Low-income transgender people are some of the most overlooked members of the LGBTQ+ community, especially when it comes to receiving healthcare services.
Not only do stigma and discrimination persist, but certain treatments like gender-affirming hormone therapy and the use of oestrogen or testosterone to help a person achieve the appearance of their gender identity can still be out of reach for many.
Things are about to change. In late January, the government approved the allocation of 145.63 million baht to the National Health Security Office to provide hormone medicine to 200,000 transgender people.
Local activists applaud the move and say it will benefit those with little or no access to hormones the most.
“The approval of hormonal therapy support under the gold card scheme by the National Health Security Office is important because it can [help] low-income informal workers who are in the golden card scheme but lack access to hormonal therapy support,” said Nachale Boonyapisomparn, vice-president of the Foundation of Transgender Alliance for Human Rights.
Nachale: Health literacy a must
“At the same time, it is necessary to expand this service in other provinces or make the service more accessible at the primary stage of healthcare to ensure those who live outside the city get access to this treatment,” she added.
In late January, deputy government spokesman Anukool Pruksanusak said the subsidy for hormonal therapy for 200,000 people was in line with the government’s support for marriage equality.
This would eliminate health risks, particularly among those seeking access to hormonal therapy via informal channels. The support would also create health equity in being able to access the service, formerly available to only those with the means to afford it, said Mr Anukool.
The policy was welcomed by Tlaleng Mofokeng, the United Nations Human Rights Council’s Special Rapporteur on the Right to Health, who visited Thailand in February.
“Previously, this was an out-of-pocket cost thereby preventing access,” she said.
“I urge the National Health Security Office to also be conscious of the multiple ways that transgender people experience violence within the health system and ensure the health system does not operate in a way that further violates or alienates transgender people out of care.”
Dr Mofokeng added that while Thailand has shown progress in healthcare policy, the country still needed to put the rights of the people at the centre of its healthcare system to ensure inclusivity, especially among the most vulnerable and discriminated.
“Globally, the goal of availability, acceptability, accessibility and quality of healthcare is becoming even harder to reach. This is especially true for those in vulnerable situations including, among others indigenous peoples, migrants and refugees, internally displaced people, ethno-religious minority communities, people with disabilities, people deprived of liberty, sex workers, people who use drugs, LGBTIQA+ and gender diverse persons,” she said.
Mofokeng: Ensure inclusivity
BOOST EDUCATION
Ms Nachale also said health knowledge and health literacy should be promoted more among those receiving the hormones, through the cooperation of both the government and the civil sector.
This is to ensure they are protected from hormones obtained via unofficial channels that might be detrimental to their health, she said, suggesting that disseminating knowledge about hormones on social media might be a suitable way to reach transgenders in their teens, for example.
Ms Nachale said each person has his or her own specific hormonal requirements. Some can take hormones without having to go through gender affirmation surgery at all.
“Hormonal therapy usually continues for those who have undergone surgery as they need to rely on it on a permanent basis,” she added.
Rena Janamnuaysook, Programme Manager at IHRI Tangerine, Asia’s first transgender-focused health clinic, said hormonal therapy costs, dosages and types of medication vary depending on an individual’s needs.
Transgender people who receive therapy at her clinic would spend on average about 5,000–7,000 baht a year, which cover medication and laboratory costs.
Thailand does not have the data on how many transgender people exactly are in need of or are receiving hormonal therapy, said Ms Rena, but there are about 7,000 transgender people being treated at her clinic each year.
“We are the largest transgenders’ clinic in Asia, therefore, we have a very large number of patients,” she added.
Rena: Treatment costs vary
