Between the Body and Regulations: The Difficult Situation for Transgender People in Taiwan
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This article is part of the 60th issue of LEAP — Voices of Youth e-letter. Subscribe now.
In recent years, two court cases in Taiwan involving transgender individuals changing their gender markers on their IDs without surgery have sparked public discussion on transgender issues.
In 2021, a transgender woman, Xiao E, won her case in court, allowing her to change the gender marker on her ID without requiring surgery. On May 30th of this year, a transgender man, Nemo, also won his case, becoming the second such precedent in Taiwan. These legal rulings have elicited opposition, with many insisting that transgender individuals should undergo surgery to change the gender marker on their IDs. These differing voices not only reflect public concerns but also indicate a lack of awareness of the costs and risks associated with surgery.
The Costs, Risks, and Medical Evaluations of Surgery
For many transgender individuals, the gender marker on their ID acts as a significant hurdle. Whether seeking employment, medical care, or banking services, many institutions rely on ID verification. When the gender marker on an ID does not match a person’s outer appearance, however, transgender individuals are often “forced to come out,” exposing themselves to scrutiny and questioning, which can affect their basic welfare in employment and healthcare.
Taiwanese law requires a diagnosis from two psychiatrists and proof of surgery to remove the original sexual organs to change the gender marker on an ID.
Undergoing gender-affirming surgery requires a lengthy medical evaluation. Transgender individuals must undergo long-term follow-up to obtain a diagnosis, then proceed with hormone therapy and “real-life experience” (RLE) [1] for six months to two years before they can schedule surgery.
Along with a risk of infection, surgical outcomes vary among individuals, and require months of recovery. Beyond the surgical risks, transgender individuals may face challenges during the evaluation phase. During this process, the role of the doctor shifts from provider to evaluator, with inconsistent standards, leaving much room for subjective judgment on who is suitable for surgery.
Transgender people who seek to undergo gender-affirming surgery are not always lucky enough to see a doctor that supports them. One research reveals that one transgender individual was unable to obtain a diagnosis after two years of evaluation due to the judgment of a “lack of family support” by a doctor. Some psychiatrists have even told transgender women to bring photos of themselves as young men and draw long hair on the photos, saying, “If you look like this as a woman, people will be scared,” discouraging them from pursuing surgery.
Requiring Surgery for ID Change Raises Human Rights Concerns
To avoid experiencing discrimination during psychiatric evaluations or spending years with no results, the transgender community relies heavily on lists of friendly medical institutions and some trans women may dress in highly feminine clothing during consultations to emphasize their transgender identity [2].
Undergoing gender-affirming surgery can take years and cost hundreds of thousands of dollars. Not all transgender individuals have the physical, economic, or work environment conditions to choose surgery. Justice Sheng-Lin Jan has stated that making surgery a requirement for changing ID gender markers exposes personal gender identity to public scrutiny. Considering the costs, risks, and side effects of surgery, such a regulation does not adhere to the principle of proportionality and raises concerns about gender autonomy and human rights.
Moreover, not all transgender individuals consider surgery necessary. Some strongly reject the sexual characteristics of their birth gender to the extent of self-harming their sexual organs. However, many transgender individuals, like Stella from the other article, can accept their birth gender’s sexual characteristics.
Transgender individuals face frequent scrutiny of their bodies and appearances in daily life, and the clear-cut binary gender regulations that consider surgery as a requirement for changing ID gender markers ignore the costs and risks, as well as the diverse body imaginations of the transgender community. Many transgender individuals strive to create a secure living space within the narrow confines of bodily appearance and social norms. Taiwan’s medical, legal, and social systems need more communication to create a friendlier regulatory and medical environment.
[1] Real Life Experience (RLE) refers to the experience of living in the gender role with which the transgender person identifies. Taiwan follows the health care standards set by the World Professional Association of Transgender Health (WPATH), requiring transgender individuals to have at least two years of RLE before surgery.
[2] Mei-Hua Chen, Ching-Yi Tsai (2013). “Saying What the Doctor Wants to Hear: The Politics of Gender Reassignment Evaluation.” Taiwan Human Rights Journal, 2(2), 3–39.
[3] Constitutional Court Ruling №112, 2023, concurring opinion by Justice Sheng-Lin Jan.
Also in This Issue: Drawing a Blueprint for the Body: Diverse Body Imaginations Among Transgender People
The gender identification Stella experiences is nothing like a static one. She has a unique blueprint for her own body.
Author: Lin Hung-cheng
Freelance journalist exploring gender and public issues.
