The Book of Transgender in Hong Kong
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
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.
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.
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 = 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.
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.
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.
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.
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.
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.
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.
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 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.
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 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.
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 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.
● 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’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.
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
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
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
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)
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。
- 跨性別 = 變性？
- 易服 = 病態？
- 跨性別 與 同性戀 之關系
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。
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。
跨性別 = 變性？
易服 = 病態？
跨性別 與 同性戀 之關係
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。
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。
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。
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)。
2. 性傾向（Sexual Orientation）
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。
5. 雙性人 (Intersex)
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
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」。
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)
13. Pass / Passable
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。
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)
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)
20. 扮裝皇后/皇帝 (Drag Queen / King)
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)
23. 性別酷兒 (Gender Queer)
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。
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)
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。
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）
校對：Garry Kan、Lucetta Kam
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
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。
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：
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。
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) 。
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。
《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。
(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。
(9) 例如，在 P v S and Cornwall County CouncilCase C-13/94  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。
(11) 2001年3月16日《南華早報》第3頁，「Sex-change Mormon sues church」
(14) 這是據英國 Corbett v Corbett  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 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 EWCA Civ 1140 案例所確定。
(21) R v Tan and others(1983) 1 QB 1053 案例 。
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。
2012 UNDP: Lost in Transition: Transgender People, Rights and HIV Vulnerability in the Asia-Pacific Region
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)
2012 UN OHCHR: Born Free and Equal: Sexual Orientation and Gender Identity in International Human Rights Law
2003 'Country report': Hong Kong, legal issues
Little Prince is Depressed
智友站 - 抑鬱症
Smart Patient - Depression
TWGHS-Chen Zao Men College
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
The Hong Kong Satir Center For Human Development
Sexuality Zone - Supportive & Counseling Service on Sexual Behavior of Youth
熱線: 6188-5555 （可whatsapp）
The Samaritan Befriends Hong Kong
Tung Wah Group of Hospitals CEASE Crisis Centre
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