Well-being of Transgender Adults and Gender-Diverse Children in China
Fortune Global Forum 2013 (c) Stefen Chow/Fortune Global Forum, CC BY-NC-ND 2.0 DEED
“I wrote entries in my diary at that time. One day I drew an image. The image showed a small person figure [you usually see] outside men's rooms, a male sign. At the same time, I drew a female's sign at the place of the heart. Then I realized that I was this girl in my heart”.
WX, a transgender woman interviewed by Yan and colleagues for their study on transgender women’s experiences with identity, stigma, and HIV in Jiangsu Province, China. Like most participants in the same study, WX talks about realizing her gender identity at an early age [1].
Similar to Western countries, China has historically recognized only two genders: man and woman [2]. And like Western countries, growing research in China shows that gender-diverse people also exist within cultures that have traditionally recognized only two genders [3].
Multiple studies demonstrate that Chinese transgender and gender-diverse adults experience higher levels of mental health issues, like anxiety, depression, stress, and substance use disorders. Within these studies, Chinese transgender and gender-diverse adults also report higher rates of suicidal thoughts/feelings and self-harming behaviours [4,5]. Compared with other gender-diverse people in China, transgender women report the highest levels of mental health issues [3-5]. Reasons why Chinese gender-diverse adults experience high rates of mental health problems include: being discriminated based on their gender identity/expression; having a lack of social support; having difficulties accessing gender-affirming healthcare (i.e. hormones and surgery); and lacking knowledge and awareness about HIV (human immunodeficiency virus) prevention [1, 4-7].
An example of the discrimination faced by Chinese gender-diverse adults can be seen when QQ, a Chinese transgender woman in Yan and colleagues’ study on transgender women’s experiences with identity, stigma, and HIV in in Jiangsu Province, China, talks about her experiences with violence from her father:
“My dad, my dad, and he will keep asking me, asking if I am a man or a woman. When I refused to answer, he slapped me. Every time I refused to answer, he slapped me, throwing me down directly on the ground and beat me” [1].
Because of this discrimination and harassment, Chinese transgender women find ways to protect themselves, such as through hiding their gender identity and feminine appearance. As PM, another transgender woman from Yan and colleagues’ study, describes:
“When you get used to people's staring and gossiping, you learn how to avoid being hurt. So, as I said, I go out without makeup during the day, when my voice is good, I use a girl's voice to talk, when the voice is bad, I use a boy's voice to talk” [1].
Similar to gender-diverse adults, a 2023 study found that Chinese boys tended to have poorer psychological well-being, such as low self-worth or behavioural issues, when they expressed their gender differently from cultural norms [3]. One possible explanation is because Chinese children are less positive towards peers who do not follow cultural norms about gender [8]. However, in the same 2023 study as mentioned above, a negative relationship with peers did not influence the level of psychological well-being for Chinese children whose gender expression differed from cultural norms. More research must be done to understand what factors impact the relationship between gender diversity and poor psychological well-being in Chinese children [3].
As seen with both children and adults, being gender-diverse in China can be associated with poor mental health outcomes. Efforts must be taken to reduce the stigma, discrimination, and barriers to healthcare experienced by Chinese gender-diverse people to improve their mental health and well-being [1, 3-6].
[1] Yan, Z. H., Lin, J., Xiao, W. J., Lin, K. M., McFarland, W., Yan, H. J., & Wilson, E. (2019). Identity, stigma, and HIV risk among transgender women: A qualitative study in Jiangsu Province, China. Infectious Diseases of Poverty, 8(1), 94–94. https://doi.org/10.1186/s40249-019-0606-9
[2] Qian, M., Wong, W. I., Nabbijohn, A. N., Wang, Y., MacMullin, L. N., James, H. J., Fu, G., Zuo, B., & VanderLaan, D. P. (2023). Children’s implicit gender–toy association development varies across cultures. Developmental Psychology, 59(12), 2287–2295. https://doi.org/10.1037/dev0001590
[3] Wong, W. I., van der Miesen, A. I. R., Shi, S. Y., Ngan, C. L., Lei, H. C., Leung, J. S. Y., & VanderLaan, D. P. (2023). Gender variance and psychological wellbeing in Chinese community children. Psychology of Sexual Orientation and Gender Diversity. In press. https://doi.org/10.1037/sgd0000632
[4] Lin, Y., Xie, H., Huang, Z., Zhang, Q., Wilson, A., Hou, J., Zhao, X., Wang, Y., Pan, B., Liu, Y., Han, M., & Chen, R. (2021). The mental health of transgender and gender non-conforming people in China: a systematic review. The Lancet. Public Health, 6(12), e954–e969. https://doi.org/10.1016/S2468-2667(21)00236-X
[5] Zhu, X., Gao, Y., Gillespie, A., Xin, Y., Qi, J., Ou, J., Zhong, S., Peng, K., Tan, T., Wang, C., & Chen, R. (2019). Health care and mental wellbeing in the transgender and gender-diverse Chinese population. The Lancet. Diabetes & Endocrinology, 7(5), 339–341. https://doi.org/10.1016/S2213-8587(19)30079-8
[6] Spielmann, J., Feng, S., Briley, D. A., & Stern, C. (2022). Mental health contributors among transgender people in a non-WEIRD society: Evidence from China. Social Psychological & Personality Science, 13(3), 747–757. https://doi.org/10.1177/19485506211039388
[7] U.S. Department of Health & Human Services. (2022, June 30). HIV. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/whatishiv.html
[8] Wang, Y., Qian, M., *Nabbijohn, A. N., Wen, F., Fu, G., Zuo, B., & VanderLaan, D. P. (2022). Culture influences the development of children’s gender-related peer preferences: Evidence from China and Thailand. Developmental Science, 25, e13221. https://doi.org/10.1111/desc.13221
What it’s like being transgender in China by South China Morning Post
Out of Place: The Trans Chinese Community Fighting for Gender Equality (Part 1) by Vice
Out of Place: The Trans Chinese Community Fighting for Gender Equality (Part 2) by Vice
Three Chinese share their stories about being trans outside China by Maya Song (2023), published on The China Project
Explained: What it’s really like to be trans in China by Sky News
Watch the video below to learn more!
Learn more about the relationship between gender variance and psychological well-being in Chinese children, including what gender variance is and what factors play a role in the psychological well-being of gender-variant children, through conversation with Dr. Ivy Wong, Associate Professor for Gender Studies Programme & Department of Psychology, Director for Gender Studies Programme, and Assistant Dean (Interdisciplinary Programmes) for Faculty of Social Science at The Chinese University of Hong Kong.