gender reassignment surgery hong kong

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Transitioning Medical Information

Information provided here are not always updated. for doctor visit, please call for enquiry and booking., outline and details of arranging sex reassignment surgery (srs) in hong kong.

If you have a valid Hong Kong Identity Card ( Public Charges – Eligible Persons ), you will be subsidized by the government on GID assessment as well as SRS in the Public Hospital System and the overall cost is very low. The only problem is the period of time is much longer. It might take 1 to 4 years from beginning to SRS depends on your situation. Yet we do not recommend you should rush for the surgery as during the period of assessment, doctors will help you in the preparation and let you have time to understand your needs on the transitioning. That's very important for your future life. If you have enough preparation already and can bear a high private clinic cost, you can use the information below to connect to some of the private psychiatrists to move on the transitioning process.

1. A summary on Public GID Clinic vs Private Clinic

2. the process of sex reassignment.

*the information provided below only attended to the procedures relevant to the Surgery itself. If you do have a need for sex reassignment and are confident and prepared to face the new challenges of a new life, these are roughly the steps you have to walk through

• Acquire a letter of referral from a general practitioner or a family doctor for the referral to GID Clinic. (Check with 3. Detail Description)
• Submit the letter to Gender Identity Disorder Clinic, Department of Psychiatry in Prince of Wales Hospital for an appointment. (On the left of the entrance, 3/F Li Ka Shing Specialist Outpatient Clinics North Wing) or recognized psychiatrists and psychologists (contact us for more info)
• Informed by the Psychiatric Unit/Sex Clinic of the first appointment (may take 6-18 months *).
• Referred by the psychiatric unit to the psychologist and other specialties including the endocrinologist, speech therapist and social worker, etc.
• For a certain time of period, the doctor will discuss with the client of undergoing the “Real Life Experience” (RLE). The client will receive a supporting letter from the doctor for him/her to live more easy as another gender.
• Receive “Hormone Replacement Therapy” (HRT) prescribed by the psychiatric unit or endocrinology.
• Confirmation of client’s need and applicability for Sex Reassignment Surgery from the psychiatric unit and psychological unit separately.
• With the 2 referral letters of surgery from the two units mentioned above, head for Prince of Wales Hospital to book an appointment in the surgical out-patient unit.
• Informed by the surgical unit of the first appointment.
• Client makes pre-operative preparation upon doctor’s request.
• One or more Sex Reassignment Surgeries are commenced.
• The client will receive a testimonial letter of SRS from the hospital after he/she has completed the full SRS procedures according to the government administrative guideline.
• A deed poll should be drafted by a legally qualified person to change the name if there is a need.
• Go to the Immigration Department to apply for the change of sex and/or name with the testimonial letter of SRS.
• Amend the relevant entry/entries in other credentials and service accounts upon the reception of the updated identity documents. In general, the patient’s record kept by the Hospital Authority will be updated automatically after the surgery.
• Prescription of after-surgery hormone supplements from the doctor according to client’s need.
• Further consultations by the psychiatric unit and surgical unit until satisfactory.
• The sequence of steps varies slightly according to the client’s condition and the hospital’s arrangement.
• To amend the gender marker on ID card in Hong Kong, one should complete the SRS procedure described in the administrative guideline of Immigration Departure. For more information, please check with Q22 of the link here http://www.gov.hk/en/residents/immigration/idcard/hkic/faq_hkic.htm
• Service charges for medical services provided by HA hospitals/clinics: https://www.ha.org.hk/visitor/ha_visitor_text_index.asp?Content_ID=10045&Lang=ENG&Dimension=100&Parent_ID=10044&Ver=TEXT
• GID Clinic provides one-stop cross-specialized assessments and medical services for patients across the territory, with no territory restrictions.
• GID respect the privacy of their patients in which all letters can be collected from the clinic on request. The clinic will contact each patient when there is letter ready for collection.

Waiting Time for New Case Booking at GID Clinic: 4-6 months

For information such as the arrangements under the epidemic situation and new case booking wait time, please contact the Prince of Wales Hospital (Psychiatric Unit) directly as it will be updated from time to time. Below is the contact information:

Location: 3/F, Block B, Staff Quarters, Prince of Wales Hospital, No. 30-32 Ngan Shing Street, Sha Tin, N.T. Phone number: 3505-3415 Service Hours: Monday to Friday 8:45am to 5:30pm

The following diagram is reproduced with permission from "Quarks". For details of the post, please click the original post link:  https://www.instagram.com/p/CdDHpucP-nk/

3. Detail Description

If you seek to arrange a sexual reassignment surgery in Hong Kong or are experiencing severe anxiety of gender identity, you can book an appointment with the GID clinic under the psychiatric unit of Prince Wales Hospital. The client needs to acquire a letter of referral from a registered doctor in Hong Kong by stating during the consultation, his will to be referred to a particular psychiatric specialty due to gender identity disorder. The ID card no. and the name of the client must be indicated in the letter. If there is any occasion of discourtesy of discrimination from the practitioner of doctor, you hold the right to declare the service unprofessional and request suspension of service. In general, it is very unlikely to happen in the government general out-patient clinic.

As the letter of referral is valid for 3 months only, please accompany a relative or go by yourself within three months, to  the  GID  clinic of Prince Wales Hospital  to book for an appointment with the letter of referral, identity documents and address proof (such as water, electric bill). The waiting time for a new case is around 6 to 18 months. 

Prince of Wales Hospital Psychiatric Unit- Gender Identity Disorder Clinic Address: Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories.

* If the patient is under age of 18, his parents must approve and accompany him on the first appointment in a sex clinic. * The Government GID Clinic and SRS service now only provided to Hong Kong permanent citizens . Non-citizens should go to a private psychiatrist and private hospital.

Fees: ( Please refer to Public Hospital Website for the exact fee )

Referral Letter for GID Clinic: A general practitioner or family doctor will not charge an extra fee for referral letter and we are not able to provide information of different doctor's fee.  GID Clinic Assessment Fee：Including the psychiatric department, the first visit charge is HK$135, followed by HK$80 each time. Each drug charges HK$15. Surgery (SRS) Fee: Hospital Admission fee HK$75. Daily charge HK$120 with a small amount of misc. charges. Variant Surgery Selective materials such as breast implants are required to pay, depending on the price chosen, ranging from about HK$8000.

* TGR does not benefit from disseminating the medical practitioners' information. It is for user's reference only. Please call before visiting doctor to confirm the cost, service time, address and the kind of treatment and hormone they can provide.

4. gender assessment and srs private clinic, psychiatrist.

Hong Kong Psychiatry And Integrated Medical Centre Unit A, 18/F, Lokville Commercial Building, 27 Lock Road, Tsim Sha Tsui, Kowloon, Hong Kong

Certified Sex Therapist at centre

Dr. Wong Chung Hin Willy  Tang Wing Kam Cannis  Ho Ming Hei Hugo Chang Yuen Wai Virginia  Leung Kai Man

Sex Reassignment Surgeon

Dr. Yuen Wai Cheung, Albert Ethics First Medical Practice (Central) Suite 2804, 28/F, Bank of America Tower, 12 Harcourt Road, Central, Hong Kong (Central MTR Exit L) Tel: 2110 2151/2110 2152 Info on FindDoc:  https://www.finddoc.com/en/doctors/yuen-wai-cheung-albert-2528

Family Doctor who can issue GID referral letter for transgender people

Dr. Ng Wing Ying Angela Family Doctor & Sex Therapist https://www.neohealth.com.hk/ch/team/item/546-dr-angela-ng.html Tel: ‭31677040 Address: Room 1106, 11/F, No. 19 Des Voeux Road Central, Central, HK

5. Precaution on Hormone Replacement Therapy

So transgender people wish to purchase and apply self-medication of hormone to alter their body condition towards the opposite sex. TGR do not encourage self-medication of hormone without doctor’s prescription or follow-up, but please have a regular body check if this is the only way. Hormone supplement affects the function of liver and kidney, and due to physique or other problems, unnatural obesity, headache, fatigue, emotional fluctuation or other serious effects may happen after dosage. Therefore, take great care of the changes of your body.

The hormone applied on FTM and MTF is entirely different, FTM uses injected testosterone in most cases, which has the least effect on liver and kidney, with the highest absorption rate. MTF in most cases takes oral Estrogen and Anti-Androgen simultaneously, while some choose injection, adhesives or rub on cream on skin. There are also some people who prefer natural foods or Chinese medicines to adjust their bodies, of which the effect is not strong, yet safe.

List of Private Endocrinologists (Prescribe Hormonal Treatment)

Dr. Annie Kung Tel: 2525 3331 / 2525 3335 Address: Suite 709, 7/F, Central Building, 1-3 Pedder Street, Central, Hong Kong Web: https://www.edr.hk/doctor/info/kung-wai-chee-annie

6. MTF Voice Surgery

Dr. su voice beauty clinic（business closed）.

http://www.voicebeautycenter.com/en

Far Eastern Voice Clinic

http://www.voicedoctor.tw/english

Kamol Cosmetic Hospital

Open Feminization Laryngoplasty :  https://www.kamolhospital.com/en/Voice-Feminization.php

MTF Voice Feminization Training :  https://www.kamolhospital.com/en/Voice-Feminization-Training.php

 7. Thailand SRS Information

Website： https://www.kamolhospital.com/en

WIH International Hospital (Chettawut Plastic Surgery Center)

Website： https://www.wihhospital.com

Website： http://www.chet-plasticsurgery.com

Dr. Suporn's Clinic

Website： https://supornclinic.com

Dr. Pichet Rodchareon M.D.

Website： http://www.bangkokplasticsurgery.com

8. Useful Information

(The following information is provided by others and edited by TGR. Only for reference.)

• Preparation List for SRS (Chinese)
• Procedure for Sex and Name change after SRS (Chinese)
• Doctor Referral Letter Sample
• Peecock - FTM/Transman Products
• Emisil Prosthetics - FTM/Transman Products
• transthetics - FTM/Transman Products

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*We can’t arrange any more interview as we are busy with the daily workloads. But may have other arrangements in the future.

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TGR COUNSELING SERVICE

"TG.AskME" is a service for you to ask any questions regarding your worries, and difficulties in a safe channel via Facebook chat or email.

Facebook: TG.AskME Inbox:    https://fb.com/msg/tg.askme Email:  [email protected]

Trans Friendly Hotline:

Queer Sister Hotline

Hotline: 9260-8191 Please send a WhatsApp message to  arrange the time to speak to a peer counsellor

24-hour Supporting Hotline for Sexual Minorities:

PRIDE Line 2217-5959 Click here for details

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Hong Kong Amends Its Surgery Requirements to Change Gender Markers on IDs

H ong Kong no longer requires transgender people to undergo full gender-affirming surgery to change their legal gender markers in their IDs, more than a year after the Chinese enclave’s top court called the requirement unconstitutional.

The government announced the change on Wednesday, “having prudently considered the objective of the policy, relevant legal and medical advice, as well as drawing reference from the relevant practices overseas.”

Under the new rules, Hong Kong residents who have not undergone full sex reassignment surgery [SRS] who want to have their gender marker on their ID changed still must have completed select surgical treatment to modify their sexual characteristics—removal of the breasts for transgender men, removal of the penis and testes for transgender women—along with medical documentation. Previous guidelines required the removal of the uterus and ovaries or the construction of a penis or “some form” of it for female-to-male transition, and the removal of the penis and testes and the construction of a vagina for male-to-female transition.

“We are still concerned about the heavy emphasis on sex reassignment surgeries being a requirement,” Wong Hiu-chong, the lawyer for transgender activist Henry Tse , whose case led to the policy change, told TIME. “SRS can be life threatening.”

Those who wish to change their gender markers must also statutorily declare that they have gender dysphoria—the medical term for the psychological distress a person feels when their gender identity does not match with their assigned sex at birth—and have lived as the opposite sex for at least two years before their application. They must also show proof of receiving hormonal treatment throughout the previous two years, and will be subjected to random blood tests to check their hormonal profile.

“Our clients have waited a very long time for such an unconstitutional policy to be revised, and for them, the wait has been painful,” Wong said in a statement. She also questioned the need for blood tests, calling this requirement, among others that remain for gender marker changes, “potentially discriminatory” as it does not apply to other Hong Kong ID card holders.

A government spokesperson clarified in the announcement that the gender marker change will only apply to the Hong Kong Identity Card and that “the sex entry on a Hong Kong identity card does not represent the holder’s sex as a matter of law. It does not affect any other policies of the Government or the handling of any other gender-related matters under the law in Hong Kong or relevant legal procedures.”

The policy change comes years after Tse filed a case in 2017 to question the full gender-affirming surgery requirement. Despite the city’s Court of Final Appeal issuing a ruling deeming the requirement unconstitutional in February 2023, implementation of the ruling was long-delayed, which Tse also challenged . The ruling said “such surgical procedures are at the most invasive end of the treatment spectrum” and that “full SRS is not medically required by many transgender persons whose gender dysphoria has been effectively treated.”

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Hong Kong transgender men win appeal over status change

Transgender activist Henry Edward Tse speaks to reporters outside of Court of Final Appeal in Hong Kong, Monday Feb. 6, 2023. Hong Kong’s top court ruled Monday that full sex reassignment surgery should not be a prerequisite for transgender people to have their gender changed on their official identity cards, in a move that is likely to have a far-reaching impact on the transgender community. (AP Photo/Anthony Kwan)

Transgender activist Henry Edward Tse holding a sign written ‘Legal Victory’ and a flag of transgender identity poses for a photograph outside of Court of Final Appeal in Hong Kong, Monday, Feb. 6, 2023. Hong Kong’s top court ruled Monday that full sex reassignment surgery should not be a prerequisite for transgender people to have their gender changed on their official identity cards, in a move that is likely to have a far-reaching impact on the transgender community. (AP Photo/Anthony Kwan)

Transgender activist Henry Edward Tse holding a sign written ‘Legal Victory’ and a flag of transgender poses for a photograph as he speaks to reporters outside of Court of Final Appeal in Hong Kong, Monday, Feb. 6, 2023. Hong Kong’s top court ruled Monday that full sex reassignment surgery should not be a prerequisite for transgender people to have their gender changed on their official identity cards, in a move that is likely to have a far-reaching impact on the transgender community. (AP Photo/Anthony Kwan)

• Copy Link copied

HONG KONG (AP) — Hong Kong’s top court ruled Monday that full sex reassignment surgery should not be a prerequisite for transgender people to have their gender changed on their official identity cards, in a move that is likely to have a far-reaching impact on the transgender community.

A transgender activist, Henry Edward Tse, and a person identified only as Q appealed to the court last month over the government’s refusal to change the genders on their ID cards because of their decision not to have full sex reassignment surgeries.

Tse and Q are both transgender men who have had their breasts removed, received hormonal treatments and lived their lives as males with professional support and guidance as well as psychiatric treatment.

The judgment by the Court of Final Appeal is expected to have a wide impact on the LGBTQ community because many of its transgender members consider having the operation unnecessary and risky.

The two went to court because existing government policy only allows transgender men to change their official gender if they have removed their uteruses and ovaries and constructed male genitalia. Only those who cannot undergo the surgical procedures due to medical reasons can be exempted.

Both the Court of First Instance and the Court of Appeal dismissed judicial review proceedings brought by Tse and Q. The two were allowed to go to the Court of Final Appeal.

In a judgment made public Monday, the court said the government’s policy was unconstitutional and imposed an “unacceptably harsh burden.” They also said that the policy was “disproportionate” in its encroachment upon the rights of the two to gender identity and physical integrity.

The judges also said any administrative issues that usually arise tend to pertain to a transgender person’s outward appearance and not the appearance of their genital area, and that leaving the gender on their identity card unamended “produced greater confusion or embarrassment.”

Tse welcomed the ruling, saying many transgender people have been longing for a “final victory” for years.

“Now I have a male ID card, it will be a lot easier for me to access gender-segregated spaces,” he said. “I wouldn’t be questioned and humiliated by being outed by my ID that’s incongruent to who I am.”

Liam Mak, co-founder and chairperson of local transgender youth organization Quarks, described the win as an “important milestone” for the transgender community in Hong Kong.

“We believe that the gender identity of oneself should not be tied to medical intervention, we should ensure minimal to no medical intervention in the policy,” said Mak. “Given that every individual has different preferences or decisions in their own gender transition journey, I hope that the government will be referencing the advice from the court to protect the right of all transgender people.”

Associated Press journalist Alice Fung contributed to this report.

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Bernard Hibbitts

The Hong Kong government revised on Tuesday the Hong Kong ID cards sex entry policy. After the revision, individuals who have not completed full sex reassignment surgery may apply to change the gender marker on their identity cards.

After the revision, preoperative transgender individuals may still apply for an amendment if the individual has completed surgical treatment such as the removal of breasts or removal of the penis and testes. The individual must also make a statutory declaration to confirm they have gender dysphoria, have lived in the opposite sex throughout the period of at least two years before the application, and will continue to live in the opposite sex for the rest of their lives. In addition, the individual must also have received hormonal treatment for two years before the application is made and must confirm that they will continue to undergo hormonal treatment and submit blood test reports when required by the Director of Immigration.

The government reiterated that the change to the gender marker on Hong Kong ID cards does not represent the holder’s sex as a matter of law. It also does not affect other government policies or the handling of any other gender-related matters under the law.

To apply for an amendment to the gender marker on the Hong Kong ID cards, the government previously required transgender individuals to undergo full sex-reassignment surgery. In February 2023, the Hong Kong Court of Final Appeal ruled that the requirement was unconstitutional. The court held that requiring transgender individuals to undergo the most invasive surgical intervention in the range of treatments for gender dysphoria went to far because it may be medically unnecessary. The court, therefore, required the government to present a more compelling reason to uphold the policy. Consequently, the court also held that a full sex reassignment surgery is not the only workable, objective and verifiable criterion to determine the application to change gender marker.

International human rights experts came up with the Yogyakarta Principles in 2006. Principle 3 provides for the right to recognition before the law. It specifically states, “[E]ach person’s self-defined sexual orientation and gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom.” Principle 3 also provides that undergoing medical procedures should not be a requirement for legal recognition of people’s gender identity.

Requirements for legal gender recognition vary among different countries. South American countries such as Argentina, Brazil, Uruguay, Colombia and Ecuador have already provided legal gender recognition by self-determination. The revised policy adopted by Hong Kong is similar to the UK Gender Recognition Act 2004 , except with an additional requirement of having completed certain surgical treatments.

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Transgender men win Hong Kong court case over ID cards

HONG KONG — Hong Kong ’s top court ruled Monday that full sex reassignment surgery should not be a prerequisite for transgender people to have their gender changed on their official identity cards, in a move that is likely to have a far-reaching impact on the transgender community.

A transgender activist, Henry Edward Tse, and a person identified only as Q appealed to the court last month over the government’s refusal to change the genders on their ID cards because of their decision not to have full sex reassignment surgeries.

Tse and Q are both transgender men who have had their breasts removed, received hormonal treatments and lived their lives as males with professional support and guidance as well as psychiatric treatment.

The judgment by the Court of Final Appeal is expected to have a wide impact on the LGBTQ community because many of its transgender members consider having the operation unnecessary and risky.

The two went to court because existing government policy allows transgender men to change their official gender only if they have removed their uteruses and ovaries and constructed male genitalia. Only those who cannot undergo the surgical procedures due to medical reasons can be exempted.

Both the Court of First Instance and the Court of Appeal dismissed judicial review proceedings brought by Tse and Q. The two were allowed to go to the Court of Final Appeal.

In a judgment made public Monday, the court said the government’s policy was unconstitutional and imposed an “unacceptably harsh burden.” They also said that the policy was “disproportionate” in its encroachment upon the rights of the two to gender identity and physical integrity.

The judges also said any administrative issues that usually arise tend to pertain to a transgender person’s outward appearance and not the appearance of their genital area, and that leaving the gender on their identity card unamended “produced greater confusion or embarrassment.”

Tse welcomed the ruling, saying many transgender people have been longing for a “final victory” for years.

“Now I have a male ID card, it will be a lot easier for me to access gender-segregated spaces,” he said. “I wouldn’t be questioned and humiliated by being outed by my ID that’s incongruent to who I am.”

Liam Mak, co-founder and chairperson of local transgender youth organization Quarks, described the win as an “important milestone” for the transgender community in Hong Kong.

“We believe that the gender identity of oneself should not be tied to medical intervention, we should ensure minimal to no medical intervention in the policy,” Mak said. “Given that every individual has different preferences or decisions in their own gender transition journey, I hope that the government will be referencing the advice from the court to protect the right of all transgender people.”

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• Copy URL https://www.pbs.org/newshour/world/hong-kong-transgender-men-win-appeal-over-id-status-change

Hong Kong transgender men win appeal over ID status change

HONG KONG (AP) — Hong Kong ’s top court ruled Monday that full sex reassignment surgery should not be a prerequisite for transgender people to have their gender changed on their official identity cards, in a move that is likely to have a far-reaching impact on the transgender community.

A transgender activist, Henry Edward Tse, and a person identified only as Q appealed to the court last month over the government’s refusal to change the genders on their ID cards because of their decision not to have full sex reassignment surgeries.

Tse and Q are both transgender men who have had their breasts removed, received hormonal treatments and lived their lives as males with professional support and guidance as well as psychiatric treatment.

The judgment by the Court of Final Appeal is expected to have a wide impact on the LGBTQ community because many of its transgender members consider having the operation unnecessary and risky.

READ MORE: Report says at least 32 transgender people were killed in the U.S. in 2022

The two went to court because existing government policy only allows transgender men to change their official gender if they have removed their uteruses and ovaries and constructed male genitalia. Only those who cannot undergo the surgical procedures due to medical reasons can be exempted.

Both the Court of First Instance and the Court of Appeal dismissed judicial review proceedings brought by Tse and Q. The two were allowed to go to the Court of Final Appeal.

In a judgment made public Monday, the court said the government’s policy was unconstitutional and imposed an “unacceptably harsh burden.” They also said that the policy was “disproportionate” in its encroachment upon the rights of the two to gender identity and physical integrity.

The judges also said any administrative issues that usually arise tend to pertain to a transgender person’s outward appearance and not the appearance of their genital area, and that leaving the gender on their identity card unamended “produced greater confusion or embarrassment.”

Tse welcomed the ruling, saying many transgender people have been longing for a “final victory” for years.

“Now I have a male ID card, it will be a lot easier for me to access gender-segregated spaces,” he said. “I wouldn’t be questioned and humiliated by being outed by my ID that’s incongruent to who I am.”

Associated Press video journalist Alice Fung contributed to this report.

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Hong Kong’s top court rules surgery is not needed to register gender change

HONG KONG — Hong Kong’s highest court handed down a landmark ruling Monday that will allow transgender people to amend their gender listing on their identity cards without undergoing full reassignment surgery.

Activists said the decision sets a positive tone for future debates on transgender rights in Hong Kong, but they called for gender recognition legislation as the crucial next step to protect their rights.

The Court of Final Appeal ruled that the government had breached the rights of two transgender people when it rejected their applications to have their gender listing changed on their ID cards because they had not undergone full reassignment surgery.

The case means that transgender people will now be able to access activities as simple as bank services or gender-segregated facilities such as gyms or toilets without having to worry about being humiliated, embarrassed or outed.

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The legal challenge was brought in 2019 by Henry Edward Tse and another person — who was identified only as “Q” — against the Commissioner of Registration after an official refused to review their gender status on their Hong Kong identity cards. The two transgender men have successfully amended their gender markers on their British passports.

In 2019 and 2022, two lower courts in Hong Kong rejected Q and Tse’s appeal, siding with the government that a transgender person is required to undergo full sex reassignment surgery to amend their gender marker.

The procedure for Q and Tse would include the removal of the uterus and ovaries and the construction of male genitalia, surgery that Tse said could be risky and lead to complications. The challenge asked to scrap such a prerequisite.

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In a judgment released Monday afternoon, the court reasoned that the kind of “incongruence” that most commonly causes problems for transgender people arises from discordance “between the gender marker and a transgender person’s outward appearance,” and not the appearance of the “genital area.”

“The policy’s consequence is to place persons like the appellants in the dilemma of having to choose whether to suffer regular violations of their privacy rights or to undergo highly invasive and medically unnecessary surgery, infringing their right to bodily integrity. Clearly this does not reflect a reasonable balance,” the court wrote.

In Taiwan, Pride is a potent mix of LGBTQ and democratic rights

Hong Kong’s struggle over transgender rights has been primarily advanced through battles in court. In another landmark case, in 2013, the Court of Final Appeal decided that a transgender woman who had undergone full sex reassignment surgery was entitled to marry as her acquired gender. Following the case, the city launched a public consultation in 2017 to explore the possibilities of creating gender recognition laws, but no further action was taken.

Compared with other Asian countries, Hong Kong falls somewhere in the middle in terms of transgender rights, said Kelley Loper, director of the Master of Laws in Human Rights program at the University of Hong Kong.

India affirmed the right to gender self-determination in previous court cases; Taiwan in 2021 stripped the surgery requirement for legal gender change. Last year, China scrapped the conditions of psychiatric treatment and counseling and lowered the minimum age for trans youth to access gender reassignment surgery, according to the China Project .

Elsewhere, Argentina was the first among 30 countries that adopted gender recognition laws, allowing self-declaration of one’s perceived gender identity, without the need for medical evidence. In the United States, the State Department moved to allow a third gender option in passports in 2021, but anti-trans laws in individual states are increasing.

Anti-trans laws are on the rise. Here’s a look at where — and what kind.

Loper said that although Monday’s ruling is a significant step toward better protection of transgender people in Hong Kong, there is still a long way to go. She noted that the city still does not recognize nonbinary gender categories, unlike many other countries.

“Hopefully this decision will spark or restart discussion about gender recognition in Hong Kong and what sort of legislation may be needed,” she said.

In Hong Kong, half of transgender people report facing discrimination in their everyday lives, with more than 70 percent of respondents saying they had contemplated suicide, according to a 2021 study by the Sexualities Research Program at the Chinese University of Hong Kong.

Suen Yiu-tung, associate professor of gender studies, led the research and said that Monday’s court ruling dispelled many commonly held ideas about transgender people. But Suen called it a “limited victory” because it focused narrowly on the ID card as an administrative document and “does not involve dealing with legal gender recognition more widely.”

Pressure for change has grown over the past two years, from advocacy organizations such as Tse’s Transgender Equality in Hong Kong and Quarks .

Tse believes self-determination of one’s legal gender is a fundamental human right. Outside the court Monday, he said the ruling was “delayed justice.”

“We all dreamt that we will not be outed by our ID cards anymore, that we will no longer be rejected to cross borders and come back to Hong Kong, our home, and be stripped of our rights to marry and establish a family with the opposite sex. In every aspect of everyday life, our dignity has been damaged,” Tse said. “This case should never have happened in the first place.”

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Hong Kong transgender men win appeal over status change

THE ASSOCIATED PRESS

February 7, 2023 at 12:50 JST

HONG KONG--Hong Kong’s top court ruled Monday that full sex reassignment surgery should not be a prerequisite for transgender people to have their gender changed on their official identity cards, in a move that is likely to have a far-reaching impact on the transgender community.

A transgender activist, Henry Edward Tse, and a person identified only as Q appealed to the court last month over the government’s refusal to change the genders on their ID cards because of their decision not to have full sex reassignment surgeries.

Tse and Q are both transgender men who have had their breasts removed, received hormonal treatments and lived their lives as males with professional support and guidance as well as psychiatric treatment.

The judgment by the Court of Final Appeal is expected to have a wide impact on the LGBTQ community because many of its transgender members consider having the operation unnecessary and risky.

The two went to court because existing government policy only allows transgender men to change their official gender if they have removed their uteruses and ovaries and constructed male genitalia. Only those who cannot undergo the surgical procedures due to medical reasons can be exempted.

Both the Court of First Instance and the Court of Appeal dismissed judicial review proceedings brought by Tse and Q. The two were allowed to go to the Court of Final Appeal.

In a judgment made public Monday, the court said the government’s policy was unconstitutional and imposed an “unacceptably harsh burden.” They also said that the policy was “disproportionate” in its encroachment upon the rights of the two to gender identity and physical integrity.

The judges also said any administrative issues that usually arise tend to pertain to a transgender person’s outward appearance and not the appearance of their genital area, and that leaving the gender on their identity card unamended “produced greater confusion or embarrassment.”

Tse welcomed the ruling, saying many transgender people have been longing for a “final victory” for years.

“Now I have a male ID card, it will be a lot easier for me to access gender-segregated spaces,” he said. “I wouldn’t be questioned and humiliated by being outed by my ID that’s incongruent to who I am.”

Liam Mak, co-founder and chairperson of local transgender youth organization Quarks, described the win as an “important milestone” for the transgender community in Hong Kong.

“We believe that the gender identity of oneself should not be tied to medical intervention, we should ensure minimal to no medical intervention in the policy,” said Mak. “Given that every individual has different preferences or decisions in their own gender transition journey, I hope that the government will be referencing the advice from the court to protect the right of all transgender people.”

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Why Hong Kong’s underage trans teens want age limits for the city’s gender clinic scrapped

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Transgender teens in Hong Kong say they have been “cast adrift” by years-long waits for lifechanging treatment at public hospitals, as government policy bars doctors from offering transgender health services to patients under the age of 18. 

“A few members who were turning 18 in a couple of days were turned away from booking an appointment at the Gender Identity Clinic (GIC),” Liam Mak, the co-founder of Quarks, a local organisation providing peer support to young transgender individuals and promoting awareness through public education, told HKFP. 

Many of those who turn to Quarks are underage pupils. They speak of shared experiences, such as being unable to get a foot in the GIC’s door before entering adulthood and frustration at the long waiting times once they do. 

“There was nothing I could do but to wait. That’s the policy,” said Mak, 20, with a sigh. Mak struggled with his gender identity since he was in pre-school, feeling the sex he was assigned at birth was a mismatch. 

Mak began his gender transition with hormone replacement therapy (HRT) when he turned 18 in 2019, two years after he first sought treatment at a public hospital. Gender-affirming hormone treatment aims to align a person’s physical characteristics with their gender identity.

“I have always regretted not having HRT earlier,” Mak said. 

The GIC, the city’s first and only one-stop gender clinic at the Prince of Wales Hospital in Sha Tin, has been providing services to adults with issues relating to gender since 2016 through a team of psychiatrists, surgeons, endocrinologists, social workers, therapists and more. 

Patients undergo psychological assessments, a basic physical examination and hormonal tests to establish a diagnosis. Psychiatrists may make referrals to endocrinologists for HRT, according to each patient’s clinical situation and personal wishes. And patients will experience a minimum of 12 months “real life experience,” or living in the gender role that is congruent with their gender identity, before potentially undergoing gender confirmation surgery. 

However, the gender clinic has a strict age limit and will not provide services to patients under 18. 

Internationally, the question of when a minor can begin to transition continues to inspire debate. Guidelines drafted by experts from the World Professional Association for Transgender Health (WPATH) last December recommend that adolescents not only undergo rigorous mental health assessments, but that they show “several years” of “well-documented… evidence of persistent gender incongruence or gender nonconformity/diversity” before receiving hormones or having surgery.

The document also notes the issue of “informed consent,” adding that gender affirming treatment may only be offered if an “adolescent demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.” Internationally there is no agreed age limit at which minors can pursue treatment without a parent or guardian’s approval.

Additionally, changes associated with many of the procedures involved in transitioning can be long-lasting or even irreversible. As a result, doctors and health experts remain divided on when treatment of minors should begin.

In the UK, under 18s seeking treatment for gender identity issues will usually be referred to clinics under the Gender Identity Development Service, run by publicly funded healthcare system the National Health Service (NHS).

“Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty,” the NHS website states. Some patients will be referred to a hormone specialist if they meet “strict criteria,” but the emphasis remains on psychological support.

The UK’s “largest and oldest” gender clinic operated by the NHS accepts referrals from those aged 17, but does not offer appointments before a patient’s 18th birthday. 

Veteran psychiatrist Dr Gregory Mak, who worked at the Prince of Wales Hospital from 2008 to 2012, told HKFP why he believed treatment at Hong Kong public hospitals was inaccessible to under 18s. “Because of the limited experience and manpower in the current public hospitals to serve a niche group,” he said. “It would involve a lot of family [work] compared with those transgender adults.”

Dr Mak, who specialises in treating people with gender identity issues, went into private practice in 2013. Around a quarter of his patients are trans teenagers. He said that in Hong Kong, many families struggle to accept that their children are experiencing gender identity issues, triggering difficult discussions and, possibly, damaging consequences.

Early intervention a double-edged sword?

“Many trans teens are actually very, very depressed about the growth of breasts, the enlargement of the penis,” Dr Mak said.

He said that “early intervention,” such as the prescription of puberty blockers, was becoming more common overseas as the distress of childhood gender dysphoria could be worsened by the sexual maturations of puberty. “Gender dysphoria” replaced the archaic diagnostic label “gender identity disorder” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, to remove the stigma associated with the word “disorder.” 

The UK’s NHS defines gender dysphoria as “a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity,” adding that it “may be so intense it can lead to depression and anxiety and have a harmful impact on daily life.” 

“Try[ing] to suppress or even stop… puberty changes… can give time for the clients to think clearly about the direction or the treatment that they want in future,” said Dr Mak. 

The WPATH guidelines advise that a patient should have reached the second Tanner stage of puberty, which is when physical changes become visibly apparent, and is at least 14 years old before receiving puberty blocking hormones. And while the Endocrine Society in the US suggests gender affirming therapy could start at 16 with the support of “an expert multi-disciplinary team that includes a mental health professional,” the age at which people can access hormone therapy varies globally.

However, Dr Willy Wong, a specialist in psychiatry, said that undergoing such treatment at a young age could be a double-edged sword, describing it as irreversible.

We have to be cautious in taking care of paediatric patients Dr Willy Wong, psychiatrist

“It is a big deal. There are some cases where young patients regret or have changed their mind… it is important to let them understand the decision and the consequences, for example taking hormones for the rest of their life,” Dr Wong told HKFP.

Dr Wong added more assessments were required when diagnosing gender incongruence and gender dysphoria in adolescents compared to adults. 

“We have to be cautious in taking care of paediatric patients,” Dr Wong said. A spokesperson for the Hospital Authority (HA) told HKFP that patients under the age of 18 were treated at child and adolescent psychiatry clinics near their homes, offering greater convenience when it came to attending follow-up appointments. The GIC only takes referrals once a patient turns 18. 

Quarks has urged the HA to consider scrapping the GIC’s age limit, however, the government body said it had “other considerations” and scarce resources. “We are still on a mission to end its underage ban,” said Mak from Quarks. 

Challenges facing trans teens

“The policy [that GIC is solely for adults] is utter nonsense. Underage trans teens also share the same medical needs,” said Yuki Liu, a 17-year-old trans girl who turned to a private clinic for hormone therapy two years ago after being unable to seek treatment at a public hospital. 

Despite the higher price, she decided to pursue treatment before turning 18. Liu spends more than HK$1,000 per quarterly visit, whereas consultations at a public hospital cost just HK$135 for the first visit, and HK$80 for subsequent appointments.  

“I really hate living as a boy. At least making changes in appearance comforts me,” said Liu.

Liu, who became uncomfortable with her assigned sex at birth when she was 14, experienced mental health problems and self-harm after being called “disgusting” by classmates.  

Doctors suggested that she speak to school counsellors, but Liu said that most of them did not have relevant knowledge or training in LGBTQ issues. 

“I was told to grin and bear it by the counsellors,” Liu told HKFP. “There was a time when I decided to grow my hair long, which stirred outrage among teachers. One of them asked me to wear a wig instead. I knew she was being helpful but it was heart breaking.”

Nearly half of transgender people in Hong Kong showed moderate to severe symptoms of depression and more than three-quarters contemplated suicide, according to a survey conducted by the Chinese University of Hong Kong in 2021. Half of the respondents experienced discrimination in employment, education, or the provision of goods and services.

Wing Tse, a counsellor from Pride Line, a 24-hour hotline providing support to Hong Kong’s LGBTQ community and their families, said Pride Line wanted young transgender individuals to know that they were not excluded from society. 

The hotline service comes with diverse counselling services, emotional support, and peer support groups. Tse suggested trans teens consider trying clinical psychological services offered by the Social Welfare Department or other NGOs. 

From July to September 2021, Pride Line received a total of 1,009 calls asking sexual orientation and gender identity-related questions.

Long waits for treatment

Hong Kong does not have official data on its transgender population, but according to the Food and Health Bureau, public hospitals saw on average 720 patients with “gender identity disorder” annually from 2015 to 2020, with attendance showing a rising trend. 

According to the HA, the provisional median waiting time for new routine cases to get an appointment at a psychiatric specialist out-patient clinic, such as the GIC, was 32 weeks in 2019-20. 

Dr Mak believed the waiting time for the GIC was longer than that because more patients were willing to seek treatment and there was a shortage of medical professionals. 

According to Quarks, the average wait for a new appointment at the GIC exceeded 43 weeks. The longest wait the organisation has heard of was nearly a year. 

“Doctors [at the] public hospital said I have to wait at least nine years to have the sex reassignment surgery. [It is] almost impossible to wait,” Lau Pui-laam, a co-founder of Quarks, who was planning to have transfeminine bottom surgery to remove her penis in Thailand, told HKFP. 

Lau said she had been told that between eight and 10 gender confirmation surgeries were performed at public hospitals each year. From 2010 to 2015, a total of 40 patients had full or partial sex reassignment surgery at public hospitals. Lau said had been placed on the waiting list for an appointment in 2031.

Demand for specialist psychiatric services has long exceeded what is available, with the attrition rate among full-time psychiatrists at public hospitals reaching 7.2 per cent in 2020. 

At a meeting with the HA last year, Quarks and Hong Kong-based concern groups Gender Empowerment, Transgender Equality Hong Kong, and the Association for Transgender Rights, called for an expansion of service capacity. The authority said the increase in average waiting time was due to staff loss, resources allocation and the Covid-19 pandemic.  

Greater gender inclusivity

In 2019, the World Health Organization followed the DSM-5 in announcing it would remove “gender identity disorder” from its global manual of diagnoses, reclassifying it as “gender incongruence,” and moving it from the “Mental and behavioural disorders” chapter into a new chapter, “Conditions related to sexual health.” 

Last year, the HA accordingly renamed the Gender Identity Clinic, once called the Gender Identity Disorder Clinic. The authority has pledged to foster a more inclusive and welcoming space by introducing gender-neutral public facilities in the redevelopment of the Prince of Wales Hospital, which is currently underway. 

Dr Mak urged the government to review the rights of transgender individuals and to put an end to stigmatisation and discrimination through public education. 

He also suggested offering more specialist training for doctors or healthcare professionals. Those who were interested, he said, should join international organisations such as the Asian branch of WPATH, Asia PATH, which provide regular training and supervision. 

“I hate to say [it], but transgender people are among the most marginalised, even within the LGBT community, and many of us really need help,” Lau said.

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Diversity・Equality・Inclusion

Legal gender recognition.

At present, there is no legislation in Hong Kong to recognize a person's changed, acquired or intended gender for all legal purposes. In some cases, gender changes can be recognized within the scope of identity, but not at the level of legal status. The current system is that a post-operative transgender person can apply to change the gender mark on his/her Hong Kong identity card, and he/she needs to provide medical evidence to prove that his/her gender has changed after a series of treatments.

In general, a person may, by virtue of a medical certificate, apply under Sections 14 and 18 of the registration of persons regulation ( cap. 177A of the laws of Hong Kong ) to change the gender mark on the Hong Kong identity card to reflect his or her reset gender. If sex reassignment surgery is performed outside Hong Kong, the medical certificate should state the medical qualifications of the doctor performing the surgery, the place of qualification and other contact information. If it is difficult to obtain the relevant certificate from a doctor who performed the replacement surgery outside Hong Kong, the applicant may request a registered doctor in Hong Kong to make an assessment of the replacement surgery performed.

The EOC expressed support for the Gender Recognition law legislation, arguing that the legislation should not provide for transgender people to complete sex reassignment surgery, and that the self-declaration approach is the best model for legislation. The intention is to respect the rights of transgender persons and to guarantee their rights to dignity, physical integrity and autonomy, consistent with international human rights standards. Amnesty International also supports a fast, transparent and accessible application process for those in need and a careful assessment when referring to foreign examples to prevent the introduction of regulations that have the opportunity to violate human rights.

The EOC submission stated that the Gender Recognition Act should not require transgender persons to receive a medical diagnosis, but should have the right to change their gender in order to respect their human rights. The council suggested that the authorities could consider requiring a transgender person's doctor or psychiatrist to make a statement that the person was receiving appropriate clinical treatment, which could be psychological counselling, but not hormonal or surgical treatment. The EOC did not agree with the British model, arguing that the British requirement for medical diagnosis, etc., is not suitable for Hong Kong. "The best model for gender identity legislation is one that allows self-declaration with no or only minimal medical requirements," the council said.

EOC Makes Submission on Consultation Paper by Inter-department Working Group on Gender Recognition (2018.01.02)

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Hong Kong LGBTQ activists upset at revised ID card gender rules

HONG KONG - Hong Kong will allow transgender people who have not completed full sex reassignment surgery to change gender on their ID cards, the government said on Wednesday, but activists are upset by strict new surgical and hormonal requirements.

The Court of Final Appeal last February unanimously sided with appeals launched by transgender activists that barring transgender people from changing their gender on their mandatory ID cards unless they undergo full sex reassignment surgery violates their rights.

The court ruling for activist Henry Tse and another appellant identified as Q was hailed as a victory for transgender rights in the Chinese-ruled city. Wednesday's announcement comes two weeks after Tse launched a legal challenge over the delay in allowing him to change his gender on his ID card.

Citing the February 2023 judgment, the government said in a statement that if people had not completed the full sex reassignment surgery but "satisfied the revised criteria and requirements, they may apply for a change of sex entry on their Hong Kong identity cards".

The revised requirements include the removal of breasts for transgender men, and removal of penis and testes for transgender women, which some activists say are too extreme. They must also undergo continuous hormonal treatment for at least two years before the gender change ID application is made.

Tse's legal representative, Wong Hiu Chong, said in a statement that they welcomed the revised policy but they are "concerned about the heavy emphasis on undergoing blood tests and submission of blood reports on hormone levels".

"We do not see the justifications, but the contravention of individuals’ rights, forcing them to take unnecessary medical tests and their right to privacy," Wong said.

Zephyrus Tsang, a director at Quarks, an organisation for transgender youth, said the surgical requirements were "a violation of the rights of physical integrity" of transgender individuals.

Christine Chu, a legal and operation manager at Quarks and a transgender woman, said that the new requirements were particularly unfair for transgender woman, as asking them to remove genitalia was "a forced sterilisation".

Hong Kong, a former British colony, returned to Chinese rule in 1997. Transgender individuals in Chinese society are still widely stigmatised, with crackdowns in recent years on LGBTQ activism. REUTERS

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