Transgender people in the People's Republic of China include persons whose gender identity differs from their sex assigned at birth. They face a legal and social environment in which medical transition and changes to legal sex are permitted under restrictive conditions. Reliable estimates of the transgender population are limited, but transgender people have become more visible in Chinese medicine, media, and public life since the late twentieth century. While there have been advances in transgender rights in recent years, violence and discrimination remain alongside widespread censorship and barriers to healthcare. There are about four million transgender people in China.
Changes to the legal gender marker are possible, but it requires gender-affirming surgery. Transgender identity is still classified as a mental disorder despite changes to the ICD-11. Access to hormones and surgery is available but restricted; some resort to informal or unregulated treatment. Specialist services have expanded, including clinics for transgender youth, despite government promotion of "traditional gender roles".
Transgender people in China may face discrimination in employment and housing as well as violence. Like all transgender people, they are at a higher risk for depression and anxiety relative to the broad population. Furthermore, they may face difficulties reauthenticating prior academic records as well as family pressure and parental involvement in healthcare.
History
In the mid-1930s, after the father of Yao Jinping (姚錦屏) went missing during the war with Japan, the 19-year-old reported having lost all feminine traits and become a man, was said to have an Adam's apple and flattened breasts, and left to find him.P. Zhu, Gender and Subjectivities in Early Twentieth-Century Chinese Literature (2015, ), page 115. Du He, who wrote an account of the event, insisted Yao had become a man, while doctors asserted Yao was female. The story was widely reported in the press, and Yao has been compared to Lili Elbe, who underwent sex reassignment in the same decade.
According to some scholars, female infants were dressed up as males ("cross-dressing"). They claim that this, in turn, affected those children to live transgender lives.
Cross-dressing in Peking Opera
Sinologists often look to theatrical arts when imaging China in a transgender frame because of the prominent presence of cross-gender behavior.
Peking Opera, also known as Beijing Opera, had male actors playing female dan characters. Men traditionally played women's roles due to women being excluded from performing in front of the public as a means of preventing carnal relations. Although, before 1978, male to female cross dressing was mostly for theatrical performances, used for comedic effect or to disguise a character in order to commit a crime or defeat enemies. Female to male characters were considered heroic in theatrical performances.
During the Ming and Qing Dynasties of China, cross dressing occurred both onstage and in everyday life. Within theater, some who were intrigued by it would roleplay, organize their own troupes, write, and perform theatrical pieces.
Many of early modern China's stories reflected cross-dressing and living the life of a different gender for a short period of time, mainly featuring the cross-dressers as virtuous, like Mulan.
Li Yu, a writer and entrepreneur, featured the gendering of bodies to be dependent upon men's desires and operated by a system of gender dimorphism, as assumed by social boundaries of the time. When Li Yu created an acting troupe, as many elite males did, he had a concubine who played a male role as he believed she was "suited to male" or considered her more of the masculine gender.
In modern-day Peking Opera and film, there are male to female cross dressers and vice versa for characters, especially with certain time periods.
Legal and medical aspects
China has signed and ratified the International Covenant on Economic, Social and Cultural Rights. It has signed but not ratified the International Covenant on Civil and Political Rights.
After the World Health Organization dropped "gender identity disorder" from its International Classification of Diseases (ICD-11) in 2018, China promoted the new guidelines in medical institutions across the country.
China's CCMD-3 psychiatric classification (published 2001) lists "gender identity disorder" () and "transsexualism" () under psychological disorders. Previously, "transsexualism" was written as 易性病 .
In March 2019, China accepted recommendations by the United Nations Human Rights Council on banning discrimination against LGBTQ people.
In 2020, a Beijing court ruled in favour of a transgender woman who was unlawfully dismissed by e-commerce company Dangdang despite having submitted a medical certificate and having followed doctor's advice. The court said that Dangdang should "continue to honour her original contract of employment" and that the company should "pay her salary from the date she applied for sick leave to the date of arbitration", amounting to 128,028 yuan. The ruling was based on Articles 4, 48, and 87 of the Labour Contract Law. Furthermore, the court stated that "social tolerance is a blessing of the rule of law" and called for the protection of the dignity of transgender people.
On October 31, 2024, a Chinese transgender woman was approved by Changli county people's court in Qinhuangdao to receive 60,000 yuan (£6,552) in compensation from a hospital that gave her electroshock conversion treatment against her will. This was the first time any transgender person in China won a legal challenge against the use of electroshock conversion treatment.
In 2025, China voted against a motion to renew the mandate of the United Nations Independent Expert on Sexual Orientation and Gender Identity at the United Nations Human Rights Council.
Gender reassignment Gender reassignment surgery has been permitted in mainland China since 1983. The same year, the first male-to-female surgery was performed in the country. Medical regulations for such procedures were first standardised in 2009. The three main rounds of regulations were published in 2009, 2017, and 2022, respectively.
In early 2014, the Shanxi province started allowing minors to apply for the change with the additional information of their guardian's identification card. This shift in policy allows post-surgery marriages to be recognized as heterosexual and therefore legal.
2009 Regulations: Technical Management Standards for Sex Reassignment Surgery (Trial) The first round of regulations concerning gender reassignment surgery were issued in 2009. The official terminology used was "sex change surgery" ().
Requirements for the patient include:
At least 20 years old, unmarried, with full civil capacity; At least 5 years of desire for transition, without reversal; At least 1 year of prior psychiatric treatment without success; "Transsexualism" diagnosis from a psychiatrist with no other abnormal mental state; Sexual orientation directed at the opposite of their target gender; No surgical contraindications; No criminal record; Notarised written request from patient; proof of notification to immediate family; ethics approval; informed consent
2017 Regulations: Gender Reassignment Technology Management Standards (2017 Edition) The official terminology used was "gender reassignment technology" (). Most notably, the sexual orientation requirement was removed.
Requirements for the patient include:
At least 20 years old, unmarried, with full civil capacity; At least 5 years of desire for transition, without reversal; At least 1 year of prior psychiatric treatment without success; "Transsexualism" diagnosis () from a psychiatrist; No surgical contraindications; No criminal record; Notarised written request from patient; proof of notification to immediate family; ethics approval; informed consent
Latest 2022 Regulations: Management Specification for the Clinical Application of Gender Reassignment Technology (2022 Edition) Requirements were further relaxed with this revision. As of July 2026, this revision is still in force.
Requirements for the patient include:
At least 18 years old, unmarried, with full civil capacity; At least 5 years of desire for transition, without reversal; Diagnosis of either "transsexualism" (), "gender dysphoria" (), or "gender incongruence" () from a tertiary hospital; No surgical contraindications; No criminal record; Signed written request from patient; proof of notification to immediate family; ethics approval; informed consent Under these new regulations, "transsexualism" was no longer described using the noun for "disease" () but was instead replaced using the noun for "condition" ().
Change of legal gender marker Gender reassignment surgery is a prerequisite for legal gender recognition; China does not allow gender self-identification. Changing the gender marker on official identification documents (Resident Identity Card and Hukou) requires the following: A formal written request from the applicant; Household Registration Book (which may need to be retrieved from the applicant's family) and Resident Identity Card; A certificate of gender authentication issued by a domestic tertiary hospital, along with verification of the certificate from a notary public office or judicial accreditation body. Since 2022, according to new regulations of the National Health and Family Planning Commission, changing the legal gender marker no longer requires a full-sequence gender reassignment surgery; only the removal of reproductive and gonadal organs (testes, penis, breasts, ovaries) is required.
For Chinese nationals of Hong Kong and/or Macau holding the Home Return Permit (MTP), the MTP's identity particulars are subordinate to the person's officially registered Hong Kong/Macau identity particulars. Such persons seeking to change their legal gender marker in the mainland must do so for their Hong Kong Identity Card or Macau Identity Card, after which they can have their MTP replaced.
On 6 February 2023, Hong Kong's Court of Final Appeal decided Tse Henry Edward v Commissioner of Registration. Old rules required transgender persons to undergo "full sex reassignment surgery" before changing the sex marker on their HKID. The Court unanimously found that the full SRS requirement was unconstitutional, pursuant to the right of privacy under Article 14 of the Hong Kong Bill of Rights. The Court required the Government to introduce a new policy, which it did on 3 April 2024. Under the new policy, full SRS is no longer required (for MtF, only removal of the penis and testes are needed; for FtM, bilateral mastectomy is required).
Macau is the only jurisdiction within China that does not allow transgender persons to change their legal gender marker.
Changing one's ID card information may lead to an abnormal match with their academic qualifications, which often seriously impacts one's employment as one cannot change their student status information after graduating from university.
According to Chinese law:
Multiple reports indicate that it is difficult to change gender information on academic credentials and degree certificates after graduation, with only a few isolated cases claiming success.
Gender-affirming hormone therapy (HRT)
China has no single national regulation on HRT. Therefore, requirements that exist for gender reassignment surgery are not necessarily present for HRT.
A 2017 survey conducted by Beijing LGBT Center and Peking University found that up to 71% of respondents who sought HRT said they had "difficulty" accessing it. Almost 50% of transgender people who wanted access to HRT reported being unable to obtain it "in any form at any point in their lives".