China loosens restrictions on gender-affirming surgery – but many trans people are still shut out

More trans people in China will be able to access gender-affirming surgery and legal recognition under new rules.

The National Health Commission in China published new guidelines on 20 April which lower the age requirement for gender-affirming surgery from 20 to 18.

It also drops a requirement that people undergoing such surgeries must first go through a year of psychological counselling or psychiatric therapy, and makes the path to legal recognition easier.

In China, trans people can only change the gender marker on their official documents once they have undergone surgery.

Under the old regulations, two surgeries were required, genital removal and reconstruction, while trans men were also required to have top surgery.

The updated rules still require that trans people to have genital removal surgery, but drop the reconstruction requirement. Top surgery has also been eliminated from the list.

Medical terms have also been updated. While the stigma-laden ‘transsexualism’ remains a formal and required diagnosis, it has been joined by the terms gender dysphoria and gender incongruence.

Unchanged are the requirements that trans people “voice continuous demand” for surgeries for at least five years, have a clean criminal record – something that prevents many trans sex workers from accessing surgery and recognition – and gain consent from an “immediate family member”, usually a parent, even in adulthood.

While the new rules are still highly restrictive and medicalise the path to legal recognition, they have been welcomed as a step in the right direction as they will provide a quicker and more affordable pathway for those who want to change the gender on their IDs.

In China, removal surgery costs around 10,000 yuan (£1,197)m according to SupChina. In total, a person’s essential surgeries can cost up to 60,000 yuan (£7,184).

This simplified process will surgery up to more people, Āwǎn 阿婉, a Shanghai-based medical practitioner, told SupChina.

Āwǎn said: “Many trans people I know reposted the news on WeChat. The community was applauding the change.”