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Black market hormones one of many hurdles for Thai transgenders

21 February 2016, 15:01

Bangkok - Chalit Pongpitakwiset has always felt like a man. Now the 25-year-old wants everyone else to see it too.

But unlike most transgender people in Asia, who are left to self-administer hormone supplements, Chalit is being helped by a pioneering clinic.

"I am in the hands of doctors," said Chalit, who was born female, but identifies as a man.

"I'm not doing it by myself, so it isn't dangerous," the software company worker said.

Several days after receiving his first testosterone injection, Chalit returned to get a blood test at Tangerine, the new clinic inside a Red Cross centre in downtown Bangkok.

The centre is a pilot programme that organisers hope could be replicated across Asia.

Its location is no accident - Thailand has a large and visible transgender population and is one of the world's top destinations for sex-reassignment surgery.

But just like elsewhere in Asia-Pacific, a region home to more than nine million transgender people according UN estimates, long-term care for patients is patchy at best.

The clinic is a rare place providing follow-up treatment, both physical and mental, for those who have undergone sex-reassignment surgeries, procedures where patients are often at risk of infection.

"Most of the centres where the surgery is performed only provide short-term post-surgical care," explained Nittaya Phanuphak, the head doctor at Tangerine.

- Unregulated hormones -

In Thailand, hormones are commonly purchased on the Internet or in local pharmacies, and administered on advice gleaned from friends or web forums.

Recent university graduate Benyapon Chimsud, who was born a man but identifies as female, said she has been taking hormones for two years.

"I have been taking hormones by myself for two years, I consult with my friends," to determine the proper doses of contraceptive pills, she explains.

She also gets monthly black market oestrogen injections at a rudimentary neighbourhood clinic.

That leaves her cut off from regulated healthcare, prone to receiving inaccurate medical advice and at risk of over-consuming hormones in a rush to see rapid results.

Also read: Thai elephant gores Scottish tourist to death on trek

Chalit, on the other hand, met with a psychiatrist several times before receiving his first injection to prepare for the changes to his body.

"The psychiatrist asked me how long I've wanted to be a man, and whether my friends and other people around me would accept it if I changed," Chalit told AFP.

Now he is getting hormone injections every two weeks.

"The hormones will stop my periods, change my voice, give me a beard and moustache, and develop my muscles," he said. "All things that will help me no longer be a woman anymore."

That should insulate him from the dangers of taking the wrong doses of hormones which experts say can lead to liver and cardiovascular problems. HIV is also always a risk if needles are shared.

Rights groups like the Asia-Pacific Transgender Network (APTN) say this public health issue is largely neglected by the mainstream medical community.

"There are no official guidelines on the administration and monitoring of hormones among trans people," said Joe Wong of the Asia-Pacific Transgender Network (APTN).

- Discrimination still commonplace -

Although Thailand can appear tolerant on transgender issues from the outside, many segments of society remain deeply conservative.

The kingdom's transgenders, often men who become women and are known colloquially as "ladyboys," are over-represented in the entertainment and sex industries.

Despite high levels of education, many struggle to secure full-time work or prominent positions in the workplace.

Same sex marriage is also still not legally recognised, and up until 2012, transgenders were considered mentally ill by the army.

Tangerine doctor Nittaya says discrimination remains widespread in medical centres, making access to proper healthcare a challenge for many transgenders.

But Chalit is one of a small number of people to have been made aware of the dangers and commitment that comes with long-term hormonal therapy.

Several days after starting his treatment, Chalit, who is considering an operation, got a tattoo of the testosterone molecule on his arm.

"I have to take hormones for the rest of my life," he said. "This tattoo will also stay with me for the rest of my life."



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