Transgender people in China

Cross-dressing in Peking Opera

Sinologists often look to theatrical arts when imaging China in a transgender frame because of the prominent presence of cross-gender behavior.^[7]

Peking Opera, also known as Beijing Opera, had male actors playing female dan characters. Men traditionally played women's roles due to women being excluded from performing in front of the public as a means of preventing carnal relations.^[8] Although, before 1978, male to female cross dressing was mostly for theatrical performances, used for comedic effect or to disguise a character in order to commit a crime or defeat enemies.^{[citation needed]} Female to male characters were considered heroic in theatrical performances.^[9]

During the Ming and Qing Dynasties of China, cross dressing occurred both onstage and in everyday life. Within theater, some who were intrigued by it would roleplay, organize their own troupes, write, and perform theatrical pieces.^[6]

Many of early modern China's stories reflected cross-dressing and living the life of a different gender for a short period of time, mainly featuring the cross-dressers as virtuous, like Mulan.^[6]

Li Yu, a writer and entrepreneur, featured the gendering of bodies to be dependent upon men's desires and operated by a system of gender dimorphism, as assumed by social boundaries of the time. When Li Yu created an acting troupe, as many elite males did, he had a concubine who played a male role as he believed she was "suited to male" or considered her more of the masculine gender.^[6]

In modern-day Peking Opera and film, there are male to female cross dressers and vice versa for characters, especially with certain time periods.^[10]

Gender reassignment

Gender reassignment surgery has been permitted in mainland China since 1983. The same year, the first male-to-female surgery was performed in the country. Medical regulations for such procedures were first standardised in 2009. The three main rounds of regulations were published in 2009, 2017, and 2022, respectively.^[18][19]

In early 2014, the Shanxi province started allowing minors to apply for the change with the additional information of their guardian's identification card. This shift in policy allows post-surgery marriages to be recognized as heterosexual and therefore legal.^[20]

In 2020, a transgender employee who was terminated by the e-commerce platform Dangdang for undergoing her reassignment surgery sued the company and won.^[11]

Change of legal gender marker

Gender reassignment surgery is a prerequisite for legal gender recognition; China does not allow gender self-identification.^[26] Changing the gender marker on official identification documents (Resident Identity Card and Hukou) requires the following:^[27]

• A formal written request from the applicant;
• Household Registration Book (which may need to be retrieved from the applicant's family) and Resident Identity Card;
• A certificate of gender authentication issued by a domestic tertiary hospital, along with verification of the certificate from a notary public office or judicial accreditation body.

Since 2022, according to new regulations of the National Health and Family Planning Commission, changing the legal gender marker no longer requires a full-sequence gender reassignment surgery; only the removal of reproductive and gonadal organs (testes, penis, breasts, ovaries) is required.^[28]

However, changing one's ID card information will lead to an abnormal match with their academic qualifications, which often seriously impacts one's employment as one cannot change their student status information after graduating from university.^[29]

According to Chinese law:

学历注册并提供网上查询后，学校不得变更证书内容及注册信息，不再受理学生信息变更事宜。注册信息确有错误的，须经省级教育行政部门审核确认后方可修改。

[Once an academic qualification has been registered and made available for online verification, the institution may not alter the contents of the certificate or the registration information, and will no longer accept requests to change student information. If the registered information is indeed incorrect, it may be amended only after review and confirmation by the provincial-level education administrative department.]

Multiple reports indicate that it is difficult to change gender information on academic credentials and degree certificates after graduation, with only a few isolated cases claiming success.^[30][31][32]

Gender-affirming hormone therapy (HRT)

China has no single national regulation on HRT. Therefore, requirements that exist for gender reassignment surgery are not necessarily present for HRT.^[33]

A 2017 survey conducted by Beijing LGBT Center and Peking University found that up to 71% of respondents who sought HRT said they had "difficulty" accessing it. Almost 50% of transgender people who wanted access to HRT reported being unable to obtain it "in any form at any point in their lives".^[34][35]

In November 2021, Bloomberg reported that transgender people seeking hormone treatment or gender-affirming surgery in China were required to notify family, prove they have no criminal record, and receive psychological treatment in order to be allowed a prescription for hormone replacement therapy (HRT).^[36] Familial disapproval had led many to seek alternative sources of their medication, including online sources.^[37][38]

In November 2022, Chinese government began preparations to restrict internet purchases of estradiol and cyproterone, and a draft had been reviewed.^[37][38] The ban was put in place in December so that even those with prescriptions cannot buy these drugs online.^[34]

Youth

Transgender youth in China face many challenges. One study found that Chinese parents report 0.5% (1:200) of their 6 to 12-year children AMAB and 0.6% (1:167) of children AFAB often or always 'state the wish to be the other gender'. 0.8% (1:125) of 18- to 24-year-old university students who were AMAB (whose sex/gender as indicated on their ID card is male) report that the 'sex/gender I feel in my heart' is female, while another 0.4% indicating that their perceived gender was 'other'. Among students AFAB, 2.9% (1:34) indicated they perceived their gender as male, while another 1.3% indicated 'other'.^[42]

One transgender man recounts his childhood as one filled with confusion and peer bullying. In school, he was mocked for being a tomboy and was regularly disciplined by teachers for displaying rowdy boy-like behavior. Some recommended that his parents have him institutionalized.^[43]

These attitudes may be slowly changing and many Chinese youth are able to live happy and well-adjusted lives as members of the LGBTQ+ community in modern China.^[44] In July 2012, the BBC reported that the new open economy has led to more freedom of sexual expression in China.^[45]

In 2021, China's first clinic for transgender children and adolescents was set up at the Children's Hospital of Fudan University in Shanghai to safely and healthily manage transgender minors' transition.^[46][47] The opening of the clinic received positive coverage by state media despite recent crackdowns on LGBTQ activists, censorship of LGBTQ accounts, and an emphasis on traditional gender roles, attracting "slight confusion".^[48] The 2022 Chinese expert consensus on multidisciplinary treatment of gender identity disorder' recommends puberty blockers as a treatment for transgender youth.^[49][50] As of 2025, there are 7 medical centers that provide treatment to transgender youth and 3 of those offer puberty suppression as a treatment option.^[49]

According to a survey conducted by Peking University, Chinese trans female students face strong discrimination in many areas of education.^[51] Sex segregation is found everywhere in Chinese schools and universities: student enrollment (for some special schools, universities and majors), appearance standards (hairstyles and uniforms included), private spaces (bathrooms, toilets and dormitories included), physical examinations, military trainings, conscription, PE classes, PE exams and physical health tests. Chinese students are required to attend all the activities according to their legal gender marker. It is also difficult to change the gender information of educational attainments and academic degrees in China, even after sex reassignment surgery, which results in discrimination against well-educated trans women.^[52][53]

Workplace discrimination

A 2021 survey in Beijing showed that half of the transgender respondents do not express their gender identity at work and 34% said they had experienced workplace discrimination. The unemployment rate in the transgender community is three times higher than China's urban unemployment rate among the general population.^[11]

One study, presented by Beijing LGBT Center and the Department of Sociology of Peking University, indicated a self-reported unemployment rate of 11.87% for transgender people versus the general rate of 3.97%.^[35]

Gender-affirming treatments

In 2019, Amnesty International reported that transgender people in China resorted to unregulated use of medication and self-surgery due to inadequate access to information, legal and administrative barriers to gender-affirming surgeries. Many were afraid to come out to their parents. Some purchased hormone drugs through unregulated channels online, overseas, or on the black market. Specialized gender-affirming health care facilities are not common in China, although a multi-disciplinary medical team for gender-affirming treatments, the first of its kind, opened in 2018 at Peking University Third Hospital.^[15]

Literature

Literature and plays in the 17th century featured cross-dressing, like Ming dramatist Xu Wei who wrote Female Mulan Takes Her Father's Place in the Army and The Female Top Candidate Rejects a Wife and Receives a Husband. Despite the female to male cross dressing, the woman would eventually return to her socially gendered roles of wearing women's clothes and would marry a man.^[6]

Social media and technology

Technological advancements help to promote greater awareness among youth of LGBTQ issues. Access to Western media such as trans-themed websites and the featuring of transgender characters in Western movies are broadening the knowledge and sense of community that many trans youth seek.^[44][54]

Transgender people in media

Entertainers:

• Jin Xing^[55]

Citizens:

• Liu Ting [zh]^[56]

The following Chinese films portray transgender characters:^[8]

• Swordsman II (1992)
• The East is Red (1993)
• Whispers and Moans (2007)
• Splendid Float (2004)
• Drifting Flowers (2008)

In addition, in the 2019 documentary film, The Two Lives of Li Ermao, a trans migrant worker "transitions from male to female, then back to male," which some promoted as part of "Love Queer Cinema Week".^[57]