identity – her skin became softer, her breasts grew and her body hair growth slowed. She was excited about the changes happening in her body but, like many others, her greatest worry was buying and taking dangerous counterfeit medication.

In the absence of formal channels to access prescribed medication in China, transgender individuals are often forced to obtain hormone treatments in ways that put their lives at risk.

“We were stuck in a situation in which there was no medical professional who could take care of our healthcare needs. Therefore, everyone tried medicating themselves.”

Zijia started taking hormone medication in 2017
Zijia started taking hormone medication in 2017

Another transgender person who took this path was Shanshan from Beijing, 21, who turned to the black market when her anxiety about her gender incongruence became too much to bear. She had suffered frequent beatings and verbal abuse from her father throughout her childhood due to her feminine temperament.She went to one of the best high schools in Beijing, but she was bullied and could not get along with her classmates.

“My greatest anxiety is being a man, a man in a medical sense,” she said. “It was very, very painful. Sometimes it felt so bad I wanted to commit suicide.”

She started acquiring hormone medication and using it without a doctor’s supervision. She continues to self-medicate now and cannot imagine stopping.

“No matter where I go, I have to prepare enough hormones,” she said. “If I am travelling and I run out [of medication], I just go home. I must carry them with me all times. Or else I will die. Stopping hormone treatment is excruciating.”

As long as deeply ingrained discrimination persists in China, transgender people will continue to face a choice between living a lie or risking their life to align their sex characteristics with their gender identity. For many, the only avenue for support is the internet, where transgender people have shared their stories and made each other realize they are not alone.

After her unsuccessful attempt at self-surgery, Huiming covered the bleeding wound with a thick stack of tissues and took a taxi to the emergency room. The doctor agreed to lie to her family and say that she had had an accident.

But traumatic though it was, this experience hardened Huiming’s sense of who she was. She sought support from other transgender people , and met someone who changed the way she looked at herself. 

“It was a non-binary transgender person. That person showed me the possibility of living with the gender identity I have. I wasn’t that abnormal. Someone else was as ‘abnormal’ as I am.”

She eventually let go of her fear and came out to her mother before going to Thailand for gender-affirming surgery in 2017.

“She was a bit frustrated, but she accepted me,” Huiming said of her mother’s reaction.

As a first step, acceptance is all China’s transgender community asks.

*All names are changed to protect the identity of interviewees.