The Book of Transgender in Hong Kong

 

Preface

This is a handbook consolidated and translated from three of our Chinese booklets Gossip Boys & Girls series. The first booklet was published in 2012 as we found easy understanding information for Chinese readers was absent. Although there was quite a lot of information in English from western countries, we cannot just copy it from different contexts and cultures as the transgender community is so diverse all over the world. Another reason why we need to create our own book is that publications available are either produced by Transgender people, telling the outside world what people should do, or written by cisgender professionals or researchers.

 

Taking into consideration the general public’s perspective, Gossip Boys & Girls series were written in the language for the wider population. Gossip in Chinese is 是非. It also means Right and Wrong. Gender and sexuality of a person could always be the focus in gossips among people no matter you are LGBT people or not. What even worst is that transgender people are always judged by the others as “right or wrong”. Two of my best transgender friends were unable to bear the suppression and committed suicide one in 2004, followed by another one in 2008. Another gay friend of mine has committed suicide recently in Jan 2017. What caused them to make such a decision? Is it their fault being true to themselves? I hope this handbook laid out from the experience of a transgender person who has overcame those unspeakable difficulties in life will give you more insight about the transgender community in Hong Kong. 

 

The Basic Concept of Gender

Pronoun

To respect and embrace different gender identifications, we intend to use “singular they” throughout our booklet.

Singular they is the use in English of the pronoun they or its inflected or derivative forms, them, their, theirs, and themselves (or themself), as a gender-neutral singular pronoun. It typically occurs with an antecedent of indeterminate gender, as in sentences such as:

● "Somebody left their umbrella in the office. Would they please collect it?"

● "The patient should be told at the outset how much they will be required to pay."

● "But a journalist should not be forced to reveal their sources."

The singular they had emerged by the 14th century and is common in everyday spoken English, but its use has been the target of criticism since the late 19th century. Its use in formal English has increased with the trend toward gender-inclusive language.

source: https://en.wikipedia.org/wiki/Singular_they

 

Transgender Terms

There are quite some evolution on those terms used in the transgender community. For some reasons, more people started using Transman to replace FtM and Transwoman to replace MtF so as to address transgender individual in a more affirmative way naming only their desired gender identity but not the past history. Yet this may take time for cisgender people to get familiarized with the terms and we need to respect people who prefer different addressing.

 

We also used more “Trans” in recent years instead of Transgender person, Transman, and Transwoman, etc which is a more inclusive and non-binary term representing the diversity of the community in causal usages. But for this handbook, we intended to use more easy understanding terms for our readers who might not be familiar with this topic. More transgender terms can be found on Internet. We prefer to use different terms in different occasions for better understanding and mutual respect but not to focus only on our concern.

 

What is “Gender”?

Most people naturally think there are only male and female when we talk about gender. Yet have we ever thought about the implications of this seemingly incontestable binary definition? What is the correlation between gender and our daily life? Does gender give us an advantage or cause us trouble? 

 

Though “gender” and “sex” are actually the same word in Chinese, in fact the term “gender” carries different meanings and is seldom recognized by the Chinese culture. Sex refers to one’s biological and physiological characteristics, while gender refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women. These gender characteristics evolution and construction are the result of cultures and traditions, not innate. Those daily life gender manifestations, such as one’s appearance or clothing, are not physiological sex. It is rather a demonstration of gender that most people learned from imitation. 

 

Broadly speaking, gender could be categorized into gender identity, roles and expression.  In most cases, sociological and psychological gender cannot be defined by sex alone but more by one’s functionality and characteristics. Gender is a blending of masculinity and femininity and could be easier to be understood  through the concept of Chinese philosophy yin and yang. 

 

In fact, biological sex is not dichotomous. There are male and female, as well as asexual and androgyny in biological world, all of these determinations depends on the living condition and reproductive requirements. No doubt reproduction is an important condition for species to be preserved, but we must understand that the diversity of species in the world. Reproduction is only one of the functions, and not every individual must undergo the same process.

 

What is Transgender?

Transgender (TG) people are those whose gender identity, or behavior does not correspond with their assigned sex at birth or falls outside of stereotypical gender norms. Those conditions can be expressed or presented via the recognition of their own gender, perception of their body, social identity, family roles, intimate relationships, temperament, appearance and clothing, etc. Nonetheless, there are still people falling into this group that do not consider themselves as transgender. We need to respect the identification of every individuals and never impose labels on anyone. 

 

What is Gender Identity?

Gender identity is the innermost psychological perception of one’s gender. The gender identity of most people seems to be consistent with their assigned sex at birth, while transgender people undergo an incongruous or conflicted situation. Gender identity can be male, female, both or neither. Non-binary gender diversity do exist and there are agender, androgyne, bigender, genderfluid, etc. Indeed, most people may not fully meet the socially constructed stereotypical gender norms in some of their behavioral characteristics. They just conceal those experiences as we are are forbidden or taught not to go beyond these boundaries when we grow up.

 

The Concept of Sexual Orientation

Sexual orientation refers to being romantically, sexually, emotionally, or spiritually attracted to people of a specific sex (or gender). People in the society often experience emotionally and/or sexually attracted to people who are the opposite sex. For them, the relationship between the same sex people can only be limited to friendship. People may hear more about heterosexual, homosexual and bisexual as one of the sexual orientation. Bisexual refers to a person who is emotionally, and/or sexually attracted to people of both the same and opposite sex. This definition is based on binary gender and some bisexual persons might experience attraction toward different genders. Another term people are less familiar with is pansexual, where it refers to a person who experiences sexual, romantic and/or spiritual attraction for people of all genders or that gender is not a matter. Meanwhile, there are also people experiencing little or no sexual attraction to other and/or lack of interest in sexual relationship or behavior, i.e. asexual. 

 

It is roughly estimated that 10% of the population is homosexual. However, we are unable to understand the population of people of different sexual orientation until society is inclusive enough for non-heterosexual people to feel secure to express their identity freely. 

 

Why SOGIE?

This is a short form of Sexual Orientation, Gender Identity and Expression. The most recently usage is SOGIESC, adding Sex Characteristics at the end to represent the condition of Intersex status. When we talk about LGBT, we are talking about homosexual which is part of the sexual orientation and transgender which is also part of the gender identity. But for SOGIE, we are talking about the whole spectrum of sexual orientation, gender identity as well as gender expression without exclusion of anyone. For some topics like anti-discrimination, we should not only protect the rights of LGBT & I people and ignore the possibility that  straight and cisgender people will also suffer from discrimination in terms of their SOGIE status as well as Sex Characteristics.

 

Transgender

Transgender = Transsexual?

Not all transgender people wish or desire to alter their bodies through hormonal treatment or surgery to align with their gender identities. For some, crossdressing eases their inner struggle. Many factors such as environment, economic situation, and health status may determine how the individual wishes to live and express their gender identity. Therefore, it is hard to determine someone is a transsexual person or not. Transsexual is a person people who has strong and consistent desire to alter their own body to another sex. It’s not about their stage in transitioning or whether or not they have completed the sex reassignment surgery. There are post-op TS who has completed the SRS, pre-op TS who are in the transitioning process before the surgery and non-op TS who do not consider to have surgery at that particular moment.

 

Transgender vs Homosexual

Transgender is an understanding of the denial of one’s own body or gender, from the very own “self”. When we say someone is a transgender, we are dealing with the person’s gender identity, which should not be confused with that person’s sexual orientation.

 

When we talk about homosexuality, we are looking at a person’s sexual orientation determined by the gender who the person attracted to. Let us simplify the complex situation by eliminating transgender here and assuming there are only male and female. Homosexuals are attracted to people of the same sex while heterosexuals are attracted to the opposite.

 

Under general circumstances, homosexuals and heterosexuals only, excluding people who identifying as transgender, accept and affirm their bodies as well as gender identity. Some homosexuals like to be dressed as another gender but usually as a form of entertainment or gender expression. In most cases they do not feel anxious about their bodies and gender identity like transgender people. 

 

When it comes to transgender as the subject, it becomes more complicated to define whether the person is heterosexual or homosexual. Usually, it is based on their desired gender identity regardless of whether they have undergonesex reassignment surgery (SRS) or not. It is important to identify based on one’s personal perception instead of forcing someone to accept a certain sexual orientation or label. In the transgender community, there are heterosexual, homosexual, bisexual and other sexual orientations, but their proportion is still unknown. 

 

For transgender people, of course, their sexual orientation might have some implication on their own gender definition. However, in many cases, it affects more their attitude or decision to have SRS but not their gender identity. The complexity and close relationship between gender identity and sexual orientation has not only confused the public, but also created anxiety in many transgender people and made them hesitant about what course to follow. 

 

Beginning of the community

Transgender people have always been a hidden clan in society. Influenced by the West, society becomes more open and the Chinese tradition has become less restricted towards men’s roles and family lineage. In the 1970s and 1980s, young people became financially independent and autonomous, they can afford more time and space to contemplate and imagine about sex and gender. In 1990s, the Internet became more popular in Hong Kong and came the broadband era in 2000s. Some people who were anxious about their SOGIE status were able to search from a wealth of information on the Internet. They also found some local crossdressers and from all over the world. This encouraged them to explore and pursue their dream in life. The term transgender was not yet known by the community until later introduced by scholars and activists like Dr. Sam Winter who was the Associate Professor of the University of Hong Kong (HKU) for 12 years until 2013 working for transgender health and rights.

 

A group of experts led by Dr. Ng Man Lun in Hong Kong recognized the need for patients with transsexual desire. In consideration of that, they set up the first sex clinic in Queen Mary Hospital in 1979. This launched a new page on SRS in Hong Kong. Since then, news about transgender people was published in the media from time to time. Even so, transgender people were not been well accepted by society. They still encounter a lot of difficulties and anxieties in work and life. These resulted in the high degree of people who have undergone SRS to hide their identity or even commit suicide. It is still the case even today and in other countries as well. According to "Mental Health of Transgender People in Hong Kong", a survey released by Associate Professor of the Chinese University of Hong Kong, Dr. Suen Yiu-tung and Transgender Resource Center in 2016, over 70%of transgender youth had contemplated suicide.

 

There are a few transgender people who tried to find a way out from self-repression of late years. Embracing their identity with a positive attitude, they bravely disclose it to the public and the media. In the case of W v Registrar of Marriages in 2010, the coverage of the incident sparked public discussion about the rights of transgender people. It also indirectly increased the visibility of transgender people in society. 

 

In fact, the transgender population should be larger than we know. However, the only way to raise the awareness and understanding of society and the government for it to allocate resources and support, is to increase transgender people’s visibility. In view of this, in recent years concern groups are committed to reveal the reality of this community to the public. 

 

The History and Present Situation of the Community

In the past, the transgender community cannot actually be regarded as a community. Most transgender individuals can only chose to have a double life, living in pain and struggles, leaving them no strength to seek out or contact other fellows. In 2002, several transgender people founded Hong Kong’s first online forum for crossdressers, hkcdfamily. Stepping out from the dark, a huge number of members appeared in a sudden and hkcdfamily became the only transgender forum at that time. Later, three similar forums emerged: cdgal, cd paradise and TSense. The first two forums specifically catered for crossdressers and TSense targeted mainly for transsexual people.

 

It is always not easy to step forward from the virtual world to reality. At that time, led by doctors, several people who had undergone SRS in Hong Kong formed a liaison group. The number of members was as high as over 20 in the later stage, including expatriates and cisgender scholars. In 2004, the liaison group registered as a society in the name of “Transgender Equality & Acceptance Movement” (TEAM). However, the organization has become silent in recent years. 

 

 “Genderconcerns” was established in 2005 and it focuses on hotline service to transgender people. Over the same period, there was also a team known as 蛇王工作室, dedicated to transgender sharing among different organizations and schools. By 2008, a number of transgender people and scholars set up “Transgender Resource Center” to promote transgender concept and to provide services across the transgender community. 

 

After years of development, there are still approximately less than 200 transgender people who are willing to show their faces in the community. The development of the transgender 

community still requires the efforts and perseverance of the people concerned. 

 

Transgender Population

Owing to their low visibility, there is no clear figure of the transgender population in a given society. Therefore it is difficult to understand their situation by simple statistics. The situation also varies in different countries and cultures. For example, some countries are more open to the diversity of gender, this will make it easier for transgender people to be present in public. Transgender people in the developed countries where information is more accessible will be more likely to accept themselves as transgender, thus increasing their visibility in society. Meanwhile, there seems to be relatively less transgender people in certain countries in which there are threat of life on them. 

 

The major reason for the high degree of concealment of transgender people in the society is the fear of rejection and discrimination. Besides, patriarchy of the traditional Chinese culture also deters transgender people from disclosing their identity. According to the Hong Kong government, there are about 100 cases of SRS performed in in the public hospital so far. We also believe that more transgender people are having SRS in countries such as Thailand, Taiwan and the United States who lives in Hong Kong and the estimated number of Transsexual people who have completed SRS is about 200 to 300.

 

According to two online forums in Hong Kong exclusive for crossdressers, they have over 51,000 and 23,000 members respectively at the end of 2016. Most of the members were male-to-female crossdressers (i.e. people who identify themselves as female while assigned as male at birth). Taking out repeated registrations, non-transgender people and non-residents, etc, a conservative estimate of transgender population is over 10,000 to 20,000 in Hong Kong. The number does not include those transgender people who are female to male, did not have access to the Internet, and those who did not dare to register on the website. Some research estimated that one in every 300-500 persons in the population is transgender which is quite identical to our estimation.

 

Why are there more Male-to-Female (MtF) Transgender People?

According to statistics from around the world, the proportion of “male-to-female (MtF)” and “female-to-male (FtM)” is nearly equal. The data of Hong Kong government hospitals also affirms this proportion. Perhaps, higher visibility of MtF made people feel they are more in number. There are a few possible reasons we can think of: 

 

● With regard to local observation, FtM transgender people in Hong Kong tend to be more independent and they participate mostly in small group gatherings, while MtF prefers large group gatherings and their social circle is relatively wide. They confide in friends, welcome peer supports and their identity is known to more people. 

● FtM will become more masculine after taking hormones and their voice will also change. It is easier for them to adopt into usual daily life. Instead the change of MtF after taking hormones is sometimes less obvious and it takes a long time for them to go through the transitioning process. 

● The change of life and clothing of FtM in transition is easier to handle since the changes are usually undetectable. On the contrary, MtF may have experienced a lot of difficulties during the early crossdressing stage. They may encounter a lot of problems in life where they need to gather information and experiences from members in the community. This helps the building of a strong relationship with and facilitates the development of the MtF community.

● The changes of MtF during transition are obvious, the reaction and impression will be stronger and more profound. 

 

Difficulties in Life

The difficulties transgender people encounter in their lives are complex. Here let us simplify it into two parts. The first part is before they disclose their gender identity and the second part is after coming out or undergoing enormous change in their appearance and lifestyles, or the situation after completing SRS.

 

Transgender people usually conceal and suppress their feelings before they accept they are different and recognise their true identity in front of others as they do not believe that there are people who will understand them. They even believe they are abnormal or insane. It is hard for transgender people to have someone to talk to and they always feel lonely. They may force themselves to dress according to the social norm so as to cover up their true selves. By and by their suppressed feeling lurking deep inside may disrupt their lives. They become withdrawn or negative about life, and they are likely to hurt themselves or commit suicide. They will often attribute all unhappy incidents in life to their gender identity issue. 

 

When a transgender person begins to accept the other side of themself, their appearance and way of life are likely to change to a great extent. They have to face questions from family members, neighbours, relatives, friends, and colleagues. Sometimes they may feel uncomfortable even though the questioners bear no malice, since they may not be well prepared to face such in-depth and harsh questions. 

 

In addition, they also wish to dress and express in line with their gender identity in workplace. However, the company or colleagues may find it incongruous. They may also encounter difficulties when they dress up for job interviews. In particular, transgender people often have to face the embarrassment of using the toilet in public and in workplace. For those who have completed the SRS and have their identity documents’ sex marker changed, it presents no problem. However, before the surgery or when they are undergoing “Real Life Experience” (RLE) required by the sex clinic, it is very difficult for them to position their gender in daily life without the gender marker change on their ID card. For as simple as using the toilet, some may choose to use the one for the disabled, or simply try not to use the toilet in public places to avoid embarrassment and this often causes different health issues to them.

 

Religious belief may also be one of the challenges to be tackled. It may be a great impact to transgender people themselves, or to believers in the opposition group. 

 

Of course we have met transgender people who are positive about life and we hope their experience can encourage more people to come out of the haze and live a meaningful life. 

 

Discrimination

The degree of acceptance of transgender people in Hong Kong during the last two to three decades has increased, and the term “transgender” introduced to Hong Kong in recent years entailed a more positive image than the older terms. Previously men wearing women’s clothes are often known as the metamorphosis or “人妖” (human monster), or considered a criminal intent. Yet women in men’s wear seems not to be a big problem. 

 

However, since it is very difficult for transgender people to disclose their identity when they encounter discrimination situations and there are a great reluctance for them to report cases to proper channels, coupled with their low visibility in society, it is indeed hard to analyze the existing discrimination situation toward transgender people. 

 

From the experience of the community, there is less discrimination against transgender people in industry like design, IT and fashion while they encounter unpleasant experience more seriously in the workplace, job application, church, school, places of entertainment, immigration, detention and imprisonment, etc. 

 

Legal Protection

At present, there is no legislation in Hong Kong to protect the rights of transgender people. The existing Sex Discrimination Ordinance is not able to cover the situation of transgender people. Only those being diagnosed as "Gender Identity Disorder (GID)" can be protected by the Disability Discrimination Ordinance (DDO). The reason is that GID is classified as mental disease in Hong Kong which is in turn a transgender stigma. A recent update of "Diagnostic and Statistical Manual of Mental Disorder" (DSM V) by American Psychological Association in 2013 has replaced GID with Gender Dysphoria which eliminates the pathological implication of transgender status and hope Hong Kong will follow later.

 

Transsexual

Is Transsexual Psychotic?

Currently in Hong Kong and most countries in the world, people who want to have SRS are required to undergo psychiatric and psychological assessment for a minimum of two years. Once they are being diagnosed as having GID, they can be referred to the surgical department and schedule for SRS. Currently in Hong Kong, only government hospitals this surgery and the services was centralized in Prince Wales Hospital’s as Gender Identity Disorder Clinic in Oct 2016. 

 

The long history of the western countries using the old version of WPATH’s (named as the Harry Benjamin International Gender Dysphoria Association before 2006) Standards of Care for Gender Identity Disorders version 6 (SOC-6) and the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV ) as the blueprint made GID still a psychiatric disorder in some countries including Hong Kong. 

 

As a result of the action of the concerned parties, the world Professional Association for Transgender Health (WPATH) released the seventh version of SOC in late 2011. Taking the perspective of transgender people, numerous amendments and additions were made in order to clarify public’s misunderstanding of transgender people in the past. The removal of GID in DSM V clearly indicates that gender incongruence alone is not a mental illness. Yet the recent update of the SOC-7 and DSM V will not be effective in Hong Kong shortly and we hope with the efforts of the international experts in the field, there will soon be some changes.

 

There will be the new version of International Classification of Diseases (ICD 11) to be released in 2018 by WHO which will remove GID from the category Mental and Behavioural Disorders. The WHO proposes a ”gender incongruence” category under the new section 6: ”Conditions related to sexual health” which will further eliminate the stigmatization of transgender people.

 

The Stages of Self-discovery

From growing up to discovering themself, a transgender person may have gone through several stages. From birth to school age, they began to learn to differentiate between men and women. During the nursery period, teachers asked the boys and girls to line up separately to the toilet. All these lead them to query about their genders and their own gender. So in general, from four to eight years’ old, transgender kids began to realise their own differences. This is the Stage of Enlightenment.

 

Their whole school years are filled with endless self-doubt and struggles. This is an important stage of physical and mental development of oneself. Puberty could be one of the most difficult issues they will be encountered. If transgender children cannot accept being different and go their own way, they may live in pain and confusion. They cannot find anyone to talk to, nor do they know how to face the issues. They are also likely to be bullied at school. This is the Stage of Doubt.

 

When they began to understand their uniqueness, they will continue to explore their own needs. They will go everywhere to look for relevant information. When they become economically independent, they may begin to purchase clothing of the opposite sex. However, people in this stage are most likely to suffer from great pain and inner conflicts. It will be even more worse if they are in a relationship as it make things more complicated for them to deal with both their own gender issue as well as romantic love and sexual desire at the same time. They are constantly tortured by craving to be another sex and self-blaming, and many of them might contemplate suicide if they cannot find any support. This stage is regarded as Exploration and Struggles.

 

Some transgender people may seek help from social workers, counselors, doctors, and even the church. However, the public’s limited understanding of transgender people may sometimes even worsen the situation. In recent years, there are organizations established by transgender people and the emergence of inclusive churches providing a better support to this helpless group. Regardless of whether those people will eventually decide to undergo SRS, it is important to deal with their emotional and psychological needs, help them understand and accept themselves so they will live in a positive way.

 

Assessment Process for Surgery

In order to undergo SRS in Hong Kong, one needs to go through the required assessment procedure. Psychiatric and psychology assessments help determine whether the person is suitable for SRS. The whole process also involve professionals in occupational therapy, speech therapy, Genetics, Endocrinology, Gynecology, social worker and Legal Counsel. Prior to 2005, the "Sex Clinic" of the Queen Mary Hospital was responsible for the assessment of gender identity cases of all districts and providing one-stop services. However, the clinic was closed due to some doctors in the sex clinic retired and lack of resources. After that, services are supposed to be handled by hospital in its own cluster where the patients live but doctors were not trained to deal with such cases and there were only very limited support for people who have been anxiously waiting for SRS for almost 10 years. In the past few years, some doctors who are concerned with transgender people’s needs have been working hard to resume the assessment services in different clusters and finally the new Gender Identity Disorder Clinic was set up in Oct 2016 at Prince of Wales Hospital to provide integrated services for transgender people for all districts including SRS. 

 

Generally, the assessment process takes a minimum of two years. The most important part of the assessment process is Psychiatric and Psychological assessment, Hormone Replacement Therapy, and Real Life Experience. The lengthy process ensures the patient to have a clear understanding of their own needs to avoid making the wrong decision for an irreversible surgery.

 

Real Life Experience (RLE)

Those patients who are assessed will have to spend at least one year or more to live full time in their desired gender in order to assure that they can psychologically function in that gender role. The doctor will issue a letter certifying that the patient is being assessed and need to dress in their desired gender so as to avoid trouble when using the toilet or in other occasions. However, since the gender marker on their identity card cannot be changed at this moment without full SRS, they may encounter difficulties at work and in other circumstances. Therefore, the doctors will usually discuss with the patient for a partial RLE.

 

Hormone Replacement Therapy (HRT)

In the assessment process, doctor will start prescribing hormone replacement therapy to the patient once diagnosed with GID with no other major issues for SRS. HRT may be given by either oral or injection. The patient will experience a certain degree of physical and mental changes including the development of the secondary sex characteristics of the desired sex, such as breasts and a feminine pattern of hair, fat, and muscle distribution and other side effects. It cannot undo many of the changes produced by naturally occurring puberty. To some extent, some of these effects are reversible. This stage helps to determine if the patients are ready for the surgery and live in the opposite gender in the future. 

 

After the completion of surgery, the patient might require to continue the HRT as to keep the hormonal balance that the body needs. The side effects of medication vary from person to person and patients should decide whether to use it persistently or not. However, it is not necessary to take hormones for life.

 

Surgical Consideration

Sex reassignment surgery is the surgical procedures to alter the body  to align with their desired gender so that they look and function like the opposite sex. It usually involves genital reconstruction, but there may be other necessary surgeries including chest reconstruction or breast augmentation, facial plastic reconstruction, Adam’s apple reduction, or even vocal surgery. All these are to facilitate the patient’s integration into the new life after surgery.

 

The surgery is more complex than most people can imagine, and it involves the reconstruction of sexual organs. It’s more accurate to call it Sex Reassignment Surgery (SRS) or Genital Reconstruction Surgery (GRS) than people usually name it as Sex Change Surgery. There is a more progressive term called Gender Affirming Surgery being introduced in recent years.

 

The most important and complex part of the surgery is the reconstruction of sexual organs, which deals with the appearance and function of the sexual characteristics of their identified gender. Genital reassignment reshapes the genital by using their existing body parts and nerve tissue to build a tactile and resembling organ. 

 

Sex reassignment surgery for male-to-female is relatively simple. It usually includes breast augmentation, urethral displacement, penile and testicular resection, vaginoplasty (i.e. foreskin is inverted as a flap while preserving its blood and nerve supplies to form a fully sensitive vagina, and part of the glans of penis reshaped into a clitoris), labiaplasty (i.e. the scrotal tissue forms the labia majora and minora). In some cases, colon vaginoplasty may be a choice in which a section of sigmoid colon may be grafted in a vaginal lining that will form a deeper vagina with natural secretion. It also includes chondrolaryngoplasty (i.e. the thyroid cartilage is reduced in size by shaving down the cartilage through an incision in the throat). This series of surgical procedures is usually completed in one or two operations. 

 

Sex reassignment surgery for female-to-male is more complex. It usually involves a variety of surgical procedures including bilateral mastectomy (i.e. the removal of the breasts and the shaping of a male contoured chest with grafting and the reconstruction of the nipple-areola), and hysterectomy (i.e. the removal of the vagina, uterus and ovaries). After that, phalloplasty (i.e. the construction of artificial penis) will take place. The graft is usually taken from the arm, the leg, or the flap, bone, muscle and nerve tissues, and then transplanted to the appropriate location. It normally takes several large-scale surgeries to complete. Depending on the desired effect, different techniques for penile reconstruction will be employed. However, since phalloplasty is invasive, involves higher risk and with a low success rate, a lot of people will choose to have metoidioplasty/clitoral release or even not undergo a complete genital reassignment surgery.

 

Surgery is the Only Way Out?

For a person with gender dysphoria, living as another gender is a lifelong hope. The price for this is, however, extremely high until this moment in Hong Kong and in a lot of other countries. Apart from the invasive surgery, there is pressure from society as well as family and friends. For transgender people who do not opt for SRS, there seems to be no solution to their eternal quest. 

 

According to Transgender Resource Center’s understanding, the source of stress and anxiety of transgender people is a combined result of complex social and self-identity construction, intertwined with physiological and psychological factors. Issues are not only from within the subject’s own body and mind. And yet we must understand changes in the society do not take place in a fortnight. If transgender people sort out the issues they are facing and unite with their transgender movement counterparts, improvement of the environment for transgender people can be achieved more effectively.

 

In the past, issues and services related to transgender were being dominated by outsiders who lack understanding of and show little empathy towards transgender people. From medical, counseling to the legal system, the outsiders determine the fates of many transgender people. In recent years, leaders from the community have stood up in many places, leading the equality movements. The long-buried voices are heard. Visibility of the transgender community has been raised and more understanding from the public. Some public services also take into consideration the genuine need of the transgender community.

 

It is believed that in the near future, surgery is only one of the means for transgender people to express their identity and orientation, rather than the only way out. 

 

Gender Marker Change

All residents of Hong Kong who have undergone SRS in a recognized hospital in any country may submit application to the Immigration Department (IMMD) to change the gender marker on their identity card. Applications should be submitted together with a medical certificate issued by the doctor who performed SRS in accordance with the criteria set out below. Upon completion of the vetting process, the change of gender markers on other legal documents or certificates, such as passports, HKEAA certificates, banks, insurance, Mainland Travel Permit for Hong Kong and Macau Residents, driving licenses, etc. may follow. However, the mechanism of gender marker change in corresponding documents in some schools and organizations is absent, while change of gender marker in passports issued by other countries are subject to the provisions of that particular country.

 

The following are the criteria for the completion of SRS set out by the Immigration Department: 

(i) For sex change from female to male

removal of the uterus and ovaries; and

construction of a penis or some form of a penis

(ii) For sex change from male to female

removal of the penis and testes; and

construction of a vagina

 

Please refer to Q22 at www.gov.hk/tc/residents/immigration/idcard/hkic/faq_hkic.htm for more information. 

 

Post-Operative Life

In the past, most of the post-op TS have chosen to lead an entirely different life after the completion of SRS. They may conceal their past for fear of rejection or because they want to be more secure in a relationship. Their lives are no different from those ordinary people and they have developed their career in different fields. Their quality of life is not as bad as most people imagine. It is found that emotional anxiety is likely to arise in transgender people who shut themselves off lest their identity be revealed, this usually built up anxiety and unhappiness. On the contrary, post-op TS who keep a connection with the community are less stressed out in life and tend to be happier. 

 

Rumor has it that transsexualr people after SRS have a short life span but this argument is unfounded. Transsexual people were under a great pressure facing the stigmatization and discrimination from the society in the past. Some of them chose to end their life prematurely even after the surgery. There are also people suffering from overdose of hormonal treatment to keep their beautiful figure and at the same time keeping the functionality of their penis like those performing on stage and doing sex work in Thailand. They might encounter different kinds of health issues. After all, the real situation can only be revealed after more transgender people tell their own stories. 

 

Gender Recognition Ordinance

Although a transgender person can change the gender marker in all Hong Kong issued identity documents after the completion of SRS, as stipulated by the Immigration Department in accordance with its administrative guidelines. However, there is still no law that clearly defines the legal gender of a transgender person. After the vote down of the Marriage (Amendment) Bill by the Legislative Council in 2014, a transgender person who has completed SRS and has the gender marker changed on their identity card may still lawfully marry someone in the opposite sex in Hong Kong according to the judgement of the Court of Final Appeal. However, the gender status of the transgender people in all other laws is still in doubt. In 2014, the Government set up an Inter-Departmental Working group to study the legislation on the Gender Recognition Ordinance but no public announcements of the study was made until the end of 2016.

 

Crossdresser

Introduction

Crossdressing is the act of wearing the clothes of the opposite gender to express their dissatisfaction of their own. Crossdressing could be a kind of protest, or an external expression of their own feelings. To a crossdresser, sometimes it is a matter of beauty or the right fitting (sorry r i dun understand right fitting ar). It is a natural thing to do or sometimes they do not even have a choice.

 

This kind of choice may lead to certain social pressure or even persecution from the outside world. Xunzi said: “Nothing is originally appropriate, but accepted through common practice”. We cannot help but ask, who determines these boundaries? 

 

Crossdressing = Abnormal? 

Crossdressing denotes the act of a person who wears clothing of the opposite sex. Any person can have the experience of crossdress and it does not mean that there is any problem. As society continues to evolve, clothing of men and women is undergoing considerable alteration. Nowadays, clothing and fashion has become more gender vague. But in fact those identified as women’s clothing are originally men’s wear in some old days. The degree of societal acceptance for crossdressing varies for male and female. Females may be given more latitude than males for wearing clothing associated with the opposite gender. On the contrary, males in women’s outfits may be regarded as abnormal. 

 

Only a person who has the desire to wear clothes of the opposite sex with consistency either full time or part of the time will be regarded as crossdresser. Cross-dressers in most of the cases only define men who like to dress as women, while women dress up as men does not constitute a significant issue of identity in life. In Hong Kong, transgender people who do not have a transsexual desire or who do not have a strong and persistent sense of dysphoria with the sex assigned at birth are usually defined as crossdresser, which includes different sexual orientations. The proportion of heterosexual seems to be higher in this group of people due to reasons yet to be explored.

 

The cause of crossdressing desire in some people is not known yet. Many of them who crossdress describe it as an outlet for stress. After all, this may be related to gender identity anxiety but the extent of the influence is not strong enough for them to alter their bodies to align with the desired gender. 

 

Cross-dressers usually have a stable job, and their life is no different than others. They may have a partner or are married, or they may even be a father. Some of their family members understand their crossdressing behavior. Unfortunately, as crossdressing is still a taboo in society, their anxiety cannot be relieved no matter how hard they try. Actually crossdressers just, to a limited extent, wish to express their gender expression rather than disturb other people’s lives. It is more accurate to say that society is not inclusive enough of gender diversity than to say crossdressers are abnormal. 

 

Only Men Like to Dress as Women?

In the feudal society, the roles of men and women are very strict in both the West and in China, especially for women. Women are expected to stay at home and listen to what men tell them to do. Since coming out from the patriarchal world, women often present in masculine dresses, or do it as a form of political protest. 

 

Today, women’s attire sees a wide spectrum, from very feminine to very masculine. They can dress more masculine at any time won’t cause any troubles at all. It broadens the gender expression of women in quite some aspects yet not all. We cannot deny that there are women who crossdress. The butch women in the lesbian subculture are females manifesting more masculine traits. In Wikipedia, a tomboy is a girl who exhibits characteristics or behaviors considered typical of a boy, including wearing masculine clothing and engaging in games and activities that are physical in nature and are considered in many cultures to be unfeminine or the domain of boys. The reason why there is no known crossdressing women is that it is unnecessary to identify them as such. We only recognise them until these people express the need to alter their sex. 

 

Sexual Behavior and Crossdressing

In the past, crossdressers refers to men who love to wear women's clothing. They have neither the intention to alter their gender, nor are they homosexual. That means they are usually men who identity themselves as male and attracted to women. Crossdressing is only a habit or lifestyle, and more often linked with sexual behavior.

 

We cannot rule out such possibilities, in-depth study of the transgender groups showed many intricate relationships were previously not being observed and analyzed. In the past or even today, there are people who have desire to alter their sex, people who are heterosexual, homosexual, bisexual, and asexualin the crossdressing community. We are indeed unable to separate "crossdressing" and "transsexuality" in just two simple groups. Ignoring the complex uniqueness of an individual by causally labeling someone is equivalent to slander.

 

Let's start with the issue of sexuality. Supposed a man has sexual fantasies, needs, and even sex behaviors after crossdressing, we may mistakenly focus solely on his crossdressing and ignore the other external conditions. Crossdressing may only be one of the conditions arousing this person‘s sex drive. Sex drive for this particular person may not always involve crossdressing. And crossdressing behaviour for this person may not always involve sex drive.

 

Here is another example: I want to have sleep not because I was wearing pajamas, have spent three hours watching TV, it is now 11 pm or I have gone to toilet five times today. It was just that I feel sleepy and need to satisfy my hunger. People should not conjecture that I am sleepy as I was dressed in pajamas, as there is no cause-and-effect relationship between the two. Similarly, we should not blindly say that a person has sexual fantasies and desire for sex because of crossdressing. Whether or not there is a link between them really depends and a lot is still unknown to us. 

 

We also found that transgender people’s sexual desire level affects their determination to alter their gender. It does not affect the degree of desire for sex change but it is one of the factors being considered before making a decision.

 

No Need for SRS?

As mentioned, there are people who identify themselves as crossdressers wish to undergo SRS. From our interviews with crossdressers, we were surprised to find most of them wanted to be the opposite sex. Yet they felt that physically they do not qualify to be another gender and would not possible for them to do so. In addition, after weighing the pros and cons for themselves and for their families, some of them determinedly decided not to realize their own dream. Some of them think that they do not need it, or they think it is unnecessary to undergo invasion operation to change the body condition.

 

Self-recognition

Self-recognition among most crossdressers is rather low. Thinking that their desire of crossdressing is unusual, or even abomination. On the contrary, those with strong self-recognition believe that other people in society failed to understand their behaviours, causing them not to confess or reveal their identity. Innately they feel something wrong, but no matter how hard they try, they cannot get rid of the desire. Since they can only live in constant torment, they can only pretend to be a happy man.

 

Way Out

One of the key focus in the transgender movement is to facilitate this group to accept themselves and to look at life in a positive manner. Since it is impossible to change their tendency in crossdressing as we know, it is better to explore the bright side of it. No matter what, as long as crossdressing does not inflict harm on others, there is always a chance to make people understand.

 

Crossdressing can in fact be a form of art or a cultural expression. It takes tremendous skill and effort to look truly alike, expressing both the inner and external beauty of the gender they aspire to be. Transgender people have lived between both genders and always more sensitive and have a better understanding than other people about the divergences and contradictions between men and women. Use it well and we can benefit a lot of people in the world who are exhausted but still have to live their lives in the other gender.

 

Come Out

Come out of the closet

Come out is a figure of speech for LGBT people's self-disclosure of their sexual orientation and/or gender identity. Since disclosing their identity involves risk, coming out is usually the last resort. 

 

Major facets for coming out:

1. Coming out to friends: LGBT people is under a lot of stress and they may not have LGBT friends to support them. When they are still in doubt about their SOGIE issues or still exploring their identity, they might not feel comfortable in joining the LGBT community, nor will they seek relevant support services. For this reason, they need friends to listen to them. They usually talk to friends who are more trustful or who they are not closely related to in their network to minimize the risk.

 

2. Coming out to family: A few of the LGBT people may be alienated or even at feud with family due to their SOGIE issues. In any case, family is always family. There are also quite a lot of LGBT people who have close relationship with family like most people. It is hard for them to conceal their identity with those they love and ultimately hope their family can understand and accept them as they are. Family acceptance has a great impact on LGBT people as it allows them a great support to face the ups and downs in life. There is always family pressure to get married in traditional families and is  often a source of stress to LGBT people. Coming out to their family seems to be essential yet a big challenge. (For more on family relationships, please refer to the "Transgender Parents' Handbook" of Gossip Boys and Girls series).

 

3. Coming out in workplace: LGBT people who are positive about their identity and have confidence that both their employer and colleagues, they will have the courage to come out to the co-workers. On the contrary, in the absence of a safe and friendly environment, they are less willing to take the risks to lose their job or promotion opportunities. Working in a LGBT-friendly working environment releases a lot of stress for their daily life and in the same time boost up their potential and performance that benefit the company ultimately.

 

4. Coming out to church: In fact, there are many LGBT people concealing their identities in almost every church. They share the same beliefs in different religious like others. Some of them grew up in the church environment with their parents, and some joined the church for different reasons. In any case, unless the church does not take a discriminating stance against LGBT people, they are likely choose to leave or confess their identity due to the doctrine of the church. Unfortunately, some churches will force them to convert or not to tell anybody in the church so as to stay there. All these hurt their faith in their religious beliefs.

 

5. Coming out publicly: Publicly come out, or being an openly LGBT person mean that they do not conceal their identity to anybody but not necessary disclose their identity to the public, such as to the media. Usually LGBT people who are very well committed with their identity with a positive thinking, and well prepared to face attacks and challenges will ultimately come out publicly. Public disclosure is also a very powerful advocacy tool in the equality movement, but that person must has a deep understanding of the community and theoretical knowledge. They should also be a person with logical thinking and strong public speaking technique, otherwise they will very easily be under attack by both the public as well as from within the LGBT community.

 

6. Kicked out of the closet (by others): It is the act of disclosing an LGBT person's sexual orientation or gender identity without that person's consent while they are not ready yet.

 

Trans Ally

Introduction

Being a Transgender Ally one does not have to fully comprehend, understand or agree about what is transgender. What most important is to accept others who are different from you Believe that each individual is unique and should be respected. Everyone have inherent rights and obligations in society and should not be treated unequally due to their different sexual orientation or gender identity.

 

Trans Buddy

Trans Buddy denotes a friend or more than an ally of transgender people. Growing up, transgender people often experienced suppression of feelings and discriminations due to traditional moral and ethical values. They gradually formed a distrust of others, a self-defence mechanism. They often believe that no one will accept and understand what they want and will lead to different kind of difficulties in their life. The meaning of Trans Buddy is to encourage more people in society to be their supporters by entering into their life,  learn more about what is transgender, the community characteristics and the difficulties they have they have experienced in daily life. Advocating equal rights in daily life so that transgender people can live a better life. Be their friend so that they can be more confident to reveal and discover their true self, and thus able to choose the best way to live. Being a Trans Buddy, the most important is accompany and listening. Trans Buddy is definitely the guardian angel to every transgender person that let them dare to be who they are.

 

Whether you have LGBT people around you, or do not know if there are, you can follow some simple principles and become more LGBT-sensitive. You are not able to know whether there are any LGBT people in your life as in many cases they cannot be recognized simply by their appearance or behavior. This group of people will not open to you unless there is a safe environment. It’s all depends on you for such an environment.

Do’s 

● Listen patiently to their story, be prepared to learn and challenge your gender awareness with an open mind.

● Ask the person how they want to be called or addressed.

● Say something that encourages, such as "No matter what gender you are, you are always a good friend of mine", "What a company requires is a person's ability, not their gender".

● Talk about some positive LGBT icons.

● Display some LGBT-friendly publications, signs, rainbow flags etc. in a conspicuous place.

● Promote anti-discrimination messages to friends in a friendly manner; understand more about human rights awareness and the meaning of LGBT equality. Changes come from love and sharing, not coercion and blame.

 

Don’ts

● Don’t judge or discuss a person's SOGIE status or try to find out whether they are transgender, homosexual or not.

● Don't criticize or deny but respect their self-understanding when you are being told about their SOGIE status.

● Don't casually disclose their SOGIE status to others or even to their family unless you have their consent.

● Don't ask them to or help them to make a decision if they are still exploring their SOGIE status. Gender is non-binary and can be fluid. For gender-fluid people, they do not identify themselves as having a fixed gender. They may also change over time, environment or mood. Gender can also be undefined and doubting it is not anything wrong.

● Don't often stress or overemphasize gender stereotypes and binary sexuality, such as "men are strong" or "women should be feminine", etc.

● Even if you want to express your acceptance or friendliness, you shouldn’t keep mentioning their own SOGIE status, unless they initiate it.

● If you do not know about the status of someone, you should avoid gossiping or joking on their SOGIE status. You should be sensitive and pay attention to the reaction of others regarding the SOGIE topics.

● You should avoid using gender pronouns such as "Mr" or "Miss" towards LGBT people even if society generally considered it a courtesy to do so. It is better to make sure what pronoun a person prefers by asking them.

● Don't make assumptions about a person's other half must be the opposite sex, so avoid question like: "What is your girlfriend's job?" because this might embarrass others. You can try to use "partner" or "the other half" instead.

● Avoid any physical contact even the person is the same gender as you. You should be scrupulous with all people even though you understand their SOGIE status.

● Don't ask a person about their name used before, or ask to see their old photos, unless you know the person does not mind. Some transgender people are very concerned about their past or even feel disgusted with it. Mentioning it carelessly may hurt their feelings.

● Don't ask about the person's gender or their genitals condition unless you know it is ok to do so, and never make any judgement on that.

● The formation of identity and self-expression of transgender people vary from person to person and the process of exploration and transitioning is always different. We should not assume that a transgender person should achieve a certain standard or should entirely resemble the opposite gender, nor should one be forced to fit in with the social norm.

 

Hong Kong Transgender Legal Rights and Advocacy Timeline

*The timeline below shows only information we can collect at the moment and is not representing the whole history.

 

1. In 1985, the first sex reassignment surgery took place in Hong Kong.

 

2. In 1986, Queen Mary Hospital set up the very first Gender Identity Clinic in Hong Kong, led by Dr. Ng Man Lun. It provided one-stop assessment services to Hong Kong citizens who would like to undergo sex reassignment surgery. Members include clinical psychologists, psychiatrists, endocrinologists, gynecologists, urologists, social workers, genetics doctors, orthopedic surgeons and lawyers. 

 

3. In 1988, Dr Yuen Wai-cheung began to perform sex reassignment surgery in Hong Kong.

 

4. In 1998, 變性邊緣人 written by Ye Jiaming and Li Peien was published by SCMP Book Publishing Limited. 

 

5. In 2000, broadband Internet access became more common and the crossdressing community began to converge on the Internet. 

 

6. Around the year 2000, several people who underwent sex reassignment surgery in Hong Kong formed a liaison group (the predecessor of TEAM).

 

7. In 2002, the first large-scale forum for crossdressers, "hkcdfamily", established.

 

8. In June 2003, the renowned radio program host Hung Chiufung published his new book, 繾綣男女, which interviewed 10 persons including those who have desire to change their sex, underwent sex reassignment surgery and crossdressers.

 

9. In 2003, the term "transgender" was introduced in the community. Some of the transsexual people used this term to differentiate themselves from crossdressers which arouse some certain disputes within the community.

 

10. In 2003, effort made by transgender group and academics successfully requested the Immigration Department to remove the mark of gender change on the identity document.

 

11. 2004, the transsexual people liaison group was registered under the name “Transgender Equality and Acceptance Movement” (TEAM) as a non-profit-making organization.

 

12. In 2004, the community began to discuss the judicial review of the transsexual marriage rights to the Government, but was unable to find any litigants.

 

13. In 2005, Dr. Ng Man Lun retired, the only sex clinic for GID assessment was closed.

 

14. In 2008 Transgender Resource Center (TGR) was established.

 

15. In 2008, Miss W brought the case of transsexual marriage right to court for judicial review.

 

16. In 2009, W v Registrar of Marriages case was in session. With the extensive discussions in the community, Joanne Leung, chairperson of "Transgender Resource Center", standing out as a transgender lesbian Christian and received a lot media coverage. Transgender Resource Center has also begun to develop various supporting services to the group, as well as public education and advocacy projects.

 

17. In 2010, the Court of First Instance upheld the Registrar's decision on W’s case.

 

18. In 2011, the Court of Appeal dismissed the appeal of W’s case.

 

19. In 2011, Transgender Resource Center published the first Handbook: Gossip Boys and Girls Book 1 – Domestic Transgender Reading Manual.

 

20. In April 2012, the Immigration Department tightened the requirement for changing the gender marker on the ID card. The applicant must have completed the reconstruction of the genitalia and compulsory sterilization. Before the change, applicant only needs to show a letter from any surgeon in any country to certify the person has completed a sex reassignment surgery which could provide more flexibility.

 

21. In May 2013, the Court of Final Appeal overturned the Register’s decision and issued a stay in July to put the decision of letting W to marry her boyfriend on hold for a year to allow Government time to amend the law to give transsexual people the right of marriage after they change their sex. It also urged the Government to enact a comprehensive Gender Recognition Ordinance with reference to relevant laws of the United Kingdom.

 

22. In June 2013, the Government set up an Advisory Group on Eliminating Discrimination against Sexual Minorities, which included representatives of various stakeholders such as Joanne Leung, Siu Cho and Chan Chi-chuen.

 

23. In 2013, the Sexual Orientation Discrimination Legislation Front and Hong Kong Queer Alliance (HKQA) established, its aims to include sexual orientation and gender identity protection in the discrimination law. Transgender Resource Center is a member of the HKQA.

 

24. In 2013, to prepare for the Marriage (Amendment) Bill 2014 proposed by the Government, Transgender Resource Center and other LGBT, legal and human rights organizations organized seminars and discussions and put in much effort in lobby and advocacy work. Transgender Resource Center has a consent with the other LGB organizations of striving for no surgical requirements for transsexual people to acquire gender change on legal ID and recognize transsexual marriage is a heterosexual marriage which is not a stepstone for legalizing gay marriage.

 

25. In January 2014, the Equal Opportunities Commission launched the Study on Legislation against Discrimination on the Grounds of Sexual Orientation, Gender Identity and Intersex Status.

 

26. In February 2014, the Government submitted the Marriage (Amendment) Bill to the Legislative Council and set up an Inter-departmental Working Group to study the feasibility of the Gender Recognition Ordinance. However, the Government's proposal lacks public consultation and it was drafted based solely on the advice of one single expert who was the surgeon who conduct sex reassignment surgery in Hong Kong without enough knowledge on transgenderism and transsexualism. The draft was so crude that it aroused strong opposition from both groups who support as well as against transgender rights. It caused another round of extensive discussion and media coverage on transgender in Hong Kong.

 

27. In February 2014, Transgender Resource Center, Pink Alliance and Big Love Alliance formed a strategic front to express their views at the public hearing of the Government proposed Marriage (Amendment) Bill. There are also other transgender individuals, LGBT groups and anti-LGBT individuals made speeches also. Unfortunately the other transgender individuals expressed their support of full sex reassignment surgery as a prerequisite in the bill. Fortunately singer Denise Ho was one of the representative from Big Love Alliance gave a strong statement together with Joanne Leung and that became the focus of media coverage. Dr. Ng Man-lun, the first person to provide gender assessment in Hong Kong, opposed sex reassignment surgery as prerequisite, while Dr. Yuen Wai-cheung, insisted genital reconstruction was necessary which went against the prohibition of forced sterilization, advocated by United Nations and International Organizations. They have a very strong debate at the Legislative Council on the Marriage (Amendment) Bill.

 

28. In March 2014, TGR and TEAM received the letter from the World Association of Transgender Health Professionals (WPATH) to press the Government by supporting our position on no surgical requirement to acquire gender change for transgender people.

 

29. In March 2014, the Constitutional and Mainland Affairs Bureau has commissioned Policy 21 Limited (the Consultant) to conduct a study on whether sexual minorities are being discriminated against in Hong Kong.

 

30. In March and October 2014, Pink Alliance members and Joanne Leung went to Geneva, United Nations and gave a verbal presentation to CEDAW committee members on how transgender people were being oppressed in Hong Kong.

 

31. In 2014, Transgender Resource Center and Pink Alliance began a lobbying campaign for Legislative Council members who did not have a strong oppose to LGBT equality. They also met with senior officials of the Security Bureau who proposed the Marriage (Amendment) Bill in the hope that the Government would not press the Pro-establishment legislators to pass the Bill.

 

32. In July 2014, the government has made an announcement as it failed to pass a revised draft within one year according to the CFA order. The announcement stated that any person in the same situation as Miss W, that has undergone the government-mandated complete SRS, whether they are FtM or MtF, can register for marriage in Hong Kong with the opposite sex in accordance to their new gender.

 

33. In October 2014, the Marriage (Amendment) Bill was being voted down during the second reading by a majority. 

 

34. In 2015, Miss W's solicitor prepared for a judicial review for Mr Q, who is a Female to Male transgender person has not undergone sex reassignment surgery unlike Ms W.

 

35. In 2015, Transgender Resource Center published Gossip Boys and Girls Book 2 – A Handbook for Parents of Trans People.

 

36. On 31 December 2015, the Constitutional and Mainland Affairs Bureau published a two-year work report proposing a number of recommendation on safeguards against discrimination towards sexual minorities. However, no definite timetable has been set for legislative consultation.

 

37. On 26 January 2016, the Equal Opportunities Commission published the results of a study entitled "Report on Study on Legislation against Discrimination on the Grounds of

Sexual Orientation, Gender Identity and Intersex Status".

 

38. In February 2016, Transgender Resource Center published the Gossip Boys and Girls Book 3 – A Handbook for Trans Ally.

 

Author’s bio

Joanne was born as a boy in Hong Kong and completed her Sex Reassignment Surgery in 2009 after struggling for over 40 years. Yet she still insists to claim herself as a Transgender Lesbian Christian even after she has acquired her legal gender as a female. She is now a public figure in the LGBT movement devoted to the supporting works in the community as well as advocacy for LGBT and human rights in Hong Kong and Mainland China.

 

She founded Transgender Resource Center (TGR) in 2008 and have been the chairperson since then. The aim of the organization is promote public understanding and acceptance regarding the transgender community, and to provide resources and support for transgender people. She also took up the chair position of the leading LGBT organization Pink Alliance from 2015 to 2017 and brought the largest LGBT activity Pink Dot into Hong Kong.

 

In 2012, Joanne was selected one of the "45 People aged 45 or below making a difference in Hong Kong" by Baccarat Magazine and in 2013 she received the “She dare to change” Award by HER Fund. In 2016, Joanne has taken a big step forward in the LGBT movement by joining the Democratic Party as the first transgender politician in Hong Kong and participated in the Legislative Council pre-election trying to push for change not only for the LGBT community but a broader group of people in civil society.

 

In 2017, the U.S. Consulate Hong Kong and Macau selected Joanne as this year’s nominee for the Secretary’s International Women of Courage Award honoring women who have demonstrated exceptional courage, strength, and leadership in acting to improve others' lives. 

 

Nobody is born LGBTI
We are just born different
Those labels exist because
of "Prejudice"

 

This project is sponsored by
Equal Opportunities (Sexual Orientation) Funding Scheme
Any contents of this material do not represent the position of Government of HKSAR

 

本土跨性別閱讀手冊 – 香港版

Domestic Transgender Reading Manual – Hong Kong Version

 

自序

跨性別人士的性別身份,與及其性傾向的掙紮與含糊,都會很容易挑動一般被認定為社會主流價值觀人士的大腦神經,要由他們來定個是非對錯,或是罪與不罪!一個人是男是女,竟然會引來是是非非、流言蜚語,或多或少是社會對此群體的不認識與不理解,然而當局者又有多少能夠理解及認同到自身的處境呢?

原本申請政制及內地事務局 - 平等機會(性傾向)資助計劃時,只預備寫一份數頁紙的資料,向社會人士介紹關於跨性別族群的狀況,用以消除一些誤解。但後來只怪自己想的太多,一時間意隨氣發、筆隨心走,一寫就是萬多字的文章。原來以為可以有一組義工參與編寫工作,後來發現雖然網上相關資料不乏,但論及本地,適切地描寫本土的跨性別狀況的資料幾乎於無,那就只有閉門造車,以自身四十多年的血淚,與同行者的經驗,描摹成書,冀能出門合轍,裨益各方。

此前曾參與過香港舉辦的「真人圖書館」活動,感覺蠻有意思,作為一本真人的跨性別圖書,給人借閱,通過互動,讓讀者更能明白理解書中內容。願此書字裡行間,能給予大眾一個平易的管道,認識理解跨性別群體,就像一本閱讀手冊,讓您有一天遇上眾多獨特生命個體當中的一位跨性別朋友時,能夠好好細讀他精彩的生命故事。

此書能夠完成,首先要感謝參與此項目的 Eleanor Cheung,提供部份詞解內容及校對,Lucetta Kam 及Garry Kan 幫忙校對及給予意見、Elaine Mui 幫忙排版。另外也不得不感謝在我尋覓自我身份認同這條路上,給了我很大啟發與支持的一些朋友,Connie Chan、Momo Li、Dr. Sam Winter、何春蕤老師、Eleanor Cheung、Rose Wu、Diana Kwok、Kenneth Cheung、Lucetta Kam、Day Wong、小曹、慧琛、柏琛,前老板彭宏陵先生、前上司Leslie Wong女士、宏馬國際的一眾舊同事、我媽媽及多不勝數的朋友,沒有您們的支持,我不會走到今天。最後亦是最重要的,是要感謝一直與我同行,看顧帶領我的主耶穌,願榮耀頌讚歸予我們的父上帝!

梁詠恩 Joanne Leung

跨性別資源中心創辦人兼主席

2012年2月11日寫於香港馬鞍山

 

序一

There may be as many as 20 million trans people worldwide, with perhaps 11 to 12 million in Asia. Some are assigned male at birth but grow up identifying as female, others are assigned as female but grow up identifying as male. Still others grow up identifying as both male and female, or as neither, or indeed as a third gender. However they identify, their sense of their own identity challenges what we normally think of as male or female, or otherwise cause us to question our ideas of gender.

Throughout the world trans people find themselves living on a slope that leads from stigma and prejudice (rooted in ignorance and misinformation) towards social exclusion and life on the margins of society. Trans people fall victim to stigma and prejudice, experience discrimination, harassment, and abuse, and fall victim to violence. They get shunted out to the margins of society where, unable to get jobs or housing, and cut off from their families, they fall into poverty, get into risky situations and engage in risky patterns of behaviour. Their health and well-being, both emotional and physical, suffer. For too many the final point on the slope is sickness and/or death. And in all this governments seldom offer effective protection, and indeed sometimes aggravate the problem with laws and policies that are antagonistic towards trans people and make their situation worse. Health systems seldom provide trans people with the health care they need.

In many places worldwide trans people are mobilizing; going out into broader society to educate others about the trans experience. For several years Transgender Resource Center (TGR) has been doing this on behalf of the Hong Kong trans community. This excellent booklet is the latest in their efforts.

We all need to learn more about trans people. There are more of them among us then we tend to think, and it is high time we started to appreciate the diversity they bring to our human experience. I highly recommend this booklet to the HK public.

Sam Winter, Member of the Board of Directors, WPATH (World Professional Association for Transgender Health)

 

序二

Mandy當年十六歲, 樣子清秀可愛, 出生時是男孩, 自小便覺自己是女生,要求我用”她”來形容其性別。Mandy和男生一起感到格格不入, 反而跟女生很投緣。男同學排擠她,大叫:”女人型”, “不正常”, 老師也不阻止, 只叫她多做運動, 增强 “男子氣概”。她一向是成績中上的乖巧小孩, , 不明白為什麼會因為她喜歡做女孩子而受到如此不平待遇。情竇初開的Mandy對愛情充滿期待。平日多作男性打扮的她有一次打扮亮麗和一位男性朋友到處遊玩,男性朋友把她當作”小公主”, 對她百般呵護。Mandy覺得被那位男性朋友視為女性感到十分享受,可以隨心所欲做回自己。她說: “做女孩子真好!”

認識Mandy令我重新學習甚麽是性別, 也讓我體會到社會狹窄的性別定型如何令Mandy在成長階段嚐盡被排擠和歧視的苦頭。 社會上大部人常以性別兩分化(非男即女)的角度去理解我們的性別, 認為性別只有男和女兩種, 而男孩應有男子氣, 女孩應是女性化, 如果有些男孩是女性化而女孩有男子氣的話, 這些朋友們便被視為不自然, 或不正常, 遭受社會人士, 例如宗教人士, 老師, 社工, 甚至家人的誤解, 在日常生活中長年面對種種壓力和不公對待。Mandy做回自己的盼望是那麽真實, 她的成長經歷又有多少同伴和老師明白?

從Mandy的故事中, 我認識到性別不一定只有男女兩種, 也不一定是固定不變的。 有些人的性別像水一樣流動, 不止是男及女, 可以是 “又男又女”或同時具備男性化和女性化, 或多元性別的特質。跨性別人士便具此種性別特色。跨性別是一個多元的概念: 1) 它是指那些挑戰或超越性與性別界限的人士; 2) 它也可以是指一群天生性別與後天性別認同不一樣的朋友; 3) 以及那些透過手術或其他方法將其性別重新設定的朋友。跨性別朋友可以是任何一種性傾向,包括異性戀, 同性戀, 雙性戀等。跨性別現象亦非單一現象, 它在各個文化中展現, 在亚洲, 美洲, 歐洲, 非洲等世界各地均有跨性別群體。 多元性別是活生生存在的, 不容否定。在香港, 有許多人的性別是流動多元的, 卻苦於社會的偏見, 年年月月, 日覆一日默默承受不公平的對待, 不必要的壓抑。

西方英語世界有關跨性別的研究和書籍近年越來越豐富, 但在香港有關跨性別的中文出版文章不多, 跨性別朋友及其家人都缺乏中文資訊, 跨性別資源中心是推動香港華人跨性別權益的先鋒組織, 很高興看到中心的跨性別朋友出版此本小冊子, 以教育為目的出發,為社會人士及跨性別社群提供資訊及資源,加深認識跨性別議題,消除誤解, 推動跨性別社群的平等權利。

郭勤

香港城市大學

應用社會科學系情性輔導研究計劃社會工作導師

 

目錄

  • 跨性別資源中心簡介
  • 什麼是跨性別
  • 引言
  • 跨性別 = 變性?
  • 易服 = 病態?
  • 跨性別 與 同性戀 之關系
  • 跨性別人口比例
  • 可見度
  • 為什麼男變女的變性人比較多?
  • 香港跨性別族群歷史及現況
  • 生活上的困難
  • 歧視情況
  • 法律保障
  • 變性
  • 變性是精神病?
  • 發現自我的階段
  • 評估過程
  • 荷爾蒙治療
  • 真實生活體驗
  • 手術概念
  • 手術是唯一出路?
  • 手術後的身份轉換
  • 手術後生活狀況
  • 易服
  • 解說
  • 只有易服男?
  • 跟性行為有關?
  • 沒有變性傾向或需要?
  • 自我認同
  • 出路
  • 名詞與概念
  • 結語
  • 熱線服務

 

跨性別資源中心簡介

跨性別資源中心(Transgender Resource Center)簡稱TGR,成立於2008年7月1日,致力於推動香港跨性別運動,以教育為基礎出發,為社會人士及跨性別社群提供資訊及資源,幫助社會加深認識跨性別議題,及讓跨性別人士得到應有之協助及權益。

TGR早於註冊為社團以前,已一直積極參與香港各間大學院於性別課題之分享,至今已舉辦及參與過百場的講座及工作坊。又於電台、電視台、雜誌等媒體接受訪問,將積極正面之跨性別身份呈現於公眾面前。組織也一直與行政機關、醫療部門、法律機構、輔導團隊、基督教組織等保持密切聯系,於醫療、法律、平等機會、健康、心理、日常生活、及工作機會上推行倡導工作。

組織每月舉辦聚會,讓跨性別人士有適當空間,發揮關顧互助精神,又讓社會上對跨性別友善的人士,有接觸及支援群體的渠道。

 

什麼是跨性別

引言

社會上存在著各式各樣的人,彼此的不同,形成了一個色彩繽紛的世界。人類生活的土地本來就是一個多元的國度,萬物有序而各從其類,各依其本相而存活繁衍,生生不息。宇宙被創造美妙之處,從來就不是單一的,不像人類發明電腦時所建基的二元世界,只有1和0(True or False),卻是一個無始無終,無窮盡的世界,萬物到了盡頭,又回歸於始。在穹蒼之下,一切都是帶著多元、流動、變化、和活潑的色彩。光和暗之間有美妙的層次、日與夜之間是最美好的時光、黑與白之間充滿晶瑩斑斕、對和錯之間原來是寬恕與包容。

但人類喜好自義、分類的本性,將一切有別於己的東西都嘗試定性為「錯」,也就是不正常。將一切本來多樣化的事物簡約為單一的二元觀念。很自然地,大多數的、強勢的就成為了唯一的標準,杖量之尺卻執掌在這些主流之人手上。

歷史坦白地告訴我們,人類不斷重覆犯錯,許許多多的殺戮流血,都是源出於這個二元排己的觀念,但人類始終不能汲取教訓,只是將定位不斷轉移,再排立異己。

近年的人權運動,似乎為社會帶來了一線生機。人類一直在建立的一堵圍牆,已開始慢慢被拆解推倒了,為的是要建立一個更廣闊包容的空間,讓人可以依照自己各自的不同,為理想而活。解放宣言如雨後春筍般蓬勃萌芽,推動者為著比自己弱小的人群作出了努力,企圖實踐一個平等互愛的新世代。

是非黑白,從來都沒有一個本相,從前的「是」,可以是今日之非。世上本來就存在著許許多多性別模糊的出生嬰兒,只是從前在醫療霸權體制下被改變為兩性中之一,成為了犧牲品。現代醫學告訴我們,人類性別已不能只用外在的生殖器官去定義,科學告訴我們中性人(Intersex)存在的事實,只是對於跨性別(Transgender)的研究,一直未有被認真處理,而又因著社會的歧視狀況,其可見度幾近於零,以至一直未能被社會理解。近年跨性別者的勇敢站出來,冀能打破僵局,為跨性別族群及社會帶來新的希望。

 

跨性別 = 變性?

跨性別是一個集合詞語,主要是形容心理或行為上的性別認同,有異於其出生性別的人士,或其思想行為,顛覆了主流社會的性別定位。在社會上跨性別人士一般都極其隱藏,當中比較能被社會認知的主要有兩個族群,分別是變性及易服人士,而因著變性人士的可見性比較高,需要的支援比較明確,而對社會的訴求又比較明顯,所以一般大眾都會理解變性人就等同於跨性別人士。

跨性別族群當中,不是所有都會有變性的意欲,有部份只希望通過易服來處理內心的掙扎,而因著環境、經濟、健康各方面的條件,都可能影響當事人的取向,所以在跨性別人士當中,要真正判別一個人是否有變性傾向並非容易。

 

易服 = 病態?

易服是形容穿著異性服飾的一種行為,任何人也可以有易服的行為或經驗,不代表有什麼問題。因著社會不斷改變,男女的服飾亦不斷變化及更替,現在普遍社會上被認定為女性的服飾,曾幾何時本來就是男性所穿著。今天社會的性別服飾已較前模糊,現今女性的穿著也趨向男性化,而社會上一般接受女性穿著男性服裝,但反之言男性若穿上女性衣物,或穿得比較女性化,就很多時會引來批評甚至被視為變態。

一般有連續性的易服行為,才會被稱為易服者,所指的一般是指男性穿著女性衣物,因女性穿著男性衣服一般不會構成明顯的身份或生活上的問題。在香港的情況,一般未有變性意欲或沒有強烈持續對出生性別的不安情緒的跨性別人士,都會被界定為易服者,當中涉及不同的性傾向,而族群裡一般相信異性戀的人口比例會較高。

至今關於易服人士為何要易服,仍未有一個確切的理解,當事人一般會說穿著女性衣物後可以舒緩壓力。而歸根究底,可能也與其性別認同的焦慮有關,只不過在易服者的身上,其影響的程度,未至於令當事人有改變性別的欲望。

就觀察而言,一般易服者都有固定的工作,生活模式與一般人無異,也可能有伴侶,甚至已為人父,有部份家人亦了解當事人的易服行為。只不過他們自知社會未能接受他們此種行為,但無論當事人如何努力,也改變不了這種焦慮。事實上,易服者都不希望影響他人,只不過在有限程度上去表達及抒發其個人的性別取向,如果說他們是病態,倒不如說社會對多元性別認同和表達的不包容吧。

 

跨性別 與 同性戀 之關係

跨性別的概念是一個人對自我身體或身份性別的一種否定,從「自身」出發。當我們討論一個人是跨性別時,是針對其性別認同單獨來看,不應與其性傾向混為一談。

而當我們討論同性戀這個概念時,是針對其性傾向的「對像」來取決,去界定其為同性戀、是異性戀或是雙性戀。讓我們先簡化當中的一些複雜元素,先撇除跨性別這個元素,假設性別就只有男和女兩種,一個同性戀人士喜愛的對像是相同性別的,而異性戀人士喜愛的對像,就是跟其性別剛好是相反的。

就一般而言,不包括跨性別在內,同性戀及異性戀者均接受及肯定自我的身體性別及身份認同,不會因為其性傾向的關係,而欲改變其身體,或欲打扮成另一種性別。在同性戀中偶有喜愛易裝打扮的,也通常是作為一種娛樂或性別表達方式,而不會像跨性別人士,對身體及性別身份感到焦慮不適。

而當以跨性別為主體討論時,情況就比較複雜,通常會以當事人認定的性別(不論是否完成性別重建手術),去界定自己到底是異性戀還是同性戀,但基於相互尊重的原則,最終應以個人的感受為依歸,不應強迫其接受。而跨性別族群中,異性戀、同性戀及雙性戀也各有存在,暫時亦無一個清晰確實的比例。

當然對於跨性人士來說,其性傾向亦多少會影響其自身的性別定義,但很多時候只會影響到其會否接受性別重建手術的心態,而相對比較少影響其身份認同。性別認同與性傾向的複雜與密切關係,不只令社會人士混淆,亦令很多跨性別的人士躊躇當中,不知何去何從。

 

跨性別人口比例

跨性別的人口比例從來都沒有一個比較明確的定案,因其可見度非常之低,所以很難以統計數字去理解此群體的各種狀況。而在每個不同的國家,其情況也大有不同,譬如有些國家對性別的觀念比較開放,就會令跨性別人士容易向社會大眾呈現。資訊比較發達的國家,也會令此類人士容易認識及認定自我身份而現身。而在一些國家當你承認自己是跨性別時,是會帶來生命危險的,就相對好像比較少此類人士的存在。有些說法指跨性別人口比例是1:1000,但一般都相信其實際人口要比此計算的數目為大。

社會的歧視狀況是主因導至跨性別人士高度隱蔽的狀況,香港有著中國人傳統重男輕女的觀念,也令跨性別人士不敢走前一步。就香港而言,變性人大約為數200-300人,有約100人是在香港政府醫院完成性別重建手術的,所以這個數目應該比較確定,而其餘的百多人則是估計是在泰國、美國、英國、台灣等地完成手術的人士。

跟據香港一個專屬易服人士(Crossdresser)的網上論壇資料顯示,會員數目在2011年尾高達33,000人,當中絕大部份都是男跨女(原生男性,認同為女性)的易服人士,差不多沒有包括女跨男及變性人士,撇除了重覆登記、非跨性別人士等之外,保守估計會高達一萬人以上,這已經沒有包括其他沒有上網、及未敢於網站上登記的跨性別人士。

 

可見度

一直以來,跨性別人士都是社會裡的隱蔽一族,但隨著社會慢慢的變得較以前開放,也受著西方影響,中國人傳統對於男性及傳宗接代之觀念都變得比較寬鬆。七、八十年代的年青人開始擁有經濟獨立的自主權,也對性有較多的思考空間和想像。到了九十年代香港的互聯網開始普及,寬頻年代來臨,令一些對自身性別感到焦慮的人士,於遼闊的互聯網世界裡搜尋到相當豐富的相關資料,也認識到來自世界各地以及本土的同道中人,進而一步一步去探索及追尋自我的生命旅程。

而香港以吳敏倫醫生為首的一組專家,明白到有變性欲望的求診者之需要,於1979年率先在瑪麗醫院成立了性診所,開展了香港性別重建手術的新一頁。自此,報章上也不時有變性人士的報導,但始終在當時社會的氛圍底下,當一個變性人在工作及生活上都會遇上很多困難,以至大部份接受了性別重建手術的朋友都會選擇隱藏身份,到了今天也不例外。

不過,近年亦有少數變性人士,嘗試從自我壓抑中尋找出路,勇敢地向公眾及傳媒公開身份,以積極態度面對自我身份認同。以2010年爭取變性人婚姻權的W小姐為例,該事件的報導引發了公眾對變性人士的權益關注,間接提升了跨性別人士在社會上的可見度。

其實跨性別族群的人口比例應該不少,但能夠令社會及政府關注,從而明白到他/她們的需要,提供資源分配及援助,最重要還是其可見度。所以近年來一些關注跨性別的團體,都致力於向公眾呈現此群體的現實狀況。

 

為什麼男變女的變性人比較多?

從世界各地的資料顯示,「男變女」跟「女變男」的變性人比例都是相約的,沒有太大差別,而本港政府醫院的數據也顯示同樣的結果。感覺上男變女的數目比較多是可見度的問題,原因可能有以下幾點:

  • 就本地觀察而言,香港的女變男變性人士比較偏向獨立、多以小型聚會交往。而男變女的則較喜歡群體聚誼,生活圈子比較闊,喜愛傾訴心事,知道其身份的人也比較多。
  • 女變男的用了賀爾蒙藥之後會變得相當男性化,就連聲線也會轉變,很容易隱藏變性的身份。相反男變女用藥後的變化較不明顯。
  • 女變男的在變性前的期的生活及衣著改變一般不易察覺,比較容易處理。相反,男變女的,在前期都可能經歷過易服的階段,生活上有很多需要處理的問題,需要大量在群體中交流及搜集資料,形成了關系較強及闊的群帶關係,造就了她們族群的發展。
  • 男變女過渡其間的轉變程度明顯,引起的反應和印象會較大和較深刻。

 

香港跨性別族群歷史及現況

過往的跨性別族群,其實根本說不上是一個族群,因為各自都只能在其生命中痛苦掙扎,每天過著雙面人的生活,根本沒有膽量去尋找或接觸其他同道中人。機緣巧合,2002年幾位跨性別人士組成了香港首個跨性別網上論壇(cdfamily),由不見天日的年代,一下子遇上了碩量無窮的族員,風頭一時無兩,期間亦分別出現了cdgal、cdparadise及 TSense三個論壇,頭兩者都是針對易服人士,而最後的TSense主要對像是變性人士。

但始終由虛擬世界走到現實處境,都不是一件容易事。當時有幾位於香港接受變性手術的人士,由醫生穿針引線下,組成了聯繫小組,後期人數一度高達廿多位,當中包括外籍人士及非跨性別人士的學者,其後於2004年註冊成為社團,定名為「跨性別平等與接納行動」Transgender Equality & Acceptance Movement,簡稱TEAM,但近年組織較少舉辦活動。

2005年成立的「性?無別!」主力於跨性別的熱線服務。同期也有稱為「蛇王工作室」的隊伍,專責到不同機構及學校作跨性別分享。至2008年數位跨性別人士與學者一同成立了「跨性別資源中心」,主力向社會推廣跨性別概念及服務跨性別社群。

經歷了多年的光景,現時估計會露面於社群內的跨性別人士仍不到一百,族群的發展仍要待當中有心人士繼續努力與堅持。

 

生活上的困難

跨性別人士在生活上遇到的困難,我們可以先簡化為兩部份來看,一是在其公開自己身份之前,一是在身份轉換之後,大程度上改變自己的外表及生活模式,或完成了性別重建手術後之情況。

在跨性別人士能夠認同自我及公開身份前,一般都會極度隱藏和壓抑自己的感受,原因是感到外在環境不可能接受自己的想法,也普遍地覺得自己的思想行為有問題、甚或變態。在他們的世界裡沒法找到可以傾訴的對像,感覺孤單之餘,也可能強迫自己改變,外表上裝扮成另一個別人心目中的形象來掩飾。久而久之,內心的抑壓越來越膨脹,沒法找到出路,性格可能會變得孤僻或負面,更可能做出傷害自己事情或自尋短見。好多時候他們會將生活上遇到種種不如意的事情,歸咎為身份認同的問題。

而當一個跨性別人士開始接納自己的另一面時,外表及生活模式都可能會作出很大程度上的改變。他們需要面對家人、鄰舍、親戚、朋友、同事的質疑或提問,有時候這類的提問亦未必帶有惡意,但對於當事人來說,都可能未有充份準備面對深入和嚴苛的提問而感到難受。

另外,他們在工作環境,也希望能以符合自己身份的衣著出現,但很多時候公司或同事都未必能夠配合,而當他以這一身裝扮去面試新工作時,都可能會遇上種種困難。

在日常生活中,他們經常要面對的一個尷尬就是洗手間的問題,當然在變性人士完成了手術後,更改了身份證明文件上的性別一欄,似乎就沒有問題。但在他們還未有決定變性,或在變性前評估中醫生要求的真實生活體驗中,需要全時間以另一性別方式生活,但身份證又未能更改時,就可能會無所適從。有些朋友為免尷尬,會選擇使用傷殘人士洗手間,或乾脆不在外間上廁所。

信仰也可能是其中一個需要面對的挑戰,無論是當事人自己,或是信仰群體中的反對聲音,都可能對其做成很大的沖擊。

當然,我們也遇見過性格積極正面的跨性別人士,也期望以他們的生活態度為方向,鼓勵更多朋友,走出陰霾,活出精彩有意義的人生。

 

歧視情況

我們從跨性別人士的第一身經歷中看見,香港在這二、三十年間對變性人的接納程度都有很大的改變,而跨性別這個詞語或概念,都是在近年才被引入本港。在此前對於男穿女裝,都好多時被冠以變態的名號,或稱為「人妖」,不然就被認為有犯罪的意圖,反而女穿男裝,似乎一直都沒有太大的問題。

但由於真正能夠以一個跨性別的身份出現,去面對各方面情況的機會都不多,又由於群體的可見度低,坊間亦很少收到有關的歧視的投訴個案,所以都未能有效地分析到現時的歧視情況。

從群體的經驗得知,在服務性行業中對跨性別人士的歧視情況都有所改善,而比較嚴重的範圍是在工作間內、求職時、教會、部份娛樂場所、入境問題、拘留及監禁等等,多會遇到不愉快的經歷。

 

法律保障

現時本港沒有法例保障跨性別人士,性別歧視條例中亦不包括此等情況,只有被判別為「性別認同障礙」的變性人士,因為被列於美國「精神疾病診斷與統計手冊」(Diagnostic and Statistical Manual of Mental Disorder,簡稱DSM或稱為 精神病學名冊)之中,才能引用殘疾歧視條例加以保障,但此名冊亦同時帶有另一層的歧視意味,所以一般都不喜歡引用此法例去處理事件。

 

變性

變性是精神病?

現時本港及大部份國家,均要求欲接受變性手術(亦即性別重建手術)的求診者,必須通過為期最少兩年認可的精神及心理評估過程,當被界定為性別認同障礙症後,才可轉介至外科部門排期接受手術,而香港暫時只有公立醫院提供此項服務。

由於西方一向依據2001年發表的「性別認同障礙護理指引」第六版本 (Harry Benjamin International Gender Dysphoria Association’s Standards of Care For Gender Identity Disorders, SOC) 及「精神疾病診斷與統計手冊」第四版 (DSM IV) 作藍本,到目前為止仍將性別認同障礙例為精神病的一種,所以香港處理此項目的仍然屬精神科部門專責,但有很多這方面的專家都不認同此種分類。

近年經業者努力推動下,世界跨性別健康專業協會 (World Professional Association for Transgender Health, WPATH) 已於2011年尾發表了第七版本的 SOC,新版本以跨性別主體為本,作出了大量修改及補充,將從前對跨性別人士的誤解逐步釐清。

 

發現自我的階段

一位跨性別人士,從成長到發現自我,都可能會經歷過數個階段。從出生到入學,開始有機會接觸及學習到男女之別,或在幼兒院時期,上洗手間或排隊時,老師要求男女分開,這種種的機會都會引發當事人對性別的疑惑,所以有說一般的跨性別人士,都是從4至8歲開始認識自我的不同,此為啟蒙期。

而整個在校期間,越來越多的疑問及掙扎會充斥及伴隨著其成長,這個時期也正藉身心發展的重要階段,若然不能接受自己的不同而我行我素的話,就可能會活在痛苦與困惑當中,既找不到傾訴對像,也不知怎樣面對,當事人也很可能會成為校園欺凌對像,此通常為一段疑惑期。

到當事人開始明白到自己的與別不同,嘗試去尋覓答案,及至出外工作,擁有經濟獨立能力時,都會不停地去探索及發掘自己的需要,到處找尋相關資訊,或開始添置異性衣物。但這個階段最可能令當事人產生極大的痛苦與予盾,反覆在渴求與自責中糾纏,當中很多人會萌生輕生的念頭。若然此時他也正在面對戀愛的問題,事情會變得更加複雜,面臨的壓力更大。此階段視為探索及掙扎期。

有部份跨性別人士會向外尋求幫助,可能是社工、心理輔導、醫生、甚至教會,但外間對於跨性別的認識都極之有限,有些時候甚至會令事情更加惡化。近年有由跨性別人士自組的團體成立,及兩間接納跨性別人士的基督宗教教會出現,似乎都對這群無助的人士提供一些支持及援助,無論其最終會否決定變性,都期望能先處理好其情緒及心理質素,使其確立及認識自己,再積極正面去處理人生將來的路。

 

評估過程

要在香港接受變性手術,必須通過認可的評估程序,除了精神科及心理科醫生的評估報告,確定當事人是否適合進行變性外,亦須接受一連串其它科的治療與檢驗過程,當中包括社工、職業治療、語言治療、遺傳科、內分泌科、婦產科、及法律顧問,2005年以前瑪麗醫院的「性診所」專責處理所有分區的性別認同評估,提供一條龍服務。但因資源調配問題而結束後,各區醫院網絡要分別處理該區的求診個案,又由於該性診所的部份醫生相繼退休,中間出現了一段真空期,令當時的求診者無所適從。

這幾年間,在一些願意幫助變性人的醫生努力下,現時已有數個分區從新開始評估工作,而以沙田威爾斯醫院的「性診所」整合得最為完善。該醫院轄下的整形外科,亦正準備為性別重建手術而舖路。

一般評估過程最短需要2年,當中比較重要的部份為心理評估、荷爾蒙治療、及真實生活體驗,希望能令當事人清楚了解自己的需要,避免做成錯誤決定。

 

荷爾蒙治療

在評估過程當中,如醫生初步確認求診者屬性別認同障礙個案及情況穩定,就可能會進入荷爾蒙治療階段,通常會用口服或針藥,以減低其體內原性荷爾蒙指數,同時亦增加另一邊荷爾蒙的指數。此階段會讓當事人感覺到一定程度的身體及心態上的改變,以確定其身心皆適合進行變性。此期間的轉變在停止服用藥物後,視乎用藥時間長短,某程度上可回復至原先的身體狀態,讓當事人可以在能夠逆轉情況下,測試及體驗藥物及手術對當事人帶來的影響。

在完成手術後,病人的生理上亦不能夠製造身體所需的荷爾蒙,所以也需要繼續進行荷爾蒙治療。

 

真實生活體驗

接受評估人士要全時間以另一性別身份生活最少一年以上,以確知其手術後能適應新的生活,醫生會發出一封證明信件,證明當事人正接受評估,有需要作異性服裝打扮,以免於洗手間或其它場合出現麻煩。但由於當事人身份證未能於此時更改性別一欄,在工作上及其它方面都可能會遇到困難,所以醫生一般都會與當事人商議真實生活體驗的比重。

 

手術概念

變性是以外科整形手術,將當事人的身體重建為另一個性別,通常是針對其生殖器官作改造,但因各人不同的情況,亦可能包括胸脯、面型、喉結、甚至聲帶等的各種手術,務求令當事人於手術後更容易融入新的生活。

現今的變性手術過程要比一般人所理解的繁複,當中涉及性器官的重建,正確應稱為性別重建(整)手術 SRS (Sex Reassignment Surgery),或性器官重建手術 (Genital Reconstruction Surgery)。

手術中最重要及複雜的是性器官的重建,當中涉及外觀上及功能上的處理 ,以當事人的自身器官及神經組織為材料,建造成有感覺、像真度高的身體部位。

男變女的手術比較簡單,一般包容隆胸、尿道移位、陽具及睪丸切除、包皮逆反作陰道形成、龜頭形成為陰核、陰囊組織形成為大小陰唇,最後就是喉結磨平等等,一般會一次過或分開兩次完成。另外也有採取以大腸作為陰道材料的手術,好處是會有自然分泌及較長的陰道。

女變男的手術較為複雜,胸脯切除後,除掉了多餘皮膚組織的傷口非常之大,乳頭亦要重新移位。除了切除陰道、子宮及卵巢外,亦要從零開始建做男性的性器官,人工陰莖的建造多選擇從手臂、小腿或其它部位取皮瓣、骨、肉及神經組織,在原處培植好,再移植到適當位置上,一般都需要做好幾次的大型手術。陰莖重建手術的處理方法有很多種,視乎需要的效果而定,但危險性高,傷害性大,成功率低,這種種因素都令很多人退而求其次,選擇不做完整的性器官重建。

 

手術是唯一出路?

對於有性別認同障礙的人士來說,能夠擁有另一個性別是終其一生追求的夢想,但換取得來的代價非常之大,除了身體上之傷害外,手術後也要準備面對各種來自社會或家人朋友的壓力。而對於沒有變性意願的跨性別人士,更好像沒有解決方法。

以「跨性別資源中心」的理解,跨性別人士所面對的壓力與焦慮,源於不同層面錯縱複雜的社會與自我身份建構,與及生理心理間之相互糾纏。我們要清楚,其問題不是全然來自自身,但要社會改變並不是一朝一夕的事。若返回從其自身出發,先釐清自身問題,再結集群體力量,推動跨性別運動,改善社會對跨性別人士的環境,自會事半功倍。

但昔日處理跨性別議題的力量都源自於外部,且由不甚理解並缺乏同理心的權力人士主導,從醫療輔導,到法律體系,無不以神聖不可侵犯的姿態,去主宰跨性別人士的命運。今天跨性別人士紛紛起來,在各地推行平權運動,埋沒已久的聲音已被聽見,跨性別族群已經是可見及可被理解的,對於內部的支援服務,也能夠更確切地考慮到群體的真正需要。

相信不久的將來,手術只不過是其中的一種手段,去表達自身的價值及取向,而不再是跨性別者的唯一出路。

 

手術後的身份轉換

凡香港區民,在任何國家的認可醫院完成變性手術後,憑醫生發出的手術證明文件,都可以於人民入境事務處申請更改身份證上之性別。完成手續後,以新的身份證就可處理其它的性別更改事項,如護照、考評局的證書、銀行、保險、回鄉證、駕駛執照等等,但仍有一些學院及機構沒有更改性別的機制。至於其它國家所發的護照,則視乎該國家的條文規定。

 

手術後生活狀況

以往的變性人士,在完成了手術後,一般都選擇以完全屬於另一個性別(即手術後的性別)身份過新的生活,亦因擔心被歧視,或希望較容易結識另一半,故此都會想盡辦法隱藏自己的過往。他們的生活與一般人無異,亦有在各個行業中發展,而並非好像一般人想像中的生活不濟。

但因長期處於怕被別人發現身份的壓力底下,比較容易引起情緒焦慮。而反觀於手術後仍然保持與跨性別群體連繫的朋友,比較能舒緩各方面的壓力,從而活得更加開心。

傳聞中亦有說變性人一般活得不久,但這說法沒有根據,而因以往社會對變性人的歧視,對變性人做成巨大的壓力,以至有部份公開了身份的,最終在年青時就了結餘生。相信在有更多可被觀察的個體出現後,真相才會被理解。

 

易服

解說

易服是通過穿著另一性別的服飾,以表達對自身性別的不滿。易服可能隱含著對外在環境的一種政治手段或是抗爭,又或是對自身感受的一種外在表達,但很多時候對當事人來說,可能純粹是美與不美、對與不對的選擇,是自然不過,甚或沒有選擇的餘地。

但這種選擇往往帶來外在環境的壓力甚至迫害,企圖將一些不為社會接納的行為或價值觀,從新推回界線的另一邊。荀子曰:「約定俗成謂之宜」,我們不禁會問,到底這些界線又是誰來判定的呢?

 

只有易服男?

昔日封建社會的年代,無論西方或我國,對男女之角色定位都非常嚴緊,尤以女性為甚。但自從女性開始從男權世界走出來之後,每每都以男性的打扮自居,或作為一種行為或政治上的抗爭手段。

今天社會對女性穿著服飾的界線比較模糊,女性隨時打扮得較為男性化,都不會衍生太大的問題,反而造就了女性寬闊的表達空間。所以我們不可以說沒有易服的女性,女同性戀中的其中一類,在在就是以陽剛方式登場,表現出鮮明的性別形象,只是社會暫時沒有易服女性呈現的必要或空間,而當此類情況到達當事人表達需要改變性別的一刻時,我們才會赫然大悟。

 

跟性行為有關?

以往對易服的理解,就是喜愛穿著女性服飾的男士,他們既沒有變性的意圖,更是愛女性的異性戀,易服只為喜好,很多時更與性行為扯上關係。

我們不能排除此類的可能性,但當對跨性別群體進行深入了解後,發現當中有很多以前未被觀察及分析過的錯綜關系,從前,或者到今天仍被認為是易服的群體裡,原來充斥著有變性意欲的、異性戀的、同性戀的、雙性戀的、無性戀的個體,這些不同的需要及取向,都建構出各式各樣不同的個體模式,我們根本無法簡單地、二元地,將「易服」及「變性」兩者分開,這樣做就只會是以某人的意願,去將一個個體的獨有特質強行污蔑。

讓我們先處理有關性行為的問題,假設我們說一個男士,在易服後會有性的幻想、需要、甚至行為,我們可能會錯誤地將焦點單獨放置於易服這個因素上,而否定當時的其它外在條件。我們可以想像,若果當事人不是一個易服者,只是個一般的男性,他在一個私人空間裡,有一個空餘的時段,一切的外在條件都驅使他去作出一些關於性的幻想、需要、甚至行為,我們會否假定他在一種沒有易服、或什麼什麼的狀態底下,就會誘發出一種性癖好呢?

再舉個簡單的例子:我要吃晚飯的原因並不是我穿著了睡衣、用了三小時電腦、現在是晚上八時或者今天上了五次廁所等等,只是我覺得肚餓,需要用膳以作充飢而已。其他人不應該胡亂猜測我穿著了睡衣後才想吃晚飯,因為兩者是沒有因果關係的。同理,我們亦不應該胡亂地說一個人因易服而有性的幻想、需要、甚至行為,因為兩者同樣是沒有因果關係的。

我們也發現,一個跨性別人士在性方面的需要高低,也影響其對改變性別的決心多少,這並不意味著其改變性別的欲望程度怎樣,只是在各方因素底下,權衡過後的取決方向而已。

 

沒有變性傾向或需要?

上文說到在被界定為易服者的當中,也存在有變性傾向的。在訪問一些易服者中,出奇地發現大部份人士都希望能成為另一性別,只是覺得自身條件不足,根本無法實現這種想法。也有在衡量過得失以後,毅然決定不作此想。當然,也有覺得沒需要、或沒必要去傷害身體,去換成另一種性別,但如果將問題換個角度,說如果有一種藥只管吃了,就能變成另一種性別的,很多這類人士都表示會,「想也不想、二話不說」就會吃掉!

 

自我認同

易服者當中絕大部份的自我認同度都偏低,覺得易服這種行為是不正常、甚至變態。自我認同比較強的,就會覺得只是社會上的其他人,未能明白接受其行為,以至不敢向人表白,或顯露人前。他們既覺得不妥,但又無論如何努力,也擺脫不了心裡的欲望,常自稱為無間道,既然只得活在煎熬當中,唯有笑看人生。

近年內地及香港出現一些自稱為偽娘的男性,敢於走到人前,正面表達自己,但要當一個偽娘也有自身的條件限制,通常是較年輕的,樣貌極像女生,而且走可愛路線,他們的出現通常都會引來正面的回響。

 

出路

跨性別運動中,其中一個重要項目,就是令此群體能夠接納自我,正面去找尋出路,面對人生。既然沒法改變自己此方面的傾向,倒不如發掘其正面的好處,反正易服的行為只要不傷害人,總是有機會讓人理解的。

而易服的行為,可以作為一種藝術、一種文化表現,要做得專業及神似,其實一點都不容易,要花上很多功夫鑽研其中,才可能表現當中的美態與內涵。而跨性別人士,一般都曾遊走兩性之間,對於兩性間之差易與矛盾,都比一般人更加明白及了解,居中之人若將此道成為益人之器,當能廣結善緣,事事通達。

 

名詞與概念

 

1. 生理性別(Sex)與社會性別(Gender)

由二十世紀中開始,學者把性別的概念劃分為生理性別(sex)和社會性別(gender),但在一般人心目中兩者是同一個意思,兩者必需相配。前者以生理角度把人分為男、女、雙性人(或中性人)等不同的性別。後者則建構於文化、社教化(socialization)和自我的性別身份認同(gender identity)。大部人的生理性別和社會性別是一致的,但有些人則有不同程度的不一致。例如,有些人出生的生理性別是男,但其社會性別可以是女,如我國古代的「花木蘭代父從軍」是為一例。

 

2. 性傾向(Sexual Orientation)

根據美國心理學會(APA)的解釋,性傾向是指一個人對另一個人有持續的情感、浪漫愛、性慾或感情上的吸引。性傾向與性別認同(詳見下文)是兩個不同的概念,前者指一個人對另一個人的吸引,後者指一個人自己的身份認同。

 

3. 性別認同(Gender Identity)

根據Lev(2004, p. 397)的解釋,性別認同意指一個人在不考慮身體生理性別的前提下,對自身性別所產生的界定。

 

4. 跨性別 (Transgender/TG)

根據 Lev(2004, P. 399)的解釋,跨性別是一個總稱,當中包含許多不同類別的人。他們共同之處是自己在性別認同(gender identity)上或表達自己性別(gender expression)的方式──或多或少地──與出生時的生理性別或社會期望的性別角色(gender role)有異。跨性別一詞所包含的族群包括:變性人、易服人士、扮裝皇后/皇帝、性別酷兒等等。

但早年,跨性別一詞是指那些自己性別認同上與出生時的生理性別有異的人;但跨性別一詞有別於變性,跨性別人士沒有做性別重建手術。他們亦有別於易服人士,因為他們不只是衣著上選擇異性的服飾,而是性別認同上也傾向或認同另一個性別。現今的香港,仍有一些人用這一個定義,所以要注意。

 

5. 雙性人 (Intersex)

亦稱為「間性人」、「中性人」或「陰陽人」,是指在出生時生殖器官發生異變,或發育不全的人士,原因可能與染色體及性激素水平有關。由於有部份身體上會同時擁有兩種性別、或不完全發育的性器官,所以也有稱為雌雄同體。有統計說在2000個出生嬰兒中,就有一個屬於雙性人。

早年醫學界偏向將雙性嬰兒,通過手術改造成單一性別,但發現很多此類個案成長後,都出現性別認同的問題,所以現在醫學偏向保留其性徵,直至其成長懂性後,再商議作決定。

 

6. 變性 (Transsexual/TS)

變性一詞多被醫學界及大眾採用。根據 Lev(2004, P. 400)的解釋,變性人認為自己的身體不能反映他們真實的性別。雖然大部份變性人都希望能做性別重建手術,但變性人一詞可以應用在已經做了手術(post-op),等待做手術(pre-op),或不做手術(non-op)的人士。op指的是Operation手術的意思。

 

7. Post-op / Pre-op / Non-op TS

由於很多時候,我們指變性人其實是指變性欲者,即是有變性意欲的人士,而不特定地指完成了手術的人,為免混淆,在此等情況下,會將其身份再分類為以上三種,而統一歸入TS類別。

 

8. 性別認同障礙 (GID)

全寫是Gender Identity Disorder或Gender Identity Dysphoria,帶有濃厚精神病學色彩,日本稱為「性同一障礙」。近年學術界比較偏向使用Gender Identity Non-conformity或Gender Identity Diversity以減輕其負面意味,中文可譯作「性別認同模糊」、「性別認同不一致」及「性別認同多元」。

GID一般是指先天對自身性別感到焦慮,有持續長期改變性別的欲望,從醫學的角度指出一個人的狀況,但很多時被理解為變性人的等稱。

 

9. 性別重建手術 (SRS)

在香港普遍稱為變性手術,Sex Reassignment Surgery 是通過外科整形手術,將一個人的性別重建為另一個性別。由於需求不斷增加,現時在很多國家都有此項服務,而香港的變性人普遍選擇在本港、台灣或泰國進行此項手術,在泰國做手術除了方便、價錢比其它國家經濟外,其技術也備受推崇。

 

10. 賀爾蒙治療 (HRT)

Hormone Replacement Therapy 是以口服、注射、或皮膚吸收等方法去調整一個人身體內的賀爾蒙指標,除了性別重建手術前後期為變性人士施行外,也會應用到其他賀爾蒙失調的病人。

 

11. 真實生活體驗 (RLE)

Real Life Experience,以前亦稱為 Real Life Test (RLT),但由於近年的方向是希望欲變性的人士,能夠體驗將來新的生活,而不是去測試當事人合符資格與否,一般都將名稱更正為RLE。此程序要求當事人,嘗試全天候式以另一個性別身份生活,而因各人條件的不同,可能會以循序漸進及部份時間方式進行。

 

12. 過渡期 (Transition)

一般指決定變性的人士,在應用賀爾蒙治療開始,到完成手術為止的一段期間,由於對變性人士來說,是一個很重要的關口,一旦決定後,變化都會非常明顯。

 

13. Pass / Passable

是跨性別族群當中的術語,意謂一個人易服後、或以自己認同的性別生活時,外表會否引起其他人的懷疑。

 

14. FtM

指「女變男」或「女跨男」Female to Male,認同自己為男性,而未必需要是完成了手術的變性人士。

 

15. MtF

指「男變女」或「男跨女」 Male to Female,認同自己為女性,而未必需要是完成了手術的變性人士。

 

16. 易服 (CD)

CD可以是名詞作Cross-dresser,也可以作動詞為Cross-dress或Cross-dressing,指穿著異性服飾的人士或其行為,一般指男穿女裝。

 

17. 偽娘

從日本傳至中國及香港的一個詞語,本屬ACG (Animations, Comics and Games) 動漫界的日本漢語名詞,指打扮成女生的男性,比真女性更女性可愛女生,有萌(意思類似「可愛」,但在不同時候,用法和定義也不一樣,在此不作詳述)的屬性在當中。至於與易服一詞間之分野定義,仍有待群體中的消化與發展。

 

18. 扮異性症 (TV)

Transvestite亦稱作易服癖,是醫學界的名詞,當此字於1910年被提出時,是以Trans(解跨越)加上拉丁語中的Vestitus(解穿著服裝)而成,基本上與今天的跨性別同義,但後期被泛指為需要通過穿著異性服裝而達至性興奮一種症狀,帶有病態意味。

易服的行為,在大部份的時候,都不牽涉有性的行為。但如果一位易服人士,在易服後有性行為的情況,可能只是當其以自身意願的性別呈現時,剛巧有性行為同時出現而已。未必等同上例的易服癖狀態,所以當我們稱呼易服人士時,不應隨便加上「癖」字。

 

19. 癖

對事物的偏愛,成為習慣,也指久治不愈的疾病。原意是指潛藏在兩脅間的積塊。中醫分為食癖、飲癖、寒癖、痰癖、血癖等。現代人愛指為帶有病態之喜好。

 

20. 扮裝皇后/皇帝 (Drag Queen / King)

通過易裝打扮來表演的男性或女性,扮演女性角色的是皇后,扮演男性的就是皇帝。他們通常只出現於娛樂場所、遊行、或其它表演的活動,平時多以原生性別示人。其服飾都會以誇張華麗為主,也會伴以歌舞於演出中,當中大部份也沒有變性的意圖,但也有例外。

 

21. 同志群體

同志一詞在早於1989年的「香港同志電影節」裡,被引用為同性戀的別稱,漸漸被同志界受落及廣泛應用於中港台間。後因運動的焦點逐漸從性傾向轉移到性別議題上,開始納入其他的性小眾群體,主要包括男女同性戀、雙性戀及跨性別人士,而在國際上等同這四大族群的縮寫LGBT,分別代表Lesbian, Gay, Bisexual and Transgender及其延伸。

 

22. 酷兒 (Queer)

酷兒一詞來自英語的Queer,本來是指古怪、不正常的意思,於20世紀被用為帶有貶意的同性戀稱呼。但從80年代開始,同性戀族群將這個稱呼應用為指一切不容於主流社會價值觀的性愛表達方式與立場的人,同志之外,也包括如失婚人士、性工作者等等。是一個帶有抗爭意味的政治詞語。在學術界及基督教宗派裡發展出酷兒理論及酷兒神學等範疇,社會上也逐漸出現一種獨特的酷兒文化。

 

23. 性別酷兒 (Gender Queer)

在社會當中,其實除跨性別人士外,也有一些不服於原生性別、或二元性別框架底下的人,無法落入或歸類於任何一種性別身份之內,又不喜歡被定義及標簽,或喜歡遊走於兩性之間,不能被跨性別這個詞語所形容的,一般被稱為性別酷兒。

 

24. 精神疾病診斷與統計手冊

The Diagnostic and Statistical Manual of Mental Disorders簡稱DSM,是由美國精神醫學學會出版的一本指導手冊,在美國及其他國家最常被使用來診斷精神疾病,目前最新版本是2000年的第四版修訂版,預計第五版會到2013年才會發表。

雖然這本手冊受到心理學家與精神病學家的廣泛接受,但是當中的精神疾病列表卻備受爭議。其中最有名的就是手冊第二版(簡稱為DSM-II)中將同性戀列為精神疾病的一種,這個條目在1973年由APA美國心理協會投票通過予以移除。

 

25. Harry Benjamin

班傑明可以算是首個對變性欲者進行有系統研究及定義的醫生,從1948年開始接觸第一個案例,至1966年發表「The Transsexual Phenomenon」變性欲現象一書,都主張通過變性手術,以減輕因性別焦慮而受痛苦的病人。1977年成立「Harry Benjamin International Gender Dysphoria Association」班傑明國際性別焦慮協會,主導及推廣對變性人士的醫療護理。

 

26. 性別認同障礙護理指引 (Standards of Care For Gender Identity Disorders)

此護理指引從1979年第一版開始,一直是由班傑明國際性別焦慮協會所制訂及出版,直至2001年更新至第六版。但由於一直是以精神學的角度出發,以至內容方面都未能符合及完全照顧欲變性人士的需要。

及至2011年尾,由世界跨性別健康專業協會 (WPATH) 經眾多專家及研究人員努力底下,第七版本終於作出了重大及眾多的改變,由第六版的23頁增加至現時的120頁詳盡的指引,亦將名字更改為「變性、跨性別及性別不一致人士健康護理指引」Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People,充份反映該指引之適切性及去除病理意味。

 

結語

人類在地球上活了數千年的文明,科學一日千里,本以為對大部份的事物都經已有一定的理解。事實上,在不斷求真求變、不斷發問的人類本性底下,我們每天總會發現一些新的事物、新的知識與見解。從前人類以為地球是平的,也確信不疑,但有一天迷底被揭開,我們才恍然大悟。

性別在男女二分的界線底下,原來擁有無窮的變化與可能性,只是在某些人的定義下,被約化為單一的概念,而被大多數人所接受了,很可能當初企圖定義「男和女」這兩個字的人,萬不料後人會這樣理解其意思。在我們一般生活圈子當中,好多時會出現有定義自己是100%的男生或女生,想問,他們旁邊的其他人,又會是在他所理解中的百分之幾呢?

日光之下,我們以為並無新事,誰知雨過天清以後,會乍現彩虹。今日科學的重新整理與發現,展示出一幅多元而美麗的性別圖畫,就好像毛蟲蛻變後,化為彩蝶翩翩。

 

- 參考書籍(References):

Lev, A. I. (2004). Transgender emergence: therapeutic guidelines for working with gender-variant people and their families. New York: The Haworth Clinical Practice Press.

 

- 參考網頁 (Reference Websites)

American Psychological Association(美國心理學會)

http://www.apa.org/helpcenter/sexual-orientation.aspx

 

和諧不是一百個人說同一番話

和諧是一百個人

有一百句不同的一番話之餘

而又互相尊重

(引自香港無線電視劇集《天與地》2011)

 

作者:Joanne Leung

資料搜集:Eleanor Cheung

校對:Garry Kan、Lucetta Kam

 

本活動計劃由平等機會(性傾向)資助計劃資助

本刊物的內容只代表本機構的意見,並不代表香港特別行政區政府的立場。

 

作者:香港大學法律學院 Robyn Emerton

Robyn Emerton 版權所有。受版權條例管轄範圍內的複製及傳播必須獲得版權持有人的事先同意

中文翻譯:凱詩

中文編輯:性權會/邵國華

此翻譯只供參考。如中文版與英文版不一致,應以英文版為準。

首次上載於29/1/2003,於27/10/10更新

 

備忘

此報告主要探討影響以香港為家的變性人士(包括已完成或正進行性別重塑手術的,下稱變性人士)的法律問題。這只是一份初稿;當我找到更多關於香港變性人士的資料、獲得會影響跨性別人士(Transgenders,指在心理上對另一性別有所認同的人士,有時也泛指一切不服膺於性別二分的人士。)生活的政策制定組織或部門的回應、以及當我進一步研究與這方面有關的法律(一個非常不獲公認的範疇(1) )後,我會將這份報告加以延伸。

 

定義

變性人士(Transsexual,簡稱TS)是指不安於原生性別而希望/正在/已經通過手術(或/和使用荷爾蒙)來改變性別的人士。根據變性手術進行的程度可以分為non-op(因身體、環境等原因不選擇進行手術的人士)、pre-op(準備或正在進行身體改變的人士)、post-op(已經完成變性手術的人士)。此報告主要是有關已經完成變性手術人士的法律問題。

跨性別人士(Transgender,簡稱TG)一般來說跨性別人士包括變性人士、易服人士(Crossdresser)、舞台扮裝人士(Drag Queen)等,在此報告裡主要關注的是跨性別裡的已完成手術的變性人士。

 

身份

當參與性別重塑計劃的人士,進行實際生活體驗的時候,她/他們會獲得醫生/精神科醫師發出的一封信,解釋她/他們的處境。當完成性別重塑手術後,她/他們通常要求更改她/他們的身份證明文件,以反映她/他們的新身份。在這件事情上,有些情況會比較其他情況容易:

姓名:任何人士如欲更改姓名,可以在民政事務處的分區辦事處辦理改名契手續。可是,有關人士在出生證明書(出世紙)上的姓名將不能更改。

身份證:完成性別重塑手術的人士,可以向入境事務處申請更改身份證上的資料(2) 。(事實上,入境事務處建議我們,完成性別重塑手術的人士,有法律責任通知該處)(3) 。通常需要一張有效的醫學證明及個人的宣誓書來確認性別資料的更改。新的身份證會獲簽發,證上將顯示變性人士新的名字、性別(以M或F代表)和照片。跟據入境事務處處長提供的資料,1994年1月至2002年6月期間,該處共收到27個變性人士要求更改身份證資料的申請。其中12個申請是男變女的,15個是女變男的。所有申請皆獲接納,用以替代原身份證的新身份證亦獲簽發(4) 。一名變性人士告訴我們,入境事務處的職員處理她的申請時相當專業,過程中她幾乎沒有難為情的感覺。

出生證明書:在香港法律下,完成性別重塑手術後的人士不能更改出生證明書上的資料,除非她/他們可以證明在出生時登記的記錄內有文書上或事實上的錯誤(5) (如果她/他可以證明解剖性別在出生時被錯誤地判斷,她/他或可提出更改出生證明書的申請--雖然我們並不知道任何這樣的先例。)縱使已完成性別重塑手術,但法律依然以她/他們本來的生理性別對待。下面會對此作更清晰的探討。

其他個人文件:當收到新的身份證後,變性人士可以以此更改其他個人文件上的資料,如駕駛執照、信用卡和銀行戶口等。

 

事業上的自由

很多香港跨性別人士表示在工作環境中受到歧視和騷擾。香港法例提供了性別歧視及殘疾歧視的保障,在就業、教育、使用公眾場所、貨品、服務和設施提供等方面皆受保障(6) 。這是透過《性別歧視條例》和《殘疾歧視條例》這兩條涵蓋私人機構的歧視條例來實現的。另外,針對政府和公共機構的歧視行為,《人權法》亦提供了保障,「以防因…性別…或其他身分而生之歧視」(7) 。可是,香港的法庭尚未有案例裁定此等歧視條例是否適用於變性人士。以下我們將探討幾個可能衍生出來的重要議題:

性別歧視條例:在此條例中,主要的測試條件在於一名女性會否因為她的性別而被給予差於男性的待遇(反之亦然)(8) 。這與一名變性人士因其轉換性別的身份而受到歧視,明顯地沒有直接關係。因此,相信法庭會難以以現行法例的字眼,將對變性人士的歧視也涵括其中。

人權法:人權法(只約束政府及公共機構,但不適用於私人機構)裡把歧視的意義定義得更廣,包含了對「性別或其他狀況」等層面。在其他司法轄區曾有案例,對基於性別的歧視作出廣義詮釋,包括了對變性者的歧視(9) 。當香港的法庭有需要就此問題作出裁決時,這些案例或有一定的說服力,但卻並非約束性的。

殘疾歧視條例:對變性人士的歧視亦有可能構成《殘疾歧視條例》所指的殘疾歧視(10) 。如果「性別認同障礙」被認定為適用於上述定義,那對跨性別人士在工作間所受到的歧視和騷擾皆足以抵觸有關法律,包括招聘、培訓機會、職位升遷及解僱等有關範疇。在最近一宗案例裡,一名完成了性別重塑手術的變性人士被逐出她崇拜多年的教會(11) ,她提出了訴訟,但最後卻庭外和解了。若她的訴訟真的送到法庭裡去,將會成為香港的首宗案例;然而,訴訟的無疾而終卻使得變性人士是否受《殘疾歧視條例》所保障這問題懸而未決。縱使《殘疾歧視條例》可能為變性人士提供重要的法律保障;然而,條例的論點卻可能造成一個兩難的局面--因為它涉及性別轉換現象作為一種「失調」和「殘疾」的爭論,帶有負面的意義。

 

出入境自由

變性人士收到了新的身份證,她/他便可以申請替換香港特區護照。

 

婚姻自由

在香港法律下,一段婚姻必須是在一名男子和一名女子之間(12) 。根據生死及婚姻註冊處所指,「男子/女子」是以出生證明書上所登記的生理性別作準(13) 。這表示變性人士不能合法地以她/他們手術後的性別結婚(14) ,雖然,諷刺地(因香港法律不容許同性婚姻),一名由女變男或一名由男變女的同性戀者,是可以跟與她/他們手術後新性別相同性別的人結婚。

事實上,一個完成了性別重塑手術的香港居民可以與她/他的異性伴侶舉行婚禮。程序上,香港居民只需以她/他的身份證登記結婚,而非出生證明書(註:一如上述,一名完成了手術的變性人士可以更改她/他身份證上的性別欄)。然而,這段婚姻在法律上是無效的(15) ,也就是說,從一開始這就已被視為無效。而且,一名變性人士若明知道該婚姻會在香港法律下無效而繼續結婚,這行為就是犯法的,一經定罪,最高刑罰是監禁兩年(16)

 

海外婚姻的承認

假若一名香港市民(不論是變性人士或其配偶)在海外有有效婚約,該婚姻也不能在香港獲得法律上的承認。如果是香港以外的婚姻,法庭只能對一夫一妻制下的婚姻,處理有關離婚、分居等訴訟(17) ;且該婚姻須獲當時當地的法律承認為不容他人介入的一男一女自願終身結合(18) 。就如上面討論過的,我們可以預期「男子」和「女子」等用詞是指當事人的生理性別,法庭根本不會處理變性人士有關海外婚姻的訴訟。

我正等待生死及婚姻註冊處澄清有關問題,亦等待入境事務處處長答覆,當婚姻關係的其中一方不是香港市民時,變性人士的海外婚姻會否被承認作移民用途。

 

供養孩子的自由

變性人士完成性別重塑手術後,她/他們與子女在法律上的身份不變。可是,當一名變性人士與孩子的另一方家長分居或離婚,不排除她/他的前妻/前夫會以其進行性別轉換為由,提出改變她/他對子女的監護令或探視令。

在香港,一名變性人士除非已婚,否則不可以領養孩子,無論這些孩子是供領養的,或屬其伴侶的孩子(19) 。上面已經討論過,在香港一名變性人士不可能以其手術後的新性別結婚,所以這嚴重地限制了變性人士在手術後領養孩子的機會。我希望跟社會福利署署長確認一下這種情況。

我還未找到任何政策(如有的話),有關若一名女士跟一名由女變男的變性人士結婚,而該名女士接受人工受孕的話,其處理手法如何。如有任何人有這樣的經驗,我很樂意知道。

 

其他法律問題

在變性現象上,還存在很多法律問題有待解決,其中很多與變性人士在香港的生活息息相關,且比其他人更重要,這包括:完成性別重塑手術後,當加入一張全新保單(如人壽保險、第三者保險)時,變性人士必須披露她/他以前的性別,否則該保單(被要求「最高誠信」的合約)將會無效。

完成性別重塑手術後,變性人士或許需要通知任何現行財務合約(如人壽保險合約、第三者保險合約、抵押、貸款、保證等)的另一方有關其改變了性別的情況(如合約帶有要求披露任何個人資料變更,否則合約作廢的條款)。

《刑事罪行條例》裡的若干罪行,有指明涉案人的性別。例如,強姦罪是指一名男子與一名女子非法性交(20) 。雖然香港的法院並未裁判過涉及變性人士的這類案件,但就有關刑事法的判決極有可能會以一名變性人士的本來生理性別來作依據,不會理會其是否有進行性別重塑(英格蘭有案例就是如此(21) )。無論該變性人士是犯案者或是案件中的受害者,這將引發一連串的怪現象。

 

總結

顯而易見,在爭取手術後變性人士的新性別在香港獲得法律承認、變性人士的尊嚴、自由和私隱的運動上,我們還有漫長的路要走。隨著國際間改善變性人士法律地位的趨勢日漸增長,這或許是適當時機,認真探討香港在這方面的問題。

 

註釋

(1) 一份變性人士在香港面對的法律問題的摘要收錄於 Ng, Wong, Chow等人的 Transsexualism: Service and Problems in Hong Kong, Hong Kong Practitioner 11:12 (1989) 591, 599-600。這份是我唯一可以找到的、有關變性人士在香港面對的法律問題的出版物。

(2) 這是根據香港法例第177A章,《人事登記條例》第14(1)(a)條。

(3) 《人事登記條例》第18條。

(4) 2002年8月7日入境事務處處長回覆作者的信件。

(5) 《生死登記條例》第184章,第27條。

(6) 包括家庭崗位,受《家庭崗位歧視條例》規管,但這跟現在討論的題目無關。

(7) 第22條。

(8) 第5及6條。

(9) 例如,在 P v S and Cornwall County CouncilCase C-13/94 [1996] IRLR 347 這個在1996年比歐洲法院所判的更早的案例裡,指出《歐盟平等待遇指示》裡所提及的工作崗位性別歧視,應廣義地詮釋至包括對那些正進行或已完成性別重塑手術的性別轉換者的歧視。

(10) 香港法例第487章,《殘疾歧視條例》第二條有關殘疾(g)項。

(11) 2001年3月16日《南華早報》第3頁,「Sex-change Mormon sues church」

(12) 香港法例第181章,《婚姻條例》第40條。

(13) 2002年8月7日,寄給作者的信件。

(14) 這是據英國 Corbett v Corbett [1970] 2 All ER 33 的案例。該案例技術上可影響香港法院裁決,儘管它的論據被歐洲人權法庭在2002年7月11日歷史性地就 Christine Goodwin and I v the United Kingdom Government, No 28957/95 (1995) ECHR 的案例判決所推翻。在那個案例裡,該歐洲法院裁定英國政府不承認 Ms Goodwin 手術後的新性別以及因此而包含的結婚權利,違反了《歐洲人權協定》。

(15) 香港法例第179章,《婚姻訴訟條例》第20(1)(d)條表明,如結婚時,參與的雙方並非分別為男性和女性,該段婚姻是無效的。香港的法庭亦會跟隨英國 Corbett v Corbett[1970] 2 All ER 33 的案例,即一名在舉行婚禮前已完成了手術的由男變女TG與一名男性追求者的婚姻是無效的,因為他們生物學上的性別並非相異。這個判決立場亦被最近英國的 Bellinger v Bellinger[2001] EWCA Civ 1140 案例所確定。

(16)《婚姻條例》第33條。這指一個人若明知道她/他在法律上不可以結婚,但仍「有意地及蓄意地」結婚的情況。

(17)香港法例第179章,《婚姻訴訟條例》第9條。

(18)《婚姻訴訟條例》第2條。

(19)見香港法例第290章,《領養條例》第4條。

(20)香港法例第200章,《刑事罪行條例》第118條。

(21) R v Tan and others(1983) 1 QB 1053 案例 。

 

2015 世界衛生組織:《性衛生、人權及法律》

《性別認同與表達》

對人類健康、福利和基本人權來說,能夠在沒有侮辱、歧視、排斥和暴力的情況下,確認並表達一個人的性別認同是非常重要的。在法律上和日常生活上,讓一個人能夠根據自我認同的性別去生活,是讓其在一切福利上,包括醫療、社會及其他服務上得到應有之權益。任何人都不應因法律上的性別認同和表達,而被迫接受任何醫療程序,包括性別確認手術、絕育、賀爾蒙治療,或被迫離婚。這是對人權的尊重,保護和實現的基本要求。事實上,許多曾經應用這些程序為變更性別條件的國家已被質疑及修正,或已經制訂新的法律,來符合人權標準。

全文下載

 


在香港締結婚姻的程序

跟據變性人婚姻案的終審判決,雖然婚姻修訂草案於立法會二讀被否決,但政府已作出公告,入境處亦已在行政指引上作出修訂。詳情請參閱以下網址 Q17:

http://www.immd.gov.hk/hkt/faq/marriage-registration.html

 


2014年婚姻(修訂)條例草案

引言:在二零一四年二月十八日的會議上,行政會議建議,行政長官指令向立法會提交《2014年婚姻(修訂)條例草案》(條例草案),以落實終審法院於W訴婚姻登記官(FA C V 4/2 01 2)一案(簡稱「W案」)下達的命令。

以下為草案委員會的會議內容

http://www.legco.gov.hk/yr13-14/chinese/bc/bc52/general/bc52.htm

 


2012 UNDP: Lost in Transition: Transgender People, Rights and HIV Vulnerability in the Asia-Pacific Region

全文下載

 


世界跨性別健康專業協會:《變性者、跨性別者、 和非性別常規者的 健康照護準則》(第七版)

WPATH: Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (Version 7)

全文下載: 繁體中文

全文下載: 簡體中文

全文下載: 英文

 


2012 聯合國人權事務高級專員辦事處:《生而自由、一律平等:國際人權法中的性取向和性別認同》

2012 UN OHCHR: Born Free and Equal: Sexual Orientation and Gender Identity in International Human Rights Law

http://www.ohchr.org/CH/Issues/Discrimination/Documents/Born_Free_and_Equal_chinese.pdf

 


2003 國家報告:香港有關性別轉換及變性人士的法律問題

2003 'Country report': Hong Kong, legal issues

中文全文下載

English Content

 


台灣性別不明關懷協會創辦人寫的一篇很不錯的文章

「觀點投書:跨性別社群裡的矛盾與衝突」

 

以下提供的資訊,希望能夠讓有情緒困擾的人士作及時的幫助。由於不同情況的人士有不同之需要,以下的資訊只作參考之用,並不代表本組織的立場及方向,亦不涉推薦成分。

 

情緒支援網站

 

憂鬱小王子之路

Little Prince is Depressed

由香港大學香港賽馬會防止自殺研究中心提供

網站:http://www.depression.edu.hk

 

智友站 - 抑鬱症

Smart Patient - Depression

由香港醫院管理局提供

網站:http://www21.ha.org.hk/smartpatient/tc/chronicdiseases_zone/details.html?id=175

 

小鬱亂入

Depressy Trouble

由小鬱亂入提供

網站:http://depressytrouble.tw/index.php/quiz/

 

東華三院陳兆民中學

TWGHS-Chen Zao Men College

由東華三院陳兆民中學提供

網站:http://www.twghczm.edu.hk:82/tc/subject/Sex_Edu/ie/sexed/aids/aidtest1.htm

 


情緒支援讀物

 

抑鬱自療

作者 : 湯國鈞、李靜慧、呂慧詩

ISBN : 978-962-8913-95-4

出版日期 : 2008年02月01日

定價HK$ 98.00

頁數264

網站:http://www.btproduct.com/tc/book/product.php?id=9168453

7

 


情緒支援機構

 

香港沙維雅人文發展中心

The Hong Kong Satir Center For Human Development

在本港推廣和發展沙維雅模式及其他人本主義的輔導及治療法

網站:http://www.hksatir.org/chinese/index.html

 

明愛「情性地帶」

Sexuality Zone - Supportive & Counseling Service on Sexual Behavior of Youth

青少年性健康支援及輔導服務

熱線: 6188-5555 (可whatsapp)

網站:http://www.facebook.com/caritas.szproject

 

香港撒瑪利亞防止自殺會

The Samaritan Befriends Hong Kong

於1960年成立,為一所植根於香港的志願服務機構。一直以聖經中好撒瑪利亞人的友善博愛和助人為樂的精神作榜樣,向絕望及瀕臨困境人士伸出同情之手,予以扶持及情緒輔導,達到助人自助的目標。

網站:http://www.sbhk.org.hk

電郵:Email住址會使用灌水程式保護機制。你需要啟動Javascript才能觀看它

24小時熱線:2389-2222

 

東華三院「芷若園」

Tung Wah Group of Hospitals CEASE Crisis Centre

危機介入及支援服務,主要為性暴力受害人、面對家庭暴力或其他家庭危機的個人或家庭,提供全面的援助,包括24小時熱線、外展服務和短期住宿服務。

網站:http://ceasecrisis.tungwahcsd.org

電郵:Email住址會使用灌水程式保護機制。你需要啟動Javascript才能觀看它

24小時熱線:18281