Kevin Lee’s father used to grunt in affirmation if someone asked if Lee was a girl. He did the same if someone asked if Lee was a boy. Growing up in the 1980s in Guiyang in southwestern China, Lee was relatively withdrawn, in part because he didn’t know what gender he was. He was less sensitive than the girls, he said. But he looked different than the boys.
Lee came out to his parents when they asked him about dating. He said he wasn’t interested in dating men and that he saw himself as male. They said “OK” and ignored the issue. Their response, Lee said, felt like being shoved back inside the closet.
It’s not uncommon for transgender people to get a negative reaction from their parents when they come out. But parental support is particularly crucial in China, where trans people need parental consent to undergo gender-affirming surgery and change their legal gender—even as adults. (If their parents are deceased, trans people must prove that to authorities.) These hurdles often make it harder for trans people to obtain care.
Lee, who wanted to pursue the surgery, said he considered the consent requirement an effort to prevent parents from seeking legal or physical retribution against doctors. “They’ll make a scene,” he said of parents who may not support their child’s decision to undergo surgery. “There will be family members taking out knives to kill doctors. It will become a social issue.”
That was one of the reasons Lee didn’t pursue gender-affirming surgery in China. “My mom is conservative,” he said. Though consent forms can be forged, he didn’t want her to go after the doctor who helped him.
In China, the need to obtain parental consent for gender-affirming care forces families to resolve their differences about the procedure ahead of time, dealing with drama or disagreements inside the family. According to Cherry, an LGBTQ+ organization worker, who requested the use of a pseudonym to protect their safety, the requirement exists to avoid parents causing a stir at the hospital.
It is also the product of a Confucian and patriarchal way of organizing society, Cherry said. For instance, police who want to put pressure on young queer activists often visit their parents’ workplaces and out them—so that the target has to deal with the ensuing family drama. “The person is managed through the family so they don’t become a problem in the public domain,” Cherry said.
The first gender-affirming procedure in China was carried out in 1983. The process entered the mainstream consciousness when Jin Xing, a famous dancer and TV presenter, recorded her surgery in a documentary released in 2000. Her father, a military officer, gave her his unconditional support. He even went to the local police station and demanded that they give Jin Xing a new ID card that reflected her gender.
That kind of parental support is rare. A 2021 report by the Beijing LGBT+ Center, which was shut down in 2023, found that only 3.2 percent of fathers and 5.9 percent of mothers in China “completely supported” their children after they came out as transgender.
Some conservative parents who do not accept their children’s gender identities send them to conversion therapy. A trans woman successfully sued a hospital last year for being subjected to electroshock therapy and being held against her will for three months. “People making policies lived through the Cultural Revolution,” Cherry said. “There’s a fear of not being the same,” they said, referring to the great emphasis placed on collectivism during that time.
Xiaoma, who grew up in the small city of Huzhou in southeastern China and requested a pseudonym to protect her privacy, recalled that before the internet reached her town, her first encounter with trans culture came from tabloids sold by street vendors, which told sensationalist stories about trans people. In phone directories, she saw advertisements for gender-affirming operations alongside those for double eyelids and breast augmentations. When she came out to her parents and told them she wanted to get gender-affirming surgery, “there was crying, there was arguing,” she said.
“There is a saying: Your body, your hair, your skin is from your parents,” said a doctor working in fertility who spoke on the condition of anonymity because she was not authorized to talk to media. Ties between generations are close: “Most parents will think you’re always their child and that they have authority over you,” she said. To her knowledge, gender-affirming surgery is the only surgery undertaken by adults in China that legally requires parental consent. Other major or high-risk surgeries, such as heart surgery, often require a family member’s consent, but it can come from another direct relative or a spouse.
Xiaoma’s parents eventually acquiesced to her gender identity, even offering to help pay for a better doctor for gender-affirming surgery than she could afford on her own. Still, she couldn’t bring herself to ask for their consent. “Acceptance is one thing. Asking them to sign a consent form is another,” she said, since it would require that they actively support her decision rather than simply tolerate it. Xiaoma instead traveled to Thailand, where she could get the surgery without asking for anyone’s approval.
The barrier posed by parental consent has led to the growth of a gray industry of illegal surgeries and hormone replacement drugs in China. People exploring their sexuality and gender identity often turn to sources outside the public medical system for guidance.
When Lee was looking into gender-affirming surgery, he turned to the online forum Baidu Tieba, which is similar to Reddit. He reached out to people posting about which hormone replacement drugs worked and which did not and bought the drugs they recommended. He joined a group organized by drug sellers on the social media platform QQ, where the group’s 1,500-plus members could purchase the drugs.
After taking the medicine, Lee felt strange, and his periods got heavier. When he complained about these side effects, the drug sellers pushed him to get surgery. They told them that unless he did, he’d still be a woman. He believed everything they said. “To put it nicely,” Lee said, “they brainwashed me.”
Lee flew to Shanghai to visit the hospital where these sellers worked; he said he saw them sell the same medicine directly to another patient, a 16-year-old boy, in exchange for cash—far from standard procedure in Chinese public hospitals. Lee left and took a walk along the city’s waterfront, processing what he had seen. He turned it over in his mind. Something felt wrong.
Lee sent the hormone replacement drugs that he bought to a lab for testing. The results revealed that they were substandard anabolic steroids made from a mix of veterinary drugs. “It’s like they sold me an iPhone but just a shell,” he said. “I didn’t know what brand of battery they replaced it with, and it could explode.” When Lee applied to study abroad in Australia, he didn’t initially pass the health tests required to obtain a visa because the drugs had affected his liver and kidneys. “I was responsible for my own ignorance,” he said.
There have been some victories for China’s trans community over the past decade, such as winning a landmark work discrimination case in 2016. But it is still very difficult for trans people to change their gender on the education certificates often required by employers, which in effect outs them. Public medical insurance doesn’t cover hormone replacement therapy and gender-affirming surgery.
In 2022, China released regulations that lowered the minimum age for gender-affirming surgery from 20 to 18 and removed a requirement that people undergo a year of psychiatric treatment before surgery. It also lowered the threshold for changing official ID documents: Though the Chinese government used to require that individuals had undergone full reconstruction of their sex organs, a person can now apply for a new ID after having their reproductive organs removed—a less complex surgery that nevertheless carries medical risk.
However, those looking to change their IDs still face obstruction from local administrators, who are not always up to date on the regulations, slowing down the process.
“I was very willing to go for surgery” after reading the new regulations, Lee said. He chose to have gender-affirming surgery in Thailand rather than in China, in part because he did not want to push for his parents’ consent when he knew they did not approve of his decision. He also wanted to avoid causing them more pain. “I don’t want my parents to be gossiped about on the street,” Lee said. “My parents live in a small city where everyone knows each other.”
Lee flew to Bangkok and stayed in the hospital for four days. While he was undergoing surgery, he dreamed of Burger King. When he woke up, he had a hamburger and then vaped.
The ensuing paperwork did not go as smoothly. After returning to China, he started the process of changing his ID card in the island province of Hainan, where he previously lived and was registered as a resident. It was the start of a legal tug-of-war. The administrators asked him to prove that he was a man. He asked them to prove that he was a woman. They found reasons to delay the process, and he had to keep flying back and forth from Guizhou in southwestern China, where he currently lives.
At one point, Lee lost his temper and told the authorities that he would make a reel on Douyin, the mainland Chinese counterpart to TikTok, or talk to the media about his experience. He eventually received his new ID card.
Though China leaves a route open for trans people to pursue gender-affirming surgery, the government actively discourages open trans activism and advocacy. Under its current leadership, China has seen a rise in nationalist rhetoric and heightened distrust of foreign influence, leading to a crackdown on international funding for local organizations, which often rely on such support.
In 2016, the government passed the Overseas NGO Law, which made it more difficult for grassroots organizations to receive funding from international donors. Organizations such as Cherry’s, which received overseas funding before the law was passed, have had to shrink the scope of their work significantly.
Before 2016, Cherry and their colleagues used to go to schools and universities to talk about sexual diversity. They displayed the Pride flag openly and organized rainbow-themed runs and cycles.
The organization still helps transgender people who are looking into surgery, providing them with information on where to stay, which doctors are friendly, and which hospitals can provide the appropriate medicine. They also put on small-scale gatherings and carry out sexual disease prevention work.
But the organization must now report any gathering with more than 10 people to the police for approval, which is not a given. Ahead of dates the authorities consider politically sensitive, such as International Day Against Homophobia, Biphobia, and Transphobia or International Women’s Day, Cherry’s organization receives calls from the police checking that it will not hold any events, according to people who work there.
Advocating for the rights of sexual minorities and displaying symbols such as the Pride flag are increasingly considered by authorities as proof of foreign influence. “Anything involving the Pride flag is not allowed,” said Lotus, who works with Cherry and also asked to use a pseudonym for fear of political retribution.
“There are many voices telling us to shut up,” Lotus said. A lot of people online take the attitude “We respect you—just don’t speak out.” Though the comments are made by private individuals, that social media moderators do not delete them shows that the comments reflect an “official stance,” they said.
The main sources of funding for Lotus and Cherry’s organization are now state bodies, including the China’s Center for Disease Control and Prevention and the All-China Women’s Federation, which focus on AIDS prevention rather than trans advocacy. The organization can receive money from these bodies when their work aligns with that objective.
Lotus gestured to a jar near where we were sitting in their office, which contained a miniature Pride flag alongside China’s national flag. “If we only put the Pride flag, there would be a problem.”
Lee now runs his own company, selling prosthetics to trans people. He drives a bright orange electric vehicle that bears a sign saying, “I’m a straight guy.” Despite the red tape that he encountered in his transition, Lee told me that he considers China’s policies to be friendly toward trans people. He pointed to other countries such as North Korea, where transgender issues are not formally addressed in law, or Russia, where trans people are not permitted to change their legal gender. In Thailand, trans people cannot change their ID cards following surgery.
He acknowledged that many trans people were reluctant to acknowledge their past for fear of discrimination. He often fielded questions from other people in the trans community asking him how he dealt with showing his education certificates to employers. But since he is self-employed, he has not faced that issue.
Lee had little contact with his parents before his surgery, and that did not change after he returned to China from Thailand. When I spoke to him in January, he said he planned to travel over the Lunar New Year holiday to Xishuangbanna in southwestern China. I asked him if he planned to see his parents, and he said he might see his father, that they might even travel together. He didn’t think his mother would want to join them.
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