Gender identity encompasses an individual’s self-perception as a man, woman, or another gender. For some people, this sense of identity feels easy and innate and is an integral part of who they are—they were born biologically male, and inside, they feel like a boy or a man. For many such people, gender identity is maybe not something they’ve given much thought to because how the world sees them is the same as how they see themself.
For others—such as people who are transgender, non-binary, and gender-diverse—the gender identity they feel aligned with on the inside does not easily align with the sex assigned to them at birth. People across the spectrum of gender identities often face unique challenges in reconciling their internal self with exterior societal expectations. For these people, embracing their authentic self is a process and can be a testament to the rich diversity of human experience, but this process of trying to live in alignment with their gender identity can also be very difficult. One sphere of life which can be particularly challenging to navigate is health.
For all Cambodians to live happily and fully as themselves, it is crucial that healthcare is safe and accessible for all. Many people who are trans, non-binary, or gender-diverse will require a type of health service called gender-affirming care. This is medical care that helps people in their gender expression journey.
Gender-affirming care supports individuals on their personal journeys of growth and development, providing the resources, space, and assistance needed to explore identity, shed limiting societal expectations, and fully embrace their true selves. It is important to note that there is no one-size-fits-all path. Each health journey is highly personal. Some people may just need to socially transition—taking a new name, new pronouns, changing from saying បាទ to saying ចា, getting a new haircut, wearing new clothing, etc. But some people may need medical interventions to align their inner gender feelings with their outer gendered appearance. People who require this type of care may seek hormone therapy and may choose to undergo gender-affirming surgery.
For the people in Cambodia who need medical care to feel like they are living a complete and authentic life, lack of access to gender-affirming healthcare can be a great barrier to fulfill the government’s commitments promoting and protecting human rights and ongoing human development progress.
Gender-affirming care in Cambodia
However, at the moment, gender affirming care in Cambodia is limited, with scarce resources for this service in both public and private institutions. Challenges include a lack of trained healthcare providers, inadequate insurance coverage, and social stigma that prevents many transgender or non-binary individuals from even seeking out necessary care.
In 2015, when Rainbow Community Kampuchea undertook a feasibility study related to trans healthcare, no gender affirming care services were available in Cambodia. Advocacy efforts have led to some progress on this front. It is now possible to get hormone therapy in Cambodia from certain clinics, including through the Reproductive Health Association of Cambodia, which has run workshops which provide clinical training about transgender-related topics. These workshops equip service providers with the skills needed to offer hormone therapy. Recently, another clinic has also started providing hormone therapy for the trans community.
Although hormone therapy now exists in some places in Cambodia, the trans community still faces challenges in terms of healthcare. Sophea, who is a trans woman, shared her experience with me to illustrate what it’s like to navigate Cambodia’s health systems. When Sophea went to a clinic to seek out care, she encountered a doctor who was not well trained and who made her uncomfortable while seeking services. Additionally, the clinic she visited lacked the medication she needed, and when those medications were in stock they were offered at a higher price than local pharmacies.
Sophea noted that many transgender individuals she knows on hormone therapy face similar issues, leading to a lack of trust overall in healthcare providers. Some trans community members who can afford it choose to travel to neighboring countries such as Thailand to receive gender-affirming care. Some community members choose to purchase or use medications based on peer advice outside of a medical context, often neglecting to screen for pre-existing health conditions which might put them at risk as they undertake this treatment. Self-injection of hormones, when not done under the guidance of a medical professional, can also be a high-risk activity when it comes to disease transmission and infection.
Although Cambodia-specific data on trans needs is limited, the data that does exist clearly indicates that for the people who need it, gender-affirming care is absolutely crucial. A 2016 report from the National Center for HIV/AIDS, Dermatology, and STD focused solely on transgender women and those assigned male at birth identifying as a third gender, revealed that nearly half of those surveyed had used some sort of hormone or non-hormone substances as part of their transition. As this was before hormone therapy was available in medical settings, it can be assumed that at least some of these people were finding ways outside of the medical establishment for accessing this care. This clearly shows a significant need for more gender-affirming care in trusted medical settings in Cambodia.
Limited resources and access—or outright denial of gender-affirming care—can lead people to turn to illegal clinics and black market methods for undertaking these treatments and procedures. In 2021, for example, authorities closed an unauthorized gender reassignment surgery clinic which had been offering procedures and medications in an unregulated manner. Those services may also be offered at a higher price with uncertainty of the quality and safety.
This situation has clear parallels to the consequences of banning abortion. As we know from abortion, banning a medical procedure which people need does not mean people will just not get the medical care, instead, they will seek it out behind closed doors, and in the shadows. This can lead to unsafe health services and loss of life.
Importance of gender-affirming care in Cambodia
Gender-affirming care, when administered with sensitivity, has a significantly positive impact on the overall health and functioning of the trans community, enhancing long-term physical and mental health, which contribute to productivity, and protection and promotion of rights as Cambodian citizens.
While healthcare for trans Cambodians should not always be linked to HIV prevention, it is also crucial to note that more accessible gender-affirming care can go hand in hand with these important public health goals. Linking trans and non-binary Cambodians with the healthcare services that affirm their gender identities means this community is more likely to trust the healthcare system in general, which makes it easier for medical providers to reach them with initiatives which can help keep them safe and healthy. Cambodia is at a crucial turning point with some of its HIV prevention goals, so improving trust amongst vulnerable communities is more important than ever.
In addition to this, gender-affirming care promotes a more inclusive society by promoting understanding and acceptance of diverse gender identities. By providing inclusive and respected healthcare services, the government and healthcare providers can diminish stigma and discrimination against transgender and non-binary individuals, thereby creating a safer and more supportive environment. This inclusivity benefits not only those receiving care but also strengthens community cohesion and social stability. As public awareness of gender diversity increases, it fosters dialogue and education about human rights under the Cambodian Constitution, leading to greater empowerment for marginalized groups. Therefore, investing in gender-affirming care is not merely a healthcare issue; it is a crucial and concrete step toward achieving inclusivity and equality for all Cambodians.
Possible ways forward
To ensure equitable and quality healthcare for everyone, on-going collaboration and meaningful engagement with transgender individuals from all backgrounds in the design of national healthcare programs and strategic plans, involving relevant stakeholders and policymakers, is strongly encouraged. This participation in discussions about program design and strategic plan development, health budget advocacy for funding gender-affirming care services for both trans feminine and trans masculine individuals.
It is also crucial to implement inclusive practices for medical staff and healthcare providers while expanding their knowledge and resources. For example, the Trans Health and Rights Module offers valuable online training. Training to medical staff should cover a wide range of services, including hormone therapy, surgeries, facial hair removal, speech and communication modifications, and careful assistance with behavioral adaptations such as genital tucking or chest binding. Although each of these interventions may present potential challenges, the right guidance and support from knowledgeable providers can effectively address these issues. By prioritizing education and inclusivity in healthcare, Cambodia can make significant strides toward creating a more supportive and affirming environment for all individuals, regardless of their gender identity.
Note: Seaklay Say is a young research fellow at Future Forum.
