We shine a light on the transgender community's unique challenges that set them apart from the rest of the LGBTQ community.
By: Natasha Lee & Rogini Nachiappan
What do you think of when you hear “LGBTQ community”? Two men holding hands, parades, drag queens, rainbows and glitter? But do you think of life-changing haircuts? Do you think of surgery? Do you think of needles?
TATTOO ADDICTION: Luke Mendoza, 25, showing his tattoos: a rainbow cross to represent him reconciling his faith with his gender and sexuality; the words “work in progress” which refer to his transition; and a ribbon around his wrist which is a family tattoo. (Photo: Natasha Lee)
With all the conversation around LGBTQ rights in Singapore, it may seem like the community is making strides in this relatively conservative country. However, in this flamboyant and often “loud and proud” community, there is one group of people that has remained overlooked - the transgender community. Much of the activism of Singapore’s LGBTQ community has centred around repealing Section 377A and accepting sexual minorities. This discounts many of the struggles that transgender people face in Singapore.
Gender marker change policy
Transgender people face many more legal obstacles due to their identities, in particular, the gender marker change policy. This is a policy that has existed since 1973, when Singapore legalised sex-reassignment surgery. It allows transgender Singaporeans to change the gender marker on their IC, but only with an ICA form from a doctor verifying that they had “completely” changed their genitalia. While there are a variety of steps that a transgender person may take in their medical transition, this policy focuses only on genital surgery, also known as bottom surgery.
A survey conducted by TransgenderSG found that only 9.7% of surveyed transgender Singaporeans had managed to change their gender marker legally. Despite existing as a policy directive rather than a statute or law, the gender marker change policy has posed many obstacles to most transgender people’s daily lives.
Legal issues
The gender marker change policy creates other legal issues in the lives of transgender people. Marriage is complicated by this because a transgender person is required to change their gender marker in order to marry someone of the opposite gender.
According to A Joint Report on Transgender Issues by TransgenderSG and Sayoni: “Transgender Singaporeans who have transitioned but are unable to change their legal sex end up in a legal limbo where they are unable to marry anyone of any sex. This and restrictions against same-sex marriage lock the majority of transgender people out of public HDB housing before the age of 35, and force many in abusive home environments to either tolerate domestic violence or become homeless due to a lack of alternative housing options.”
Social issues
WHO I AM INSIDE: Dan Lee, 27, poses for a mirror selfie in the MRT. (Photo: Dan Lee)
The biggest social issue arising from this policy is gender mismatch, where the sex on a transgender person’s IC does not match the gender they are seen as. A transgender man may have started hormone replacement therapy (HRT), had top surgery and/or hysterectomy, and pass as a man, but his IC will still say F as long as he has not undergone bottom surgery.
According to A Joint Report on Transgender Issues: “Transgender persons with incongruent legal gender documentation face heightened vulnerability to harassment, discrimination and violence.”
This also poses issues when doing things like opening a bank account, travelling, or looking for a job.
Luke Mendoza, 25, is a transgender man and Singapore PR that has had this policy interfere with his ability to find a job.
“It has been considerably harder for me to find a job this time, after I came out. Because my name is not changed, and I can't get my name changed because I'm not a Singaporean citizen… So it kind of outs me immediately when I apply for jobs because I have to use my legal name and of course the IC says F. And I've gotten a call I think once where they were a bit confused because I don't sound female.”
Another common issue transgender people face is discrimination. Even families that would usually support LGB people may have different attitudes towards transgender people.
Luke recalled rhetoric that he heard often from religious Catholics like his extended family: “Being gay like obviously is bad right, for Christians, but they will also say like, you can't mutilate the body that God gave you. So obviously that stopped me from even considering that I might be trans because like being gay is one thing, but to some people I knew being trans was worse. For a long time I just settled like "ok I'm gay I'm gay" until eventually I stopped denying it. It was mostly religion that stopped me from realising that I was trans.”
Fortunately for Luke, his mother and her family learned to accept him after some time. But for transgender people without supportive families, they face the risk of domestic abuse. They might even be kicked out of their homes, and therein lies another issue. Many homeless shelters do not take in transgender people. Only one homeless shelter openly accepts transgender people. Thus, transgender people are often left in dire straits.
Health issues
DO NOT THROW AWAY YOUR SHOT: Luke getting his testosterone shot at Tan Tock Seng Hospital. (Photo: Natasha Lee)
Another issue posed by the gender marker change policy is forcing transgender people to get surgeries they may not want. There are a myriad of reasons why a transgender person might not want to pursue bottom surgery, such as a lack of dysphoria.
Christopher McClung, MD, a urologist with OhioHealth in Columbus, Ohio, says: “What I always tell patients is if you don’t have dysphoria about a body part, [then] don’t have surgery.”
Alternatively, given the imperfect techniques currently available for female-to-male bottom surgery, transgender men in particular may be waiting for better surgical techniques. Costs for bottom surgery can also be prohibitively expensive, reaching up to $125k or more. Yet, many transgender people we spoke to echoed the sentiment of getting bottom surgery just to get their gender marker changed.
“Personally I don't really have bottom dysphoria,” Luke said. “Mostly I'm focusing on top surgery now, but in the future, I definitely want the gender marker change and that requires some kind of bottom surgery.”
Dan Lee, 27, also spoke about agonising over the decision. "I don't know if I want to have bottom surgery because I have bottom dysphoria, or because I want the gender marker change."
FLATTEN THE CURVE: Dan’s chest binder from Peecock, meant to give the impression of a flat chest. (Photo: Dan Lee)
Age limits are another barrier to transgender youths receiving timely care. Singapore’s age limits for accessing gender-affirming procedures are much higher than that of other countries. Currently, transgender people can begin their medical transition (HRT or surgery) when they reach age 21, or at age 18 with parental consent. This is higher in comparison to the age of majority in most countries. For example, the UK’s National Health Service allows people aged 18 and older to be seen in an adult gender identity clinic to begin hormone therapy and surgery.
Singapore’s higher age limits force transgender teenagers to choose between outing themselves to parents who may not be supportive, or remaining dysphoric and unhappy for three years.
The World Professional Association for Transgender Health (WPATH) says: “Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization.”
This can also have adverse effects on mental health, causing issues like depression and suicidal ideation. A study on transgender adolescent suicide behaviour found that transgender individuals report suicide behaviours at a higher rate than their cisgender peers. 41% of transgender adults have attempted suicide, compared to 0.5% in the general population.
However, a study found that psychological outcomes improved after HRT and gender reassignment surgery. Gender dysphoria was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population.
Therefore, Singapore’s relatively stricter age limits prevent transgender youth from accessing potentially life-saving treatments. Mental ill health and extreme unhappiness may push transgender youth to alleviate their dysphoria through non-governmental means.
Lewis, 20, who wanted only to be known by his first name, is currently taking testosterone outside of the public or private clinic route. Being under 21 and not out to his parents, he gets his testosterone from “connections” while awaiting his 21st birthday in January. He also got top surgery from Dr Danny Oh, a surgeon in Penang, Malaysia that does not require a psychiatrist’s letter or parental consent for under-21s.
Lewis’ case illustrates the desperation that transgender people in unaccepting family situations face. Trans youth who transition without their family’s knowledge lose financial and social support. Yet, they would rather take on great financial cost, and risk adverse effects and social alienation than to wait to transition.
CUT IT OUT: Lewis poses in his compression garment after top surgery with Dr Danny Oh in 2019. (Photo: Lewis)
Conclusion
Transgender people face very different issues from LGB folks in Singapore, because their gender identity affects the way they live and move in the world. They have remained overlooked by both the government and fellow members of the LGBTQ community. There is a huge lack of statistics covering the transgender community here in Singapore. This reflects and results in the lack of proper legal recognition for the community.
So if transgender people had the choice to set the criteria for a gender marker change, what would they choose?
Lewis said: “I don't want it to be gatekeeping, so maybe one year on [testosterone], so they have experienced fully living as their actual gender.” He also suggested having one surgery, but not necessarily bottom surgery, as a criteria. “You don't want the criteria to be too high or financially impossible.”
Dan echoed this sentiment: “Maybe one or two years on [testosterone], or one surgery if they really want to have a surgery requirement.”
Luke agreed: “I think top surgery should be a consideration. Like if they wanna have it as, you need to have surgeries to go forward, I think it should be either-or. Maybe if you got top surgery or you got bottom surgery, but like, you don't have to get all of this.”
Comments