FEATURE: Why Seven out of Ten Transgender Taiwanese Consider Suicide

Seven out of ten transgender people in Taiwan have thought about suicide or tried to kill themselves — nearly twice the rate among the U.S. transgender community.

A 2014 survey conducted by the Intersex, Transgender and Transsexual People Care Association (ISTSCare) in Taiwan showed that 70 percent out of the more than 200 transgender respondents said they had attempted or thought about suicide.

“But I think the real number may be higher,” says Abby Wu (吳伊婷), co-founder of ISTSCare and long-time advocate for transgender people in Taiwan.

If you or someone you know needs help, contact one of the many free hotlines available anywhere in the world.

Wu, 31, says the difference between Taiwan and the U.S. might be due to gender-related stereotypes and inequalities being more prevalent in Chinese culture.

“Domestic abuse is a norm among transgender people [in Taiwan],” she tells The News Lens.

Elaine Chang (張以琳), a 40-year-old transgender woman, says “the high [suicide] rate is definitely imaginable,” but she notes the number might differ depending on the population surveyed and the questions asked — there is no official record of the number of transgender people living in Taiwan.

“But based on my own experience, I personally know five transgender people who died by suicide,” Chang tells The News Lens. “Many transgender people think everything will go smoothly once they go through [sex reassignment] surgery, but that’s not true. Most of them are still troubled with life, relationships and other things after surgery.”

According to Wu, ISTSCare has been receiving increasing reports of domestic abuse in the past two years. As a transgender woman, Wu also experienced abuse at home in her teenage years after she “came out” to her parents.

Wu suffered mental stress and occasional physical abuse at home, but she says some cases involve serious violence in which the victims are “beaten all day.” Other types of abuse include emotional blackmail and tight control over finances.

“I have a friend who was saving up for sex reassignment surgery. He had NT$70,000 to NT$80,000 (US$2,300 to US$2,600) saved but his mother worked with his banker to take away the money,” Wu says. “He was over 20 years old, so what they did was actually illegal. But he couldn’t press charges because they are family.”

While the definition of domestic abuse differs for each person, there is usually more tension in a transgender person’s family, says Chang.

“Relationships in which parents and the child are very close or very distant lower the possibility of domestic abuse,” she says. “Families with an average level of closeness usually see relationships deteriorate [after a transgender person comes out].”

After a member of the transgender community in Taiwan died by suicide in 2008, a transgender hotline was established by Taiwan Transgender Butterfly Garden and Taiwan Tongzhi (LGBT) Hotline Association. But due to a lack of volunteers, the hotline is only available every Wednesday from 7:00 p.m. to 22:00 p.m.

There are other government-run centers and hotlines that provide help for victims of domestic abuse. However, according to Wu, these centers lack knowledge in the issues transgender people face, and therefore usually don’t know how to respond to these cases.

“For example, the domestic abuse hotline 113 will find shelters for ‘traditional’ Taiwanese woman if needed. [...] But currently these resources aren’t available for transgender people,” she says.

Photo Credit: Provided by Abby Wu.

Lack of medical resources

Transgender is a term used to describe people whose gender identity differs from the sex they were assigned at birth, according to GLAAD, a U.S. non-governmental media monitoring organization.

Some transgender people bring their bodies into alignment with their gender identity — either through prescribed hormones or surgery. But not all transgender people can or will do so, and being a transgender person is not dependent upon medical procedures.

Taiwan requires the surgical removal of gender-specific organs and two psychological assessments before a person is allowed to apply for gender reassignment. The Legislative Yuan, Taiwan’s parliament, changed this rule in January 2015, but the Ministry of Interior is still reviewing the law.

Many Taiwanese parents also refuse to allow their transgender child receive any form of medical treatment. Though sex reassignment surgery (SRS) is considered to be a kind of cosmetic surgery in Taiwan, a parent or guardian’s consent to surgery is still required.

“There are cases in which the parents are more active than their transgender child in searching for medical resources, but there are very few of these,” says Chang.

While Taiwan boasts several of the best sex reassignment surgeons in the world, there is an overall lack of doctors offering the service, Wu says.

Wu says there are only two or three psychiatrists in the country that are “friendly” to transgender people — meaning that the doctors understand the needs of the community and are willing to lower medical costs. Another two or three doctors provide hormone replacement treatment (HRT); and only one surgeon is well-known for female to male SRS. (Most transgender people who wish to have male to female SRS still travel to Thailand to undergo the surgery.)

“There might another three or four surgeons [that do SRS] but the quality is a problem,” says Wu. “Repercussions, like infections, dysfunctional genitals, nerves not connected well, can occur if the surgery isn’t done well enough.”

While these procedures are cheaper in Taiwan compared to other countries, they can still accumulate to a significant amount, especially if one chooses to receive HRT as a lifelong treatment.

According to Wu, some psychotherapy sessions and HRT are covered by health insurance; this lowers the costs to a few hundred NT dollars for both a session and a three-month prescription for HRT medication. However, she adds most psychiatric evaluations are not covered by national health insurance and can cost NT$2,000 to NT$3,000 for each session.

In Taiwan, psychotherapy is required before one is allowed to receive HRT, but there are some people who skip seeing a psychiatrist and instead purchase HRT medication from certain pharmacies. This costs up to NT$3,000 to NT$4,000 for a three-month prescription.

“We know of transgender friends who are unable to receive HRT through the standard procedure (which requires psychotherapy),” says Wu. “Our organization provides them with information on dosage and the types of medication because if we don’t, they will still buy 'meds' on their own. We would rather give them the right information so that they don’t misuse drugs.”

Some transgender people choose to do SRS after receiving HRT. The surgery is not covered by health insurance. And in Taiwan, male to female SRS costs NT$250,000 to NT$300,000, while female to male SRS is divided into two stages: the first being eligible for legally changing one’s registered gender (removal of the breasts, ovaries and uterus), and the second being genital reconstructive procedures. The first stage costs around NT$300,000 and the second ranges from NT$500,000 to NT$600,000.

No matter what medical treatment transgender people choose to undergo, it can be a significant financial burden. However, the community also faces a high rate of employment discrimination, which forces many transgender people to rely on their families for financial support.

“The discrimination local transgender people face is built upon class; parent and child, employer and employee,” says Wu. She adds that among the transgender people she is acquainted with, 50 percent has a stable job while the other 50 percent is unemployed or works in more temporary positions.

Wu went through employment discrimination in 2008 when she left home. She says that during job interviews, employers would ask why her hair was so long and whether she was male or female.

“I almost committed suicide, but I got over it,” says Wu. “The way I think about it now is if you discriminate me, is that your problem or mine? If it’s your problem, then why should I hide? You’re the one that should be hiding. This is how I built confidence.”

Wu currently works as a security engineer in the financial technology industry and Chang is in the interactive entertainment industry. Both say jobs that require more technical skills tend to discriminate less.

But Chang points out that if a transgender person and a “normal” person have similar skill sets, employers are still more likely to hire the latter to avoid “unpredictable future risks.”

Photo Credit: Provided by Elaine Chang.

Fighting the long battle against discrimination

Despite the many issues transgender people in Taiwan face, the situation is not a lost cause.

“Something that is seen in the U.S., but not Taiwan, is hate crime,” says Wu. “This is a good thing, because hate crime is even more dangerous. Class discrimination is difficult to resolve but at least it’s not a direct harm to lives.”

The National Center for Transgender Equality in the U.S. reports, 27 transgender people were killed in 2016, and since Jan. 1, 2017, eight transgender women of color have been murdered.

Taiwanese media and society are also understanding the transgender community more as transgender public figures — such as minister without portfolio Audrey Tang (唐鳳) — emerge in the last few years.

“These people make the public realize different transgender people exist,” says Wu. “I hope more of these people come out. The more the better, because everyone has their own characteristics.”

ISTScare since 2013 has worked with the media to provide journalists with correct information when covering the transgender community.

Chang notes the progress seen in the Taiwan society, but she also points out the cause of these issues goes back to sexual liberation.

“If you can’t break through gender stereotypes, any ‘friendliness’ is superficial,” says Chang. “The situation seems to be improving for transgender people in Taiwan. You can talk about it on a certain level, but I think we are still a bit far from being completely accepted by the general public.”

Communicating with family members is key to resolving gender issues, says Chang, and she often encourages her transgender friends to improve their relationship with their families.

While Chang has managed to maintain an “okay” relationship with both her parents, Wu hasn’t seen her parents and two younger brothers since she left home nearly 10 years ago.

“My family now is me, my partner and six cats. But I hope that one day my partner and I can have dinner on New Year’s Eve with my family. Something like that,” Wu says.

Photo Credit: Provided by Abby Wu.

If you or someone you know needs help, contact one of the many free hotlines available anywhere in the world.

Editor: Edward White