Story of teens at a transgender clinic in Beijing

At the clinic, doctors call kids "visitors," rather than "patients."

The topic of transgender people has come into the public's view late in China. But more and more medical facilities targeting the group are gradually changing the landscape.

In 2017, Peking University Third Hospital opened a general transgender clinic in China. Pan Bailin, the founder of the clinic, also started a non-profit fund dedicated to supporting the transgender group in 2020. Moreover, in 2021 Shanghai opened China's first multi-discipline transgender clinic for children and teenagers, according to the Paper.

[Note: According to the definition from Johns Hopkins Medicine, "transgender" is "an umbrella term for people whose gender identity does not match the sex they were assigned at birth. Transgender people may identify as straight, gay, bisexual or some other sexual orientation."]

Transgender people struggle with not only their gender identity but also their place in society. Within the group, trans teens are under even more pressure, as they juggle huge physical and mental changes in puberty, as well as relationships with peers and family members.

Today's newsletter is about teen visitors at a transgender clinic in China, which sheds light on the group's needs, struggles, and hope. Doctors may provide professional knowledge, but as you will see in the piece, a successful treatment plan needs cooperation between professionals, transgender kids, and their parents, with the help of volunteers from non-profit communities. Through the progress made in the transgender clinic, we will get a clear route of how to build a warmer environment for the special group in China in the future.

The article was originally published on Truman Story 真实故事计划, a WeChat blog focusing on telling touching stories in China. [Check the list of the ten most worth-reading stories of 2022, a summary piece compiled by the blog.] Together, they portray a colorful China and loving people from all walks of life on this land. Truman Story gave permission for the story's translation to be published in Ginger River Review (GRR).

Now the story begins.

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The general public in China has mixed impressions of gender clinics. Some see them as a mental harbor where they seek shelter from the cruel reality, while others see them as a den where unscrupulous doctors collude with each other to poison teenagers' minds for money.

Perhaps no other clinic needs to deal with the great conflicts between visitors and their family day in and day out like a gender clinic.

However, the gender clinic is just a small "battlefield" for transgender people. Visitors here bear unimaginable risks simply for being themselves. Among them, minors are often struggling hardest, and facing the most complicated situation.

A Crack of Light

On the table in the consulting room of Doctor Pan Bailin 潘柏林, there is always a pack of tissues. It's for parents shedding tears there.

At one time, a kid and his parent were about to leave the consulting room. When the kid stepped out, the parent quickly turned around and handed Pan a note. The note writes, "Don't you dare to prescribe hormones to my child again!" Doctor Pan also received another threat from the relative of another visitor, "If something goes wrong with her, her family will make you pay."

Some fathers even blocked Pan in his office, begging with tears in their eyes, "I'd rather not have this kid instead of seeing him turn into a ladyboy."

One parent unwillingly signed the informed consent for the sex reassignment surgery due to pressure from his kid. But to stop the surgery, the parent made many complaints to the hospital, claiming that doctor Pan "poisons the minds of Chinese teenagers" and suspecting that he "is infiltrated by foreign forces." "I won't stop making complaints until I achieve my aim," the parent told Pan. One other parent accused him of "colluding with psychiatrists and prescribing drugs to my kid to make money." Some parents even called the Beijing city hotline.

Another doctor at the clinic suffered more. One day, as he finished diagnosing a kid, the parent suddenly rushed in with a knife and stabbed him. The doctor was sent to the operation room to stitch the wound and had to take sick leave for some time. Pan has been mentally prepared for things like this. "Maybe one day the same will happen to me," he said.

But in the eyes of transgender teens, the clinic is a safe haven. They call Doctor Pan "Lao Pan" 老潘 [literally meaning "old Pan." That's the kind of nickname Chinese people gave to their close friends.] or "Uncle Pan." "I came to him for a chat, and he is so gentle." "Lao Pan is getting bald, but we love him so much." Visitors wrote these comments on social media. When someone is in a really bad mood, they would suggest, "Go to the Peking University Third Hospital and talk to Doctor Pan."

When Pan received malicious complaints, several transgender teens wrote a joint letter to the hospital because they were afraid that the hospital would misconstrue Pan. "Doctor Pan's team has brought us great hope, despite the huge risks and pressure." Pan received a bunch of letters with words like these. He collected them as treasures.

At the clinic, doctors call kids "visitors," rather than "patients," because "patients" have a more negative implication. For these doctors, they understand the group well enough, and transgender kids don't need to explain their unique thoughts and behaviors.

Peking University Third Hospital opened the " Comprehensive Transgender Clinic" in 2017, and doctor Pan is the founder of China's first medical team for transgender people. The team combines medical resources in various branches, including counseling, endocrinology, reproductive medicine, otolaryngology, general surgery, and plastic surgery. All is to provide medical support for transgender people.

Photo | Doctor Pan in his office

About ten percent of the visitors to the clinic are teenagers aged between 14 and 18, a special phase of life for transgender people. Pan found that about half of the visitors were confused about their biological sex even when they were little. The youngest visitor he had was only 10 years old. But the situation generally spirals out of control when they reach puberty.

[Note: The data is provided by the interviewee, and no official data is available to confirm it.]

"The problems facing transgender teens are actually more complicated than transgender adults," said Pan, adding that teens are more likely to harbor bigoted and extreme ideas. He often spots self-harm wounds on their arms. And a regular question about medical history is whether they have suicide attempts and self-harmed behaviors. 90 percent of the kids coming to the clinic said yes. The suicide rate of the group is five times greater than that of other teenagers.

[Note: The data is provided by the interviewee, and no official data is available to confirm it.]

Parents are much more insecure too. Transgender adults already have relatively stable lives. In parents' eyes, giving minors access to gender-affirming treatments will undoubtedly bring the greatest risk to their lives that have barely started. What if they couldn't find good jobs? What if they don't have their own family? Therefore, parents are more inclined to "fix" their kids. Most importantly, as legal guardians, parents have the final say. A precondition for transgender kids to receive medications or surgical treatments is that the parents "are fully aware of and support the medical plan."

The special group also raised other medical teams' attention. In 2021, the Children's Hospital of Fudan University established China's first multidisciplinary clinic for transgender children and teenagers.

"Transgender treatment for teens is only getting started in China," Pan said. When it comes to teenagers, the topic is more "sensitive," and more likely to draw controversy.

It's also a huge test for doctors on the teams. They already have jobs in different departments, which means most of them have to work extra hours and make time for transgender visitors. They are under great pressure in their daily work, not to mention they must deal with complaints, threats, or even attacks from some parents. Endocrinologist Liu Ye is an important member of Pan's team. She considered quitting at one time. "With so many kids counting on you, do you really want to go?" Pan asked her. From then on, doctor Liu never mentioned leaving again.

Sometimes Pan would be caught in a dilemma. Once, a mother came to his office behind her kid's back. She cried and begged Pan to persuade her kid to stop the medicine. "Because of the kid, our family is in splinters. The grandmother was so frustrated that she ended up in the hospital and we didn't have much money. Doctor, please, I beg you." Pan was worried about widening the family's rift, so he had to agree to think of something. The mother bowed deeply, then left in a hurry.

Later, doctors found several abnormal indicators after the physical examination. Though they wouldn't affect gender treatment, Pan told the kid, "Why not go to internal medicine to deal with the abnormal indicators first? And then you can come to me again, all right?" The kid paused for a moment and left with disappointment.

Several days later, Pan received a message from the kid on the hospital's online medical platform. "Doctor Pan, thank you for looking after me. But I have already bought a ticket to Xiamen and decided to commit suicide. Thank you."

Pan immediately contacted a nonprofit organization that intervenes in extreme incidents to step in. Since then, Pan made the decision that he would never compromise on the rights of kids, even if it meant spending more time and effort to make parents understand.

At first, even some colleagues couldn't understand Pan's effort. Years ago, due to a lack of understanding toward transgender people, some believed that Pan was simply "seeking attention." A doctor once questioned him, "don't you think your job is a violation of medical ethics?"

However, doctors who really get in touch with transgender people see things differently.

Zhao Yede 赵烨德, chief of the plastic surgery department at the Hongkou Branch of Shanghai Changhai Hospital, mentioned his teacher He Qinglian 何清濂, "the father of sex-change operations in China." Zhao said, "When these kids couldn't get help from doctors in the 90s, they pricked their finger and wrote him letters with blood. I have seen the letters with my own eyes."

Mismatch

When parents hear that their children are transgender, the common response is that, "Are my kids poisoned by the Internet?" "Is it the influence of Japanese ACG culture (Animation, Comics and Games)?" Overwhelmed by new information, parents are inclined to retreat back to the world they know, and point a finger of blame in a simple and brutal way.

The reality is quite the opposite. “It’s because they (transgender teens) have confusion and worries about their own body. They hope to find scientific knowledge to understand and help themselves, but nobody around them can answer their question. So they have to search the Internet for an answer to save themselves,” Pan said.

Huaxian is a member of a nonprofit organization. She is a transgender woman (Transgender women are assigned male at birth, but identify themselves as females). Huaxian began to feel confused about her gender when she was in Grade 2. One morning, as she was ready for school, she suddenly told her mother, "I don't want to be a boy anymore." She was surprised by her own words. Huaxian's mother scolded her and Huaxian never brought up the topic again. In an interview, a transgender male recalled that he told his parents that he had a penis, but somehow it was cut off.

When she reached Grade 5 or 6, Huaxian noticed some physical changes in the boys around her. Their voices grew deeper, and they started to grow mustaches and leg hair. She was scared and secretly searched the Internet for the first time. Back then, the concept of transgender was not known in China. So all she found online was about "ladyboys in Thailand." The web page wrote that [Ladyboys] are poor kids that have no other way of making a living, and they wouldn’t live past 30. Frightened, she closed the web page and suppressed the thoughts deep down in her heart.

Then Huaxian tried to be "normal." In order to fit in and not be bullied because she was too "feminine," she became one of the bullies in middle school. Transgender kids are often more eager to fit in and have friends with other kids. She pretended to be vicious and followed other bullies to demand "protection fees" from her classmates. When she met someone not "masculine" enough in the bathroom, she would move around behind them and pull their pants down on purpose. Or she would push them suddenly so that they would pee in their pants.

But a strong sense of guilty tortured Huaxian. Whenever she recalled that experience, she often felt sick about herself. She didn't understand why she would be a bad person when she could have done better. And she couldn't force herself to bully others anymore. Soon, the bully became the bullied again.

Parents often wonder, is the transgender thing a whim of thought for those teens? Pan is also very careful about this. But he notices that before trans teens reach adulthood, they generally suffer from gender dysphoria for five to six years before they reach adulthood. "We believe that no matter for cisgender people or LGBTQ people, gender identity is wired in genes, and it's not learned or influenced by external factors," said Pan in a speech.

Pan treated minors that had castrated themselves at home almost every year. They learned the procedure online, including how to get anesthetics and tools, and how to do the operation on their own. However, the DIY procedure caused hemorrhages and severe complications in many cases.

A few months ago, a kid (transgender female) was sent to the emergency room. She cut off a testicle according to video instructions. But when she wanted to remove the other one, she couldn't bear the pain anymore. A couple of days later, she bought some other drugs to necrotize the tissue. When her parents found out about it, they sent her to the hospital.

And another kid cut off both the testicles and penis. The parents scrambled to find the organs and rushed to the emergency room.

Photo | doctor in operation

"(The situations) are more common in teens. Adults are more rational and understand the consequences," Pan said.

Huaxian used to join chat groups like "yaoniangba" 药娘吧 to buy hormone drugs that can give her female characteristics. When many transgender teens have an episode of depression or gender dysphoria, they eat a lot of drugs and some even a whole box of drugs. If they don't get access to drugs, they will use veterinary medicine on their own.

After a regular physical examination, the hospital called Huaxian's mother. "Take your kids to the hospital immediately," said the doctor. Her examination results shocked the doctor. Her liver function indicators were three times higher than normal.

These kids actually know the repercussions. Years ago, transgender people had a consensus, that is, using medicines harms the body in the long run, and they cannot live past 30. However, compared to death, being trapped in a body they don't belong to is worse.

Some transgender teens were cut off by their parents. They went astray and even traded sex for money to buy medicines and pay for gender affirmation surgery. A transgender person once mentioned knowing a trans woman who was led to drug-using by a client.

Such tragedies could have been avoided.

For first-time visitors, Pan needs to spend a lot of time changing the views of their parents. "There is nothing wrong with kids. They can stay the way they are. In fact, I'm afraid you are the ones that need to change your minds ..." Pan said to the parents gently. With tears in their eyes, some parents tried to understand the situation. If the parents gradually come around, Pan can discuss medical options with the kid and the parents together.

In fact, not all kids need hormone therapies or surgeries. If they were willing to try non-medical measures, including wearing make-up, changing their clothing, and training their voices. If they can accept their true colors, there's no need to resort to medical treatments. If that doesn't work, then they may consider puberty blockers.

Puberty blockers are medications that can help stop or postpone puberty. One dose per month or three months will press "the pause button" of physical changes in puberty. If one stops taking puberty blockers, his or her body will continue to develop, which means the procedure is reversible. The therapy offers an "experience" opportunity that allows kids to think and explore and think about their true needs.

But some kids suffering from serious gender dysphoria reject the plan, saying, "What's the point if I can't change my gender?" If the visitor is above 16, and the parents give permission, hormone therapy can be an option (using exogenous hormones to get the gender features transgender people want). Exogenous hormones are in the greatest demand among transgender people. But relevant medical resources are also in huge shortage. Moreover, the therapy is chaotic at present.

The whole procedure must be conducted under doctors' instruction, and there must be regular examinations. Only in this way is hormone therapy safe. Pan requires kids receiving hormone therapy to take medicine according to doctors' advice and asks them to visit the clinic regularly. But some trans teens don't follow the rules. "I met a very emotional transgender female once. When she had an episode of mood swings, she would take too many drugs uncontrollably. In a subsequent appointment at the clinic, doctors found out that her hormone levels were ten times higher than normal. Later, we provided her with psychological treatments. In the end, she stopped taking medicine, and her hormone level went back to normal gradually.

Parental authority

There is a stack of transgender pamphlets on the desk of the clinic. Parents could take some home. "They may not read it now, but if they look through it one day when they want to, there will be more understanding," said Pan.

Educating parents is one of the most important works in the gender clinic. The work takes time and patience. A detailed explanation could easily take Pan one or two hours. In Pan's view, Family is the first social environment kids are exposed to. If their parents can't understand and support them, the kids can hardly be happy.

《2017中国跨性别群体生存现状调研报告》2017 Chinese Transgender Population General Survey Report, jointly issued by the Beijing LGBT Center and the Department of Sociology at Peking University, showed that among the 1,640 interviewees of whom the parents or guardians may or surely know their transgender identity, only six were not victims of any form of domestic violence. Most of them had the experience of being grounded, beaten, cut off financially, kicked out of the family, or sent to a conversion center.

[Note: No official data from the authorities to validate the data mentioned in the report. In the questionnaire, options for domestic violence include restriction of personal freedom; economic control; beating; word abuse; ignoring me for several days; forcing me to have sex with someone; kicking me out of the family/disowning me; intentionally overlooking/ignoring my gender identity and not giving me care and support; sending me to conversion treatment without my permission; asking me to change my clothing, behaviors, and appearance.]

Source: 2017 Chinese Transgender Population General Survey Report

Huaxian is a volunteer for Beijing LGBT+, a nonprofit organization that aims at promoting sexual diversity. Together with other volunteers, she set up the crisis interference network for transgender teens. She encountered many parents in saving trans teens. During the process, she witnessed the complexity of parent-child relationships in China.

Some extreme parents may say, " I would rather you die if you choose to be this half-man half-woman creature."

For adolescents, such words are without doubt a deadly blow. "Any pressure from the workplace, school or society pales compared with a strike from the parents," said Huaxian. Some children really ended their lives after hearing those words.

For some parents, they only start self-examination when they see their kids lying in a hospital bed or in a morgue.

But there are exceptions. After a transgender woman committed suicide, her parents still called her "my boy," according to Huaxian. Even the inscription of her tombstone wrote "Beloved son." From the beginning to the end, she never got to become herself in the family.

Conversion therapy has been banned in many countries. But it still enjoys broad popularity in China. Huaxian and other volunteers once acted as clients and investigated some conversion therapy institutions in secret. While passing a ward, she saw an instructor abusing the students. One kid was kicked to the ground and forced to eat swill.

Almost every province or prefecture-level city in China has several institutions like this, claiming that they're committed to helping internet-addicted teenagers. When visiting am abandoned institute, Huaxian saw the words carved by many students on the desks. "I can leave here in XXX days," one student wrote. Some expressed their hatred towards instructors, while some wrote down names of their favorite dishes.

The most difficult part is to persuade parents to take their kids home instead of collecting criminal evidence.

Huaxian tried to call the police. But if parents insisted on keeping their kids in the institutes for "therapy," there's not much anyone can do about it. And the older generation often has a set of logic to justify their decisions.

“天将降大任于斯人也。”

"The almighty is about to place a great responsibility on a great man."

[Note: A well-known saying by Chinese ancient philosopher Mencius. The full paragraph goes as follows: when the almighty is about to place a great responsibility on a great man, it first exercises his mind with suffering and his muscles and bones with toil. It exposes his body to hunger and subjects him to extreme poverty. In this way, his patience and endurance are developed, and his weakness is overcome.]

"Think about how the older generations overcame struggles for revolutions. Think about how soldiers in the military are trained. How can my kids fit into society if they couldn't handle this?"

In front of powerful parental authority, volunteers' hands are tied. "In China, the parents of minors have powerful rights to take control of everything about their kid," Huaxian said.

A conversion therapy institute charges as much as 10,000 to 20,000 yuan (around 1,491 to 2,984 U.S. dollars). Some institutes require parents to pay fees for three to six months, even up to one or two years in advance.

Therefore, even if they know their kids are abused, some parents still hesitate. Once they bring the kids home, they throw a large amount of money away. So they start to comfort themselves, thinking that maybe what the institutes do is for the good of the kids. In situations like this, Huxian will persuade the parents, "Don't worry about the money. You can take it back by filing a lawsuit." Only then will they agree to take their kids home.

However, sometimes parents are more painful. The father of a transgender was diagnosed with terminal cancer. He didn't dare to tell his kid the truth and underwent chemotherapy in secret. Furthermore, the family's financial condition is dire. The kid kept asking the father for money so that he could do the sex-change surgery. To take care of his kid, the father tried to save money by eating less. Sometimes he only ate some porridge for a meal. However, the role of volunteer prevented Huaxian from disclosing the truth to his kid.

But she started to reflect on the parent-child relationship: the kid should not be the private good of the parents, nor should the parents be the "donor" of the kid.

Mutual understanding between kids and parents is rare in many families. Some even don't know each other well. Some parents grip kids tight in their hands, but some sacrifice without a bottom line. Concepts like equality and individual independence never seem to exist in those relationships.

Patch the rift

Huaxian has a special WeChat online chat group for parents. Unlike some parents Huaxian had met before, they don't scold or attack volunteers. Some of them have already accepted that their kids have come out. Some are seeking help for their kids. Some neither support nor oppose their kids' decisions.

It took four years for the Beijing LGBT+ family WeChat chat group to draw nearly 400 parents, many joined upon the recommendation of transgender-friendly doctors like Pan.

Decades of experience with transgender people make Pan realize that parents, like their children, also need help. "Coming out to parents is like locking them inside."

At the clinic, when learning that their child is transgender, the first thing almost all parents do is to reflect on themselves. They ponder over what might go wrong in bringing up the kids and blame themselves for irrelevant details. Some single mothers believe their sons become feminine because they grew up without their fathers around. Some parents believe that their kids become transgender because they spent too little time with kids or punished kids at some time. Pan has to explain over and over again that transgender people are born this way. There's nothing wrong with kids, and it has little to do with how parents raise them. An hour or two passes by quickly in conversations.

A mother of a visitor to the clinic once cried, "Our family is broken due to the kid, the grandma is hospitalized because she is too angry. We don't have much money. And this is not something you could tell relatives."

As public awareness of transgender people is on the rise, nonprofit organizations dedicated to providing help and care for transgender kids have emerged, and more and more young people are beginning to understand gender diversity. In comparison, however, older generations are often isolated and helpless, trudging alone in despair.

Even the most open-minded parents have been through dark hours. A father shared his experience on the platform of Beijing LGBT+.

After his kid came out to him, he responded briefly, "Mom and Dad will always love you no matter what." But when he was alone, he searched the internet and was too afraid to go on and then burst into tears. "At one moment, I felt that even if you had everything, be it money or power, it is useless anyway. It's beyond my knowledge and ability. I don't know what to do."

After that, he tried to keep things normal and let the kid take online classes as usual during the pandemic. However, when the kid was not around, he shut himself in the study, drinking with some snacks and crying, until he was black-out drunk." The next day, he woke up, and walked to the bath center in the compound where he lived like a zombie. He went in, stared in the air, cried, ate lunch, and then went home.

A month later, he left for Beijing to seek help from transgender-friendly hospitals and nonprofit organizations.

Photo | Members of the medical team for transgender people founded by Doctor Pan Bailin

The father is just one of the many helpless parents Pan often meets. At the clinic, psychologists in the team offer consulting services to the parents too. However, the medical team alone is not enough to solve the problems facing all the parents. "In most cases, we rely on communities," said Pan. He took part in transgender lectures for parents for many times. And in 2020, Pan established the Bailin Fund 栢林基金 with money raised by himself. It is the first nonprofit fund dedicated to supporting the transgender groups in China.

In the Wehat group, other than professionals like doctor Pan, there are also lawyers and psychologists. Parents ask a lot of questions there. "Is the gender affirmation surgery an option?" "Is it possible to change the gender written on the diploma?" "Would changing sex affect job-hunting?" As they embark on a bumpy road, parents face various problems at each stage.

Every month, volunteers hold sharing sessions online. Sometimes, active parents who joined the support group earlier would jump in and answer other parents' questions before volunteers replied. Some parents send lengthy texts to share their experiences. Many parents said, "I wish I had known the group earlier." Actually, many parents have already accepted their kids. Some supported their kids and witnessed them go through sex-change surgeries. After all, these parents just want to find someone they could talk to.

In real life, they don't know how to tell old people what happened to their grandchildren. They don't know what to say when a friend asks whether their kid has been married or not. They struggle with the first conversation with teachers at school, as well as strange looks from others ... Maybe only parents with similar experiences can offer consolation and support to each other. Many lonely lines come together to create a supporting net.

One time, a parent joined the chat group and asked immediately, "Any recommendations for conversion therapy institutes?" Soon, one after another, other parents in the group told the parent bot to do that in the chat room. The same thing is always more acceptable coming from other parents. Not long after, the father asked questions again. But this time, these questions became "what is the best way to let the child take hormone drugs without too much harm to the body?" "Which hospital is good at sex-change surgeries?" A while later, Huaxian saw the parent talking in the group again. This time, he said, "What a hard job to give my kid a new name!" This is the happiest moment for volunteers because they know another transgender kid gets acceptance and support from the family.

"Tough road ahead" “路漫漫” was a father's alias when he joined the group, which said a lot about how he saw the future, dark, helpless, uncertain, and hopeless. Later, he changed his group alias to "Journey" “征途”. Life is a journey, and he decides to go on the journey with his kid shoulder by shoulder. Enditem

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