Challenges Facing Transgender Individuals in Taiwan’s Healthcare System
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This article is part of the 58th issue of LEAP — Voices of Youth e-letter. Subscribe now.
April 7 is World Health Day. This year’s priority theme emphasizes how health is a fundamental human right, regardless of gender, race, or identity, and how everyone should have access to high-quality healthcare. However, for Taiwan’s transgender community, their right to health is still not fully protected, resulting in many significant challenges in the daily lives of transgender individuals.
Many transgender individuals require both physiological and psychological medical assistance, such as hormone replacement therapy (HRT), gender-affirming surgery, and psychological support. However, the availability of medical support for transgender individuals still needs to be improved.
According to the Taiwan Tongzhi Hotline Association’s (TTHA) “2023 Taiwan Transgender Community Living Conditions Report” released this year, the top five issues of concern for the transgender community are: (1) the integration of transgender education into compulsory education, (2) subsidies or inclusion in national health insurance for gender confirmation surgery, (3) transgender-friendly healthcare, (4) decoupling gender identity changes from mandatory surgery, and (5) subsidies or inclusion in national health insurance for hormone therapy.
Going “in” a hospital and being forced to “com out”
From the TTHA survey, it can be inferred that Taiwan’s current medical environment is still not friendly enough to transgender individuals. Whether it’s the attitudes of medical staff, the accessibility of medical resources, the overall environment and atmosphere of medical facilities, or the gender-binary assumptions of medical instruments All these factors can continue to hinder transgender individuals from seeking medical care.
According to the TTHA survey report, 56% of transgender respondents have been called by medical staff using their assigned gender at birth while waiting for their appointments; 45% of transgender respondents find it difficult to explain their transgender identity to medical staff; and even 28% of transgender individuals avoid seeking medical care due to concerns about the unfriendly medical environment, such as facing misgendering or the awkwardness of being forced to come out.
One transgender (trans woman) individual once shared in a social media post that she had been feeling unwell for several days but hesitated to seek medical attention because she was worried that healthcare professionals would address her as “Mr.” when checking her health insurance card or related information, causing her extreme anxiety and embarrassment. However, as her symptoms did not improve, she reluctantly went to the hospital for treatment. Fortunately, everything went smoothly, and she was not treated differently by the medical staff in the consultation room.
The TTHA survey report and the above-mentioned case both indicate that although Taiwan’s medical institutions maintain a considerable level of professionalism towards transgender individuals, concerns and anxieties still exist. If more proactive efforts can be made to promote anti-discrimination measures in medical institutions or effectively reduce transgender individuals’ reluctance to seek medical care, it would further advance the goal of “Health for All”.
When gender identity does not match the legal gender
As mentioned earlier, the concerns of transgender individuals about medical institutions are due to the insufficient understanding of transgender issues among the public, leading to fear or rejection of situations where one’s gender expressions and legal gender do not match.
Since Taiwan has not yet passed legislation on “surgery-free legal gender change”, transgender individuals who want to change the gender on their identification cards must undergo stringent psychological assessments and complete genital removal surgery. Otherwise, the gender column on their identification cards will still be registered according to their assigned gender at birth.
When transgender individuals have to interact with various medical staff during registration, waiting, treatment, payment, and medication collection in medical environments, the pressure to come out and the suspicion of their identity are further increased due to being addressed based on their assigned gender at birth.
What matters to the transgender community
Improving the friendliness of the medical environment is a worthwhile goal — when the healthcare system recognizes the needs of everyone, it can best promote health.
The “2023 Taiwan Transgender Community Living Conditions Report” systematically summarizes the difficulties faced by transgender individuals when seeking medical care, pointing out the top five issues of concern for transgender individuals. These five issues are interconnected, and it is also necessary to understand the diverse appearances and needs of transgender individuals and explore the possibilities of connecting with the medical system.
Under the current regulations, the threshold for transgender individuals to change the gender column on their identification cards is extremely high. In addition to the cost of gender-affirming surgery and the physical pain involved, the pursuit for body modification by transgender individuals varies depending on the degree of gender dysphoria they experience. When the regulations still rigidly require “genital removal” as a threshold for changing the gender column, the anxiety and concerns that transgender individuals face in their daily lives and in medical institutions become difficult to fundamentally eliminate.
In addition to loosening regulations, healthcare professionals should have a higher level of gender sensitivity during clinical consultations and treatments, actively recognizing the gender identity of transgender individuals and addressing them in the manner they prefer to be addressed. This would be a significant step forward for Taiwan in advancing gender inclusivity.
Also in This Issue: Seeing the Needs of Transgender People — Taipei City Government’s Trans-Friendly Service Guidelines
In hopes of promoting trans inclusion, the Taipei City Government introduced guidelines for public servants on how to properly interact with trans people.
Author : Vivian May
Freelance journalist exploring gender and public issues.
