Gender and Health in Asia: Toward Gender-Affirming Care in the ASEAN Region

In a recent article, Shirin et al ¹ explored the beliefs and values influencing healthcare providers’ delivery of gender-affirming care (GAC) to transgender and gender-diverse (TGD) youth amidst the social and political dynamics in the United States. In the United States, protective state-level health policies related to gender-affirming care are present in approximately half of the nation. On the other hand, explicitly restrictive policies for private insurance and Medicaid are present in 5.9% and 17.6% of states. ² Despite the varying provisions across the United States, the study by Shirin et al ¹ emphasized that healthcare providers view GAC as evidence-based and essential for alleviating distress, promoting autonomy, and potentially life-saving among TGD.

Similar to the United States, the Association of Southeast Asian Nations (ASEAN) member states, composed of Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam, have varying policies regarding TGD.^3,4 Nonetheless, TGD in the ASEAN region, as with the United States, can face significant stigmatization and health disparities, including workplace discrimination, harassment, violence, and higher rates of mental health conditions.^{3 -5} Therefore, several insights can be drawn from the study of Shirin et al if the ASEAN region is to improve its policies regarding its TGD population.

First, compared to the United States, studies and evidence of TGD disparities in the ASEAN region remain limited. For instance, it was previously noted that some countries, such as Brunei and Cambodia, lack studies exploring the mental health of TGD individuals.^4,5 Therefore, ASEAN countries can draw from the study’s findings to frame future research frameworks and evidence-based policies that explore gender-affirming care (GAC) for TGD youth in the region. The emphasis on GAC as life-saving and essential can be used as a ground for inclusive healthcare research and services that prioritize the well-being of this marginalized population.

Second, there remains a limited number of training programs and guidelines for GAC for TGD youth in the ASEAN.^4,6 Therefore, the study highlights the beliefs and values of healthcare providers, which ASEAN member states can use in designing their future training programs and guidelines. These programs can help ensure healthcare providers are appropriately equipped to deliver ethical, respectful, and evidence-based care to TGD youth.

Third, compared to the United States, the ASEAN region has limited policies upholding the rights of TGD youth, including gender identity recognition. For example, despite having a high number of gender-affirming surgeries, Thailand has limited recognition of self-determined gender identity. ³ In addition, Vietnam and Singapore recognize the self-determined gender identity of TGD individuals only after they have undergone gender-affirming surgeries. ³ The study supports advocacy efforts to protect the rights of TGD youth, addressing stigma and discrimination; it highlights and adds to the contemporary evidence supporting respect for gender identities and autonomy aligning with universal human rights principles, a shared value among ASEAN countries.

Lastly, as with studies elsewhere in the world,^7,8 Shirin et al found that GAC alleviates distress and improves mental health, which can be critical for ASEAN nations aiming to enhance public mental health equity and outcomes. Therefore, investing in GAC can reduce mental health disparities among TGD youth and promote overall societal well-being. As a start, primary healthcare workers and physicians can be trained in providing GAC, including hormone therapy and post-operative care, in their respective communities.

Overall, the study could provide a valuable framework for ASEAN countries to advance gender-affirming care and research, respect TGD rights, and build inclusive healthcare systems in a region characterized by diversity while aligning with universal human rights.