This story is part three in a series. For the full series, go here.
Note: this story includes descriptions of suicide and transphobia.
Ma You, a trans woman in China, is scared for her future. She’s been affected by a government block on hormone replacement therapy (HRT) medication, and says she doesn’t want to become “another statistic”.
“I can’t check my hormones and adjust the HRT plan accordingly,” she tells Crikey. “It makes me feel insecure.”
In December 2022, the Chinese Communist Party (CCP) banned key ingredients necessary for HRT and forbid third-party sales.
When used by transgender and non-binary people, HRT is referred to as gender-affirming hormone therapy (GAHT). Recipients are prescribed sex hormones by a doctor to help them feel comfortable in their body. Following the implementation of a series of policies banning HRT medications, there appears to have been a number of trans and non-binary suicides across China.
While some other countries have restrictions on HRT for minors, Ma is 30; the CCP’s policies block treatment for people of all ages. Like many others in her community, Ma has turned to the black market and has become worried about dosage.
“I am very worried if I am using hormones correctly, and the absorption rate of the orally taken hormones in my body often varies when the season changes,” she says.
She says it is possible to receive a prescription for transgender HRT treatment at the Peking University Third Hospital in Beijing, but the hospital itself doesn’t stock the medications: “The pharmacy doesn’t have them either. In fact, it is impossible to obtain the medications anywhere in China now.”
Many members of China’s transgender community are concerned about estradiol being on the CCP’s banned medicines list. Estradiol is an estrogen steroid hormone and the major female sex hormone. It’s used as a key medication for trans women in gender-affirming hormone therapy.
Ma says while the CCP is “more subtle” in its suppression of China’s gay, lesbian and bisexual population, its legislation banning HRT sends a more direct message to trans and non-binary communities.
“Recently, there is no policy against LGB people,” she said, purposefully leaving off the T for transgender. “Perhaps they want to kill us one by one.”
When she spent the 2023 Chinese New Year alone, she felt she was not using enough estrogen: “As a result, I took two full boxes of progynova, a total of 42 pills, which amounted to 42 milligrams. My heart was hurting for several days after taking them. I can’t see a way to live.”
Data seen by Crikey from Telegram groups with thousands of members show people mentioning the ban on HRT medication in their suicide notes.
Noah, a 20-year-old trans woman who committed suicide in January, wrote that “online [black market] HRT medication is difficult to buy” and that her doctor “didn’t want to see her any more”.
“The future is dark,” she writes. “Why not end this six-year nightmare?”
In one of her last Twitter posts, Noah posted a photo of what appears to be sodium nitrite and some blue and white pills. Sodium nitrite overdoses are increasingly used in the epidemic of LGBTQIA+ suicides in China.
Sodium nitrite is a potent oxidising agent that impairs oxygen transport and delivery through methemoglobin formation. Clinical manifestations are known to “induce methemoglobinemia, dysrhythmia, hypotension, and death”, according to reports.
Death by sodium nitrite has become so prevalent that one Chinese trans activist’s Twitter account claimed it was the “most sold in-store item” at one shop.
Crackdown on ‘illegal trans’ in schools
On top of the CCP’s ban on HRT medication, the government has cracked down on students who undertake HRT via a series of policies aimed at “destroy[ing] illegal transgenders”. The CCP uses the term “yaoniang” to refer to transgender people. It literally translates to “medicine girl” or “pill girl”.
In 2022, at least two regional governments including Chifeng City and Alu Horqin City released policies with the exact wording stating they will carry out a “100-day special action to crack down” on illegal crimes involving “illegal transgender people”.
“Through a series of strict actions, we will earnestly safeguard the legitimate rights and interests of women and children,” the policy read.
An online trans activist said the replicated legislation from separate regions suggests a nationwide crackdown.
“This is a national operation, not just a local one,” activist Hou Kang wrote.
Ma tells Crikey that trans students are expelled from school because of these policies: “The practice of HRT is openly prohibited in middle schools, and anyone who uses hormones is expelled. As a result of this policy, many of my friends are currently at home. Some of them commit suicide due to the pressure.”
CCP policies have also begun grouping “illegal transgender” people with drug and human traffickers. One example is the Guangdong Provincial Bureau detailing a “Shenzhen illegal transgenders case” in the 13th five-year national drug safety plan.
Another is the Ulanqab Municipal Public Security Bureau including “rectifying illegal transgenders” as part of an eight-step policing plan announced for the 100th anniversary of the founding of the CCP. It includes details on “strike forces” cracking down on “explosions and guns”, “rape and sexual assault” and “narcotics”. It also shows images of military officers carrying assault rifles and police officers handcuffing people.
An Australian study found that transgender people are the “highest at risk of suicide group of any population”. It also found “there is evidence that mental health outcomes improve significantly when individuals are able to access gender-affirming hormones”.
A 2017 national survey in China found that 71.7% of transgender respondents reported difficulties accessing hormones from medical providers. Across the sample, the proportion of self-reported suicidal ideation was 46.3%.
These statistics are taken from data acquired in 2017 — before the CCP tightened its grip on China’s trans community and rolled out stricter legislation on HRT medication.
Trans woman Xia Li tells Crikey she knows of 58 transgender suicides in China from January 1 to February 11 this year.
“This is an unprecedented and devastating loss of life, and it is heartbreaking to think about the countless others who have suffered and passed away beyond the scope of my knowledge,” she says. “These individuals were someone’s friends, family members, and loved ones, and their loss is a profound tragedy that must not be ignored.”
The names and details of people interviewed in this story have been changed to protect their identities.
For anyone seeking help, Lifeline is on 13 11 14 and Beyond Blue is on 1300 22 4636. In an emergency, call 000.
