Impact Journalism Day 2016

Transforming Transgender Health Treatment

Asia's first transgender health clinic opened in Bangkok late last year. Doctors have been surprised to discover that a quarter of their clients are transgender men.

Kanattsanan 'Mukk' Dokput, center, at the Tangerine Community Health Center in
Bangkok.
Chayanit Itthipongmaetee

Kanattsanan “Mukk” Dokput was 27 when he sank the first needle-full of black market testosterone into his thigh. He chose a dose recommended by veterans of DIY hormone therapy. The needle was too short to reach muscle; his entire thigh swelled painfully.

That first injection came after a nine-year obsession sparked by a documentary on gender reassignment surgery. “This is what I’m gonna do,” he had told himself when the program ended.

Mukk’s mom was the first to learn of his plan. “Couldn’t you just be a tomboy?” she asked.

“Yes,” Mukk replied, “but I won’t be happy for the rest of my life.”

Mukk was born female but showed masculine tendencies from an early age. His mother had to chase him around the home to slip on the skirt worn by girls in kindergarten. He cried all day until he could take it off.

Many more injections would follow. For the first year, Mukk struggled with the mechanics of getting male hormones into his body. By the second, third and fourth, he’d become an expert.

But there were times when his self-administered treatment left him feeling light-headed, among other side effects. And late last year, he began suffering chronic fatigue.

While the world is just catching up to Thailand’s awareness of the full spectrum of gender and sexual identity, the attention here and elsewhere remains focused on transgender women.

There’s a broad base of knowledge and a community supporting “transwomen,” who in Thailand often begin hormone treatment at the onset of puberty.

But there’s been little available for “transmen,” who retain all the medical needs of women and put their health in jeopardy by going it alone to realize their full identity.

That changed late last year, though, with the opening of the first transgender health clinic in Bangkok (and all of Asia).

Hormone overdoses

At the Tangerine Community Health Center, Mukk learned from a doctor that his liver was ravaged from years of overdosing on testosterone, with his levels roughly twice the normal amount in men.

Tangerine offers full services for transgender clients, including psycho-social counseling, vaccines, hormone treatment, Pap smears and STD tests.

As Mukk learned, hormone overdoses are common among transmen, who sometimes overdo things out of a desire for “manliness.”

“Testosterone administration has been spread word of mouth from one transman to another. There have been a lot of hormone overdoses, which can cause liver function problems, high levels of blood fat and diabetes in the long term,” says Nittaya Phanuphak Pungpapong, the clinic’s head doctor.

She says the clinic was unaware of the demand for services from transgender men until they opened to find female-to-male transsexuals at the front of the line.

“We didn’t expect we’d have this many transmen coming to us,” admits Nittaya, who also heads AIDS prevention efforts for the Thai Red Cross Society. “This shows they couldn’t find any service like this before – as if they had been waiting for this to happen for a long time.”

A quarter of the clinic’s approximately 200 clients are men.

While hospitals offering gender reassignment surgery are easy to find, Nittaya says most don’t provide the follow-up care available at Tangerine, such as hormone therapy, hormone-balance tests, blood tests and Pap smears.

Although Thailand is tolerant of its identity diversity, that doesn’t necessarily mean attitudes are progressive.

“In Thailand, transgender people have limited access to health-care services because they’ve had unpleasant experiences with stigma and discrimination,” explains Nittaya. “Therefore, we want to be a transgender-friendly clinic to eliminate stigmatization and discrimination toward trans people.”

‘Uncomfortable and embarrassed’

With close-cropped hair, bearded chin, flat chest and deep voice, Mukk looks like any other man in his early 30s. But speak to him for a while and he might confide that he once attended an all-girls school.

Mukk had his breasts removed around the time he started taking hormones. But because he is likely to always have ovaries, a vagina, and the medical needs that come with them, things get awkward when he has to sit among dozens of women in the hospital gynecologist’s waiting room.

He doesn’t like presenting his ID, which identifies him as female: “I don’t feel it’s right at all,” he says. “I felt very uncomfortable and embarrassed, and I believe that the women staring at me would feel the same.”

As part of Asia’s first clinic offering anonymity to clients, Tangerine is keen on sensitivity. Instead of shouting patients’ names from loudspeakers, for instance, they are called by assigned codes.

Cost has been another barrier. “That’s the main problem why many transmen choose to inject themselves and buy hormones from the black market,” says Mukk.

At Tangerine, a hormone session costs some 300 baht ($8.50) – about a third the cost of private hospitals.

Funded by USAID and operated by the Thai Red Cross Society, the clinic has partners in various local and regional LGBT organizations such as Sisters, Asia Pacific Transgender Network and Thai Transgender Alliance.

Cianan Russell, a 33-year-old American expat who now goes to Tangerine for hormone treatment, said it didn’t take long to realize that “transgender” almost always referred to women.

Russell, an activist who transitioned from female to male in 2001, said he struggled to find services during his first three years in Bangkok.

“I didn’t find anywhere I felt comfortable to go for a regular blood test,” he says. And just going to a doctor unfamiliar with transgender issues can be traumatic, he notes.

“It makes people just not go. They just don’t do it. Or don’t do it often enough. And then all of a sudden you have Stage 4 cervical cancer, and you didn’t know until it’s too late.”

That makes clinics such as Tangerine indispensable.

“They’re not doing anything else, it’s just about making sure trans people get effective and respectful care,” Russell says.

(With additional reporting by Sasiwan Mokkhasen)

This article first appeared on Thai news site Khaosod English.