🏳️‍⚧️Annex 3: Trans-specific healthcare

Trans-specific healthcare refers to a set of interventions and care related to trans people’s physical and mental health, which includes but is not limited to hormone replacement therapy (HRT), gender affirming procedures, and sexual reproductive and health needs.

In Malaysia, trans people lack trans-affirming healthcare information and services, due to institutional barriers. In the 1980’s, a team at the University of Malaya Hospital performed gender-affirming surgeries for transgender women and supported them to change their gender markers on identity cards. However, the National Fatwa Council issued a fatwa against these surgeries, leading the university to stop offering services to trans people.

Legally, there is no explicit barrier to such surgeries in Malaysia, as the 1982 fatwa was not officially endorsed by any state. However, the lack of availability of gender-affirming procedures means that transgender and non-binary people have to travel abroad to access surgeries.

The expenses associated with gender-affirming healthcare services are typically not included in public health systems or private insurance coverage. Consequently, transgender and non-binary people are required to cover the costs themselves to access services such as counseling, diagnostic procedures, laboratory tests, hormone therapy, hair removal, surgeries, and other treatments. These services are frequently exclusive to private hospitals or clinics, making them excessively costly for the majority of transgender and non-binary people.

The Guidelines to human rights-based trans-specific healthcare recommends the adherence to the following principles as guided by international human rights frameworks, including the Yogyakarta Principles

non-discrimination
bodily integrity, bodily autonomy and informed consent
freedom from torture and degrading and inhuman treatment
free self-determination of gender
quality, specialized and decentralized care
right to decide on number and spacing of own children
the best interest of the child