Vietnam has been increasingly progressive in protecting and promoting LGBT rights. In November 2015, Vietnam made a big milestone when it granted individuals who have changed their gender the right to apply for a change of civil status affairs, and at the same time set forth the right to legal gender recognition for transgender people. Not only that, Vietnam has removed the ban on same-sex marriage since 2013, and legalized gay people serving in the military since 1992.
Yet, policy gaps persisted, such as the fact that same-sex marriage, though not illegal, has yet to be recognized. Trans Vietnamese continue to face many challenges outside of strictly legal matters, such as in access to healthcare services and providers that understand and are specialized in issues affecting trans people. Saigoneer talked to four trans Vietnamese about their experiences and concerns surrounding healthcare for the transgender community in Vietnam.
Going to the doctor
There are yet to be any formal policies protecting transgender people (and individuals from the LGBT community in general) against discrimination in hospitals and most healthcare providers are not educated on working with transgender patients specifically. Yet, even without specific guidelines or training systems in place in place, many transgender people do not encounter problems when interacting with doctors.
“I go to the hospital for monthly health checks, and so far have never faced any problems with the doctors and nurses,” says Ngọc Nguyễn (she/her), who lives in Hanoi. “The hospital serves hundreds of patients a day. They really don’t have time to discriminate against you.” Chúc Linh (he/him) shares the same experience in hospitals in Ho Chi Minh City. “I’ve rarely been disrespected by doctors in a hospital before.”
However, that isn’t to say that transgender people share the same healthcare experiences as everyone else; nor it is to say that all transgender people share the same experiences as each other.
“Since I haven’t undergone reassignment surgery, sometimes doctors would ask me about my gender. I never hesitate to say that I am a transgender male. It really doesn’t matter, since the reason why I visit the doctor is for my health, not my gender,” Chúc Linh shares. “I know that some people are uncomfortable with doctors asking too many questions. However, this is not unexpected, some of my friends don’t even know the difference between being gay and being transgender, let alone middle-aged doctors.”
According to Ngọc, people who have only been using hormones recently face more challenges than those who have been using them for a long time. One of these challenges occurs during medical procedures that require one to remove their clothing. “When you have just used hormones, your body isn’t completely ‘one-gendered.’ Specifically, when someone has just recently undergone feminizing hormone therapy, their breasts will start to develop but not yet fully developed. They would have a hard time looking at themselves, let alone letting others see them.”
For Vi (she/her), the real problem is not discrimination but rather the medical services themselves: “I have a positive experience at a private hospital I went to, but a problem I have is that being born a male, I don’t get to receive scans for breast cancer for my monthly health check. This is an issue because when I use birth control, I am at a higher risk of breast cancer.”
Sharing pronouns
Many transgender people face challenges sharing their pronouns with staff in hospitals. These challenges don’t occur a lot when they work with doctors, but rather with hospital receptionists. “When I talk to doctors, they usually refer to me as em, which is a neutral pronoun. However, hospital receptionists tend to refer to patients as either anh or chị,” Ngọc shares.
Thanh Tường (she/her) shares that she is open to sharing her preferred pronounces; yet, that depends on different circumstances. “I have no problem telling the doctor my pronouns if they ask. However, that would only be the case if I am alone in a room with the doctor. Most of the time, when receptionists call out your name along with your pronoun from your identity card, they do so in front of hundreds of other people at the hospital. That to me is uncomfortable.”
According to federal law since 2017, people who have undergone gender reassignment surgery are allowed to change their legal gender. However, the process of changing one’s legal gender is complicated not only because of its many procedures but also because it involves ambiguity. “I’ve thought of changing my name and gender before, but it’s not easy,” Vi shares. “Vietnam’s law doesn’t state clear instructions for changing the information on your identity card; even lawyers I’ve met don’t know for sure.”
Using medical insurance
For transgender people, trying to use medical insurance poses the same challenge as using identity cards. Ngọc shares: “I never face difficulties using my insurance, but that’s because I don’t mind being open about myself. Usually, the medical staff asks you a lot about yourself when your appearance has undergone noticeable changes as a way to confirm your identity to avoid recording your information incorrectly and prevent insurance fraud.”
The issue that medical insurance poses to transgender people goes beyond asking uncomfortable questions. “The fact that the insurance doesn’t cover costs for voluntary medical examinations or medical examinations you choose to undergo without having any symptoms of any diseases, is an issue for transgender people. It is crucial for transgender people to have monthly health check-ups, as they are at a higher risk of sexually transmitted diseases such as HIV or Hepatitis B,” Ngọc shares.
She also explains that the lack of insurance coverage for voluntary health examinations also impacts hormone therapy. “It’s a widespread misconception that using hormones reduces your life expectancy. In fact, if you do monthly health check-ups when using hormones, you can live as long as anyone else. However, I always have to pay for my health check-ups out of pocket.”
Mental health treatment
Conversations about mental health treatment can be much more contentious than those about physical health, especially in Vietnam where mental health diseases are not widely accepted. Although this is an issue for everyone trying to access mental health treatment, transgender people in need of mental health care often face many more complications because there is no consensus in the mental health community on how to approach transgender.
“When I tried visiting a psychiatrist in Hanoi, they treated me as if being transgender is an issue to solve,” Ngọc recalls. “They asked me why I want to be transgender, and told me to do more exercises and live more like a man. Not to mention that mental health treatment is extremely expensive.”
“One time when I went to Bạch Mai hospital to seek mental health treatment, they told me that I wasn’t depressed,” Vi says. “That was the last time I went to that hospital. The lack of mental health treatment is a big issue for transgender people, who tend to face body dysmorphia, depression, and other mental health effects that are heightened by hormones and birth control pills.”
Those who do have access to a therapist, they report life-changing experiences. “After seeing a therapist, I not only feel more comfortable with my gender identity, but also understand myself better. I sought therapy because I was undergoing feelings of frustration, confusion, and insecurity with my body. After going to therapy, my therapist helped me gather the courage to come out to my family. After healing with the help of therapy, I became more courageous, more confident, happier, and freer in expressing myself,” Linh shares.
What should be done?
“I think there should be more training for doctors and nurses. Before they graduate, they should have taken at least one course on gender studies,” Tường suggests.
“There is still so much that both healthcare providers and transgender people themselves don’t know,” says Linh. “Healthcare for transgender people is still such a new thing.” Linh has started a personal YouTube channel to provide an honest and frank perspective on his life experiences as a trans man, including informative tips about some medical conditions trans people can face while on hormone therapy and more light-hearted content like how to find the right binders. “So far, I am the only person on YouTube talking about transgender people’s health. The lack of awareness on this is the cause of every issue you and I just talked about.”
“I’ve created a website to help transgender women gain more medical knowledge. With more medical knowledge, visiting the hospital would be much less intimidating,” Ngọc shares. Check out her website here.
For Thanh Tường, solving issues regarding healthcare for transgender people in Vietnam goes beyond educating healthcare providers and improving hospitals. “Transgender exclusion exists everywhere, and even within families. When parents have children, they always tell boys to play soccer, to like the color blue, and to marry a woman when they grow up. Girls are told to only wear pink and jump rope. No one ever tells their children that no matter who they marry or who they are when they grow up, they will always be loved as long as they care for the environment and the people around them.”
This underscores how progress for transgender individuals will not succeed with the efforts of one aspect of society, alone. If families see health industries treating transgender individuals with more care, they might become more accepting of them as well. In return, if families raise tolerant and mindful children, more respectful healthcare professionals will enter the healthcare industry.
