HEALTH

Gender-affirming Care

Meeting with the Hospital Authority

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Regular meetings are held between the Hospital Authority (HA) and Hong Kong transgender organizations regarding the service of the Gender Identity Clinic (GIC).

Other service areas, as well as matters concerning transgender healthcare professionals and students, are also discussed.

Apart from regular meetings, each organization also maintains communication with HA.

Gender-affirming Arrangements for Transgender Workers and Students at HA

In addition to providing gender-affirming care, HA has designated personnel to make appropriate gender-affirming arrangements for transgender workers and students. Local transgender organizations, including Quarks, have been in contact with HA regarding this matter. Below is HA's email response in June 2023:

(Translated from HA's original email in Chinese)

"The human resources department of each hospital cluster has designated personnel to handle matters related to transgender healthcare students during their internships. These personnel collaborate with the relevant clinical departments, professional representatives, and other support departments to follow up based on the hospital's operational circumstances and the varying needs of the students.

The designated personnel in the human resources department of each hospital cluster possess relevant work experience and receive internal training. HA understands that transgender individuals may face challenges and uncertainties in unfamiliar work environments.

If students encounter any issues during their internships, they can first raise these concerns with their supervisors so that they can be referred to the designated personnel for follow-up. The designated personnel will do their best to provide assistance and support, ensuring that students can successfully complete their internships."

Date: 8th December, 2023 (Friday)

Starting time: 16:30

Venue: Hospital Authority Head Office, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong

Attendees:

Hospital Authority (5 representatives)
Gender Empowerment (2 representatives)
PrideLab (2 representatives)
Quarks (2 representatives)
Transgender Equality Hong Kong (1 representative)

What is gender identity?

Everyone has their own gender identity. It is a person’s innate sense, or self-understanding, of their gender. This may or may not be the same as one’s assigned sex at birth.
What is assigned sex at birth?

Assigned sex at birth refers to the gender marker indicated on one’s birth certificate, based on appearance or category of external genitalia (or other sexual characteristics). It can also be considered as society’s expectation of gender identity based on one’s assigned sex at birth.
What does cisgender mean?

Cisgender means one’s gender identity is the same as that of society’s expectations based on their assigned sex at birth.
What does transgender mean?

Transgender means one’s gender identity is not the same as that of society’s expectations based on their assigned sex at birth. E.g. transgender women have a female gender identity, and were assigned male at birth, and vice versa for transgender men. The transgender and gender diverse community also includes non-binary people, whose gender identity (e.g. genderfluid, agender) does not fall into the gender binary of male or female.
Does transgender refer to a certain sexual orientation?

No! Gender identity is independent of sexual orientation. E.g. transgender women can be attracted to women, transgender men can be attracted to men, non-binary individuals attracted to more than one gender, and so forth.
Is being transgender a mental illness?

No! Being transgender and gender diverse are natural parts of human diversity, and are neither pathological nor negative. Depathologization efforts have been emphasized by the DSM-5* published in 2013, and by the WHO, on their ICD-11^ endorsed in 2019. The pathologizing term “gender identity disorder” has been abolished. As of ICD-11, having a gender identity different from one’s assigned sex at birth, is termed as gender incongruence, and included in the chapter “Conditions related to sexual health”. *Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ^International Classification of Diseases, Eleventh Revision
Is being transgender defined by whether one receives gender-affirming healthcare?

No! One’s gender identity, or being transgender, is not based upon receiving gender-affirming healthcare. Appropriate and medically necessary healthcare should be arranged according to one’s needs.
Are there any international clinical guidelines for gender-affirming healthcare?

Yes! Currently, the major international clinical guideline is the Standards of Care Version 8 (SOC 8), published by the World Professional Association for Transgender Health (WPATH) in 2022.
What is the Gender Identity Clinic (GIC)?

GIC is a multidisciplinary clinic offering gender-affirming healthcare to transgender and gender diverse individuals. According to the World Health Organization (WHO), gender-affirming healthcare can include any single or combination of a number of social, psychological, behavioural or medical interventions designed to support and affirm an individual’s gender identity. Gender-affirming healthcare has been offered at public hospitals since 1980. In 2016, the one and only GIC was established at Prince of Wales Hospital in Shatin. At GIC, a psychiatrist first understands the gender identity and mental health needs of a service user, offering support and follow up. According to one’s needs, they will then be referred to corresponding services.
Who can write a referral letter to GIC?

Any doctor (including general practitioners and specialists) registered in Hong Kong, or any clinical psychologists of the Hospital Authority.
Who can be referred to GIC?

Anyone 18 years old or above, and intends for gender-affirming healthcare. Psychiatric or physical illnesses, if present, should not be a hindrance nor barrier to the referral. One’s healthcare needs and arrangement will be followed up by GIC.
What do I need for new case registration at GIC?

Please visit GIC in person, on 3/F, Li Ka Shing Specialist Outpatient Clinics (North Wing), Prince of Wales Hospital, with the following: Hong Kong identity card A referral letter issued within 3 months. Please note that GIC's office hours are from Monday to Friday: 9AM to 1PM, then 2PM to 5PM. It is closed on Saturdays, Sundays, and public holidays. Please ensure to arrive at least 60 minutes prior to closure time for registration.
Are there any private doctors offering gender-affirming healthcare?

Yes! For visiting a private psychiatrist, one can directly book an appointment without any referral letters. For visiting a private endocrinologist, a referral letter from a public or private psychiatrist (or proof of upcoming appointment at GIC endocrinology) is required. For details, please refer to our page Private Service.
Is gender-affirming care offered to individuals below 18 in Hong Kong?

Yes, with parental consent. Private There is no age restriction for private service. Public GIC accepts registration only from those who are 18 years old or above. With referral from public or private psychiatrists, to endocrinology of the Hong Kong Children's Hospital, a transgender individual would be prescribed puberty blocker if appropriate. The department of childhood and adolescent psychiatry of various hospital clusters do not offer any gender-affirming hormones.
Hospital Authority's pamphlet on the Gender Identity Clinic

Details

HA stated that the waiting times for new cases at GIC across various specialties are not longer than those of other clinics or hospital clusters. For information on the waiting times for new cases in different specialty outpatient clinics across various hospital clusters, please visit the following webpage: Waiting Time for New Case Booking for Specialist Out-patient Services

HA further explained that gender-affirming surgeries have separate waiting lists and surgical schedules, with feminizing surgeries and masculinizing surgeries each having their own allocated surgical times. Regarding the notable difference in the number of feminizing and masculinizing surgeries performed in the year 2022-2023, HA supplemented that the ratio of individuals waiting for feminizing surgeries to those waiting for masculinizing surgeries is approximately 2:3. Surgical schedules may also be affected by other factors, such as public holidays or adverse weather conditions.

(We understand that the schedules for feminizing and masculinizing surgeries are each allocated approximately 1 day of operation every 2 months)

Other Items Discussed

Child and Adolescent Psychiatry
HA stated that GIC has provided relevant training and established connections with the departments of child and adolescent psychiatry across various hospital clusters. These departments offer gender-affirming care to individuals under the age of 18. Once they reach 18 years of age, they will be referred to GIC for continued follow-up.

HA emphasized that GIC will continue to accept only individuals aged 18 or above and currently does not consider providing gender-affirming hormones to those under 18.

Waiting Times for New Cases at GIC
Even if individuals can provide follow-up records from public department of child and adolescent psychiatry, private doctors providing gender-affirming care, or overseas gender-affirming healthcare services, the waiting times remain roughly the same.

HA stated that it will review its services to explore whether individuals already under follow-up in child and adolescent psychiatry, and deemed suitable, could access the psychiatric and endocrinology services at GIC earlier. However, HA emphasized that all cases must first be referred by GIC's psychiatry department to other specialties, and skipping the psychiatric assessment is not appropriate.

Gender-affirming Hormone Intramuscular Injection Services
At the beginning of 2023, a total of 7 government general outpatient clinics temporarily suspended testosterone injection services. These services were fully restored not until April 1, 2023. HA had responded by collaborating with the department of endocrinology in March 2023 to produce training videos and materials to improve the operational process and enhance the safety of service users.

Information Pamphlet on Gender-affirming Hormones
HA will produce an information pamphlet on gender-affirming hormones. The content has been finalized, and printing will commence shortly.

Internal Training on LGBTQIA+ Inclusive Healthcare Services
In March 2023, HA launched an online course titled "Effective Communication with Sexual Minorities" through HA's e-Learning Platform. HA noted that many healthcare professionals providing gender-affirming care have already completed the course. Quarks hopes that the course will see participation from healthcare professionals across different hospitals, specialties, and disciplines.

New Policy on the Update of HKID Gender Marker
HA stated that it is one of the units consulted by the Security Bureau regarding this policy. It has provided professional input during previous meetings.

Miscellaneous
HA indicated that the Public-Private Partnership Programmes, allowing stable cases receiving medication and follow-up at government general outpatient clinics, and blood taking in other hospital clusters are currently not applicable to services of gender-affirming care.