More than any other time in recent history, trans-related issues have seen increased discourse in Singapore. The year started with a local transgender student, accusing the Ministry of Education of intervening in her hormone therapy treatment (HRT). Then, more recently, 24-year-old NUS undergraduate Dana Teoh has been thrust into public scrutiny for an opinion piece that centres around her frustration at the “woke movement” in Singapore. Teoh’s article has since drawn mixed reactions from the Internet, with some criticising her for a lack of sensitivity in addressing the issues faced by an already-marginalised group in Singapore—the transgender community.
Both issues highlight the increasingly pressing need to address a question that has yet to be dealt with properly in mainstream media: what is being transgender really like in Singapore?
Mainstream awareness of transgender issues
Local attitudes towards LGBTQ issues remain largely conservative, according to the latest World Values Survey published in February by the Institute of Policy Studies.
Even then, such surveys are not entirely representative of attitudes towards the trans community in Singapore. The lack of official documentation on the community – ranging from basic things like its estimated size to more critical issues such reporting on violence experienced – contributes towards a general lack of awareness of transgender issues.
Poorly-understood issues that are indispensable from the trans experience include the transitioning process, the procedures one might choose to undergo, and the current laws in place for those seeking medical care for transitioning.
This story aims to unpack these issues, and delve deeper in its implications for a community of individuals in Singapore that are slowly, but surely, emerging into the light of public discussion.
1) What is the history of the trans community in Singapore?
The transgender community has always played a part in Singapore’s history.
The Bugis people, an Indonesian ethnic group, were one of the first people to settle in Singapore after the British began to transform the island into a trading hub. What is less well-known, however, would be the fact that the Buginese community is known to be accepting of five types of genders.
Besides the two genders that make up the “traditional” binary gender system, the Bugis people recognised the calalai (analogous to transgender men or masculine women), the calabai (analogous to transgender women or effeminate men), and the bissu, who were androgynous shamans with both male and female characteristics.
One of the first places the Bugis people settled in after arriving in Singapore was the area that stretched from Kampong Glam up to Rochor River. Today, areas occupied by landmarks such as the Bugis MRT station, Bugis Junction and Bugis Street pay homage to the district’s connection to the Buginese through their names.
In an interesting coincidence, from the 1950s to the 1980s, the same area became home to a vibrant community of transgender individuals. Bugis Street drew nightly crowds of foreign servicemen, sailors and tourists drawn to all the charms the area had to offer: alfresco bars, hawker stalls and of course, transgender women.
For a brief blip in time, Singapore had more to offer than the sanitised shopping malls and the fancy skyscrapers that adorn Marina Bay, thanks to the transgender women who defined Bugis Street. The area has since been neatly cobblestoned over, and rebranded as another tourist-hub-cum-shopping mecca. One look at Bugis Street today, and one could be forgiven for being none the wiser about its riotous, colourful past as a hub for the local trans community.
2) What does gender dysphoria mean?
Gender dysphoria, or the distress experienced when one feels a mismatch between their gender identity and biological sex, is typically brandished in debates about whether being trans can be considered a mental disorder.
While gender dysphoria is categorised as a mental disorder, the condition refers to “the distress experienced from being transgender, and not the state of being transgender itself”.
For many experiencing gender dysphoria, ‘transitioning’, or adopting the outward characteristics (be it in terms of clothing, behaviour, or pronouns) of the gender identity they feel most comfortable with, remains one of the most effective ways to alleviate the condition.
However, while it is common for trans individuals to experience some form of gender dysphoria, particularly when they have yet to transition in any way, not all of them do.
To transgender woman Anabel Goh (not her real name), transitioning was simply a “procedure” for her to get a gender marker change—a decision that was “expedited” by the arrival of her enlistment letter for National Service, and not any sense of gender dysphoria.
3) What’s the difference between sexual orientation, gender expression, and gender identity?
To put it simply, gender identity refers to one’s personal, internal sense of being male, female, both, or neither. Being transgender boils down to identifying with a gender that deviates from the one’s biological sex. Non-binary people, or those whose gender identity lies outside of the binary (male or female) are also considered part of the trans community.
“Being transgender is defined by how you feel,” stresses Goh.
With this in mind, it’s easy to see how sexual orientation, or one’s pattern of emotional, sexual and romantic attraction to a particular gender, is entirely separate from gender identity. On top of being transgender, one can also identify as heterosexual, homosexual, or bisexual—just to name a few.
Gender expression, however, can be a trickier concept to grasp. Contrary to popular opinion, the way in which one behaves or presents themselves, specifically within the standard categories of femininity and masculinity, does not necessarily have to align with one’s internal sense of gender identity.
For example, a person who identifies as a heterosexual male can still ‘present’ femininely, such as by occasionally wearing skirts, putting on makeup on painting their nails. Physical appearance, as well as mannerisms and behaviour, all contribute towards one’s gender expression.
Likewise, non-binary people can also vary their gender expression based on what feels most right to them.
“Just because they are non-binary doesn’t mean they have to present androgynously (partly male and partly female in appearance),” says 19-year-old student Eljiah Tay, who identifies as non-binary.
4) What is this pronoun thing?
For many heterosexual, cisgender individuals, it might be easy to feel like one is treading around landmines when learning the correct way to refer to trans individuals.
For many trans individuals, however, being misgendered, or spoken or referred to with language that does not correspond with one’s gender identity, can worsen or excavate long-buried feelings of gender dysphoria.
“When you misgender someone on purpose, you are affirming what you think they should be, instead of acknowledging who they are, and how they came to be who they are, at present,” says 24-year-old NUS undergraduate Lune Loh, who identifies as a transgender lesbian.
“Correct pronoun usage [is] a mode of care—you care for your friends by referring to them in a manner they feel safe and comfortable with, that does not make them relive the trauma of a gender they do not feel right with,” Loh adds.
5) What does transitioning mean?
While the concept of transitioning may seem straightforward, there are multiplicities to its meaning that often escape the attention of the wider community.
For starters, transitioning does not always entail going under the knife, the injection of hormones or even a change of clothes.
One can choose to transition in two primary ways: social, or medical. The former refers to publicly ‘affirming’ one’s gender identity, typically by adopting a new name and pronouns, or tweaking one’s mannerisms, behaviour and dressing to align with the gender identity that one feels at peace with. One can be considered to have transitioned, even without having gone through any form of surgery or hormone treatment.
Medical transitioning, however, can range from receiving hormone injections, through a process known as hormone replacement therapy (HRT), to going for sex reassignment surgeries, or what is more commonly referred to as gender confirmation surgery in the trans community.
Even then, surgeries vary in their level of complexity, with some transgender men choosing to remove their breasts (mastectomy, or ‘top’ surgery) and female reproductive organs (hysterectomy, or ‘bottom’ surgery), while opting to skip procedures for penis construction, such as metoidioplasty or phalloplasty.
Yap Wei Xin, a 27-year-old transgender man, is one such individual. At 23, he had flown to Thailand on his own for mastectomy and hysterectomy procedures, which had set him back roughly SGD$14,000 in total.
For Yap, the multiple surgical processes required for the creation of a penis, as well as the relative lack of credible information and advanced technology for metoidioplasty and phalloplasty procedures, were reasons why he did not go through with either up till that point.
The high costs attached to medical transitioning, be it for HRTs or surgical procedures, as well as the need for parental consent before undergoing most of these processes, make up some of the main barriers in the transitioning process of many trans individuals.
Tay, who is interested in undergoing top surgery, cites not having come out to their family yet as one of the reasons for not having undergone any form of medical transition.
In Singapore, the minimum age for one to start HRT without having to obtain parental consent first is 21, while those under 17 are barred from starting any form of HRT.
Individuals are also required to undergo psychiatric evaluations to certify that they are of sound mind before they can begin HRT, or undergo any form of surgical procedures. This applies even if one were to receive treatment abroad.
6) What are gender confirmation surgeries?
Singapore is no stranger to gender confirmation surgeries. On 30 July 1971, a then-24-year-old Singaporean man made history as the first person to successfully undergo a sex reassignment surgery in Singapore. The operation gave rise to a few legal issues for trans individuals who have medically transitioned, such as the right for them to marry legally following a gender marker change.
Although not all trans individuals opt for them, surgical procedures can be a crucial step in the affirmation of one’s gender identity and overall transition process.
“Every day, I fall in love with myself; everyday, I live my fairy-tale life,” says Goh, on having transitioned in every way she sees fit.
However, Loh believes more can be done towards providing local trans individuals with access to the estimated costs of the different “chemical and surgical means of transitioning”.
The myriad procedures available, for both male-to-female and female-to-male procedures, as well as the differences and trade-offs between specific forms of procedures, remain poorly-documented in local health resources.
Post-operation realities also remain an area of low documentation outside of transgender pages and support groups. For Yap, unsightly scarring was a concern that he struggled with after his mastectomy procedure. Beyond receiving treatments to reduce the scarring, there was “not much the doctor could do”.
Hormone blockers and hormone therapy treatment
In December 2020, the High Court of the United Kingdom (UK) ruled to ban trans individuals under 16 from receiving access to “puberty blockers and cross-sex hormones”, on the grounds that those under 16 would be “unlikely to give informed consent” for receiving medical care aimed at helping them medically transition.
The ruling came after 23-year-old Briton Keira Bell launched legal proceedings against a national gender health clinic for inadequate levels of investigation and therapy prior to her decision to transition to a male using puberty blockers. Also known as hormone blockers, puberty blockers put a pause on puberty-inducing hormones like estrogen and testosterone in trans children or teenagers.
The UK High Court’s decision aligns with the current laws regarding HRT for trans individuals in Singapore, which place parental consent at the core of medical transitioning.
On the age requirement of 21 years, Loh says: “[In practice,] many adults past [the age of] 21 are still at the mercy of their parents’ authority and rules.
Thus, with regards to puberty blockers, I do think children and teenagers should be given the choice whether or not to use them… This must be done with [them] knowing all their terms, [as well as the] potential risks and consequences.”
The age requirement also gives rise to a conundrum for trans children and teenagers who wish to transition medically, but have already gone through puberty and face a limit to how much HRT can reverse the process.
Having started HRT well into adulthood, Yap shares that while he did become slightly taller and hairier from his regular testosterone injections, it would be impossible for him to grow much much further as “[his] bones have reached the growing limit”.
To circumvent this problem, some trans Singaporeans under 21 are procuring hormonal medication online, which cannot be proven to be authentic or safe for consumption.
To Tay, the conversation about hormone blockers should be directed towards addressing “structural concerns”, such as the lack of adequate information on gender identity issues, and providing young trans individuals with the resources they need to make informed decisions, instead of debating about whether they are capable of making such decisions.
Besides helping trans individuals make more informed decisions about their gender identity, providing access to more inclusive education to all can also help to debunk certain misconceptions held by non-trans individuals, such as the notion that these decisions are “irrational”, notes Tay.
7) Why should I care about Trans issues?
Life after transitioning is not a bed of roses for the trans community.
The use of shared, gendered spaces remains one of the biggest challenges faced by trans individuals who transition in ways that do not immediately translate to a perceivable change in their outward appearance.
In Singapore, there are currently no laws in place to enforce sex-specific use of public restrooms. However, this does not exempt trans individuals, particularly those who appear to be androgynous or are in the midst of receiving HRT, from adverse public reactions, ranging from microaggressions to even censure, when using public restrooms.
Yap recalls feeling apprehensive of making the switch to male public restrooms, even after his gender confirmation surgeries. For as long as one month after his surgeries, he had stuck to using female restrooms.
“I do get stares from other ladies in the restroom—some even ask me whether I am a girl,” says Yap, who would just “go with it and say yes”, for fear of being probed further.
According to Yap, a push from one of his friends is a reason why he eventually found the courage to start using male restrooms.
“I was still going back and forth between the ladies’ and the gents’ [restrooms], until my friend found out and said: ‘You’re a guy, right?’ I said yes, and she said: ‘Okay, then from now on don’t you dare go [to the] ladies; I will judge you!’,” Yap laughs.
At that point in time, his voice was also getting deeper from the HRT he was receiving, giving him the confidence he needed to start using men’s restrooms.
With so many considerations in mind, the only option that remains for trans individuals still in the process of transitioning medically is often to simply opt for unisex, wheelchair-accessible restrooms—an option that is not always available.
At Loh’s residential college at NUS, there are only about two to three wheelchair-accessible bathrooms in the whole building. As part of a special housing arrangement with the college, she is allowed to use such bathrooms, but with a catch—she still has to stay on the mixed-gender floors of the college, and on the ‘male’ side of the floor.
“There’s no way I can be placed on an all-female floor—[the] NUS housing policy would not accede to that,” explains Loh.
Transitioning can also be a complicated and often painful process for those still receiving education in government-funded schools.
Tay, who recently completed their studies at a local junior college (JC), recounts how they used to get into trouble at school for their reluctance to don their skirt, which remains part of the gendered uniforms that school-going students in Singapore, from primary school all to the way up to JC, are required to wear.
To avoid wearing a skirt, Tay would try to be in their Physical Education attire as much as possible. Even then, they would still be chided by more “picky” teachers and forced to put on a skirt.
In Secondary Four, a teacher of Tay’s had addressed them indirectly in front of hundreds of other students in a lecture theatre.
“[She] said: ‘As long as you’re wearing a skirt, I’ll take that you’re a girl. If you want to be a guy, wait for your next life.’
To face transphobia from [a teacher that I respected] really took me aback, and destroyed my trust [in] anybody with authority in the school,” Tay shares.
Working towards a more trans-inclusive society
Transgender individuals have always been a part of our society. Despite shifts towards more progressive values in recent years, more has to be done to provide trans individuals in Singapore with the avenues to voice their very real concerns, born from their very real “experiences, histories, traumas, dreams, and desires”, as Loh puts it.
According to the NUS undergraduate-led research report entitled Cisgender Students’ Attitudes and Beliefs towards Transgender Individuals and Trans-Inclusive Efforts, there are three main aspects to building a more trans-inclusive community: Model, Educate and Collaborate.
Besides being changemakers in terms of trans-inclusive efforts like adopting the use of trans individuals’ preferred pronouns, as well as making strides to include trans voices in policymaking, the report advocates for correcting common misconceptions about the trans community—which is exactly what this story hopes to achieve.
Ignorance breeds misunderstanding, which in turn devolves into hate and violence if left to fester.
The trans community may face many battles in their daily lives, but this is one that the rest of us can ride alongside with them into—if we could just care to ask, and listen.