Differences in the situations of TG and TS people
in different countries around the world
by Lynn Conway


Copyright @ 2002-2006, Lynn Conway. All Rights Reserved.

[V 4-19-06]

[see this link for changes in latest update]


[Note: This page and website focus mainly on the situations of MtF transitioners.

For more about the situations of FtM transitioners, see the website of

FtM international and also the Successful Transmen page.]


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Lynn's webpages about transgenderism and transsexualism are written from the perspective of someone living and transitioning in the United States of America. However, transsexualism and transgenderism have always been "international." Girls from all around the world have often looked out beyond their own country's borders when trying to escape the gender traps they've found themselves in. Every country has always put a different spin on how it treats TG/TS people, and transitioners can often find special advantages in medical services or jobs or citizenship in some other country than their own. Lynn herself had to go outside the United States for her SRS back in 1968, at a time when those surgeries were seldom permitted here.
Every aspect of transition and post-transition life is affected by one's nationality and culture. Different countries have vastly different customs, social traditions, cultural taboos, legal rules, and bureaucratic regulations regarding TG/TS conditions and transitions. One's nationality thus has a huge effect on how difficult it is to complete a TG or TS transition, and the degree to which a transitioner is accepted by society and has opportunities for a fulfilling life after transition.

Historically, many non-Western cultures have long recognized and accommodated transgender people, and in a wide variety of ways.  Even when such cultures were not politically or militarily colonized by Western countries, their desire to imitate Western values often resulted in the repression or elimination of their gender minorities.  In some countries, traditional gender minorities are remembered through oral tradition, while in others they barely survived, perhaps “underground” or in geographically-remote areas considered “backward.”  Now that Western culture has begun to accept gender and sexual minorities, these other groups are also emerging from the shadows.  Examples include the Polynesian fa’afafine and mahu, the takataapui of the Maori culture in New Zealand, the khanith and mukhannath of the Arabian peninsula, the muxe of Mexico, and the Two-Spirit people of the Native North Americans (including the nadle of the Navajo and the winkte of the Lakota).  Another important example is the Hijra, who exist in large numbers in India and Bangaladesh (see below). And surely there are others.

We can visualize the huge country-to-country variations in TG/TS life, among even the western countries, by making basic comparisons of things like (i) the ease of access to transition services and medical treatments, (ii) who pays for these services and treatments, (iii) social responses to the conditions, (iv) degree of recognition as women after transition, (v) legal status before/after transition, (vi) variations in the freedom to "start a new life", and (vii) access to employment before, during, and after transition.
United States:
By most measures, the United States is now the best country in the world for TG/TS transitioners. At present, transition expenses are rarely covered by health insurance, and must be paid out-of pocket by most transitioners here. However, the wide range of good employment opportunities in the U.S. provides many transitioners with the means to support themselves and pay for expensive procedures before, during and after transition. Many companies even support "on the job TG and TS transitions" here. No other country provides such wonderful opportunities for women in the workplace and in life in general, and many post-op TS women can go on to have fine careers and lives here.
The U.S. also has a long social tradition dating back to our frontier days of "starting over again somewhere else". Family bonds are not as strong here as in most countries. Instead people build "extended families" among their friends at work and in their recreational activities. Not feeling the constraints of a traditional society, and being able to build lives far beyond their birth families and communities, people here do not fear pulling up roots and moving and starting over. Fortunately, most states in the U.S now enable post-op women to obtain revised birth certificates and other ID after TS transition, and to have full legal rights as women, including the opportunity to marry men. All these things work to the great advantage of transitioners here.
The U.S. has also made rapid progress in formal civil rights for TG/TS people, and they are protected by anti-discrimination legislation in many large cities now. On the other hand, there is a small but ever-present violent element in U.S. society, and TG/TS people here must always be on guard to avoid people and places where they might be assaulted and hurt. Nevertheless, the U.S. is for the most part a friendly "live and let live" society, and transitioners are relatively free from harassment here.
People in the U.S. tend to be more self-reliant and independently self-supporting than those in many other countries of the world. A big part of our freedom to "do our thing" is that we have to be responsible for ourselves and not expect others to take care of us. People who cannot easily manage to take care of themselves here, and who instead expect others to take care of them, cannot expect to transition well here. Freedom is thus a double-edged sword: You have the freedom to try to succeed here in the U.S., and a wonderfully open society in which to do so, but you also have the freedom to make big mistakes and fail - all on your own.
Latin America:
As we go south into the countries of Mexico, Central America and South America, the situation of TG/TS people is very different. In these countries most males are "macho", defining their masculinity as "not being feminine" - and the two genders are more highly polarized than in the U.S. Any males who are feminine in any way are subjected to extremely intense ridicule and stigmatization. As a result, many TG/TS people in Latin America remain in a state of fear and repression, are terrified about showing their gender feelings, and most never even attempt to resolve their gender conditions.
At the same time, there is a long tradition of "travestis" in these countries. The travestis are a large but more or less underground community of transgender women who work predominantly in the so-called sex industry, i.e. prostitution, strip clubs, pornography, etc. This has long been an option for a “landing zone” for gender-variant youngsters in Latin America who have been thrown away or run out by their families. Lacking education, identification papers and any other form of social support – this at least provides them with a means of economic survival.
However, the travestis are heavily stigmatized in many of these Catholic-dominated societies, where Church teachings and intrigue wield so much power over society. Without any proper ID's, most have no chance of finding regular employment and they usually remain ghettoized and in sex work. Many of them are very pretty and womanly, as seen in the following website of "Brazilian Transsexuals" (Note: That site is pornographic). These pretty she-males and trans women can easily attract lusty male customers as prostitutes. 
The internet is now enabling many of these women to make sexual contacts (as "escorts") and to also earn money from pornography, without having to resort to dangerous "streetwalking". Nevertheless, many are harassed and terribly abused by the authorities and the police. Even those who are transsexual and somehow manage to undergo full gender transition are usually unable to get proper ID's, and are still considered "travestis" and remain stigmatized in most of these countries. Many attempt to emigrate to Europe (and some to the U.S.), where they might have a chance to build a better life - either as she-males or as TS transitioners.
Brazil has been an exception in Latin America to some degree. For quite some years, beautiful and talented Brazilian transgender women have been able to build respectable careers in entertainment, and some became national icons, as was the case with Roberta Close.  However, the separate concept of transsexualism was slow to be recognized in Brazil, and these women were almost always considered travestis even if they fully transitioned. 

Roberta Close’s eventual reassignment surgery in Europe in 1989 greatly increased public awareness of transsexualism, especially when a controversy arose over the government's denial of a legal change in her gender. A government-sponsored program was finally established in Brazil in 1998 to provide a limited number of MtF transsexuals with counseling and reassignment surgery “on an experimental basis.”  The growing number of post-op women in Brazil then caused greater public awareness of the validity of this form of gender variance. This government then relaxed its rigid position on changes of name and gender on official records, and Roberta was finally able to have her documents legally changed in 2005.


The 1990s also saw the emergence in Brazil of crossdressers as a distinct category of gender variant people who earlier would have been automatically equated with travestis.  Some Brazilian crossdressing groups maintain an internet presence, and organize events in the major cities there, similar in some ways to what is done in the U.S.  In addition, the various gender-variant groups in Brazil are forming productive alliances with gay and lesbian activist groups.  There is some indication that several other Latin American countries are beginning to evolve in these same directions.

Western Europe:
In contrast with most of Latin America, certain countries in Europe are good places to transition. The Netherlands and the Scandinavian countries are particularly accommodating and accepting of transitioners. Spain, which recently legalized same-sex marriage, has also become more open to gender transitions, and publicly-funded sex reassignment surgeries (both MtF and FtM) are now available to a moderate extent. Some of the other European countries also provide transition medical treatment and surgery under government health plans. However, there are often very long bureaucratic delays in gaining access to treatment in some of those countries. Therefore, many European girls go to Thailand for their surgeries, bypassing the government support systems. After transition, postop women in most European countries can obtain full legal ID's and have full legal rights as women, including the right to marry men. However, employment opportunities are not yet quite as wide-ranging in Europe as they are in the U.S. For more about TS transitioning in Europe, see the European TS website.
The U.K. is also a good place to transition. Full support for medical and surgical care is provided under the National Health Plan, and U.K. society is rather accommodating of gender transitions. However, up until 2004 an old legal precedent prevented post-op transitioners from being legally recognized in their corrected gender. They weren't able to get revised birth certificates, and had to "out" themselves every time they got a new job and in other encounters with the state bureaucracy. Worse yet, they weren't allowed to marry in their new gender. Under pressure from U.K. trans advocacy groups (notably "Press for Change") and pressure from the European Union the U.K. revised its archaic laws in the Gender Recognition Bill of 2004, and now recognizes trans people in their appropriate gender following transition. For more about TG/TS issues in the U.K., see the websites of the many U.K. women in Lynn's TS Successes webpage and also the Press for Change website.

In Switzerland, SRS is covered by the health insurances, as long as the person is at least 25 years old, if it takes in a public hospital, if the person has been recommended for surgery by a psychiatrist and if she has been examined during at least two years. Official ID changes are made through a simplified court procedure and are accepted unless the person is married. The most important problems are currently that is it really difficult to find a respectful psychiatrist ready to help you, that FtM surgeries are only practiced outside public hospitals (and health insurances refuse to cover them) and that health insurances are likely to refuse covering surgeries for early transitioners. Transgender people are unable to update their official documents. The administration currently refuses to take into account the identity changes of married people. Legal actions are likely to improve this situation in the following years. The professional situation of people is different from case to case. But some people have been able to keep their position of top manager through and beyond their transition, some have been able to get one after. The local mentality which favors the respect of the private life is really helping the people who are able to manage their transition successfully (Swiss information from Marie-Noëlle).

Australia is increasingly accomodating gender transitioners. Many of the people there (at least in the major cities) are friendly and have a "live and let live" attitude much like people here in the U.S.  Thus many transitioners in Australia can find reasonable employment before and after transition, and can afford the surgeries done in nearby Thailand. Many Australians are also well-networked via the internet, and transitioners there benefit greatly from this connectivity and the access to information it provides. For more about Australia, see the websites and stories of the many Aussie girls on Lynn's TS Successes webpage.
Russia and Eastern Europe:
With the fall of the Soviet Union, and the emergence of open societies in Russia and the eastern European countries, we are now seeing quite a few successful transitions in those countries. It is still much more difficult to transition there than in western Europe - there is more bureaucracy to deal with and greater difficulty qualifying for treatments. However, the treatments are often covered by state medical systems and some women (and transmen too) are now reporting successful transitions in those countries. This is a very hopeful trend, and should accelerate as these countries further "westernize". See the websites of Lena (Kiev, Ukraine) and Iva (Czech Republic) for more insight into transition in these countries.
Asia and the Middle-East:
There is a wide variation in the situations in the countries of Asia. China has recently begun quietly permitting transitions. Very few are done there compared to the size of the population, but the women are also permitted to marry men after their transitions. Japan is much more backward, being an intensely conformist society that strongly rejects those "outside the norm". However, some intensely TS women have somehow managed to transition even there. Girls from these countries usually go to Thailand for their surgeries, and take a chance on somehow being able to survive back at home afterwards. Some spectacularly successful, beautiful post-op girls are now influencing public opinion for the better in some of these traditional societies, a prominent example being Harisu - a beautiful young girl from South Korea who is well known as an actress there.
In contrast, Thailand has a long tradition of "lady-boys" or "kathoey" as bar girls and entertainers. Many TG/TS girls there manage to transition at a young age, with many eventually undergoing SRS surgery - which is easily and inexpensively available there. Although Thai society is accepting of these "lady-boys", they unfortunately are not considered women after their transitions and cannot get updated ID's and working papers as women. Thus very large numbers of kathoey remain marginalized in jobs as bar-girls and prostitutes in Thailand, even after becoming women. As a result, the sex trade in Thailand is widely known around the world as having large numbers of very beautiful "she-males" and trans women. Many post-op girls in Thailand try to find work or husbands in other countries, in order to escape a life limited to sex work and entertainment. Many emigrate to countries such as Germany, where men know they make wonderful wives and where they are fully accepted as women.
For more details and insights into the many variations of TG/TS life across the Asian countries, see the Transgender Asia website maintained by Prof. Sam Winter of the University of Hong Kong.
India is yet another and completely different story. Indian society has long provided a ancient form of "gender change" as a physical escape for transsexual girls. There they can become "Hijra" by undergoing a "sex change" consisting of a complete emasculation as a teenager, and then joining the Hijra caste. While not complete women (they lack vaginas and breasts), the young Hijra escapes masculinization and can live as women for the rest of her life. This ancient method of resolving the transsexual condition is widely practiced in India, where there are at least a million Hijra (one out of every 400 or so boys becomes Hijra). In a country where many are very poor, this provides an inexpensive means of escape for those affected by intense transsexualism. In recent years the government has begun helping Hijra women by providing some of them with hormones, so that they can feminize themselves, look more like women, and hopefully be better accepted in society. However, becoming Hijra in India exacts a high price in terms of living forever in between the genders in group communes in this lowly, despised caste, and mainly working as prostitutes and beggars. Recently some Hijra have begun interacting with western transgender and transsexual women, and are learning about the western methods of gender transition. More Hijra will likely seek hormone therapy and even full sex changes in the future, if they can find ways to afford those treatments. (See Lynn's page about Transsexualism and also Lynn's SRS page for more about the Hijra).
There are also many Hijra in the secular Muslim countries of Pakistan and Bangladesh, where the Hijra custom spread to from India long ago. The situation of Hijra in these countries is similar to or worse than in India, with most Hijra relegated to a marginalized existence as street prostitutes and beggars.
In other secular Muslim states, such as Turkey, Indonesia and Malaysia, TG/TS women find themselves in situations similar to those in the countries of Catholic-dominated Latin America. In these countries many girls undertake social (TG) transitions. However, those who do transition become identity-less and unemployable, and are marginalized into living in urban ghettoes. There they must usually resort to sex work or begging to survive. Although some may manage to obtain female hormones and feminize their bodies, few ever manage to complete a TS transition. And even if they did, they aren't considered to be women and remain unemployable and socially marginalized.
The bleakest scenarios for transgender and transsexual people exist in the strict Islamic world, where any sexual orientation variation or gender variation is treated with the utmost ostracism and cruelty. In many strict muslim countries such as Saudi Arabia, gay men and lesbians are routinely executed simply for being gay. As you can imagine, there is no hope whatsoever for transgender and transsexual people in such countries. It is simply inconceivable that one could transition in such a medieval, religiously superstitious, incredibly brutal and dangerous environment without incredible risks to life and limb.

There are exceptions to the marginalization and persecution of trans people in the Islamic world. The most notable is Iran, which provides social and medical help for gender transitioners and state recognition of their new social gender. This practice has quietly expanded there in recent years, building on a favorable ruling years ago by the Ayatollah Khomeini. (Note however that same-sex relationships are brutally repressed in Iran, and many young gay people have been executed there). 

The world-wide impact of the internet:
Fortunately the internet is helping many TG/TS people become more aware of the situations in other countries than their own. These contacts are helping many girls in countries where it is difficult or impossible to transition to figure out ways to somehow escape the trap they are in. Many other transitioners also now take very detailed country-to-country differences into account when seeking medical treatment, finding employment, seeking love partners and planning their long-term futures.
For example, many TG/TS people try to emigrate from less-tolerant countries to more supportive ones - such as from Latin America to Europe or the U.S. Very many TS women evaluate surgeons from all over the world before deciding on where to go for critical procedures such as SRS. Differences in the cost of quality medical care, especially the costs of surgeries, leads many people in expensive countries such as the United States to go to countries such as Thailand for treatment. Differences in legal acceptance of postop transsexuals leads many young TS women from countries like Thailand and countries in Latin America to attempt to emigrate to Europe, often by marrying European men.
You can gain more insight into all these issues by reading and comparing details of the individual stories on Lynn's TS Women's Successes webpage, which includes women from countries all around the world .
As we look around the world, we see that older, traditional, post-colonial, third-world, and medieval societies treat overtly TG/TS women much the same way they've always treated ANY disenfranchised women. In traditional and medieval societies, a young woman without any supporting family or any means of financial support becomes a total social outcast. She then usually has only two options if she is to live: She can become a prostitute, or a beggar.
However, as we shift our view to the more advanced countries, we see increasingly better conditions for gender transitions without the women being ghettoized or ostracized in the process. In the most advanced countries, we see ever improving opportunities for employment and even for a normal life as a woman post-transition. Hopefully the many improvements now being made in the advanced countries will provide models for rapid improvements in the less-developed countries, especially under the influence of modern media and communications.
Links for further study: 

1.  "Links to International Support and Information Sites," LynnConway.com


2.  "Historical and cross-cultural evidence of transsexualism," LynnConway.com.


3.  "Vaginoplasty: Male to Female Sex Reassignment Surgery - Historical Background," LynnConway.com


4.  "TransgenderAsia", by Sam Winter.


5.  European Transgender Network (TGEU)



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