China issues sex change guidelines for public discussion

China is set to issue its first clinical guideline on sex-change surgery, according to a notice put on the website of the Ministry of Health Tuesday.

The ministry is now soliciting public and professional opinions on the draft guideline. The coming guideline aims to regulate and standardize sex reassignment surgery, part of a treatment for gender identity disorder in transsexuals.

Experts estimate nearly 2,000 Chinese have undergone sex-change surgery while 100,000 to 400,000 are still considering it. However, no official number is available.

In the draft, the MOH sets minimum criteria for both surgical candidates and medical institutions.

Candidates for the surgery must be older than 20 and single, the draft guideline said.

They are also required to prove a persistent desire for a sex change, to live for at least five consecutive years full-time in the new gender role, and to engage in mental therapy for at least one year.

Before surgery can take place, a candidate must receive a recommendation for the operation from a psychologist after an appropriate series of therapy sessions.

Also, several legal requirements must be met before the procedure.

The candidate must provide proof from police that he or she has does not have any criminal offenses in the past.

Police must also agree to change the sex status on the identity card of the prospective receiver before the operation can take place.

Qiu Renzong, bioethicist at the Chinese Academy of Social Sciences, said he believes this last requirement is not appropriate.

‘As long as a person meets the physical and mental requirements, she or he should be granted the permit to have the surgery,’ he told China Daily. ‘The police should change the sex of the receiver on the identity card accordingly.’

He did, however, acknowledge the validity of the requirement for no criminal offenses, citing public security.

He also disagrees with the clause that the candidate has to live for at least five consecutive years full-time in the new gender role.

‘Transsexuals who might consider sex change remain largely hidden in China’s mainstream social life. It’s hard for them to live and work openly in the gender role they want,’ he explained.

But the advent of such a guideline shows that the government is concerned about the needs of a relatively small number of people who want to change sexes, he said.

He Qinglian, a veteran doctor of plastic surgery including sex-change operations with the Shanghai 411 Hospital, said all stakeholders, including the hospital and prospective receivers, should be highly cautious about this surgery.

The operation is more than a medical procedure due to its huge social and legal consequences, He noted.

‘The surgery should be the last resort for people who are struggling with the gender,’ he said.

Doctors should make it clear to those seeking sex-change surgery that the option always remains to continue to live in the original role, he noted.

The guideline requires surgeons to tell patients about other options such as hormone therapy. They also are required to explain the risks involved, and underlying social barriers including discrimination, and administrative recognition and approval.

Xiao Feng (alias), a transsexual in Beijing, told China Daily that he visited different doctors and got varied opinions. Some suggested the sex-change surgery while others did not.

‘I was confused by the different ideas and I hope the government can set scientific and uniform guidelines for such surgery,’ he said.

He said that he knows of some cases in which the person requesting a sex-change operation in the end decided that he or she hated the new role.

If these people had had the surgery, ‘that would have been a life disaster,’ He said.

For candidates, the surgery itself is not the big issue in the long run. The real issue is the kind of life he or she will have to lead afterward, said Qiu.