A Taiwanese reporter interviews transgender teenagers about the challenges they face from the medical system
Following the legalisation of gay marriage in 2019 – the first Asian country to do so – public discourse in Taiwan has continued to shift on LGBTQ+ issues, including improved awareness of young transgender people. The same year, 2019, saw Taiwan’s first transgender march. Taiwan’s flourishing cultural and political scene around LGBTQ+ issues as been documented in an excellent series of articles by Edric Huang, available here. Rights organisations such as TAPCPR have long campaigned to remove surgery as a requirement for individuals wanting to change their legal gender. They’ve recently celebrated a major legal victory.
But for transgender teenagers in particular, the situation remains tricky. In an article for The Reporter, journalist Hong Qinxuan interviews transgender teenagers to understand the continuing mismatch between legal norms, the health system and their hopes for the future.
Current Taiwanese law stipulates that the desired hormonal treatments necessary for changing gender are reserved for those over the age of 18 with full medical autonomy. The situation is more complicated for younger teenagers seeking gender-related medical care. Most hospitals will only see minors after they have received parental consent—one of the bigger hurdles—and undergone a strict psychological evaluation.
The Reporter interviews several teenagers about the medical and other challenges they face. One key takeaway is the diversity of lived experiences and challenges. “Every transgender person’s anxiety is different,” says Simon, a first-year high school student. “I don’t get anxious when I wear a skirt or have long hair… I just don’t like my body, voice and how society views my gender: why are they all different from what I think?”
Prevented from easily accessing the medical care they would like, some teenagers resort to alternative solutions found online. Weihao (a pseudonym) was fifteen when he first injected testosterone, bought from someone presenting themselves as a fitness coach (Weihao uses the term “bodybuilder”). The exchange took place at a bus station in Ximending (“10 thumb-sized bottles for 3,000 yuan in cash” notes The Reporter).
Seven years on, he is still using the privately sourced treatment. (An alternative is to go via Chinese pharmaceutical companies online.) But these medications aren’t without additional risks. An increased risk of blood clots and early onset of osteoporosis are two possible side-effects of hormonal treatments, says Xu Zhiyun, a child and adolescent psychiatrist who has opened a sought-after consultation clinic at Taiwan University Hospital’s Department of Psychiatry and seen over a hundred young transgender patients.
Nor is all hormonal medicine is the same. Trans women don’t need to rely on injections, but can rather take pills, much easier to source online. The Reporter speaks to Wan Cake who bought 300 pills for 500 yuan. She didn’t notice much physical change initially, but she did notice something else: empowerment. “Taking the medicine has a psychological effect. When you take the medicine, you feel ‘I’m finally starting’” When she couldn’t afford a steady long-term supply, Wan had to resort to less regular means of obtaining the medication – and adjust her doses.
Trans woman Jinger’s life took a more radical path. Growing up in China, Jinger came to her transgender identity as a pre-teen, initially stealing money from home to secure blood pressure medicine which has the side effect of suppressing testosterone production. The most obvious thing the medicine did, initially, was to reduce her acne. Her life spiralled out of control when her mother found out about and confiscated her medicine at the age of 13. Five years later, she resorted to extreme measures and removed her testicles herself in the bathroom of a rented house. She has since moved to Taiwan, cut off from her mother but staying in touch with her father.
At the time she is interviewed for the article, Jinger she is 19, dressed in gender-neutral clothing with pony-tail. She used to think about trying to talk in a higher pitch in order to sound more stereotypically female, she says. But “I’ve read enough feminist articles now to not force myself”. If she could turn back the clock, she sometimes wonders whether she would make the same choice of radical self-surgery. Though it’s hard to re-imagine herself into that time, she feels she would: “I wanted to do it from the bottom of my heart”.
December 2024. Jinger is on her way to a Christmas gathering of the local Taiwanese transgender community, showing her sense of humour by wearing a T-shirt with the words ‘Made in China’ in Gothic font. Much has changed for Jinger over the last years – she can be far more open about who she is.
Yet elements of this world remain underground. She shows The Reporter a small flask of oestrogen, made up by a Brazilian trans woman. It is only purchasable with crypto and disguised as skin oil.
Full original article by Hong Qinxuan (洪琴宣) available here.
‘年輕跨性別世代素描：性別認同覺察提早，在尋醫與私藥間找出路’, The Reporter, 19 January 2025.
The Reporter (報導者) is an independent non-profit news organisation in Taiwan.
