Trans people in China are performing highly dangerous surgery on themselves and buying unsafe hormone treatments on the black market because it is almost impossible for them to access the health care they urgently need, Amnesty International revealed in a new report.

The report ‘I need my parents’ consent to be myself - Barriers to gender-affirming treatments for transgender people in China’ reveals that prevalent discrimination and stigma, restrictive eligibility requirements and a lack of available information often leave trans people seeking unregulated and unsafe gender-affirming treatments.

In China, trans people are classed as having a “mental illness” and require the consent of families for gender-affirming surgery. This is a major barrier in accessing safe treatment. Due to the fear of rejection, many trans people choose not to tell their families.

Many other criteria to qualify for gender-affirming surgeries - such as not being married or having a clean criminal record - also create significant barriers to accessing this treatment. Let down by the health system, many trans people have taken the highly dangerous step of attempting to perform surgeries on themselves.  

Doriane Lau, China Researcher at Amnesty International, said:

“China is failing transgender people. Discriminatory laws and policies have left many people feeling they have no choice but to risk their lives by performing extremely dangerous surgery on themselves and to seek unsafe hormone drugs on the black market.

“The authorities and medical profession must stop classifying transgender people as having a mental illness. The highly-restrictive requirements for accessing gender-affirming surgeries and lack of health-related information needs to change so people can access the health care they need.

“The Chinese government can show it is serious in addressing discrimination against the LGBTI community by removing the barriers transgender people face when trying to access safe gender-affirming treatments.”

Discrimination against trans community

The trans community in China is largely invisible, and faces entrenched discrimination at home, school, work and in the healthcare system. Amnesty interviewed 15 trans people from across the country who were willing to share their experiences. 

Zijia*, a 21-year-old trans woman, told Amnesty why she started to use hormone treatment: “I was anxious to change my body. I felt disgusted with my male sex characteristics. The medication brought changes gradually, but I felt much better right away. I could finally start being myself.”

Dangerous self-surgery

Amnesty found an alarming lack of knowledge about how trans people can access gender-affirming treatments in the public health system. This, combined with stringent and discriminatory eligibility requirements, means trans people are often not supported to access the health care they need.

Two of the interviewees told Amnesty of their traumatic experiences, including Huiming*, who became desperate to align her male sex characteristics with her female identity after the onset of puberty.

The 30-year-old began to self-medicate while still in university, buying hormone drugs via the online black market - but stopped after only a month due to suffering extreme mood swings and significant impact on her mental health. 

Accessing gender-affirming treatments at a hospital was not an option as she feared her family would reject her when she asked for their consent. In 2016, she took the desperate decision to attempt surgery on herself.

Huiming felt she had no other option: “I thought I was an abnormal person. How could I explain this to my family? I was both happy and scared. I was scared because I was bleeding so badly, I could die right there. I feared I would still die a man, since I only did part of my surgery.”

Huiming was rushed to hospital, where she asked the doctor to lie to her family and say she had an accident. Her parents remained unaware about their child’s desperate act to remove her male sex organs. In 2017, Huiming travelled to Thailand for gender-affirming surgery. Before travelling, Huiming came out to her mother who accepted her for who she is.

Unsafe medication

Due to the failings of the health system, people who are trans, and have an urgent need to align their body with their gender identity, told Amnesty that they have had little choice but to resort to the black market to obtain hormone medication.

This includes buying medication through social media chat groups, online shops, and via overseas surrogate shoppers, often at inflated prices compared to the legal market. None of the trans people Amnesty interviewed had accessed advice from medical professionals before taking these drugs.

Without any regulation and oversight, there is a real risk the drugs purchased on the black market are unsafe and counterfeit. Without knowing the required dose, side-effects, or quality of the drugs, many told Amnesty how they experienced mood swings, with some even suffering depression, with no medical supervision or access to a doctor to address these conditions.

Shanshan*, a 21-year-old trans female from Beijing, hated her male sex characteristics and began buying hormone medication on the black market. She said: “My greatest anxiety is being a man. Sometimes it felt so bad I wanted to commit suicide.”

Healthcare failings

Health care facilities specialising in gender-affirming treatments are not common. There is only one multi-disciplinary clinic in the whole of China that specialises in a range of gender-affirming treatments. The multi-disciplinary medical team for gender-affirming care opened in September 2018 at Peking University Third Hospital and is the first of its kind in China.

The current guidelines for medical professionals on gender-affirming treatments are not fit for purpose. These guidelines, combined with a lack of adequate information, means trans people face significant barriers and challenges to access the care they need.

In March 2019, the Chinese government accepted recommendations by the UN Human Rights Council to legislate to ban discrimination against LGBTI people.