Life as a transgender person can often be difficult and isolating. Here's where to find help for transgender issues in Hong Kong and advice for how to be an ally.
Although attitudes are changing in many parts of the world, transgender people in Hong Kong continue to suffer from social and systematic exclusion. I wanted to learn more about transgender issues and the effects of this exclusion, and the realities of living as a transgender person in Hong Kong. So, I sat down with Dr Winston Goh (he/him), and Dr Tsang Ling Yin, Zephyrus (he/him) to talk about transitioning, what it means, and how we can support people in our lives who are transgender.
Transgender issues in Hong Kong
Hi Winston and Zephyrus, thanks for meeting me today! I’m wondering, how might a person know that they are transgender? And what steps could they take if they think they might be?
Zephyrus: To start with, the definition of transgender is that one’s gender identity is different from their assigned sex at birth, meaning the sex on your birth certificate. Often a trans person will experience gender dysphoria at some point, meaning they feel some form of distress about their assigned sex, and they might become aware that they have a different relationship to their assigned sex than others. Dysphoria can happen during puberty when the body is changing, or at any time. Socially, you might experience it by seeing how you are treated by others, like feeling uncomfortable being referred to as a man or woman.
If you think you are trans it’s a great idea to explore online spaces, to see if there are any labels or terms that resonate with you. If you can, experiment with your style and see what makes you feel comfortable and aligns more with your gender. By experimenting you might experience gender euphoria, which is the feeling of joy when you are more aligned with your true gender. A moment of gender euphoria for me was when I got my first chest binder. However, it’s important to remember that there’s no one way to be trans, so your story might be different from mine, but all our stories are valid and real.
Winston: If a person thinks they might be transgender or has questions, if they feel comfortable, we recommend they speak to their parents, friends, or someone close to them to whom they can trust. If you feel comfortable speaking to your doctor, you can do that, too. We understand, though, that these people might not be supportive, helpful, or safe to speak to. In which case, we recommend reaching out to local organisations. There are many helpful organisations in Hong Kong that will be able to give you advice and support (more on that later).
What’s the difference between a social and a medical transition?
Z: A social transition can include how you introduce yourself, your name, your hairstyle, your clothes. This can include what bathroom you use in public or sports teams you play on, it basically relates to how you are treated in society.
Medical transition has lots of different aspects, including seeing a psychiatrist who can explore your gender identity with you, and may be able to help you to get a supporting letter to state that you are your gender and that you are experiencing gender dysphoria. This letter can be given to your workplace or school to allow you to live more in line with your gender. Then, you might be referred to a doctor to get gender-affirming hormones. You might see a voice coach or speech therapist to help change your voice. Some people may also choose to have gender affirming surgery (GAS), such as top surgery for chest masculination or breast augmentation, face feminisation or masculinization surgery, gonadal surgery, and genital surgery. Gonadal surgery refers to orchidectomy, or bilateral salpingo-oophorectomy.
There are many other aspects of a medical transition, as well. However, we know that gender identity is formed when we are very young so, if someone is reading this and is trans but hasn’t done any of the above, know that these things don’t change your gender identity. Trans people don’t need to do any of these things if they don’t want to, and there’s no such thing as a ‘full’ or ‘complete’ transition. It all depends on what someone wants, what their dysphoria is, and what they have access to. Even if a trans person wants to undergo a medical transition, they might not be able to due to societal or institutional barriers.
Can you elaborate on barriers trans people face in Hong Kong?
W: Transitioning medically is expensive if done privately. There can also be long waiting times in both public and private systems. However, to change the gender markers on one’s HKID card, a trans person must have surgery to remove the gonads and undergo construction of corresponding external genitalia. This means they might have to do the surgery to be accepted legally as the gender they really are. This can cause a lot of anxiety for people and acts as a barrier, as they must choose between a surgery they might not want, or not being recognised for their true gender.
Another barrier is the lack of education among medical professionals. Not much is taught in the formal curriculum about LGBTQ+ healthcare in many medical institutions in Hong Kong. This can mean that if transgender people do talk to their doctors they might encounter discrimination, lack of support, and confusion from having to explain themselves to medical providers. This can be exhausting and can hurt trans people; it’s something that I know Quarks and the Hong Kong LGBT Medical Society in Hong Kong are working towards helping. I first worked with trans patients in San Francisco, and this helped me realise all the consequences of transphobia that they face and the barriers they were up against. It was a really formative experience for me.
Z: Socially, trans people also have to deal with pressures from their families, friends, employers, and social circles. If you still live with your family, they might not support your decisions or allow you to experiment with different styles and clothing. My mother didn’t want me to cut my hair, so I was only able to do this a few years ago. Many people aren’t able to transition because they might lose their support system, which can cause a huge amount of anxiety.
Another barrier might be the fear of discrimination and lack of gender-neutral facilities in Hong Kong, could you talk about the effect these two have on the trans community?
Z: It can be very difficult for trans and non-binary people to decide which bathroom to use. Trans people should be able to choose if they want to use the sex segregated bathroom or a gender neutral one, but unfortunately often those options aren’t available. If trans people use a single sex bathroom they may be accused of using the bathroom for the ‘opposite sex’. So, to try and be safe and comfortable, a person might opt to use the disabled bathroom. However, there is usually only one disabled bathroom, which is often less clean and possibly further away. We also don’t want to have to compete with disabled people to use their bathroom. So, it’s a no-win situation. This predicament often cuts trans people out of many aspects of daily life, meaning they can’t exercise or socialise as easily as others.
At Quarks we made a new gender friendly bathroom sign, as even the gender-neutral signs often have a figure in a skirt and trousers, depicting two genders. The signs we have made are for all people of all genders. We advocate for all genders to have bathroom access, so everyone, including trans and non-binary people can use public spaces comfortably.
It’s important that people understand that trans people are not predators in bathrooms, but that they feel a lot of fear and suffer discrimination because of this misconception. The lack of understanding and education hurts us all.
W: Often in Asia we still have a binary way of thinking, such as male and female. In some countries they are embracing more of the grey areas and gender fluidity. I hope over time, with more visibility, that people will be able to understand that there is a spectrum of gender and people don’t have to strictly be one or the other. Asian culture is often about conforming, and you want to blend in. Trans people are seen in this situation as rocking the boat.
What effects do all these things, such as barriers to treatment, lack of secure facilities, and social exclusion, have on the mental health of trans individuals?
W: When people can’t be themselves it causes them to feel lonely and isolated. They may use substances to cope with the anxiety and stress they’re experiencing because of social and systematic oppression. The overall mental health consequences could be that they suffer from depression and anxiety, and this will be exacerbated if they have no social support networks such as family or friends. Unfortunately, having mental health issues like depression and anxiety—in and of themselves—can be stigmatising in Asia already. It’s a double-edged sword; people can’t talk about their mental health issues, and then they’re not able to talk about being trans and live their life as they want to. It becomes a vicious cycle.
Z: The rate of anxiety, depression and suicidality is very high. If you’re in school, this might mean you’re not able to focus and achieve your potential. All these issues also affect your job prospects, as if your gender marker does not match up with your identity you might be asked in interviews to dress differently, and subsequently denied job opportunities. If you want to have GAS overseas, this requires a lot of time off and money, and even if it’s financially possible for you, your employer might not give you the time you need.
How can you support someone in your life who is transgender?
Z: This person is sharing a very personal and important thing with you, so it’s vital not to make assumptions. Ask your friend if they want to keep this between you and them, what pronouns to use going forward and how you should refer to them with friends, with family and in public, or if it’s only safe to use certain pronouns or names when you’re alone with them.
Following that, it can be useful to do some independent research to help you understand your friend. If they change their style, don’t make negative comments – be encouraging and open! You can offer to help them by going to meet members of the local community, going with them to restrooms, or to the doctor. Make sure to ask if they want your help, don’t make assumptions or act without prior consent.
W: If someone opens up to you, thank them for their honesty, and try to be non-judgemental. They might have questions that you can’t answer, but they’re in the process of realising who they are. As their friend, you can help them if you’re able to listen, be present and support them on their journey the best you can.
Where can trans people get help in Hong Kong for the above issues?
Z: If anyone thinks they might be trans or needs help with anything we’ve discussed here, I encourage you to try and reach out to the local trans community through Quarks, which is an organisation that I help with. Quarks is mostly in Cantonese and has lots of resources for transgender issues on our social media page.
W: AIDS Concern might be able to help you if you need assistance finding an LGBTQ+ friendly doctor. For parents with non-traditional families, there is also a Facebook group called Rainbow Families available.